Jan Chetna Manch, Bokaro (JCMB), is a Non-Governmental Organization (NGO) working with marginalized populations in the Chandankiari block of Bokaro district, Jharkhand. The study was conducted in rural areas of Bokaro district through the women’s health Centre, Chetna Mahila Swasthya Kendra (CMSK), run by JCMB. Over the years, the centre observed a growing presence of men during pregnancy and childbirth care. However, male involvement was largely limited to accompanying women to the health centre, with minimal engagement in providing sustained support during pregnancy, childbirth, or post-delivery recovery.
Data from the National Family Health Surveys (NFHS) conducted between 2005 and 2021 indicate a substantial increase in men’s awareness of antenatal care (ANC), their attendance at ANC visits, and their exposure to information on pregnancy complications, emergency preparedness, maternal nutrition, institutional delivery, and essential newborn care. However, there are state-wise variances.
Also, surveys highlight the need to distinguish between increased presence and meaningful involvement. While the JCMB staff has observed an increased presence of men during ANC visits and childbirth, they have also encountered instances where inappropriate interference by male family members contributed to adverse maternal outcomes.
Male Interference Leads to Maternal Death: The Tale of Kanchan Devi
Kanchan Devi had been receiving antenatal care at the CMSK and had become familiar with the facility and its staff. On one occasion, she was admitted for false labour pains and remained there until her condition stabilized. Soon after, however, she returned following an episode of domestic violence, which led to her waters breaking, after which contractions began. She returned with her mother because her husband was drunk.
Tragic cases like these highlighted the urgent need to improve male participation and its quality by promoting positive, respectful, and supportive involvement in maternal health.
Two hours later, her husband arrived at the CMSK with a group of more than 12 men. Most of them were drunk, and all were aggressive. They questioned the care Kanchan was receiving and abused and ridiculed the nursing staff on duty. The husband dragged Kanchan — who was resting peacefully — out, encouraged by his friends, and took her to a small private nursing home about 35 km away. Since one member of the group was an agent of the nursing home, a caesarean section was performed shortly after arrival.
Following the operation, Kanchan’s husband and his companions left to celebrate the birth. The doctor returned home, while her parents were left behind. Postoperative monitoring, however, was inadequate. Kanchan continued to bleed. When her heart stopped beating, the nursing staff called the doctor, who quickly arranged a taxi to send her to a “higher centre.”
On the way to Ranchi, Kanchan’s father realized that his daughter was no longer breathing. He asked the taxi driver to return to the nursing home. The doctor hurriedly handed him a cheque for two hundred thousand rupees, and the father took Kanchan for cremation.
The cheque later bounced. Kanchan’s husband has since remarried.
Tragic cases like these highlighted the urgent need to improve male participation and its quality by promoting positive, respectful, and supportive involvement in maternal health. Therefore, a counselling-led, couples-focused initiative was launched to provide information on various aspects of maternity and childbirth care.
The study aimed to assess the feasibility, acceptability, and preliminary effects of this initiative.
A mixed-methods pilot study combining quantitative surveys, Focus Group Discussions (FGDs), and In-Depth Interviews (IDIs) was conducted among couples visiting the CMSK.
Specific objectives were to:
- Assess whether the intervention improved:
a. Knowledge,
b. Attitudes,
c. Birth preparedness,
d. Supportive behaviour,
e. Maternal health experiences. - Identify barriers and facilitators to positive male involvement.
In this counselling-led intervention, couples participated in trimester-specific sessions led by JCMB staff. These sessions provided information on dietary and physical activity requirements, the significance of regular antenatal visits, immunisation, and birth preparedness. Information, Education, and Communication (IEC) materials such as flip charts, posters, videos, and birth preparedness booklets were used to convey key messages. Interactive birth classes were also conducted to prepare couples for delivery and childcare.
A mixed-methods pilot study combining quantitative surveys, Focus Group Discussions (FGDs), and In-Depth Interviews (IDIs) was conducted among couples visiting the CMSK.
Key Findings
A total of 103 men aged 24–27 years took part in the intervention. Most participants belonged to the Scheduled Castes (SC), Scheduled Tribes (ST), and Muslims, and had studied up to the higher secondary level.
The intervention helped improve men’s knowledge and attitudes toward caring for women during pregnancy and childbirth. Many participants became more involved in supporting their wives by accompanying them to health facilities, helping with household chores, buying nutritious food, and ensuring they had a healthy diet. Some men also provided emotional support to their wives during childbirth.
