Keywords
Qualitative study, narrative research, Black African males, stages of pregnancy, knowledge base
Pregnancy is a disembodied experience for men in any culture. In South Africa, more than three decades ago, social changes advocating gender equality in homes, communities, and society began. It is estimated that more than 75% of perinatal deaths occurred amongst Black African women. To investigate the possibilities of social change, this narrative inquiry sought to explore and describe the knowledge base of Black African males about pregnancy to assess their needs for caring for their pregnant partners.
Face-to-face in-depth narrative interviews were conducted with three Black African males in their natural settings and the interviews were audio-recorded on a digital voice recorder. In this study, the question was, what were the needs of Black African fathers in caring for their pregnant partners? The study followed an adaptation of Creswell’s (2009) model of thematic analysis. To enhance the trustworthiness or rigour of the results, the model of Guba and Lincoln (1985, cited in Polit & Beck, 2010) was adapted to include the narrative requirement for authenticity.
Five major themes emerged as part of a broader doctoral study programme. Specifically, storytellers disclosed their level of knowledge about pregnancy; storytellers described the different ways of seeking information on technological platforms about pregnancy; storytellers expressed a need for an educational programme and their commitment to such a programme; storytellers described the different delivery platforms for the programme; and storytellers described the role of the Department of Health and other stakeholders.
Black African males need sufficient knowledge to ensure they provide the necessary care and support for their partners during pregnancy. The gravity of the need is illustrated by identifying what needs to be learned to enable storytellers to provide practical support to their pregnant partners and encourage them to engage fully with the pregnancy journey.
Qualitative study, narrative research, Black African males, stages of pregnancy, knowledge base
Paternal involvement is described as a man being present, accessible, understanding, and willing to learn about the gestation process, and willing to provide emotional, physical, and financial support for the pregnant partner (Omolola et al., 2022). Male involvement in pregnancy is also described as a process of social and behavioural change, which is needed for them to play more responsible roles in maternal health care, with the purpose of ensuring women and children’s well-being (Annoon et al., 2020:2). Like other social and behavioural process, male involvement requires time and effort on the part of both expectant fathers and their pregnant partners as well as other stakeholders. For male involvement in pregnancy to show a positive effect, Asante (2015:153) argues that such a process needs to ensure centrality and agency. According to Kanter’s structural empowerment theory, support, opportunities, resources, and information are necessary, as power is about influencing behaviours and attitudes (Cho, Laschinger & Wong, 2006: Siu, Laschinger & Vingilis, 2005).
There is empirical evidence suggesting that a lack of male involvement in pregnancy has negative consequences for pregnant women and their unborn children. The disadvantages of a lack of male involvement can result in low utilisation of antenatal care (ANC), health facility delivery, and postnatal care, leading to increased tendency to maternal morbidity and mortality because men are key financial decision makers at the household level (Annoon et al., 2020:5). The study by Ongolly and Bukachi (2019) found that economic barriers were responsible for the non-involvement of men in pregnancy in Kenya. This study indicated that there was insufficient financial support for both partners to attend the antenatal care clinics, and the hours of operation did not favour men who are working. In Nigeria, Omolola et al. (2022) observed that the non-involvement of a supportive male partner can lead to increased stress and depression in expectant mothers, which can also affect the child’s health outcomes at birth. Conversely, with sufficient resources and commitment, these disadvantages could be translated into opportunities for male involvement. Therefore, strategic ways need to be explored to encourage and motivate male involvement in pregnancy.
The benefits of male involvement in maternal and neonatal care have been documented. In their cross-sectional study assessing the perceptions of pregnant partners on male involvement in Ghana, Annoon et al. (2020:5) found that there was high male involvement in antenatal care provision. The high turnover of male involvement was attributed to the opportunities that exist within Community-Based Health Planning Services, which adopt a family-centred approach. Using systematic review and meta-analysis, Yargawa and Leonardi-Bee (2015) investigated the impact of male involvement on maternal health outcomes of women in developing countries. The review showed that the active participation of men was associated with decreased likelihood of maternal depression and childbirth complications and utilisation of maternal health services during the antenatal care phase of pregnancy.
