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Fellow nursing students, Dr. Karima Velji, Dr. Doris Grinspun and myself.

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The Role of Fathers in Promoting Exclusive Breastfeeding

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The Role of Fathers in Promoting Exclusive Breastfeeding

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Review

Search strategy

A narrative study or review was carried out using the PubMed archive, a platform that can be used to conduct reviews of many original articles and to find information on breastfeeding interferences that discloses breastfeeding barricades and promoters available in the English language. There were no topographical boundaries, but only studies in English were comprised because of the source boundaries. The research was initiated using keywords and combinations such as "breastfeed" and "father" or "partner" or "spouse" and "role" or "promotion" or "influence" or "support".

The criteria which were included and excluded in the review are presented in Table 1.

Mother's knowledge and EBF experience

Individuals have the potential to achieve greater levels of performance in practice if they possess the appropriate contextual information, but having insufficient knowledge unquestionably results in low performance. When it comes to the practice of exclusive breastfeeding, the attitude of the mother is quite important, and it is mainly characterized by maternal knowledge [ 5]. The lack of a favorable attitude towards EBF and a lack of sufficient information may result in a decreased likelihood of initiating and maintaining EBF at the appropriate times [ 6]. In addition, a person's level of education, coupled with their prior experiences, may both be significant sources of information and help shape an attitude about their attitude to breastfeeding.

Father's knowledge and support in EBF

The researchers focused on mothers' knowledge of breastfeeding practices. Some researchers have also studied the father's command, attitude to support, and participation in breastfeeding practices. Although this task of nourishing the child is primarily taken care of by the mothers, the male partners, on the other hand, can increase the nourishment exponentially through their knowledge and support of EBF practices [ 7]. Fathers can increase breastfeeding potential because a father who is adequately educated can support his wife or partner and help her learn more about starting and continuing breastfeeding. Men have the most significant role to play in assisting mothers with parenting and feeding their infants, and their knowledge and attitude are crucial in this respect. Furthermore, because the father's role is regarded as the most important in a family, the partner's or wife's observation of the father's mentality has the potential to change her subjective standards on EBF [ 8].

Role of the father in supporting EBF

A father's main responsibility is to become a supporter and enabler of breastfeeding the infant [ 9]. Housework, taking care of older children, caring for their partner's well-being, meal preparation, recognizing an infant's hunger cues, burping the baby, and changing the infant's diaper after feeding should all be part of the responsibilities taken up by the father[ 10].

The father's knowledge of breastfeeding causes him to want to support it, and his encouragement of breastfeeding enhances the mother's confidence to start it. A mother's earlier experiences and knowledge also encourage her to start and continue breastfeeding her children (Figure 1).

Figure 1. Role of fathers in promoting breastfeeding.

[ 3]

The effect of the father's support in EBF

Appropriate breastfeeding support from a partner is vital for the baby's nutrition and also impacts a new mother's decision to start, endure, or discontinue nursing in the initial period after delivery. Although partner nursing assistance can take many different forms, the effects on the start of breastfeeding, duration, and selectivity are almost always positive, especially when verbal support is provided [ 11]. Partner responsiveness, assistance in avoiding and dealing with breastfeeding issues, and assistance with household work and childcare tasks are all important and critical types of partner-supporting activities that result in optimal breastfeeding behavior [ 12]. Even though various analyses and studies suggested that specific types of husband support might have a significant impact on breastfeeding success in society, they also showed that there is still a dearth of high-quality, demographic-based research on the impact of partners' specific roles in breastfeeding behaviors. In the studies, the fathers also experienced the urge to be emotionally and practically there to support the mother during breastfeeding. They could support the mother through love, affection, and motivation, and by encouraging her that breastfeeding is a team sport [ 13]. They may perceive the opportunity to nourish their child as a source of constructive knowledge and as a contributive element to the creation of the father and infant bonding over either the feeding of the expressed breast milk by bottle or infant formula throughout the breastfeeding time or giving solids whenever the child is prepared [ 14, 15].

Support interferences for fathers during breastfeeding

Researchers that looked into the connection between the quality of life (QOL) of fathers and the feeding habits of their babies discovered that fathers of breast-nourished babies had higher QOL ratings than fathers of bottle-nourished babies [ 16]. This was seen because breastfed babies were found to be healthier than bottle-fed ones in their early childhood. They should be made aware of the various ways they can assist with breastfeeding and how beneficial all forms of support provided by them can be. A large portion of the fathers in the studies required online supervision from father-to-father mentoring networks, prenatal support groups, breastfeeding literature, health care professionals, and other sources of technology [ 17]. Concerning the support provided by healthcare professionals, some of them reported feeling overburdened with information that was occasionally conflicting [ 18]. In contrast, others voiced unhappiness with the lack of programs and resources that were specifically created for them [ 19]. The majority claimed that information may not have reached them at all or may have been delivered to them via their partner or family members in the form of pamphlets. A few of them mentioned getting information from healthcare professionals directly [ 20]. On the other hand, several men who received prenatal advice from healthcare professionals thought the material was beneficial [ 21]. There were mixed emotions regarding the interventions created for them. Supporting the mother in the post-natal period, especially during the period of EBF, represents the fathering and parenting role of a man. Thus, their insight that their care results in a positive breastfeeding experience for the mother pushes them to better parenting. Each partner has a vital role to play and must contribute in some way, but both must be willing to stand up when necessary. Additionally, they must synchronize their efforts and have faith in one another to complete their necessary responsibilities. This needs constant contact, observation, and focus on what the other person is performing. Then, if any one partner requires assistance, the other can be there for them and can move aside if everything is under control.

