Association of Male Partners’ Gender-Equitable Attitudes and Behaviors with Young Mothers’ Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC
Abstract
:1. Introduction
Context
2. Materials and Methods
2.1. Data
2.2. Variables
2.2.1. Outcomes
- FTM-reported shared MNH decision making: This composite index measured the number of MNH-related decisions that the FTM made jointly with her husband/male partner, such as when to start seeking ANC and how soon to start breastfeeding (see the full list of items in Table S2). The FTM-reported shared MNH decision-making index consisted of nine items and had a Cronbach’s alpha of 0.841 at endline. Analysis of this outcome was restricted to FTMs with live births.
- Completion of the MH continuum of care: This binary variable measured completion of all three sequential recommended maternal healthcare services: four or more ANC visits, at least one of which was with a health professional; delivery in a health facility; and postpartum check within 48 h of delivery. Analysis of this outcome was restricted to FTMs with a live birth. Although the 2016 WHO Guidelines on Antenatal Care for a Positive Pregnancy Experience recommended at least eight ANC visits to reduce perinatal mortality and improve women’s experience of care [53], at the time of the study, the DRC Ministry of Health guidelines on the number of ANC visits had not been updated to reflect the new standards. Therefore, we used four or more ANC visits to reflect adequate ANC.
- Exclusive breastfeeding (EBF) for six months: FTMs were coded “1” if they reported that their baby received only breastmilk until 6 months of age and no other liquids or solids, not even water (except for oral rehydration solution or drops/syrups of vitamins, minerals, or medicine), and “0”, otherwise. Analysis of this outcome was restricted to FTMs with a live birth that survived for 6 or more months.
2.2.2. Gender-Equitable Attitudes and Behaviors among Male Partners
- GEM Scale. The GEM scale is a measure of attitudes towards gender equality or separate roles for men and women, and previous psychometric testing has yielded satisfactory validity and reliability [18,19], including for the DRC sample in a multi-country study of men’s lifetime perpetration of physical IPV [44]. In the present study, the GEM scale was constructed from 11 statements covering gender norms, violence, sexuality, masculinity, and reproductive health, with response codes “totally agree”, “partially agree”, or “disagree.” Items are listed in Table S3. Responses to some of the statements were reverse-coded to reflect gender-equitable attitudes. Item analysis and factor analysis with rotation were used to test the construct validity of the GEM scale and clarify its domains. Factors loading less than 0.3 were dropped and the GEM scale score was constructed from the predicted values of the first factor which had an eigen value greater than 1. The components of this score had a Cronbach’s alpha of 0.722, with higher values of the score representing more supportive attitudes towards gender equity.
- History of IPV perpetration: At baseline, male partners of FTMs were asked whether they had ever perpetrated 13 acts of physical, sexual, and emotional violence against the FTM. The acts of violence included in the questionnaire were adapted from the Conflict Tactics Scale used in DRC’s most recent Demographic and Health Survey [54]. An affirmative response to any of these acts indicated that the male partner had a history of IPV perpetration in his relationship with the FTM.
- MH involvement index: This additive index was constructed from the male partner’s endline survey data and included the following binary items/actions measuring the male partner’s presence at the various occasions during pregnancy and labor, and his involvement in ANC and birth planning (e.g., sitting in the consultation room with the FTM during the checkup, etc.). As FTMs were asked the same questions, missing data on any of the male partner-reported items were replaced with the FTM’s reports of his involvement in that activity. This 12-item index ranged from 0 to 12, had a Cronbach’s alpha (scale reliability coefficient) of 0.851 at endline and a KMO coefficient of 0.879. See Table S4 for descriptive statistics of the individual components of the index.
- Index of willingness to perform caregiving activities for infants: In the baseline survey, male partners were asked how willing they were to perform 11 caregiving activities after their baby was born (e.g., changing the baby’s diapers, etc.). Response categories were “not at all willing”, “somewhat unwilling”, “undecided”, “somewhat willing”, or “extremely willing.” The response for each component was coded as 1 if the male partner was extremely willing to perform the activity, and 0 otherwise. Cronbach’s alpha for the 11 items was 0.916. Factor analysis revealed a distinct one-factor solution, with an eigen value of 4.004 and all components had factor loadings exceeding 0.45. The index of willingness was constructed from the predicted values of the first factor, with higher values of the index representing greater willingness of the male partner to engage in infant caregiving activities. See Table S5 for the descriptive statistics of the individual components of the index.
