Labor and childbirth are profound experiences for women, necessitating psychological support, traditionally provided by experienced women in many cultures.1 In most developing countries, cultural norms limit men’s involvement in childbirth, with their role typically ending at the labor ward entrance.2 Conversely, in industrialized countries, fathers are increasingly present in the labor room, providing support during delivery.3 This involvement has been associated with enhanced maternal well-being, improved father-child bonding, and positive outcomes for child development.4,5
Despite the recognized benefits of paternal involvement, cultural and health system barriers in developing countries, including northern Nigeria, often prevent fathers from participating in the birthing process.6 Attitudes in this region are deeply rooted in cultural and religious norms.7 In northern Nigeria, traditional gender roles assign distinct responsibilities to men and women, with men seen as providers and protectors, while childbirth is considered a woman’s domain.8 The concept of modesty further discourages male presence during childbirth due to the intimate exposure involved, which is culturally and religiously sensitive.9,10 Local customs also reinforce these norms by upholding childbirth as a private event typically attended only by women.11
These factors contribute to strong resistance to paternal involvement in childbirth, driven by fears of violating cultural and religious expectations. Moreover, many healthcare facilities do not permit companions during childbirth due to a lack of supportive policies, negative attitudes among healthcare providers, and insufficient privacy measures, such as the absence of curtains and inadequate provisions for companions’ comfort. Increasing fathers’ participation requires addressing these deeply held beliefs through community engagement, involving religious leaders, and tackling challenges within the health system.2,7 While some Nigerian studies indicate that women value their spouse’s presence for psychological support during labor,12–15 this has not been thoroughly examined in the culturally conservative northern region.
This study aims to assess the attitudes of expectant mothers towards their partners’ presence during childbirth in a tertiary hospital in Kano, northern Nigeria, and identify the predictors of these attitudes. Understanding these factors is crucial for designing interventions that could improve paternal involvement, potentially enhancing maternal and neonatal outcomes in this context.
METHODS
Setting/Study population
This study was conducted at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria, a 550-bed tertiary hospital with a catchment population exceeding 13 million people.16 The study population consisted of antenatal clinic attendees from Kano and neighbouring states. The clinic operates four days a week, with an average daily attendance of 180 women. While some men accompany their spouses, the clinic does not provide specific provisions for them.
Study design and Sampling
This cross-sectional study involved a sample size of 370 pregnant women, calculated using Fisher’s formula, assuming a 32% prevalence of positive attitudes towards partner presence during labor from previous studies. The power analysis assumed a type 2 error rate (β) of 20% or power of 80%, a type 1 error rate of 5% , and accounted for a 10% non-response rate.
Systematic sampling was used to recruit participants as they arrived for antenatal care. After registration, sequential serial numbers were assigned to each participant. The sampling interval was determined based on the average attendance and the sample size. The first respondent was chosen by selecting a random number between 1 and the sampling interval, followed by inviting every nth woman to participate. Informed consent was obtained from all participants, and ethical clearance was granted by the AKTH Health Research Ethics Committee.
Study instrument and data collection
Data were collected using a pretested, structured, interviewer-administered questionnaire adapted from previous studies.17,18 The questionnaire was culturally adapted through translation into Hausa, with back-translation to ensure accuracy. Content validity was confirmed by specialist obstetricians, and reliability was verified with a Cronbach’s alpha of 0.83. The questionnaire assessed socio-demographic characteristics and attitudes toward fathers’ presence during childbirth, using a five-point Likert scale.19 Attitude items included both positive and negative statements to reduce social desirability bias, with scores ranging from strongly agree (+2) to strongly disagree (-2). Total scores were aggregated to classify attitudes as positive or negative, with the median score as the threshold.20 The cultural adaptation process involved ensuring that the language and content were culturally sensitive and relevant to the local context.
Pre-testing was conducted on a 10% sample of pregnant women at a different hospital to refine the instrument. Experienced female interviewers, fluent in Hausa and familiar with the cultural context, administered the questionnaires.
