Men's Confrontation with Pregnancy from Women's Point of View: an Ethno Phenomenological Approach.

Introduction: In providing pregnancy services, particular attention is given to the mother and her infant and comparatively less consideration is paid to men's role. This study aimed to explore how Iranian men are confronted with pregnancy from pregnant women's point of view.
Methods: This study was conducted, using an ethno-phenomenological approach. 25 Pregnant women were recruited via purposeful sampling from health centers, hospitals, and private obstetric clinics in Mashhad, Iran. In-depth semi-structured interviews (n=25), vignettes, (n=13) as well as observation were used for data collection. The data were organized with MAXQDA software version 10 and analyzed, using van Manen descriptive- interpretive phenomenological approach.
Results: The main theme which emerged was: "adaptation, skillfulness and self-actualization of man in confrontation with pregnancy". This was derived from two themes: 1) "spouse's emotional engagement" subthemes spouse's emotional confrontation with pregnancy occurrence, man's sentimentality following being an expectant father, husband`s confrontation with wife's motherhood, man's emotional excitement, seeing the symptoms of fetal survival, husband's gender orientation and 2)"Concentration, vigilance and active efforts of spouse during pregnancy" subthemes managing wife towards successful pregnancy, efforts to acquire paternal skills and pregnancy as an issue to expand spouse's mental horizons.
Conclusion: Besides an overwhelming sense of emotion, men tend to be supportive in managing successful pregnancy. As an opportunity window pregnancy seems to develop thinking, vision and horizons of life among men and increases their responsibility. By promoting male participation in pregnancy, important steps could be taken to improve maternal and infant health using spouses` support approach.

Introduction

Pregnancy and childbirth are very important and challenging incidents in a woman's life. They can bring about significant physical and mental changes in women.[1,2] While pregnancy services are specifically focused on maternal and neonatal health, pregnancy, childbirth and parenthood are also known to contribute to physical, social, emotional and psychological changes in men.[3] For a long time, reproductive health programs primarily were not concerned about men due to the women's centrality in fertility, and lack of adequate knowledge about men.[4]

Little attention has been paid to pregnancy as the context in which the attitude of men towards fatherhood and paternity is developed.[5,6] Also, historically, less attention has been paid to the role of men in reproductive health programs[4,7,8] while men can play the role of educator, observer or contributor during pregnancy.[6] In the study of Sawyer et al., women strongly believed that having a child is a common subject for both mother and father and men must share this responsibility with them. Most women said that through increasing men’s participation during pregnancy, more benefits come to the family.[2]

The results of previous studies showed that men play a vital role in pregnancy, which has long-term effects on maternal and child health,[9-11] and their participation is considered a strategy that could reduce maternal mortality.[3,12] Men can provide mental, emotional and even verbal support for their pregnant women during pregnancy.[13,14]

Conversely, a lack of support and companionship is accompanied by mothers and child's adverse consequences such as maternal depression in pregnancy, smoking, delayed maternal care and even birth-related complications.[15-17] there is vidence suggesting that men’s paternal function has an important and specific effect on the development of children[18-20] and improves social, mental and cognitive health among adolescents.[18,20-22]

Despite the evidence that men's involvement in pregnancy is important, there is little knowledge about their role in pregnancy.[23] The international conference on population and development has emphasized the promotion of men's participation in their responsibilities, including pregnancy health, and parental responsibilities.[24] The World Health Organization (WHO) emphasizes the involvement of men in safe maternal programs and the identification of the appropriate strategies for their involvement.[25] Men's participation is an important strategy to achieve the third millennium development goals, that is, promoting maternal health.[26,27] following these policies in the recent decades, there has been an increasing focus on the importance of men’s participation in reproductive health programs including pregnancy.[25,28] Also, the expectations of men in the society have also changed.[29] Nowadays, the traditional expectations of men as bread winners in the family have undergone a change, and spouses are significantly more involved in children’s day care although they still spend less time in childcare in comparison with women.[30,32] However, men’s participation in pregnancy has changed[4] More than 90% of men in the United States participate in prenatal care and interact with women about it.[33]

