Duncan Fisher

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.

Fatherhood birth, breastfeeding, Fatherhood