Data Analysis
Data from the questionnaires were entered and analyzed in SPSS v.22 (SPSS Inc., Chicago, IL).21 Continuous variables were summarized using mean± standard deviation or median and range, depending on the distribution. Categorical data were presented as frequencies and percentages. At bivariate level, Pearson’s chi-square or Fisher’s exact test was used to test for significant associations, with a p<0.05 considered significant. Using dichotomized attitude (positive or negative) towards partners’ presence in the labor room as outcome variable, a logistic regression model was loaded and fitted with variables that had p<0.10 at bivariate level and conceptually important variables, irrespective of significance.22 Adjusted Odds Ratios (AOR) and Confidence Intervals (95% CI) measured the predictive strength of independent variables. All tests of hypothesis were two-tailed, with a type 1 error rate set at 5%.
RESULTS
Sociodemographic characteristics
Out of 370 women approached, 351 (94.9%) completed the interviews. The average age of respondents was 29 years (SD ± 7.12), with the majority being of Hausa/Fulani ethnicity (93.7%), Muslim (97.2%), and married (96.6%). Most respondents (86.0%) and their partners (89.5%) had at least a secondary education. Nearly half (47.9%) were in the second trimester of pregnancy, while the rest (52.1%) were in the third trimester.
Table 1.Sociodemographic and obstetric characteristics of respondents, Kano, Nigeria.
Characteristics
Frequency
No. (%)
N=351
Age group
<20
14 (4.0)
20-29
167 (47.6)
30-39
105 (29.9)
≥40
65 (18.5)
Ethnicity
Hausa
259 (73.8)
Fulani
70 (19.9)
Others
22 (6.3)
Religion
Islam
341 (97.2)
Christianity
10 (2.8)
Education
No formal
29 (8.3)
Primary
20 (5.7)
Secondary
108 (30.8)
Post-Secondary
194 (55.2)
Marital status
Married
339 (96.6)
Divorced
11 (3.1)
Widowed
1 (0.3)
Type of marriage
Monogamous
272 (77.5)
Polygamous
79 (22.5)
Occupation
Homemaker
109 (31.1)
Trading
90 (25.6)
Civil servant
131 (37.3)
Others
21 (6.0)
Parity
0
46 (13.1)
1-4
237 (67.5)
≥5
68 (19.4)
Gestational age (weeks)
≤12
2 (0.6)
13-28
168 (47.9)
29-40
183 (52.1)
Husband’s education
No formal
20 (5.7)
Primary
17 (4.8)
Secondary
58 (16.6)
Post-Secondary
256 (72.9)
Attitude of women towards men’s presence at childbirth
Only 15.4% of expectant mothers supported the idea of male partners witnessing childbirth, with nearly half (45.9%) strongly opposing it. The majority of respondents felt that the presence of male partners would not provide emotional support (59.8% strongly disagreed), reduce pain perception (33.1% strongly disagreed), or strengthen the couple’s relationship (52.7% strongly disagreed). Many believed that men’s presence could be psychologically distressful (58.1%) and exacerbate the woman’s anxiety (43.0%). Cultural and religious beliefs were also significant barriers, with 37.9% and 51.6% of respondents, respectively, viewing men’s presence in the labor room as culturally inappropriate or religiously forbidden (Table 2).
Table 2.Attitudes towards partners’ presence during labor, Kano, Nigeria.
