This study aims to improve the health and safety of mothers during pregnancy and childbirth by working closely with their husbands. In many communities in Ethiopia, husbands play an important role in decisions about where women give birth.

The study involves educating husbands in group sessions to help them understand how to support their wives during pregnancy, prepare for childbirth, recognize danger signs, and encourage giving birth in health centers where skilled care is available.

At the same time, some health workers receive training to improve their ability to handle childbirth emergencies and provide respectful, culturally sensitive care.

Communities are divided into groups that receive either husband education, health worker training, both, or no additional support. The study will see which approach helps more women deliver safely in health centers and receive care after birth.

By involving husbands and improving health worker skills, this study hopes to support mothers better and improve outcomes for families.

This study is conducted in Southern Ethiopia to improve the utilization of maternal health services, helping more women access safe childbirth and postnatal care. Many women face challenges in using health facilities for delivery, which can increase risks for mothers and babies. The study tests two key interventions that support mothers by involving both their families and health workers.

1. Husband Group Education:

   Since husbands often influence decisions about childbirth, this intervention provides group education sessions for husbands. These sessions focus on:

   Supporting their wives during pregnancy and childbirth.

   Preparing for birth and recognizing danger signs.

   Encouraging facility-based delivery where skilled care is available.

   Promoting shared decision-making and responsibility sharing between husbands and wives around pregnancy and childbirth.

   By increasing husbands' knowledge and encouraging joint responsibility, the study aims to improve the use of maternal health services by women.

2. Health Worker Training on Helping mother survive integrated RMC:

This intervention improves health workers' skills at local health facilities in Southern Ethiopia to:

Manage common childbirth emergencies.

Provide timely referrals and emergency care.

Deliver culturally sensitive and woman-centered care.

Enhance overall quality of care, making health facilities more effective and trusted.

The study uses a cluster randomized controlled trial design with four groups to compare the effects of these interventions:

Husband group education only,

Health worker training only,

Both husband education and health worker training,

No intervention (control group).

The primary goal is to identify which intervention best increases the number of women who give birth at health facilities and receive postnatal care. Secondary goals include improving husbands' knowledge and attitudes about birth preparedness, gender roles, and shared responsibilities, as well as enhancing health workers' knowledge and skills.

Overall, this study seeks to find effective ways to increase maternal health service utilization by fostering husband involvement and strengthening health system readiness, contributing to safer childbirth and healthier families in Southern Ethiopia

Inclusion Criteria:

A husband whose wife is under 27 weeks of gestation

• A husband whose wife had a previous baby within 5 years
• A husband who lives with his wife together
• A husband who has lived with his wife in the selected cluster for at least six months

Exclusion Criteria:

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Male