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The Impact of Fatherhood on Men’s Health
and Development
Milton Kotelchuck
1 The Importance of Fatherhood for Men’s Health
and Development over the Life Course
This chapter, the second of a pair of related chapters in this volume, provides a broad
overview, and new conceptualization, about the various ways in which fatherhood
influences the health and development of men. The first, chapter “The Impact of
Father’s Health on Reproductive and Infant Health and Development”, explores the
impact of father’s health on reproductive and infant health and development
(Kotelchuck 2021). Together these two deeply inter-related chapters endeavor to
illuminate the here-to-fore under-appreciated topic of the father’s importance and
necessary active involvement in the perinatal health period, including for his own
health and development. [For purposes of discussion in this chapter, the term
“perinatal period”will encompass the period from conception into the first few
months of life (i.e., pregnancy and early parenthood)].
As noted in the previous chapter, the traditional focus of the U.S.-based Maternal
and Child Health (MCH) field (and the closely aligned Obstetric, Pediatrics and
Nursing fields) has been on the mother’s health and behaviors and their impact on
reproductive and infant health and development outcomes. Reproductive health and
early parenting has been perceived as primarily, if not exclusively, the mother’s
responsibility and her cultural domain; and to a significant extent, fathers and men
have been excluded. Not surprisingly, as a result, the impact of fatherhood on men’s
health and mental health, especially in the perinatal period, has not been the subject
of much inquiry.
M. Kotelchuck (*)
Harvard Medical School and Massachusetts General Hospital Fatherhood Project, Boston, MA,
USA
e-mail: mkotelchuck@mgh.harvard.edu
©The Author(s) 2022
M. Grau Grau et al. (eds.), Engaged Fatherhood for Men, Families and Gender
Equality, Contributions to Management Science,
https://doi.org/10.1007/978-3-030-75645-1_4
63
First, these two chapters on father’s health are modeled after and build upon the
dual orientation of the current women’s preconception health movement in the MCH
field, which simultaneously addresses the impact of the mother’s health during
pregnancy on both infant’s health outcomes and on mother’s own lifetime health.
This intergenerational approach respects the integrity and health of both mothers and
infants simultaneously, without valuing one’s life above the other (Wise 2008). This
chapter, like chapter “The Impact of Father’s Health on Reproductive and Infant
Health and Development”, shares this same perspective; together they explore both
the father’s health contributions to infant health (in the previous chapter; Kotelchuck
2021) and the impact of fatherhood on men’s own health (in this chapter)—a
virtually new topic in the MCH literature.
Second, this chapter attempts to create a new conceptual framework that can
organize and document the multiple pathways by which the perinatal experiences of
fatherhood impact on men’s own health and development. By comparison to the
previous chapter, there is an even more limited and scattered set of research on this
under-explored topic. Several of this chapter’s conceptual themes build upon similar
themes first expressed in an earlier article on preconception health and fatherhood
(Kotelchuck and Lu 2017). This chapter however moves beyond its more limited
reproductive health time frame, explores additional, newly evolving paternal repro-
ductive health themes, and separates the reproductive health impacts on infants from
those on fathers. This chapter adopts a very broad holistic approach to men’s
health—blending physical, mental, social and generative health dimensions into a
single comprehensive longitudinal fatherhood health framework.
Third, this chapter, like the prior one, also explores the perinatal roots of the
impact of fatherhood on men’s health and development. Here-to-fore, fatherhood
research has been supported primarily by the large, well-established developmental
psychology literature that has repeatedly demonstrated positive impacts of father’s
involvement on multiple facets of child development and family relationships (Lamb
1975,2010; Yogman et al. 2016; Yogman and Eppel 2021). This chapter aims to
more explicitly expand the understanding of men’s full life course development as
fathers into earlier pre-delivery temporal periods.
Fourth, as noted in the initial associated chapter, this chapter’s focus on father-
hood and men’s health does not emerge in an ahistorical vacuum, but is linked to,
and hopefully contributes to, numerous ongoing political and professional move-
ments. In particular, this chapter is partially embedded in the larger evolving social
and gender equity debates over roles and opportunities for women and men in
society—especially given that many aspects of parenthood are socially determined
and that fatherhood is transitioning from an older, traditional, distant economic-
provider, patriarchy model to a newer one based on greater parental equity and
paternal engagement. The increasingly large numbers of women who have now
entered into the paid labor market, with its associated economic, social, and
childcare workplace transformations, is undoubtedly hastening these conversations.
This chapter also builds upon the National Academy of Science, Engineering, and
Medicine (NASEM) inspired multigenerational child-development efforts to foster
effective parenting and parenting health, but now expanded to explicitly include
64 M. Kotelchuck
fathers (NASEM 2016,2019). And finally, this chapter derives in part from the
emerging men’s health movement, with new added emphasis on fatherhood health
dimensions.
Fifth, and finally, it is hoped that in articulating the multiple domains of father-
hood’s impact on men’s health and development, this chapter, along with its
companion chapter, will encourage more paternal perinatal health research (both
basic and translational), will help guide more effective and targeted father-oriented
programs and policies, and will help generate further political will and advocacy for
their implementation. These, in turn should further encourage fathers’earlier, more
active and healthier involvement in the perinatal health period, strengthen what they
bring to, and take from, their fatherhood experiences, and improve their subsequent
health and development throughout their life course.
2 Pathways Through Which Fatherhood Impacts on Men’s
Health and Development
There are multiple potential pathways through which the experiences of fatherhood
could have an impact on men’s health and development during the perinatal preg-
nancy and early parenting period and over their life course. This chapter will note
and briefly explore the scientific evidence base for six distinct pathways. These
fatherhood health pathways, in turn, also directly and indirectly influence the current
and intergenerational health and well-being of their infants, partners, families, and
communities. Specifically,
1. Men’s physical health status during the perinatal period (pregnancy and
early parenthood)
2. Changes in father’s physical health during the perinatal period: Impact of
Fatherhood on Men’s Physical Health
3. Changes in father’s mental health during the perinatal period: Impact of
Fatherhood on Men’s Mental Health
4. Changes in father’s social health and well-being during the perinatal period:
Impact of Fatherhood on Men’s Social Well-being
5. Men’s psychological maturation of paternal generativity: Men’s Improved
Capacity for Parenthood and Fatherhood
6. Men’s life course development of fatherhood.
2.1 Men’s Physical Health Status During the Perinatal
Period
Men’s physical health during the pregnancy and early parenthood period has a much
more important and direct impact on reproductive and infant health than perhaps
The Impact of Fatherhood on Men’s Health and Development 65
most MCH professionals and parents have here-to-fore understood (Kotelchuck
2021). Given the traditional cultural focus on mothers and their well-being, the
topic of father’s health has not drawn much attention. However, and perhaps not
surprisingly, given men’s generally sub-optimal health status and health care utili-
zation, men’sphysical health status during perinatal period reveals substantial health
problems and potential opportunities for its improvement.
Ascertaining men’s health status on a population-basis during their prime repro-
ductive years has been methodologically challenging, and possibly here-to-fore of
limited reproductive health interest. Although some broad longitudinal epidemio-
logic data sets exists for men of childbearing ages, they are not usually stratified by
parenting status; the NHANES survey, for example, appears to have no publications
describing father’s health. Yet health status may differ for men between pre- and
post-fatherhood years. In general, though, matched-age fathers initially should be
healthier than non-fathers, as men with a wide variety of health issues are less likely
to achieve successful fertility (CDC 2019; Frey et al. 2008).
Choiriyyah et al. (2015) examined the 2006–2010 US National Survey of Family
Growth, which suggested that 60% of men aged 15–44 were in need of preconcep-
tion healthcare; 56% were overweight or obese; 58% binge drank in the last year;
and 21% had high sexually transmitted infection (STI) risk. Pre-pregnancy over-
weight and obesity is a more pervasive problem for men than for women
(53% vs. 29%) (Edvardsson et al. 2013), a fact which takes on added importance
since men’s obesity is an independent predictor of childhood obesity (Freeman et al.
2012). One might assume that fathers in the pregnancy and early parenthood period
would continue to still have a similar set of broad health risks. The MGH Obstetrics
Prenatal Fatherhood studies (Levy and Kotelchuck 2021) noted nearly 75% of
antenatal fathers are overweight (including 25% obese), reflecting their self-reported
low physical activity, high sedentariness and extensive media usage; plus 14% of
fathers revealed signs of infertility or delayed fertility. Smoking rates are highest
among men during childbearing years. For example, almost 30% of men aged
20–24, and 25% of men aged 25–34 smoked in Canada (Canadian Tobacco Use
Monitoring Survey 2006).
Men are well known for their lesser use of health services than women, even
adjusting for women’s reproductive health services usage (Bertakis et al. 2000;
Smith et al. 2006). Perhaps due to their own social construction of masculinity,
men differentially ignore screening and preventive health care and delay help
seeking for symptoms (Smith et al. 2006; Addis and Mahalik 2003). Yet the
opportunity for care exists, as most men (~70%) in the US would appear to receive
primary health care annually (Choiriyyah et al. 2015; Levy and Kotelchuck 2021).
However, too many receive no preconception health care at those visits; Choiriyyah
et al. (2015) reported very limited receipt of STI testing (<20%) or counseling
(<11%) services.
Perhaps similar to women, the pregnancy and early parenthood period could
be an opportune time to address men’s health needs overall. Limited, one-time,
self-reported assessments of father’s health status during the preconception and
antenatal periods suggest that there is much room for improvement in men’s
66 M. Kotelchuck
own physical health and health care utilization. There remains however great
need for more creative epidemiological studies of men’s overall health during
his prime reproductive years, specifically stratified by fatherhood status.
2.2 Changes in Father’s Physical Health During
the Perinatal Period
Pregnancy and early parenthood are associated with four broad sets of changes in
father’s physical health status: paternal weight gain; sympathetic pregnancy (cou-
vade) symptoms; brain and hormonal transformations; and increased longevity.
