Beyond the waiting room: exploring male participation in maternal health care in Nyasa District, Tanzania

This study examined male participation in maternal healthcare in Nyasa District, southern Tanzania. Although health policies emphasise men's involvement, it is often narrowly defined as physical presence at antenatal or delivery facilities. Using a qualitative case study with 45 semi-structured interviews and four focus group discussions with men and women, the research explored how men actually engage in maternal care. Thematic analysis revealed that men's contributions extend well beyond clinic attendance to include financial and logistical support, birth preparedness, household assistance, emotional care, family planning participation, and monitoring maternal wellbeing. Women appreciated these forms of involvement but also reported persistent inequities, particularly in contraceptive decision-making, where male authority often prevailed. Limited clinic attendance was largely shaped by structural and livelihood constraints rather than disengagement, including subsistence farming, informal work, long travel distances, and gendered clinic environments. In the context of rural poverty and evolving gender norms, men's participation reflects both continuity and change in household gender relations. The study highlights the need for a comprehensive, context-sensitive understanding of male involvement that recognises relational care, addresses power imbalances, and informs inclusive, gender-equitable, and locally responsive maternal health policies and interventions.