› IN PRACTICE

Encouraging breastfeeding:
The role of fathers
and Ventura, 2009; Scott et al, 2012; McCrory
› Abstract and Layte, 2012), diabetes and cardiovascular
disease (Horta and Victora, 2013). Some research
National and international policy and guidance recognise suggests that breastfed babies may have better
the health and other benefits of breastfeeding. Fathers are neurological development, and improved
often the closest form of social support to the mother, with performance and intelligence later in life (Horta
research suggesting that fathers can be an important source and Victora, 2013). There is a growing consensus
of breastfeeding support; however, they are not acknowledged that breastfeeding can offer protection for the
in many existing breastfeeding protocols or policies. The aim
mother against the risk of ovarian and breast
of this literature review is to explore the role of the father in
cancer (World Cancer Research Fund, 2009),
supporting breastfeeding. Nine studies were included in the
literature review. Three themes were identified: duration of as well as promoting breastfeeding, positive
breastfeeding; educating fathers; and breastfeeding support parenting and attachment (Gutman et al, 2009;
from fathers. Findings suggest fathers offer a potentially Field, 2010; Wave Trust and Department for
valuable support for breastfeeding mothers. Resources and Education, 2013).
interventions for fathers need to be designed and researched This evidence base has underpinned both
with a need for policies and guidelines to acknowledge national and international breastfeeding policy
their role. with UNICEF, the World Health Organization
(WHO), and the US Department of Health and
Key words Human Services encouraging breastfeeding from
› Breastfeeding › Fathers› Support › Health visitors › Mothers birth (WHO, 2009; US Department of Health and
Human Services, 2011; UNICEF, 2013). Likewise,

P
in England, government policy (DHSC, 2009)
rofessionals have long known that has recognised breastfeeding as a priority for
breastfeeding brings short- and long-term health professionals. Most recently (DHSC, 2014),
health benefits for both mother and infant it has placed responsibility on health visitors to
(UNICEF, 2013). There is an established encourage breastfeeding to positively influence a
evidence base to support encouraging mothers to child’s start in life.
breastfeed. In the UK, higher rates of breastfeeding Nearly three-quarters of mothers in England
prevalence have been correlated with lower initiate breastfeeding (73.8%) (NHS England,
admissions for infections, such as gastroenteritis 2015); however, data from Public Health England
and lower respiratory tract infections in infants (PHE) (2016) suggest that only 43.7% of infants
under 1 year of age (Department of Health and at 6–8 weeks are still breastfed. There are
Social Care (DHSC), 2013). several points in antenatal and postnatal care
International studies have shown that plans where women should receive information
breastfeeding reduces the risk of allergies, eczema about the benefits of breastfeeding. Often, the
and sudden infant death syndrome (American midwife initiates discussions about breastfeeding
Academy for Paediatrics, 2012). In the longer and midwives are identified by mothers as the
term, there is evidence that breastfeeding offers most common source of information (83%) on
protection against childhood obesity (Bartok breastfeeding (McAndrew et al, 2012). Once
mother and baby leave maternity care, the
health visitor becomes the primary professional
Rachael Louise Bhairo, clinical nurse specialist, Mother supporter for continued breastfeeding. However,
and Infant Mental Health Service, Kent and Medway NHS health visitors do not see the mother and baby
© 2018 MA Healthcare Ltd

and Social Care Partnership Trust; and Helen Elliott, senior until 10–14 days after birth, a crucial period for
lecturer, Faculty of Education and Health, University of sustaining breastfeeding. Fathers can support the
Greenwich mother during this time.
[email protected] Fathers are often the closest form of social
support to the mother, with research suggesting

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Methods
ADOBE STOCK

Search strategy
An initial search was conducted using Google
Scholar. This identified the volume of research
and helped in finding key terms for the literature
search. This process highlighted key studies and
focused the project on the period between 2009 and
2016, when most of the research was published.
The database EBSCOHost was searched including
Academic Search Premier, MEDLINE, Psychology
and Behavioural Sciences Collection, PsycINFO,
SPORTDiscus and CINAHL Plus with Full Text. Key
terms are displayed in Table 1.
At the outset, the following inclusion criteria
were identified:

ŠŠ
Publications that originated from western
Europe, north America, Canada, Australia or
New Zealand (due to similar demographics and
cultures to the UK and, therefore, findings more
likely to be transferable)
ŠŠ
Primary research
ŠŠ
Studies focusing on fathers’ attitudes, knowledge
and support in relation to breastfeeding rates
or mothers’ breastfeeding experiences in the
postpartum period
ŠŠStudies focusing on fathers (originally, the
inclusion criteria were cohabiting biological
fathers; however, due to limited findings of this
description in studies, the criteria was widened to
that fathers can be an important source of just fathers)
breastfeeding support (Bar-Yam and Darby, ŠŠPeer-reviewed papers
1997). Despite this, the father’s role has not been ŠŠPublished in English only.
acknowledged in existing breastfeeding protocols.
None of the existing international or UK policy All papers were critically appraised using the
or guidance specifically refer to the role of the Critical Appraisal Skills Programme (CASP) tools,
father, although some do mention ‘partner’ (CASP, 2014). Three different types of the CASP
support (DHSC, 2009; WHO/UNICEF, 2009; checklist were used: a randomised controlled trial
National Institute of Health and Care Excellence (RCT) checklist; a cohort study checklist; and a
(NICE), 2015). qualitative study checklist.
There is currently a gap in the knowledge
of fathers’ understanding of the value of Sample
breastfeeding, their attitude towards it and their The initial search identified 1698 papers. Of these,
interest in supporting their partners. Could they 1197 were duplicates. The remaining 501 papers
play a more prominent role? were assessed against the inclusion criteria. Nine
papers were identified as relevant to this study. Of
Aims and objectives the nine papers collated for the review, three were
This article reviews the literature exploring the conducted in Canada, two in Australia, two in
role of fathers in the continuation of partial north America, one in the UK and one in Cyprus
or exclusive breastfeeding. The methodology (Table 2). The studies employed various research
was chosen to allow exploration of the existing designs; three were quantitative studies using an
© 2018 MA Healthcare Ltd

research, and to critically appraise any strengths experimental method of a RCT.

and weakness in the published evidence base Three papers were quantitative studies that used
with a view to examining whether current a non-experimental design of a cross-sectional
breastfeeding policies adequately reflect the role study. Three qualitative studies used a thematic
of the father. analysis approach. Common trends were identified

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with the quantitative studies through comparison

of the findings. The process of deriving themes was
Table 1. Search strategy: databases and search terms
completed using a deductive thematic analysis Search database Search terms
approach. Pre-assigned codes and themes were EBSCOHost Health AND AND
developed and findings of the papers were used Sciences Research Breastfeeding Assistance Dad
to support them. Following the stages of thematic Database Attitude Father
analysis, themes were identified through coding Academic Search Premier, Encourage Husband
and categorising data to redefine themes MEDLINE, Psychology Help Men
(Braun and Clarke, 2006). Themes and trends and Behavioural Sciences Involvement Partner
identified were: Collection, PsycINFO, Knowledge Paternal
SPORTDiscus and Role
CINAHLPlus with Full Text Support
ŠŠ
Duration of breastfeeding.
ŠŠ
Fathers’ education.
ŠŠ
Fathers’ support.
duration, and partner support in the first 48
Findings hours of the postpartum period. Findings revealed
Duration of breastfeeding that EBF at 6 months was significantly higher
A trend throughout seven studies was the duration among mothers who reported involvement and
of the mother’s breastfeeding. Ozluses and support from their partners. The study showed
Celebioglu (2014) conducted a RCT to explore the a big effect, albeit reliant on subjective data of
exclusive breastfeeding (EBF) rate after mothers mothers’ self-reporting. Mothers were recruited
and fathers had received EBF education vs mothers via two different types of antenatal classes, but
only receiving EBF education. no difference in effect on breastfeeding experience
The EBF rate was higher at 6 months for was found between classes. The study did, however,
mothers and fathers receiving EBF in comparison concentrate on first-time mothers limiting any
to mothers only. The results showed significant bias for previous breastfeeding experience. There
differences in the duration of breastfeeding were also no strict inclusion criteria, suggesting
between the groups from the first to the sixth that findings could be generalisable to other
month postpartum. In the study, however, the breastfeeding mothers.
researcher was not blind to group allocation Maternal confidence and maternal satisfaction
so there was a risk of contamination between were identified as themes in three studies. Mannion
different intervention groups. In comparison to et al (2013) conducted a survey to identify mothers’
Özlüses and Çelebioglu (2014), Maycock et al perceived partner support and breastfeeding
(2013) did not find any significant difference in self-efficacy, finding that partner support was
breastfeeding status at 6 months postpartum, in a associated with higher maternal confidence in
RCT where fathers received a male-led antenatal breastfeeding. Women who perceived positive
education session and 6-week postnatal support or active support from their partner had higher
package. However, Maycock et al (2013) did self-efficacy and breastfed longer in comparison to
find that there was a significant difference in those who did not report positive partner support.
mothers engaging in any breastfeeding at 6 weeks Mannion et al (2013) also found no significant
postpartum between the two groups. difference between those mothers who perceived
In a study by Abbass-Dick et al (2015), although positive support and those who did not in their
results were non-significant, more mothers were perception of milk production. It concluded
EBF at 6 weeks and 12 weeks postpartum in a that partner support has a greater influence
RCT intervention group where mothers and on breastfeeding confidence than the mother’s
fathers received a co-parenting breastfeeding perception of her milk production. The study
support education package. The study did discover had self-selection bias, where participants chose
significantly higher rates of any breastfeeding at
12 weeks in the intervention group. There was a
high follow-up participation rate in this study,
» There is a gap in the knowledge
but although the sample was multicultural, of fathers’ understanding of the value
© 2018 MA Healthcare Ltd