- Improved Knowledge
The intervention significantly increased men’s awareness regarding the expected date of delivery (EDD), nutrition during pregnancy, tests during antenatal care, the labour process, and complications that could arise during pregnancy and childbirth.
Post-intervention,
- 96.1% (vs. 21.4%) were aware of the EDD.
- 92.2% (vs. 35%) identified the correct dietary sources for iron & calcium
- 80.6% (vs. 49.5%) knew the correct and best time for an ultrasound during pregnancy follow-up visits.
- 98.1% (vs. 66.0%) understood that the length of time between labour pain and childbirth varies.
- 1.9% (vs. 0%) knew about emergency preparedness
Women also mentioned that-
“At home, he started helping with cooking and washing utensils… he never did all this before, but after listening to the health center didi, he said I should not overwork.”
“He brings fruits for me… says the baby will be healthy if I eat properly, just like they told us in the class.”
- Birth Preparedness
Counselling played an important role in helping couples prepare for childbirth. Men became more involved in planning for delivery, including arranging transportation, setting aside money for delivery-related expenses, and planning for emergencies, such as identifying a blood donor or referral facility.
- Knowledge about arranging transportation before childbirth was already high before the intervention (90.3%) and remained high after the intervention (86.4%).
- 59.2% (vs. 23.3%) of men had made financial arrangements for delivery and emergencies
- 1.9% (vs. 0%) became aware of the referral system in case of emergencies.
Many women shared that they appreciated the emotional support they received from their husbands during labour. They felt especially supported when their husbands stayed with them and comforted them during long and painful labour.
“When the pain was coming, he held my hand and kept telling me to breathe… I felt less scared because he was there.”
For some husbands, childbirth was an emotionally transformative experience. One husband stated:
“I cried seeing her in so much pain… but I stayed there till the baby came. I didn’t want to leave her alone.”
- Positive Attitude Changes
Many men developed more positive attitudes towards pregnancy and women’s needs during labour. Participation in birth classes increased men’s awareness regarding the importance of treating women respectfully during labour. The proportion of men-
- who believed that using abusive language during labour was necessary decreased from 23.3% to 18.6%.
- who were aware of the importance of couples’ exercises to support a normal delivery increased from 34.0% to 86.4%.
- who understood the nutritional needs of breastfeeding mothers improved from 12.6% to 68.0%.
“We both did the walking and exercises together… he said we should do whatever helps the delivery become easy.”
Such experiences highlighted couples’ joint participation and emotional investment during pregnancy and childbirth.
- Communication and Decision-Making
Couples found counselling very helpful in encouraging shared decision-making and improving communication between spouses. Many men also reported learning about their role during pregnancy for the first time. Women also reported discussing the place of delivery, and arrangements for transportation and finances before the due date.
- Behavioural Changes Were Modest
Actual behavioural changes were relatively modest. Despite improved knowledge, the study team observed that deep-rooted gender norms and work pressures limited involvement, leaving a gap between knowledge and practice. However, the study demonstrated that with constant counselling behavioural changes are possible. This study assessed changes during a very short period of time.
- Barriers to Male Involvement
Although the intervention positively influenced several aspects of maternity care, the team observed constraints that limited men’s participation. For instance, occupational demands such as daily wage labour and migration for work constrained husbands’ participation in maternal care despite their willingness to be involved. In some cases, the strong influence of mothers-in-law and cultural beliefs dominated decisions regarding food restrictions, pregnancy care, and childbirth practices.
Structural availability was reported as a constraint specific to the study population. As CMSK is a women-centred space, men were not allowed to stay inside the wards with their wives. A few husbands mentioned that the lack of male-friendly spaces within the health facility discouraged them from actively participating in their wives’ care during hospital stays.
Overall Conclusions
- The study provides valuable evidence for public health programmes seeking to integrate men into maternal health care without undermining women’s autonomy.
- The report emphasizes the need to redefine male involvement from male control to shared responsibility, empathy, and support for women’s dignity and autonomy during pregnancy and childbirth.
- Respectful and supportive male involvement can improve maternal care experiences.
- Counselling-led, couples-focused interventions are feasible and acceptable in rural India
- Such interventions significantly improve men’s knowledge, preparedness, and attitudes.
- However, broader structural and gender-related barriers continue to limit behavioral change.