Involving fathers in maternal and child health: are we there yet?

Sir,

There is a growing body of research which highlights the pivotal role of fathers in women’s health and child development. The WHO report on fatherhood and health outcomes in Europe notes that increased involvement of fathers during pregnancy and delivery leads to better outcomes for women, babies and men [1]. Studies have shown that when men provide psychological support to women during pregnancy and childbirth women report lower reported pain during labor and delivery. Furthermore, women who are supported by men during are less likely to give birth to babies with low birth weight.

The paper by Surkan et al. [2] provides further support for the promotion of father’s involvement and the association with birth outcomes. In a study to explore the effect of paternal, familial and friend support during pregnancy on preterm (PTB) and small for gestational age (SGA) they used data from the Boston Birth Cohort (n = 7047). Absence of paternal involvement was associated with a 21% increased risk of PTB with lack of paternal support showing a borderline relationship with PTB. In addition, lack of paternal involvement and support were shown to be marginally associated with higher odds of women having an SGA baby. Whilst providing a note of caution in that the associations were mainly found in low income African Americans, the authors note future research is needed to confirm these findings and explore issues such as the quality and timing of paternal support.

Traditionally, research on perinatal mental health (PMH) has focussed on the wellbeing of mothers as opposed to fathers. Past research in PMH is dominated by research into maternal postnatal depression. However, there is now a growing body of research which is addressing the mental health needs of men during pregnancy, birth and the postnatal period. The paper by Ayinde and Lasebikan [3] extends this work to Africa in providing an interesting study assessing the prevalence of depression in Nigerian fathers in the postnatal period. Men were assessed at baseline and 6 weeks postnatal using a structured clinical interview to obtain DSM diagnoses whilst controlling for other demographic variables and levels of social support. In the total sample (n = 331), 29 fathers (8.8%) were found to have postnatal depression. It should be noted that the prevalence of depression in mothers at 6 weeks was higher than the incidence of depression in fathers. However, the findings revealed that for a subgroup of men who were unemployed the prevalence of depression at baseline was significantly higher than men with employment. Whilst the subgroup numbers were low, and this research requires confirmation, the study provides support for the provision of perinatal mental health services to include men, especially those in low income groups.

Taken together these two papers make a good case for why fathers should be encouraged to be involved with their partners during perinatal period and why men’s health needs are also important. Many maternity services are still focused on the needs of women and babies, and may not be considered to be “father friendly”. The growing body of research on the positive effects of fathers’ involvement shows that although we are not there yet, we are on the way to a better understanding of the need to prioritize research in this area.