A research report submitted to the Discipline of Psychology, Faculty of Humanities, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters in Clinical Psychology Johannesburg, South Africa December 2015 / Extensive literature emphasises that good quality maternal care is crucial for infants to develop secure attachments which positively shapes their future mental health. In a developing society such as South Africa where many mothers are raising children in contexts of multiple adversities, interventions which focus on improving the quality of maternal care are vital. Home visiting programmes are an effective way to support mother-baby dyads. In South Africa, it has been found that lay women from local communities trained to work as home visitors can make a significant difference to these mother-infant relationships. Ongoing supportive supervision has been found to be particularly important for lay home visitors. The evaluation and improvement of these intervention programmes is recommended. One aspect of programme evaluation is the investigation of the programme staff experiences. Currently, there is a dearth of research focusing on the experiences and supervision of lay community health care workers, internationally as well as in South Africa. The Ububele Mother Baby Home Visiting Project, run in the Alexandra Township in Johannesburg, is one such intervention and no evaluation of this intervention from the perspective of the staff has, as yet, been conducted. It was felt that research into the experiences of the home visitors and their supervisors would be beneficial in gaining clarity regarding which aspects of the project they perceive to have been effective and those that have been challenging, as well as to assist the team in developing their intervention further. The current research aimed to gain insight into these experiences and to gain an understanding of the main concerns. The form of data included 10 semi-structured in-depth interviews with the staff of the programme: the home visitors, the supervising psychologists and the director of the project. An interpretive thematic analysis was used to interpret the results. The findings indicated that the staff’s experience included a mixture of positive and challenging experiences. The staff all agreed on their passion for the project and their belief in the effectiveness of their work in improving the bonds between mothers and babies in the community. The challenges included working in a community faced with multiple adversities, as well working in a team divided by education level, race, culture and socioeconomic class. Suggestions for the Ububele Mother Baby Home Visiting Project team are also provided.

Thesis advisor: Shanta Pandey / A growing body of literature, particularly from low and middle-income countries, has focused on the role of male involvement in maternal care as a crucial strategy to improve maternal and neonatal health outcomes. The purpose of this three-paper dissertation is to add to this evidence base within the context of India, and to gain an in-depth understanding of one aspect of male involvement – that is, male partner attendance in antenatal care. This dissertation utilized data from the National Family Health Survey (NFHS-3, 2005-06 and NFHS-4, 2015-16) and was framed using the Social Ecological Model, Connell’s Theory of Gender and Power and a Gender-Transformative lens. Paper 1 summarized the levels of male partner attendance in antenatal care and assessed changes over time. Further, multivariable logistic regression models were used to examine the factors influencing male partner attendance in antenatal care. The results show an overall increase in male partner attendance in India during the period of 2005-06 to 2015-16, with the Southern region reporting the highest level of male partner attendance in both years. Higher level of education and household wealth, increased knowledge of pregnancy-related complications, older age at marriage, and women’s autonomy were positively associated with male partner attendance in antenatal care. Paper 2 examined the association between male partner attendance in antenatal care and maternal health service utilization. Controlling for all socio-demographic variables and adjusting for report of pregnancy complications, the results showed that women who were accompanied by a male partner for antenatal care reported increased odds of maternal health service utilization (early initiation of antenatal care, frequency of antenatal care contacts and institutional delivery). While the place of residence (rural/urban) did not influence the association between male partner attendance and maternal health service utilization, region had a significant moderating effect. Paper 3 examined the association between antenatal care and infant birth weight, adjusting for gestational age. Further, the analysis also assessed whether the relationship between antenatal care and infant birth weight varied by male partner attendance. Findings indicate that early initiation of antenatal care and maternal immunization was associated with reduced odds of low birth weight among infants. The results showed that male partner attendance in antenatal care did not have a moderating influence. Taken together, the findings of the three papers have implications for policy and practice; further, they provide support for interventions that aim for a more inclusive and gender-transformative approach to maternal and neonatal health. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social work.