In Iran, the results of studies indicated the increased tendency of men to participate in pregnancy.,[16] Along with the studies conducted in the world, the attention of Iranian researchers to the role of men in family health has increased,[8] and different studies have examined the relationship between men and women in reproductive health issues like the educational needs of men for perinatal care,[6] male participation in the care of pregnant women,[34] and mental problems of men during pregnancy and postpartum.[35] However, to our knowledge, no study has examined the experiences of men and their related challenges in pregnancy in Iran. Overall, men’s role in pregnancy has been marginal,[36] and there are still many challenges in our society about the role of men in the family during pregnancy. Also, little knowledge is available on the.[7,37]

On the other hand, due to the changes which have occurred in gender roles of women and men and the fundamental changes in the structure and characteristics of families, as well as the sensitive nature of the gender relationships in the Iranian culture,[38,39] it is noteworthy to understand the context of men’s encountering pregnancy.[40]

There are few studies in this regard, but one study showed that men and women have different cultural beliefs and attitudes in relation to the household responsibilities. Simbar et al., in Tehran found that to provide mental support for pregnant women, men act as the breadwinner and women expect them to help in the household duties.[6] This contradictory perspectives of men and women has significant effects on women's experiences of sharing responsibilities of household affairs, particularly during pregnancy.[2]

Considering the importance of the aforementioned issues and the need for planning to increase the Participation of men in the care of pregnant women, exact and detailed data are needed regarding the intuition of men’s confrontation with their wives’ pregnancy according to the dominant gender role and cultural context of Iran.[40]

Considering the necessity of gathering information about this phenomenon, the importance of the role of men in promoting women’s health and the limitations of Studies on the meaning of men’s confrontation with pregnancy from the perspective of pregnant women, there is a need to study the experiences of pregnant women in the Iranian society.

To achieve the aim of the study, a qualitative research was conducted, because quantitative studies could not explore all aspects of this phenomenon. In addition, there was no previous knowledge on this phenomenon [41], and a qualitative research could address this issue with a deep and comprehensive exploration of this phenomenon from the perspective of pregnant women in the context of their life experiences.

Therefore, this study was designed to explore how men are confronted with pregnancy from pregnant women’s point of view in Iran.

Materials and methods

In this study, a combination of interpretive phenomenology and ethnographic approaches has been used. The two approaches can be integrated in different ways. They are both exploratory; in both the researcher acts as a data collector; both use interviews and a combination of open and structured questions and both search for meaning in the statements of individuals .[42] By integration these two approaches into one study, the phenomenological view will enable the researcher to focus on the phenomenon, and achieve the meaning of experience, while the ethnographic approach allows cultural beliefs and behaviors involved in shaping this experience, the perspective of the cultural group and its cultural context to be considered. Thus the beliefs and behaviors shaping the confrontation of men with pregnancy would be explored.[42]

The study setting was health centers, hospitals, and private obstetric clinics in Mashhad, Iran. The participants included Iranian pregnant women with the ability to speak and communicate in Persian and were willing to participate in the study and to transfer their experiences.

Purposful sampling was adopted during 2016-2017. In order to access participants with different experiences, criteria such as age, education, employment, social class, number of pregnancies, delivery, gestational age and even religion were taken into consideration.

In this study, 33 in-depth interviews with 25 pregnant women were conducted. The method of data collection was in-depth semi-structured interviews with open questions as well as vignette interviews (19 interviews), observations, field notes and post-interview notes. The interviews were carried out in health centers, clinics which provided maternity services, private clinics and some participants` homes. The duration of the interviews was about 45-110 minutes.

The interviews were initiated with general questions Such as: “How did you feel when you found out you are pregnant?” “Please tell me about your experience of pregnancy?”

