A Better Start

Dads matter too!

A Better Start
Amy McDonald

Positive father and child relationships play a key role in the wellbeing and development of children. Research showing the impact of fathers (both biological and non-biological) on the wellbeing of expectant mothers, babies and children is gaining pace, build a strong case for father-inclusive practice. At Small Steps Big Changes (SSBC) increasing the opportunities for father inclusive practice, and broader system change with Dads engagement in mind, is a key area of focus.

A recent systematic review adds to the growing body of evidence highlighting the benefits of father-inclusive practice, in this case in relation to breastfeeding. The review undertaken by Abbass-Dick et al (2019) looked at studies of breastfeeding interventions that included a focus on fathers, either by themselves or in combination with the other parent, during the perinatal period. To be included, studies needed a comparison group, which typically compared those receiving the intervention with those who received normal care.

The review found 12 studies that met the predefined criteria for inclusion and were drawn from across middle and high-income countries. Studies looked at the effect of including fathers in relation to breastfeeding initiation, exclusivity and duration. The studies varied in relation to how the intervention was delivered, to whom and how often. Interventions were delivered prenatally or postnatally; some were delivered as one off interventions whilst others included multiple contacts. Some interventions were delivered individually and some in groups. The person delivering the intervention ranged from a trained lay or peer support worker to health professionals.

The results showed that across the different types of interventions, the inclusion of fathers led to improved breastfeeding outcomes. The inclusion of fathers was associated with higher rates of breastfeeding initiation, in three out of four studies. Five of the nine studies showed a significant increase in breastfeeding duration. Breastfeeding exclusivity was found to be higher in eight out of the ten studies. At 24 weeks post-partum, six of seven studies that targeted fathers, had a significant effect on breastfeeding exclusivity.

Improving breastfeeding initiation, exclusivity and duration is an important outcome for Small Steps Big Change (SSBC). In Nottingham, breastfeeding rates vary significantly with large inequalities between different wards in the city. Two of our ward areas have particularly low rates of breastfeeding initiation and duration. For Aspley, breastfeeding initiation is 50.9%, with breastfeeding at 6-8 weeks being 35.9%. In another ward, Bulwell, our 6-8 week breastfeeding rate is 31.8%. With lower initiation and prevalence rates in some of our wards, the argument for father inclusive practice is easily made.

Local breastfeeding support workers actively invite fathers to both antenatal contact and postnatal contacts and they are welcome to attend breastfeeding groups. Contact is always encouraged from fathers, but local peer supporters recognise that further involvement would be beneficial.

The workforce is currently working towards more father inclusive practice. SSBC offers ‘Think Dads!’ training, which is delivered through a train the trainer model across the SSBC partnership. To date, the training has been delivered to 226 participants from across 18 partnership organisations. The interactive training encourages participants to reflect on how their practice can become more father inclusive.

As the system in Nottingham continues to embrace father inclusive practice, the benefits and opportunities of including fathers, is likely to support the improvement in child development outcomes, including outcomes around breastfeeding.

Useful resources

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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