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Fathers and the well-child visit.

OBJECTIVE: Societal and economic shifts have expanded the roles that fathers play in their families. Father involvement is associated with positive cognitive, developmental, and sociobehavioral child outcomes such as improved weight gain in preterm infants, improved breastfeeding rates, higher receptive language skills, and higher academic achievement. However, father involvement in health care has been studied little, especially among nonmarried, minority fathers. Fathers are a significant part of the child's medical home, and comprehensive involvement of both parents is ideal for the child's well-being and health. Well-child visits (WCVs) represent opportunities for fathers to increase their involvement in their child's health care while learning valuable information about the health and development of their child. The objective of this study was to explore fathers' involvement in, experience and satisfaction with, and barriers to WCVs using qualitative methods. METHODS: In-depth, semistructured, qualitative interviews were conducted in 2 cities with a subsample of fathers who were participating in the national Fragile Families and Child Wellbeing Study. The 32 fathers who participated in our study come from a nested qualitative study called Time, Love, and Cash in Couples with Children. Fathers in our study reside in Chicago or Milwaukee and were interviewed about health care issues for 1.5 hours when the focal child was 3 years of age. Questions focused on the father's overall involvement in his child's health care, the father's attendance and experiences at the doctor, health care decision-making between mother and father, assessment of focal child's health, gender/normative roles, and the father's health. The open-ended questions were designed to allow detailed accounts and personal stories as told by the fathers. Coding and analysis were done using content analysis to identify themes. Particular themes that were used for this study focused on ideals of father involvement and dis/satisfaction, barriers to, and experiences in the health care system. RESULTS: Of the 50 fathers from the Time, Love, and Cash in Couples with Children study in the 2 cities, 3 had moved out of the state, 6 were in jail, 7 had been lost in earlier follow-up, and 1 had died, leaving 33 eligible respondents. Of those, 1 refused to participate, resulting in a final sample of 32 fathers and an adjusted response rate of 97%. The mean age was 31 years, and the sample was 56% black, 28% Hispanic, and 15% white; 53% were nonmarried. Only 2 fathers had attained a college degree or higher, and 84% of the fathers were employed at the time of the interview. The majority (53%) had attended a WCV and 84% had been to see a doctor with their child in the past year. Reasons for attending a WCV included (1) to gather information about their child, (2) to support their child, (3) to ask questions and express concerns, and (4) to gain firsthand experience of the doctor and the WCV. Fathers reported positive and negative experiences in their encounters with the health care system. The 3 main contributors to fathers' satisfaction with health care professionals were (1) inclusive interactions with the physician, (2) the perception of receiving quality care, and (3) receiving clear explanations. The negative experiences were often specific instances and noted along with positive comments. The negative experiences that were mentioned by the fathers included feeling viewed suspiciously by health care staff, being perceived as having a lesser emotional bond with their child than the mother, and the perception that they were receiving a lower quality of service compared with the mother. Major barriers to attending WCVs include employment schedules as well as their relationship with the focal child's mother. For example, some fathers stated that they did not attend WCVs because that was a responsibility that the mother assumed within the family. Other fathers lacked confidence in their parenting skills, which resulted in lower involvement levels. Also mentioned were health care system barriers such as inconvenient office hours and a lack of access to their child's records. Despite the presence of several barriers that seem to prevent fathers from attending WCVs, many fathers (20 of 32;63%) mentioned "situational flexibility," which enables them to overcome the stated barriers and attend doctor visits. For example, some fathers viewed the seriousness of the visit such as "ear surgery" as a reason to rearrange their schedules and attend a doctor visit with their child. CONCLUSION: The majority of fathers from our sample have attended a WCV, and most have been to their child's doctor in the past year; WCVs and doctor appointments are ways in which fathers are involved in their child's health care. Fathers detailed specific reasons for why they attend WCVs, such as to support their child, ask questions, express concerns, and gather information firsthand. The fathers reported more positive than negative experiences with the health care staff, and, overall, they are satisfied with their experiences with the health care system. Reasons for satisfaction include feeling as though their questions had been dealt with seriously and answered appropriately. However, the fathers in our study did report a variety of barriers to health care involvement, including conflicting work schedules, a lack of confidence in their parental role, and health care system barriers. Professionals who care for children and families need to explore creative ways to engage fathers in the structured health care of their children. For example, pediatricians can stress the benefits of both parents being involved in their child's health care while reframing the importance of WCVs. Understanding that many fathers have situational flexibility when it comes to health care encounters may encourage physicians to suggest more actively that fathers attend WCVs. Pediatricians can also support existing public policies such as the national 2003 Responsible Fatherhood Act that provides grants and programs that promote the father's role in the family and advocate for additional policies that would foster quality father involvement. Continued collaboration among families, physicians, and other health care professionals is essential to support father involvement and ensure positive health outcomes for children.

