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When Fathers Show Up: Why Male Involvement Is Key to Saving Mothers and Children in Nigeria

Responding to the diphtheria outbreak in a remote Northern Nigerian hamlet exposed me to scenes that left a permanent scar on my memory. As a front-line surveillance officer conducting case searches, contact tracing and follow-up visits, I came across a terrifying reality, rows of under-five children who were frail and stunted, their stomachs protruding from severe malnutrition. Feeling helpless and overburdened, their mothers informed us that they had been unable to assess assistance from the neighborhood primary health care center because their husbands had refused to provide consent to access essential healthcare services. I was literally dazed and couldn’t hide my tears.

The image of these children brought to mind the haunting photographs from the Biafra war, where hunger was used as a weapon and malnutrition (kwashiorkor) ravaged a generation. The faces were different, but the suffering was the same-children sickened and starved by forces beyond their control. This time, however, the weapon wasn’t a military blockade, but a harmful socio-cultural barrier that prevented mothers from saving their own children. This experience revealed a critical flaw in our public health system.

Having witnessed such injustice, we could not just leave.  We notified the local government health authorities, who in turn provided the necessary support and urgent care for those kids, and declared a nutritional emergency.  Some of the children had already begun to succumb to diphtheria because of poor nutritional status and weakened immune system. We called on healthcare workers to mobilize and engage with men, who often serve as the community’s gatekeepers, within their communities to advocate for timely consent to life-saving treatments and immunizations. In addition to a health emergency, gender conventions had created an imperceptible barrier in front of us.  And far too many communities in Nigeria still have that wall.

 

The Invincible Walls Between Fathers and Family Health:

Nigeria is at the epicenter of the global maternal health crisis. With a mortality rate of nearly 1,000 mothers dying for every 100,000 live births in 2023, the nation shoulders an enormous, disproportionate burden. Of the 260,000 global maternal deaths recorded in 2023, over one-quarter (28.5%) occurred in Nigeria, making up nearly three-quarters (70%) of all maternal deaths in Sub-Saharan Africa (WHO, 2025).”

 

A study in Lagos reported a maternal mortality ratio of 430 deaths per 100,000 live births (BMC, 2024). Child health statistics are also worrying, with an under-five death rate of 117 per 1,000 live births, newborn mortality of 74 per 1,000, and neonatal mortality of 37 per 1,000 (UNICEF, 2023). Nigeria loses around 844,000 children under the age of five per year, which equates to about 2,300 unnecessary deaths every day. Even after decades of investment, the results are still inconsistent. Men are one of the most potent untapped resources in maternity and child health (MCH), but we frequently ignore them.  Culturally, MCH is seen as “women’s business,” and males continue to have the final say in decisions.  This disconnect is lethal, as it leads to low antenatal service utilization, delayed emergency care seeking behavior, inadequate postpartum follow-up, and low vaccine coverage.

This case scenario brought to life what the data has long shown: a father’s presence is a powerful tool for public health. Studies analyzing Nigeria’s national health data reveal a clear connection. When a father attends antenatal care, mothers are far more likely to deliver in a health facility with a skilled birth attendant and to exclusively breastfeed their infants. The effect on child immunization is equally striking, with a father’s involvement often associated with significantly better rates of children being fully vaccinated against common diseases (Yargawa & Leonardi-Bee, 2015).

 

The most compelling evidence for why fathers matter comes from studies on babies born to HIV-positive moms. In Nairobi, Kenya, researchers discovered that when fathers accompanied their partners to antenatal care, their newborns had a much higher chance of survival and becoming HIV free. In fact, newborns whose fathers were absent during this journey were nearly four times more likely to die or get HIV within six weeks of birth than those whose fathers showed up and supported the mother (Aluisio et al., 2016). Similarly, in South Africa, another study found that when fathers stayed uninvolved, infants faced more than four times the risk of HIV infection in their first year of life (Peltzer et al., 2015). These findings make it obvious that a father’s presence during pregnancy and early childhood is more than just a gesture of concern; it can literally mean the difference between life and death for a child.

 

For too long, we have treated maternal and child health as a woman’s responsibility alone. It is time we change that. We must work to break down the cultural barriers that keep men on the sidelines, showing them that their presence and support are a crucial form of care. When we empower fathers, we don’t just improve health outcomes, we build healthier families and stronger communities.

