Maternal health is a known crisis in the United States, with maternal and newborn mortality rates several times higher than in comparable countries. In recent years, increased awareness of this problem has led to interventions at the federal and state levels and increased surveillance and data collection. Although significant improvements remain elusive, it is becoming clearer how many new mothers are dying and why.
A research letter published Monday in JAMA Pediatrics argues that fathers deserve similar consideration. To support their argument, the authors report the results of a preliminary study in Georgia of the deaths of fathers of children born in a given year, which found that nearly 800 deaths occurred in the first five years of fatherhood.
“In my experience, it’s more common for the father to die during the mother’s pregnancy or during the postpartum period,” Craig Garfield, a professor of pediatrics at Northwestern University and lead author of the study, said in an interview.
Most of the researchers STAT spoke to thought the idea of monitoring and investigating fathers’ deaths was a legitimate pursuit, although there were some concerns. However, the authors’ framework that “father death is more than just a men’s health problem, it is also a family and public health crisis” did not receive much support.
As it turns out, the paper found something very impressive: becoming a father is associated with decreased mortality.
Garfield, a pediatrician at Chicago’s Lurie Children’s Hospital, has been studying fathers for years. The role of fathers in children’s well-being and the impact fatherhood has on men’s mental and other health. In 2018, he developed the Pregnancy Risk Assessment System for Fathers (PRAMS). This is the PRAMS mirror survey for mothers, developed in 1987 to monitor the health status of mothers and children. The study began in Georgia and has since expanded to nine other states.
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“We developed PRMS for fathers because we realized there was a huge gap in our understanding of fathers’ perinatal health,” he said. Similarly, he was interested in gaining further insight into the death of the child’s father at an early age.
For this pilot study, the authors looked at the birth certificates of children born in Georgia in 2017 and searched their fathers’ death certificates over the following five years. The first few years are “a very stressful time for families, before the kids reach kindergarten age and start school, so there’s all kinds of pressure on families during this time,” Garfield said.
The study found that more than 60 percent of father deaths were due to preventable causes: homicide, accident, suicide, and overdose, in order of frequency. This is consistent with broader trends in male mortality, with natural causes overtaking preventable causes of death for men only after age 45. Still, compared to men in general, fathers have lower mortality rates “at all ages after age 25,” Garfield said. “So despite the higher mortality rates for this group, there is something protective about fatherhood.”
This is very different from what happens to mothers, where pregnancy and childbirth increase the risk of death.
“The authors are taking a new step forward by viewing preventable paternal death as a family health problem,” said Neil Shah, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and chief medical officer of Women’s Health Virtual Clinic Maven. “Father health absolutely requires further attention, research and solutions in the broader context of family health,” he said.
Shah said he found the insight that fatherhood is independently protective was worthy of further investigation, especially “in light of the crisis of male loneliness and declining life expectancy for men overall.”
The study notes that compared to living fathers of young children, deceased fathers were more likely to be older, black, lived in rural areas, unmarried, and had Medicaid insurance. Homicide deaths were more common among black fathers, while fatal drug overdoses and suicide were more common among white fathers.
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These findings may point to areas for intervention, but they also create a narrative of blame similar to the one that has long held Black women partly responsible for their own deaths, said Monica McLemore, visiting professor of nursing and birth equity scholar at New York University. “Rather than replicating what we have already done for maternal health, why not approach this from the perspective of family support needs?” she asked.
In their discussion, the authors suggest that “paternal death” be integrated into the Maternal Mortality Review Committee (MMRC), a group that scrutinizes records of maternal deaths at the local level to ensure accuracy. Maternal mortality experts rejected this idea. Shah is skeptical that this is justified. “The MMRC was really set up to understand and address pregnancy-related deaths, and this needs and deserves focused attention,” he said.
“The MMRC’s current focus is on maternal mortality research,” said Eugene Decler, a professor of community health sciences at Boston University’s School of Public Health and a leading expert on maternal mortality data. “While this is interesting research, I don’t think there is enough research to warrant expanding the duty for paternal death,” he said.
The paper acknowledges limitations, starting with the fact that data collected in a single state cannot be extrapolated nationally. Additionally, the data does not include fathers who were not married to the birth mother and do not acknowledge paternity, nor do fathers who died outside of Georgia.
McLemore also challenged the study’s premise that “father involvement is associated with improved child and family health outcomes,” calling it a heteronormative assumption. “Queer literature (and adoption) shows that two or more adults are more important in a child’s life than the nature of the relationship,” she said. Professor Garfield acknowledged that one of the study’s limitations was that it did not capture the death of a female non-biological parent who was not the man listed on the birth certificate.
“All we have is the data that has been collected. Obviously this is an area of future work,” he said.
STAT’s coverage of health issues facing men and boys is supported by Rise Together. Rise Together is a donor-advised fund sponsored and managed by the National Philanthropic Trust and established by Richard Reeves, founding president of the American Association of Boys and Men. and by the Boston Foundation. Our financial supporters have no input into any decisions about our journalism.