In South Africa, the government has introduced national policies and formulated strategies to fortify community and family-based health programmes through Primary Health Care re-engineering strategies and Ward-based Primary Healthcare Outreach Teams. Primarily, these teams are composed of female community health workers (CHWs) (Department of Health, 2017:3; Tsolekile, Schneider, & Puoane, 2018: 1). Moreover, the National Development Plan 2030 also emphasises that gender equity, strong family ties, and better health are the main objectives for development (National Planning Commission, 2012: 23-30). Such goals are consistent with both the Sustainable Development Goals, particularly SDG 3, and Agenda 2063, which focus on inclusive development in Africa. Over time, driven by the positive contribution of medical male circumcision on HIV prevention, South Africa has introduced a men and boys’ package of services founded on seven pillars, which focuses on sexual and reproductive health for self-care (Department of Health, 2021: 14). However, this milestone needs to be transformed into knowledge related to pregnancy.
While these policies are helpful, there is still a major lack of understanding about the informational, emotional, and psychological needs of Black African expectant fathers to support their partners during pregnancy. Although several scoping reviews and qualitative studies have discussed male involvement, very few have concentrated on the needs and experiences of Black African men in South Africa (Jackson, Erasmus & Mabanga, 2023; Makusha, 2024). In addition, these studies usually do not include men’s opinions or perspectives on how barriers such as cultural practices like intlawulo affect their lives as expectant fathers (Samukimba & Moore, 2020:2). In certain African settings, intlawulo is a cultural practice where an unwed male or his family is obligated to pay in kind or in monetary terms to the family of the unwed pregnant woman for impregnating her, and it does not automatically translate into bride price (Samukimba & Moore, 2020:2).
This manuscript is part of a doctoral thesis that builds on the existing literature by employing a narrative inquiry to foreground the lived experiences of Black African expectant fathers. This seeks to answer the following question: What are the needs of Black African fathers in caring for their pregnant partners? This manuscript focuses on the description of specific needs of Black African expectant fathers, aiming to generate context-sensitive insights that can inform culturally relevant and gender-inclusive antenatal care interventions in South Africa.
The study received approval from the University Research Ethics Committee (UREC) of Walter Sisulu University (Protocol Number 0105252/2023). Background information was provided to storytellers as part of the recruitment and enrollment processes. Written consent forms were issued, and written informed consent was obtained from storytellers (Oglee & Kawulich, 2012:62-63). Given the narrative nature of the study, the storytellers were assigned pseudonyms (Thabiso, Moholwane, and Rakgwebo) to protect their true identities. Storytellers were informed that they were free to withdraw from the study at any time without explanation. They were given the contact numbers of study advisors if they were not satisfied with any aspect of the study and the conduct of the corresponding author.
The study followed a descriptive, exploratory, and qualitative-narrative research design. Narrative inquiry is a specific strategy within the qualitative research paradigm, characterised as spoken or written texts that describe events or actions in chronological order (Creswell, 2009:13,70). While saturation is considered important in qualitative research, individual biographical experiences are recognised as valid sources for understanding meaning and do not require external validation (Etherington, 2005:305).
Non-probability purposive sampling procedures were employed (Polit & Beck, 2010:465). A background information leaflet outlining the study's objectives and purposes was shared in both English and Sesotho (the local African language) as part of the study’s recruitment and enrollment process. The study recruited three Black African men from Sedibeng Health District who lived with pregnant partners, had experienced at least one pregnancy, and consented to participate in the study. Individuals who were not residing with their pregnant partners at the time of pregnancy were excluded.
Face-to-face in-depth interviews were conducted with three Black African male storytellers in their natural settings, such as their residences. Narrative studies are driven by a single broad question, which is supported by probing questions. The narrative question was formulated as follows: Based on your experience of living with a pregnant partner, what was your knowledge base about pregnancy? (Butina, 2015; Ramvi, 2015). Further probing was used to ensure the objectives of the study were met. The interviews ranged in duration from 39 minutes to 1 hour and 16 minutes. Audio recordings of these interviews were transcribed verbatim. Narrative summaries were developed and shared with the storytellers to ensure participant validation.
A thematic analysis was used following Creswell’s adapted model of analysis (see Jirojowong, Johnson, & Welch, 2015:141; Polit & Beck, 2010:465).
The criteria of trustworthiness, as outlined in the model of Guba and Lincoln (1985, cited in Polit & Beck, 2010:492), were rigorously applied to ensure credibility, confirmability, transferability, and overall truth value of the results. Credibility was established through participant validation by sharing interview summaries with study participants, maintaining prolonged engagement with data, and regular interaction with supervisors. For confirmability, interviews were transcribed to allow independent verification of neutrality by other researchers. The transcriptions were also reviewed by supervisors and an independent coder, creating an audit trail to support the dependability of the findings. Transferability was managed through a thorough description of design and methods. Authenticity was ensured as storytellers recognised the need to enhance their knowledge regarding pregnancy.
