Duncan Fisher

I was busy writing my second blog on shared parenting when the debate about maternity and paternity leave took off.  Here is what I said to the journalists and policy people who have phoned me in the last two days.

The two changes - transferability of maternity leave to fathers and extension of paid maternity leave from 9 to 12 months - were firm commitments five years ago when nine months of paid maternity leave were put in place for mothers and two weeks for fathers.  The actual news is that one of the commitments has been dropped and the other has been kicked forward to be dealt with by the next Government.  The desk has been cleared.

Good, I am pleased.

The extension of leave for mothers, without an extension of leave for fathers, immediately precedes the increase in the pay gap starting in 2007, after years of progress towards equality.  This was predicted beforehand and I believe the connection is causal.  The currrent leave system has legitimised the idea that men have an entitlement to unblemished work and career prospects when they become a father and has legitimised the idea that the sole responsibility for nurturing children rests with the mother.  This is one of the biggest differences in paid leave entitlements between women and men in the world.  So I am happy that further extension of paid maternity leave has been stopped.  I do not think that stopping this extension will reverse the damage to women from this legislation, but at least we have stopped digging deeper.  We can start introducing more leave for mothers only when we have adequate leave for fathers; then, quite apart from the benefits that accrue from fathers being more active in caring for children, women will avoid the penalties of being the only parent expected to take time off work.

As for transferability, I am, frankly, rather bored by the debate.  It is a debate about empty gestures.  Government knows the system is not going to work anyway; it published its analysis of why not in 2004 (see paragraph 28).  Only 4-8% of families where the mother is eligible for maternity leave, are predicted to use transferability.  Partners of women who are not eligible for maternity leave will have no entitlement, whatever their employment status.

It is obvious why it won’t work.  What mother and father, after six months, want complete role reversal?  Very, very few.  But if the leave were flexible, then you would see something very different.  Take one conservative possibility of the millions that flexibility would make possible - perhaps mum on 2 days/week of work with 3 days maternity leave, and dad on 4 days/week of work and 1 day of leave.    In that arrangement, baby is only out of parental care 1 day a week, and the smallest amount of work flexibility could remove even that.  We need the leave system to be amenable to the boxing and coxing that is the stuff of life for parents of babies.

And why the transferability?  This is a nightmare to administer - someone has to track what both parents are doing.  Just let each parent have a period of leave, and then each can negotiate individually with their employer.

Then there is the problem of pay.  The leave is not well enough paid to be affordable by many families.  The unpaid component of the maternity leave is purely hypothetical - there is already three months of unpaid parental leave for each parent, but hardly anyone knows it exists because it is not affordable and not worth knowing about.  In the example above, the family might even decide that one day off a week for the father is not affordable, given all the other penalties he is likely to face by declaring to his employer that he is prepared to compromise work for something else.  I would rather see, for a specified sum of public money, less leave and more pay.

I also question the six month rule - that any mother wishing to return to work, even part-time, before the child is six months, is not allowed to use her leave to let her partner take care of the baby.  Human beings are distinct in the degree to which the care of infants is shared with kin; six months alone at home all day is a pretty tough call for mothers, going against how we humans are hard-wired to share this work.  Breastfeeding is often used to justify six months, but going back to work for short periods does not stop breastfeeding, and a father who has been well prepared to support breastfeeding can be the best person to look after the baby while the mother is at work.  I am not presenting this as the way to do things; I am just asking how it helps mothers to withhold this choice? (And, of course, there is the problem that most fathers are not well prepared to support breastfeeding, even though, in terms of bang for buck, this would be the cheapest way to increase the UK’s amazingly low breastfeeding rates.)

The shelving of changes to the leave system till the new Government means there is the opportunity for a real re-think.  If we introduce the currently proposed changes in 2011, it will take about five years to ascertain they do not work, then three years to introduce a change.  So by 2020, we will be starting to introduce a workable system.  Let’s save ourselves a decade and start the incremental process of building a rational system, starting with a sound foundation, based on what real families really need.

Fatherhood breastfeeding, gender equality, paternity leave, work

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