How is it possible that in the richest nation on earth, childbirth remains all too often a death sentence?
New data from the Centers for Disease Control and Prevention’s National Center for Health Statistics reveals that the United States is now the most dangerous place among high-income countries to give birth, with maternal deaths reaching the highest rate in nearly 60 years. Black women were disproportionately affected by maternal mortality, with a mortality rate 2.6 times higher than that of white women, and 30 percent of all maternal deaths occurred among Black women.
Doctors and health officials have attributed this alarming trend to numerous factors such as cardiovascular problems, healthcare disparities and the added pressure of COVID-19, including healthcare disruptions during the pandemic. Nevertheless, as we search for ways to prevent maternal mortality in the U.S., there has been a growing recognition of one key group’s role in promoting maternal health and reducing maternal mortality rates: expectant fathers.
By empowering and educating fathers-to-be — for example, by reforming family-related public policy, increasing access to healthcare services, improving communication between healthcare providers and fathers and promoting cultural and social norms towards father involvement in maternal and child health — we can reduce maternal mortality rates.
One way to empower fathers is through paid family leave policies, which a growing body of research suggests can have significant positive impacts on maternal health outcomes. For example, studies in Europe and other countries where paid family leave is extended to fathers suggest that even minimal paternal leave (two days to five weeks, compared to 12 to 40 weeks for mothers) has a positive impact on outcomes such as postpartum depression, maternal mental health, increasing postnatal medical check-ups and increased time spent with the infant.
In addition, paid paternal leave is also associated with lower wage and career gaps for mothers, more equal household financial contributions and more egalitarian household responsibility distribution. In particular, the research shows a significant increase in the time fathers spend with their children, especially among lower-income households.
Unfortunately, the United States lags behind other developed countries in terms of paid family leave policies. The Family and Medical Leave Act (FMLA) provides eligible employees with up to 12 weeks of unpaid leave, but this does not help fathers who cannot afford to take unpaid time off. Unpaid leave is not a realistic option for many workers who cannot afford it or who risk losing their jobs if they take it. Such policies are likely to be most effective when they secure a full or almost full-wage replacement, and when they provide incentives for fathers to take leave. In the U.S., paid paternity leave is dependent on employers offering it as a benefit to workers, and is therefore offered disproportionately to more advantaged employees, deepening racial and socioeconomic disparities. To address these disparities and improve maternal health outcomes, a federal paid family leave policy should be implemented in the United States.
Additionally, educating expectant fathers can also be a decisive factor in promoting maternal health. Simply put, fathers frequently lack knowledge about maternal health. By helping fathers understand the importance of attending prenatal appointments, recognizing danger signs during pregnancy, promoting healthy behaviors and seeking prompt medical attention when necessary, they can promote positive health outcomes.
Programs like “Fathers Supporting Breastfeeding,” for example, provide education and support to fathers to promote breastfeeding, which is associated with improvements in maternal and child health — everything from lower risks of asthma and diabetes, to lower risk of postpartum depression. In fact, paternal support of breastfeeding turns out to be one of the strongest indicators that new moms will attempt breastfeeding, and families with fathers who have participated in prenatal training are more likely to weather challenges and have a successful breastfeeding journey.
As powerful, vocal and visible advocates within their families and communities, fathers can help promote positive attitudes toward maternal health and encourage others to take action. A mixed-methods study the three of us are leading right now examines fathers as agents of change in reducing maternal mortality in the District of Columbia, which has one of the highest rates of maternal mortality, especially among Black women.
It is time to recognize the important role fathers play in maternal and child health and take steps to fully empower them through paid family-leave policies and education. By providing support and advocacy during pregnancy, childbirth and postpartum recovery, fathers can help ensure that their partners receive the care they need to have a healthy pregnancy and delivery.
Y. Tony Yang is a professor of health policy at the George Washington University’s School of Nursing and Milken Institute School of Public Health. Sherrie Flynt Wallington is an associate professor and health disparities and health equity researcher at George Washington University. Terrance Staley is the executive director of the Alliance of Concerned Men in D.C.