Statement regarding partner’s presence in labor room
Strongly Agree
No. (%)
Agree
No. (%)
Undecided
No. (%)
Disagree
No. (%)
Strongly disagree
No. (%)
1. Is acceptable since observing childbirth is one of the most important moments in life
11 (3.1)
43 (12.3)
23 (6.6)
114 (32.7)
160 (45.9)
2. Will provide emotional support to the mother
2 (0.6)
7 (2.0)
6 (1.7)
126 (35.9)
210 (59.8)
3. Will provide the mother the opportunity to express her problems to a familiar person
8 (2.3)
12 (3.4)
20 (5.7)
136 (39.0)
175 (50.1)
4. Will increase the husband’s sympathy and gratitude towards his wife
7 (2.0)
7 (2.0)
9 (2.6)
117 (33.3)
211 (60.1)
5. Will allow the husband to share the pain of delivery with his wife
5 (1.4)
25 (7.2)
19 (5.4)
116 (33.2)
186 (53.3)
6. Will prepare the husband to accept his paternal responsibility
9 (2.6)
11 (3.1)
16 (4.6)
115 (32.8)
200 (57.0)
7. Will strengthen the couple’s relationship
7 (2.0)
5 (1.4)
13 (3.7)
141 (40.2)
185 (52.7)
8. Will decrease the mother’s anxiety
27 (7.7)
52 (14.9)
41 (11.7)
133 (38.1)
98 (28.1)
9. Will help the mother bear labor pain
20 (5.7)
29 (8.3)
27 (7.7)
158 (45.1)
116 (33.1)
10. Will have a positive effect on father–child relationship
21 (6.0)
15 (4.3)
38 (10.9)
113 (32.3)
163 (46.6)
11. Is not helpful to the mother
54 (15.4)
119 (33.9)
34 (9.7)
95 (27.1)
49 (14.0)
12. May lead to psychological distress in the husband
78 (22.2)
126 (35.9)
32 (9.1)
78 (22.2)
37 (10.5)
13. May transfer the husband’s anxiety to the mother
48 (13.7)
103 (29.3)
56 (16.0)
87 (24.8)
57 (16.2)
14. Is not a good idea as the delivery room is not suitable for men
44 (12.6)
112 (32.0)
36 (10.2)
107 (30.6)
52 (14.9)
15. Will be unpleasant for the mother
51 (14.5)
119 (33.9)
42 (12.0)
99 (28.2)
40 (11.4)
16. Is the husband’s duty
32 (9.1)
80 (22.8)
49 (14.0)
147 (41.9)
43 (12.3)
17. Will decrease the husband’s anxiety
32 (9.1)
90 (25.6)
60 (17.1)
131 (37.3)
38 (10.8)
18. Will not be tolerable for the husband
44 (12.5)
114 (32.5)
65 (18.5)
105 (29.9)
23 (6.6)
19. Is against our culture
36 (10.3)
97 (27.6)
33 (9.4)
149 (42.5)
36 (10.3)
20. Will be frightening in the case of a complicated delivery
33 (9.4)
91 (25.9)
29 (8.3)
132 (37.6)
66 (18.8)
21. Not allowed by our religion
62 (17.7)
119 (33.9)
30 (8.6)
105 (29.9)
35 (10.0)
22. Can only happen in a private ward
43 (12.3)
57 (16.3)
11 (3.1)
98 (28.0)
142 (40.6)
Predictors of attitude towards men’s presence in the labor room
At bivariate level, positive attitude towards the presence of the male partner during childbirth was significantly associated with respondent’s age only (p<0.05). However, at the multivariate level, age and parity were significant predictors of a positive attitude towards men’s presence during childbirth. Younger women, particularly those under 20 years of age, were more likely to support male partners in the labor room, being over seven times more likely to have a positive attitude compared to women aged 40 and above ( adjusted odds ratio, aOR=7.6, 95%CI=2.12-14.40). Similarly, women in their twenties were more than three times as likely to favor their partner’s presence compared to older women (aOR=3.44, 95%CI=1.18-15.29). In addition, women with five or more children were twice as likely to accept their partner’s presence during childbirth relative to first-time mothers (aOR=2.08, 95%CI=1.21-8.38) (Table 3).
Table 3.Logistic regression model for predictors of positive attitudes to partner’s presence in the labor room, Kano, Nigeria.