- Male-partner-reported shared MNH decision making: This composite index was included in the regressions of completion of the maternal continuum of care and EBF for six months. This index was created in the same way as the FTM-reported index but was based on the male partner’s report. The male-partner shared MNH decision making index consisted of 9 items and had a Cronbach’s alpha of 0.804 at endline.
2.2.3. Control Variables for PPFP Outcomes
2.2.4. Control Variables for MNH Outcomes
2.2.5. Control Variables for All Outcomes
2.3. Statistical Analysis
2.4. Ethical and Country Approval
2.5. Patient and Public Involvement
3. Results
3.1. Sample Characteristics
3.2. Bivariate Results
3.2.1. PPFP Outcomes
3.2.2. MNH Outcomes
3.3. Multivariate Results
3.3.1. PPFP Outcomes
3.3.2. MNH Outcomes
4. Discussion
4.1. Limitations
4.2. Program Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Baseline Characteristics | Postpartum Family Planning | FTM-reported Shared MNH Decision Making | Completion of the MH Continuum of Care | Exclusive Breastfeeding |
---|---|---|---|---|
Male partner’s gender-equitable attitudes and behaviors | ||||
GEM Scale 1 | −0.015 (0.860) | −0.0122 (0.859) | −0.019 (0.854) | −0.01 (0.85) |
History of IPV perpetration: % | 51.5 | 51.8 | 51.4 | 52.1 |
MH involvement index 1 | 6.951 (3.035) | 6.955 (3.024) | 7.062 (2.944) | 7.022 (2.930) |
Index of willingness to perform caregiving activities for infants 1 | 0.035 (0.934) | 0.037 (0.916) | 0.058 (0.903) | 0.068 (0.891) |
No. of shared MNH decisions reported by male partner (a) 1 | 1.667 (2.424) | na | 1.668 (2.430) | 1.643 (2.405) |
FTM’s baseline characteristics | ||||
Unintended pregnancy: % | 80.5 | 80.7 | 80.1 | 80.7 |
Intervention health zone: % | 47.0 | 46.5 | 47.1 | 47.6 |
Age 20–24: % | 55.2 | 54.9 | 56.1 | 56.5 |
Never married: % | 20.8 | 20.5 | 19.7 | 19.9 |
Worked in past 12 months: % | 25.2 | 24.8 | 25.0 | 25.3 |
Years of schooling 1 | 10.604 (2.542) | 10.612 (2.518) | 10.597 (2.585) | 10.620 (2.580) |
Bakongo ethnicity: % | 35.7 | 35.1 | 35.1 | 35.6 |
Household wealth: % | ||||
Low | 32.7 | 32.4 | 30.8 | 31.3 |
Medium | 33.7 | 33.8 | 35.2 | 35.0 |
High | 33.6 | 33.8 | 34.0 | 33.7 |
FTM’s PPFP knowledge and attitudes | ||||
No. of modern FP methods FTM knows 1 | 6.224 (2.194) | |||
Approved of FP use in immediate postpartum period: % | 73.7 | |||
FP myths rejection index 1 | 19.807 (4.405) | |||
FTM’s PPFP perceived norms | ||||
Injunctive norms index 1 | 10.342 (5.659) | |||
Descriptive norms: % | 11.6 | |||
Normative expectations 1 | 10.972 (2.304) | |||
Community reaction to PPFP use: % | ||||
Say good things | 33.5 | |||
Say bad things | 37.7 | |||
Indifferent | 28.8 | |||
FTM’s FP-related behaviors | ||||
Ever used FP before pregnancy: % | 54.2 | |||
Discussed FP with male partner in the immediate postpartum period: % | 55.6 | |||
FTM personal agency | ||||
PPFP self-efficacy 1 | 18.963 (5.194) | |||
EBF autonomy: % | 60.9 | |||
