Fathers' Experiences during Delivery of Their Newborns: A Content Analysis.

Background: Paternal involvement during pregnancy has been shown to have a positive impact on the mother-baby dyad during and after birth. The presence of the father during birth also positively influences father-child attachment, reduces, apprehension, and stress, increases maternal satisfaction, and increases love and respect for the partners. This study explored the experiences of fathers who were present in the delivery room during the delivery process. Methods: This qualitative content analysis study was conducted at a maternity hospital in Kingston, Jamaica from June to July 2022. A total of ten (10) fathers of babies delivered within six weeks were purposefully selected to be interviewed via telephone over four weeks. Data were analysed using a thematic approach. Results: Four sub-themes and one theme were extracted from data analysis. Fathers perceived satisfaction and empowerment in the shadow of positive and negative feelings as the theme. Sub-themes emerged from the data including "clinician's acceptance and support", "close bonding and attachment with mother and baby", "preparedness of fathers to give support", and "inspiring and amazing feeling by fatherhood experiences". Conclusion: Fathers experienced the feeling of empowerment and wished to take up their role during the delivery of their newborns. Their experiences were influenced by the midwives and the resources available to support their accommodation. More policies are needed to strengthen the fathers' involvement during antenatal clinic visits, delivery, and postnatal care.

Effects of Fish Oil Supplementation on Reducing the Effects of Paternal Obesity and Preventing Fatty Liver in Offspring.

Nonalcoholic fatty liver disease (NAFLD) is a serious public health concern, which calls for appropriate diet/nutrition intervention. Fish oil (FO) has several benefits in reducing obesity, but its intergenerational role in reducing the effects of paternal obesity has not been established. Hence, we hypothesized that FO supplementation to an obese father during the pre-conceptional period could improve the metabolic health of the offspring, specifically in the liver. Three groups of male mice were fed with a low-fat (LF), high-fat (HF), or high-fat diet supplemented with FO (HF-FO) for 10 weeks and were then allowed to mate with female mice fed a chow diet. Offspring were sacrificed at 16 weeks. The liver tissue was harvested for genomic and histological analyses. The offspring of HF and HF-FO fathers were heavier compared to that of the LF mice during 9-16 weeks. The glucose tolerance of the offspring of HF-FO fathers were significantly improved as compared to the offspring of HF fathers. Paternal FO supplementation significantly lowered inflammation and fatty acid synthesis biomarkers and increased fatty acid oxidation biomarkers in the offspring liver. In summary, FO supplementation in fathers shows the potential to reduce metabolic and cardiovascular diseases through genetic means in offspring.

Extensive pedigrees reveal the social organization of a Neolithic community.

Social anthropology and ethnographic studies have described kinship systems and networks of contact and exchange in extant populations1-4. However, for prehistoric societies, these systems can be studied only indirectly from biological and cultural remains. Stable isotope data, sex and age at death can provide insights into the demographic structure of a burial community and identify local versus non-local childhood signatures, archaeogenetic data can reconstruct the biological relationships between individuals, which enables the reconstruction of pedigrees, and combined evidence informs on kinship practices and residence patterns in prehistoric societies. Here we report ancient DNA, strontium isotope and contextual data from more than 100 individuals from the site Gurgy 'les Noisats' (France), dated to the western European Neolithic around 4850-4500 BC. We find that this burial community was genetically connected by two main pedigrees, spanning seven generations, that were patrilocal and patrilineal, with evidence for female exogamy and exchange with genetically close neighbouring groups. The microdemographic structure of individuals linked and unlinked to the pedigrees reveals additional information about the social structure, living conditions and site occupation. The absence of half-siblings and the high number of adult full siblings suggest that there were stable health conditions and a supportive social network, facilitating high fertility and low mortality5. Age-structure differences and strontium isotope results by generation indicate that the site was used for just a few decades, providing new insights into shifting sedentary farming practices during the European Neolithic.

The Efficacy of Two Group Interventions on Mental Representations, Attachment Security, and Trauma Symptoms in Ethnically and Socioeconomically Minoritized Young Adolescents in an Urban Middle School.