Adult↗

Testosterone and prolactin are associated with emotional responses to infant cries in new fathers.

To determine the responsiveness of new fathers and non-fathers toward infant cues, we exposed fathers and non-fathers to infant cries and to control stimuli and we measured affective, heart-rate, and endocrine responses, including salivary testosterone and cortisol and plasma prolactin concentrations prior to and after cry presentations. We found that (1) fathers hearing the cry stimuli felt more sympathetic and more alert compared to groups who did not hear the cries or to non-fathers who heard the cries; (2) fathers and non-fathers with lower testosterone levels had higher sympathy and/or need to respond to the infant cries than fathers with higher testosterone levels; (3) fathers with higher, as opposed to lower, prolactin levels were also more alert and more positive in response to the cries; (4) fathers hearing the cry stimuli showed greater percentage increase in testosterone than fathers not hearing the cry stimuli; (5) experienced fathers hearing the cries showed a greater percentage increase in prolactin levels compared to first-time fathers or to any group of fathers hearing control stimuli; finally, (6) partial correlations with parity and experience entered as a covariates indicated that both experience and testosterone contributed to the variance in fathers' affective responses to infant cries. Taken together, these results indicate that, as with a number of other biparental species, human fathers are more responsive to infant cues than are non-fathers and fathers' responses to infant cues are related to both hormones and to caregiving experience.

Adult↗

Young, disadvantaged fathers' involvement with their infants: an ecological perspective.

PURPOSE: To investigate fathers' involvement with their children using an ecological model, multiple respondents, and a comprehensive definition of fathers' involvement. The study's primary objectives were: (a) to describe the characteristics of fathers whose infants are born to low-income, urban, African-American adolescent mothers; (b) to describe the ways in which fathers are involved with their children; and (c) to identify factors associated with fathers' involvement. METHODS: A total of 181 first-time mothers (aged <18 years) living in three-generation households (infant, mother, and grandmother) were recruited from three urban hospitals shortly after delivery and invited to participate in a longitudinal study of parenting. Mothers provided the name of their infant's father; 109 (60%) of the fathers also agreed to participate. Baseline interviews of mothers, fathers, and grandmothers addressed demographic characteristics, relationships, and the father's involvement with his child. RESULTS: Three multivariate regression models were used to identify factors associated with paternal involvement, explaining 35% to 51% of the variability in father involvement. Regardless of the respondent (mother, father, or grandmother), paternal involvement was predicted most strongly by the quality of the parents' romantic relationship. The father's employment status, the maternal grandmother's education, and the father's relationship with the baby's maternal grandmother were also associated with paternal involvement. CONCLUSIONS: The study confirmed the value of an ecological perspective that uses multiple informants and a comprehensive definition of father involvement that includes multiple role functions. Efforts to increase paternal involvement should help young parents separate the father's relationship with their child from the romantic relationship between the mother and father, address the roles played by maternal grandmothers, and assist fathers to complete their education, and obtain and keep jobs.

