Male partner involvement in ANC to increase institutional delivery and postnatal care utilization in developing countries: a systematic review and meta-analysis

Male partner involvement in antenatal care (ANC) is defined as a woman’s husband actively participating in prenatal care-related activities and processes during ANC visit. Lack of male partner involvement affects preparation for health facility delivery and postnatal care utilization; this leads to increased maternal mortality. This association is inconsistent from study to study. However, there is limited evidence about the pooled (quantitative) impact of male partner involvement in ANC. This study aimed to assess the relationship between male partner involvement in ANC and both institutional delivery and postnatal care utilization. The data were searched from different electronic databases like PubMed/Medline, Embase, POPLINE, ScienceDirect, and Google Scholar. We included observational studies and randomized trials that reported male partner involvement in ANC and its association with institutional delivery and postnatal care utilization. Qualitative studies, systematic reviews, case reports, and studies done in developed countries were excluded. The study populations were women who had given birth and their male partners. Two authors independently assessed the quality appraisal using the Joanna Briggs Institute checklist. If there were disputes between them, they were solved by the third author. Data were extracted by two independent authors using a pre-prepared Excel spreadsheet and finally analyzed with Stata 14 and Review Manager 5.3. We used a random-effect model to show the pooled result. Subgroup analysis and publication bias were also performed, using a funnel plot and Begg’s test. A total of 2206 articles were retrieved from data base, and nineteen articles were included in the meta-analysis. The pooled result showed that there is a positive relationship between husband involvement in ANC and both institutional delivery and postnatal care utilization [OR: 2.2, CI: 95% 1.73–2.80, I²=94% at P < 0.001] and [OR: 2.81, CI: 95% 1.56–5.07, I²=91% at P < 0.001], respectively. Based on the Egger’s test, publication bias was non-significant (P = 0.62). In the subgroup analysis using the categories of study designs, countries’ income level, and study sample size, the level of heterogeneities was 95%, 91%, and 97%, respectively. Husband involvement during ANC has a positive effect on institutional delivery and postnatal care utilization. In developing countries, governments and stakeholders need to exert efforts on the male partner involvement approach of ANC utilization. The PROSPERO registration number of this study is CRD42019147770.