Symptoms resulting from childhood trauma can negatively impact socioemotional well-being and school performance during early adolescence unless positive changes in attachment security and mental representations of significant relationships occur. A sample of 109 eighth grade urban students were randomly assigned to one of two weekly, one-hour, school-based group interventions-Storytelling/Story-Acting for Adolescents (STSA-A) or Mentalization-Based Treatment Group Intervention (MBT-G). The Object Relations Inventory (ORI), Adolescent Attachment Questionnaire (AAQ) and Child PSTD Stress Scale (CPSS) were administered to students and their primary group leaders at the beginning (October) and end (May) of the intervention protocol as outcome variables. Participants in both the STSA-A and MBT-G intervention conditions experienced significant increases in attachment security and decreases in trauma symptoms. Over the course of eight months of group intervention, affective valence of paternal mental representations significantly decreased for boys and for participants in the STSA-A condition, while affective valence of primary group leader mental representations significantly decreased for participants in the MBT-G condition. STSA-A and MBT-G were found to be efficacious at improving attachment security and reducing trauma symptoms in young adolescents. The strengths of each group intervention for addressing interpersonal issues unique to specific types of adolescents are discussed.

A systematic review and narrative synthesis of fathers' (including migrant fathers') experiences of pregnancy and childbirth.

OBJECTIVE: The purpose of this review was to consider factors that influence the experiences of pregnancy and childbirth by fathers including migrant fathers. METHOD: A systematic review and narrative synthesis were conducted as per the PRISMA guidelines. The spider tool was used to build a search strategy which was used to conduct literature search in eight identified electronic databases: ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO, PUBMED, Sage and Scopus. Grey literature was searched through the King's Fund Library database, Ethos, The North Grey Literature Collection, Social Care Online and other charity websites such as the Refugee Council and Joseph Rowntree Foundation. The search was conducted across all the databases in the week commencing January 7, 2019, and restricted to studies published in the English language. RESULTS: The search across all the eight electronic databases identified 2564 records, 13 records through grey literature databases/websites and an additional 23 records identified through hand-searching/forward citation. The number of records after duplicates were removed was 2229. Record screening based on titles and abstracts identified 69 records for full text screening. Dual screening of these full text records identified 12 full records from 12 separate studies, eight of which were qualitative studies, three of which were quantitative studies and one mixed method study. FINDINGS: This review has revealed three main themes: influence of society and health professionals; adjustment to a new life of fatherhood; and involvement in maternity care. However, the literature has focused on non-migrant father's experiences of pregnancy and childbirth, with little attention paid to fathers who may be migrants. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: This review has exposed a dearth of research on migrant fathers' experiences of pregnancy and childbirth in an era of increasing globalisation and migration between countries. Midwives and other health professionals should be alert to the needs of any father when providing maternity care. More research is needed which considers experiences of migrants and how choosing to move to a new country or being forced to move could influence migrant father's experiences and therefore their needs.

"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan.

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

Longitudinal associations between mindfulness and changes to body image in first-time parent couples.

Pregnancy and postpartum are associated with declines in body image. Research on postpartum body image focuses almost exclusively on the person who gave birth and studies examining protective factors for postpartum body image are scarce. We assessed 257 new-parent couples from mid-pregnancy to 6-months postpartum to examine whether mindfulness-a recognized contributor to psychological well-being-buffered against declines in both partners' perceptions of mothers' body. Mothers' positive body image and partners' perception of mothers' body were collected at four time-points (second and third trimester; 3- and 6-months postpartum); both partners' mindfulness facets-observing, describing, awareness acting, non-judgement, and non-reactivity-were assessed in the second trimester. Dyadic latent growth curve modeling revealed that both partners' perceptions of mothers' body were positively correlated at all moments; however, mothers' positive body image worsened over time, whereas partners' perception of mothers' body remained stable. Mindfulness facets were positively associated with mothers' positive body image (observe, describe, and non-judging) and fathers' (non-judging) perceptions of mothers' body in pregnancy. Mothers' mindfulness facets (acting with awareness, non-judging) were associated with subsequent trajectories of their own body image. By identifying mindfulness facets as targetable protective factors during pregnancy, these findings have implications for future research and interventions focused on perinatal body image.