Adolescent↗

Expectant fathers' response to pregnancy: review of literature and implications for research in high-risk pregnancy.

It is evident that couvade syndrome exists in the industrialized culture. However, there are questions about the occurrence of couvade given the large range of reported incidence. Clinton found no difference in the occurrence of symptoms between expectant fathers and nonexpectant men throughout the three trimesters of pregnancy. Differences were noted, however, in the types and perceived seriousness of symptoms between these men, with expectant fathers reporting more colds, unintentional weight gain, insomnia, and restlessness. Significant differences in health deviation were reported by the new fathers during the immediate postpartum period. These new fathers experienced fatigue, emotional and cognitive disturbances, and headaches. Strickland's work did not provide comparative estimates of the incidence of couvade syndrome. The focus of this study was to explore the nature of pregnancy-related symptoms among expectant fathers. These expectant fathers reported key symptoms during the second trimester of pregnancy with increasing occurrence during the last trimester of pregnancy. Expectant fathers most likely to experience couvade were anxious, black, working class men experiencing an unplanned pregnancy. Anxiety, suppression of hostility, and identification with the pregnant partner were explored as predictors of the occurrence of couvade syndrome. Anxiety is likely to occur in expectant fathers because of financial concerns and changes in relationships and roles. Feelings of protectiveness toward the partner and fetus/infant also can be anxiety producing for the expectant father. The developmental tasks described by Duvall and Penticuff were predicated on the transitional nature of becoming a parent. Each task depicts the inherent change in both structure and function of the male's family role which is influenced by society and the family unit. May proposed that expectant fathers have unique styles that predict the degree of involvement with the partner and the pregnancy. Phases of father involvement, described by May, and the father's laboring for relevance, described by Jordan, are conceptually consistent with the developmental tasks identified by Duvall. Each phase or subprocess is sequential, marked by intrapersonal and interpersonal characteristics. Movement through these tasks, phases, or subprocesses is dependent upon accepting the reality of the pregnancy, cultural norms, and society's expectations of fathers. Herzog identified degrees of involvement among fathers whose partners delivered prematurely. In this retrospective inquiry, fathers with a high degree of involvement were more likely to experience symptoms of couvade syndrome than were fathers who were less involved. All fathers in the study, regardless of the involvement, reported being fearful of the unknown outcome and experiencing grief over the preterm delivery.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗

Feasibility, Satisfaction, and Preliminary Efficacy Trial of text4FATHER for Engaging Expectant Fathers in Infant Care from Pregnancy to Early Infancy.

Engaging fathers perinatally improves infant outcomes and parent well-being, yet few strategies share evidence with fathers. We explored the feasibility, acceptability, and preliminary efficacy of text4FATHER-a texting intervention designed to improve fathers' infant care beliefs, self-efficacy, behaviors, and partner support from mid-pregnancy to 2&#xa0;months post-birth. In this exploratory pilot randomized controlled trial, 97 adult expectant fathers with less than a college degree were randomized to receive text4FATHER or not. Self-reported outcomes by fathers and mothers were assessed at baseline (mid-pregnancy) and 2&#xa0;months post-birth. We analyzed intent-to-treat effects using random coefficient regression models. We found recruiting expectant fathers feasible; of eligible father-mother dyads, 123/163 consented (recruitment feasibility&#x2009;=&#x2009;68%). All intervention fathers (100%) reported being satisfied with text4FATHER; 100% of mothers of intervention fathers also reported satisfaction with the father getting texts. First-time fathers' antenatal attachment beliefs and coparenting support were higher in text4FATHER condition vs. control from baseline to 7-month follow-up; increases in first-time fathers' confidence in fathering and infant care were also observed-the latter finding was corroborated by partners of first-time fathers. text4FATHER is a promising intervention, particularly for first-time expectant fathers with lower educational levels who have no natural clinical or public health touchpoints. Its efficacy and effectiveness should be confirmed using larger and more diverse samples.

