Postpartum experiences of first-time fathers in a Tanzanian suburb: A qualitative interview study

Abstract

Objectives

to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting.

Design, setting and participants

individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania.

Findings

these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers’ and infants’ nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information.

Conclusion

these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood 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.

Recommendations

these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers’ active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum.

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.