participants were middle class, educated and

highly motivated to breastfeed. Therefore, the of breastfeeding, their attitude towards
results may not be generalisable to other mothers.
Hunter and Cattelona (2014) conducted a
it and their interest in supporting
survey to explore breastfeeding initiation and their partners «
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Table 2. Studies included in review

Journal Study aims Sample Data collection Data analysis Findings Study
article characteristics limitations
Tohotoa, J, To identify 48 postnatal 8 focus groups of Qualitative Fathers’ support Non-
Maycock, what women mothers. 4–10 mothers each data thematic essential to the representative
B, Hauck, and men Breastfeeding using interview analysis. Coding mother being self-selected
YL, Howat perceive as or had in past 6 questions. and categorising able to breastfeed sample.
P, Burns S, essential months. 28 men. Fathers variety of themes. Two successfully. Small sample
Binns CW paternal Recruited via means, telephone major themes: Mothers identified
Dads make support to posters at child interviews, online ‘Dads make a that fathers should
a difference: facilitate health clinics, survey and focus difference’ and encourage and
An successful child care centres groups ‘Wanting to be problem solve.
exploratory breastfeeding. and early learning involved’. Mothers Fathers identified
study of What men centres. Fathers subthemes: that they require
paternal believe they recruited by their ‘Anticipating information,
support for need to assist partners with needs and getting recognition of their
breastfeeding them to be ‘wanted’ notices at the job done’, role and involvement
in Perth, a successful the above centres. ‘Encouraging to in antenatal classes
Western breastfeeding Mainly first-time do your best’ for them to be
Australia. advocate parents, married or and ‘Paternal advocates and
International living together commitment to supporters
Breastfeeding breastfeeding’. of breastfeeding
Journal Fathers
Australia, subthemes:
2009 ‘Wanting relevant
information’,
‘Learning the role’
and ‘Being an
advocate’
Rempel LA, To examine Study 1: 64 women Questionnaires Statistical analysis Responsiveness most Small
Rempel JK, the and 41 men (34 either online or frequent influence sample sizes.
Moore KCJ. relationship couples) with by mail. Partner behaviour. Mothers’ Sample not
Relationships between children born in breastfeeding breastfeeding representative
between fathers’ past year. Sample influence scale satisfaction and of wider
types of reported and identified from (PBIS) used to success rates population.
father mothers’ newspaper birth measure mothers’ significantly positively Breastfeeding
breastfeeding perceptions of announcements and fathers’ correlated with behaviours
support and breastfeeding and recruited by breastfeeding her perceptions may not be
breastfeeding support and telephone. duration intention. of partner’s representative
outcomes. mothers’ Study 2: 80 mothers Breastfeeding responsiveness during of different
Canada, 2017 breastfeeding and 63 fathers experiences rated breastfeeding. When cultures
Maternal intentions, had originally by mothers and fathers claimed
and Child satisfaction participated in fathers using breastfeeding
Nutrition and duration breastfeeding best breastfeeding support behaviours of
practice guidelines satisfaction appreciation, presence
implementation scale. Study and informed about
study (Rempel and 2: 12 months’ breastfeeding, mothers
McCleary, 2012), post-partum actually breastfed for
initially recruited follow-up study. shorter time. May not
from hospitals Questionnaire by have been sensitive
telephone or mail. and responsive
PBIS, maternal enough if mother
breastfeeding having difficulties and
evaluation scale, affected self-efficacy
© 2018 MA Healthcare Ltd