A description of the sample in summary form is presented in Table 1 of the three Black African males who were the storytellers. This summary provides details of the three Black African males who were the storytellers regarding their age, level of education, employment status, parity, and their experience related to living with a pregnant partner (see Table 1).
The thematic analysis resulted in five major themes. For the purposes of this manuscript, the following theme will be described and discussed: storytellers expressed their need to be involved in support of their pregnant partners. However, within this theme, participants identified five priorities, which are discussed as categories (see Table 2).
Having experienced living with their pregnant partners, storytellers revealed that their levels of knowledge about pregnancy were low or inadequate. Their massive knowledge deficit was evident in their search for information about pregnancy on various social media platforms. The hunger for information may have been spurred on by their unplanned pregnancies. By their admission, pregnancy was a new adventure for them. Two of three storytellers openly said that they lacked knowledge about pregnancy, stating:
“I don’t have any knowledge about pregnancy, all I know is the little that I’ve known” (Thabiso).
“I was clueless about female stuff. I think there is a lot that we don’t know” (Rakgwebo).
The narrations in the above verbatim statements from Thabiso and Rakgwebo clearly show that some Black African men in South Africa lack knowledge about pregnancy, and this could have implications for the ways they support their pregnant partners. Rakgwebo empathically disclosed his complete lack of knowledge or information about pregnancy. Overall, the findings from the verbatim statements of the storytellers enabled the researcher to conclude that some Black African men in South Africa may lack the necessary knowledge about pregnancy. This lack of knowledge can have significant implications for pregnant women, maternal and neonatal health outcomes, and for the participants.
Storytellers described different ways of seeking information about pregnancy on technological platforms. In their desperation to support their pregnant partners, they reported using various methods to seek information on digital platforms, mentioning the internet, Google, and MomConnect as their sources of information. Furthermore, Rakgwebo emphasised the importance of purchasing magazines to seek information, acknowledging his lack of knowledge about pregnancy. These storytellers narrated:
“If there was something I didn’t understand, I would actually Google it on the internet” (Thabiso).
“Most of the guidance, I think we used to buy magazines, baby magazines, just to have guidance through the magazines, we would buy every month, and there was a WhatsApp line that’s called MomConnect, and we would get tips on that WhatsApp line” (Rakgwebo).
The narratives by Thabiso and Rakgwebo attempted to provide a detailed explanation of how the internet and MomConnect helped them access information about pregnancy. Rakgwebo also highlighted that he incurred monthly expenditures on baby magazines. From these stories, it can be inferred that technological or digital platforms played a significant role in providing information about pregnancy, as did print media. This also showed that despite the challenge, they sought information from various sources. This lack of knowledge has implications for their anticipated roles in future pregnancies, especially for Thabiso and Rakgwebo, who intended to have more children.
The storytellers expressed the need for educational programmes as well as their commitment to such programmes. Thabiso, one of the storytellers, narrated that educational programmes with more sessions about pregnancy were needed. He also mentioned several important issues for which information was needed, such as roles and responsibilities during pregnancy, knowledge of medication, management of pain at home, and information on contact numbers to call during an emergency. Thabiso described a sense of helplessness in living with a pregnant partner. Furthermore, Thabiso added the importance of maternal nutrition. Overall, Thabiso revealed the different areas of information needed for a better pregnancy outcome. His narratives strengthen the need for educational programmes. Thabiso storied as follows:
“Obviously, I think we need to look out for sessions that teach us about pregnancy more. We need to know what to do when our partners are pregnant, what to do when your partner experiences pain during the night, what numbers to call for help, what medication can you give to reduce the pain. Yeah, neh! We need to be taught how to live with a pregnant woman … need to know what a pregnant woman must eat, not eat” (Thabiso).
Similarly, Moholwane also emphasised the need for educational programmes for Black African men that cover all things related to pregnancy. He further indicated that age should not be a barrier or a hindrance to seeking knowledge, describing an institutional framework akin to the traditional circumcision school model. Furthermore, he expressed the anguish of enduring the six of nine months of pregnancy. He clearly acknowledged and appreciated the role that knowledge and education can play in pregnancy. In his own words, Moholwane said the following:
“But I will generally answer, there is no age for education. I think men should go to some kind of initiation school for pregnancy, just to be taught about pregnancy and all of the things related to pregnancy. Pregnancy and the nine months are the hardest journey of life for us as men. we need the same education for the nine months to be smooth” (Moholwane).
