In the last month, the Daily Mail has run five particularly good pieces on modern fatherhood - well informed, sympathetic, challenging of stereotypes. Taken together, they represent a remarkable portrait of fatherhood today. I take my hat off to the Daily Mail!
Kate Hilpern (Teenage fathers: ‘I love my child as much as any older dad’) ran a long series of case studies on young fathers, the most positive thing ever run in the media on the subject. She opens: “Young dads are often maligned by society. But, as these four prove, many turn their lives around, face up to grown-up responsibilities and swap socialising for night feeds. And they wouldn’t have it any other way.”
The old ideas remain - the genetic incompetence of fathers to do a good job of parenting. But when Emily Andrews (The fatherhood taboo: Men finally break their silence on the ‘potential misery’ of becoming a dad) reported the comment by an American author, Steve Doocy, based on a sample of one (himself), “New mums are better at parenting than new dads…they are programmed to mother”, it resulted in a chorus of dissent - 176 comments in just two days. I blogged about this discussion thread two weeks ago, regarding it as the most interesting and well-informed on-line discussion on fatherhood I have ever seen.
I believe the uncomplicated and positive tone of these articles heralds a new step forward - we are now able to talk about fatherhood like we talk about motherhood.
"Time to stop work, Dad". Taken as part of the DCSF's Think Fathers Campaign at RAF Halton last week.
I hand this week’s blog to Barack Obama, the greatest ever orator on fatherhood.
He gives a message we can all identify with…..
It is rarely easy. There are plenty of days of struggle and heartache when, despite our best efforts, we fail to live up to our responsibilities. I know I have been an imperfect father. I know I have made mistakes. I have lost count of all the times, over the years, when the demands of work have taken me from the duties of fatherhood. There were many days out on the campaign trail when I felt like my family was a million miles away, and I knew I was missing moments of my daughters’ lives that I’d never get back. It is a loss I will never fully accept.
The Daily Mail, along with various other national papers, reported last week on a new genre of confessional literature - by new fathers experiencing negative feelings after their baby was born: The fatherhood taboo.
One of the authors of the three books, is quoted as saying, “New mums are better at parenting than new dads, but there’s a reason why: they are programmed to mother.”
This resulted in an outpouring of comments in the following days, most characterised by generosity and common sense - 176 comments in total. It is the best discussion on fatherhood on-line that I have ever seen. Participation was 50/50 men and women. About one quarter of respondents agreed with the statement and the rest disagreed - vehemently.
A father's place is in the home - at least some of the time?
So, it’s official. The extension of paternity leave has been ditched. The official reason is the recession, but the decision to delay an increase in paternity leave until after the next general election had been taken well before any recession was in sight.
There are two key points about the current situation that no commentators have pointed out.
First, dumping the change to paternity leave is not going to make much difference to families and children because the system was not going to work anyway. Read more…
Tradition: the sacred mother-baby bond. Joseph is there in the dark, top right if you look very carefully!
Last week was Mind’s Mental Health Week and it focussed on men. And this week I am speaking at the Primary Care 2009 conference on postnatal depression and fathers. (I am told my audience will be about 1000 people!) Here is my full presentation, which is summarised below (references at end of blog).
Eight studies on PND and fathers have been published since 2008 and in June the Daily Telegraph and the BBC highlighted the issue: Father’s baby blues blight children.
Studies suggest about 10% of fathers suffer from postnatal depression (PND), a third of those severely. This is about twice the average rate for men in the age group. Correlates of PND in fathers include a history of severe depression, anxiety and depression antenatally, problems with the baby and - highly significantly - depression in the mother and a poor relationship with the mother.
Maternal depression is similarly correlated with a poor relationship with the father and depression in the mother. In short, it would appear that parents are interdependent. As one researcher put it, depression is “contagious”.
Depressed fathers interact less with their children and there is a significant correlation between PND in fathers and psychiatric disorders in children at 3.5 and 7 years. Severe depression in fathers correlates with an 8-36x greater likelihood of a child having behaviour and peer problems.