FTM perceived EBF norms | ||||
Injunctive norms index 1 | 9.653 (6.153) | |||
Descriptive norms: % | 16.2 | |||
Normative expectations: % | 30.3 | |||
ANC content (a) | ||||
Adapted index of WHO-recommended actions for positive pregnancy 1 | 7.431 (1.773) | |||
Index of ANC counseling 1 | 9.228 (2.925) | |||
Received ANC counseling on EBF: % | 92.5 | |||
N | 1335 | 1286 | 1108 | 1054 |
Male Partner Variables | Discussed FP with Partner in Immediate Postpartum Period | Obtained/Bought a FP Method in the Immediate Postpartum Period | Used a Modern FP Method in the Immediate Postpartum Period | Used a Modern Contraceptive 0–11 Months After Childbirth or Pregnancy Loss | |||||
---|---|---|---|---|---|---|---|---|---|
% | % | % | % | N | |||||
GEM Scale | |||||||||
Low | 57.0 | 26.1 | 8.7 | 48.6 | 675 | ||||
High | 54.1 | 23.8 | 8.2 | 45.8 | 660 | ||||
History of IPV perpetration | |||||||||
Low | 56.0 | 23.8 | 7.6 | 45.9 | 647 | ||||
High | 55.2 | 26.0 | 9.3 | 48.4 | 688 | ||||
MH involvement index (a) | *** | * | ** | ||||||
Low | 40.6 | 20.4 | 8.8 | 40.3 | 397 | ||||
High | 61.9 | 26.8 | 8.3 | 50.1 | 938 | ||||
Willingness index to perform caregiving activities for infants | |||||||||
Low | 55.5 | 25.1 | 8.4 | 46.0 | 641 | ||||
High | 55.6 | 24.8 | 8.5 | 48.3 | 694 | ||||
Total | 55.5 | 24.9 | 8.5 | 47.2 | 1335 |
Male Partner Variables | FTM-Reported Shared MNH Decision Making Index | Completion of the MH Continuum of Care | Exclusive Breastfeeding for Six Months (b) | |||
---|---|---|---|---|---|---|
Mean (SD) | N | % | N | % | N | |
GEM Scale | ** | |||||
Low | 2.808 (2.670) | 647 | 72.8 | 558 | 43.1 | 526 |
High | 3.125 (2.803) | 639 | 74.4 | 550 | 37.5 | 528 |
History of IPV perpetration | ||||||
Low | 2.965 (2.675) | 620 | 74.0 | 538 | 41.0 | 505 |
High | 2.967 (2.803) | 666 | 73.2 | 570 | 39.7 | 549 |
MH involvement index (a) | *** | * | *** | |||
Low | 2.079 (2.420) | 381 | 69.2 | 318 | 28.6 | 304 |
High | 3.339 (2.783) | 905 | 75.3 | 790 | 45.0 | 750 |
Willingness index to perform caregiving activities for infants | ||||||
Low | 2.926 (2.758) | 618 | 74.4 | 520 | 41.8 | 491 |
High | 3.003 (2.726) | 669 | 72.8 | 588 | 39.1 | 563 |
MNH shared decision-making index | ||||||
Low | na | 73.4 | 837 | 39.6 | 798 | |
High | na | 74.2 | 271 | 42.6 | 256 | |
Total | 2.966 (2.741) | 1286 | 73.6 | 1108 | 40.3 | 1054 |
Independent Variables | Discussed FP with Partner in Immediate Postpartum Period | Obtained/Bought a FP Method in the Immediate Postpartum Period | Used a Modern FP Method in Immediate Postpartum Period | Used a Modern Contraceptive 0–11 Months after Childbirth or Pregnancy Loss | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | |||||
Male partner’s gender-equitable attitudes and behaviors at baseline | ||||||||||||
GEM Scale | 1.048 | [0.914, 1.203] | 0.926 | [0.787, 1.089] | 0.967 | [0.765, 1.222] | 1.003 | [0.878, 1.147] | ||||
History of IPV perpetration | 0.968 | [0.764, 1.228] | 1.159 | [0.879, 1.527] | 1.256 | [0.839, 1.879] | 1.114 | [0.886, 1.401] | ||||