Fathers' perceptions and experiences of support to be a parenting partner during the perinatal period: A scoping review.

AIMS AND OBJECTIVES: The aim of this study was to explore fathers' perceptions and experiences of support in the perinatal period. Change in society has seen the increased visibility of fathers being involved during pregnancy and engaging in their infants' lives and the expectation and benefits of men playing an equal and direct role in caring for their children. However, less is known about the nature of support that fathers require to facilitate this role transition. DESIGN: A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. METHODS: A systematic search of CINAHL Plus, MEDLINE, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology, Soc INDEX and Behavioural Sciences Collections databases for qualitative or mixed methods studies with qualitative data was undertaken. Qualitative data were extracted from original studies for coding and theme generation. Thematic synthesis was employed for the final stages of analysis. RESULTS: Overall, 23 papers were included. Men desired to fulfil their rite of passage to be an involved father to their child. This transitional process commenced with men articulating their commitment to creating a role as an involved father and to be a role model for their children. Becoming a father is seen as having a significant status in society which contributes to their self-efficacy as fathers. CONCLUSION: Fathers require support from all levels of the 'ecosystem' including policy, socio-cultural and workplace changes as well as recognition and support from partners, family, peers and in particular from health service providers. Developing the parenting partnership requires a co-production approach and commitment at macro, meso and micro levels. RELEVANCE TO CLINICAL PRACTICE: Supporting men to be engaged fathers requires policy, socio-cultural and workplace changes; however, maternity services and particularly midwives have an important role in this change.

The partner's experiences of childbirth in countries with a highly developed clinical setting: a scoping review.

BACKGROUND: In Western countries, it is common practice for a woman to be supported by a trusted person during childbirth, usually the other parent. Numerous studies have shown that this has a positive effect both on the woman's satisfaction with the birth process and on physical outcomes. However, there is little research on the birth experience of partners and their wellbeing. The aim of this review is to summarise the existing literature on partner experience, consider its quality and identify the underlying themes. METHODS: Both a systematic literature search in three databases and a manual search were conducted, for qualitative, quantitative, and mixed-methods studies from Western countries examining the experiences of partners present at a birth. RESULTS: A total of 35 studies were included. Only one study included same-sex partners (the other studies addressed fathers' experiences only) and only one validated questionnaire examining partners' birth experiences was identified. Four major themes were found to influence partners' birth experiences: (1) intense feelings, (2) role of support, (3) staff support, and (4) becoming a father. CONCLUSIONS: Partners may feel very vulnerable and stressed in this unfamiliar situation. They need emotional and informal support from staff, want to be actively involved, and play an important role for the birthing woman. To promote good attachment for parents, systematic exploration of the needs of partners is essential for a positive birth experience. Because of the diversity of family constellations, all partners should be included in further studies, especially same-sex partners.

The effect of midwifery-led counseling on expectant fathers' fear of childbirth: a smartphone- based randomized controlled trial.

BACKGROUND: Expectant fathers experience a range of different emotions during their wife's pregnancy; one of these feelings is fear. It has adverse consequences on both the father and his family. The aim of this study was to investigate the effect of midwifery-led counseling on the fear of childbirth among expectant fathers. METHODS: A two-armed parallel design randomized controlled trial was conducted from July to August 2020. Fifty expectant fathers with severe fear of childbirth at the 24th-27th weeks of gestation, in the Iranian setting, were assigned to intervention and control groups (allocation ratio1:1) using permuted block randomization. Participants assigned to the intervention group were engaged in six 60-90-min midwifery-led counseling sessions (twice a week) in the Skyroom platform. Measures were administered at recruitment, post-intervention, and one-month follow-up. The primary outcome was the change in fear of childbirth score between groups over time. Secondary outcomes were changes in the General Self-Efficacy score as well as changes in the frequency of the preferred type of delivery between groups over time. RESULTS: The mean age of the participants was 31.64 (3.33) years. In the intention-to-treat analysis, the fear of childbirth score in the intervention group significantly decreased (ß = - 11.84; 95% Confidence Interval: - 21.90 to - 1.78; P = 0.021) compared to that of the control group. In terms of secondary outcomes, the intervention group showed a significant increase in General Self-Efficacy compared to the intervention group at one-month follow-up measurement (ß = 1.43; 95% Confidence Interval: 0.28 to 2.58; P = 0.014). However, the frequency of preferred delivery type was not significantly different between the intervention and control groups (P = 0.139). CONCLUSIONS: Midwifery-led counseling can be an effective approach in reducing expectant fathers' childbirth fear with potential clinical significance. Although the inconclusive results imply more research on this issue. TRIAL REGISTRATION: Registration number: IRCT20150608022609N6 . Registered 12/04/2019.