2.2.1 Paternal Weight Gain
Fatherhood, on a population basis, is associated with increased weight and elevated
Body Mass Index compared to comparable aged men who are not fathers. Using the
American Changing Lives panel data, Umberson et al. (2011), showed that fathers
have more accelerated weight gain throughout their life course and weigh ~14 lb
more than non-parental males. Garfield et al. (2016), using the National Longitudinal
Study of Adolescent to Adult Health (ADD Health) data base, documented that the
transition to fatherhood was associated with an additional weight gain of 3.5–4.5 lb
more for residential fathers than for non-residential fathers or non-fathers.
Moreover, the popular literature has noted and commented extensively on the
“Dad Bod”or “preg-MAN-cy weight.”One widely cited informal British study
estimates that new fathers gain 11 lb over the course of the pregnancy, speculating
that they partake in their partner’s binge eating, finish up the left over foods, eat out
more in restaurants, and increase eating to respond to their own stress (BBC News
2009). Saxbe et al. (2018) more formally assessed seven possible behavioral,
hormonal, psychological, and partner mechanisms for the increased weight gain in
fathers; they concluded the likely sources included decreased sleep, less exercise,
less testosterone, more stress, and partner effects (shared diets).
Specifically, the transition to fatherhood is associated with significant sleep
disturbance and disruption (e.g., partnered men with young children sleep approx-
imately 80 fewer hours per year than single, childless men (Burgard and Ailshire
2013)) and reduced time available for men’s own leisure and exercise (e.g., 5 h/week
decrease in physical activity with the first child and a further 3.5 h/week decrease
with a subsequent child (Hull et al. 2010)). Parenting-associated physical activity
declines are more pronounced for men than for women. Fatherhood was not asso-
ciated with changes in men’s diet (Saxbe et al. 2018). Paternal pregnancy weight
gains set the stage for men’s greater obesity morbidity throughout their lives
(Umberson et al. 2011; Saxbe et al. 2018).
The Impact of Fatherhood on Men’s Health and Development 67
2.2.2 Couvade Syndrome
In many cultures, fathers experience “Couvade syndrome”or “Sympathetic preg-
nancy”; that is, physical and psychological symptoms and behaviors that mimic the
expectant mother’s during her pregnancy and post-partum period (Kazmierczak
et al. 2013), including insomnia, nausea, headaches, toothaches, abdominal pain,
as well as increased stress and weight gain. Couvade is not a recognized (DSM-5)
mental illness or (ICD-10) disease. Thus, the extent of couvade syndrome’s preva-
lence has been difficult to ascertain, and estimates vary widely, from 11% to 65%,
depending on the symptoms and populations being assessed (Masoni et al. 1994).
Symptoms seem most common in the first and third trimesters, and most subside
after the baby is born (Brennan et al. 2007). The sources of couvade in men remain
elusive, drawing extensive psychological and psychosomatic theorizing (e.g., empa-
thetic responses to pregnancy; compensatory or even competitive symptoms; or
shared hormonal changes) (Kazmierczak et al. 2013). So called “primitive couvade,”
is associated anthropologically with male pregnancy rituals, in which men refrained
from, or partook in special antenatal or birthing rituals thought to impact the spirit of
the developing child. Couvade symptoms are associated with increased paternal
health service utilization, though they are often unrecognized or associated with their
partner’s pregnancy status (Lipkin and Lamb 1982).
2.2.3 Biologic Adaptions: Hormonal and Brain Structure
Transformations
While it has long been noted that women’s hormones change or adapt as a function
of motherhood (Fleming et al. 1997; Edelstein et al. 2015), there is also now growing
evidence of men’s biologic adaptation to fatherhood (Edelstein et al. 2015; Gettler
et al. 2011; Grebe et al. 2019). Testosterone, which is important to male sexuality,
mating and aggression, declines notably as men prepare to assume enhanced parental
roles. Testosterone levels are lower among fathers than non-fathers (Grebe et al.
2019), decline over the course of pregnancy (Edelstein et al. 2015), and further
decrease among fathers who more actively provide infant care compared to men who
provide little or no care (Grebe et al. 2019). The synchronous decline in paternal and
partner’s testosterone levels during pregnancy is associated with stronger post-
partum relationship investment (Saxbe et al. 2017). Among the ~6% of animal
species where males participate in parenting activities, the post-conception internal
regulation of testosterone levels increases the Darwinian survival of their children
(Grebe et al. 2019). Other paternal hormones: estradiol (Edelstein et al. 2015);
oxytocin (Gordon et al. 2010); and prolactin (Hashemian et al. 2016) increase in
men over the course of pregnancy and early post-partum period; and all are associ-
ated with increased child care, nurturing behaviors, and engagement in both men and
women.
68 M. Kotelchuck
The term “Dad Brain”has also gained some prominence in the popular literature,
perhaps inadvertently reflecting the new beginning exploration and documentation
of the plasticity of men’s brain structure associated with parenting. There is growing
evidence that both fathers and mothers neurally process infant stimuli in similar
manner (e.g., the global parent caregiving neural network) (Abraham et al. 2014).
Paternal brain plasticity is associated with greater paternal caretaking involvement,
especially in the social–cognitive pathway network (e.g., the amygdala-superior
temporal sulcus brain connectivity), which in part allows men to better infer infant
mental states from their behavior (Abraham et al. 2014). Fathers, like most mothers,
can recognize and pick out their own infant’s crying, but only if they spend extensive
time daily with them (Gustafsson et al. 2013). Moreover, within the first 4 months
postpartum, there are changes in the volume of gray matter in the regions of the
paternal brain involved in motivation and decision-making (Kim et al. 2014), further
suggesting plasticity in father’s brain after becoming a parent. Additionally, there is
an extensive and growing animal research literature showing paternal brain structure
changes with active fatherhood, especially among prairie voles (Rolling and
Mascaro 2017).
2.2.4 Paternal Longevity
And finally and positively, fathers live longer than men without children, even
controlling for marital status (Modig et al. 2017; Grundy and Kravdal 2008; Keizer
et al. 2011), similar to that reported for mothers. The longevity impact of parenthood
is stronger for men than women (e.g., 2.0 vs. 1.5 years greater life expectancy gap at
60 years of age (Modig et al. 2017)), and for fathers with 2 or 3 children versus none
(Grundy and Kravdal 2008; Keizer et al. 2011). As men age, fatherhood could be a
source of deep emotional satisfaction, as well as companionship and non-isolation.
Alternatively, these longevity findings may also reflect a confounding of healthier
men being more likely to wed and have children, which then play out over their life
course.
Father’s physical health is much more profoundly affected by the onset of
early fatherhood than perhaps most of the existing popular and professional
literature here-to-fore would have assumed. During the perinatal period and
likely beyond, father’s minds and bodies, like the mother’s, adapt biologically
to their new parenting roles—perhaps preparing them for the physical and
mental stresses, joys, and requirements of parenthood. The changes in men’s
physical health associated with fatherhood should encourage both greater
attention to paternal health promotion activities and increased utilization of
reproductive and primary health care services during the perinatal time period
and beyond. Basic research on this topic is now just beginning, with the
emerging interest in father’s perinatal health.
The Impact of Fatherhood on Men’s Health and Development 69
2.3 Changes in Father’s Mental Health During the Perinatal
Period
Pregnancy and the onset of parenthood is a time of substantial mental health
transition for men—as it is for women (Singley and Edwards 2015). There is greater
awareness and recognition of fatherhood’s impact on men’s mental health than on
his physical health. Perhaps the greater awareness of perinatal mental health issues is
due to the growing appreciation of perinatal depression on maternal and infant health
and the increasing calls to similarly address paternal mental health needs by the
family sociology, clinical psychology, and nurse-midwifery communities (May and
Fletcher 2013; Baldwin and Bick 2018). Men’s mental health responses to father-
hood are very salient during pregnancy and early parenthood—both as sources of
stress and of growth and love. And in turn, father’s mental health status profoundly
influences maternal reproductive and parenting health and infant health and devel-
opment (Kotelchuck 2021; NASEM 2016,2019).
Parenthood, especially for first time fathers, is an unknown and unfamiliar event,
out of his normal control (Baldwin et al. 2018); multiple potential sources of
perinatal stress emerge, including the changing relationship with the mother,
added financial obligations, and concerns over the ability to be a competent parent
(Coleman and Karraker 1998; Singley and Edwards 2015). Moreover, given limita-
tions in parenting- and sex-education in schools and in gender role experiences
developmentally, most men have limited or no understanding about pregnancy
biology, perinatal health services, or practical parenting skills. They often feel
helpless about what to do or expect as they enter into fatherhood. Postnatally, fathers
confront additional new concerns about work-family balance, childcare logistics, all
while sleep deprived, and often with limited social or peer support to help them
adjust to their new fatherhood roles. Moreover, today, men, especially first-time
fathers, are further challenged to create a new internal fatherhood identity for
themselves (Baldwin et al. 2018), and often with deep conflicting fatherhood gender
role expectations at play (Singley and Edwards 2015). Most men today were raised
in an era with more traditional male gender roles and now are being confronted with
expectations for more engagement and equity in childcare, roles that some men may
perceive as more feminine or weak; i.e., something of a fatherhood generation gap
exists today. Overall, these and many other factors contribute to a potent brew of
men’s mental health challenges in the pregnancy and early parenting period.
2.3.1 Paternal Stress, Anxiety and Depression
Paternal stress. Given the formidable parental role transformations associated with
fatherhood, not surprisingly, there are numerous reports of elevated paternal stress
associated with pregnancy and early parenthood. A review article by Philpott et al.
(2017) located 18 quantitative studies on paternal perinatal stress, 11 with elevated
stress levels. Paternal stress increases continuously throughout the antenatal period,
70 M. Kotelchuck
peaks at birth and then declines afterwards. The principle factors identified that
contribute to paternal stress included negative feelings about the pregnancy, role
restrictions related to becoming a father, fear of childbirth, and feelings of incom-
petence related to infant care. Higher stress levels negatively impact father’s health
and mental health, contributing to increased anxiety, depression, psychological
distress, and fatigue (Philpott et al. 2017).
