A study in Rwanda carried out by two Swedish nursing undergraduates, Eleonor Bergström and Olivia Söderström Högling at Sophiahemmet University, looked at the involvement of nurses in encouraging father involvement in child nutrition. They interviewed 8 nurses in 3 community health centres in the Huye District of Rwanda.

They conclude that more needs to be done to support nurses to engage effectively with fathers and family members in maternal, newborn and child healthcare.

Though the sample size is small, the two authors made observations that are valuable to the whole field of family inclusive maternal, newborn and child healthcare.

They took as their theoretical starting point a Swedish definition of family centred nursing care. This describes the family as a complex and changing system of mutual influences and dependencies, affecting every member of the family for better or worse. Nurses should work as equals with family members and should seek as much as possible to mobilise positive family resources for health.

In the interviews the Rwandan nurses were united in their opinion that engaging fathers is important.

“Both parents should take care of children equally. The child is not only the mother’s responsibility but also the father’s.” 

“If you only tell the mother what to do, she cannot take care of the whole family; they have to care for the family together. You have to tell them together if you want them to understand, otherwise the message can be wrongly translated to the other partner. It also has a better impact if it is a nurse who tells them [the fathers], not only the mother.” 

The authors noticed, however, that the nurses, in talking about childcare, themselves only referred to mothers. The authors comment that “the nurses sometimes had a slightly more traditional view on the division of family responsibilities than they wanted to portray…..It is essential that the nurses…..become aware of how/if their personal beliefs affect their practice.”

The Rwandan nurses reported that they offer group counselling, couples counselling and counselling for mothers only. Prenatal counselling includes advice on breastfeeding and advice on the importance of prioritising spending and family discussion. In Rwanda, participation of fathers in the first prenatal session is mandatory. The nurses said that they encourage fathers to be more engaged, welcome them at the centre and give them extra attention.

“We say that they are good fathers and encourage them to come more often.”

But the authors observed, when visiting the centres, that few fathers were in evidence and that there is a possibility the nurses were perhaps responding in a way they felt expected to and may not be reflecting reality.

Most of the nurses considered the fathers’ low level of practical nutritional knowledge as the biggest barrier. According to the nurses, many fathers see their main contribution as providing money. Though things have been changing, there is still a risk in rural areas that fathers actively involved in caring for babies can be considered bewitched or poisoned by their wives.

The nurses had few suggestions about what more they could do to increase participation by fathers. They tended to point to the need for others to be active – community health workers and peer educators – and the need for public education projects.

The authors discuss why this might be so, given the pivotal influence that nurses have and the potential for their active role in encouraging fathers to be more active. The authors question whether the nurses are given the mandate, tools and resources for leading change.

The authors also noted that only one nurse they interviewed commented on the role that mothers might play in sustaining traditional gender roles. They quote an earlier study by The Rwanda Men’s Resource Center described in a Catholic Relief Services report that, while 44% of fathers considered changing diapers, bathing and feeding kids was the responsibility of mothers, 78% of mothers held the same belief. The authors conclude that challenging gender boundaries will require engaging men and women together.

The study highlights the need for training for nurses, covering issues such as reflection on how one’s own gender beliefs influence professional practice, practical steps that can be taken to engage fathers and the need to engage with both mothers and fathers as a partnership in sharing caring responsibilities more.

Bergström E & Söderström Högling O (2017), Fathers’ engagement in childcare to prevent stunted growth in children: a qualitative study at the primary healthcare level in Rwanda, Student Thesis at Sophiahemmet University

Photo: US Army Africa. Creative Commons.