A project in Vietnam to engage fathers in “team parenting” with the mother around the birth of the baby and to bond with their baby has led to enhanced language, motor and personal/social skills in 9-month-old infants. Both mothers and fathers reported fathers’ greater emotional attachment to and affection towards the infant and this was linked to the enhanced development of language ability in the infant.

Without intending to, and without containing any baby boy/girl gender material, the programmed removed a preference by fathers for boys that was seen in a control group.

The project built on an earlier intervention with a similar design (Bich et al., 2014; Bich et al., 2015). The earlier intervention, which was specifically focused on encouraging fathers to support their partner’s exclusive breastfeeding, doubled the rate of breastfeeding in the first hour from 40% in a control group to 81%. It also doubled the rate of exclusive breastfeeding at four months, from 11% to 21%. The current project focused on father involvement both by supporting breastfeeding and through direct interaction with their infants.

The project is, in the opinion of the Family Initiative, the most sophisticated and systematic of any fatherhood programme yet seen in the Global South. The programme is designed on the basis of a thorough analysis of global research. It delivers substantial results in two domains in one go – health and child development – by tapping into the resource of the father-child bond. We believe there is enormous potential for improving health and child development throughout the Global South by adopting an approach that encourages fathers to parent their children together with mothers as a team.

Project objectives

The project took place in Hai Duong Province in Vietnam. The intervention group was in one district and the control group in another district with a similar socio-economic profile. A total of 390 couples were recruited through 13 health centres in the intervention district and 412 couples were recruited though 12 health centres in the control district.

The programme had four objectives:

• Develop knowledge and attitudes of individual fathers. Fathers were informed about what infants of different ages can do and given suggestions about how to engage with them in responsive caregiving and play.

• Promote “team parenting” between mother and father. The concept of team parenting is the foundation of the programme – fathers need to be part of a team with mothers to care for their infants jointly. Team parenting involves being sensitive to and aware of the needs of the other parent, regular communication, coordination of tasks, knowing when to contribute and when to let the other parent get on with things unaided. Such collaboration creates a more positive environment for the child’s early development.

• Support the father-infant bond, so creating a foundation for sensitive caregiving. The project was developed on the premise that fathers have a strong innate capacity to bond affectionately with their infants, if given the opportunity. The programme systematically communicated the message that fathers need quality time to get to know their babies. Fathers need to provide warmth and sensitive care, be responsive to their baby’s needs and provide gentle control and correction. Touch is important, as is talking to and playing with the baby.

• Foster social support for father involvement, through Fathers Clubs and publicity.

Project activities

The programme consisted of ten activities.

1. Two-day training for one or two health workers from each health center.

A manual was developed, covering in particular the key principles of the parenting teamwork approach and the importance of the father-infant relationship.

2. A personal invitation to expectant fathers from the health worker to a prenatal group session, 2 months before the baby due date.

Discussion focused on fathers hopes and dreams about fatherhood and about their baby, the concept of team parenting and the particular role that this teamwork can play in supporting breastfeeding.

3. Follow-up home visits by the health workers, to reinforce the connection and the messages made at the group.

4. Opportunity to interact with the baby immediately after the birth.

Midwives were trained to help fathers physically touch their babies and to help fathers elicit facial mimicking from the baby. The fathers were encouraged to change a diaper.

5. Father-infant relationship calendar, given immediately after the birth.

A large five-page wall hanging showing how to interact with a baby at different ages – month 1, 2-3 months, 4-6 months, 7-9 months and 10-12 months. The calendar had place for fathers to add their own notes and images and it communicated the key principles of father involvement.

6. Home visits by the health workers at 7 days, 6 weeks and 15 weeks after the birth.

The discussion focused on what the fathers could do to interact well with their infants in the coming weeks.

Fathers were asked to rate the extent to which the health worker gave them useful information about being an involved father.

7. Posters in health centres about the value of father involvement.

8. A 10-minute message about the value of father-infant interaction for broadcast on outdoor loudspeakers in each commune.