The MGH Obstetric Prenatal Fatherhood studies (Levy and Kotelchuck 2021)
reinforce these observations antenatally; ~56% men endorsed the observation that
pregnancy is associated with high levels of paternal stress; with concerns focused on
financial issues (44%), ability to care for the baby (29%), less time for self (20%),
changing relationship with mother (15%), and not repeating their father’s mistakes
(14%). Further, 35% of men reported not having any place or person to go to for
fatherhood support, which likely further added to their stress symptoms.
Paternal anxiety. Substantial levels of clinical anxiety disorders are found among
men during the perinatal period. A recent systematic review by Leach et al. (2016)
reported the prevalence rates of anxiety disorders in men ranged between 4.1% and
16.0% during the prenatal period and 2.4–18.0% during the postnatal period.
[As compared to a 13.0% rate in general population of men (McLean et al. 2011).]
Anxiety disorders increase steadily throughout antenatal period and then decline
after birth (Philpott et al. 2019). Factors contributing to anxiety disorders included
lower income levels, less co-parent support, fewer social supports, work-family
conflict, partner’s anxiety and depression, and paternal anxiety history during a
previous birth. Higher anxiety levels increase paternal stress, depression, fatigue,
and lower self-efficacy (Philpott et al. 2019). The few behavioral or education trials
to reduce paternal anxiety, to date, have all been successful (Philpott et al. 2019).
Paternal depression. There are numerous reports of elevated levels of depression
associated with fatherhood. A meta-analysis of the prevalence of men’s depression
in the perinatal period (Paulson and Bazemore 2010) showed higher rates of paternal
depression (10.4%) than in similar aged men in the general population (4.8% over a
12-month period) (Kessler et al. 2003). Garfield et al. (2014), using the ADD Health
data, documented that new fathers were 1.68 times more likely to be depressed
compared to comparable aged men without children, and that resident father’s
depression symptoms increased from before pregnancy through the pregnancy and
beyond. The Paulson and Bazemore (2010) analysis documented substantial rates of
paternal depression throughout the pregnancy: 11% in first and second trimester and
12% in third trimester; and then varied rates throughout the first year post-partum:
8% at 1–3 months, peaking at 26% at 3–6 months, and then 9% from 6 to 12 months.
When stratified by country, paternal depression rates are higher in the
U.S. (14.1%) than in the rest of the developed world (Paulson and Bazemore
2010), perhaps associated with the lack of childcare support and paid parental
leave in the U.S. (Glass et al. 2016). Paternal depression is strongly correlated
(r ¼~.30) with maternal depression (Ramchandani et al. 2008; Paulson and
Bazemore 2010), though prevalence rates are consistently higher for mothers. In
the MGH Obstetric Prenatal Fatherhood studies, 26% of the antenatal fatherhood
sample endorsed at least one of the two PHQ-2 depression screener symptoms, with
The Impact of Fatherhood on Men’s Health and Development 71
8% reporting more severe or frequent symptoms (Levy and Kotelchuck 2021).
A wide variety of risk factors have been linked to paternal depression; including
prior mental health depression experiences, changing paternal hormones, lack of
social supports, maternal depression, and poor relationship satisfaction (Singley and
Edwards 2015; Gemayel et al. 2018).
Paternal post-partum depression. Increasingly, there has been a heightened
awareness that post-partum depression (PPD) is not restricted to only women, and
that men also experience PPD (Kim and Swain 2007; Ramchandani et al. 2008;
Singley and Edwards 2015). Paternal PPD is increasingly recognized as a chronic
condition, with the 10% prevalence rate from the Paulson and Bazemore (2010)
meta-analysis widely quoted. Ramchandani et al. (2008), using the Avon Longitu-
dinal study (ALSPAC) found the highest predictors of paternal PPD to be high
prenatal anxiety, high prenatal depression, and a history of severe depression;
findings consistent with a more recent meta-analysis (Gemayel et al. 2018).
2.3.2 Behavioral and Externalizing Mental Health Impacts
The mental health consequences of fatherhood aren’t only manifested internally, but
also through externalizing behaviors. Men often express their depression, stress, or
anxiety through “self-medicating”drinking, over-eating, interpersonal anger, or
physical absence. Intimate partner violence (IPV), for example, is known to be
markedly elevated after conception and again after delivery (Nannini et al. 2008).
Many new fathers retreat to over-working at their employment (the traditional model
of fathers as providers) to partially withdraw from their infant care and family
involvement and associated stresses (Singley and Edwards 2015; Baldwin et al.
2018). Research on this topic is limited, although theoretically, many negative
paternal perinatal health behaviors can be interpreted as mental health linked.
2.3.3 Positive Mental Health Impacts
While fatherhood is a time of much negative emotional stress, it is also a time of deep
joy, happiness, and satisfaction for most men. While most qualitative studies of
men’s mental health during the perinatal period acknowledge positive emotional
responses, few have explored them in detail. Baldwin et al.’s(2018) systematic
review of this topic noted that paternal satisfaction resulted from achieving mastery,
confidence, and pleasure over the reality of dealing with a newborn, becoming a
competent father, and doing it in a constructive way with one’s partner. Moreover,
some men’s negative health behaviors change for the better as they move into their
new parental roles, similar to many women. In the Fragile Families and Child Well
Being Study, for example, among low-income urban fathers,fatherhood was asso-
ciated with more healthy behaviors and decreased substance use (Garfield et al.
2010). In this chapter’s subsequent fifth section (Sect. 2.5), the positive impact of
72 M. Kotelchuck
fatherhood on men’s psychological development and generativity is further
explored.
2.3.4 Perinatal/Infant Specific Sources of Paternal Depression
The post-partum mental health impact of fatherhood has bi-directional roots; it can
be influenced by the infant’s health and behavior characteristics, not just by men’s
own psychological responses to the pregnancy and his new paternal and family roles.
Fatherhood and pregnancy loss. While there is a robust literature on the impact
of fetal loss on mothers’mental health, the equivalent literature for fathers is very
limited. A summary review by Due et al. (2017) identified only 29 articles on
paternal responses to fetal loss versus 3868 articles on maternal responses. They
concluded that fathers primarily feel the need to be supporters of their partners, but
that they also feel overlooked and marginalized about their own responses to the
loss. Fathers, like mothers, experience a loss of parental identity and of parental
hopes and dreams for their deceased infant, though these negative emotions appear
less enduring for fathers. There is a striking absence of informational brochures or
clinical materials specifically directed towards fathers to help them deal with the
emotional trauma of fetal loss.
Fatherhood and prematurity. Fathers of premature or low birth weight (LBW)
infants are more likely than mothers to experience post-partum depressive symptoms
(Cheng et al. 2016). This takes on added significance since paternal depression is
also an independent predictor of subsequent child development (Cheng et al. 2016).
Interventions to address the mental health needs (including depression) of parents of
infants in NICUs are increasing, but only some are directed at both parents (Garfield
et al. 2014).
In sum, the perinatal period is a time of significant mental health transition
for fathers, especially first-time fathers, as they address the multiple new
challenges of fatherhood. Fatherhood is associated with both substantially
elevated levels of stress, anxiety, and depression, as well as joy, pride, and
emotional maturation. Interest in men’s perinatal mental health derives heavily
from the increasing appreciation of maternal depression and its impact on
reproductive and child outcomes. Paternal mental health has been the main
initial area of focus for the exploration of the impact of fatherhood on men’s
health. Moreover, men’s perinatal mental health necessarily engages with
important cultural crosscutting themes such as contemporary masculinity,
family gender roles, and work-life balance. Only recently has there begun to
be any, even slight, professional recognition of men’s own mental health needs
in the perinatal period, and virtually no mental health services are directed
towards them.
The Impact of Fatherhood on Men’s Health and Development 73
2.4 Changes in Father’s Social Health and Well-Being
During the Perinatal Period: The Impact of Fatherhood
on Men’s Social Health and Well-Being
Fatherhood doesn’t only influence men’s physical and mental health, but also his
social health and well-being. Fathers differ from non-fathers in their social connec-
tions, family relationships, and work behavior (Eggebeen and Knoester 2001). Each
of these can directly impact maternal, infant, and men’s health and development.
While the MCH reproductive health community (and popular culture) widely
acknowledges and embraces the women’s changing social roles (and prestige) as
new mothers, the same is not true for the social transformative impact of men
becoming fathers. By contrast, many other professional communities, in business,
social welfare, governmental policy, and economics, have grappled more with men’s
social well-being and how it is impacted (positively and negatively) by fatherhood,
especially as it relates to gender role equity at home and work (Bowles et al. 2021).
Indeed, most of this larger book focuses on father’s social well-being in society. This
topic also reflects, in part, the emerging social determinant of health (SDOH)
perspectives in the MCH community, recognizing that fathers are often the main
vector for family’s SDOH (Kotelchuck 2021). However, importantly here is a new
recognition that the father’s social well-being (and SDOH characteristics) are not
static but are malleable during the perinatal period.
2.4.1 Fathers as Employees
Fatherhood has the potential to profoundly challenge men’s relationship to his
employment and his traditional employee social roles. Fathers now face new,
competing, and deeply-valued societal pressures: to be engaged nurturing fathers
and to continue to be economically productive employees (Hobson and Fahlen
2009). New fathers experience substantial added social role conflicts over work
versus family life (Baldwin et al. 2018; Harrington 2021; Ladge and Humberd
2021). These may further heighten men’s own conflicting internal cultural views
about the nature of work and the newer involved fatherhood concepts of this era—
especially since most men’s identity and sense of masculinity is heavily influenced
by his employment/career and its associated income (Humberd et al. 2015; Ladge
and Humberd 2021). Men, in general, increase work hours post-delivery, perhaps in
part to meet the growing family economic needs and to further assume men’s
traditional breadwinner social roles (Hodges and Budig 2010). Men’s post-delivery
work experiences as a father can become a critical arena for impacting his health,
mental health, and sense of responsibility for his family’s well-being. [Many of the
subsequent chapters in this book examine the social health and well-being chal-
lenges that new working fathers experience in trying to achieve a healthier work-life
balance, and the employment and social welfare policies and practices that could
help alleviate them.]