breastfeeding and autonomy

status and duration
of breastfeeding

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Table 2. Studies included in review

Journal Study aims Sample Data collection Findings Study
article characteristics limitations
Abbass-Dick To evaluate Primiparas Follow-up data collected at Co-parenting Possibly
J, Stern SB, the effect of a mothers 6 weeks postpartum from intervention increased measured too
Nelson LE, co-parenting and fathers mothers and fathers, and from breastfeeding duration early to detect
Watson W, breastfeeding cohabiting. mothers alone at 12 weeks, at 12 weeks significantly. significant
Dennis C. support Recruited from which included breastfeeding Duration rate at 6 difference
Coparenting intervention hospital in the status, duration and how weeks and exclusivity in exclusive
Breastfeeding on exclusive first 2 days much interventions learnt in rates at 6 and 12 breastfeeding
support and breastfeeding postpartum. the group were used. 12 weeks weeks higher than between the
exclusive 107 couples in co-parenting relationship scale. control group but not groups. Highly
breastfeeding: intervention Brief scale used at baseline and significant. Significant motivated to
a randomised group 6 weeks. Postpartum partner improvement in breastfeeding
control trial. support scale at 6 weeks. paternal breastfeeding sample. Limited
Pediatrics Breastfeeding self-efficacy scale self-efficacy over first 6 variability.
Canada, 2015 adapted to assess paternal weeks in intervention Selection bias.
breastfeeding self-efficacy group. Significantly Eligibility.
to measure confidence in more mothers received Postpartum
assisting the mother. Baseline breastfeeding help from period busy
and 6 weeks. Paternal infant fathers in first 6 weeks time to review
feeding attitude scale at and were satisfied with information
baseline and 6 weeks for father involvement and could have
fathers. Mothers breastfeeding information received been delivered
support 6 and 12 week who prenatally
supported and frequency.
Self-report online or telephone
questionnaire
Hunter T, To explore the First-time Self-administered questionnaire Prevalence of exclusive
Cattelona G. influence of social mothers assessing demographics, breastfeeding at 6
Breastfeeding support of the recruited from breastfeeding initiation, early months significantly
initiation male partner on Bloomington post-partum breastfeeding, higher among mothers
and duration first-time mothers’ Area Birth breastfeeding plans, support who had involvement
in first time breastfeeding Services, Indiana. and duration and support from fathers
mothers: initiation and Had a baby in during the early post-
Exploring duration. To assess last 12 months. partum period (first 48
the impact the level of father 146 mothers hours)
of father involvement and
involvement support. Assess
in the early the partner
postpartum participation in
period. breastfeeding
USA, 2014. decisions
Health
Promotion
Perspectives

to take part in the study, which affected the perceptions of the help they needed to support the
generalisability of the results. The study also mother effectively. The study had limited success in
relied on subjective self-report data from mothers’ recruiting fathers, although used a range of data
perceptions, which could increase the risk of collection methods to overcome this limitation.
recall bias. Fathers were recruited via mothers, suggesting a
© 2018 MA Healthcare Ltd

Tohotoa et al (2009) found that mothers felt possible sample of the most committed mothers to
increased self-confidence in relation to her breastfeeding risking self-selection bias.
partner’s support. This study conducted eight In a quantitative study, Rempel et al (2017)
focus groups to explore mothers’ perceptions of found maternal satisfaction in breastfeeding to
her partner support and to ascertain partners’ be a protective factor in reducing the risk of early

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Table 2. Studies included in review