Then based on the answers and information given by the participants, the researcher gradually got help from probing questions to explore the spouse's confrontation With pregnancy from pregnant mother's point of view. Also an attempt was made to explore the cultural beliefs and behaviors surrounding this issue, using questions such as "how did your husband react to your pregnancy", "How did he feel when he got aware of your pregnancy?", “To what extent does he understands you? "," How do you feel about his encounters and feelings? "," How has your spouse's behavior possibly changed after your pregnancy compared to the pre-pregnancy phase? "," When you talk about your spouse's behavior with you during pregnancy, what comes to your mind or what's your experience like? ". If necessary, some probing questions such as "Can you explain more on this" or "What do you mean?" were used to explore further the participants' experiences. At the end of the interview, the participants were asked to express any opinion that they had not already discussed.

Similarly, the researcher used vignettes. For this purpose, she showed a number of photographs, which were the result of a widespread and relevant search of men's behavior in confrontation with pregnancy and fatherhood in global as well as Iranian cultural context. Then the researcher asked the participants, in the event of a personal experience similar to those photos, to place themselves as the characters in the photo, try to recall their own similar experiences, and explain their feelings towards the photos and discuss their thoughts with the researcher. In addition to the interviews, the researcher used field notes, based on her field observations of the behaviors and actions of mothers related to the topic of study. The researcher did the observation as "Observer as participant" and it was done for more than half of the participants.

Additionally, in order to gain a deeper understanding of the phenomenon studied and, upon receiving permission from the participants, the researcher would be present in their homes to collect related data and notes through observation and interviews.,. Then these notes were read out and the findings were reviewed. After interviewing each participant, the interviews were recorded, rewritten and coded as soon as possible. The interviews continued until data saturation (new data were not received from the participants).

In order to analyze the data, the "six-step van Meenen" interpretive phenomenological approach was used. This approach involves: 1. Orientation to the nature of lived experience. 2. Exploring the experience as we live it and not how we conceptualize it. 3. Reflecting about the main themes that reveal the characteristics of the phenomenon. 4. Art of writing and rewriting 5. Maintaining a strong and direction relation with the phenomenon; 6. Matching the field of research with the continuous consideration of components and the whole .[43]

The first stage, the development of a phenomenological question, clarification of the assumptions and pre understanding of the researcher has been sought. Second stage considered carefully and sensitized data collection. In order to obtain the true meaning of the phenomenon and discover the main theme, thematic analysis using three holistic, selective and detailed approaches has been used. It should be noted that step back and considering the contribution between parts and total has been continuously carried out in order to make the content more realistic. In order to differentiate between incidental and essential themes, the main concepts of the phenomenon were discarded from unnecessary meanings.[30] MAXQDA software 10 was used to analyze the data. It should be noted that during the whole period of the study, the researcher's involvement with the research question (one of the necessities of the phenomenology), and the continued consideration of the research question helped with extracting the study findings .[43] The necessary ethical considerations, including written consent of the participants, the purpose of the use of tape recorders and also ethical permissions from the Ethics Committee of Mashhad University of Medical Sciences were done in this study.

To validate the data, four Lincoln and Cuba criteria including credibility, dependability, authenticity and transferability were utilized. In order to achieve these goals, choosing from the precision of participants with different characteristics and long interaction with them, the use of different methods for data collection, returning interviews with coding to the participants and asking their opinions on confirming or changing the data, utilizing the guidance and supervision of the professors of qualitative research and, finally, providing the possibility of reviewing the research stages by others by clarifying the stages of the study were utilized .[44] The study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Code: 940519).

Results

25 pregnant women participated in this study, with an average age of 30.36 (6.55) years. The level of their education varied from illiterate up to the doctorate (Table 1).

