A second implication relates to the significant negative
relationship between empowerment and antenatal accompaniment
in Malawi. The negative trends in Malawi were
observed among all empowerment dimensions, although
the relationship was only significant for the combined and
economic empowerment scores. Thapa & Niehof [31] also
found in Nepal that increased women’s autonomy was
associated with lower likelihoods of husband’s presence
at ANC. In our analysis, one explanation for the reverse
relationship could be that women with greater participation
in health care and household decisions, including
asset ownership, saw less of a need to invite spouses to
ANC. It may be also that such an invitation was viewed as
unnecessarily overlapping with women’s roles. Kululanga
et al., [55] found in Malawi that some women viewed male
involvement in pregnancy as a “foreign concept” and synonymous
with an infringement on “territory they did not
want men to invade”. Thus, women with more influence
in household matters may also be more likely to voice and
achieve their preferences. This suggests that enabling
women and their partners to identify potentially beneficial
and acceptable norms of male participation during pregnancy
may assist in implementing approaches that do
not undermine women’s autonomy. Alternatively, higher
empowerment scores could indicate male partner absence,
such as a spouse who works abroad, where women alone
bear the burden of decision-making out of necessity –
which is not the aim of empowerment approaches.
Kululanga et al., [55] also found in Malawi that male
involvement programs were sometimes perceived as
unfair to unmarried or otherwise single women and
perpetuated cultural norms that men were superior. In
this regard, male involvement strategies may more appropriately
empower women by identifying other peers or
relatives who can assist in preparing for birth and support
women’s continuity of care throughout the postpartum
period.