MH involvement index (a) | 1.176 | *** | [1.128, 1.226] | 1.015 | [0.966, 1.066] | 0.986 | [0.920, 1.057] | 1.039 | [0.998, 1.082] | |||
Willingness index to perform caregiving activities for infants | 0.962 | [0.847, 1.093] | 1.006 | [0.870, 1.162] | 0.841 | [0.691, 1.025] | 1.047 | [0.925, 1.185] | ||||
FTM attitudes and knowledge | ||||||||||||
Approves of PPFP | 1.066 | [0.755, 1.505] | 0.814 | [0.539, 1.230] | 1.121 | [0.611, 2.056] | 1.152 | [0.824, 1.610] | ||||
No. of modern FP methods known | 1.067 | * | [1.008, 1.129] | 1.005 | [0.941, 1.074] | 0.945 | [0.857, 1.042] | 1.034 | [0.978, 1.092] | |||
No. of FP myths rejected | 1.010 | [0.981, 1.040] | 1.045 | * | [1.010, 1.081] | 1.055 | * | [1.004, 1.108] | 1.031 | * | [1.003, 1.061] | |
FTM perceived norms | ||||||||||||
Injunctive norms index | 1.013 | [0.987, 1.040] | 1.042 | * | [1.009, 1.075] | 1.028 | [0.981, 1.077] | 1.026 | * | [1.001, 1.053] | ||
Descriptive norms | 0.991 | [0.681, 1.444] | 0.753 | [0.480, 1.182] | 0.97 | [0.493, 1.908] | 1.267 | [0.879, 1.826] | ||||
Normative expectations | 1.022 | [0.952, 1.097] | 0.989 | [0.910, 1.074] | 0.976 | [0.866, 1.099] | 1.015 | [0.948, 1.087] | ||||
Community reaction to PPFP use | ||||||||||||
Say bad things | 1.068 | [0.792, 1.439] | 0.952 | [0.677, 1.339] | 0.756 | [0.452, 1.264] | 0.881 | [0.660, 1.176] | ||||
Indifferent | 1.119 | [0.823, 1.521] | 0.452 | *** | [0.311,0.656] | 0.785 | [0.475, 1.298] | 0.741 | * | [0.550,0.997] | ||
FTM personal agency | ||||||||||||
PPFP Self-efficacy | 1.008 | [0.980, 1.038] | 0.989 | [0.955, 1.024] | 0.979 | [0.932, 1.028] | 1.009 | [0.981, 1.038] | ||||
Other FTM baseline characteristics | ||||||||||||
Unintended pregnancy | 1.187 | [0.862, 1.633] | 0.988 | [0.683, 1.430] | 0.986 | [0.578, 1.682] | 1.004 | [0.738, 1.368] | ||||
Intervention health zone | 2.629 | *** | [2.053, 3.367] | 1.818 | *** | [1.355, 2.439] | 1.970 | ** | [1.270, 3.054] | 1.663 | *** | [1.303, 2.122] |
Age | 1.054 | * | [1.001, 1.110] | 1.046 | [0.985, 1.111] | 1.035 | [0.949, 1.129] | 0.960 | [0.914, 1.009] | |||
Never married | 0.996 | [0.738, 1.343] | 0.908 | [0.635, 1.296] | 0.731 | [0.424, 1.261] | 0.599 | *** | [0.446, 0.804] | |||
Worked in the past 12 months | 0.979 | [0.741, 1.292] | 0.739 | [0.528, 1.033] | 1.286 | [0.809, 2.044] | 1.190 | [0.910, 1.557] | ||||
FTM’s years of schooling | 0.997 | [0.947, 1.050] | 0.963 | [0.907, 1.022] | 0.923 | * | [0.854, 0.998] | 0.954 | [0.908, 1.003] | |||
Bakongo ethnicity | 1.014 | [0.791, 1.299] | 0.859 | [0.643, 1.148] | 1.494 | [0.992,2.249] | 0.880 | [0.692, 1.118] | ||||
Household wealth | ||||||||||||
Medium | 0.887 | [0.664, 1.184] | 0.660 | * | [0.471, 0.926] | 1.758 | * | [1.045,2.958] | 1.103 | [0.834, 1.458] | ||
High | 0.819 | [0.605, 1.108] | 0.969 | [0.686, 1.368] | 2.186 | ** | [1.274,3.751] | 1.074 | [0.801, 1.439] | |||