74 M. Kotelchuck
Second, on a more positive note, for some fathers, employee-based paid paternal
newborn leave provides a special opportunity for their psychological and practical
growth as parents (i.e., paternal generativity). Fathers who take 2 or more weeks of
leave are more involved in direct childcare at 9 months (Nepomnyaschy and
Waldfogel 2007), are more likely to remain in their marital relationship (Petts
et al. 2019), and to enhance their partner’s health and wealth (Persson and Ross-
Slater 2019); though the direct benefits for fathers of paid paternal leave have been
less well researched. Short or no paternal newborn leaves, in general, are associated
with difficulties establishing a sense of paternal identity, paternal confidence, and
competence in caregiving, and more work-family stress (Harrington et al. 2014).
Third, fatherhood, like for motherhood, can contribute to men’s capacities to be a
better employee. Father’s psychological development and maturity, and the skills of
parenthood, often carry over into the workplace, including better self-managerial
skills, enhanced time management, focus, patience, responsibility, and leadership
(Ladge and Humberd 2021). Fathers at work are perceived as more kind, compas-
sionate, and mature (Humberd et al. 2015), and builders of social connections and
bonds (Ladge and Humberd 2021). Among men with similar skill levels and CV’s,
fathers are more likely to be offered a position (Correl et al. 2007). There is a
growing recognition within business communities, especially their human resources
professionals, that more family- (and father-) friendly workplaces are associated with
higher productivity and profits than traditional workplaces—possibly through more
motivated, loyal, and skilled employees, with less work-family conflict, staff turn-
over, and burn out (Ladge et al. 2015; Ladge and Humberd 2021; Harrington 2021).
2.4.2 Fathers as Family and Community Members
It is widely believed that fatherhood, for most men, draws them ever more tightly
into their family and community; and, in general, men do adapt to society’s father-
hood expectations and family social welfare responsibilities, no matter what their
personal perspectives are on the nature of fatherhood. The MCH reproductive and
child development communities acknowledge this important paternal social role
transformation, but mostly from a negative or deficit perspective, focusing heavily
on father-absent or “deadbeat dad”families. Rarely, does the MCH community
discuss paternal family commitment and community involvement from a majoritar-
ian perspective that focuses on father’s positive transformative social well-being.
[The impact of the non-residential father-absence on children and men’s develop-
ment is discussed, in part, by others in this book (Yogman and Eppel 2021).]
First, the vast majority of fathers readily acknowledge their paternity. Histori-
cally, acknowledgement of paternity was related to infant legitimacy and inheri-
tance, and was closely tied to the marital status of the father and mother. Despite
increases in births to unmarried parents (~40% of U.S. births) (Martin et al. 2019),
the rate that men embrace and acknowledge their paternity is increasing (Almond
and Rossin-Slater 2013); perhaps a reflection the increased legal mandates to
establish an “Acknowledgement of Paternity”(AOP) for each birth to an unmarried
The Impact of Fatherhood on Men’s Health and Development 75
mother in the U.S. Birth outcomes among unmarried women with partners who sign
an AOP were significantly better than among unmarried women without an AOP,
though still not as positive as among married women (Almond and Rossin-Slater
2013.)
Second, though obviously a partnered decision, the vast majority of fathers reside
with and support their families financially, practically, and emotionally during the
perinatal period and beyond (whether married or not). Clearly, over time the extent
of this involvement does decline, especially among poorer and unmarried families.
In the U.S., among Fragile Families Study participants, only 50% of unmarried
couples cohabitating at birth are still living together at the child’sfirst birthday, and
just 37% are by the child’sfifth birthday (Carlson et al. 2008). But even among the
non-residential fathers studied, fatherhood serves as a source of engagement and
social well-being for themselves and their children; the majority saw their children at
1 year of age and provided informal and in-kind support (Carlson et al. 2008);
fatherhood gave meaning to their lives (Garfield et al. 2010). Married marital status
increasingly is a marker of higher social classes, conveying social and developmen-
tal benefits for the father and his children (McLanahan et al. 2013). Moreover,
fatherhood is not restricted solely to biologic fathers, many other men assume
parental roles, nearly 4% of U.S. children under age 6 live with a mother and a
step-father (Census 2018). The father’s continued involvement and presence in his
family can be viewed, in part, as a bi-directional impact of fatherhood on men’s
social well-being—a positive behavioral response to stresses and joys of parenthood
and his relationship with the child’s mother.
Third, positive perinatal cultural and institutional support for men’s social tran-
sition to fatherhood is quite limited. Many community and professional organiza-
tions and cultural practices are prepared to honor women’s new maternal social role
and to welcome her and her infant into their communities (e.g., baby showers,
prenatal yoga classes, maternity stores, etc.). There are no similar equivalent positive
cultural acknowledgements for men’s changing social roles. With the exception of
limited father-inclusive child-birth education classes, most maternal reproductive
health services do not actively encourage father’s involvement or acknowledge his
new emerging fatherhood status (Steen et al. 2012). Moreover, fatherhood, like the
experiences for some women, can also sometimes reveal or increase men’s social
isolation from their communities. In the MGH Obstetric Prenatal Fatherhood studies,
35% of fathers reported that they had no place to go for fatherhood support or
information (Levy and Kotelchuck 2021). Fatherhood and men’s family and com-
munity involvement needs greater and earlier perinatal social affirmation. If it takes a
village to raise a child, that village needs to include the fathers.
2.4.3 Fathers as Economic Providers: Fathers Own Lived SDOH
Transformations
Most father’s and family’s economic realities are transformed as a result of parent-
hood. Families, almost by definition, have decreased per capita income and
76 M. Kotelchuck
substantial new direct childcare expenses, though some potential new financial
resources. The impact of fatherhood on the transformation of men’s own social
and economic welfare, his own lived social determinants of health (SDOH) charac-
teristics, has yet to emerge as a topic in the MCH reproductive health community.
First, fathers are eligible for some societal benefits that favor families relative to
single or married men without children. The latter are often restricted from social
welfare benefits, such as paid paternity leave or family allowances, or are the last to
receive access to public housing, food-assistance, or medical care programs—a
positive discrimination in favor of fathers. Tax benefits in the U.S., including direct
child, child and dependent care, and earned income tax credits (EITC), in general,
also favor working families, and therefore fathers with children.
Second, economists have documented a “fatherhood wage bonus,”and women’s
income “motherhood penalty.”In adjusted analyses, fathers earn 6% more salary
than non-fathers (Budig and Hodges 2014). Additionally, the wage gaps between
employed men and women increases substantially for parenthood; non-parent
women earn 93% of non-parent men’s salary, whereas, working mothers earn only
76% of father’s wages (Budig and Hodges 2014); plus, this wage gap is even greater
for low-income fathers and mothers, further reinforcing social disparities. In some
employment situations, fatherhood is associated with a “fatherhood premium,”
increased wages to be able to support their families (Correl et al. 2007).
Third, fatherhood can, however, also limit or harm men’s social health and
financial status, especially for non-residential, low income, and minority fathers,
whose social welfare benefits are heavily influenced by federal and state government
programs and policies. U.S. policies often both encourage and discourage paternal
involvement with their families—perhaps reflecting the current political ambiva-
lence towards such fathers and their partners (Edin and Nelson 2013). Many social
welfare programs are structured to penalize or limit benefits for non-residential,
non-married fathers. Traditional U.S. family welfare and Medicaid eligibility was
explicitly restricted to mothers without residential male partners. Aggressive federal
and state child support enforcement agency efforts, while potentially enhancing
mother’s income, often inadvertently decrease father’s family involvement, by
further burdening the poorest men with high arrears penalty interest rates, asset
seizures, and possible incarceration (Tollestrup 2018; Boggess et al. 2014). And the
U.S. “War on Drugs”disproportionately ensnared poor men (and often fathers) of
color. The major U.S. federal Healthy Marriage and Responsible Fatherhood Initia-
tive (ACF 2019) primarily emphasizes the father’s traditional social and financial
family roles; it provides low income men with relational skills and marriage moti-
vational training, though not direct income or social welfare supports. Its initial
program evaluations were mixed (Knox et al. 2011); perhaps its limited, politically-
influenced, individual responsibility training model may be insufficient to overcome
the structural realities for poor fathers in the U.S. Other countries, especially in
Europe, provide more positive supports for father’s social well-being as part of their
more universal family social welfare policies—including father-specific paid family
leave and family allowances (see, e.g., Kvande 2021, in this volume).
The Impact of Fatherhood on Men’s Health and Development 77
Overall, men’s own social health and well-being is impacted by their expe-
riences of fatherhood—in employment, family, community involvement, and
economic resource provisions. Each of these social experiences of fatherhood
are important influences on men’s physical health, mental health, and paternal
generativity, which in turn can directly impact reproductive and infant health
and development. While the social transformation of women into mothers is
widely acknowledged and celebrated, a similar recognition of the social health
transformation of men becoming fathers is lacking—especially in the MCH
reproductive health community. Fatherhood can change men’s own SDOH
characteristics, though the extent may depend on the unique employment and
social welfare policies and practices within each country. The United States, in
particular, has weak and often punitive social welfare policies that substantially
impact on low income and non-residential fathers. Further reproductive health
research on the social impact of fatherhood is needed.
2.5 Men’s Psychological Maturation of Paternal
Generativity: Men’s Improved Capacity for Parenthood
and Fatherhood
Fatherhood can be a major influence on men’s own adult psychological development
and maturation, especially during his first pregnancy and early parenthood experi-
ence. This transformation represents one of most important health impacts of
fatherhood. Virtually all men can biologically procreate children, but it takes more
than just sperm to become a father. Having children is a powerful biologic urge that
can profoundly affect men and women’s psychological maturation. Many fathers,
similar to most mothers, go through substantial psychological transformations and
growth during the perinatal period. Fatherhood can be viewed as an adult psycho-
logical developmental stage of life.