Table 1

Demographic of participants in the study

Pregnancy week	Gravidity	Education	Age€
34	2	Bachelor	34
25	2	Associate Degree	33
22	1	Associate Degree	22
37	1	Bachelor	30
36	1	Bachelor	30
24	2	PhD Student	33
19	4	9 elementary	37
17	3	Illiterate	40
26	1	Bachelor Student	28
8	1	Associate Degree	36
36	1	PhD	32
12	1	Master's degree	32
16	1	6 elementary	15
32	4	Diploma	30
12	1	Bachelor	25
19	1	Bachelor Student	20
28	3	Bachelor	36
34	4	Associate Degree	38
39	3	PhD	38
40	3	Bachelor	36
32	1	Bachelor	24
13	2	PhD	34
22	1	Bachelor	26
8	1	Bachelor	19
19	2	Diploma	31

€Year

Data analysis led to the development of the main theme of "adaptation, practice and self-actualization of men confronting pregnancy." This was derived from the two themes and eight sub-themes (Table 2).

Table 2

Sub-themes, theme and main themes of this study

Main theme	Theme	Subtheme
Adaptation, skillfulness and self-actualization of men confronting pregnancy	spouse's emotional engagement	spouse emotional confrontation with pregnancy occurrence men's sentimentality following being an expectant father; husband`s confrontation with wife's motherhood; men's emotional excitement seeing the symptoms of fetal survival Husband's gender orientation;
	Concentration, vigilance and active efforts of spouse during pregnancy	managing wife towards successful pregnancy; effort to acquire paternal skills; pregnancy as an issue to expand spouse's mental horizons

Adaptation, skillfulness and self-actualization of men confronting pregnancy

In the face of pregnancy, men get experiences of emotional and mental encounters and were actively involved in this process. They attempted to reach self-actualization.

After confrontation and acceptance of pregnancy, they used coping strategies and adaptation to pregnancy and their concentration and concern for pregnancy were more than ever. Afterwards, they tried to successfully manage pregnancy and their horizons were extended compared to pre-pregnancy. This main theme consisted of subthemes which are described below:

Spouse's emotional engagement

To encounter pregnancy, men experienced dual and sometimes contradictory emotions. Pregnancy, in addition to conceiving of pleasures and emotions and even disbelief, led to a flurry of paternal feelings and a tremendous tribute to the confirmation of masculinity.

"My husband was very happy, but he did not believe it."P24

"My husband was very happy, because his sense of manhood was strengthened."P4

The women also stated that their husbands, after being informed of pregnancy, experienced a sense of confusion and fear of staying alone. They worried about changing their relationships with their wives after childbirth, and they were constantly pointing this out to women.

"My husband told me that ‘if the child comes, you are will be paying more attention to the child than me. He was stressed out."P2

"He has the concern that, for example, the child may affect our relationship."P10

The women acknowledged that their exclusive attention and concentration in pregnancy was on the fetus, but some men were happy about it, highlighted the maternal role and encouraged women to carry on doing that.

"My husband says that women are selfish to eat .... They are all because they want to preserve the child."P9

"My husband says that ‘I feel so comfortable, seeing that the maternal feelings are more important to you than other things such as your job… I feel more comfortable now.’"P14

The women stated that their husbands cheered up when confronted with the fetus and in particular with the symptoms of fetal life and pregnancy. It seemed that the intuition of pregnancy symptoms was the leverage of understanding pregnancy and even becoming a father for men.

"My husband came home...he was looking at the images and describing the child. He listened to the fetus’s heart at the doctor's office… he would not believe it at all."P14

"We were to the ultrasound lab and could see the fetus’s body. I saw his feeling of joy."P21

"When my husband saw the baby, he realized that it was really a creature."P7

In this study, some women stated that their husbands were happy about finding the sex of the fetus. Some other women stated that their husbands, despite the unwanted sex of the child, were happy, thanked god and supported the women.

The women in pregnancy were confronted with the marital traditions of their husbands, which were based on their beliefs about masculinity. The women stated that their husbands looked at them as an absolute guardian of the child, and for looking after household, children, and calming down the family. Other men looked at their wives from only two perspectives of bringing up the child and sexuality. For some men women's fertility was of great importance, and only expected women as a reproductive wheel.