Journal Study aims Sample Data collection Data Findings Study limitations
article characteristics analysis
Mannion CA, To find out Convenience Breastfeeding Statistical Women who Non-representative
Hobbs AJ, if mothers sample from self-efficacy scale analysis. perceived active or sample of wider
McDonald reporting a larger study. and the Hill and Responses positive support population. Majority
SW, Tough SC. positive Recruitment Humenick Lactation to questions from their partner highly educated and
Maternal support from posters at scale perceived milk of perceived in breastfeeding had only majority living
Perceptions their partners health centres, supply. Demographic partner higher self-efficacy with partner. Only
of partner would have breastfeeding questionnaire support scores than those who focuses on maternal
support a higher women also addressed categorised perceived negative or perceptions, could
during confidence approached breastfeeding into ambivalent support. have changed over
breastfeeding. in breast milk and referred status, duration and positive, Only 5% discussed time. Self-report-
International production to research variables that can negative/ decision to breastfeed recall bias, could
Breastfeeding and higher assistants. affect breastfeeding. ambivalent with partner. No have forgotten initial
Journal breastfeeding 76 mothers. Also perceived differences in perceptions.
Canada, 2013 self-efficacy Inclusion partner support perceived support Convenience sample-
currently and lactation scale selection bias. Small
or recently sample size limits
breastfeeding generalisability
women currently
with the partner
Maycock B, To investigate Sample recruited Questionnaires Statistical Any breastfeeding Breastfeeding
Binns CW, the effects of from eight antenatal and analysis rates at 6 weeks rates higher in
Dhaliwal an antenatal maternity postnatal 6 weeks significantly greater Australia than other
S, Tohotoa education hospitals. Fathers and 6 months. in intervention group countries, harder
J, Hauck package and had to intend Breastfeeding status and less formula use. to measure change.
Y, Burns S, postnatal to participate in assessed at 6 weeks. Exclusivity at 6 weeks Small chance of
Howat P. support the rearing of the Fathers followed up non-significant. No contamination
Education targeted to child. 295 men by questionnaire significant differences between control
and Support fathers on the attended session or by telephone. at 6 months between and intervention
for fathers initiation and and responded Iowa Infant Feeding the groups group. Did not
improves duration of to 6-week Attitude Scale account for previous
breastfeeding breastfeeding questionnaire measured at baseline breastfeeding
rates: A and 6 months experience.
randomised Intervention
control trial. stopped at 6 weeks,
Journal of contributes to
Human lack of significant
Lactation difference at 6
Australia, 2013 months

Nickerson To examine Convenience 19 semi-structured Thematic Mothers perceived Not representative

LE, Sykes mothers’ sample. Living interviews using analysis. fathers to play an of populations in
AC, Fung experiences with biological questions on type Ten important role in other areas of the
TT. Mothers of support father. Had of support received thematic breastfeeding process USA.
Experience received from baby in last 12 from fathers for categories by emotionally and Socially and
of fathers’ fathers for months. No more breastfeeding. found physically supporting economically
support for breastfeeding than 3 months Questions included the mother and are homogenous
breastfeeding. since stopped mother’s opinion of a critical component sample. Mothers’
Public Health breastfeeding the role of the father to success. Fathers’ perception only
Nutrition and breastfed for in breastfeeding support was crucial
USA, 2012 at least a month process, preparation during breastfeeding
of the father for challenges to help
© 2018 MA Healthcare Ltd

breastfeeding and them persevere and

what is absent in the continue
fathers support for
breastfeeding

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Table 2. Studies included in review