Psychological transition to fatherhood. In reviews of men’s psychological
transition to fatherhood studies, Genesoni and Tallandini (2009) found pregnancy
to be the most demanding period for the father’s psychological reorganization of
self, and labor and birth to be the most emotional moments. Baldwin et al. (2018)
characterized some of the most salient features of men’s positive psychological
transition into their new fatherhood identity: “Becoming a father gave men a new
identity, which made them feel like they were fulfilling their role as men, with a
recognition of changed priorities and responsibility and expanded vision; however
they worried about being a good father and getting it right.... Fathers who were
involved with their child and bonded with them over time found the experience to be
rewarding. Those who recognized the need for change, adjusted better to the new
role, especially when they worked together with their partners.”Beyond the limited
and predominantly qualitative professional literature, this developmental transition
is perhaps best noted in the popular media through movies and television shows that
78 M. Kotelchuck
capture the profound paternal psychological transformation of men as a result of
parenthood (e.g., Kramer vs. Kramer;Mrs. Doubtfire;Three Men and a Baby; and,
more recently, Marriage Story).
There are numerous different terms used to describe this developmental transfor-
mation in men from biological procreation to responsible fatherhood. For many, it is
commonly and best discussed in terms of life fulfillment, or even of religious or
spiritual goals (e.g., “Fatherhood as the highest calling in life”). I prefer to use the
psychological term of “generativity”to describe this transformation; it is a term
coined by Dr. Erik Erikson (1950) and defined as “establishing and guiding the next
generation, with a capacity for love and sense of optimism about humanity”(i.e.,
successfully nurturing the next generation). Hawkins and Dollahite (1997); Dollahite
et al. (1997), and Hawkins and David (1997) have expanded on this concept and
coined the term “generative fathering,”a perspective on fathering rooted in the
ethical obligations for fathers to meet the needs of the next generation. They
conceptualize fathering as generative work, rather than as a social role, embedded
in a changing socio-historical context from which both fathers and children benefit
and grow. Singley and Edwards (2015) interpret the term generative fathering to
describe the type of parenting used by fathers who respond readily and consistently
to their child’s development needs over time, a key element of Erik Erikson’s adult
development theory, rooted in broadening the sense of self to include the next
generation. The generative fathering perspective highlights a clear way that men
can focus their instinct to protect and to provide for their children in a strengths-
based way—by being involved and responsive to their children’s needs even from
their earliest (antenatal) age. Moreover, the concept of generativity, or generative
fathering, adds an internal motivational and a moral dimension to men’s ongoing
psychological transformation in becoming fathers, a sense of paternal agency. Men
themselves are, and must be, the agents of their own psychological transformation.
Even for the most marginalized fathers, creating and nurturing life is perceived as
one of the most meaningful statements about one’s presence on earth and contribu-
tion to life (Edin and Nelson 2013). In the Fragile Families and Child Well Being
Study, fatherhood was associated with being present for their child’s future (Garfield
et al. 2010). From a parallel perspective, Roubinov et al. (2016) describe “familism”
in Latino (specifically, Mexican-origin) communities as a father’s deep ethical and
cultural commitment to nurturing his children and family, even if also deeply imbued
with a “machismo”social-roles perspective. Additionally, the Black women’s repro-
ductive justice movement is now also beginning to recognize the importance of
reproductive and economic justice for their impoverished Black male partners as
well (e.g., Edwards et al. 2020).
As fathers are increasingly present with their partners in the delivery room, there
is now a growing literature on its transformative effects on men’s psychological
development (Genesoni and Tallandini 2009; Darwin et al. 2017; Baldwin et al.
2018; Johansson et al. 2015). Fathers can share the joy and miracle of birth, be
supportive of their partners, and further crystalize their own paternal role transition.
However, many men report very mixed experiences in the delivery rooms, with
clinical staff not always supportive of their presence (Steen et al. 2012; Jomeen
The Impact of Fatherhood on Men’s Health and Development 79
2017). Only recently have a few birthing services intentionally tried to enhance the
father’s contributions and engagement, both to foster a more positive family-forming
health event and to support men’s own psychological development as fathers (Pol
et al. 2014; Johansson et al. 2015).
Programmatic support for men’s psychological transition to fatherhood.
Fatherhood psychological transition is not universal. Generative or responsible
fathers don’t just magically appear, but they emerge from a gradual transformative
process, and they can be helped along in this transformation. Going beyond the
previously noted politically constrained U.S. federal Healthy Marriage and Respon-
sible Fatherhood Initiative (ACF 2019), non-governmental community-based, par-
enting, social service, advocacy, and religious organizations, especially in the Black
community, have taken the initiative to develop local fatherhood programs (e.g.,
Concerned Black Men of America, Omega Psi Phi Fraternity, etc.). These programs
generally emphasize men’s own social and psychological transformation and
healing; paternal responsibility and generativity; and moral, spiritual, and psycho-
logical engagement with their children; as well as financial and social support of
their families. They are backed up by national fatherhood resource and training
organizations (e.g., The MGH Fatherhood Project, the National Fatherhood Initia-
tive, Mr. Dad, etc.). These organizations explicitly counter the debilitating myths of
Black men’s non-involvement with their children.
The Healthy Start Initiative was the first and is currently the principal
U.S. national MCH perinatal program to actively incorporate a positive mandate to
address Fatherhood and Male Engagement (Healthy Start 2019). Its “Dads Matter
Initiative,”with its “Dads and Diamonds are Forever”curriculum, and an annual
fatherhood conference, emphasizes father’s“inclusion, involvement, investment and
integration”across the life course, enhancing men’s sense of value to himself, his
children, the mothers of his children, and his community (i.e., generative fathering)
(Harris and Brott 2018). Several other MCH programs, serving low-income com-
munities in the U.S., such as home visiting, Head Start academic enrichment, and the
WIC nutrition supplementation programs, also have begun to target and address
father’s needs, though not yet as systematically as Healthy Start (Davison et al.
2019).
The perinatal period for many men, as for women, is also a period of marked
openness for behavioral, socio-emotional, and health changes (Addis and Mahalik
2003), wherein fatherhood imperatives can trump masculine stereotypes. Mental
health, relational, and fathering skills can be taught (Knox et al. 2011; Levy et al.
2012; Tollestrup 2018). The transition from a more traditional distant fatherhood
role to a more equitable child caretaking partnership may also free up men from other
gendered sex role stereotypes that diminish their psychological capacities to expe-
rience and express emotions, acknowledge health needs, or treat their partners more
respectfully. Father’s psychological developmental transitions during the perinatal
period however are not generally recognized or appreciated by most reproductive
and primary health care professionals, nor are there programmatic services or
support for men’s growth as generative fathers (Pol et al. 2014; Johansson et al.
80 M. Kotelchuck
2015). Much more research is needed to understand what facilitates the growth of
men’s paternal generativity, or even how best to measure it.
Similar to women, men’s adult psychological developmental as a more
generative parent is one of most important positive mental health impacts of
pregnancy and early fatherhood, especially for the first time fathers. Paternal
generativity doesn’t just happen. While the momentum for paternal
generativity must ultimately come from, and be empowered by, each man
himself, all MCH and father-involving programs should consciously engage
with and support his developmental maturation. We must go beyond the
limited federal emphasis in the U.S. on men’sfinancial and marital responsi-
bilities only; and we must create, culturally and professionally, the paternal
expectations and opportunities for men to celebrate the joys and deep satisfac-
tions of fatherhood. Most fathers make the successful adult psychological
transition to being a more generative parent and are happy to have done so.
2.6 Men’s Life Course Development as Fathers
The development of generative responsible fathers reflects a gradual longitudinal
process that has its roots long prior to the pregnancy conception and continues long
after the delivery; and it can be helped and hindered all along the way. Paternal
generativity is both personal and intergenerational. The perinatal period, the focus of
this essay, is one of its principle sensitive periods of accelerated growth.
Kotelchuck and Lu (2017) in their publication on men and preconception health
graphically highlight several key conceptual features about the growth of men’s
paternal generativity over the life course. To quote from that article:
“First, as with women’s reproductive life course (Lu and Halfon 2003), it [Fig. 1,as
reproduced here] encourages us to view men’s health and development longitudinally,
recognizing that the impact of his health and generativity transcends the moment of
pregnancy conception, and appreciate the intergenerational continuity and the
bi-directionality of men’s health. Father’s reproductive health and generativity is not
fixed; each stage of life and health builds on both prior and current life and health
experiences and evolves over the life course (Fine and Kotelchuck 2010). This new MCH
fatherhood life course graphic acknowledges that some men have more negative or positive
life experiences; that the root causes of men’s reproductive health and paternal generativity
reflects both the negative and positive social determinants influencing his past and current
health –including his adverse childhood and adolescent experiences, sexual health educa-
tion and socialization, current and past poverty, employment, and environmental and
occupational exposures, etc. The paternal MCH life course model thus reflects both a
resiliency and a deficit perspective. One’s reproductive potential is not immutable. We can
and must help build boys’and men’s resiliency to achieve both the biology and paternal
generativity of fatherhood, and thereby optimize both their own and their children’s health
and development. The men’s reproductive health life course graphic also reminds us that
there are multiple times and places to intervene to enhance (or diminish) men’s health and
paternal generativity.”
The Impact of Fatherhood on Men’s Health and Development 81
And although this graph focuses on men’s individual generativity, efforts to
encourage his shared responsibility for healthy parenthood and for equitable parental
childcare and involvement must start earlier than conception with his shared respon-
sibility for sexuality and family planning. Further, men’s development as generative
fathers must also necessarily address his pre-fatherhood adolescent social and gender
norms, perhaps beginning in schools with their parenting, sexuality, and gender-
based education programs. The preconception time period for paternal generativity
must be pushed backwards in developmental ontological time.
Additionally, men’s paternal generativity is not a simple linear age trend but is
embedded within our larger human biologic development. The roots of men’s
intergenerational and epigenetic generativity starts before birth, and has at least
two special sensitive periods of growth: puberty and the initial antenatal and early
postnatal transition to fatherhood. The latter is perhaps the most sensitive transfor-
mational life course period for men’s psychosocial development and maturation as a
father (Genesoni and Tallandini 2009); it may perhaps also reflect a new paternal
biological sensitive period due to his changing perinatal hormones and brain struc-
ture. The experiences and health consequences of fatherhood are further filtered
through and modified by the men’s pre-existing life course health and well-being
that he brings into the perinatal period, similar to that of pregnant women.
