Postpartum experiences of first-time fathers in a Tanzanian suburb: A qualitative interview study
Introduction
Fathers’ active engagement in responsible parenthood is important for reproductive, maternal and infant health (UNFPA, 1996; WHO, 1998; MoH, 2000) and the interdependence of fathers’ well-being and that of their families is increasingly being recognised (UNICEF, 2008). Reduction of persistent high maternal, newborn and child mortality and morbidity by improving access to quality health services is a challenge for many African countries, among them Tanzania. High HIV prevalence (Mlangwa and Meier, 2007) adds to the seriousness as does the shortage of health staff (MoHSW, 2008).
This paper is based on the assumptions that fatherhood is an important aspect of masculinity and a gendered relational role that is constructed and re-constructed in social interactions (Ouzgane and Morrell, 2005). Starting a family, implying sexual activity and economic independence are common social requirements for achieving manhood (Barker and Ricardo, 2005). However, becoming a father is described as stressful and involving adjustments from a previous life (Matthey et al., 2001; St. John et al., 2005). It is challenging to balance activities and develop and maintain relationships and family integrity (St. John et al., 2005). Decreased marital satisfaction is reported (Matthey et al., 2002; Buist et al., 2003) as are depressive symptoms (Buist et al,. 2003).
Christie's et al. (2008) theory of postpartum family development describe that infant nurture and life changes trigger families’ coping and adapting resources while managing the present and investing in the future. Workload and uncertainty make the period difficult. Physical, psychosocial and environmental factors are influencing how families manage the present and invest in the future.
New fathers in metropolitan suburban populations in low-income countries face considerable challenges relating to health of themselves and their families. Suburban areas in Dar es Salaam, Tanzania are characterised by congestion, poverty, unemployment, poor health and poor housing (Obrist, 2006; Prime Minister's Office, 2006). Traditionally, postpartum support in Tanzania has been provided by informal networks including relatives, friends and traditional birth attendants (Lugina et al., 2001). These traditional networks might not be available in suburban areas as many new parents have migrated from their regions of origin (Bamurange, 2004; Leshabari and Kaaya, 2005).
The postpartum programme in Tanzania aims at preventing and managing complications that occur after childbirth, and discuss infant care, breast-feeding, maternal nutrition and contraception (MoH, 2000). However, the programme focus mainly on infants (Lugina et al., 2001; MoHSW, 2008) and men are rarely involved. Thus, there is a gap between policy and practice.
How new fathers experience their situation is likely to influence their self-esteem and engagement in family health matters (Richter and Morrell, 2008). Fathers are less likely to succeed in promoting the health of the family, if they themselves have difficulties in adapting and lack knowledge. To improve family health during the post partum period, in low income, multicultural, suburban settings it is important to determine how men experience this period. Thus, this study intended to explore how first-time fathers in Ilala suburb, Dar es Salaam, Tanzania experienced the postpartum period.
Section snippets
Setting
The study was conducted in Ilala municipality, Dar es Salaam, Tanzania. Many of Ilala's 635,000 (NBS, 2003) inhabitants are internal migrants (Obrist, 2006) and represent multiple cultures. Public health-care services including RCH are given at dispensaries, health centres and one municipal hospital. The RCH clinics provide antenatal care, prevention of mother to child transmission (PMTCT) of HIV, child health care and postpartum care including family planning. Women delivered at health
Findings
The fathers’ experiences were grouped into five categories (Table 3). Expressions in Swahili are given in parentheses and fictitious names are used in the quotes.
Giving and needing support
These first-time fathers revealed happiness, uncertainty and a sincere concern for the health and well-being of the mother and infant during the post partum period. Being a father meant complete reorganisation of life and time. They were unsure of what was expected of them, experiences that they shared with fathers in western countries (Goodman, 2005; Christie et al., 2008).
These men in Ilala suburb challenged stereotyped gender norms by claiming they were very involved in infant care and
Conclusion
These new fathers struggled to gain confidence and experience while engaging in family matters during post partum period. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fathers both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers’ concerns for family health and needs for support.
Conflict of interest statement
The authors declare no conflict of interest whatsoever among ourselves or with anybody/organisation related to this paper.
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