Maternal depression has similar impacts on children, but interdependence reveals itself again: the negative impacts of maternal depression on a child are substantially worse if the father is depressed also. It would appear that fathers in better mental health buffer the influence of mothers’ poor health.
This interdependence is found also in research on breastfeeding and smoking. Together the evidence suggests that the father has a highly significant impact on maternal and child health.
Family health services are largely still based on the traditional belief that all that matters is the unique mother-child bond, with the father hovering indeterminately around the edge - as depicted in countless European representations of the Nativity, like the 15th century painting by Geertgen that I have included above. Practice based on this model believes that the health and well-being of mother and baby can be achieved simply by engaging with the mother. The evidence, however, presents a different picture - a system of influences where every individual and every relationship around a child impacts profoundly on every other individual and relationship. Only a systemic approach can deliver the desired health outcomes.
So the reason why maternity services need to engage with fathers is because this is necessary to support the health and well-being of mothers and babies - in other words, it is core business. PND in fathers is not just the latest diverting curiosity of media discussion: it requires a change in health services.
Small trials of interventions with fathers have worked well. One antenatal session for first-time parents together on mental health issues correlated with less distress in mothers six weeks after the birth. A randomised control trial in Canada showed less depression in mothers where the fathers participated in four out of seven visits. Interestingly in this study, paternal depression was greater for the fathers who were not included. This evidence is reflected in rather more substantial trials of breastfeeding and smoking interventions. In short, engaging with fathers works, and just by including fathers in existing services - it does not cost more.
NICE Clinical Guidance, Antenatal and postnatal mental health: clinical management and service guidance (2007) specifies that health professionals should “assess and, where appropriate address, the needs of the partners, family members and carers of a woman with a mental disorder during pregnancy and the postnatal period.”
The evidence suggests also that where mothers are depressed, it is important to support mental health in the father and positive father-child interaction. This requires a proactive and tactful approach, given the tendency for mothers lacking confidence to exclude fathers and the tendency for fathers in this situation to hang back.
References
Areias ME, Kumar R, Barros H, Figueiredo E, Correlates of postnatal depression in mothers and fathers, Br J Psychiatry, 1996 Jul;169(1):36-41
Broom BL, Impact of marital quality and psychological well-being on parental sensitivity, Nursing Research, 1994;43:138-143
Buist A, Morse CA & Durkin S, Men’s adjustment to fatherhood: implications for obstetric health care, Journal of Obstetrics, Gynaecology & Neonatal Nursing, 2003;32:172-80
Cowan CP, Cowan PA, Heming G & Miller N, Becoming a family: marriage, parenting and child development. In Cowan PA & Hetherington EM (eds), Family Transitions: Advances in Family Research. 1991. Hillsdale, NJ: Lawrence Erlbaum
Dave S, Sherr L, Senior R, Nazareth I, Associations between paternal depression and behaviour problems in children of 4-6 years, Eur Child Adolesc Psychiatry, 2008 Aug;17(5):306-15
Dudley M, Roy K, Kelk N & Bernard D, Psychological correlates of depression in fathers and mothers in the first postnatal year, Journal of Reproductive and Infant Psychology, 2001;19(3):187-202
Dudley M, Roy KFisher JRW, Cabral de Mello M, Patel V & Rahman A, Maternal depression and newborn health. Newsletter for the Partnership of Maternal, Newborn & Child Health, 2006;2. Geneva. (Available at http://www.pmnch.org)
Gao LL, Chan SW, Mao Q, Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period, Res Nurs Health, 2009 Feb;32(1):50-8
Goodman JH, Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health, J Adv Nurs, 2004 Jan;45(1):26-35
