How can we increase the father's  
involvement in child care? 

Ted Greiner, PhD, nutritionist, International Child Health Unit,  
Uppsala University, Sweden  

Unfortunately, infant care is almost exclusively a woman's realm in virtually every culture, no doubt due in part to the fact that only women can breast feed. Yet the father has important roles to play both in sharing child care responsibilities and in providing crucial support to the vulnerable mother-child dyad in the early weeks and months of life. Occasionally we do see examples in which the father takes on the major burden of child care and thus know it is possible for men to do more. This is much needed in a changing world that puts increasing pressure on women, threatening to reduce the quality of care received by children, particularly among impoverished groups struggling just to survive. 

I will begin by emphasizing the need for the breastfeeding movement to address this issue more explicitly and to give it high priority. If we do not, the infant food industry will beat us to it, establishing a social norm based on the image: "male support = the father holding the bottle." 

From studies of time allocation within the family that I have seen from different countries, men have more leisure time than women. This is an inexpensive potential source of additional support to the breastfeeding mother available already within the home. However, it may not be such a simple matter to mobilize this support. 

In 1979-1983, I worked on a Rockefeller Foundation/Cornell University project with the Ministry of Health in North Yemen to promote breastfeeding. There were very few educated women and thus it was run largely by men who communicated with health professionals who also were almost only men, including the nurses. Since most women in Yemen at that time began bottle feeding within the early months of life, it was natural for the men working in our project to concentrate on educating fathers about the importance of breastfeeding. At first this seemed to work well, as the better educated men quickly understood and accepted scientific arguments for the superiority of breastfeeding. 

However, gradually anecdotes began to filter to us about men who threatened their bottle feeding wives with divorce if they did not switch immediately to breastfeeding. In other cases we heard that once men found out that breastfeeding increases birth spacing, they brought home bottles even earlier. Thus we stopped working with men, realizing that broader issues regarding their attitudes toward women needed to be dealt with first. 

There are many types of support women need from the baby's father. Indeed, the division of labor within the family is being renegotiated throughout the world. In this talk, however, I will concentrate on child care. Images of men being involved in infant care seem to be limited almost exclusively to bottle feeding. We all would agree that it is more fun being responsible for "input" into the baby than the "output" end, though diaper changing could just as easily be done by the father at less risk to infant health than if he does the feeding (with the exception of cup feed with expressed breast milk). 

Once solid feeding starts, the father could also easily take part or better yet take full or major responsibility. It works much better when a man feels he is completely in control, understands what to do, and figures out the details of how to do it himself. Men enjoy much more doing things their own way rather than being given instructions from a woman on how to do something her way. (Maybe women too would prefer to learn from other women, I don't know!) He needs to be up to date on infant nutrition and hygienic requirements and then he can easily manage solid feeding. 

With my own sons, I cooked one food at a time (just extra of foods I was cooking anyway), puréed them, placed them in ice cube trays, froze them, introduced one at a time from six months of age, and then gradually learned how many cubes of what kinds of foods they would eat. They never got any commercial baby food of any kind. Men will find that once they know what they are doing, child care is not difficult-as long as you give it first priority among anything else you are trying to do at the same time! 

There are huge differences among different cultures in what tasks are "assigned" to men and women but playing with children is common among men and probably gives many women an "opening" for expanding the father's involvement in child care. Just as a woman does not want to be forced to breast feed, kindly persuasion will work better than force to increase male involvement in child care. 

Even more effective might be discussion with other men who have ventured farther into the forbidden territory of "women's activities" associated with child care. In my experience, men learn easier about changing male roles from each other than from women, especially the woman who has a vested interest in his changing! This is nothing I have given a great deal of attention to, and thus I could be out of date, but it does seem to me that family life issues are not discussed much by teenage boys, young men, married men or media directed to men such as men's magazines. Indeed, men seem to lack ways of getting support that may be crucial if they are to succeed in coping with the kinds of frustration one encounters in caring for children. Women naturally seem to give and receive this from each other both face to face and through such media as women's magazines. 

In most countries boys probably do not learn much about family life in school and health care systems have no routine opportunities to discuss anything much with men like they do with women during pre- and postnatal visits to MCH services. In Sweden, where my boys grew up, boys do take home economics (and girls take "shop", that is wood working and metal working) and all young teens are given sex education. There have been some books by men dealing with their roles in the family in the past couple decades, at least in the USA, so maybe change will be more rapid in the coming years. 

Probably the best opportunity to discuss male involvement with the father is during prenatal visits, but again I doubt that many prenatal care services have given adequate thought to how this could be done, including the provision of opportunities for men to talk with other men about it. Naturally it would be valuable if the father understands the benefits of breastfeeding and is willing to support the mother in doing so if she so chooses. It would be even better if he were willing and able to provide her with emotional support and assistance to get through any difficulties or crises that might occur during breastfeeding. 

Men also need to know that they will feel left out, even jealous, at times during the first months, as the mother and baby develop a special bond. But the baby will bond more and more with the father as time goes by, as long as they continue to spend time together. 

Men need to know that mothers will not roll over on their babies and smother them during the night. This is a myth, except perhaps if a woman is intoxicated from alcohol or drugs. Sleeping with the baby will make night feeding much easier for both mother and baby at very little sacrifice on the father's part. I found that there were enormous benefits for my children from continuing with a family bed until they were old enough to feel comfortable sleeping on their own (at about 7 and 10 years of age). With a bit of creativity, one can limit how much impact this has on one's sexual life a point that most men I have discussed this with seem to be afraid of. 

Finally, men would benefit from discussing with others the issue of women breastfeeding in public. This too makes life so much easier for mother and child at no cost to the father, as long as he has had a chance to think and discuss it and realize there is nothing wrong with it. Maybe we need a male La Leche League! 

More active male involvement will be facilitated (but not guaranteed) by paternity leaves (many countries now give fathers one-two weeks paid leave at the time of delivery) and parental leaves. Several countries offer parental leaves after the period of maternity leave. In Sweden paid parental leave is about 40 weeks long and at least one month must be taken by the father or it will not be paid out. In recent years about 30% of fathers take some parental leave and about 10% of all parental leave is taken by them. Though a good beginning, it will take much more than this of course to achieve a situation in which raising children does little more harm to women's careers than to men's.