Indeed, the differential risk and protective factors (the conceptual arrows in
Fig. 1)influencing the growth of men’s generativity over the life course can be
Risk Factors
Protective Factors
05 years Puberty Pregnancy Life Course
Paternal Generativity
Paternal Generativity Over the Life
Course
Fig. 1 How differential exposure to risk factors (downward arrows) and protective factors (upward
arrows) over the life course affect developmental trajectories in father involvement/generativity.
Lower involvement (dashed curve) results from cumulative exposure to more risk factors and less
protective factors across the life span, particularly at sensitive periods of development. (Source:
Kotelchuck and Lu 2017)
82 M. Kotelchuck
viewed as reflecting the many contributors to the fatherhood health pathways already
discussed throughout this chapter—including, for example, family income, work-
family stress, substance use, social connectedness, etc. These factors, in turn, are
strongly modulated (positively or negatively) by national and state health, economic,
and social welfare policies and programs—including both those operating in the
immediate perinatal period (e.g., paid leave, living wages, health insurance access),
as well as those operating long before (e.g., childhood health and education,
masculinity gender role socialization and childhood SDOH).
Moreover, fathers are not homogeneous; different subgroups of fathers are likely
to experience the life-course health and developmental challenges of fatherhood and
fatherhood generativity differently, based on both their personal and socio-historical
life course experiences. Potentially important fatherhood subgroups to consider
might be based on socio-economic status, race/ethnicity, first-time or experienced
fatherhood, teen or older paternal age, planned or unplanned pregnancy, residential
status, disability status, incarceration, or military service. In the U.S., the experiences
of poor fathers, especially those of color, are particularly challenging given historical
structural racism and its ongoing negative health, social welfare, and employment
biases. Too little is known about the life course sources of more positive father
generativity.
The developmental roots of paternal generativity are not restricted only to
the critical and sensitive perinatal period, but build off of men’s prior life
course health and developmental experiences. Paternal generativity should be
viewed as an intergenerational and epigenetic phenomenon, building off of
prior generations and towards future generations. Paternal generativity is not
fixed but malleable. The momentum for paternal generativity, for fatherhood,
with all its satisfactions and stresses, must be empowered by each man himself;
but it is embedded in the larger developmental world in which his full repro-
ductive potential is either encouraged and grows or is stunted and
underachieved. The fatherhood life course perspective suggests that there are
multiple places and times in which both positive and negative program and
policy interventions and life experiences can influence men’s paternal
generativity. Paternal generativity, the essence of fatherhood, is shaped over
his life course.
3 Enhancing Fatherhood to Foster Men’s Health
and Development During the Perinatal Period:
Implications for Research, Practice, and Policy
Fatherhood profoundly impacts men’s health and development. It impacts his
physical, mental, and social health, and his sense of paternal generativity, both
immediately and over his life course. These, in turn, impact his infant’s, partner’s,
and family’s health. Indeed, fatherhood can be viewed as a risk or resiliency factor
The Impact of Fatherhood on Men’s Health and Development 83
for men’s subsequent health across his life course. The focus on men’s changing
health as a consequence of fatherhood is an important new perspective for the MCH
reproductive health field, which has historically focused on the mother and her
health.
This chapter is one of a pair of inter-related chapters on father’s health in the
perinatal period that parallels the dual approach of the current women’s preconcep-
tion health movement, which simultaneously addresses the impact of the mother’s
perinatal health both on the infant’s health outcomes and on the mother’s own
subsequent lifetime health. Both topics for men also are critical and intractably
bound. Father’s health, like mother’s health, is thus similarly a bi-directional and
inter-generational topic.
This chapter pulls together and articulates six broad pathways through which
fatherhood could potentially positively or negatively impact men’s health and
development—men’s pre-existing health, his perinatal changed physical, mental,
and social health, his generativity, and his life-course experiences. This emerging
conceptual framework encompasses the father’s entire life course, but focuses here
on the perinatal time period, a time frame not usually thought of as impacting on
men’s health. These six specific pathways are written to try to isolate and better
articulate them, though many of them likely overlap and are synergistic. Several
emerging themes merit further discussion.
First, going beyond the impact of fatherhood on men’s physical and mental
health, this chapter, in particular, emphasized and explored two new health topics:
men’s psychological maturation of paternal generativity, and men’s social health and
well-being. The first topic, men’s psychological maturation into more generative
fathers, is not a well articulated fatherhood topic, especially antenatally. It has not
been the focus of virtually any formal MCH or prenatal health services to date,
although a large popular “Advice for New Dads”social media literature exists,
which may at times touch on this theme. The psychological empowerment of fathers
requires, in part, that our current health service systems (and men themselves)
overcome their traditional sexist assumptions about men’s supposedly limited
roles and needs, his marginality, during the pregnancy and early childhood period.
Second, men’s social health and well-being may be a difficult pathway for the
MCH reproductive health community to appreciate, as this topic links more broadly
to men’s larger social roles within the family home and employment. The transfor-
mative impact of fatherhood on men’s social health, and therefore ultimately on
reproductive health, is heavily influenced by social welfare and employment pro-
grams and policies, many of which are also closely linked to women’s gender equity
issues. This emerging pathway has the potential to bring the MCH community
productively together with other business and human service professions that are
grappling with similar paternal (and maternal) social health and well-being issues to
create multi-sector transformative change (Bowles et al. 2021).
Third, this chapter further builds upon the growing recognition that fathers are a
key vector for the SDOH and well-being of their families (Kotelchuck 2018,2021),
and begins to add a more nuanced understanding of this theme. As noted previously,
this chapter emphasizes that men’s own social well-being, his SDOH characteristics,
84 M. Kotelchuck
are not fixed, but can change due to his experiences of fatherhood. Moreover, the
father’s historical and current compromised SDOH can diminish his positive health
responses to fatherhood and limit his fullest and healthiest participation in the
perinatal period and beyond. And, while paternal generativity is not principally
determined by social class, poverty does make it harder for some men.
Fourth, the positive or negative impact of fatherhood on men’s physical, mental,
social, or generative health and development is not pre-ordained. This chapter,
reflecting the limited existing literature, predominantly notes the negative paternal
physical and especially mental health impacts of fatherhood. There is much less
balanced research on the more positive health experiences of fatherhood, and how to
foster them.
Fifth, this chapter documents that the impact of fatherhood on men’s health
begins before delivery (i.e., the perinatal roots of father’s own health). It strongly
reinforces the initial chapter’s parallel efforts to expand the time frame for the impact
of men’s health on reproductive and infant health into the antenatal period. This
essay however emphasizes not merely the perinatal impact of fatherhood on men’s
health, but an even longer ontological life course perspective on father’s health. The
health of men and their paternal generative characteristics start early, epigenetically,
long before conception; although like for women, the experiences during the peri-
natal and early parenthood period seem to be an especially biologically sensitive
period of impact. Fatherhood is not simply a sperm and post-partum parenting;
paternal generativity must be conceptualized across the life course.
Sixth, this chapter and the prior one dispute the prevailing view that mothers and
their health and well-being alone are solely responsible for positive reproductive and
infant outcomes and that women are the only or primary gender affected by
parenthood. If men actively assume or are encouraged to participate in the joys
and responsibilities of reproductive and infant care, they will likely become more
generative fathers, and in turn that could help free up women and men from overly
prescribed gendered parental behavioral and economic roles. This chapter, while a
self-contained MCH theme, has been inspired by, and hopefully contributes to, the
larger social gender equity movement, as well as the growing parenting health and
men’s health movements.
Seventh, hopefully, this chapter and the prior one have demonstrated that a focus
on father’s health and well-being should be a more formal and important MCH
perinatal health research, practice, and policy topic. These chapters provide an ever-
stronger, positive, empirical and theoretical developmental science rationale to
support more extensive, earlier, and healthier paternal perinatal involvement. The
six pathways noted in this chapter summarize our current scientific knowledge base
to date (Knowledge Base), which can now provide the basis to develop more
effective targeted fatherhood programmatic and policy interventions (Social Strate-
gies) and to support more effective and scientifically justified fatherhood advocacy
efforts (Political Will) for their implementations (Richmond and Kotelchuck 1983).
Clearly the core public health action message of this chapter (and the prior one) is
that there should be more active, earlier, and healthier paternal involvement in the
perinatal period. Many of this chapter’s six pathways call out for readily
The Impact of Fatherhood on Men’s Health and Development 85
implementable ameliorative actions and interventions to address the added chal-
lenges of fatherhood on men’s health. The fatherhood life course perspective further
suggests that there are multiple places and times for potential synergetic interven-
tions to enhance men’s and father’s health throughout his life course. Hopefully, this
essay will add to the momentum for more targeted and effective father-oriented
perinatal health interventions and policies—in order to ensure both more optimal
reproductive and infant health and development and more optimal men’s health,
development, and paternal generativity.
This book highlights three key sectors for paternal program and policy
interventions—social policy, work/organizational practices, and health care. No
single sector alone can solely enhance the impact of fatherhood on men’s health
and development or assure greater parental gender equity for men and women; all
sectors are needed and must be synergetically involved. Sadly, however, there is
relatively little professional recognition of father’s own unique perinatal health
needs—and even less formal services directed towards him. This Conference and
edited book reflect an effort to enhance fatherhood activities within each of three
sectors and importantly across sectors (Bowles et al. 2021).
Fatherhood is a life course developmental achievement. Fatherhood is not a
singular point in the life course, but a profoundly human experience that occurs
over time and across generations. The developmental trajectory of fatherhood starts
long before conception and impacts fathers and their children and family throughout
their lives, long after conception and inter-generationally. Healthy and engaged
fathers help insure healthy children, healthy families, healthy workforces, and
healthy communities.
References
Abraham E, Hendler T, Shapira-Lichter I, Kanat-Maymon Y, Zagoory-Sharon O, Feldman R
(2014) Father’s brain is sensitive to childcare experiences. Proc Natl Acad Sci U S A 111
(27):9792–9797
Addis ME, Mahalik JR (2003) Men, masculinity and the contexts of help seeking. Am Psychol 58
(1):5–14
Administration for Children and Family (2019) Healthy marriage and responsible fatherhood.
