Berti, P., et al., An adequacy evaluation of a maternal health intervention in rural Honduras: the impact of engagement of men and empowerment of women. Rev Panam Salud Publica, 2015, 37(2): p.90-97 



To determine the impact that a 6-year maternal and child health project in rural
Honduras had on maternal health services and outcomes, and to test the effect of level of father
involvement on maternal health.


This was a program evaluation conducted through representative household
surveys administered at baseline in 2007 and endline in 2011 using 30 cluster samples
randomly-selected from the 229 participating communities. Within each cluster, 10 households
having at least one mother-child pair were randomly selected to complete a questionnaire, for
a total of about 300 respondents answering close to 100 questions each. Changes in key
outcome variables from baseline to endline were tested using logistic regression, controlling
for mother’s education and father’s involvement.


There were improvements in most maternal health indicators, including an
increase in women attending prenatal checkups (84% to 92%, P = 0.05) and institutional
births (44% to 63%, P = 0.002). However, the involvement of the fathers decreased as reflected
by the percentage of fathers accompanying mothers to prenatal checkups (48% to 41%,
P = 0.01); the fathers’ reported interest in prenatal care (74% to 52%, P = 0.0001); and fathers
attending the birth (66% to 54%, P = 0.05). There was an interaction between the fathers’
scores and the maternal outcomes, with a larger increase in institutional births among mothers
with the least-involved fathers.


Rather than the father’s involvement being key, changes in the mothers may
have led to increased institutional births. The project may have empowered women through
early identification of pregnancy and stronger social connections encouraged by home visits
and pregnancy clubs. This would have enabled even the women with unsupportive


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