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• W2021003732 abstract "Sometimes when I am travelling with my husband, we visit cultures where it is customary to talk to the man rather than the woman. It offends me and makes me feel invisible when I am treated like an appendix to my husband, rather than a person in my own right. It strikes me that this is exactly the same feeling that fathers have described in qualitative studies 1, 2 when talking about their experiences with child health services in Sweden. Even if fathers appreciate the medical content of perinatal and postnatal services and understand that the mother, and then their child, should be the services' first priority, they constantly feel ignored and alienated by them. Although child health centre (CHC) nurses are generally positive towards the presence of fathers, they echo the fathers' experiences by viewing them as secondary, somewhat less able parents 3, 4. No wonder nurses do not address fathers directly, do not expect them to participate in the child's health surveillance as actively as the mother and give them misguided encouragement for being so good at changing diapers! Another experience that has helped me to understand how fathers feel when they visit CHCs is when I have to pick up the car at the mechanics. At the more traditional end of the business, there are still garages where pictures of pouting, half-naked women adorn the walls. These pictures, and some of the magazines on display, send a signal to me that as a woman I don't belong there, that I am an anomaly. Our study of the physical environments of 31 CHCs in Sweden showed that the environment included and addressed the needs of the mothers and children, rather than the whole family's 5. With virtually no pictures of fathers on the walls and with messages about men being primarily negative, as perpetrators of domestic violence or exposing the child to passive smoking, it can be hard for males to feel included in the CHC environment. The semiotic visual analysis we conducted during our study also showed that fathers played more with their child in the waiting room and read more of the information displayed in environments that were categorised as family oriented 5. Of course, men are excluded from child health services long before their child is born and old enough to visit child health centres. Studies of both prenatal 6 and postnatal care 7 show that men often feel left out of decision-making and lack support in their own parenting role. It is as if this traditionally female dominated area of life has a really hard time truly accommodating the needs of fathers. As a Scandinavian parenting researcher, it is very common to be met with awe at international conferences. Sweden's parental leave policies and universal child health services are widely admired. Paternal leave is just a dream for many countries, and Swedish policies have clearly done a lot to enhance the involvement of fathers compared with other countries 8. And just to make the point, involved fathers are important for their children; they have an impact on their child's development and welfare over and above that of the mother's 9. Why, then, is it the case that the service that reaches 98–99% of the child population in Sweden fails to endorse fathers as parents in their own right? Why does study after study show that fathers feel invisible and rendered incapable of a system that has, as one of its main goals, serving the whole family, not just the mother and the infant? And why are we still not doing anything about it? Even fathers who attend CHCs for check-ups do not participate in parenting groups. Why? Because they take place in the middle of the day when they work, there is not enough space for both parents to participate and, or, when it is time for fathers to take parenting leave, the groups are over 4. Fathers do not come along as often as mothers to the child health centres because CHC nurses do not expect or encourage them to 3, 4. It is not rocket science! Fathers' experiences can be used to help child health services to develop and become more inclusive of fathers and their needs. In a qualitative study performed in the United States, fathers were interviewed about the well-child visits at their paediatrician's office 10. Fathers reported specific reasons to attend the service, such as to support their child, ask questions, express concerns and gather first-hand information. They also tended to be more satisfied when they felt their questions had been dealt with appropriately. Barriers for participation included practicalities, such as work schedule conflict and a lack of confidence in their role. They also include maternal gatekeeping, a phenomenon where mothers, not always consciously, limit the father's involvement with the infant. Based on what we know from studies examining fathers' experiences of perinatal and child health services in Sweden 3-7 and elsewhere 10, and on work done by the Family Action Centre in Newcastle, Australia 11, I would like to propose a few very simple rules for health professionals working at CHCs to follow. It really is more common sense than anything else and does not cost any money: Even if health workers are doing their best, and think that they make fathers feel welcome, it is time to take fathers' experiences of feeling excluded by prenatal, perinatal and postnatal services seriously. Given that most studies have at least some bias towards more assertive and resourceful fathers participating, more vulnerable men are even more likely to be intimidated and alienated by a system that is not meeting their needs. If we are serious about our system serving the whole family, we have to do much better than that." @default.
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• W2021003732 date "2014-02-10" @default.
• W2021003732 modified "2023-10-04" @default.
• W2021003732 title "The invisible father: How can child healthcare services help fathers to feel less alienated?" @default.
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• W2021003732 doi "https://doi.org/10.1111/apa.12523" @default.
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