In the United States, approximately 28 million men aged 15-44 are fathers, nearly three-quarters (73%) of whom live with their children.[1] Over the past decades, our understanding of the roles and contributions of fathers to families has improved: we now know paternal involvement with children is strongly associated with better prenatal and postnatal maternal health, and improved developmental outcomes for children.[2] However, there has been limited research on how fatherhood impacts the health and wellbeing of the men themselves, especially around the time of the transition into fatherhood. While levels of father involvement in families have continued to increase overall since the 1960s,[3] surveillance of the behaviors and attitudes of new fathers remains to be fully operationalized.
Fathers have an important influence on the health of mothers and infants during the perinatal period. The involvement of expectant fathers during pregnancy has been associated with both increases in maternal prenatal care in the first trimester,[4] and reductions in prematurity and infant mortality.[5,6] Enhanced surveillance on paternal health also benefits fathers. A healthy father is more likely to produce healthy offspring, support his partner in parenting, participate fully in childrearing, and contribute financially to the family. To advance our understanding and ability to support families today, there is a growing recognition of the importance of including fathers in population-based data systems.
Currently, CDC's Division of Reproductive Health and Northwestern University Feinberg School of Medicine is examining the health effects of fatherhood and the attitudes and experiences of new fathers by building upon the ongoing Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is a surveillance project conducted by the CDC and state health departments that has been a model for collection of maternal health data since 1987. For almost 30 years, PRAMS has successfully provided state-specific data on perinatal health, attitudes, and experiences surrounding the birth of a child from the perspective of the mother and is now being explored for its potential to measure paternal health and experiences before, during, and shortly after the birth of a child. This new surveillance project is the "PRAMS for DADS."
There are a number of issues to consider when developing a paternal-focused component of PRAMS designed to collect information directly from new fathers. These include how to effectively reach the greatest number of new fathers, and what content to assess. PRAMS current model relies on birth certificate data for identifying mothers to be surveyed. The standard certificate of live birth in the United States has 58 data fields, the overwhelming majority pertaining to the mother (including her contact information) and infant. Seven data points relate to fathers including name, date of birth, birthplace, social security number, education, race and Hispanic origin as reported by mothers.[7] Data collected on births at the state level are entered into the Electronic Birth Registration System (EBRS), which serves as the sampling frame of all mothers with a recent birth from which PRAMS selects prospective participants. No contact information for the father, independent of the mother, is included in the birth certificate; married couples are assumed to live together, and non-married couples are expected to complete a separate Acknowledgment of Paternity (AOP) form in order for the father's information to be included on the birth certificate. Data collected on the AOP is not currently part of PRAMS and its quality and validity remain unexamined. Obtaining this data is critical; however, in order for PRAMS for DADS to reach non-resident and unmarried fathers, a group responsible for 40% of all births. Far less is known about how these fathers influence their children, compared to residential and married fathers.
Adding the voice and experiences of new fathers will provide value for public health surveillance of the developing family. Piloting father-focused surveys and methodologies at the state level is the necessary next step in order to test its feasibility and address the known and unknown barriers. Different recruitment and participation approaches to PRAMS for DADS can then be tested in order to arrive at a viable approach capable of reaching the greatest number of new fathers.
REFERENCES
Jones J, Mosher WD. Fathers' involvement with their children: United States, 2006–2010. National health statistics reports. 2013;71:1-22.
AMCHP Fact Sheet: Father Involvement in MCH Programs. Association of Maternal & Child Health Programs. 2009.
Parker K, Wang W. Modern Parenthood. Pew Research Center. 2013
Teitler JO. Father involvement, child health and maternal health behavior. Children and Youth Services Review. 2001;23(4):403-425.
Alio AP, Mbah AK, Grunsten RA, Salihu HM. Teenage pregnancy and the influence of paternal involvement on fetal outcomes. Journal of pediatric and adolescent gynecology. 2011;24(6):404-409.
Alio AP, Mbah AK, Kornosky JL, Wathington D, Marty PJ, Salihu HM. Assessing the impact of paternal involvement on racial/ethnic disparities in infant mortality rates. Journal of community health. 2011;36(1):63-68.
Birth Data. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/nvss/births.htm. Accessed June 7, 2016.