Ever used FP before pregnancy | 1.169 | [0.914, 1.496] | 1.149 | [0.859, 1.536] | 1.380 | [0.896,2.126] | 1.364 | * | [1.074, 1.733] | |||
Partner discussion of FP | ||||||||||||
Partner discussion of FP in immediate postpartum period | na | 5.462 | *** | [3.898,7.655] | 1.447 | [0.931,2.249] | 1.535 | *** | [1.207, 1.951] | |||
Constant | 0.049 | *** | [0.016, 0.154] | 0.048 | *** | [0.013, 0.185] | 0.030 | *** | [0.004, 0.209] | 0.188 | ** | [0.063, 0.568] |
Log likelihood | −825.05 | −639.17 | −364.087 | −867.777 | ||||||||
Number of FTMs | 1335 | 1335 | 1335 | 1335 |
Independent Variables | Discussed FP with Partner in Immediate Postpartum Period | Obtained/Bought a FP Method in the Immediate Postpartum Period | Used a Modern FP Method in Immediate Postpartum Period | Used a Modern Contraceptive 0–11 Months after Childbirth or Pregnancy Loss | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | |||||
Male partner’s gender-equitable attitudes and behavior at baseline | ||||||||||||
GEM Scale | 1.102 | [0.944, 1.286] | 0.852 | [0.710, 1.022] | 0.871 | [0.670, 1.131] | 0.967 | [0.833, 1.123] | ||||
History of IPV perpetration | 0.89 | [0.682, 1.160] | 1.386 | * | [1.018, 1.887] | 1.263 | [0.812, 1.964] | 1.001 | [0.775, 1.292] | |||
MH involvement index (a) | 1.162 | *** | [1.108, 1.218] | 1.001 | [0.947, 1.058] | 0.959 | [0.889, 1.035] | 1.037 | [0.991, 1.085] | |||
Willingness index to perform caregiving activities for infants | 0.886 | [0.762, 1.031] | 0.943 | [0.797, 1.115] | 0.778 | * | [0.624, 0.970] | 0.978 | [0.846, 1.130] | |||
Interaction terms | ||||||||||||
GEM Scale*Never married FTM | 0.800 | [0.569, 1.124] | 1.544 | * | [1.022, 2.333] | 1.850 | * | [1.014, 3.378] | 1.229 | [0.879, 1.719] | ||
IPV*Never married FTM | 1.595 | [0.881,2.889] | 0.419 | * | [0.207, 0.847] | 1.129 | [0.374, 3.407] | 1.828 | * | [1.014, 3.295] | ||
MH involvement index*Never married FTM | 1.055 | [0.957, 1.162] | 1.065 | [0.951, 1.194] | 1.153 | [0.970, 1.370] | 1.013 | [0.924, 1.110] | ||||
Willingness*Never married FTM | 1.363 | * | [1.017, 1.827] | 1.269 | [0.895, 1.800] | 1.567 | [0.876,2.801] | 1.353 | * | [1.005, 1.820] | ||
FTM baseline characteristics | ||||||||||||
Never married | 0.563 | [0.262, 1.212] | 0.996 | [0.388,2.558] | 0.276 | [0.060, 1.278] | 0.405 | * | [0.192, 0.858] | |||
Constant | 0.059 | *** | [0.019, 0.190] | 0.045 | *** | [0.011, 0.175] | 0.035 | *** | [0.005, 0.251] | 0.203 | ** | [0.066, 0.621] |
Log likelihood | −820.176 | −631.734 | −359.457 | −863.448 | ||||||||
Number of FTMs | 1335 | 1335 | 1335 | 1335 |
Independent Variables | Model 1 | Model 2 | Model 3 | ||||||
---|---|---|---|---|---|---|---|---|---|
Adj. Coef. | 95% CI | Adj. Coef. | 95% CI | Adj. Coef. | 95% CI | ||||
Male partner’s gender-equitable attitudes and behavior at baseline | |||||||||
GEM Scale | 0.134 | [−0.035, 0.303] | 0.093 | [−0.076, 0.262] | 0.073 | [−0.117, 0.262] | |||
History of IPV perpetration | 0.110 | [−0.181, 0.401] | 0.170 | [−0.120, 0.461] | 0.124 | [−0.202, 0.450] | |||