From the above narratives, there is a dire need for educational programmes towards educating Black African men about pregnancy. In the absence of sufficient knowledge, they will not be able to care for and support their pregnant partners when they need help. This knowledge deficit is a potential risk to handling the day-to-day nuances of living with pregnant women. Closing this deficit will enhance their capacity and build their confidence as agents for change and empowerment. In addition, the knowledge about pregnancy among men helps them reduce poor maternal and neonatal outcomes.
Furthermore, the storytellers representing the Black African men in South Africa also described the different delivery platforms for the recommended educational programmes to educate men about pregnancy. One of the delivery platforms mentioned by the storytellers was the utilisation of the existing healthcare facilities by men. Thabiso narrated the following:
“Yes, men really need to be part of the sessions, whenever they have time, they need to attend the clinics, depending on whether men are working or not working, to get more knowledge” (Thabiso).
Apart from using existing education sessions provided at healthcare facilities, storytellers suggested that educational programmes can be delivered to the Black African men in South Africa through flyers. Two participants stated the following:
“We can use flyers and announce the venues where we are going to hold the sessions; we can give out flyers; that will help a lot” ( Thabiso).
“I’m going back to the health department, there should be flyers that should be displayed at the clinics, for people to take in and read, and get more knowledge. And it should be specifically about fathers who are going to be fathers or about to be fathers. Now it’s for the department to decide what should be in those flyers” (Moholwane).
The participants suggested that classes be provided as another mode of delivery of educational programmes to educate men about pregnancy. The strategy of class sessions for men was also mentioned by Thabiso and Moholwane, who said:
“I think that to have classes during weekends, as men, we need to have such lessons as fathers. Maybe 15 minutes at work twice a week!” (Thabiso).
“I think … we as men should also have our sessions during the weekends rather than just sitting while women go to their sessions. Also, at the clinic, they need to get to know more too and have programmes that may be at work sometime during the week too” (Moholwane).
From the shared stories of Thabiso and Moholowane, it can be inferred that class sessions for men would help in educating them about pregnancy issues. Moholwane specifically stated:
“I think the health department should be the one organising the awareness for couples who are expecting. We need to know what to do during and after pregnancy as a couple, life and death. We know what we will do when death occurs, and we know what will happen after death. When women test for pregnancy, they must be told to bring in their partners, too. Whether the number of men is 30 or not, it is important that they come and attend with their pregnant partners. So even in pregnancy, we need to have more knowledge. And to reduce conflict … but I would say awareness or education is needed because of the generation we are dealing with. Social media platforms can be used to share information” (Moholwane).
Overall, the findings from the life experiences of the storytellers have shown that there are several diverse delivery platforms for educational programmes for Black African men in South Africa. These platforms include digital platforms, class sessions, the use of existing healthcare facilities, and the use of flyers, as well as undertaking awareness programmes. Effective use of these delivery platforms can facilitate the effective implementation of the educational programmes to educate Black African men about pregnancy and ultimately lead to improved support for pregnant women in South Africa.
Moholwane, of the three storytellers, described the important role of the Department of Health and other stakeholders in maternal health issues. Moholwane said the following:
“I think the health department should be the one organising the awareness for couples that are expecting, we need to know what to do during and after pregnancy as a couple, in life and death (Moholwane).
Further, Moholwane shared that it is not only the sole responsibility of the Department of Health but also of other stakeholders, such as the legislature. The storyteller clearly reported that pregnancy is not the responsibility of the department alone, but also of other stakeholders. Based on the findings, the Department of Health, a government agency, and other stakeholders have an important role in educating people about pregnancy and implementing pregnancy-related legislation.
Pregnancy presents a major transition in fatherhood for Black African expectant fathers. Using the narrative inquiry approach, overall, storytellers disclosed that their knowledge about pregnancy was almost non-existent. To respond to and close their knowledge deficit, they used various methods. They also stressed the need for an educational programme to educate them about pregnancy. In addition, they provided details of what needs to be learned from such a programme. They further identified the different role players to support them in their quest for knowledge, knowledge that would assist them in their future pregnancy plans.