"They know the duties of women to handle childcare andrespond to the men’s sexual needs."P11

"The man is executing you as a wheel of reproduction."P15

"That is, the duty of women at home is child's upbringing and creating calmness at home."P3

In this study, the women stated their husbands suppose that pregnancy and childbearing were factors influencing women's` attachment to life, and therefore they deliberately became pregnant.

"My husband once was joking and laughing. He said that ‘I have to do something that you stay with me for life’, and then I got pregnant."P17

Concentration, vigilance and active efforts of spouse during pregnancy

The women believed that pregnancy would make men

more responsible, and increased their responsibility and management abilities in various parts of life, including economic affairs, social role, and communication with relatives, maternal medical affairs, and fetus health. Women’s pregnancy induced managerial motivation, sense of responsibility, and increased husband's attention to life issues.

Men adjusted their work hours outside home and were more likely to be present beside the women and even reduced their workloads.

"He used to come too late from work, but now he has arranged to come early in the evening."P22

"For example, he limits his time at work to stay more at home."P21

In this study, men accompanied the women in medical and prenatal care even when they received the result of a pregnancy test. They tried to stay with the mother. Most men also insisted on attending women’s ultrasound sessions. The overall experiences of most women indicated the increased attendance in the women’s medical and maternity care and taking more responsibility for maintaining the health of fetus.

"Whenever we go to the doctor’s office, my husband asks, ‘what did the doctor say? Is there any problem? ‘He follows up on all medical examinations"P6

"When we went to the doctor’s office, he was not allowed to get in. He said, ‘I liked to see the fetus"P23

The women acknowledged that their husbands were very dissatisfied with the femininity of the therapeutic environment. Since they wished to be present in the medical care, and this presence implied better adaptation by them and the reduction of their stress in pregnancy, and ensuring that there would be no problems in the pregnancy process.

"My husband was very upset and was constantly saying how bad it was that he could not see the fetus."P18

"For example, when he heard the sound of the fetus’ heart once or twice or, read the report of ultrasound, his stress was considerably reduced.”P9

Husbands seek the cooperation of their family for doing household and confronting the traditional family demands. In general, they double their efforts and increase their responsibilities in the family to promote the goals of life and family.

My husband told her mother that he would be sad that he could not help with the home affairs. He asked his mother to help me. P5

"My father-in-law expected me to do all home affairs, but my husband told him that I had low back pain, and did things myself."P12

"After pregnancy, my husband quickly made such a great life for me that everyone was surprised."P16

In relation to the paternal role and the acquisition of necessary skills, men sought to obtain information about pregnancy. The spouses insisted on the relationship with the fetus, and especially they wanted to prove their paternal role. Pregnant women stated that their spouses along with developing such a relationship tried to empower themselves in the upbringing of the child.

"He searches through the internet to find about what I can eat. He has not much information, but he is trying to get some."P4

"He tells me when the fetus is moving, let me know."P21

"When he felt the fetus’ movements, he called her mother and said: ‘my child is moving."P24

"Soon after that, when my belly swelled up, I think that he was more emotional."P7

In general, women believed that pregnancy changed men's viewpoint towards life. They commented that pregnancy is a factor in changing the concerns of men and increase their intellectual maturity in life. Women stated that after pregnancy they experienced intellectual evolution in their husbands, which was more obvious in the second pregnancy.

"Particularly my husband’s perspective toward life changed."P19

"He feels so much better than the first pregnancy, because they do not have experience in the first pregnancy, he feels much better."P3

"Since I got pregnant, my husband has changed a lot even in the management of life affairs ...."P5

Discussion

This study aimed to explore the pregnant women's experiences of their husbands’ confrontation with pregnancy. The main theme of this study was "adaptation, practice and self-actualization of man confronting pregnancy." This was derived from ‘emotional confrontation of the spouse and “Concentration, vigilance and active efforts of the spouse during pregnancy”.

