Indicators of Husband's Role in Pregnancy and Maternity Care

The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. Antenatal Care (ANC), delivery with skilled birth attendance (SBA) at the time of delivery and delivery in institutional are universally considered important for reducing maternal mortality. Husbands can play a crucial role in pregnancy and childbirth. Therefore, the aim of this study was analyze the indicators of husband's role in pregnancy and maternity care which were suspected as one of the determinants of ANC and SBA use in Polewali Mandar Regency. The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire data processing by using SMART-PLS. The result of data analysis suggested that the coefficient value that has been standardized from each indicator were as follows: accessibility = 0.944 and engagement = 0.954, dan responsibility = 0.968. Indicators of organizational support in implementing Maternal and Child Health Information System at Polewali Mandar Regency, respectively from the most important are: responsibility, engagement, and accessibility.


INTRODUCTION
The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. In 2012, MMR showed 359 deaths per 100 000 live births. MMR increased in 2007 which is 228 deaths per 100 000 live births. International commitment to lowering MMR, as embodied in MDG No. 5 that targets for reducing the MMR by 75 percent between 1990 and 2015 [1]. Key strategies can prevent women from dying are the provision of antenatal care (ANC), ensuring skilled birth attendance (SBA) at the time of delivery [2]- [4]. World Health Organization (WHO) recommends for initiating antenatal care in the first trimesters and at least four ANC visits for low risk pregnancies [5] but most of obstetric complications are a leading cause of maternal deaths occur around late in the third trimester, the time of delivery and in the first week after delivery and can not be predicted. Therefore, it is important that all pregnant women have access to a skilled attendant. Although ANC visits is not directly reduce the MMR [6], but women attend ANC that more likely to delivery by skilled birth attendance [7].
Based on the coverage of maternity care in Indonesia, 11.7 percent started doing the ANC at the age of 4-5 months and 3.5 percent in 6-7 months. In addition, 11.6 percent reported that the frequency of visits does not meet the standards. Delivery was not in a health facility namely 36.8 percent. Childbirth is not  [9]. Based on the data of the national and district levels show that the results of the coverage of maternal health care and maternity in Indonesia that is still not optimal. It is important to understand the determinants of ANC and SBA use. Some women do not have the ability to make decisions in households [10]. International recognition in which men would play a proactive role in the health of women put forward on the agenda for the International Conference on Population and Development, Cairo [11]. The increasing of men's involvement in Maternal health can lead to a reduction in all three phases of delay ; that is delay in making decision to seek care, delay in accessing the care and delay in receiving the care [12]- [13]. Based on the aforementioned empirical problem, it was deemed necessary to conduct a research concerning husband's role in pregnancy and maternity care in Polewali Mandar Regency.

RESEARCH METHOD
The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire. Husband's role in pregnancy and maternity care, consists of indicators i.e. 1) accessibility, 2) engagement, and 3) responsibility. The response scale for items was scale that ranging from 5 (Extremely role) to 1 (Extremely does not role). After data was gathered, it was then processed and data processing by using SMART-PLS.
Result of research suggested that loading factor for each observed variables (indicators) were respectivelly as follows: accessibility = 0.944, and engagement = 0.954, dan responsibility = 0.968. The whole loading factor value were greater than 0.7 (acceptable). All of T-Student test values for loading factors for indicators are significant in 95% confidence intervals indicate that it can be concluded that three of which were significant indicators for husband's role in pregnancy and maternity care on health behavior of women during pregnancy (Figure 1).

RESULTS AND ANALYSIS
Roles are the expected behavior of a person holding a particular status. Consequence of status as a father and husband will pose a important liability in the form of a role in the family [14]. Role has shown by the husband not uniformly but positive contributions made by the husband will reduce negarif behavior of pregnant women and maternity which ultimately affects the outcome of the pregnancy. There are several important dimensions of ideal father in the context of pregnancy and childbirth includes accessibility, engagement, and responsibility [15]. In the context of pregnancy and childbirth, the role of husband as accessibility is presence of husband during pregnancy and childbirth of mother, so that pregnant women felt her husband make efforts in order to fulfill its duty to obtain results positively in maternal health services; engagement can be realized in the form of togetherness of husband during pregnancy and childbirth of mother with shows great concern in order to fulfill its duty to obtain results positively maternal health mother, the husband assuming the roles of provider, nurturer and protector in order to fulfill its duty to obtain results positively maternal health services [15]- [16]. This research has analyzed the three indicators of husband's role in pregnancy and maternity care, i.e. accessibility, engagement, and responsibility. Result of analysis suggested that three indicators are valid and reliable as the parameters of husband's role in pregnancy and maternity care. Several previous researches also reports that husband's role in pregnancy and maternity care plays important role as a determinant of women use ANC and SBA, besides other determinants, among others are: educational level, employment, number of ANC visits, and parity [17], characteristics husband, women's autonomy [18].
First indicator that has been proven as valid and reliable, accessibility has been studied by previous researchers, i.e. Role of husband limited to the aspect of attendance from husband at antenatal care [19]- [21]. Attendance of husband is at antenatal care and delivery [22]. More than half the women has husbands who are present at least onfe ANC visit [17], [20]. Attendance of husband at antenatal care can improve the male involvement in maternal health [23]. When men are present in the clinic, it will increase their knowledge of antenatal care, knowing the danger signs of pregnancy and childbirth and can act as an agent of lifesaving because they are important determinants of using SBA at delivery [17], [24]- [25].
Although some researchers report the husband's role shaped by many factors; Lack of husband's understanding about maternal health and the complications that can threaten the mother [21], [26]- [27]. Men are not given an understanding and explanation of how they should act as an ideal husband by providers of maternal health [16], waiting period for get service that require long time [16], [20], the peak hours of work coincide with the time of service [16], [20]- [21], [25]. Men feels that never been invited formally to request their involvement [16], [20], low effort to fulfill its duties [15], [20], [26]. Examples of role behaviors as "husband and ideal father" during pregnancy, childbirth and postpartum wife less is shown by the family. Men are considered incapable and inexperienced to be involved in maternal health services [15]. Maternal health services is regarded as the women domain, which can be involved in pregnancy and childbirth of mother is only woman so that the husband role was taken over by another family namely the women, especially women like my mother and mother-in-law [15]- [16], [21], [23], [26].
Second indicator that has been proven as valid and reliable, engagement, has also been studied by previous researchers, with more diverse components and with various terms, i.e.: such as physical and emotional support, encourages, positive affirmation, understands, listening, empathizes [15], encouraging and reminding, providing emotional and moral support [27], supporter [16].
Third indicator that that has been proven as valid and reliable, responsibility, has also been studied by previous researchers, with more diverse components and with various terms, i.e.: such as such as not only financial support, including caregiver, provider, and protector, [15] financial support [28], provider [16]. Based on the comparation with previous researches, it could be said that accessibility, engagement, responsibility were truly the proper indicators to measure husband's role in pregnancy and maternity care.

CONCLUSION
Based on results of data analysis it can be concluded that the indicators of husband's role in pregnancy and maternity care at Polewali Mandar, Sulawesi of West, Indonesia, respectively from the most important are: responsibility, engagement, and accessibility.