MNH involvement index (a) | 0.244 | *** | [0.196, 0.292] | 0.222 | *** | [0.173, 0.272] | 0.229 | *** | [0.173, 0.286] |
Willingness index to perform routine caregiving activities for infants | −0.059 | [−0.217, 0.100] | −0.096 | [−0.254, 0.063] | −0.131 | [−0.314, 0.053] | |||
Interaction terms | |||||||||
GEM Scale*Never married FTM | 0.108 | [−0.311, 0.527] | |||||||
IPV*Never married FTM | 0.243 | [−0.483, 0.969] | |||||||
MNH involvement index*Never married FTM | −0.027 | [−0.141, 0.087] | |||||||
Willingness*Never married FTM | 0.148 | [−0.217, 0.513] | |||||||
Other FTM baseline characteristics | |||||||||
Unintended pregnancy | −0.573 | ** | [−0.958,−0.187] | −0.567 | ** | [−0.954,−0.179] | |||
Intervention health zone | 0.079 | [−0.215, 0.374] | 0.081 | [−0.215, 0.376] | |||||
Age 20–24 | 0.491 | ** | [0.178, 0.805] | 0.500 | ** | [0.185, 0.814] | |||
Never married | −0.335 | [−0.703, 0.034] | −0.284 | [−1.200, 0.632] | |||||
Worked in the past 12 months | −0.016 | [−0.353, 0.322] | −0.010 | [−0.349, 0.328] | |||||
FTM’s years of schooling | −0.015 | [−0.077, 0.046] | −0.016 | [−0.078, 0.045] | |||||
Bakongo ethnicity | −0.225 | [−0.531, 0.081] | −0.235 | [−0.542, 0.072] | |||||
Household wealth | |||||||||
Medium | −0.207 | [−0.564, 0.150] | −0.203 | [−0.561, 0.155] | |||||
High | −0.225 | [−0.596, 0.147] | −0.231 | [−0.603, 0.142] | |||||
Constant | 1.214 | *** | [0.813, 1.615] | 1.950 | ** | [1.130,2.770] | 1.106 | ** | [1.077,2.785] |
Log likelihood | −3071.452 | −3055.339 | −3054.612 | ||||||
Number of FTMs | 1286 | 1286 | 1286 |
Independent Variables | Model 1 | Model 2 | Model 3 | Model 4 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | |||||
Male partner’s gender-equitable attitudes and behavior at baseline | ||||||||||||
GEM Scale | 1.129 | [0.961, 1.325] | 1.041 | [0.869, 1.247] | 1.118 | [0.912, 1.370] | 1.126 | [0.918, 1.381] | ||||
History of IPV perpetration | 0.981 | [0.748, 1.286] | 0.876 | [0.648, 1.185] | 0.900 | [0.643, 1.259] | 0.895 | [0.640, 1.253] | ||||
MNH involvement index (a) | 1.024 | [0.978, 1.072] | 1.022 | [0.968, 1.079] | 1.004 | [0.945, 1.067] | 1.005 | [0.946, 1.068] | ||||
Willingness index to perform caregiving activities for infants | 0.990 | [0.853, 1.149] | 0.893 | [0.752, 1.061] | 0.832 | [0.679, 1.020] | 0.834 | [0.680, 1.022] | ||||
No. of shared MNH decisions | 0.962 | [0.910, 1.016] | 0.970 | [0.911, 1.032] | 0.971 | [0.911, 1.034] | 0.948 | [0.887, 1.012] | ||||
Interaction terms | ||||||||||||
GEM Scale*Never married FTM | 0.725 | [0.468, 1.124] | 0.676 | [0.431, 1.060] | ||||||||
IPV*Never married FTM | 0.906 | [0.414, 1.982] | 0.815 | [0.369, 1.797] | ||||||||
MNH involvement index*Never married FTM | 1.092 | [0.965, 1.237] | 1.088 | [0.960, 1.234] | ||||||||
Willingness*Never married FTM | 1.287 | [0.875, 1.893] | 1.234 | [0.835, 1.824] | ||||||||
Shared MNH decisions*Never married FTM | 1.370 | [0.996, 1.883] | ||||||||||
