International organisations need to agree standards for engaging fathers and families in maternal and newborn healthcare

Babies, men

The World Health Organisation declared twice in 2015 that engaging with fathers is a priority in maternal and newborn health.

There is a wealth of evidence that engaging with fathers and families benefits the health and wellbeing of mothers, infants and the family as a whole. This evidence is diverse:

  • Evaluations of pilot projects – engaging fathers and families improves health outcomes, sometimes dramatically. We have been tracking these since 2015 on
  • Human biology and neurobiology – the connections between fathers and infants made in the first 1000 days are much more significant for children than we had imagined via the changes that take place in both father and child as a result. (See Fatherhood.Global.)
  • Family influences on child development – a large volume of research from four decades challenges the individualistic approach to family support, where only one individual receives the service. This is summed up well in a recent paper on maternal depression by one of the world’s leading family child neurobiology researchers, Ruth Feldman:

“Throughout human history and across cultural communities, family, which is the interface of familiarity and affiliation, has defined the most solid cultural institution that enhances survival, transmits values, facilitates adaptation, and supports children’s cognitive and social–emotional development through participation in multiple daily relationships with parents and siblings and observation of the relations between close others. Extant research has shown that a cohesive, warm, and harmonious family process, which is characterized by cooperation among members, individual autonomy, and low intrusiveness and rigidity, predicts a host of positive child outcomes, including social competence, lower externalizing and internalizing symptoms, reduced physiological stress, and positive emotional expression and emotion regulation.”

But the WHO statements are hardly known and never and nowhere has all the accumulated knowledge and insight been assembled and communicated; the majority of the research is entirely unknown to policy makers and practitioners in maternal and newborn health. All over the world, local programmes are testing new approaches to engage with fathers, mothers-in-law and other family members, re-inventing the wheel continually and reaching sub-optimal arrangements through lack of knowledge and lack of standards and guidance.

Now that WHO has declared engaging fathers as a priority, it is time to set a clear global agenda with a set of standards for how maternal, infant and child health services should engage with fathers and families. We need to be able to measure performance: what is not measured does not get done.

The standards should cover five areas:

  • What knowledge and skills should health workers and service managers have?
  • What information should all mothers and fathers be told?
  • How should health settings and appointments be organised?
  • What should be the key performance indicators defined in health policy?
  • In what ways should fathers and families be engaged (fathers’ groups, couple meetings, community meetings, etc.)

These standards can be developed within the framework of the WHO Standards for Improving Quality of Maternal and Newborn Care in Health Facilities.

There will need to be some diversity of approaches for different community settings, but in those cases, some examples of what works in different places would be a great help to all those planning service quality improvements.

These standards need to be developed by international organisations concerned with implementation of maternal and newborn health programmes, taking the leadership baton from the World Health Organisation. Standards need to be developed, piloted and proved with local communities in diverse settings in different parts of the world. The existing experience and understanding from all over the world needs to be connected and pooled for the first time.

In the wake of such standards, practical tools can be developed to help local, regional, national and international programmes build a more evidence-based approach and so achieve the better health outcomes promised by the published research.