Maternal health is a known crisis in the U.S., where pregnant women and new mothers die at a rate several times higher than in comparable countries. In recent years, increased awareness of the problem has led to interventions at the federal and state level and a strengthening of surveillance and data collection. Even as sizable improvements continue to be elusive, the picture of how many new mothers are dying, and why, is becoming clearer.
A research letter published on Monday in JAMA Pediatrics argues fathers deserve similar attention. To bolster their assertion, the authors reported the results of a pilot study in Georgia of deaths among fathers of children born in a single year, which found nearly 800 deaths in the first five years of fatherhood.
“It’s been more common in my experience that there’s a dad who has died during the course of the mom’s either pregnancy or in the postnatal period,” Craig Garfield, a professor of pediatrics at Northwestern University and the lead author of the study, said in an interview.
Most of the researchers STAT spoke with found the idea of monitoring and investigating the deaths of fathers a valid pursuit, albeit with a few elements of concern. But the authors’ framing that “paternal mortality is more than a male health issue; it is also a family and public health crisis” found less support.
After all, the paper found something quite striking: Fatherhood was associated with reduced mortality.
Garfield, a practicing pediatrician at Lurie Children’s Hospital in Chicago, has long researched fathers: their role in the well-being of a child, as well as the impact of fatherhood on the health of a man, mental and otherwise. In 2018, he developed the Pregnancy Risk Assessment System (PRAMS) for dads, a mirror survey to the PRAMS for mothers developed in 1987 to monitor maternal and infant health. The survey was launched in Georgia, and has since expanded in nine other states.
“We’ve developed PRAMS for dads because we realized that there’s a huge gap in understanding dad’s perinatal health,” he said. Similarly, he was interested in getting more insight into the death of fathers during the child’s early years.
For this pilot study, the authors looked at the birth certificates of children born in Georgia in 2017, and searched for death certificates for their fathers during the following five years. These first years are “a time that’s very intense for families, it’s before the child’s reaching kindergarten age and getting to go to school, so there’s all sorts of pressures on families at that particular point,” said Garfield.
The study found that more than 60% of the fathers’ deaths were from preventable causes — homicide, accidents, suicide, and overdose in order of frequency. This is in line with broader trends for male mortality: only after 45 do natural causes overtake preventable ones in men’s deaths. Still, the death rate of fathers, compared to men in general, “is lower at all ages after the age of 25,” said Garfield, “so there’s something also protective about becoming a father, despite the high number of deaths in this group too.”
This is very different from what happens to mothers, for whom pregnancy and childbirth increase the risk of death.
“The authors are breaking ground by framing preventable paternal death as a family health issue,” said Neel Shah, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and the chief medical officer of women’s health virtual clinic Maven. “The well-being of fathers absolutely requires more attention and research and solutioning in the broader context of family health,” he said.
Shah found the insight that fatherhood is independently protective particularly worthy of further investigation, especially “in the light of a crisis of loneliness among men and declining life expectancy for men overall,” he said.
The study notes that compared to living fathers of young children, the ones who died were more likely to be older, Black, living in rural areas, unmarried, and insured through Medicaid. Homicide deaths were more common among Black fathers, while fatal drug overdoses and suicide among white ones.
Though these findings could point to areas of intervention, they also set up a blame narrative similar to the one that long held Black women partially responsible for their own deaths, said Monica McLemore, a visiting professor of nursing at New York University and a scholar of birth equity. “Why not approach this from the need for familial support as opposed to replicating what we’ve already done for maternal health?” she asked.
In their discussion, the authors suggest that “paternal deaths” be integrated into Maternal Mortality Review Committees (MMRCs), groups that review the records of maternal deaths at a local level to ensure their accuracy. Experts in maternal deaths pushed back on this idea. Shah is skeptical that this would be warranted. “MMRCs are really set up to understand and address pregnancy-associated deaths, which demand and deserve focused attention,” he said.
“MMRCs are currently stressed reviewing maternal deaths,” said Eugene Declercq, professor of community health sciences at the Boston University School of Public Health and a leading maternal mortality data expert. “While this is an interesting study, I don’t think there’s enough here to merit the expansion of their mandate to paternal deaths,” he said.
There are limitations acknowledged in the paper, starting with the fact that data collected in a single state can’t be extrapolated nationally. Further, fathers who were not married to the birthing mother and did not acknowledge paternity would not be captured in this data, nor would fathers who died outside Georgia.
McLemore also challenged the study’s premise that “paternal involvement is linked to better child and family health outcomes,” which she said is a heteronormative assumption. “Queer literature (and adoption) shows two or more adults in a child’s life matters more than the nature of the relationship,” she said. Garfield acknowledged that one of the study’s limitations is not capturing the deaths of female non-birthing parents listed in the birth certificates but aren’t men.
“We only have the data that is collected; clearly this is an area for future work,” he said.
STAT’s coverage of health challenges facing men and boys is supported by Rise Together, a donor advised fund sponsored and administered by National Philanthropic Trust and established by Richard Reeves, founding president of the American Institute for Boys and Men; and by the Boston Foundation. Our financial supporters are not involved in any decisions about our journalism.