Recent research across sub-Saharan Africa shows that men are more likely to get involved in pregnancy and childbirth when clinics are welcoming to fathers, health workers are trained, and harmful cultural norms are challenged (Moyo et al., 2024). In Nigeria, local studies provide powerful real-world evidence of this. In Modakeke, Southwest Nigeria, Akinyemi and Ibrahim (2024) found that over half of men surveyed (55%) were actively involved in pregnancy care for their partners. Their study highlighted that open communication, changing community attitudes about men’s roles, and reducing stigma around attending antenatal clinics were key drivers of male participation. Similarly, in Enugu State, Mbadugha et al (2019) reported that while many men understood that their involvement in maternity care was important, practical barriers, such as unfriendly clinic environments, demanding work schedules, and uncertainty about what role to play, often limited how much they could contribute. Together, these findings show that male involvement is not just a distant aspiration. With male-friendly services, flexible clinic hours, and targeted education, more men can step into active roles in maternal and child health. And when that happens, outcomes for mothers and babies improve.

The Significance of this view:

It is impossible to overstate the importance of men participating in decisions that affect their wives and kid’s general health and welfare.  This goes beyond simply requesting men to attend a clinic.  It’s about shifting the perception that a mother’s or baby’s health is not only a woman’s problem.  Usually, men are in charge of the money.  The consent documents are signed by men.  Whether a woman gives birth in a hospital or at home is a decision made by men.  Families suffer when they are not present or are not informed. Families prosper when they are active. The evidence, the facts, and the lived experiences all point to the necessity of having our men present as partners rather than gatekeepers. (Peter Yeung 2023)

What Needs to Be Done to Tear Down the Wall: A Deeper Look

The first step in enhancing mother and child health in Nigeria is to fundamentally change how we view, interact with, and support men. Rather than seeing them as an obstacle, we must recognize them as a powerful, untapped resource. Here’s how we can begin to dismantle the invisible walls that separate fathers from their families’ health:

Create National Guidelines for Male Participation in MCH

To truly integrate men into maternal and child health (MCH), we need to move beyond ad-hoc initiatives and create clear, nationwide policies. The Federal Ministry of Health in Nigeria, in alignment with WHO recommendations, has acknowledged the need to enhance male participation, yet a significant gap remains between policy and practice. We need a comprehensive national framework that outlines specific, measurable roles for men at every level of the healthcare system. This could include guidelines that:

  1. Mandate couple-based counseling on family planning and reproductive health.
  2. Integrate male-specific health education into antenatal and postnatal care programs.
  3. Incentivize health facilities that demonstrate high rates of male involvement.

Such guidelines would provide a clear roadmap for healthcare providers, policymakers, and communities, ensuring that male involvement isn’t just a suggestion but a core component of Nigeria’s MCH strategy.

Make Health Facilities Father-Friendly

Health facilities are often designed with only women in mind, which can make men feel unwelcome or excluded. To address this, health facilities must undergo a transformation to become more “father-friendly.” This means more than just a waiting room with a TV. We need to implement concrete changes such as:

  1. Providing services that also target men’s health, such as male reproductive health clinics or health screenings, to give them a personal reason to visit.
  2. Offering father-friendly clinic hours that extend beyond the typical 9-to-5 workday, perhaps with evening or weekend appointments, acknowledging that many men have demanding work schedules. Studies from Nigeria’s Enugu State and Anambra have shown that busy work schedules are a significant barrier to male participation.
  3. Creating dedicated spaces for fathers, like waiting areas with male-focused magazines or information on parenting, to make them feel comfortable and valued. Some countries have already successfully implemented these ideas. For example, in Uganda, some clinics prioritize women who attend antenatal care with their male partners, creating a powerful incentive for men to be present. This kind of innovative thinking is exactly what we need in Nigeria.    

Launch Public Awareness Initiatives that Encourages Cooperative Parenting Cultural norms in Nigeria often position men as financial providers and decision-makers, but not as hands-on caregivers. The 2018 Nigeria Demographic and Health Survey (NDHS) reveals that only a small percentage of Nigerian men believe that contraception is a shared responsibility, with many seeing it as solely “a woman’s business.” This viewpoint is a significant barrier to progress.

