What: Project to make antenatal services more father-friendly
Agencies: St Michael’s Fellowship/ University of Bristol/ Fathers Direct
When: Research funded from 2003-05 by DH/DfES
Where: Tulse Hill, south London

Most projects aimed at improving engagement with fathers focus on men whose children have already been born. But an action research project initiated by St Michael’s Fellowship, a Sure Start partner in Tulse Hill, Fathers Direct and the University of Bristol, has helped demonstrate that antenatal services offer a golden opportunity to kick-start communication with dads – if only professionals can start thinking strategically about involving them.

The study, completed in 2005, focused on 23 young black fathers’ experiences of antenatal services in mainstream ultrasound and at teenage parents’ clinics run by King’s College Hospital in south London. It was part of a bigger project set up by Tulse Hill Sure Start to improve engagement with black dads.

Richmond Trew, a father worker employed at St Michael’s Fellowship and himself a black father, conducted the fieldwork; he contacted, established a rapport and talked with young dads in both settings, and supplemented this evidence with input from a few older dads who had used similar services in the past. Fathers Direct project manager Kathy Jones supervised the research, with Sue Pollock, social work lecturer at the University of Bristol, acting as research consultant.

The project showed that, contrary to popular belief, the young black dads accessing services were ‘a settled group in generally stable relationships who, despite the fact the pregnancy was unexpected, were committed to involvement in fatherhood and the future care of their child’. But many of them were teenagers, unemployed or in low-paid jobs, and often living apart from their prospective child’s mother (see box 1 below) – the latter being a significant risk factor for disengagement from active fatherhood.

A feeling of being marginal

In many ways these young dads were positively predisposed towards their impending role as fathers (see box 2 below) but their experiences of antenatal care, together with a high level of involvement from the mother’s family and friends, ‘tended to reinforce a feeling of being marginal to the pregnancy’.

The young men spoke of staff ignoring or adopting negative attitudes towards them; and of the mother’s family or friends taking over at clinic appointments and the labour. Only two mentioned health professionals having ‘brought them into’ the process, although interestingly both of these described this as having had a powerful effect.

The clinics’ antenatal classes were poorly promoted to fathers; it was often not made clear that fathers and younger parents (including fathers) were welcome at the clinic; and little or no attention was paid to the father friendliness or otherwise of the courses’ content and delivery.

Most men – even those whose partners were nearing the end of their pregnancy – said no-one had spoken to them about labour or what to expect, and those who had received such information felt it was too general, rather than relating to their own situation. Only one man spoke of having received specific advice from a midwife, and this had been because his girlfriend wanted a water birth.

The lack of an embedded father-focused strategy was amply illustrated by the fact that although the research had been given the go-ahead by senior managers, reception staff often appeared to be unaware of the six month long study, and were suspicious about Mr Trew’s presence in the clinic, despite an official letter confirming his identity and role. Posters and leaflets advertising the study were removed from the walls and reception desk, and the room allocated for interviews was withdrawn without notice; leaving him feeling as unwanted and superfluous as the fathers he was there to study.

To what extent institutional racism played a part in this negative attitude is unclear, but it is certainly a factor for service providers to think about. Although none of the men mentioned their ethnicity as a barrier to services, the team stressed that being young, male, poor and black may in fact have acted as a ‘quadruple indemnity’, with even relatively small signs of exclusion serving to amplify a feeling of ‘always being put to the back of the queue’.

Overall, the team found that the central focus of services on the young mother ‘did little to reinforce and support men’s emerging identity as fathers’ and highlighted ‘a need to challenge some of the established ways of thinking and working with this marginalised group…in order to promote the development of inclusive services’.

Ways of improving engagement

So how might other Sure Start groups and maternity services work towards better engagement with young black dads? The research team suggested a number of fruitful approaches:

1. Recognise that making dads feel welcome in antenatal settings might be your best chance of helping them on the road towards active, involved fatherhood
2. Think systematically – father friendliness must pervade the system, including everyone from cleaners to consultants
3. Young black men may have such low expectations because of previous experiences with educational or employment systems, that they may not expect to be involved, and may not know what they need to know
4. Reception staff and other ‘gatekeepers’ to services can undermine inclusion if not properly trained in how to communicate positively with both parents
5. Employing a father can help, in terms of making contact with dads, helping run classes, and assisting in developing a strategic approach
6. Think about the clinic environment and whether it gives out the message that men should be there
7. Special materials like ‘dad bags’ full of items for the father and baby can help acknowledge their value
8. Antenatal classes with specific sessions for teenage dads might be successful if the content and presentation are well thought through.

Remember too that by only obtaining the views of dads who had attended antenatal services, this project almost certainly produced an artificially positive picture of services‘ ability to engage. Those fathers who exclude themselves from ‘the system’ before even attending antenatal classes will by definition prove harder to reach.

Supporting maternity staff to ask questions about an ‘invisible father’ when booking in a mother (perhaps asking ‘mum’s name?’, ‘dad’s name?’, ‘do both mum and dad live at the same address?’, ‘what are the addresses then?’) might be an effective way of casting a wider net.

Box 1. The men who took part
* All the men were black or mixed heritage (mainly Black Caribbean)
* Two-thirds were aged 20 or less
* Two-thirds had been in a relationship with their prospective child’s mother for more than two years
* Just over a third were living separately from their partner
* Three-fifths (61%) were out of work, and less than a quarter were working full time (mainly in low paid skilled or unskilled jobs)
* More than two-fifths (44%) had lived in the area all their lives

Box 2. Their perspectives on fatherhood
* Nearly 50% of the conceptions were described as a complete surprise, and only three were planned
* Nearly two-fifths (37%) of the prospective fathers had had previous children; most still had some contact with the children but only two were still living with them and were engaged as actively involved fathers
* Two-thirds (65%) described themselves as having a low or medium sense of reality about their impending fatherhood
* Three-quarters were expecting the baby to have a noticeable impact on their way of life
* Three-quarters were motivated to learn more about pregnancy and fatherhood, with partners, family and friends seen as the most important source of information
* Very few thought about health professionals as a potential source of support and advice, and some would have liked to have talked to one but felt awkward about it.

Contact details: St Michael’s Fellowship 0208 677 6888; Sue Pollock; Kathy Jones.

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