Office of Family Assistance. U.S. Department of Health and Human Services. www.acf.hhs.
gov/ofa/programs/healthy-marriage
Almond D, Rossin-Slater M (2013) Paternity acknowledgement in two million birth records in
Michigan. PLoS One 8(7):e70042. https://doi.org/10.1371/journal.pone.0070042
Baldwin S, Bick D (2018) Mental health of first time fathers—it’s time to put evidence into practice.
JBI Database Syst Rev Implement Rep 16(11):2064–2065
Baldwin S, Malone M, Sandall J, Bick D (2018) Mental health and well-being during the transition
to fatherhood: a systematic review of first time fathers’experiences. JBI Database Syst Rev
Implement Rep 16(11):2118–2219
Bertakis KD, Rahman A, Jay Helms L, Callahan EJ, Robbins JA (2000) Gender differences in the
utilization of health care services. J Fam Pract 49(2):147–152
Boggess J, Price A, Rodriguez N (2014) What we want to give our children: how child support debt
can diminish wealth-building opportunities for struggling black fathers and their family. Center
86 M. Kotelchuck
for Family Policy and Practice, Madison. https://cffpp.org/wp-content/uploads/
whatwewanttogiveourkids.pdf
Bowles HR, Kotelchuck M, Grau-Grau M (2021) Reducing barriers to engaged fatherhood: three
principles for promoting gender equity in parenting. In: Grau-Grau M, las Heras M, Bowles HR
(eds) Engaged fatherhood for men, families and gender equality. Springer, Cham, pp 299–325
Brennan A, Ayers S, Ahmed H, Marshall-Lucette S (2007) A critical review of the couvade
syndrome: the pregnant male. J Reprod Infant Psychol 25(3):173–189
British Broadcasting Corporation News (2009) Fathers-to-be ‘gain extra weight’.https://news.bbc.
co.uk/2/hi/health/8063004.stm
Budig M, Hodges MJ (2014) Statistical models and empirical evidence for differences in the
motherhood wage penalty across the earnings distribution: a reply to Killewald and Bearek.
Am Sociol Rev 79(20):358–364
Burgard SA, Ailshire JA (2013) Gender and time for sleep among US adults. Am Sociol Rev 78
(1):51–69
Canadian Tobacco Use Monitoring Survey (2006) Via Health Canada Website. https://www.Hc-Sc.
Gc.Ca
Carlson MJ, Mclanahan SS, Brooks-Gunn J (2008) Coparenting and non-residential involvement
with young children after non-marital birth. Demography 45(2):461–488
Centers for Disease Control and Prevention (CDC) (2019) Preconception health and health care.
https://www.cdc.gov/preconception/index. Accessed 15 Jan 2019
Cheng ER, Kotelchuck M, Gerstein ED, Taveras EM, Poehlmann-Tynan J (2016) Postnatal
depressive symptoms among mothers and fathers of infants born preterm: prevalence and
impacts on children’s early cognitive function. J Dev Behav Pediatr 37(1):33–42
Choiriyyah I, Sonenstein FL, Astone NM, Pleck JH, Dariotis JK, Marcell AV (2015) Men aged
15–44 in need of preconception care. Matern Child Health J 19(11):2358–2365
Coleman PK, Karraker KH (1998) Self-efficacy and parenting quality: findings and future appli-
cations. Dev Rev 18(1):47–85
Correl SJ, Benard S, Paik I (2007) Getting a job: is there a motherhood penalty? Am J Sociol 112
(5):1297–1339
Darwin Z, Galdas P, Hinchliff S, Littlewood E, McMillan D, McGowan L, Gilbody S, on behalf of
the Born and Bred in Yorkshire (BaBY) Team (2017) Fathers’views and experiences of their
own mental health during pregnancy and the first postnatal year: a qualitative interview study of
men participating in the UK Born and Bred in Yorkshire (BaBY) cohort. BMC Pregnancy
Childbirth 17(1):45. https://doi.org/10.1186/s12884-017-1229-4
Davison KK, Gavarkovs A, McBride B, Kotelchuck M, Levy R, Taveras EM (2019) Engaging
fathers in early obesity prevention during the first thousand days: policy, systems and environ-
mental change strategies. Obesity 27(4):523–533
Dollahite DC, Hawkins AJ, Brotherson SE (1997) Fatherwork: a conceptual ethic of fathering as
generative work. In: Hawkins AJ, Dollahite DC (eds) Generative fathering: beyond deficit
perspectives. Sage, Thousand Oaks, pp 17–35
Due C, Chiarolli S, Riggs DW (2017) The impact of pregnancy loss on men’s health and wellbeing:
a systemic review. BMC Pregnancy Childbirth 17:380. https://doi.org/10.1186/s12884-017-
1560-9
Edelstein RS, Wardecker BM, Chopik WJ, Moors AC, Shipman EL, Lin NJ (2015) Prenatal
hormones in first-time expectant parents: longitudinal changes and within couple correlations.
Am J Hum Biol 27(3):317–325
Edin K, Nelson TJ (2013) Doing the best I can: fatherhood in the Inner City. University Of
California Press, Berkeley
Edvardsson K, Lindkvist M, Eurenius E, Mogren I, Small R, Ivarsson A (2013) A population-based
study of overweight and obesity in expectant parents: socio-demographic patterns and within-
couple associations. BMC Public Health 13(1):923. https://doi.org/10.1186/1471-2458-13-923
Edwards BN, McLemore MR, Baltzell K, Hodgkin A, Nunez O, Franck LS (2020) What about the
men? Perinatal experiences of men of color whose partners were at risk for preterm birth, a
The Impact of Fatherhood on Men’s Health and Development 87
qualitative study. BMC Pregnancy Childbirth 20:91. https://doi.org/10.1186/s12884-020-
2785-6
Eggebeen DJ, Knoester C (2001) Does fatherhood matter for men? J Marriage Fam 63(2):381–393
Erikson EH (1950) Childhood and society. Norton, New York
Fine A, Kotelchuck M (2010) Rethinking MCH: the life course model as an organizing framework:
concept paper. U.S. Department of Health and Human Services, Health Resources and Services
Administration, Maternal and Child Health Bureau, Rockville
Fleming AS, Ruble D, Howard K, Wong PY (1997) Hormonal and experiential correlates of
maternal responsiveness during pregnancy and the puerperium in human mothers. Horm
Behav 31:145–158
Freeman E, Fletcher R, Collins CE, Morgan PJ, Burrows T, Callister R (2012) Preventing and
treating childhood obesity: time to include the father. Int J Obes 36(1):12–15
Frey KA, Navarro SM, Kotelchuck M, Michael CL (2008) The clinical content of preconception
care: preconception care for men. Am J Obstet Gynecol 199(6 Suppl B):S389–S395
Garfield CF, Isacco A, Bartlo WD (2010) Men’s health and fatherhood in urban Midwestern United
States. Int J Mens Health 9(3):161–174
Garfield CF, Duncan G, Rutsohn J, McDade TW, Adam EK, Coley RL, Lindsay Chase-Lansdale P
(2014) A longitudinal study of paternal mental health during transition to fatherhood as young
adults. Pediatrics 133(5):836–843
Garfield CF, Duncan G, Gutina A, Rutsohn J, McDade TW, Adam EK, Coley RL, Lindsay Chase-
Lansdale P (2016) Longitudinal study of body mass index in young males and the transition to
fatherhood. Am J Mens Health 10(6):NP158–NP167
Gemayel DJ, Wiener KKK, Saliba AJ (2018) Development of a conception framework that
identifies factors and challenges impacting perinatal fathers. Heliyon 4(7):e00694
Genesoni L, Tallandini MA (2009) Men’s psychological transition to fatherhood: an analysis of the
literature, 1989-2008. Birth 36(4):305–318
Gettler LT, McDade TW, Feranil AB, Kuzawa CW (2011) Longitudinal evidence that fatherhood
decreases testosterone in human males. Proc Natl Acad Sci U S A 108(39):16194–16199
Glass JL, Simon RW, Andersson MA (2016) Parenthood and happiness: effects of work-family
reconciliation policies in 22 OECD countries. Am J Sociol 122(3):886–929
Gordon I, Zagoory-Sharon O, Leckman JF, Feldman R (2010) Prolactin, oxytocin and the devel-
opment of paternal behavior across the first six months of fatherhood. Horm Behav 58
(3):513–518
Grebe NM, Sarafin RE, Strenth CR, Zilioli S (2019) Pair-bonding, fatherhood, and the role of
testosterone: a meta-analytic review. Neurosci Biobehav Rev 98:221–233
Grundy E, Kravdal Ø (2008) Reproductive history and mortality in late middle age among
Norwegian men and women. Am J Epidemiol 167(3):271–279
Gustafsson E, Levréro F, Reby D, Mathevon N (2013) Fathers are just as good as mothers at
recognizing the cries of their baby. Nat Commun 4:1698
Harrington B (2021) The new dad: the career-caregiving conundrum. In: Grau-Grau M, las Heras
M, Bowles HR (eds) Engaged fatherhood for men, families and gender equality. Springer,
Cham, pp 197–212
Harrington B, Van Deusen F, Fraone J (2014) The new dad: take your leave. Boston College Center
for Work & Family, Chestnut Hill
Harris K, Brott A (2018) NHSA healthy start fathers-real life, real dads. National Healthy Start
Association, Washington, DC. https://www.nationalhealthystart.org/what_we_do/male_
involvement/nhsa_healthy_start_fathers_real_life_real_dads
Hashemian F, Shafigh F, Roohi E (2016) Regulatory role of prolactin in paternal behavior in male
parents: a narrative review. J Postgrad Med 62(3):182–187
Hawkins AJ, David C (1997) Beyond the role-inadequacy perspective. In: Hawkins AJ, Dollahite
DC (eds) Generative fathering: beyond deficit perspectives. Sage, Thousand Oaks, pp 3–16
Hawkins AJ, Dollahite DC (eds) (1997) Generative fathering: beyond deficit perspectives. Sage,
Thousand Oaks
88 M. Kotelchuck
Healthy Start (2019) Health resources and service administration—maternal and child health.