In this study, a range of excitements, including passion and disappointment, as well as the emotions of proving masculinity in men was presented by pregnant women regarding their husbands’ confrontation with pregnancy. In a study in the USA, women pointed out that their husbands were thinking about how a new child might affect their future life and prospects, such as the economic situation of life. However, they were very happy and had a positive sense about pregnancy.[45] In the study conducted by Redshaw and Henderson, over 80 percent of men felt happy confronting the pregnancy. In this study, which examined the experiences of women about their husbands, factors Such as birth rate, age, and ethnicity influenced women’s experiences.[20] In another study, men experienced severe disturbances when confronted with pregnancy.[37]

In the present study, the spouses expressed concerns about remaining alone and not receiving women’s attention as before pregnancy. These results were consistent with the fact that the concentration of the pregnant woman on the fetus, reduced their attention to their husbands and other family members, and occasionally caused the spouse's indignation .[46] Mengeli et al., also stated that all dimensions of marital satisfaction were influenced by pregnancy.[47]

Men in this study became more tangible with changes in the fetus, and in particular by understanding and observing the signs of life and the physical development of the fetus. Walsh et al., stated that the feelings of fetal movements and enlargement of the abdomen were objective evidence of the presence of the child.[37] The observation of the fetus by ultrasound helps exacerbate the attachment between men and the fetus,[48] which was consistent with the results of this study.

In this study, beliefs derived from the spouses` gender role also played an active role in the women's experience of men's confrontation to pregnancy. Sometimes the women in this study described their own importance only because of fertility and parenting. Although motherhood is a social construct whose meaning has changed over time, in many modern societies, the concept of motherhood equates the concept of gender division, which is considered the primary responsibility of women as nurturing the child.[49] It was also stated that women were not considered mothers until they met the needs of parenting and child bearing [45], which was in line with the findings of the present study.

Concentration, vigilance and active efforts of the spouse during pregnancy in this study, the women believed that pregnancy made men more responsible. So that pregnancy provoked the power of management and the commitment of men to the health of the fetus and mother. In a study by Kaye et al., men considered the responsibility of pregnancy a commitment, and stated that a man should accompany his wife and get involved in pregnancy. They also accepted "partnership" during pregnancy as "the mother’s partner", and this was considered a male commitment [50] in another study it was noted, an ideal man should be responsible and mentally mature. He must have the responsibility to take care of the child and have the necessary maturity to fulfill the needs and requirements of his role.[23]

As part of the effort to manage pregnancy, almost all men accompanied women during medical and prenatal care, and exclusion from these processes was an obstacle to completing and understanding fatherhood. The women and men believed that men should not be set aside from care affairs during pregnancy. The analysis of some other studies also showed that many men were interested in increasing participation in women and children health,

And were involved in some positive behaviors.[51,52] Simbar et al., also indicated that men's participation in prenatal care was essential from men and women’s perspectives.[6] Mortazavi and Mirzaii found that most women talked about the desire and curiosity of their husbands to attend midwifery care,[40] which was consistent with the findings of this study.

In this study, in line with the other studies,[6,40] the high tendency and men's insisting on their participation and the low possibility of their participation was discovered.

Mortazavi and Keramat reported that more than half of the women did not receive any health guidance or they were advised by their husbands at minimum level and about 25% of them experienced low level of their husband`s participation in prenatal care.[34]

Based on the research in this regard, socio cultural stereotypes in some families still prevent men from involvement in women’s care during pregnancy.[7] In one study men stated that social issues have more impact on the men's participation in prenatal care than economic problems.[6]

In the present study, pregnant women commented that men are interested in establishing relationships with the fetus. They also believed that establishing communication and engaging in childhood affairs are the features of fatherhood, which contributed to the acceptance of pregnancy and reduction of paternal stress. According to the women, men also try to empower themselves for upbringing the child. In another study, women stated that their husbands thought that they were involved in the pregnancy experience and they spoke to the fetus every night[45] Ekelin et al., stated that men immediately begin to think of them as their own child soon after seeing the image of the fetus.[48] Mortazavi and Mirzaii showed that men's participation is accompanied by a reduction in their worries.[40] Guendelman et al., also found that the level of male participation in pregnancy is related to the acceptance of pregnancy by men,[45] which was consistent with the results of this study.

