fathers, pregnancy, and infant mortality · 2020. 7. 22. · infant mortality •death to an infant...
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Fathers, pregnancy, and infant mortality
Dorothy J. Mandell
School of Community & Rural Health,
University of Texas Health Science Center at Tyler &
Population Health,
University of Texas System Administration
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Infant mortality
• Death to an infant before their 1st birthday• Majority of these deaths are within 24 days of the baby’s birth
• A rare, but still too common, birth outcome• About 5.8 deaths per 1,000 live births in Texas
• Multi-faceted causal chain of events• There is almost never ONE thing that leads to death
• Infant mortality reflects the health of the community
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Infant Mortality Disparities
• Substantial race/ethnic disparities
• Substantial geographic disparities
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Disparities and prevention
All things being equal, what causes
infant mortality
What isn’t equal
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Three overlapping points
Smoking
No Prenatal
Care
No Paternity
Established
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Baseline Understanding of Paternity Establishment• 86% – paternity established
• 67.5% – babies born to a black mother
• 62% – teen births with paternity established
• 80% – paternity establishment for 18-25 year old mothers• 54% of babies without paternity establishment are in this age range
Paternity Establishment
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Infant Mortality & Paternity
• When paternity is established: • IMR* ~ 5.0 per 1,000
• When paternity is NOT established: • IMR ~ 8.5 per 1,000
• Excess deaths associated with paternity establishment• ~ 1,000 over 6 years
Paternity Establishment
*Linked birth-death records
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Not just one thing
Smoking
• IMR: smoking but paternity• 9.0 per 1,000 babies
• IMR: smoking and no paternity established• 10.1 per 1,000 babies
• With paternity• 3.7%
• Without paternity• 9.1%
No Prenatal Care
• IMR: no PNC but paternity• 16.0 per 1,000 babies
• IMR: no PNC and no paternity established• 19.1 per 1,000 babies
• With paternity• 2.8%
• Without paternity• 8.1%
Smoking
No Prenatal
Care
No Paternity
Established
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What to remember:
• Paternity establishment overlaps with both of these high-risk behaviors
• Lack of established paternity: high-risk behaviors more high-risk• Especially seen with prenatal care
• Established paternity: Low-risk behaviors are lower risk
Smoking
No Prenatal
Care
No Paternity
Established
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When paternity is established the good things are better
• Paternity establishment does not start at birth
• Paternal involvement does not start at birth• It is a journey from conception to
birth
• How to we create the environment to make that journey positive?
How do we get to making the good things better?
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Male involvement in pregnancy care systems
What we know• Pregnancy affects men biologically,
socially, and emotionally
• Men want to be involved
• Men feel underprepared when the baby is born
• Men experience postnatal depression/anxiety, too
What we don’t know• The percent of men who attend one PNC
visit
• What are the external motivating factors to attend PNC visits
• Do men ask questions during PNC visits
• What information “sticks” with men during PNC visits
• What is the best way to present warning signs of complications to men
• Are men being included in PNC visits
• …
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Engaging Dads Early and Often:Father’s PlaybookUsing mobile application
https://fathersplaybook.org/
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Pregnancy Basics
• Changing Bodies
• Changing Emotions
• Nutrition and wellness
• Going to Prenatal Exams
• Twins and Multiples
• Building a Connection with Your Baby
Preparing for Baby
• Thinking about Finances
• Birth Preparation
• Financial Calculator
• WIC
• Establishing Paternity
• Setting up the Nursery
• Paternity Leave
Staying Healthy
• Men Change Too
• Signs of Depression &Anxiety
• Helping Your Partner
• Vaccines for Baby
• Vaccines for Mom & Dad
• Building the Team
Current Modules
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Coming content
• Action Plans• Developing a plan for the difficult things before they happen
• Revising your plan after the difficult thing happens
• Postnatal Content• Dad and play
• Dad and reading
• Dad supporting mom
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COVID-19 and Dads
• Can men attend PNC visits?• Are there innovative and best practices we can support
• How are men getting information about pregnancy?• What can we do to support quality information seeking
• Are men doing on-line prenatal classes?• How can dads get this information
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We measure what we value