https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start
Hobson B, Fahlen S (2009) Competing scenarios for European fathers: applying Sen’s capabilities
and agency framework to work-family balance. Ann Am Acad Pol Soc Sci 624(1):214–233
Hodges MJ, Budig MJ (2010) Who gets the daddy Bonus? Markers of hegemonic masculinity and
impact of first-time fatherhood on men’s earnings. Gend Soc 24(6):715–745
Hull EE, Rofey DL, Robertson RJ, Nagle EF, Otto AD, Aaron DJ (2010) Influence of marriage and
parenthood on physical activity: a 2-year prospective analysis. J Phys Act Health 7(5):577–583
Humberd B, Ladge J, Harrington B (2015) The ‘new’dad: navigating father identity within
organizational contexts. J Bus Psychol 30(2):249–266
Johansson M, Fenwick J, Premberg A (2015) A meta-synthesis of the father’s experiences of their
partner’s labour and birth. Midwifery 31(1):9–18
Jomeen J (2017) Fathers in the birth room: choice or coercion? Help or hinderance? J Reproduct
Infant Psychol 35(4):321–323
Kazmierczak M, Kielbratowska B, Pastwa-Wojciechowska B (2013) Couvade syndrome among
polish expectant fathers. Med Sci Monit 21(19):132–138
Keizer R, Dykstra PA, van Lenthe FJ (2011) Parity and men’s mortality risks. Eur J Pub Health 22
(3):343–347
Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, John Rush A, Walters EE,
Wang PS (2003) The epidemiology of major depressive disorder: results from the National
Comorbidity Survey Replication (NCS-R). JAMA 289(35):3095–3105
Kim P, Swain JE (2007) Sad dads: paternal post-partum depression. Psychiatry (Edgmont) 4
(2):35–47
Kim P, Rigo P, Mayes LC, Feldman R, Leckman JF, Swain JE (2014) Neural plasticity in fathers of
human infants. Soc Neurosci 9(5):522–535
Knox V, Cowan PA, Cowan CP, Bildne E (2011) Policies that strengthen fatherhood and family
relationships: what do we know and what do we need to know? Ann Am Acad Pol Soc Sci 635
(1):216–239
Kotelchuck M (2018) Looking back to move forward: a return to our roots, addressing social
determinants across MCH history. In: Verbiest S (ed) Moving life course theory into practice:
making change happen. APHA Press, Washington, DC, pp 57–78. https://ajph.
aphapublications.org/doi/10.2105/9780875532967ch03
Kotelchuck M (2021) The impact of father’s health on reproductive and infant health and devel-
opment. In: Grau-Grau M, las Heras M, Bowles HR (eds) Engaged fatherhood for men, families
and gender equality. Springer, Cham, pp 31–61
Kotelchuck M, Lu M (2017) Father’s role in preconception health. Matern Child Health J 21
(11):2025–2039
Kvande E (2021) Individual parental leave for fathers—promoting gender equality in Norway. In:
Grau-Grau M, las Heras M, Bowles HR (eds) Engaged fatherhood for men, families and gender
equality. Springer, Cham, pp 153–162
Ladge JJ, Humberd BK (2021) Impossible standards and unlikely trade-offs: can fathers be
competent parents and professionals? In: Grau-Grau M, las Heras M, Bowles HR (eds) Engaged
fatherhood for men, families and gender equality. Springer, Cham, pp 183–196
Ladge JJ, Humberd BK, Baskerville M, Harrington B (2015) Updating the organizational man:
fathers in the workplace. Acad Manag Perspect 29(1):152–171
Lamb ME (1975) Fathers: forgotten contributors to child development. Hum Dev 18(4):245–266
Lamb ME (ed) (2010) The role of the father in child development, 5th edn. Wiley, New York
Leach LS, Poyser C, Cooklin AR, Giallo R (2016) Prevalence and course of anxiety disorders (and
symptom levels) in men across the perinatal period: a systematic review. J Affect Disord 190
(15):675–686
Levy RA, Kotelchuck M (2021) Fatherhood and reproductive health in the antenatal period: from
men’s voices to clinical practice. In: Grau-Grau M, las Heras M, Bowles HR (eds) Engaged
fatherhood for men, families and gender equality. Springer, Cham, pp 111–137
The Impact of Fatherhood on Men’s Health and Development 89
Levy RA, Badalament J, Kotelchuck M (2012) The Fatherhood Project. Massachusetts General
Hospital, Boston. www.thefatherhoodproject.org
Lipkin M, Lamb GS (1982) The couvade syndrome: an epidemiological study. Ann Intern Med 96
(4):509–511
Lu MC, Halfon N (2003) Racial and ethnic disparities in birth outcomes: a life-course perspective.
Matern Child Health J 7(1):13–30
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK (2019) Births: final data for 2018. Natl Vital
Stat Rep 68(13):1–47
Masoni S, Maio A, Trimarchi G, de Punzio C, Fioretti P (1994) The couvade syndrome. J
Psychosom Obstet Gynecol 15(3):125–131
May C, Fletcher R (2013) Preparing fathers for the transition to parenthood: recommendations for
the content of antenatal education. Midwifery 29(5):474–478
McLanahan S, Tach L, Schneider D (2013) The causal effects of father absence. Annu Rev Sociol
399(1):399–427
McLean CP, Asnaani A, Litz BT, Hofmann SG (2011) Gender differences in anxiety disorders. J
Psychiatr Res 45(8):1027–1035
Modig K, Talbäck M, Torssander J, Ahlbom A (2017) Payback time? Influence of having children
on mortality in old age. J Epidemiol Community Health 71(5):424–430
Nannini A, Lazar J, Berg C, Tomashek K, Cabral H, Barger M, Barfield W, Kotelchuck M (2008)
Injury: a major cause of pregnancy-associated morbidity in Massachusetts. J Midwifery
Womens Health 53(1):3–10
National Academies of Sciences, Engineering, and Medicine (NASEM) (2016) Parenting matters:
supporting parents of children ages 0–8. The National Academies Press, Washington, DC
National Academies of Sciences, Engineering, and Medicine (NASEM) (2019) Vibrant and healthy
kids: aligning science, practice, and policy to advance health equity. The National Academies
Press, Washington, DC
Nepomnyaschy L, Waldfogel J (2007) Paternity leave and fathers’involvement with their young
children: evidence from the American ECLS-B. Community Work Fam 10(4):427–453
Paulson JF, Bazemore SD (2010) Prenatal and postpartum depression in fathers and its association
with maternal depression: a meta-analysis. JAMA 303(19):1961–1969
Persson P, Ross-Slater M (2019) When dad can stay home: fathers’workplace flexibility and
maternal health.IZA Institute of Labor economics discussion paper no. 12386
Petts RJ, Carlson DL, Chris KC (2019) If I[take] leave, will you stay? Paternity leave and
relationship stability. J Soc Policy 49(4):829–849. https://doi.org/10.1017/
S0047279419000928
Philpott LF, Leahy-Warren P, FitzGerald S, Savage E (2017) Stress in fathers in the perinatal
period: a systematic review. Midwifery 55:113–127
Philpott LF, Savage E, FitzGerald S, Leahy-Warren P (2019) Anxiety in fathers in the perinatal
period: a systemic review. Midwifery 76:54–101
Pol HL, Koh SSL, He H (2014) An integrative review of fathers’experiences during pregnancy and
childbirth. Int Nurs Rev 61(4):543–554
Ramchandani PG, Stein A, O’Connor TG, Heron J, Murray L, Evans J (2008) Depression in men in
the postnatal period and later child psychopathology: a population cohort study. J Am Acad
Child Adolesc Psychiatry 47(4):390–398
Richmond JB, Kotelchuck M (1983) Political influences: rethinking national health policy. In:
McGuire CH, Foley RP, Gorr D, Richards RW (eds) Handbook of health professions education.
Josey-Bass, San Francisco, pp 386–404
Rolling JK, Mascaro JS (2017) The neurobiology of fatherhood. Curr Opin Psychol 15:26–32
Roubinov DS, Luecken LJ, Gonzales NA, Crnic KA (2016) Father involvement in Mexico-origin
families: preliminary development of a culturally informed measure. Cultur Divers Ethnic
Minor Psychol 22(2):277–287
Saxbe DE, Edelstein RS, Lyden HM, Wardecker BM, Chopik WJ, Moors AC (2017) Fathers’
decline in testosterone and synchrony with partner testosterone during pregnancy predicts
greater post-partum relationship investment. Horm Behav 90:39–47
90 M. Kotelchuck
Saxbe D, Corner G, Khaled M, Horton K, Wu B, Khoddam H (2018) The weight of fatherhood:
identifying mechanisms to explain paternal perinatal weight gain. Health Psychol Rev 12
(3):1–38
Singley DB, Edwards LM (2015) Men’s perinatal mental health in transition to fatherhood. Prof
Psychol Res Pract 46(5):309–316
Smith JA, Braunack-Mayer A, Wittert G (2006) What do we know about men’s help-seeking and
health service use? Med J Aust 184(2):81–83
Steen M, Downe S, Bamford N, Edozien L (2012) Not-patient and not-visitor: a metasynthesis
father’s encounters with pregnancy, birth, and maternity care. Midwifery 28(4):362–371
Tollestrup J (2018) Fatherhood initiatives: connecting fathers to their children. Congressional
Research Service. RL31025. www.crsreports.congress.gov.
Umberson D, Liu H, Mirowsky J, Reczek C (2011) Parenthood and trajectories of change in body
weight over the life course. Soc Sci Med 73(9):1323–1331
United States Bureau of the Census (2018) Current population survey: annual social and economic
supplement survey, United States, 2017 (ICPSR 37075). https://doi.org/10.3886/
ICPSR37075.v1
Wise PH (2008) Transforming preconceptional, prenatal, and interconceptional care into a com-
prehensive commitment to women’s health. Womens Health Issues 18(6 Suppl):S13–S18
Yogman MW, Eppel AM (2021) The role fathers in child and family health. In: Grau-Grau M, las
Heras M, Bowles HR (eds) Engaged fatherhood for men, families and gender equality. Springer,
Cham, pp 15–30
Yogman MW, Garfield CF, the Committee on Psychosocial Aspects of Child and Family Health
(2016) Fathers’roles in the care and development of their children: the role of pediatricians.
Pediatrics 138(1):e20161128
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