Grube M, Pre- and postpartal psychiatric disorders and support from male partners. A first qualitative approximation. Nervenarzt, 2004;75(5):483-488, Kelk N & Bernard D, Psychological correlates of depression in fathers and mothers in the first postnatal year, Journal of Reproductive and Infant Psychology, 2001;19(3):187-202
Huang CC & Warner LA, Relationship characteristics & depression among fathers with newborns, Social Service Review, 2005; 79:95-118
Kahn RS, Brandt D, Whitaker RC, Combined effet of mothers’ and fathers’ mental health symptoms on children’s behavioural and emotional well-being, Arch Pediatr Adolesc Med, 2004 Aug;158(8):721-9
Kaplan PS, Dungan JK & Zinser MC, Infants of chronically depressed mothers learn in response to male, but not female, infant- directed speech, Developmental Psychology, 2004;40:140-148
Lewis C, Becoming a Father. 1986. Milton Keynes: Open University Press
Lupton D & Barclay L, Constructing Fatherhood: discourses and experiences. 1997. London: Sage Publications
Madsen SA, Fathers and postnatal depression: research results from the Project: Men’s Psychological Transition to Fatherhood: Mood Disorders in Men Becoming Fathers. Copenhagen: Rigshospitalet. Obtained from: svaam@rh.dk
Matthey S, Barnett B, Ungerer J, Waters B, Paternal and maternal depressed mood during the transition to parenthood, J Affect Disord, 2000 Nov;60(2):75-85
Matthey S, Kavanagh DJ, Howie P, Barnett B & Charles M, Prevention of postnatal distress or depression: an evaluation of an intervention at preparation for parenthood classes, Journal of Affective Disorders, 2004;79(1-3):113-26
Misri S, Kostaras X, Fox D & Kostaras D, The impact of partner support in the treatment of postpartum depression, Canadian Journal of Psychiatry, 2000;45(6):554-8
Morse CA, Buist A, Durkin S, First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers, J Psychosom Obstet Gynaecol, 2000 Jun;21(2):109-20
Paulson JF, Dauber S, Leiferman JA, Individual and combined effects of postpartum depression in mothers and fathers on parenting behaviour, Pediatrics, 2006 Aug;118(2):659-68
Perren A, von Wyl A, Burgin D, Simoni H, von Klitzing K, Depressive symptoms and psychosocial stress across the transition to parenthood: associations with parental psychopathology and child difficulty, J Psychosom Obstet Gynaecol, 2005 Sep;26(3):173-83
Ramchandani PG, O’Connor TG, Evans J, Heron J, Murray L, Stein A, The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression in offspring, J Child Psychol Psychiatry, 2008 Oct;49(10):1069-78
Ramchandani PG, Stein A, Evans J, O’Connor TG, ALSPAC study team, Paternal depression in the postnatal period and child development: a prospective population study, Lancet, 2005 Jen 25-Jul 1;365(9478):2201-5
Ramchandani PG, Stein A, O’Connor TG, Heron J, Murray L, Evans J, Depression in men in the postnatal period and later child psychopathology: a population cohort study, J Am Acad Child Adolesc Psychiatry, 2008 Apr;47(4):390-8
Roggman LA, Boyce LK, Cook GA & Cook J, Getting dads involved: predictors of father involvement in early head start and with their children, Infant Mental Health Journal, 2002;23(1-2): 62-78
It is time to for mothers and fathers to unite to rebel against the workaholic culture that is crushing family life, making life a misery for mothers and fathers.
John Gray writes of our work culture: “Nothing is more alien to the present age than idleness. If we think of resting from our labours, it is only in order to return to them. In thinking so highly of work we are aberrant. Few other cultures have ever done so. For nearly all of history and all prehistory, work was an indignity. For the ancients, unending labour was the mark of a slave.” (Gray’s Anatomy 2009)
Rachel Cusk in her dark, witty and disturbing novel about the 21st century motherhood, Arlington Park, writes: “When she got them [house and a husband and children] the feeling of lead started to build up in her veins, a little more each day….the time Benedict returned to work a week after Barnaby’s birth and she realised she would be looking after him alone; the countless times a domestic task had fallen to her, so that she became experienced and preferred to do it because it was easier than asking Benedict - it was all surprising to her, outrageous almost. With her sense of justice she expected that at some point the outrage would be detected and addressed, but of course it was not.”
