Factors influencing husbands’ participation in antenatal care: A study in Maluku, Indonesia

Background: Husbands’ involvement in supporting standardised antenatal care (ANC) is essential for improving maternal and neonatal outcomes in geographically remote and socio-culturally complex settings. In Maluku, Indonesia, such involvement is shaped by limited-service access and entrenched cultural, religious and family power structures; yet their combined influence across pregnancy remains underexplored. Aim: This study examined how service access, cultural and religious norms, family dynamics and knowledge influence husbands’ involvement in supporting standardised ANC in Maluku province, Indonesia. Setting: The study was conducted in six remote primary health centres in Maluku province, Indonesia. Methods: A sequential explanatory mixed-methods design was applied. Quantitative data were analysed using chi-square tests and multivariable logistic regression, while qualitative data from interviews and focus group discussions were thematically analysed. Data were collected from January 2024 to June 2024. Results: Only 27% of husbands actively supported standardised ANC. Supportive roles (adjusted odds ration [AOR] = 25.2; p = 0.039), positive family dynamics (AOR = 2.7; p = 0.005) and higher ANC knowledge (AOR = 10.7; p = 0.024) were independently associated with involvement. Qualitative findings showed predominantly passive participation shaped by culturally sanctioned authority, religious legitimacy and community influence. Conclusion: Husbands’ limited involvement reflects gaps in knowledge, as well as the influence of family decision-making structures and socio-cultural norms. Integrating local wisdom (Bakele) into a culturally grounded, trimester-based antenatal counselling model may enhance participation. Contribution: This study informs culturally adapted ANC interventions in remote and socio-culturally complex settings.