Adolescents' executive functions: Links to inattention, hyperactivity-impulsivity, trait mindfulness, and attachment relationships with fathers and mothers.

BACKGROUND AND OBJECTIVES: Considering the important role of executive functions (EF) for adjustment across the lifespan, this study aimed to deepen understanding of protective/risk factors for EF in a potentially vulnerable population: adolescents with ADHD. This study compared adolescents with versus without ADHD for differences in EF, attachment relationships with fathers/mothers, and trait mindfulness and investigated these possible protective/risk factors' contributions to EF in both adolescent groups. METHODS: Ninth graders (N = 91; 49 boys, 42 girls) ages 14-15 years (M = 14.50, SD = 0.50) comprised 45 with ADHD and 46 with typical development (TD). Adolescents completed three self-reports (trait mindfulness, attachment to mother/father). Mothers rated their adolescents' ADHD symptoms and EF. RESULTS AND CONCLUSION: Significantly more maladaptive outcomes emerged for adolescents with ADHD than TD in their EF, attachment with mothers, and mindfulness. Regression analyses demonstrated the significant risk posed by ADHD symptoms and the protection offered by trait mindfulness and attachment with fathers in explaining EF. Discussion focused on understanding these protective/risk factors' possibly unique and complementary roles, suggesting interventions for adolescents with ADHD in family and school settings.

The Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal study: cohort profile and key findings from the first three years.

PURPOSE: The objectives of the ongoing Canadian longitudinal cohort called the Alberta Pregnancy Outcomes and Nutrition (APrON) study are to: (1) determine the relationship between maternal nutrient intake and status before, during, after pregnancy, and (a) maternal mental health, (b) pregnancy and birth outcomes, and (c) infant/child neurodevelopment and behavior; (2) identify maternal mental health and nutrient predictors of child behaviour; and (3) establish a DNA biobank to explore genomic predictors of children's neurodevelopment and behavior. The purpose of this paper is to describe the participants, measures, and key findings on maternal and paternal mental health, maternal nutrition, and child outcomes to when children are 3 years of age. PARTICIPANTS: Participants included mothers and their children (n=2189) and mothers' partners (usually fathers; n=1325) from whom data were collected during the period from pregnancy to when children were 3 years of age, in Alberta, Canada. More than 88% of families have been retained to take part in completed data collection at 8 years of age. FINDINGS TO DATE: Data comprise: questionnaires completed by pregnant women/mothers and their partners on mothers', fathers' and children's health; dietary interviews; clinical assessments; linkage to hospital obstetrical records; and biological samples such as DNA. Key findings on mental health, nutrition and child outcomes are presented. APrON women who consumed more selenium and omega-3 were less likely to develop symptoms of perinatal depression. Higher prenatal consumption of choline rich foods such as eggs and milk were recommended as was vitamin D supplementation for both mothers and children to meet guidelines. Couples in which both mothers and fathers were affected by perinatal depression reported lower incomes and higher maternal prenatal depressive symptoms and lower support from fathers postnatally and their children presented with the most behavioural problems. Maternal experiences of early adversity predicted increased likelihood of perinatal depression and anxiety and children's behavioural problems. FUTURE PLANS: The APrON cohort offers a unique opportunity to advance understanding of the developmental origins of health and disease. There is a planned follow-up to collect data at 12 years of age.