Journal Study aims Sample Data collection Data Findings Study
article characteristics analysis limitations
Datta J, To evaluate an 14 men and Interviews questions Thematic Fathers felt it was mother’s Initiation rates
Graham B, intervention 4 women. on general views analysis decision to breastfeed, already high in
Wellings K. to provide Recruited at the on breastfeeding, although saw it as their the area of UK.
The role of fathers hospital when decision making role to provide support. Findings may not
fathers in information attending for regarding infant Implication is that some be generalised to
breastfeeding: about 20-week scan feeding, father’s role women may not start other areas of UK.
Decision breastfeeding. or following in breastfeeding breastfeeding without The sample was
making and Women delivery on and experiences of partner support in positive about
support. targeted to postnatal ward- breastfeeding decision making. Father’s breastfeeding-
British Journal gather views took advice from role in providing practical not generalisable-
of Midwifery. on the role midwifes as to and emotional support selection bias.
UK, 2012 of fathers in who to approach. may be essential to Small sample size.
relation to Recruitment via breastfeeding success. Well educated
breastfeeding the mothers in Fathers providing participants.
some instances. encouragement, support Some couples
Inclusion- enabled mothers to changed their
breastfeeding continue breastfeeding mind about
mother or despite facing difficulties. participating
planning to Information pack due to having
breastfeed provided new knowledge difficulties
and strengthened existing breastfeeding
attitude of breastfeeding
Ozluses E, To determine Parents of infants Infant feeding type Statistical From 1–6 months
Celebioglu the effect of younger than for EBF rate checked analysis significant differences
A. Educating breastfeeding 6 months.117 at 1, 2, 4, 6 months. between groups. EBF rates
fathers to education families Using interviews high at 6 months when
improve provided during check-ups. mother and father both
breastfeeding to fathers Paternal infant educated. Paternal infant
rates and on the rate attachment scale attachment score higher
paternal infant of EBF and used to measure in group with fathers
attachment. paternal infant strength of the bond educated also
Indian attachment between father and
Pediatrics. infant
Turkey, 2014

cessation of breastfeeding. This work presented the is a validated tool, and the PBIS used a Likert
results of two surveys, which explored how when scale, which is subjective and open to different
fathers engaged in breastfeeding this influenced participant interpretations. Each study used
behaviours. The effect on the breastfeeding different samples, although both were highly
intention, satisfaction of the experience and the educated, affluent and not culturally diverse.
duration of breastfeeding was explored. The recruitment processes have selection bias,
To measure how often fathers engaged in which opened the generalisability of the results
breastfeeding behaviours, a partner breastfeeding to question. The first study recruited via birth
influence scale (PBIS) was used, which included announcements in the local newspaper and the
subscales of being ‘breastfeeding savvy’, helping, second study used a small convenience sample;
appreciation, breastfeeding presence and mothers chose to take part, recruited through
responsiveness. Mothers who reported perceptions public health nurses.
of their partner’s presence and responsiveness
© 2018 MA Healthcare Ltd

during the breastfeeding experience was positively Educating fathers

correlated with greater breastfeeding satisfaction. A theme that emerged through the thematic
Partner responsiveness was also associated with analysis was fathers’ education of breastfeeding,
a longer duration of breastfeeding (Rempel et al, with codes of information, education and
2017). It is questionable as to whether the PBIS knowledge identified in several studies.