Rachel Cusk rails against the way that modern motherhood sucks away the identity of women. Of Juliet, one of the mothers in her novel, she writes, “She had forgotten she was a woman. She had forgotten she was a creature, a thing of the flesh…. Was that what Juliet would be, one day? Empty, all poured out into Katherine, into Benedict and Barnaby? Dead, yet living?” Meanwhile Solly “couldn’t locate a continuous sense of herself. It seemed to lie all around here in pieces, like the casings of Dora’s Russian doll when all the babies were out.” And Christine declares dramatically to her fellow mothers over coffee: “We’re all such good wives and mothers, and there we are feeding our families these healthy meals and taking our children to piano lessons and making our houses all perfect, and sometimes you just want to have some fun, don’t you? Sometimes I think, God, I could just bring all this down. I could just bring it all down around me.”
Rachel Cusk contrasts this with the husbands of the mothers. Martin, Juliet’s partner “didn’t seem to have changed at all over the years. He had only weathered a little, like a monument.” But Martin was no slouch. “In the evening, when Martin returned, Solly immediately went and lay down on the sofa in the sitting room. She stayed there until she had heard the children be fed, bathed and taken away upstairs. She felt that if she had to spend even one more minute with them she would explode. She heard Martin bellowing on the top landing, and the sounds of multitudinous footsteps running this way and that. Really, Martin was wonderful. He was what you called a hands-on father.” But then comes the real truth….”The trouble was he was never there.”
Cusk points the finger at work and at business: “I hate the way men like that think they’re important. They expect you to defer to them, just because they run a business! What’s so important about a business? It’s just selling things for your own personal profit. It’s just greed, dressed up as usefulness.”
But it’s not just business. Health services, social care services and charities are all busily making the most out of the same culture of unending labour.
These feelings are backed up by research findings. At a conference in April in USA, hosted by the Council for Contemporary Families, researchers presented the latest evidence. Families in which parents have more egalitarian roles do not on average experience a decrease in satisfaction with their relationship, unlike families where the woman slips into more housework than she did before and the man does most of the breadwinning. The tables have turned - nowadays, parents who do not share roles are more likely to split up.
The bad news is that the gender equality movement in the UK is heading in the wrong direction. Defeated by the difficulty of changing the long-hours working culture of men, it has persuaded itself that progress can be achieved by trying to make working life easier for mothers only - more leave entitlements for mothers (but not for fathers), and more regulation of business to be fairer to women, at the same time as handing businesses economic incentives to do the opposite. And so, with the best of intentions, we encourage more of the same - mothers at home more and fathers working more.
The Equality and Human Rights Commission puts it thus: “New parental rights introduced over the past decade are well intentioned but entrench the unequal division of labour and caring between the sexes and work against gender equality.” Current Government policy “conveys the message that it is primarily women who are responsible for the care of young children”.
Rachel Cusk again: “Was this what they mean when they talked about sexual inequality? Was this it, the front, the hump, the line of battle? She’d never seen her father so much as boil an egg, but then her mother had never mowed the lawn or mended the kitchen cupboards either. It had never seemed worth the bother to Christine, trying to sort it out when it was all so much of a muchness; but now she wondered whether that wasn’t exactly what kept you in your place, this acceptance of things, so that you were forever going round and round in a circle and never getting anywhere. If you accepted things, where were you meant to go when it got unacceptable? Who were you meant to tell? There had to be room for change - there had to be room for a contingency! Like her father: even when Viv was ill with pneumonia, she had to get up to make his tea. That was no way to live, was it?”