Based on their experiences of living with pregnant partners, the study found that the knowledge of the Black African expectant fathers was inadequate. Several empirical studies corroborate this observation. Alharbi et al. (2018:1467) in their research on the barriers and attitudes towards the presence of husbands in the labour room in Saudi Arabia revealed that low levels of knowledge among men are associated with negative husbands’ attitudes towards supporting their female partners. In South Africa, Nesane and Mulaudzi (2024:2325) indicated that male partners lack information and knowledge about pregnancy, concluding that it is very important for male partners to be educated about pregnancy. Also, the results by Erzse et al. (2021:13163) showed a lack of knowledge on maternal health and pregnancy issues among men in South Africa’s urban settings, leading to non-participation as well as fear of the unknown among male partners. In support of their observations, Erzse et al. (2021:13163) stated that while husbands’ interest levels in participating in pregnancy and childbirth tend to be high, low levels of knowledge appear to hinder their interests. In addition, the findings by Soltani et al. (2018:356) match the findings of the present study, where Black African men in South Africa tend to lack knowledge about pregnancy. In contrast, not all men lack knowledge about pregnancy. For instance, a cross-sectional study by Falade-Fatila and Adebayo (2020:1) examined the levels of knowledge about pregnancy-related care among male partners in Nigeria and found that 63% of the surveyed married men possessed good knowledge of pregnancy-related care. The qualitative study by Oladeji et al. (2022:26) found that some men in Ethiopia demonstrated sound knowledge of the benefits of partners visiting healthcare facilities, and an understanding of the possible complications that can occur during pregnancy and childbirth. According to the cross-sectional quantitative study by Jungari and Paswan (2020:1), which assessed husbands’ knowledge of pregnancy and women’s utilisation of maternal healthcare among the tribal population in India, husbands’ knowledge of pregnancy complications has a significant positive impact on wives’ utilisation of maternal healthcare services.
The lack of knowledge about pregnancy disempowers men who are willing to be involved to support their pregnant partners. Without the requisite knowledge about pregnancy, they cannot support the emotional, psychological, and physical needs of their pregnant partners. There is a growing trend of men in developing countries or patriarchal societies becoming more willing to participate in pregnancy-related issues. This improvement, if sustained, will bear positive results for women’s and children’s health in developing countries.
The present study found that the Black African men who lived with pregnant partners realised their knowledge gap about pregnant partners and sought information from different sources. It also showed that the storytellers wanted to be informed so that they could support their pregnant partners. This also means they have accepted responsibility for pregnancy.
Seeking maternal health and ANC-related information has been associated with the promotion of positive maternal health or pregnancy outcomes (Burleson, Naseem & Toyama, 2020:1; Kassim, 2021:182; Okafor & Goon, 2021:787). The study by Baker and Yang (2018:1) also showed that social media and internet platforms represent significant sources of information about pregnancy. These researchers found that 43% of pregnant women in the United States use social media blogs whilst 99% use the internet for seeking answers to pregnancy related and parenting related questions and 89% use social media platforms for seeking advice and guidance (Baker & Yang, 2018:1). The cross-sectional quantitative descriptive research by Okafor and Goon (2021:793), which studied information-seeking practices of the pregnant South African women, found that the MomConnect platform is employed in seeking maternal health–related information. Rakgwebo’s narratives emphasised the utilisation of MomConnect as a platform for easy access to pregnancy-related information.
However, the desperation for more information exposed these storytellers to the risk of harmful advice, necessitating guidance to credible sources of information about pregnancy. Whilst they acknowledge that there are different ways of seeking pregnancy-related information through technological platforms, Daly et al. (2018:1) argue that there are adverse consequences of seeking such information from technological platforms such as the internet. Conrad (2024:195) also observed that the accuracy of pregnancy-related information from internet sources remains a global concern for healthcare practitioners. A study by Artieta-Pinedo et al. (2018:19), which evaluated online information sources for pregnancy-related information, found that only 14 of the top websites (11%) provided quality and accurate information, while the rest (about 89%) provided poor-quality pregnancy-related information. This observation highlights the significant risks that information seekers face regarding the credibility of sources on pregnancy. This also implies that pre-pregnancy planning is crucial. It further implies the quality of the relationship dynamics and communication between couples.
The storytellers largely agreed there is a need for educational programmes and resources that accommodate their caregiving roles. Their diverse approaches to finding pregnancy-related information highlight the demand for a reliable platform. Without credible sources, information seekers risk exposure to harmful advice, as demonstrated in the study.