Overall, the women in this study believed that pregnancy changed men's viewpoint even toward life.

They argued that after the pregnancy, they deeply understood the intellectual development of their husbands, which was a blessing in pregnancy, and was highlighted in the second pregnancy. Mortazavi and Mirzaii reported that by increasing the age of men, they gain more experience and better understanding over time, which is evident, particularly, in the second pregnancy. Most women believe that their partner's participation in the second pregnancy has increased, compared to the first pregnancy.[40]

The change in our society and the diminution of patriarchal thoughts also help to broaden the view point of men.[40]

In another study, participants presented the characteristics of an ideal man in pregnancy in terms of accessibility, engagement in pregnancy and fetal care, the desire to increase their learning about pregnancy, being responsible (providing care and protecting) and Maintaining a good relationship with the pregnant woman.[23] These traits in the behavior and performance of men were also confirmed by the women who took part in this study.

These results were in the same direction to the involvement of men with children’s affairs, in particular according to the Lamb's theory. This theory consisted of three concepts: engagement, involvement, access and responsibility, which are interconnected, and determine the level of male involvement in child care.[53] According to the findings of this study and in line with the study of Alio et al., this theory can be extended to pregnancy, because the roles of parents start from fertilization and are continued after childbirth.[23] According to this theory, availability means the physical presence and availability of men in this study and their efforts to be alongside with women are in the same direction. The involvement of a father in pregnancy means the active participation of the spouse, a finding which the women’s statements confirm, the responsibility of men, as another component of this theory, is exactly in line with the findings of the current study, which refers to "pregnancy means getting spouses responsible. “The findings of this study were in line with the above-mentioned theory and the findings of Alio et al.

Another new finding of the present study was the development of mental horizons of men in pregnancy, which could be added to previous knowledge. All these components were related to self-actualization during pregnancy indicating that pregnancy and transition to fatherhood were an important evolutionary stage for men.[37]

One of the important strengths of this study was that this was the first study of pregnant women's experiences on men’s encounter to pregnancy. In this study the experiences of pregnant women were explored from a cultural perspective. In other words, an attempt was made to describe this experience in the context of gender issues.

One of the limitations of the present study was the lack of interviews with men, which is recommended to be conducted in the future studies.

Conclusion

The findings of this study showed that men have overwhelming perceptions, feelings and emotions due to confrontation with pregnancy and its consequences, including becoming a father. While some aspects of pregnancy were unfavorable for some men, they adapted to their expectations of a positive and successful pregnancy and supported their wives. The women also acknowledged that their husbands in this study were committed to good and supportive management for successful pregnancy and, in addition, they also sought to acquire paternal skills. It seems that pregnancy as a golden opportunity develops thinking, vision and horizons of life among men and increases their sense of responsibility. In other words, pregnancy can be considered as an opportunity toward men's self-actualization.

This opportunity can be used to highlight the interaction and participation of men in the society, where their presence is very valuable and can even save the life of women and children. Obviously, removing barriers to the emergence of this condition through adequate education or focus on the socio cultural matter can highlight the role of men. As negligence to these issues leads to plans contrary to the defined gender roles and the cultural norms of society. Obviously, with the positive and effective presence of men and their active involvement in pregnancy, it can be considered as one of the most important factors in promoting mothers and children’s health and provision of appropriate services to pregnant women through employing “spouses` support approach.

Acknowledgments

This study is part of the PhD thesis of the first author in Reproductive Health. The support provided by the university is appreciated. We also offer our gratitude and thanks to all participants in the study who expressed their experiences.

Ethical issues

None to be declared.

Conflict of interest

The authors declare no conflict of interest in this study