Fatherhood and men's participation across diverse antenatal care systems in rural Eastern Zimbabwe: A qualitative study.

Men's participation in antenatal care (ANC) is widely seen as essential for improving access, uptake, and pregnancy outcomes in sub-Saharan Africa (SSA), the region with the world's highest maternal and child mortality rates. However, current studies often approach participation narrowly through involvement in biomedical ANC, overlooking local fatherhood experiences and men's relational and culturally grounded roles beyond clinical settings. Drawing on Afro-communitarianism and social capital frameworks, we conducted a qualitative study in Mafararikwa, rural Eastern Zimbabwe to explore the forms and meanings of men's participation in ANC and the relational and communal factors influencing such participation. Collaborating with 101 participants including health professionals, caregivers, and community key informants, we generated data using in-depth interviews, consultative sessions, focus group discussions, and storyboarding. We thematically analyzed the data in QDA Miner Lite using a thematic networks approach, identifying two main themes and nine sub-themes highlighting men's dynamic roles during pregnancy and ANC-leadership, decision-making, provision, protection, domestic support, emotional support, love, and care-embedded in relational and communal structures. The themes also revealed that men coordinated with spouses, relatives, community members, and diverse ANC providers to support ANC across indigenous and biomedical settings, demonstrating collective responsibility. Men's ANC participation in Mafararikwa highlights local fatherhood experiences, Afro-communitarian values of identity and solidarity, and social capital mechanisms of resource mobilization, reciprocity, and trust. Interventions should recognize men's diverse roles, leverage relational networks, and integrate culturally rooted approaches to ANC. Further research should apply Afrocentric frameworks, foregrounding local fatherhood experiences, Afro-communitarian values, and social support networks.