There is ample empirical evidence to support the need for a programme. Gomez et al. (2018:409) highlighted the need for comprehensive education programmes that consider not only pregnancy planning but also attitudes towards unplanned pregnancies. Findings by Soltani et al. (2018:357) also indicated the need for targeted educational and training interventions to educate men about the benefits of involvement and participation in ANC. Another study supporting the findings of this present study, conducted by Kashaija, Mselle and Mkoka (2020:1), reported that educating men about the importance of active engagement and involvement in ANC is highly important. Furthermore, Kamau et al. (2022:1) emphasised the importance of educating men about pregnancy, recommending that male partner involvement be recognised in maternal health education.
Black African expectant fathers feel that structured pregnancy information sessions are vital. Lack of knowledge about pregnancy left many storytellers feeling unable to support their pregnant partners. Recent research indicates that inadequate paternal health literacy hinders male involvement in maternal health (Wynter et al., 2024:131). Expectant fathers in South Africa are becoming more aware of their shifting roles and are demanding more comprehensive, practical knowledge. Educational activities may enhance male prenatal care, alleviate maternal anxiety, and improve family well-being.
While the study has established the important role digital platforms play in providing pregnancy-related information, storytellers emphasised the importance of various delivery platforms for the programme they envisioned in their communities. This is an important realisation, as there may be many Black African men of reproductive age who may not have access to modern technological platforms such as the internet, Facebook, and other social media platforms. Therefore, the suggested uses of existing health facilities, flyers, community libraries, and churches are reasonable options.
The present findings are consistent with Rahman et al. (2020:1), who also recommended the need for awareness campaigns to educate men about pregnancy. Shapumba (2021:52) also recommended the need for awareness programmes to promote men’s involvement in pregnancy and childbirth, stating that community health workers must conduct community outreach programmes to disseminate information on the importance of male involvement in ANC services. The role and impact of CHWs are documented in both grey literature and scholarly works. In South Africa, CHWs are key in the Primary Health Care re-engineering programme (Department of Health, 2017). Although males are not an integral part of the CHW workforce in the programme, the envisaged educational programme could lead to greater involvement of males in the future, thereby reducing stigma associated with the resocialisation of male maternal care beliefs. Nambile-Cumber et al. (2024) support the inclusion of male facilitators within CHWs, who can further this agenda through home visits, practical instruction, and mentoring. In addition, various male-friendly health messaging initiatives in sports, music, and local radio play a crucial role in outreach to men, leading to higher male involvement in pregnancy, suggesting they should be adopted.
Similarly, Govender, Naidoo, and Taylor (2019:1) recommended utilising digital media platforms, such as social media, to deliver educational content about pregnancy to adolescents in South Africa. This is an intervention supported and emphasised by Erzse et al. (2021:13163) to ensure increased participation of South African men in pregnancy and childbirth. Based on their findings that South African men lack knowledge about ANC, Erzse et al. (2021:13163) suggested that to improve men’s participation and involvement in ANC in South Africa, there is a need to create more awareness among fathers through the provision of male-targeted ANC education. Hence, the findings for the need of educational programmes for Black African men in South Africa are in tandem with the recommendations of many scholars (Govender, Naidoo & Taylor, 2019; Erzse et al., 2021; Wynter et al., 2024). This further shows that there is support that Black African men lack knowledge, and that they need to be educated.
The participants stated that distribution systems must be flexible and accessible to fathers from diverse socioeconomic backgrounds for educational activities to be effective. Many fathers missed health education due to work and scheduling conflicts. Thus, storytellers endorsed a hybrid in-person and digital learning technique. Smartphone utilisation and connectivity in South Africa could enhance clinic-based learning through mobile applications and online portals. Wynter et al. (2024:131) found that localised and user-friendly digital interventions promote expectant fathers' health literacy and participation. In addition, asynchronous mobile systems can enable fathers to review and learn at their own pace. This multi-platform approach may improve rural-urban paternal engagement. The storytellers also discussed community-based delivery strategies beyond digital media. Storytellers favoured relaxed training programmes at community libraries, churches, and other places where fathers could participate with ease. Community health workers and peer educators, who are trusted facilitators, could bridge cultural and linguistic gaps, providing men with a safe space to talk (Mprah et al., 2023:238). Community forums are capable of fostering father solidarity and challenging gender norms, promoting a culture of shared maternal health responsibility.
