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      Navigating relationship dynamics, pregnancy and fatherhood in the Bukhali trial: a qualitative study with men in Soweto, South Africa

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          Abstract

          Background

          South Africa has a complex range of historical, social, political, and economic factors that have shaped fatherhood. In the context of the Bukhali randomised controlled trial with young women in Soweto, South Africa, a qualitative study was conducted with the male partners of young women who had become pregnant during the trial. This exploratory study aimed to explore individual perceptions around relationship dynamics, their partner’s pregnancy, and fatherhood of partners of young women in Soweto, South Africa.

          Methods

          Individual, in-depth interviews were conducted with male partners (fathers, n = 19, 25–46 years old) of Bukhali participants. A thematic approach was taken to the descriptive and exploratory process of analysis, and three final themes and subthemes were identified: (1) relationship dynamics (nature of relationship, relationship challenges); (2) pregnancy (feelings about the pregnancy, effect of the pregnancy on their relationship, providing support during pregnancy; and 3) fatherhood (view of fatherhood, roles of fathers, influences on views and motivation, challenges of fatherhood).

          Results

          While most male participants were in a committed (“serious”) relationship with their female partner, less than half of them were cohabiting. Most reported that their partner’s pregnancy was not planned, and shared mixed feelings about the pregnancy (e.g., happy, excited, shocked, nervous), although their views about fatherhood were overwhelmingly positive. Many were concerned about how they would economically provide for their child and partner, particularly those who were unemployed. Participants identified both general and specific ways in which they provided support for their partner, e.g., being present, co-attending antenatal check-ups, providing material resources. For many, the most challenging aspect of fatherhood was having to provide financially. They seemed to understand the level of responsibility expected of them as a father, and that their involvement and presence related to love for and connection with their child. Participants’ responses indicated that there were some changes in the norms around fatherhood, suggesting that there is a possibility for a shift in the fatherhood narrative in their context.

          Conclusions

          These findings suggest that the complex array of factors influencing fatherhood in South Africa continue to play out in this generation, although promising changes are evident.

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          Most cited references32

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          Reflecting on reflexive thematic analysis

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            Process evaluation of complex interventions: Medical Research Council guidance

            Process evaluation is an essential part of designing and testing complex interventions. New MRC guidance provides a framework for conducting and reporting process evaluation studies
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              Nurturing care: promoting early childhood development.

              The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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                Author and article information

                Contributors
                catherine.draper@wits.ac.za
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                8 November 2023
                8 November 2023
                2023
                : 23
                : 2204
                Affiliations
                [1 ]SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, ( https://ror.org/03rp50x72) Johannesburg, South Africa
                [2 ]Department of Global Health and Social Medicine, King’s College London, ( https://ror.org/0220mzb33) London, UK
                [3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Toronto and Departments of Obstetrics and Gynecology, Physiology and Medicine, , Lunenfeld-Tanenbaum Research Institute, Sinai Health, University of Toronto, ; Toronto, ON Canada
                [4 ]School of Human Development and Health, University of Southampton, ( https://ror.org/01ryk1543) Southampton, UK
                [5 ]Interprofessional Education Unit, Faculty of Community and Health Sciences, University of the Western Cape, ( https://ror.org/00h2vm590) Cape Town, South Africa
                Article
                17153
                10.1186/s12889-023-17153-x
                10633923
                37940937
                2bbcf6e3-af18-4375-83ad-30f0974b7e38
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 June 2023
                : 4 November 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001322, South African Medical Research Council;
                Award ID: NA
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: NA
                Funded by: FundRef http://dx.doi.org/10.13039/501100023534, DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg;
                Award ID: NA
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2023

                Public health
                fathers,lmic,qualitative
                Public health
                fathers, lmic, qualitative

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