Unhappy Father's Day: the dad-shaped hole in UK postnatal services
NHS maternity, health visiting and other family services are failing babies by ignoring their fathers during the first postnatal year, according to our latest evidence review, Bringing Baby Home, published for Father’s Day 2022.
The review, funded by the Nuffield Foundation, delves into a systematically collected body of almost 800 pieces of research exploring fathers and fatherhood in the first year – including many studies based on the UK’s three large-scale birth cohort studies, which track children’s outcomes over decades.
Even without the additional challenges of the Covid-19 lockdowns (during which fathers were routinely excluded from most elements of maternity services – for more on this see our earlier survey report, Dads Shut Out, available on our resources page) – and taking into account ongoing concerns over staffing (the RCM and Institute of Health Visiting report shortages of 2,000 midwives and 5,000 HVs respectively) – Bringing Baby Home paints a picture of NHS systems not set up to engage with, assess and support new fathers.
This is despite clear evidence, set out in the report (and summarised below), of how fathers’ physical and mental health impacts on babies’ future health and wellbeing, and despite studies suggesting the perinatal period can be a ‘golden moment’ for encouraging better health behaviours among fathers.
The 'dad-shaped hole'
Data gathering is a key problem: health records for babies in the UK only allow the inclusion of one adult (the mother), so any record relating to the father is held separately – if it is held at all – and family records cannot be seen in a joined up and connected way.
For this and other reasons, fathers have no status as patients or clients of maternity and other perinatal services; and are, as a result, treated as visitors rather than central members of a new family. Health topics not routinely discussed with fathers include smoking, alcohol/drug use, and obesity – all associated with negative child outcomes.
Fathers receive little or no support to develop their caregiving skills, help them understand child development or inform them how to keep their babies safe; nor are they screened for stress, anxiety, depression or other important psychological factors. This is despite the fact that, while almost all fathers (95%) take care of their crying infant regularly, 14% sometimes fear their stress levels are so high that it may harm their baby.
Fathers also have significant impacts on key maternal outcomes, including initiation and continuation of breastfeeding, and post-natal depression – which also impact on babies. But services do not provide information to help fathers in their support role, even though there is evidence that this can be highly effective – and 80% of new mothers say their infant’s father is their main source of support.
Finding a way forward
We suggest four key recommendations for how policy and services could be improved:
Fathers’ names, contact details and NHS numbers should be entered onto NHS birth notifications so that fathers can be contacted directly by services. As is the case for mothers, the father’s NHS number would link to his medical record for use by practitioners and for research purposes, within a framework of data protection law and ethical guidelines.
All tax-funded services and interventions for families in the perinatal period – including those commissioned by central government (e.g. the Reducing Parental Conflict programme and Family Hubs) should be commissioned, designed, delivered, promoted and evaluated in ways that recognise fathers’ own need for support (whether or not they share a household with the child’s mother) and their impact on children and mothers. Practitioners should use evidence-based strategies to achieve high levels of father-inclusion, and should follow – and where relevant be inspected against – key guidance. To support change, the Fatherhood Institute is working with the Royal College of Midwives to produce a father-engagement toolkit, to be published in October 2022: within this we will map good practice and highlight promising strategies.
The government should fund, pilot and evaluate a scalable, locality-wide approach to embedding father-inclusive practice across a whole network of perinatal services in a number of local areas.
Given the unavailability of parental leave to the vast majority of UK fathers, and the huge significance of fathers’ participation in solo parental care in baby’s first year for later care patterns, the government should pilot new approaches to leave taking, focused on different groups of working fathers, including those who are employed, self-employed and working in the ‘gig economy’. Ways in which employers do or could support fathers should be included in the pilot.
How fathers' health impacts on children's: a summary
Bringing Baby Home identifies many ways in which, according to empirical evidence, fathers’ health and wellbeing impacts on their children’s. These include:
Children of obese fathers are almost three times as likely to be obese than children whose father is not overweight (National Statistics, 2017).
Almost one new father in five is a smoker (Harrison et al., 2020) and mainly smokes in the home (Blackburn et al., 2005). Infants of fathers who smoke are more likely to develop wheeze, asthma, lower respiratory illness, chronic middle ear disease, stunted growth and to fall victim to sudden infant death syndrome (SIDS) (Burke et al., 2012; CDC&P, 2006; Washington, 2017)
International research finds that i) fathers’ alcoholism is linked with negative father-infant interactions, including lower infant responsiveness (Eiden & Leonard, 1999); and ii) fathers’ heavy alcohol use doubles the risk of an insecure mother-infant attachment (Eiden & Leonard, 1996). The effects of fathers’ alcohol/drug use on mothers or infants in the first postnatal year have not been studied in the UK.
Mental health & wellbeing
Postnatal stress in UK fathers, which may relate to stressors including work and financial pressures, sleep deprivation, lack of time to spend with their infant, wider family concerns and housing or food instability (Philpott et al., 2017) is understudied. For example, studies have not tracked men’s stress before and after having a first baby – even though 14% of fathers worry often that their stress level may have a negative impact on their baby (Scourfield et al., 2016).
Depressed fathers (fewer than 5% of UK fathers in Year One, but with higher percentages in certain groups) are more likely to behave negatively towards their infant, and fathers’ early depression is associated with: poorer infant development (Wanless et al., 2008); more problematic behaviour in their pre-schoolers (Butler, 2012; Ramchandani et al., 2005); greater risk of children’s psychiatric disorder at primary school (Opondo et al., 2017; Opondo et al., 2016); and lower educational achievement at secondary school (Psychogiou et al., 2019).
High anxiety in Year 1 – again, more common in disadvantaged fathers (Ben-Shlomo et al., 2016). – has been found to predate recurrent abdominal pain in children later (Ramchandani et al., 2006), and is associated with worryingly rapid weight gain in infants (Griffiths et al., 2007). ‘Mental distress’ in fathers reported at infant age nine months is also associated with steeper increases in fat/ body mass index in girls and boys aged 5-14 (Tommerup & Lacey, 2021).
High conflict between parents exacerbates the negative impact of mother’s depression on children (Hanington et al., 2012) and 23% of first-time fathers report increased conflict in the year after the birth (Easter & Newburn, 2014).
Download the reports
For more detail, read Bringing Baby Home - the fifth in our Contemporary Fathers in the UK series of evidence reviews, funded by the Nuffield Foundation. You can download all reports in the series via the research page on our website. You can access related resources (including factsheets drawing on the report, and the Engaging Dads toolkit mentioned above) via the resources section on our website.