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» More mothers reported receiving help diverse, educated mothers from an urban area,
meant that results may not be generalisable to
from their partner and being satisfied with the whole area. Although the study only looked at
the partner’s involvement when fathers mothers’ perceptions of support, it did account for
recall bias by ensuring that mothers had stopped
received the co-parenting intervention « breastfeeding in the last 3 months.
Datta et al (2012) interviewed mothers and
fathers to evaluate a breastfeeding information
Fathers receiving education manuals on pack for fathers. They also looked at the father’s
breastfeeding and an education session on role in decision making regarding breastfeeding
the technical processes of breastfeeding were and fathers’ experiences of breastfeeding
suggested by Özlüses and Çelebioglu (2014) challenges faced in supporting the mother. Datta
to have influenced the mother’s duration of et al’s (2012) results highlighted that fathers had
breastfeeding. Similarly, Maycock et al (2013) attended antenatal classes and read information
concluded that an education session for fathers on breastfeeding, but few were prepared for
promoted breastfeeding and influenced mothers’ problems arising during breastfeeding. Only one
breastfeeding rates. The education session and father in the study reported that the antenatal
additional 6-week follow-up package was aimed class had alerted him to possible difficulties
to increase fathers’ knowledge, skills and problem- (Datta et al, 2012). However, Datta et al (2012)
solving abilities in infant feeding by educating acknowledged limitations in the small sample size
fathers about the benefits of breastfeeding, of parents who were educated, older and positive
difficulties that can be encountered and how to about breastfeeding, creating a self-selection bias.
support the breastfeeding mother (Maycock et The study area also had higher breastfeeding rates
al, 2013). in comparison to the rest of the UK. Datta et al
Maycock et al (2013) indicated that fathers (2012) emphasised that their findings should be
attending an education session in the intervention interpreted with caution.
group had an influence on the mother’s attitude Breastfeeding knowledge was a code identified
and knowledge towards breastfeeding, with higher through the thematic analysis, with four studies
maternal favourable attitudes to breastfeeding highlighting that fathers supported the mother’s
compared to the control group. decision to breastfeed as they were aware of
In a study by Abbas-Dick et al (2015), fathers the health benefits of breastfeeding (Tohotoa
were given breastfeeding information on the et al, 2009; Datta et al, 2012; Nickerson et al,
postnatal ward and a workbook, video and 2012; Mannion et al, 2013). Despite this, Datta
website to access at home. They ascertained that et al (2012) found that some fathers still lacked
fathers participating in the programme had high knowledge of specific benefits to breastfeeding
paternal self-efficacy and infant feeding attitudes and generally felt it was the mother’s decision to
compared to the control group (Abbas-Dick et breastfeed and whether to continue during the
al, 2015). More mothers reported receiving help challenges of breastfeeding.
from their partner and being satisfied with the Fathers reported feeling they were able to
partner’s involvement when fathers received the encourage the mother to continue breastfeeding
co-parenting intervention (Abbas-Dick et by providing information on the benefits (Datta
al, 2015). et al, 2012; Nickerson et al, 2012). This supported
Two studies examined fathers attending Tohotoa et al’s (2009) findings that mothers
antenatal breastfeeding classes, which was reported fathers to be committed and supportive
collapsed into the education code (Datta et towards breastfeeding as they were knowledgeable
al, 2012; Nickerson et al, 2012). Nickerson et about the benefits. Mothers also reported
al (2012) interviewed mothers to explore the fathers being able to help reduce breastfeeding
mother’s breastfeeding experience and the support positioning and attachment difficulties for them
she received from the father. Nickerson et al (2012) by researching on the internet (Tohotoa et al,
indicated that mothers reported feeling that their 2009). Some fathers felt inadequate in their
husbands benefited from attending antenatal knowledge and ability to effectively support the
© 2018 MA Healthcare Ltd

breastfeeding classes and spending time with a mother and felt unprepared for the fathering role
lactation consultant as they could remember the (Tohotoa et al, 2009). Fathers expressed wanting
information and apply the knowledge to support more information on difficulties in breastfeeding
the mother during breastfeeding difficulties. and how they could support the mother (Tohotoa
However, a small sample size of non-culturally et al, 2009).

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Rempel et al (2017) identified that fathers’ » Previous research has found that
breastfeeding influence behaviour of being ‘savvy’,
termed as ‘learning about breastfeeding and if fathers have a positive attitude and the
using the knowledge to encourage the mother
and suggest solutions to breastfeeding problems’,
appropriate skills to support breastfeeding,
was the least demonstrated type of support to the they can have a significant impact «
mother’s breastfeeding. In contrast to other studies,
Rempel et al (2017) concluded that when fathers
used their knowledge to support the mother, Tohotoa et al (2009) suggested that
breastfeeding duration was shorter. acknowledgment of the effort in breastfeeding was
an aspect mothers found especially important.
Breastfeeding support from fathers Mothers (22%) indicated in one study (Mannion
Fathers’ support was a common theme in the et al, 2013) that their partner felt indifferently
literature. Several papers established that mothers or negatively about breastfeeding. Negative
valued fathers’ support and this influenced the comments included breastfeeding being ‘too time-
duration of breastfeeding (Tohotoa et al, 2009; consuming’ (Mannion et al, 2013).
Datta et al, 2012; Nickerson et al, 2012). Nickerson Interestingly, Rempel et al (2017) found when
et al (2012) found mothers felt the support of fathers wanted the mother to breastfeed for longer,
the father was imperative to them continuing showed appreciation, and were present and
breastfeeding. Some studies illustrated the view informed (savvy) about breastfeeding, mothers
that mothers believed without the presence and actually breastfed for a shorter time.
support of the father, they would not have been An equally important factor for mothers was the
able to continue when facing breastfeeding practical support offered by fathers (Tohotoa et
challenges (Tohotoa et al, 2009; Datta et al, 2012; al, 2009; Datta et al, 2012; Nickerson et al, 2012;
Nickerson et al, 2012). Mannion et al, 2013). Nickerson et al (2012) found
Many mothers identified fathers as ‘just being the mother’s experience of physical support from
there’ to offer support and assistance as an the father was a common theme. This included
important role for fathers (Tohotoa et al, 2009), help with household tasks, bringing items to the
especially in the first few weeks after giving birth. mother while she was breastfeeding, physically
This was clear in the study by Nickerson et al helping the mother to nurse and assisting her in
(2012), who found that most mothers perceived public. In other papers, mothers also reported
their husband to be a ‘partner’ in breastfeeding. similar practical ways in which the father
This became especially apparent in circumstances supported her (Tohotoa et al, 2009; Mannion et
where mothers felt they needed additional support al, 2013). Fathers also felt that doing as much as
from their husband (first-time mothers, mothers possible to practically support the mother was
recovering from caesarean sections and during something they could do effectively in their role
breastfeeding challenges). (Datta et al, 2012).
Partner emotional support in successful
breastfeeding was also a theme in the literature. Discussion
Many of the papers identified that mothers valued The literature supports the father’s role in
this emotional support during the breastfeeding breastfeeding. In particular, fathers are pivotal
process (Tohotoa et al, 2009; Datta et al, 2012; supporters when they are recipients of education
Nickerson et al, 2012; Mannion et al, 2013; Rempel and information about breastfeeding. Mothers
et al, 2017). Mothers reported that the beginning welcome their support, especially with the
of breastfeeding was especially difficult (Nickerson practical work around the home. They are also a
et al, 2012). Mothers perceived encouragement, motivator and encourager in the early attempts
affirmation and reassurance as key factors in at breastfeeding.
fathers providing emotional support (Tohotoa et al, Previous research has found that if fathers have
2009; Nickerson et al, 2012; Mannion et al, 2013). a positive attitude and the appropriate skills to
Similarly, fathers identified encouragement as a support breastfeeding, they can have a significant
method used to support the mother to continue impact (Clifford and McIntyre, 2008). However, a
© 2018 MA Healthcare Ltd

