Studying maternal mortality expands to paternal mortality, too

Maternal health remains a critical issue in the U.S., with the mortality rate for pregnant women and new mothers being significantly higher than in similar nations. Although efforts have been made at both the federal and state levels to address this problem, achieving substantial progress has been challenging. However, there is now a clearer understanding of the number of maternal deaths and their causes.

Recently, a research letter in JAMA Pediatrics has highlighted the need to similarly focus on fathers. The authors of the letter presented findings from a pilot study conducted in Georgia, which identified nearly 800 deaths of fathers within the first five years after their children’s birth.

Craig Garfield, a professor of pediatrics at Northwestern University and the study’s lead author, noted, “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.”

While many researchers consulted by STAT found the investigation into paternal mortality to be a worthwhile endeavor, they expressed reservations about the claim that “paternal mortality is more than a male health issue; it is also a family and public health crisis.” The most notable finding from the paper was that fatherhood appears to be linked to lower mortality rates.

Garfield, who practices pediatrics at Lurie Children’s Hospital in Chicago, has extensively studied the influence of fathers on child welfare and the health impacts of fatherhood on men. In 2018, he introduced the Pregnancy Risk Assessment System (PRAMS) for dads, which mirrors the PRAMS for mothers launched in 1987. Initially implemented in Georgia, the survey now extends to nine other states.

Garfield explained, “We’ve developed PRAMS for dads because we realized that there’s a huge gap in understanding dad’s perinatal health.” He also aimed to explore the causes of paternal deaths during early childhood years.

In the pilot study, researchers examined the birth certificates of children born in Georgia in 2017 and traced the death certificates of their fathers over the subsequent five years. Garfield described these years as “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.”

The study indicated that over 60% of these deaths resulted from preventable causes, including homicide, accidents, suicide, and overdoses, in that order. This pattern aligns with broader trends in male mortality, where preventable causes surpass natural causes until after age 45. Garfield noted that, “the death rate of fathers, compared to men in general, is lower at all ages after the age of 25,” suggesting a protective aspect of fatherhood despite the significant number of deaths.

This scenario contrasts with that of mothers, where pregnancy and childbirth elevate the risk of mortality.

Neel Shah, an assistant professor at Harvard Medical School and chief medical officer at Maven, remarked, “The authors are breaking ground by framing preventable paternal death as a family health issue.” He emphasized the necessity for more research and solutions regarding fathers’ well-being within the family health context.

Shah also emphasized the importance of investigating the protective nature of fatherhood, particularly given the rising loneliness and decreasing life expectancy among men.

The study revealed that deceased fathers were generally older, Black, lived in rural areas, were unmarried, and covered by Medicaid, in comparison to surviving fathers. Black fathers experienced more homicide deaths, while white fathers faced higher incidences of fatal overdoses and suicide.

These findings might suggest intervention points, but they risk creating a blame narrative akin to past perceptions that partially held Black women accountable for their mortality, as noted by Monica McLemore, a visiting professor at New York University. “Why not approach this from the need for familial support as opposed to replicating what we’ve already done for maternal health?” she questioned.

The authors proposed including “paternal deaths” in Maternal Mortality Review Committees (MMRCs), which review maternal death records for accuracy. However, experts in maternal mortality were skeptical. Shah commented, “MMRCs are really set up to understand and address pregnancy-associated deaths, which demand and deserve focused attention.”

“MMRCs are currently stressed reviewing maternal deaths,” added Eugene Declercq, a professor at Boston University. “While this is an interesting study, I don’t think there’s enough here to merit the expansion of their mandate to paternal deaths.”

The paper acknowledged limitations, including that Georgia’s data cannot be generalized nationally. Additionally, fathers not married to the mother or not acknowledging paternity were not included, nor were those who passed away outside Georgia.

McLemore also critiqued the study’s claim that paternal involvement leads to better outcomes for children and families, calling it a heteronormative view. She pointed out that “Queer literature (and adoption) shows two or more adults in a child’s life matters more than the nature of the relationship.” Garfield admitted one limitation is that the study did not capture the deaths of female non-birthing parents listed as such on birth certificates.

“We only have the data that is collected; clearly this is an area for future work,” Garfield stated. 

STAT’s coverage of health challenges facing men and boys is supported by Rise Together, a donor-advised fund sponsored 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.