¿Qué Está Haciendo Papá? Mexican-Heritage Fathers' Physical Activity Networks After a Father-Focused Health Program.

Physical activity (PA) is a public health priority due to holistic health benefits; however, many adults do not meet PA guidelines. Few studies have examined Mexican-heritage fathers' social networks, specifically with whom they are physically active. This study examines changes in Mexican-heritage fathers' PA networks after participation in a father-focused, family-centered health program. Families consisting of child (aged 9-11 years), mother, and father were recruited from colonias on the Texas-Mexico border for participation in a 6-week father-focused, family-centered program concentrated on healthy eating and active living. Fathers reported up to 5 people with whom they were active most in the previous month before and after the program as well as how often they were active with the person and what activities they did most often. Multilevel regression models examined changes in networks. Fathers (n = 42; mean age = 39.07 years, SD = 7.45) were significantly more likely to report more frequent PA with others after the program as compared with before. General active play and conditional support were mentioned most frequently. This study provides context to the social networks and PA behaviors of Mexican-heritage fathers and suggests that a father-focused, family-centered health program can increase the PA frequency with social network connections.

Effects of paternal overnutrition and interventions on future generations.

In the last two decades, evidence from human and animal studies suggests that paternal obesity around the time of conception can have adverse effects on offspring health through developmental programming. This may make significant contributions to the current epidemic of obesity and related metabolic and reproductive complications like diabetes, cardiovascular disease, and subfertility/infertility. To date, changes in seminal fluid composition, sperm DNA methylation, histone composition, small non-coding RNAs, and sperm DNA damage have been proposed as potential underpinning mechanism to program offspring health. In this review, we discuss current human and rodent evidence on the impact of paternal obesity/overnutrition on offspring health, followed by the proposed mechanisms, with a focus on sperm DNA damage underpinning paternal programming. We also summarize the different intervention strategies implemented to minimize effects of paternal obesity. Upon critical review of literature, we find that obesity-induced altered sperm quality in father is linked with compromised offspring health. Paternal exercise intervention before conception has been shown to improve metabolic health. Further work to explore the mechanisms underlying benefits of paternal exercise on offspring are warranted. Conversion to healthy diets and micronutrient supplementation during pre-conception have shown some positive impacts towards minimizing the impact of paternal obesity on offspring. Pharmacological approaches e.g., metformin are also being applied. Thus, interventions in the obese father may ameliorate the potential detrimental impacts of paternal obesity on offspring.

Paternal adherence to healthy dietary patterns in relation to sperm parameters and outcomes of assisted reproductive technologies.

OBJECTIVE: To investigate whether men's adherence to dietary patterns promoted for the prevention of cardiovascular disease is associated with semen parameters and couples' assisted reproductive technology (ART) outcomes. DESIGN: Prospective cohort study. SETTING: Fertility center at an academic medical center. PATIENT(S): A total of 245 men and their female partners who underwent 438 ART cycles between 2007 and 2020. INTERVENTION(S): Male pretreatment dietary intake was assessed with a 131-item food frequency questionnaire from which we calculated eight a priori defined scores: Trichopoulou Mediterranean, Alternate Mediterranean, Panagiotakos Mediterranean, Healthy Eating Index, Alternative Healthy Eating Index, American Heart Association, Dietary Approaches to Stop Hypertension, and Plant-based. MAIN OUTCOME MEASURE(S): The primary outcome was live births per treatment cycle. The secondary outcomes were fertilization, implantation, and clinical pregnancy and seminogram parameters. RESULT(S): There was an inverse association between greater adherence by men to the Panagiotakos Mediterranean diet and the American Heart Association dietary pattern and lower fertilization rate. However, there were no significant associations between men's adherence to any of the analyzed dietary patterns and the probabilities of implantation, clinical pregnancy, or live birth in multivariable-adjusted models. No significant differences in any of the semen parameters were found between participants of the lowest quartile and those of the highest quartile of the eight dietary patterns. CONCLUSION(S): These findings suggest that men's adherence to several a priori defined dietary scores with documented cardiovascular benefits is not related to major outcomes of infertility treatment with ART or semen quality.