breastfeeding (Datta et al, 2012). Both mothers recent study found that interventions are needed
and fathers reported that the father showing to engage fathers more in the breastfeeding
kindness and affection was a valued element of decision (Brown and Davies, 2014). Research
emotional support, with fathers assuming a loving has also shown that fathers are interested in
and supportive role (Datta et al, 2012). breastfeeding and want to be involved (Sheriff et

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 › IN PRACTICE

employed different methods, making comparison

Key points of findings challenging. However, the wider
ŠŠ
Research suggests that fathers can be an important source of breastfeeding support network for mothers trying to breastfeed
support but are not acknowledged in many existing breastfeeding protocols is important and there remains a lack of research
or policies in this area. Thus, even with a small evidence
ŠŠ
Fathers are pivotal when they are recipients of education and information base it is important to consider the role of
about breastfeeding the father.
ŠŠ
Mothers welcome their support, especially with the practical work around
the home. They are also a motivator and encourager in the early attempts Conclusion
at breastfeeding As discussed, there is a lack of research in this
ŠŠ
There is a need for existing policies and guidelines to acknowledge the important area. Breastfeeding researchers and
father’s role clinical academics should look closely at the
ŠŠResources and interventions for fathers need to be designed and researched father’s role, understand how they can be
supportive and what resources they need to
support them. There is a need to build on the
al, 2009). However, fathers have previously reported interventions (educational, peer support, father
feeling that they lack knowledge and want more ‘friendly’ resources) described in this article and
information to be proactively involved and able to to trial them as larger-scale studies with more
support their partners (Sheriff et al, 2009). There diverse groups of fathers.  JHV
is not a vast amount of literature on this topic
and throughout this article the limitations of the This article has been subject to peer review.
research reviewed has been discussed. Nonetheless,
against a backdrop of low breastfeeding rates and Abbass-Dick J, Stern SB, Nelson LE, Watson W, Dennis CL. Coparent-
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Milk. Pediatics. 2012;115(3):827–841.
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Call for peer reviewers for

Journal of
HealthVisiting
Are you a health visitor,
researcher or educator?
If so, the Journal of Health Visiting would
be interested to hear from you as we
aim to expand our group of committed
peer reviewers.
In reviewing articles, the reviewer is informing and
© 2018 MA Healthcare Ltd

advising the editors, who will make the final decision

regarding publication.
If you are interested, please send your CV or
contact the editor at [email protected]

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