The main aim of this activity was to buffer the fathers from fear of ridicule, allowing them to engage actively with more confidence.

9. A monthly Fathers Club in each commune, running for six months.

A peer father leader was chosen by participants and given one day of training in club leadership.

10. A competition between the Fathers Clubs.

At these light-hearted community events, fathers presented the value of father involvement and exclusive breastfeeding in creative ways and competed in a contest of knowledge, “Who loves their wives and children the most.” These events were also designed to promote wider public awareness.

Project outcomes

The project delivered a number of outcomes that were picked up in measurements.

1. Fathers’ knowledge about father-infant relationships grew more in the intervention group than in the control group, measured at 4 and 9 months.

Father-infant relationship knowledge was measured at baseline prenatally, then at 1, 4 and 9 months post-birth.

The measure was three open-ended questions: (1) what should a father do to have a good quality relationship with his baby? (2) why does a baby cry? (3) why is it good for babies to have an involved father?

Responses were coded and scored by the research team.

2. Fathers’ attitudes towards the father-infant relationship improved in the intervention group between the start and 4 months. In the control group, attitudes remain unchanged.

A 9-item list of statements was developed and fathers asked to rate from 1 (“strongly agree”) to 5 (“strongly disagree”). Statements included “Fathers need to be part of a team with mothers to jointly care for their babies,” “It is important for fathers to pay attention to what their baby needs and respond in a way that is best for the baby,” and “It is fun to play with my baby.”

3. The level of father-infant interactions by nine months was no different between the intervention and control groups, according to both mothers and fathers. The fathers in the intervention group, however, were more active earlier – more play and affection at 1 month, and more play and caretaking at 4 months.

A 23-item questionnaire was used, developed in a different context in Canada and adapted to the local context. The questions cover aspects of play, caretaking and affection. Both mothers and fathers completed the questionnaire.

4. Fathers in the intervention group were more emotionally attached to their infants at 1, 4 and 9 months. In the control group, fathers were more attached to their boys than their girls. This favouritism was absent in the intervention group.

An existing 19-item questionnaire was self-completed by fathers.

5. Infants in the intervention group had significantly higher scores on child development measures of motor, personal-social and, particularly, language abilities.

The developmental status of the baby was measured at 9 months, using the Developmental Milestones Checklist II (DMC II), translated and adapted to the Vietnam context. DMC II includes three subscales – motor, language and personal-social. Data collectors all had to have eight in-class training hours and 16 hours of supervised in-group practice.

6. A link emerged between fathers showing stronger attachment to and affection for the infant and the infant’s language development at 9 months.

This was visible in the fathers’ reports of their own attachment/affection, and even more strongly in the mothers’ report of the same. The researchers suggest that perhaps more attached and affectionate fathers use language more with their infants.

7. Infants of fathers involved in the Fathers Clubs scored more highly on the person-social development scale.

The causality could be working both ways. For example, fathers closer to their babies may be more likely to attend Fathers Clubs. But in the baseline studies, the fathers in the intervention group at baseline were actually more negative on average than those in the control group.

Rempel LA, Rempel JK, Khuc TN & Vui LT (2017), Influence of father-infant relationship on infant development: a father-involvement intervention in Vietnam, Developmental Psychology, 53(10)

This study was supported by a grant from the Grand Challenges Canada Saving Brains Program (0345-03). Additional team members at Hanoi School of Public Health include co- project lead, Dr. Tran Huu Bich, and collaborator Dr. Dinh Thi Phuong Hoa.

Bich TH, Hoa DTP & Målqvist M (2014), Fathers as supporters for improved exclusive breastfeeding in Viet Nam, Journal of Maternal Child Health 18

Bich TH, Hoa DTP, Ha NT, Vui LT, Nghia DT & Målqvist M (2015), Fathers’ involvement and its effect on early breastfeeding practices in Viet Nam, Maternal & Child Nutrition 12

Photos: from the project, provided by the research team