A qualitative study of the impact of adverse birth experiences on fathers.

BACKGROUND: Being present during labour and birth can, for some fathers, result in feelings of fear, uncertainty, anxiety, and helplessness. Witnessing birth complications or adverse events may cause immediate and long-term anxiety and stress. In turn, this experience can impact on men's sense of self and identity as a man and father and can affect his relationship with his infant and partner. The aim of this study was to explore the immediate and longer-term impact of witnessing a complicated or adverse birth experiences on men in heterosexual relationships and their role as a father. METHODS: An interpretive qualitative approach informed the design of this study. A total of 17 fathers, one from New Zealand and sixteen from Australia participated through face to face, telephone and email interviews. The ages of the men were between 24 to 48 years, and the time since the adverse birth experience ranged from 4.5 months to 20.5 years. FINDINGS: Thematic analysis revealed three major themes representing men's experiences of witnessing a complicated birth or adverse event; 'Worst experience of my life', 'Negotiating my place: communicating with health professionals' and 'Growing stronger or falling apart'. Men were unprepared and feared for the lives of their infants and partners, they expected and wanted to be involved in the birth and the maternity care journey, instead they were pushed to the side and excluded from the labour and birth during times of emergency. Being excluded from part or all of the birth perpetuated worry and vulnerability as, at times, men were left not knowing anything about what was happening to their partners. Midwives and other health professionals' support was important to the way fathers adjusted and processed the complications of the labour and birth event. This experience impacted on their own mental health and their relationship with their baby and partner. CONCLUSION: Findings demonstrate that following a complicated or adverse birth experience, men questioned their role as a father, their place in the family and their role at the birth. There is a need to include and inform the expectant father that help is available if they experience negative feelings of hopelessness or despair. Maternity services and care providers need to involve fathers so that they feel part of the maternity care system and journey which may mitigate feelings of helplessness.

Hypothalamus volume in men: Investigating associations with paternal status, self-reported caregiving beliefs, and adult attachment style.

Most studies on mammalian caregiving and attachment focused on the mother-child relationship, particularly in humans. Yet, changing societal roles of male caregivers have highlighted the necessity for research with fathers.We examined the volume of the hypothalamus, an important subcortical brain area for caregiving and attachment, in N = 50 fathering (child age 5-6 years) and N = 45 non-fathering men using a novel technique to identify the hypothalamus in 3T MRI. We furthermore employed three self-report measures to assess interindividual differences in adult attachment style across all men and caregiving beliefs in fathers.While we did not observe any significant difference in hypothalamus volume between fathers and non-fathers or associations between hypothalamus volume and self-reported adult attachment style across all men, self-reported caregiving beliefs were positively related to total hypothalamus volume in fathers. A follow-up analysis showed that fathers' self-reported belief that a father's role is important to child development was specifically related to tuberal hypothalamus volume, while self-reported enjoyment of spending time with the child was not associated with sub-regional hypothalamus volume.Together, these findings suggest that interindividual variability in self-reported caregiving beliefs in fathers is related to brain structure, warranting further research.

Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique.

Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers' roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October-November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers' involvement included the absence of fathers in many households; opportunity costs associated with fathers' accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers' broader engagement with their child at home; fathers' desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.

Midwives' experiences of father participation in maternity care at a large metropolitan health service in Australia.