Confidence↗

Fathers and child neglect.

OBJECTIVE: To examine the association between father involvement and child neglect. DESIGN: Cohort study. SETTING: Participants were recruited from an inner-city pediatric primary care clinic and a clinic for children at risk for human immunodeficiency virus infection in a teaching hospital. PARTICIPANTS: Mothers and fathers or father figures, and 244 five-year olds participating in a longitudinal study. MAIN OUTCOME MEASURES: Child neglect measured via home observation, a videotaped mother-child interaction, and child protective services reports. RESULTS: A father or father figure was identified for 72% of the children. Rates of neglect ranged between 11% and 30%. Father absence alone was not associated with neglect. However, in families with an identified and interviewed father, a longer duration of involvement (P<.01), a greater sense of parenting efficacy (P<.01), more involvement with household tasks (P<.05), and less involvement with child care (P<.05) were associated with less neglect. The overall model explained 26.5% of the variance in neglect. CONCLUSIONS: There is substantial involvement of fathers in a subset of this high-risk sample, although more than a quarter of the children lacked a father or father figure. The mere presence of a father did not significantly influence the neglect of the children; rather, the nature of his involvement did. Fathers who felt more effective as parents were less likely to have neglected their children. A greater sense of efficacy may reflect parenting skills and be important in enhancing the contribution of fathers to their children's well-being. Pediatric health care providers can play a valuable role in enhancing the involvement and skills of fathers.

Child Abuse↗

The father's role during infancy. Factors that influence maternal expectations.

OBJECTIVE: To describe factors that influence maternal expectations of the father's role during infancy. RESEARCH DESIGN: Cross-sectional survey. SETTING: Postpartum obstetric ward of an inner-city teaching hospital. SUBJECTS: Mothers who were residents in the inner-city communities that surround the hospital and who were recently delivered of a newborn. SELECTION PROCEDURE: Consecutive sampling from March to May 1992. MEASUREMENTS: Through structured maternal interviews, the father's expected role was measured in terms of accessibility, engagement in child care tasks, and decision-making responsibility. Influences included demographics, the mother's desire for the father's involvement, and her perceptions of his motivation, prenatal support, and ability to parent. RESULTS: Of 226 eligible mothers, 197 (87%) were interviewed. Expectations varied widely. Concerning accessibility, 48% and 18% of the mothers expected to see the father daily and less than weekly, respectively. Concerning engagement, 81% of the mothers expected some paternal involvement; the average mother assumed that the father would participate in one third of child care tasks. Concerning decision-making responsibility, 34% of the mothers expected to share all decisions; 30% expected to share none. In all areas, expectations were positively associated with the mother's desires, the strength of the parents' relationship, and the mother's perceptions of the father's motivation and ability to parent and the father's prenatal involvement (all, P < .001). Expected accessibility and engagement were greater for fathers who worked; expected engagement and decision-making responsibility were greater for fathers without children from other relationships (all, P < .03). CONCLUSIONS: The maternal desire for the father's participation, the strength of the parents' relationship, the mother's perception of the father as a parent, and the father's prenatal involvement are all consistently associated with the maternal expectations of the father's role. The demographic characteristics of either parent are not as strongly or consistently associated with the maternal expectations.

Adult↗

Fathers' coping style, antenatal preparation, and experiences of labor and the postpartum.

BACKGROUND: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information-seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. METHODS: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. RESULTS: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. CONCLUSIONS: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well-being.

Adaptation, Psychological↗

Nonresidential father involvement: a test of a mid-range theory.