Other FTM baseline characteristics | ||||||||||||
Unintended pregnancy | 1.050 | [0.703, 1.570] | 1.021 | [0.682, 1.528] | 0.994 | [0.663, 1.490] | ||||||
Intervention health zone | 0.620 | ** | [0.455, 0.843] | 0.617 | ** | [0.452, 0.842] | 0.618 | ** | [0.453, 0.844] | |||
Age 20–24 | 1.202 | [0.871, 1.658] | 1.197 | [0.866, 1.655] | 1.212 | [0.876, 1.678] | ||||||
Never married | 1.006 | [0.681, 1.486] | 0.623 | [0.232, 1.672] | 0.559 | [0.206, 1.514] | ||||||
Worked in the past 12 months | 1.042 | [0.733, 1.481] | 1.035 | [0.727, 1.475] | 1.050 | [0.736, 1.498] | ||||||
FTM’s years of schooling | 1.040 | [0.980, 1.104] | 1.039 | [0.979, 1.104] | 1.040 | [0.979, 1.104] | ||||||
Bakongo ethnicity | 0.790 | [0.579, 1.077] | 0.796 | [0.583, 1.086] | 0.811 | [0.594, 1.108] | ||||||
Household wealth | ||||||||||||
Medium | 1.015 | [0.708, 1.455] | 0.989 | [0.688, 1.421] | 0.989 | [0.687, 1.422] | ||||||
High | 1.086 | [0.736, 1.602] | 1.056 | [0.714, 1.563] | 1.044 | [0.705, 1.546] | ||||||
ANC content | ||||||||||||
Index of WHO-recommended actions for positive pregnancy (a) | 1.547 | *** | [1.317, 1.816] | 1.567 | *** | [1.332, 1.845] | 1.553 | *** | [1.321, 1.826] | |||
Index of ANC counseling (a) | 1.126 | *** | [1.050, 1.208] | 1.125 | *** | [1.049, 1.207] | 1.131 | *** | [1.054, 1.214] | |||
Constant | 2.555 | *** | [1.742,3.746] | 0.028 | *** | [0.007, 0.102] | 0.030 | *** | [0.008, 0.114] | 0.032 | *** | [0.008, 0.122] |
Log likelihood | −637.797 | −545.942 | −542.869 | 540.144 | ||||||||
Number of FTMs | 1108 | 1108 | 1108 | 1108 |
Independent Variables | Model 1 | Model 2 | Model 3 | Model 4 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | AOR | 95% CI | |||||
Male partner’s gender-equitable attitudes and behavior at baseline | ||||||||||||
GEM Scale | 0.887 | [0.763, 1.031] | 0.891 | [0.761, 1.043] | 0.969 | [0.812, 1.157] | 0.968 | [0.811, 1.155] | ||||
History of IPV perpetration | 0.972 | [0.754, 1.252] | 0.946 | [0.727, 1.232] | 0.952 | [0.708, 1.280] | 0.952 | [0.708, 1.281] | ||||
MNH involvement index (a) | 1.110 | *** | [1.062, 1.161] | 1.107 | *** | [1.054, 1.162] | 1.119 | *** | [1.058, 1.184] | 1.119 | *** | [1.058, 1.183] |
Willingness index to perform caregiving activities for infants | 0.864 | * | [0.751, 0.995] | 0.868 | [0.749, 1.005] | 0.806 | * | [0.677, 0.959] | 0.805 | * | [0.677, 0.959] | |
No. of shared MNH decisions | 1.079 | ** | [1.024, 1.138] | 1.080 | ** | [1.021, 1.142] | 1.079 | ** | [1.020, 1.141] | 1.085 | ** | [1.022, 1.151] |
Interaction terms | ||||||||||||
GEM Scale*Never married FTM | 0.676 | [0.457, 1.001] | 0.688 | [0.463, 1.023] | ||||||||
IPV*Never married FTM | 0.962 | [0.491, 1.885] | 0.982 | [0.499, 1.934] | ||||||||
MNH involvement index*Never married FTM | 0.963 | [0.862, 1.077] | 0.965 | [0.863, 1.079] | ||||||||
Willingness*Never married FTM | 1.275 | [0.920, 1.769] | 1.288 | [0.927, 1.791] | ||||||||
Shared MNH decisions*Never married FTM | 0.956 | [0.799, 1.143] | ||||||||||
