One of the most effective ways of keeping newborns, infants and under fives alive is by making sure that their mother does not die. That means supporting women who are planning to have children, who are pregnant, or who already have young children.
I would suggest that one of the best potential sources of support for mothers-to-be and mothers, is fathers. A lot of NGOs make a big deal of working exclusively with children, infants or mothers. But ignoring fathers, or even worse, branding them as in some way wayward, is not helpful.
Including fathers more in pregnancy and birth has not yet developed very much here in Tanzania. Some women will tell you they don't want their husband there, and some men will tell you that they don't want to be there, during the delivery.
But one of the biggest sources of opposition to fathers being present when their wives are giving birth in Tanzania, and even when they go for antenatal care, may be health facilities themselves. Health personnel in East Africa currently have a disproportionate influence on the treatment patients receive, with the wishes of the patients often being sidelined.
I have been present for the birth of my two sons here in Tanzania, the first time in Dar es Salaam and the second in Moshi. I have yet to meet a nurse who thinks it is a good idea for fathers to be present when their wife is giving birth. It is possible to persuade doctors, but many people can't afford a consultation with a doctor, and rely on the professionalism of nurses and other staff.
Perhaps Tanzanian fathers don't realize that their mere presence could strongly influence the sort of treatment their wife receives? Nurses would feel under more pressure to treat pregnant women with respect, which they do not always do when there is no one to stand up for them. Or fathers could be there just to ensure that their wives get the minimum level of attention they need, when they need it.
Tanzanians are well aware that health facilities are in bad condition, and that will not change in a hurry. They are also aware that health personnel are often far too stretched to prioritize simple courtesy. Indeed, many patients and those accompanying patients will admit that they fear being shouted at by nurses and health personnel in front of other patients, and are often too intimidated to say anything at all.
If fathers attend at least one antenatal care visit and express their wish to be present when their wife is giving birth, they can start to exert a lot more influence over the care their wives receive. Better care is safer care, and safety is paramount; safety is one of the main reasons for giving birth in a health facility, with a health professional present, it is one of the main reasons why maternal, newborn, infant and under five deaths have declined in the past few decades.
But they haven't declined nearly enough yet. Recent figures show that 26 newborns die out of every 1000 live births; 51 infants die out of every 1000 live births; and 81 under fives die out of every 1000 live births. Infants and under fives, who should be facing fewer serious health risks as they get older, are more likely to die, as if they cease to matter so much once they are no longer newborns.
Maternal mortality stands at 454/100,000 live births, and that rises to much higher levels in certain hospitals. This includes the Muhimbili Maternity Hospital, the biggest and most prominent in the country, where mortality is about three times higher than average.
It's hardly surprising that only about half of all births in Tanzania take place in health facilities!
Just being with your wife when she is giving birth can improve the care she receives. Just being in the delivery room with her can remind those attending to her that there is a reason for the father to be there; he is concerned about his wife's safety as she gives birth.
If women survive birth and leave the hospital as healthy as they were when they arrived, they will be able to give their newborn and their other children the attention they need. Newborns, infants and under fives will be healthier, and more likely to survive, go to school, grow up and have healthy children themselves.
Antagonistic attitudes towards men are detrimental to the lives of all those we profess to care about. The attitudes of NGOs and of health professionals, as well as the attitudes of men and women, need to change.