This study tested a theoretical model of postdivorce involvement of nonresidential fathers with their children. The hypotheses were (a) that postdivorce father involvement is related to father parenting role identity, role clarity, child relationship quality, and father role hierarchy ranking; and (b) that several variables serve as moderators for the relationship between father parenting role identity and father involvement. Data were collected via self-report questionnaires administered to 101 fathers. Path analytic techniques were used to assess the theoretical model. Findings supported the hypotheses related to the core constructs within the theory, but not for the moderator variables within the study. Role clarity and child relationship quality were found to have both direct and indirect effects on father involvement. Father parenting role identity had a direct effect on father involvement but also functioned as a meditating variable for constructs within the model. Significant paths were found for two variables, joint custody and satisfaction with the legal system. Father postdivorce involvement is a complex phenomenon, and forces external to fathers can contribute to levels of postdivorce involvement (e.g., legal system issues).

Adult↗

Fathers' involvement in their children's healthcare.

Fathers' involvement in the routine healthcare of young children was investigated, and fathers' relative participation in two tasks, staying home with a sick child and taking the child to the doctor or dentist, was assessed. The relationships between fathers' involvement in healthcare and several other measures, including mothers' employment status, fathers' attitudes toward women's rights and roles, the amount of time fathers spent at work, and fathers' involvement in housework, were also examined. The subjects were 50 fathers of young children in intact, White, middle-class families. Both staying home with a sick child and taking a child to the doctor or dentist were usually performed by mothers, but when mothers were employed, fathers were significantly more involved, regardless of the child's sex. Staying home with a sick child and taking a child to the doctor or dentist were positively related to fathers' involvement in housework. Fathers' staying home with a sick child was significantly correlated with fewer hours at work and liberal attitudes toward women's rights and roles; these variables were not related to taking a child to the doctor or dentist. Positive correlations between fathers' involvement in housework and staying home with a sick child and taking a child to the doctor or dentist suggests that fathers' involvement in childcare is viewed as an aspect of family work.

Adult↗

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

Adult↗

Smoking behaviour change among fathers of new infants.

Protecting infants from exposure to parental tobacco smoke is key to positive health outcomes in childhood and later life. While mothers' smoking has been well researched, fathers' smoking has received little attention. This paper reports data from a cross-sectional survey of 286 smoking fathers in the English Midlands, interviewed when their infants were 8-14 weeks old. It examines whether fathers attempt and successfully achieve two smoking behaviours positively associated with infant health: quitting and not smoking in the home. The birth of a new baby was not associated with attempting or successfully quitting smoking for the majority of fathers. Less than 20% had tried to quit and only 4% had successfully quit smoking since the birth of their baby. Half of the participants reported that they had not changed their cigarette consumption since their baby's birth. Not smoking in the home appeared to be a more achievable behaviour for many fathers; 78.0% had attempted and 60% had successfully achieved not smoking in home. Independent predictors of attempting to quit were fathers' own cigarette consumption and level of knowledge about infant exposure to tobacco smoke. Attempting to abstain from smoking in the home and being successful in the attempt were both independently associated with partner's smoking status, number of financially dependent children and father's social class. Findings suggest that promoting reductions in cigarette consumption and improving knowledge levels among fathers about passive smoking in infants may encourage more quit attempts. Not smoking in the home is a more achievable behaviour and is linked to fathers' caring and economic circumstances and their partner's smoking status. Influences on fathers' smoking behaviour appear to be multi-factorial. Understanding father's smoking and developing health promotion strategies to protect infants from passive smoking is likely to depend on research which can bridge the caring and economic spheres of their lives.

Adolescent↗

Father involvement and cognitive/behavioral outcomes of preterm infants.

OBJECTIVE: To assess the independent effect of father involvement on intellectual and behavioral outcome of 985 low birth weight preterm infants followed longitudinally from birth to age 3 years as part of the Infant Health and Development Program. METHOD: The sample for this study is drawn from eight urban sites, composed largely of ethnically diverse and relatively disadvantaged families. On the basis of a combined score for father's stable presence in the home and amount of play with the infant, we defined extreme groups of high-involvement fathers (33%, n = 305) and low-involvement fathers (16%, n = 148), with the remainder as a middle group (51%). RESULTS: Most fathers played a meaningful role as play partner with their high-risk infants. Approximately 75% of fathers were reported to play with the baby every day at 12 (peak), 24, and 36 months. Fathers who were black, younger, had teenage mothers as companions, or were from low-income families were less involved with their infants. For black fathers, low family income was significantly associated with low father involvement. Within the black ethnic subgroup only, higher father involvement was associated with improved cognitive outcome. Mean IQ for the high-involvement subgroup was 6.00 points higher than for the low-involvement group even after adjusting for family income, neonatal health, treatment group status, and paternal age. CONCLUSION: Father involvement enhances cognitive outcome in black families and may have implications for intervention.