FTM perceived EBF norms at baseline | ||||||||||||
Injunctive norms index | 1.017 | [0.993, 1.042] | 1.018 | [0.994, 1.043] | 1.018 | [0.994, 1.043] | ||||||
Descriptive norms | 1.359 | [0.937, 1.971] | 1.345 | [0.926, 1.953] | 1.344 | [0.926, 1.952] | ||||||
Normative expectations | 1.037 | [0.757, 1.421] | 1.039 | [0.757, 1.427] | 1.041 | [0.758, 1.430] | ||||||
FTM’s personal agency at baseline | ||||||||||||
EBF autonomy | 2.389 | *** | [1.808,3.157] | 2.466 | *** | [1.862,3.268] | 2.471 | *** | [1.865,3.274] | |||
Other FTM baseline characteristics | ||||||||||||
Unintended pregnancy | 1.155 | [0.813, 1.641] | 1.156 | [0.812, 1.647] | 1.163 | [0.816, 1.658] | ||||||
Intervention health zone | 1.296 | [0.988, 1.701] | 1.292 | [0.984, 1.698] | 1.292 | [0.984, 1.697] | ||||||
Age 20–24 | 1.154 | [0.866, 1.538] | 1.147 | [0.858, 1.532] | 1.145 | [0.857, 1.530] | ||||||
Never married | 1.238 | [0.879, 1.745] | 1.607 | [0.652,3.961] | 1.631 | [0.660,4.028] | ||||||
Worked in the past 12 months | 0.961 | [0.709, 1.302] | 0.947 | [0.697, 1.286] | 0.945 | [0.696, 1.283] | ||||||
FTM’s years of schooling | 0.979 | [0.927, 1.034] | 0.978 | [0.926, 1.034] | 0.978 | [0.926, 1.034] | ||||||
Bakongo ethnicity | 1.280 | [0.971, 1.687] | 1.284 | [0.973, 1.695] | 1.278 | [0.968, 1.688] | ||||||
Household wealth | ||||||||||||
Medium | 1.013 | [0.732, 1.403] | 0.993 | [0.716, 1.377] | 0.993 | [0.716, 1.377] | ||||||
High | 1.160 | [0.824, 1.633] | 1.140 | [0.808, 1.608] | 1.141 | [0.809, 1.609] | ||||||
Received ANC counseling on EBF | 2.328 | ** | [1.269,4.268] | 2.352 | ** | [1.279,4.326] | 2.336 | ** | [1.270,4.297] | |||
Constant | 0.289 | *** | [0.198, 0.422] | 0.047 | *** | [0.018, 0.121] | 0.043 | *** | [0.016, 0.115] | 0.043 | *** | [0.016, 0.114] |
Log likelihood | 691.856 | −654.996 | −651.653 | 651.53 | ||||||||
Number of FTMs | 1054 | 1054 | 1054 | 1054 |
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Gage, A.J.; Wood, F.E.; Kittoe, D.; Murthy, P.; Gay, R. Association of Male Partners’ Gender-Equitable Attitudes and Behaviors with Young Mothers’ Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC. Int. J. Environ. Res. Public Health 2022, 19, 12182. https://doi.org/10.3390/ijerph191912182
Gage AJ, Wood FE, Kittoe D, Murthy P, Gay R. Association of Male Partners’ Gender-Equitable Attitudes and Behaviors with Young Mothers’ Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC. International Journal of Environmental Research and Public Health. 2022; 19(19):12182. https://doi.org/10.3390/ijerph191912182
Chicago/Turabian StyleGage, Anastasia J., Francine E. Wood, Darling Kittoe, Preethi Murthy, and Rianne Gay. 2022. "Association of Male Partners’ Gender-Equitable Attitudes and Behaviors with Young Mothers’ Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC" International Journal of Environmental Research and Public Health 19, no. 19: 12182. https://doi.org/10.3390/ijerph191912182