It is time to rebel, mothers and fathers alike. At home we must engage in daily battle against all the economic incentives that promote non-sharing of roles - we must fight the pressures, not each other. In public we, mothers and fathers alike, must stand together to support the liberation of each other and challenge the laws and policies that force us apart.
Above all, we must challenge the slavery of unending labour. The prize is to see our children grow up. John Gray proposes contemplation as the opposite of ceaseless activity. “Contemplation is not the willed stillness of the mystics but a willing surrender to never-returning moments.” And was there ever such a never-returning moment than the millions of tiny steps of a child growing up?
Just occasionally, something really new and significant emerges and I think the new website www.mumdad.info, is such a thing. Harps and Randip Chhokar have set up a new antenatal class service that is specifically for both mothers and fathers, called MumDad Antenatal. The classes are facilitated by both Harps and Randip, parents of Anand (2) and Amrit (1).
Randip writes: “When Harps came up with the idea of providing an antenatal course which specifically caters for Mums and Dads I was thrilled to be involved. We live in an era where both mothers and fathers take equal responsibility for family matters and practical postnatal assistance by dads is vital for a happy family life. I help to prepare dads for some of the practical issues that they will face.”
In 2001, John Lewis-Stempel produced Fatherhood: an anthology. I love this book and would like to indulge occasionally in sharing some of my favourite passages.
“As she grew and changed, I was increasingly wondering what this new girl could be, with her ecstatic adorations and rages. The beaming knife-keen awakening, cracking the dawn like an egg, her furies at the small frets of living, the long fat slumbers, almost continental in their reaches, the bedtimes of chuckles, private jokes and languors.
“And what was I to her? The rough dark shadow of pummelling games and shouts, the cosy frightener, the tossing and swinging arms, lifting the body to the highest point of hysteria before lowering it back again to the safe male smell.
“But she was my girl now, the second force in my life, and with her puffed, knowing eyes, forever moving with colour and light, she was well aware of it.”
This is the only image of breastfeeding with a father present that I could find on Google.
The evidence is strong: engaging with fathers in the promotion of breastfeeding increases breastfeeding rates significantly - and in some trials, spectacularly. The UK won’t get off the bottom of the European league table of breastfeeding rates until we accept the enormous influence that fathers have over breastfeeding and the positive difference it makes when fathers are engaged by health professionals.
I write this blog inspired by two new articles on fathers and breastfeeding, published in the last few weeks.
The Academy of Breastfeeding Medicine, La Leche League International, the International Lactation Consultant Association and the World Alliance for Breastfeeding Action published a statement for the March meeting of the UN Commission on the Status of Women, called Breastfeeding and the equal sharing of responsibilities between women and men. It maintains that “it makes good sense to share of the responsibility [with men] of assuring that women can succeed at breastfeeding. It calls on “community leaders everywhere to promote an attitude of support for mothers and fathers in the crucial task of raising the next generation”.
Meanwhile an article, Fathers’ perspectives on breastfeeding: ideas for intervention by Nigel Sherriff, Valerie Hall and Martina Pickin (British Journal of Midwifery, 17.4, April 2009) looks at how fathers experience breastfeeding support in Brighton and concludes that a key requisite for the engagement of fathers is specific information and practical advice.
We have a problem in UK. In 2005, 78% of mothers initiated breastfeeding and 50% were still breastfeeding at six weeks. This is the worst rate in Europe. In Norway the equivalent figures are 98% and 95%.
We know that fathers have enormous influence on a mother’s breastfeeding; what they think and do makes a big difference to what the mother does. We know that the father’s support makes a particularly significant difference in low income families - where breastfeeding rates are lowest. (See summary of Fatherhood Institute - The Costs and Benefits of Active Fatherhood, page 23.)
More particularly, controlled trials reviewed in Costs and Benefits have shown that engagement with fathers makes an astonishing difference to breastfeeding rates. Involving fathers in a single two-hour antenatal breastfeeding session increased the rate of initiation from 41% to 74% [1]. In another trial a 40-minute session for fathers about how to help manage common breastfeeding problems increased breastfeeding rates at six months from 15% to 25% [2]. A workplace programme in US - 45 minute group class, a book and handouts, a men-only antenatal session - increased breastfeeding rates at 6 months from 21% to 69% [3].
