‘Out of mind’: why do perinatal services not engage with fathers

Fathers in Western countries nowadays tend to be more involved in their babies’ care and the evidence is that the fathers themselves, their babies and partners benefit from this involvement. In fact, there seems a consensus among researchers, supported by the everyday experience of families, that well-balanced and coordinated early experiences of infants with both mothers and fathers and with the threesome that includes themselves, are all essential for the developmental process in early childhood.

Yet fathers seem forgotten – ‘out of mind’ – within the culture and provisions of services that work with infants and their families. Rarely is the presence of fathers specifically sought at perinatal appointment with midwives, health visitors, developmental checks etc. It is not common practice to enquire after the father’s mental health or relationship with the baby.

A central contributor to the bias against fathers must surely be the dominant mother-centric theories of child development which focus on the mother-infant relationship, and in which the father’s role in infant development is subordinate to the mother’s. These ideas were rooted in historical socio-economic and cultural contexts where the father was seen to represent the ‘external world’ and the mother seen as building the emotional nest of home. As such, it was, and often remains, the quality of mothering that was linked to the emotional health of the child. This cultural-social ideology translated concretely into policy and practice over the years. For example – currently the mental health data sets can link with maternity services and thus identify mental health problems in the perinatal period among women. Such linked data sets do not exist for men.

Furthermore, systemic prejudice is reflected in organisational programme delivery so, for example, perinatal health appointments are rarely sensitive to the father’s working hours.  In addition, work pressure is already substantial. Adding the partner to a midwifery intake session, for example, taking a history, assessing his state of mind, his feelings about the pregnancy etc., would require a lot more resources of time, personnel and expertise. Such inclusivity also arouses anxiety inasmuch as the campaign to uncover domestic violence, in which the father is the suspected perpetrator, and requires time.

Psychology also plays a big role. Research shows that professionals are less likely to recognise psychological problems in fathers. This may be partly because men are more reluctant to seek psychotherapeutic help when in distress and, thus, do not press their needs on the public/service provider mind. Also, with service and practitioner attention on the mother, she may more easily gatekeep their relationship with her partner. For example, we have found at the AFNCCF that some mothers are reluctant to allow their partner to join in parent-infant psychotherapy.

However, what most seems to determine whether fathers are engaged in services is the attitude of the individual delivering the service. Is the practitioner comfortable working with men, can they hold mother, father and baby in mind?

Working with fathers and mothers can present conscious challenges for the practitioner. Is it a psychological stretch to attend to three persons – father, mother and baby – all of whom may have pressing narratives and needs.  Even experienced perinatal practitioners can feel overloaded by the totality of content and the dynamics of the family system in a meeting.  

There are also less conscious psychological factors at play, for example the practitioner’s personal experiences with her/his father and with men in general. The recommendation is that practitioners working with a perinatal population need regular reflective supervision because very basic feelings around sexuality, fecundity, rivalry are aroused. However, few services put aside the resources for this and thus, unwittingly, perpetuate barriers to engaging fathers within their workforce.

It is at all these layers of complexity – cultural, organisational and personal – that the AFNCCF is addressing the issue of keeping fathers in mind to support their active engagement with their families.  Reaching out to fathers, engaging their interest in the children and their family, adapting to the reality of work demands is part and parcel of service planning. In addition, the AFNCCF campaigns for their inclusion in service provision and publishes on the topic to influence public awareness and policy.