Paper short abstract:

Partner involvement is encouraged for first antenatal care visit, which consequently expose and exclude single women. Men wish to join to ensure quality of care but are denied access and increased commitment. Partner involvement should be embraced but only upon the consent of the expectant mother.

Paper long abstract:

The objective of this study was to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda and included extended in-community participant observation, semi-structured interviews, and focus group discussions. All informants were aware of the recommendations of male involvement for HIV-testing at first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for the women without an engaged partner. The overall quality of antenatal services was experienced as substandard, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in joining to ensure their partners reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied for their increased involvement during pregnancy. These findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's real needs within the context of their social situations. Supportive partners should not be denied at any stage of pregnancy, but should be received only upon consent of the expectant mother.