When He Shows Up, Lives Are Saved:
The Case for Male Engagement in Maternal and Infant Health

Every year in Uganda, thousands of women die from causes that are almost entirely preventable. According to UNICEF’s 2024 Annual Report, Uganda’s maternal mortality ratio has fallen significantly — from 336 deaths per 100,000 live births in 2016 to 189 deaths per 100,000 live births in 2022. That is real progress, and it deserves recognition. But it also means that hundreds of mothers still lose their lives each year in the act of bringing new life into the world. UNFPA estimates that approximately 6,000 women and adolescent girls still die every year from preventable causes related to pregnancy and childbirth in Uganda — and that for every woman who dies, an estimated 20 to 30 more suffer injuries, infections, or lifelong disabilities.

Infants pay an equally devastating price. Uganda’s infant mortality rate stands at 36 deaths per 1,000 live births, with 42% of those deaths occurring in the fragile first days of life — the neonatal period when the quality and timeliness of antenatal care matters most. In Northern Uganda and West Nile, where Maracha District is located, these numbers have historically been even more severe, with some districts recording maternal mortality ratios far above the national figure.

The painful truth is that many of these deaths share a common thread: they happen when care comes too late, or not at all. And behind that delay is often a story not just about geography or poverty — but about who in the household holds the power to decide whether a pregnant woman goes to a health facility, and whether she goes alone.

For generations, pregnancy in Uganda has been treated as a woman’s affair. Men drop women at the gate of a health facility — if they accompany them at all — and return to their daily routines while their partners face health workers, waiting rooms, and anxiety alone. This is not merely a cultural norm. It is a public health problem with measurable, deadly consequences.

Research conducted across sub-Saharan Africa finds that fewer than half of all men are involved in antenatal care with their partners, with an average of around 45.7% of men attending at least one ANC visit together across eight African countries. In some parts of Uganda, that figure has been as low as 6%. Even in communities where men attend at least once, fewer than 10% accompany their partners for four or more visits — the minimum recommended for a well-monitored pregnancy.

Yet evidence is equally clear about what happens when men do show up. Studies across Uganda and East Africa consistently show that women whose partners are involved in ANC are more likely to attend early and regularly, more likely to deliver with a skilled birth attendant, more likely to receive timely HIV counselling and care, and less likely to experience dangerous delays in seeking emergency obstetric care. Male involvement in ANC has been directly linked to improved maternal outcomes, reduced maternal anxiety, and healthier newborns. Uganda recognised this formally in 2014 when it launched a National Male Involvement Strategy in Maternal and Child Health — yet implementation at the community level in areas like Maracha remains a work in progress.

The barriers are real but surmountable. Distance to health facilities, long waiting times, unfriendly clinic environments, fear of HIV testing as a couple, and deeply held cultural beliefs that pregnancy is a “woman’s matter” all discourage men from stepping forward. But they can be addressed. And in Ajira village, that addressing has begun.

On 23rd March 2026, Amani Initiative — under the Women’s Voice and Leadership (WVL) Project supported by CARE International Uganda, as part of its Health and Wellness Program — brought together 35 community members at the Ajira sub-county headquarters in Olupi Parish, Maracha District. They came from different walks of life: women from the Nzakai Terracing VSLA Group, community members of Tara sub-county, and health workers who brought data, candour, and commitment to the conversation.

It was a participatory dialogue — not a lecture, not a workshop, but a genuine community conversation. And within it, something important happened. People spoke the truth. About fear. About distance. About husbands who stay home while wives face labour alone. About health workers who, on bad days, use words that send women away rather than drawing them in. About the poverty that means a woman cannot afford a basin or a set of clothes for her baby, so she delays going to the clinic rather than arrive with nothing in her hands.

Health workers shared the ANC attendance data they had been quietly recording, and the numbers were sobering. In December 2025, only 12 women attended ANC — accompanied by just 2 men. By February 2026, attendance had risen to 53 women and 25 men. Progress, yes. But still far from the universal couple engagement that research tells us is needed to truly protect mothers and infants in this community.

The dialogue identified the barriers clearly. And in naming them together — men, women, health workers, and community leaders in the same room — the community began the work of dismantling them.

The dialogue in Ajira was honest in ways that formal surveys rarely capture. Community members spoke freely about what keeps pregnant women — and their partners — away from antenatal care. These are not excuses. They are real structural and social barriers that any serious public health response must grapple with.

Some of the most powerful moments in the Ajira dialogue came not from data or expert presentations, but from the people in the room sharing their own truths. Two voices in particular capture the spirit of what is changing — and what can change — when communities speak openly about maternal health.

The community dialogue in Ajira concluded with a set of recommendations that were not handed down from above, but rose from the community itself. They are simple, practical, and powerful — and they tell us exactly what is needed to protect maternal and infant health in Maracha District and across West Nile.

Men must choose to show up. Not because they are told to, but because they understand that pregnancy is not their partner’s journey alone. It is a shared journey — and its outcome depends on shared care. A man who escorts his wife to ANC, who sits with her in the waiting room, who hears from the health worker about danger signs and nutrition and delivery planning, becomes a partner in the truest sense. He becomes part of the safety net that can make the difference between a safe delivery and a tragedy.

Health facilities must become welcoming spaces for couples. Community members were clear: health workers who speak with kindness draw patients in. Those who use harsh words push patients away — sometimes permanently. Investing in patient-centred care, couple-friendly ANC services, flexible clinic hours, and privacy for couples discussing sensitive matters like HIV testing are not luxuries. They are prerequisites for the male involvement that saves lives.

Community leaders — religious, traditional, and local government — must make maternal health a consistent public message. Participants called for sensitisation on the importance of early ANC to be built into every public gathering, every church service, every community meeting. When the message comes from trusted voices within the community, it lands differently than when it comes from a poster on a clinic wall.

Women must be supported to attend without shame. The poverty-driven fear of arriving at a clinic without materials for the baby is a solvable problem — through VSLA savings schemes, community support networks, and health facility policies that welcome women regardless of what they bring with them. No woman should delay life-saving care because she cannot afford a basin.

The data is clear. The evidence is compelling. And in Ajira village, the conversation has already begun. What happens next depends on all of us — men and women, health workers and leaders, grandparents and young couples — deciding that maternal and infant health is everyone’s responsibility, not just the woman’s burden to carry alone.