Storytellers recommended workplace-based training programmes for busy working fathers. Men who miss clinic or community programmes can learn together during lunch breaks or health days. The study by Ongolly and Bukachi (2019) confirmed that there were economic barriers to the involvement of men in pregnancy in Kenya. Specifically, their study found that hours of operation at health facilities do not favour working men. Diphoko-Phetla (2024:28) also found that fathers with workplace support and education are more likely to attend antenatal care and support their pregnant spouses. Supporting such events demonstrates an employer’s commitment to gender parity and family well-being, which may reduce male reproductive health stigma. In addition, Diphoko-Phetla (2024:37) found that many men reported that workplace inflexibility prevented them from attending clinic or educational sessions with their partners. Thus, employer support, such as paternity leave, flexible work hours, and workplace-based health education, can enhance male involvement in maternal and child healthcare. It will be necessary for working men to announce to their employers that they are expectant fathers or employers need to strategically plan for future paternity by regular monitoring of the reproductive age of employees, ensuring employee wellness programmes cater to men.
Community leaders, such as traditional and faith-based leaders, have significant influence in the provision of health services. Strategic community gatekeeper engagement can balance public health and culture. With their voices and support, they would be able to influence the uptake of pregnancy-related programmes. In this way, Black African men will be encouraged to attend antenatal classes and help their partners. A comprehensive review indicated that programmes using recognised community personalities are more likely to overcome resistance and make men feel welcome and obligated to participate (Mprah et al., 2023:238). The narrative findings stress community ownership and leadership in transforming gendered pregnancy attitudes and behaviours.
There are opportunities for innovations. Black African expectant fathers need creative, contextually relevant interventions due to changing gender roles. Paternal involvement improves maternal and child health, but gender norms and structures prevent it. Innovative solutions are needed to close knowledge gaps and overcome cultural, societal, and institutional barriers. Wynter et al. (2024:891) emphasised the importance of empowering men living with pregnant partners to enhance health literacy and challenge African paternity conventions. With resilience, health systems and communities can create inclusive maternity care pathways by critically examining the environment and discovering intervention opportunities.
South Africa’s growing use of digital technology offers unique potential to educate and involve future fathers. SMS advertising, WhatsApp groups, and smartphone applications advise on pregnancy and parenting. Rural and illiterate men are more likely to access culturally relevant digital content, including stories, indigenous language instructional films, and interactive learning modules (Wynter et al., 2024:131). The best digital interventions are user-driven, co-designed with fathers, and regularly updated to reflect their lives. South Africa’s MomConnect father-focused programme has improved male engagement and awareness, showcasing mobile Health’s revolutionary capacity.
Durable innovations must expand the health system. Mother-centred maternal health care has a propensity to exclude men. Couple-based antenatal sessions, expanded clinic hours, and “Father Corners” in hospitals have increased father engagement (Drysdale et al., 2022:13177). Healthcare providers require gender-sensitivity training and a shift in attitudes towards males as care partners. Male involvement, performance criteria, and accountability measures can also encourage clinics and providers to engage fathers.
Cultural and social factors influence men’s involvement in pregnancy. In low-income countries, lower-income men often discourage others from participating, and supportive fathers may face peer stigma, including teasing about their female partner’s influence over men (Nambile-Cumber et al., 2024:12). This reflects commonly observed gender roles, in which pregnancy is primarily associated with women, while men are often expected to provide financial support. Awareness among community leaders and traditional authorities of the benefits of male involvement during pregnancy may influence existing attitudes (Mprah et al., 2023:238). Men who participate in targeted interventions may influence the perceptions of their peers. Community health workers, including male facilitators, can support these efforts through home visits, practical guidance, and mentoring. In addition, broader use of sports, music, and local radio could help encourage participation in such initiatives.
Moholwane, one of the storytellers, recalled that there was a need for the Department of Labour to support the educational programming initiative. The study observes that legislation has been passed to allow expectant fathers to support the maternal care needs of their pregnant partners. Despite legal advances, Diphoko-Phetla (2024:37) found Black African males rarely use paternity leave due to ignorance, economic instability, and occupational shame. Fathers’ rights, the private sector, and informal economy businesses’ acceptance of paternity leave and family-friendly working practices require effective campaigning. Workshops, union coalitions, and mass media campaigns can inform workers and employers about the physical, social, and economic benefits of active fatherhood. Better regulations, monitoring, enforcement of anti-discrimination laws, paternity leave, and shared care role models are needed.
Expectant fathers need peer support and can learn about the emotional, psychological, and practical obstacles they may face from father-to-father mentorship programmes. Men can ask questions and share experiences in the workplace, neighbourhood, or online peer groups without criticism (Griffith et al., 2025:802). Peer mentoring normalises male involvement and promotes shared accountability and good parenting. Mentorship models for males of all socioeconomic backgrounds should be discreet, non-judgmental, and inclusive.