Characteristics
N
Positive attitude, *
n (%)
Crude Odds Ratio (95% CI)
Adjusted Odds Ratio
(95% CI)†
P-value
Age group
p=0.027
<20
14
6 (42.9)
6.94 (1.58-30.41)
7.6 (2.12-14.40)
0.012‡
20-29
191
28 (14.7)
1.59 (1.05-5.31)
3.44 (1.18-15.29)
0.033‡
30-39
105
16 (15.2)
1.66 (0.52-5.31)
1.65 (0.44-6.20)
0.34
≥40
41
4 (9.8)
Reference
Parity
p=0.20
0
46
7 (15.2)
Reference
1
72
13 (18.1)
1.23 (0.45-3.35)
1.78 (0.57-5.55)
0.53
2-4
165
19 (11.5)
0.73 (0.28-1.85)
1.18 (0.36-3.91)
0.64
≥5
68
15 (22.0)
1.58 (1.10-4.23)
2.08 (1.21-8.38)
0.025‡
Education
p=0.12
No formal
29
5 (17.2)
Reference
Primary/Secondary
128
26 (20.3)
1.22 (0.43-3.52)
1.34 (0.42-4.31)
0.71
Post-Secondary
194
23 (11.9)
0.65 (0.22-1.86)
1.01 (0.31-3.31)
0.43
Partner’s age
p=0.08
<30
31
8 (25.8)
Reference
30-39
128
14 (10.9)
0.35 (0.13-0.94)
0.77 (0.21-2.84)
0.38
40-49
118
23 (19.5)
0.70 (0.28-1.75)
1.72 (0.41-7.16)
0.27
≥50
74
9 (12.2)
0.40 (0.14-1.15)
1.04 (0.20-5.40)
0.14
Partner’s education
p=0.10
No formal
31
8 (25.8)
Reference
Primary/secondary
64
12 (18.8)
0.66 (0.24-1.84)
0.46 (0.15-1.42)
0.53
Post-secondary
256
34 (13.3)
0.44 (0.18-1.06)
0.40 (0.15-1.10)
0.32
*To the presence of male partner in the labor room during childbirth.
†Logistic model includes the following variables: age group, parity, education, partner’s age and partner’s education; CI – confidence interval.
‡Significant at P<0.05
DISCUSSION
Our study revealed a strong cultural resistance among predominantly Hausa expectant mothers in northern Nigeria to having their male partners present during childbirth. The majority of women did not expect their partners to be in the labor room, citing concerns that men’s presence could cause psychological distress, anxiety, and distraction, rather than offering emotional support. They also expressed that male presence during childbirth contradicted cultural and religious norms.
In contrast, studies from southern Nigeria indicate a more favorable attitude towards paternal involvement. For instance, research from Ibadan and Oshogbo showed that a significant proportion of women in the south prefer male partners as companions during labor, citing emotional and practical support as key reasons.14,15 Similarly, studies from southeastern Nigeria have highlighted more progressive attitudes towards male participation, with women showing a higher acceptance of their partners in labor and delivery settings.12,13,23 For instance, a study reported nearly two-thirds (63.9%) of male partners were present during their spouse’s last childbirth.24 This variation underscores the impact of regional cultural and religious norms on attitudes towards paternal involvement in childbirth.
This resistance is deeply rooted in the cultural and religious context of northern Nigeria, where traditional gender roles are strictly adhered to. In this region, childbirth is often viewed as a female-only domain,7,25 with men playing a more detached role in the birthing process. This cultural perspective is reinforced by religious beliefs that emphasize modesty and privacy for women during childbirth, making the presence of men, even husbands, seem inappropriate.7 Unlike in more urbanized or southern regions of Nigeria, where exposure to different cultural practices and the influence of global trends may have led to more progressive attitudes towards male involvement,23,26 northern Nigeria remains more conservative in this regard.
The implications of these findings are significant for efforts to promote male involvement in maternal health in northern Nigeria. Health education programs must be sensitive to these cultural and religious norms. Strategies to increase male participation should focus on educating both men and women about the potential benefits of male support during childbirth,27 while also respecting cultural sensitivities. Engaging religious and community leaders as advocates for change could also be instrumental in shifting these deeply ingrained beliefs.
