Prevalence, Domain Structure, and Correlates of Multidimensional Male Partner Involvement in Maternal and Newborn Health in Sierra Leone

Abstract

Sierra Leone continues to record one of the highest maternal mortality burdens worldwide, yet no validated multidimensional measure of male partner involvement has previously been applied there at the national scale. This study quantified male partner involvement across six behavioural domains and along the maternity care continuum, and examined the factors independently associated with it. A dyadic cross-sectional survey was conducted between January and June 2026 among 500 mother-partner couples (1000 individual respondents) recruited through a four-stage stratified cluster design covering 15 of Sierra Leone’s 16 administrative districts and all five provinces. Involvement was measured using a purpose-built 30-item Male Involvement Index (MII, 0 - 100) covering cognitive engagement, financial support, logistical support, psychosocial support, decision-making partnership, and clinical accompaniment. Women and their partners were interviewed separately by sex-matched enumerators. Data were analysed using descriptive statistics, Pearson correlation, independent samples t-tests, one-way analysis of variance, and ordinary least squares multiple regression, with cluster-robust standard errors and design effects used to qualify precision. Mean MII composite was 27.54 (SD = 15.52) by women’s report and 19.54 (SD = 11.33) by men’s self-report, with every domain falling below the scale midpoint of 50. Because involvement clustered by district (intra-cluster correlation 0.100; design effect 4.21), the design-adjusted 95% confidence interval for the composite is 24.75 to 30.33 rather than the 26.18 to 28.90 implied by simple random sampling. Clinical accompaniment recorded the lowest score (19.68) and decision-making partnership the highest (43.66). Inter-reporter agreement was moderate (r = 0.347, p < 0.001), and the intraclass correlation for absolute agreement was lower still (0.282). Couple discordance depended on the cut-point used: 184 couples (36.8%) fell on opposite sides of their respective sample medians, whereas 295 couples (59.0%) were placed in different tertiles. Involvement was lowest for the intrapartum aggregate (19.68), which comprises only the clinical accompaniment domain and is therefore not directly comparable to the multi-domain antenatal and postnatal aggregates. The regression model was significant (F = 17.708, p < 0.001) and accounted for 20.1% of the variance in involvement, with education (B = 4.021, p < 0.001), household wealth (B = 1.162, p = 0.014), travel time (B = −0.025, p = 0.013) and maternal age (B = 0.194, p = 0.047) independently associated with it. Women’s autonomy showed the strongest bivariate association (r = 0.362, p < 0.001) but added nothing once education was included in the model (change in R-squared = 0.0005, p = 0.582); the two were strongly collinear (r = 0.807). Work obligations were the most frequently reported barrier (54.4%). The study concludes that male partner involvement in Sierra Leone is systemically low and shaped by structural rather than attitudinal factors, and recommends that programs address livelihood, distance, and cost constraints alongside gender norms, and that involvement be measured dyadically.