Poor health literacy hinders the engagement of Black African expectant fathers. Innovative ways need to provide clear, culturally relevant, and context-specific information on pregnancy, delivery, and infant care. Print, radio, and in-person commercials targeting local language and literacy assistance have the potential to succeed in this regard (Osborne & Ahinkorah, 2024:156). Pictures and infographics aid uneducated males. Digital health literacy programmes should teach men how to evaluate internet content and discover reliable sources. Health literacy enables many men to become community organisers and knowledge creators.
Flexibility and innovation are needed to accommodate expectant fathers in ANC facilities. Some of the innovations could include expanded clinic hours for working men, allowing couples combined appointments, and creating father-friendly clinics. Fathers can participate in ANC, health education, delivery planning, and postnatal care (Hastings-Tolsma et al., 2021:1524). Health workers require respectful, non-discriminatory training in men’s engagement. Clinic posters should welcome and acknowledge men. Easy and cost-effective interventions can improve maternal and infant outcomes through the involvement of males. Mass media and creative arts can promote fatherhood and challenge prejudices. Well-written radio dramas, television advertising, and social media material show expectant fathers supporting their partners as ideals (Maluleke & Moyer, 2024:49). Campaigns with local artists, singers, and actors are more relevant and effective. Community cinema screenings and participatory theatre can challenge gender conventions. These programmes should highlight Black African fathers’ strengths.
Storytellers mentioned the Department of Health as the primary care provider for the provision of health facilities through which the pregnancy-related educational programme for men in South Africa is delivered. They also mentioned other stakeholders in partnership with the government. Without reliable institutional networks, an envisaged educational programme to offer pregnancy-related information to men willing to learn and be present during the stages of foetal development or during the different phases of pregnancy will collapse. This observation is well-supported by the literature. Muthoni and Muchelule (2023:272) and Nishimwe and Mchunu (2021:4) noted that several stakeholders, such as the government, non-government organisations (NGOs), and communities, have a significant role in the implementation of maternal healthcare interventions and programmes.
The study by Okedo-Alex et al. (2020:1145) also acknowledged the important roles of multiple stakeholders, including the government, private sector players, and NGOs, in educating and training people about ANC as well as implementing policies related to ANC. They proposed male-targeted instructional materials, including father-friendly sessions in antenatal care, and hosting regular community outreach events to educate men about their supportive roles throughout pregnancy. Recent empirical research demonstrates that resource constraints, lack of tailored messaging, and deeply embedded gender stereotypes that discourage male reproductive health engagement often limit these efforts (Wynter et al., 2024:895). It is therefore barriers limiting the supporting and caring roles of men in pregnancy that need to be removed and replaced by new ways of thinking that recognise that men have specific roles to play in maternal and neonatal health care.
There is a dire need for Black African males to learn more about pregnancy, including the different stages of pregnancy as well as the stages of labour, to ascertain their need for practical support. The gravity of the need is illustrated by identifying what needs to be learned to enable storytellers to provide practical support to their pregnant partners and urge them to engage more with the journey of pregnancy during antenatal care attendance. It is crucial that maternal health practice settings anticipate intimate engagement with Black African males.
Increasingly, studies show that men in African and other traditional cultures are beginning to assert their agency in maternal and neonatal healthcare issues. Professional maternal health care practice providers need re-orientation towards the emergence of Black African male involvement and engagement. Therefore, the maternal care practice settings need to re-adapt to the inclusion and involvement of Black African men to support gender equality.
This study focused on the needs of Black African expectant fathers in caring for their pregnant partners. This narrative enquiry sought to get a deeper understanding of the needs of Black African expectant fathers in caring for their pregnant partners. However, several significant limitations must be acknowledged to contextualise the findings and guide future research. The narrative nature of the study does not lend itself to generalisability, as this was not the intention of the study. Also, the study did not include maternal health providers. In addition, the study did not include Black African pregnant women to solicit their views, as this was not the intention. However, important insights could be learned from the study, which could enhance transferability using the same methods as described in this study.
Figshare: “Needs of Black African Expectant Fathers in Caring for Their Pregnant Partners, South Africa” https://doi.org/10.25406/wsu.30666260 (TAOLE, E.K., 2025)
This project contains the following underlying data:
• background information
• interview data
• an unstructured interview guide with a central research question
• a sample of informed consent forms.
Data are available under the terms of the Creative Commons Attribution license (CC0)
The authors would like to extend their gratitude to the research participants for their time.
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