Public awareness campaigns must therefore be designed to actively challenge these detrimental conventions. They should:

  1. Promote cooperative parenting through engaging, relatable messaging on social media, radio, and television.
  2. Leverage the influence of community and religious leaders as champions for shared responsibility.
  3. Use storytelling and testimonials to highlight the positive impact of fathers’ involvement on their family’s well-being.
  4. Draw parallels between a man’s role as a protector and provider and his role as a health advocate, reframing his presence in the clinic as a critical part of his duty to protect his family.

According to Moyo et al. (2024), male involvement in maternal health steps up when clinics become father-friendly, health workers are trained to engage men, and social norms that discourage male participation are actively challenged. The article highlights that interventions such as flexible clinic hours, inviting male partners to antenatal care (ANC), and using male community leaders or volunteers have shown measurable gains in male attendance.

Teach Health Professionals Gender-Sensitive Communication

A study in Nasarawa State, Nigeria, found that entrenched patriarchal norms hinder communication between healthcare providers and patients, particularly in maternal health (Oni, Ogbonnaya, & Adeyemi, 2019). Women were often reluctant to speak in their husband’s presence, and providers hesitated to address men directly. This gap limited counselling and delayed care-seeking. The authors recommend training health workers in gender-sensitive communication and raising community awareness to challenge restrictive norms (Oni et al., 2019).

This training should equip them with the skills to:

  1. Empower both parents by addressing men directly, acknowledging their decision-making roles, and including them in discussions about care plans.
  2. Use language that respects and validates a man’s role as a partner, not just as a financial gatekeeper.
  3. Actively listen to men’s concerns and questions about their wives’ and children’s health, rather than dismissing them. When health workers create a welcoming and inclusive environment, they empower men to become active participants instead of passive observers.

Implement Workplace Policies that Encourage Parental Engagement

In a society where a man’s worth is often tied to his ability to be a provider, workplace policies can play a transformative role. The private sector, in particular, has an opportunity to lead this change by implementing policies that signal to men that their role as a parent is as valued as their role as an employee. This could include:

  1. Paid paternity leave: Although still rare, some forward-thinking Nigerian companies are beginning to offer this. Making it a standard practice would encourage men to be present during a crucial bonding and support period.
  2. Flexible work arrangements: Allowing fathers to adjust their hours to attend prenatal visits or take a child to the hospital for immunization would demonstrate institutional support for their caregiving role.
  3. Appreciation programs: Recognizing and celebrating male employees who take on active caregiving roles can help to normalize and promote positive masculinity.

These policies, as seen in other global contexts, not only improve employee morale and retention but also send a powerful message that a healthy work-life balance includes being a present, engaged father.

Use Data to Monitor and Assess Male Involvement

You can’t manage what you don’t measure. In Nigeria, there’s a lack of standardized data on male involvement in MCH. We must rectify this by establishing clear indicators and consistently collecting data. The Nigeria Demographic and Health Survey (NDHS) is a great tool, and we should leverage it to add specific metrics such as:

  1. The percentage of men who accompany their partners to at least four antenatal care visits.
  2. The percentage of fathers present during delivery.
  3. The proportion of men who are aware of and use modern family planning methods.

The Moment for Change is Now:
Men are a part of the solution, not the adversary. When it comes to his wife and child’s health, a man’s presence can make the difference between life and death.  And whole families and communities gain when he is informed, involved, and empowered.

However, it also stoked a fire inside of me. We must do better. Every father deserves the chance to share in the miracle of childbirth. Every child has the right to be protected and nurtured by both parents. And every mother should feel supported, not abandoned, when bringing life into the world. Shared health comes only from shared responsibility. The time for half measures is over. We must break down the barriers that keep families apart, demand policies that welcome fathers into maternal health spaces, and foster communities where men and women stand side by side in safeguarding the next generation. The future of our families and indeed our nation’s health, depends on it.


Ogechukwu Akabuike is a public health specialist with expertise in research, health promotion, molecular diagnostics, and outbreak response in Nigeria. She advocates for sexual and reproductive health and rights (SRHR), equitable maternal and child health systems, Cancer and gender equity, with a focus on strengthening national health systems and improving population health outcomes.