This evidence is corroborated by similar findings in smoking cessation, mental health promotion and birth preparation - all of which yield better results when fathers are engaged. This evidence is also summarised in Costs and Benefits.
The Government’s Child Health Promotion Programme last year did call for routine engagement with fathers in breastfeeding (page 26), but this reference was dropped in this year’s Child Health Strategy, which states only that information about breastfeeding should be given to mothers (section 3.43) and makes no reference to fathers in relation to breastfeeding. The Child Health Strategy refers to UNICEF’s Baby Friendly Initiative, but this tool is also father-free, with no reference at all to fathers in all of the standards of good practice that it puts forward. These approaches do not stack up against the evidence nor are they in line with the Government’s own policy of “mother focussed, family centre maternity care”..
The Brighton study by Sherriff et al. provides a useful insight about how local services fail to engage routinely with men. Antenatal classes sometimes omit breastfeeding and sometimes organise sessions when fathers cannot make them. Even if breastfeeding is covered, the influence of the father and the practical support he can provide are not addressed. Health visitors’ concerns about the baby’s weight, combined with the lack of information, can push fathers towards bottle feeding as the only response the parents can think of.
Here are some suggestions for revising the breastfeeding strategy.
1. Engagement with fathers in breastfeeding promotion should be routine and the norm. Mother-only support should be specialised provision for the minority of mothers whose partners are genuinely absent or are unsupportive even after effetive engagement approaches have been tried. New family centred methods should be piloted, evaluated and promoted. Good practice already exists locally and some NCT antenatal teachers have been engaging fully with fathers on breastfeeding for years.
2. The way in with the father is his profound instinct to protect and care for his baby. The father needs to know how big an influence he is and how, by his practical actions, he can keep his baby healthy. He needs to know what these practical actions are.
3. In all materials about breastfeeding, the active involvement of fathers in breastfeeding should be shown - discussing it with the mother, being actively present when breastfeeding is happening, being knowledgeable about how to overcome problems, discussing matters with the health visitor. The father’s role is more than to do the washing up when the mother is breastfeeding. This presentation of the father’s role is entirely different to how he is commonly presented in breastfeeding promotion. In one key video now being promoted, an evidently very involved father disappears the moment the health visitor arrives and there is no interaction between her and the father for the duration of her visit. There needs to be an audit of current materials.
4. When developing new materials, they need also to be tested on couples, not, as is currently the practice, just on mothers.
5. Breastfeeding promotion needs to avoid suggesting that feeding is the only way to bond with a baby - this creates an incentive for fathers to start bottle feeding. Breastfeeding should be shown in the context of other activities that a father can undertake to support his baby’s development and become important to their child - gaze, massage, etc. There is a rich source of material in the modern study of adult-child bonding and attachment that busts the myth that babies can or should only bond with one adult.
Notes
1. Wolfberg, A.J., Michels, K.B., Shields, W., O’Campo, P., Bronner, Y., & Bienstock, J. (2004). Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. American Journal of Obstetrics and
Gynaecology, 191(3), 708-712.
2. Piscane, A., Continisio, G. I., Aldinucci, M., ‘Amora, S., & Continisio, P. (2005). A controlled trial of the father’s role in breastfeeding promotion. Pediatrics,
116(4), 494-498.
3. Cohen, R., Lange, L., & Slusser, W. (2002). A description of a male-focused breastfeeding promotion corporate lactation program. Journal of Human Lactation, 18(1), 61-65.
In the last month, the Daily Mail has run five particularly good pieces on modern fatherhood - well informed, sympathetic, challenging of stereotypes. Taken together, they represent a remarkable portrait of fatherhood today. I take my hat off to the Daily Mail!
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