OBJECTIVE: Engagement of fathers to participate in pregnancy, birth and early postnatal care has significant advantages for women and infants as well as fathers. In Australia, guidelines for midwifery practice do not include specific recommendations about father-inclusive care, and models for publicly funded maternity care do not extend to the provision of care tailored specifically towards the needs of fathers. This study investigated the perceptions of midwives regarding their role in fathers' wellbeing, the extent of fathers' attendance at and participation in their services, advantages and disadvantages of father participation and barriers and enablers to father engagement. DESIGN: Convergent mixed methods, cross-sectional. SETTING: A large metropolitan public maternity hospital that provides care to some of the most socio-economically disadvantaged suburbs and multi-cultural communities in Melbourne, Australia. PARTICIPANTS: All midwives employed at the hospital (n=196) were invited to participate. METHODS: Anonymous online survey and semi-structured interviews. Descriptive statistics were calculated for quantitative survey responses. Interview data and qualitative survey responses were analysed thematically. FINDINGS: Forty midwives working in all areas of maternity services across the hospital completed surveys, and six participated in interviews. The data illustrate the dilemma faced by midwives in their specific role of supporting women and babies. On the one hand, participants indicated that fathers' wellbeing should be part of their role and named many advantages of father participation in maternity services, including support and advocacy for mothers and bonding with infants. Participants estimated that most fathers attend births and visit their partner and infant on the postnatal ward, 52% attend antenatal appointments and 76% are present at postnatal home visits. Participants reported several midwife strategies and health service factors which facilitate father attendance and active engagement. On the other hand, participants reported several barriers to father engagement, including antenatal appointment schedules which are at odds with fathers' work commitments and the lack of on-site group antenatal education. Some of the barriers they reported are specific to the vulnerable communities for which they provide maternity care. Extraordinary circumstances were reported, including fathers working overseas, fathers in prison, new immigrant status that is often accompanied by a lack of family support to care for other children even during labour and birth, and poor socio-economic status. In addition, in many cultures, pregnancy and birth are seen as "women's work"; fathers would not traditionally be involved. Participants also reported that midwives lack training and confidence in engaging fathers, particularly in responding to fathers with mental health concerns. When providing care for families at risk of family violence, father attendance was perceived a significant disadvantage. KEY CONCLUSIONS: Midwife-provided health services represent a significant opportunity to include and address fathers, and midwives recognise the significant advantages of engaging fathers, unless there is a risk of family violence. However, midwives currently report lack of training and confidence in addressing fathers' needs, and several individual, social, cultural, and health service factors can present barriers to engaging fathers. IMPLICATIONS FOR PRACTICE: Given the substantial benefits of engaging fathers for women and infants, we argue that maternity services should promote father engagement, for example by offering after hours appointment schedules, free antenatal and parenting education, and workshops to upskill midwifery staff. Education regarding the importance of father participation and skills for working with fathers should be included in the undergraduate preparation of midwives and other key maternity care professionals. Addressing the challenges of providing care to a multicultural community requires sensitive discussion with families from each of those cultures.

The relationship between socioeconomic status and childhood overweight/obesity is linked through paternal obesity and dietary intake: a cross-sectional study in Chongqing, China.

BACKGROUND: The prevalence of obesity and overweight in childhood has increased dramatically over the past decades globally. Thus, the risk factors of overweight and obesity in children and adolescents must be studied. OBJECTIVES: This study aimed to reveal the prevalence of childhood obesity and examine the relationship between socioeconomic status (SES) and z-body mass index (z-BMI) via parental obesity and dietary intake using path analysis. METHODS: Stratified cluster sampling was used to select 17,007 participants aged 6-12 years on two avenues per region in urban, suburban, and rural areas. Path analysis was conducted to examine the mediators between SES and z-BMI. RESULTS: The prevalence rates of overweight and obesity were 13.36% and 8.60%, respectively, and were positively correlated with the father's education level, family income, a birth weight > 3000g, a parental obesity history, vegetable intake and red meat intake (all P < 0.05). Four mediators (paternal obesity history, red meat intake, vegetable intake, and nutritional supplements) were observed, and the four path analyses were significant (all P < 0.05). The adjusted total effects on z-BMI were significant for income (ßTot = 0.03; P < 0.01), father's education (ßTot = 0.05; P < 0.001), and region (ßTot = 0.11; P<0.001), and the total mediation effects were 20.69%, 16.67%, and 5.36%, respectively. All the variables accounted for 12.60% of the z-BMI variance. CONCLUSIONS: The prevalence of overweight/obesity in children was notable, and the relationship between SES and z-BMI was mediated by paternal obesity history and dietary intake.