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Curtin University
Collaboration for Evidence, Research and Impact in Public Health

FIFI - Fathers Infant Feeding Initiative (2008-2010)

Investigators

Project Manager/PhD Candidate:

Chief Investigators:

Collaborating Partners:

  • Centre for Behavioural Research in Cancer Control, Curtin University
  • Armadale/Kelmscott Hospital
  • Bentley Hospital
  • Family Birthing Centre
  • Kaleeya Hospital
  • Joondalup Hospital
  • Osborne Park Hospital
  • Rockingham/Kwinana Hospital
  • Swan/Kalamunda Hospital

Funding

Healthway WA (Health Promotion Foundation of Western Australia) ($340,653)

Project Aim and Objectives

The Fathers Infant Feeding Initiative (FIFI) aimed to impact upon several National Health Priorities, including early childhood nutrition, obesity, cancer prevention and mental health.
The intervention was designed to support fathers to support their partners to breastfeed and increase the duration of breastfeeding.

The project objectives were:

Phase One (prenatal) Objectives -

  • Identify factors which encourage fathers to support their partners’ breastfeeding (facilitators)
  • Identify factors which discourage fathers from supporting their partners’ breastfeeding (barriers)
  • Design and implement an educational/social support program to increase fathers’ support of breastfeeding.

Phase Two (Postnatal) Objectives -

  • Document the breastfeeding initiation and duration rates among mothers where fathers complete a breastfeeding intervention, compared to rates where fathers do not attend an intervention
  • Increase the percent of mothers who are still breastfeeding at the end of six months by 10%
  • Identify changes in fathers’ attitudes towards breastfeeding pre and post the paternal breastfeeding intervention as measured by the Iowa attitude scale.

Background

Evidence regarding effective strategies to assist fathers in their supportive role with their breastfeeding partner is inconclusive and there are no published examples within an Australian context. Effective strategies to assist breastfeeding are required because breastfeeding rates in Australia and in many other countries are well below WHO recommendations. Because of the importance of breastfeeding to the health of the infant and mother it is important to study the factors that influence initiation and particularly duration, which includes the acknowledged influence of fathers. This formed the basis for this study.

Project Overview

This study was conducted between 2008 and 2010 and investigated the role that fathers can play in enhancing the initiation and duration of breastfeeding. The study was a randomised controlled trial conducted in eight metropolitan maternity Hospitals (two Baby Friendly Hospitals) with 1,574 fathers and mothers to increase the duration of breastfeeding.

The intervention contained two interconnected elements designed to complement each other. The first element consisted of a one hour hospital-based antenatal education developed for the intervention fathers and focussed on three primary areas: (1) The role of the father, (2) the benefits and importance of breastfeeding to both mother and baby, (3) and how to problem solve in the first four weeks at home with a newborn. The second element involved a time specific series of social support and educational materials sent directly to the fathers in weeks 1-6 post-birth. These materials complemented and built upon the antenatal education and aimed to increase the duration of breastfeeding and delay the introduction of solids and formula.  

Key Outcomes

The completion of the FIFI has seen the intention to breastfeed undermined by the reality of breastfeeding. The outcomes of any breastfeeding at six months varied between hospitals from 79% to 28%. One of the project objectives was to have an increase in breastfeeding rates of 10% between the intervention and control mothers at six months. Two hospitals scored a 10% increase with four others comparable. The breastfeeding rates were higher between groups at six weeks, but were not sustained.

The antenatal package and support package was welcomed by the men who attended and 90% of the participants recommended it continue and become an integral part of the hospital antenatal program.

Factors which encourage fathers to support their partners’ breastfeeding (facilitators) identified in this study were:

  • Relevant information about breastfeeding and breastfeeding problems, given in a timely manner
  • Adequate resources for fathers to access help and information about breastfeeding
  • Extended family support for breastfeeding.

The barriers identified were:

  • Lack of time due to work constraints
  • Insufficient information about the importance of breastfeeding to both mother and baby
  • Lack of support for mother to breastfeed.

Educational/social support materials developed included:

  • PowerPoint presentation handout (antenatal class)
  • New fathers guide (antenatal class)
  • How to be a breastfeeding champion (antenatal class)
  • Developmental milestones of infancy (week two post partum)
  • Relaxation exercises with herbal tea bags (week three post partum)
  • Stubby holder with logo "Smarter, stronger: breastfeed longer" (week four)
  • Post natal depression postcard and brochure (week five).

Women in both groups struggled with attachment difficulties, engorgement and perceived insufficient milk supply and those in the intervention group were more able to seek help and receive support to continue. This is reflected in the six week breastfeeding outcomes with the 80% (average) of intervention mothers still breastfeeding compared to 65.4% (average) in the control group.

Limitations of the project were the high (43%) attrition rate for the six month questionnaire responses. This lowered the effectiveness of the data results and the small numbers made it hard to generalise them. The breastfeeding outcomes were 95% response rate as participants were contacted by phone on frequent occasions to answer just the two questions: “How is your baby at six months?” and “When did you introduce solids?”

Recommendations from the project are to:

  1. Advertise and promote breastfeeding more within the hospital and child health centres.
  2. Encourage fathers to attend the antenatal classes and provide an all male session with a male facilitator to allow for greater open discussion and information sharing.
  3. Promote the role of the lactation consultant, midwife and child health nurse for breastfeeding advice and problem solving common difficulties associated with breastfeeding.
  4. Offer parenting help kits for sale incorporating a breastfeeding DVD, a fridge magnet with breastfeeding help numbers, settling advice, developmental milestones and evidenced based practice advice on common parenting difficulties.

Publications

  • Tohotoa, J., Maycock, B., Hauck, Y. L., Howat, P., Burns, S. & Binns C. W. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International Breastfeeding Journal, 4,15.
  • Tohotoa, J., Maycock, B., Hauck, Y. L., Howat, P., Burns, S. & Binns C. W.      Supporting mothers to breastfeed: The development and process evaluation of a father      inclusive perinatal education support program in Perth, Western Australia. Health   Promotion International (in press).

Dissemination of results:

  • Project results were presented at the Child and Maternal Conference in Perth in October 2010.
  • Six week results were presented at the 40th Australian Public Health Conference in Adelaide in September 2010.
  • Six week results were presented at the 11th International Mental Health Conference in Surfers Paradise in August 2010.
  • Six week results were presented at the 10th International Health Promotion Conference in Geneva in July 2010.
  • Preliminary findings at six weeks were presented at the Australian Lactation Conference in Canberra in September 2009.