Black or African American↗

Promoting father-friendly healthcare.

Fathers are taking a more active role in their children's lives and healthcare; consequently, healthcare providers need to be more aware of and attentive to fathers in clinical encounters. The literature on healthcare provider inclusion of fathers is sparse. The focus has been mainly on exhortations to include fathers, or has documented treatment of fathers as invisible in healthcare settings. While not overtly hostile to fathers, healthcare providers occasionally marginalize or ignore them. The purpose of this article is to help healthcare providers: (1) become aware of and assess their interactions with fathers and (2) be more intentional in their interactions with them. To that end, this article includes a self-assessment of one's practice, including the following components: introductions, body language, eye contact, obtaining/giving information, and beliefs about the role of fathers. Intentional interactions for developing more father-friendly healthcare are discussed including both small and large changes, guided by the PLISSIT model. Finally, best practices, challenges, issues, and resources related to father inclusion in healthcare are described. The major issue for providers is to no longer question whether to include fathers, but how.

Child↗

Fathers' parenting attitudes during a child's first year.

OBJECTIVE: To determine whether fathers' interactions with their children from prebirth to 1 year of age changed the fathers' parenting attitudes as measured by the Adult-Adolescent Parenting Inventory (AAPI). DESIGN: Nonrandomized, longitudinal, descriptive study. SETTING: Private obstetricians' offices, prenatal clinics, and prenatal classes in a large city in the southeastern United States. PARTICIPANTS: White, well-educated, stable, upper-middle class fathers attending prenatal education classes. At time 1 (prebirth), n = 293 with 228 first-time fathers and 65 experienced fathers. At time 2 (3 months), n = 62 with 46 first-time fathers and 16 experienced fathers. At time 3 (1 year), n = 42 with 30 first-time fathers and 12 experienced fathers. MAIN OUTCOME MEASURES: Parenting attitudes as measured by the AAPI. RESULTS: Repeated measures analysis of variance revealed a significant difference in two of the four constructs measured by the AAPI. When their children were 3 months old, fathers scored significantly lower in the areas of expectations and belief in the use of corporal punishment, and their raw scores did not significantly differ in the areas of empathy and appropriate family roles. CONCLUSION: These fathers need education about appropriate expectations of a 3-month-old child and information regarding alternative methods of discipline.

Adolescent↗

[Fathers' participation in childbirth at a public hospital: institutional difficulties and motivations of couples].

Participation by fathers in the process of childbirth, an aspect of the humanization of obstetric care, helps foster the fathers' involvement in raising their children. This participation provides psychosocial support for pregnant women during labor and delivery, sharing of the experience by the couple, and father-child bonding. The focus of this ethnographic research was the impact of this process on fathers participating in childbirth at a State hospital in Rio de Janeiro, with two stages: participant observation of labor and delivery and eleven interviews with fathers who had been present at delivery. Fathers' participation was influenced by: the motivation of mothers and fathers; social representations of delivery and fatherhood; and exclusion of fathers from reproductive health and pediatrics services. The father's participation was not valued by the attending staff as either a source of emotional support for the mother or as part of fatherhood. The following are necessary: inclusion of fathers in prenatal care, delivery, and pediatrics services; the training of staff to work with the families; social discussion of fatherhood and health services policies to ensure the presence of fathers during labor and childbirth.

Adult↗