Our study underscores the importance of healthcare providers offering flexible options that respect the cultural preferences of women in this region. For instance, private delivery rooms where men can be present without compromising the privacy of other women in labor could be a viable solution.28 Additionally, encouraging male involvement during antenatal care may better prepare them for participation during labor. This gradual engagement could be a more culturally acceptable approach to enhancing men’s involvement in childbirth.
The association of younger maternal age with a more favorable attitude towards male presence during childbirth suggests that there is potential for gradual change in these attitudes over time. Younger women, who are more exposed to global trends and digital information, may be more open to new ideas and less bound by traditional norms. This generational shift could be harnessed by targeting younger couples with educational campaigns that highlight the positive impact of male involvement in childbirth.
This study employed a cross-sectional survey design to quantitatively assess the attitudes of expectant mothers towards paternal presence during childbirth. The survey approach was chosen for its ability to capture a broad range of attitudes across a significant sample size, providing generalizable data that can inform policy and programmatic decisions. While qualitative interviews or an explanatory mixed methods design could have offered deeper insights into the complexities of these attitudes, the study was constrained by limited resources, which precluded a more comprehensive approach at this stage.
The findings may not be generalizable to all women in northern Nigeria due to the sample’s predominance of Hausa/Fulani and Muslim participants, and the focus on a single, better-educated group from one tertiary center. Women from different ethnic, religious, and educational backgrounds, especially those in rural areas, may hold different views. Future research should include a broader range of ethnic, religious, and socio-economic groups across multiple centers to better understand the barriers to male involvement in childbirth.
The research team recognizes the value of exploring these attitudes further through qualitative methods. To this end, a separate detailed qualitative study is planned, aimed at providing richer context and deeper understanding of the cultural and personal factors influencing these attitudes.
CONCLUSIONS
Our study revealed significant cultural resistance in Kano, northern Nigeria, toward male partners’ presence during labor due to deep-seated cultural and religious beliefs. To address this, targeted education should dispel misconceptions, while maternity wards should provide clear guidelines for optional involvement of fathers in the birthing process. Healthcare facilities should first establish policies supporting labor companionship, including training healthcare workers and managers on its benefits and how to integrate companions into the care team.29 Effective implementation also involves raising awareness about the benefits, addressing health workers’ concerns, offering orientation sessions, and optimizing facility infrastructure to ensure privacy and comfort. Future research should explore men’s willingness and experiences, and health care worker attitudes toward male participation in childbirth.
Acknowledgements
We wish to thank the study participants for making this study possible.
Ethics statement
Ethics approval was obtained from the Aminu Kano Teaching Hospital Research Ethics Committee (FWA00026225).
Data availability
Data can be made available on a case-by-case basis and in strict accordance with Nigeria data privacy rules.
Funding
This work is supported by the Fogarty International Center (FIC) and the National Institute on Alcohol Abuse and Alcoholism of the U.S. National Institutes of Health, award number 1D43TW011544. The findings and conclusions are those of the authors and do not necessarily represent the official position of the FIC, NIAAA, NIH, the Department of Health and Human Services, or the government of the United States of America.
Authorship contributions
HG, SJ, TA and ZI conceived the study; HG, FY, ZI, TA, HS and MA designed the study protocol; ZI, HG, TA, and SJ supervised data collection; ZI, RA, and TA analysed the data. All authors participated in drafting the manuscript and critical review of the article; ZI, FY, RA, HS and MA finalized the manuscript; ZI is the guarantor of the paper; all authors approve the final version of the manuscript.
Disclosure of interest
The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.
Correspondence to:
Zubairu Iliyasu, MBBS, PhD
http://orcid.org/0000-0002-8669-1863
Department of Community Medicine
Bayero University
Kano, Nigeria.
(email protected)