Discussion

Breastfeeding is a natural and inalienable right for both mothers and their children. Every effort should be made to encourage, practice, and continue exclusive breastfeeding for the first six months of a child's life [ 22]. The World Health Organization (WHO) endorses that mothers nurse their babies entirely for the duration of the first six months of their babies' lives due to the significant role that breastfeeding plays in a child's development and growth, as well as the positive effects that EBF has on the health of the mother. After that, continued breastfeeding should be practiced with the addition of other foods and supplements until the child reaches the age of two [ 23]. The WHO and the United Nations International Children's Emergency Fund (UNICEF) collaborated in 1992 to develop the "Ten Steps to Successful Breastfeeding," which went on to become the foundation of the Baby Friendly Hospital Initiative (BFHI). The Baby-Friendly Community Initiative (BFCI) is also an extension and unification of the BFHI. One requires seven ladders to meet global standards, among which one suggests expanding breastfeeding education to the whole family, and one offers a warm and friendly environment for breastfeeding families [ 24].

The choices that women make about nursing are significantly influenced by the opinions of their husbands. Initiation and duration of breastfeeding are both influenced by the emotional and physical assistance that fathers provide. At the same time, this support is a morale booster for mothers, who acquire a better sense of self-efficacy if they feel empowered by their partners [ 25]. In cross-sectional studies, it was found that women who had partners who were either apathetic or opposed to nursing had lower levels of confidence in their capacity to breastfeed than did women who had partners who were supportive of breastfeeding on both a passive and active level. The support of a partner is a significant predictor of a mother's confidence in her ability to breastfeed, which is truly independent of the mother's level of prior nursing experience or the age of the newborn. There is an ever-increasing body of research that lends credence to the notion that fathers should be included in the policymaking process regarding nursing and also in the process of acquiring supportive behaviors that are both positive and functional after childbirth. This research backs up the idea that fathers need to be included in the decision-making process regarding nursing. It will be necessary to deliver material to fathers on the most efficient means by which they can support their partners in overcoming challenges related to breastfeeding a child [ 26].

Families may manage these challenges and support breastfeeding positively by being ready and having truthful expectations about how it may affect them as individuals, as couples, or as households [ 27]. The breastfeeding work intended for fathers must contain constructive representations of male parents as members of the nursing team. Any prenatal material for dads would also benefit from using the term "father" rather than "parent," which men may erroneously confuse with "mother" [ 28]. To make education more accessible to working men, mobile prenatal services where healthcare professionals visit the offices of expectant or new fathers and deliver instruction during break times can also be considered a good choice [ 29]. In antenatal sessions, mentors can be used to normalize their emotional state and understanding and guarantee them that their connection with the infant won't be jeopardized in the long term by breastfeeding [ 30].

The research was carried out, the critical components of which were interviews and group discussions with mothers, and an online questionnaire was produced for the fathers. It was shown that breastfeeding continued for a more extended period when the partners uttered words of encouragement to mothers, such as "do your best," acknowledged them for the effort they put into nursing, and provided them with emotional support [ 31]. According to the findings of the study, improved breastfeeding practice was also associated with partners who anticipated the requirements of new mothers and were successful in meeting those demands, as well as partners who displayed a dedication to breastfeeding [ 32]. In addition, the research also found that improved breastfeeding practice was associated with an increased number of partners who breastfed their children. The influence of companion support on breastfeeding start, duration, and exclusivity was generally good, even if there were differences in the forms of companion breastfeeding support. This was especially true when the support was given in the form of spoken inspiration. The reaction of the partner, help in evading and handling breastfeeding issues, and help with home and child care tasks are all significant and crucial sorts of partner-supporting activities that lead to excellent breastfeeding behavior. Even though the study demonstrated that certain kinds of support from a partner could have a significant influence on the level of success that breastfeeding has in a community, it also demonstrated that there is still a scarcity of good quality, population-based education on the effect of the precise role that fathers play in breastfeeding practices [ 4].

All this shows that in the future, families should focus their efforts on new mothers and support them in various ways. The primary goal of these efforts should be to involve fathers in child nutrition [ 20]. Less involvement of fathers in the early nourishment of children is a result of the fact that, given the hierarchical structure of power within families, partners could have a significant impact on a mother's choice to properly breastfeed their child [ 33]. In addition, including grandmothers in upcoming breastfeeding activities (if they can participate) would help maximize the benefits since, according to previous evaluations, grandmothers may also impact the nursing behavior of society. If they can participate, this will help [ 33].

Limitations

There are some limitations to the study that should be emphasized. The article does not address circumstances when there are complications with the breastfeeding process. The maternal complications could be sore nipples, reduced breastmilk production, or mastitis, and the complications associated with the baby could be the inability to latch on to the breasts. Moreover, the review included studies in the English language only, which is why it could not contain the whole spectrum of information. The use of unpublished works also minimized the sources for reference.

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The Role of Fathers in Promoting Exclusive Breastfeeding

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The cornerstone of a newborn's nutrition is breastfeeding. Due to its well-known benefits for mothers, children, and society in the short and long term, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend it as ...

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This cinéma vérité documentary is an intimate look inside one family’s struggle with poverty. Kay Rice, her partner Karl and 6 children move from town to town in …

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Our mission is to promote awareness, education, prevention, and treatment of perinatal mental health issues affecting birthing people, their families, and support systems in all areas of Canada.

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Fathers’ Experiences and Perspectives of Breastfeeding: A Scoping Review

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Fathers’ Experiences and Perspectives of Breastfeeding: A Scoping Review

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Abstract

During the transition to parenthood, fathers may experience significant challenges, including finding a place for themselves as important participants in the context of infant breastfeeding by female partners. Although generally viewed as a healthy process and the preferred method of infant feeding, breastfeeding may result in some fathers feeling excluded, inadequate, and helpless. Breastfeeding is known to adversely affect various aspects of a father's life, including parenting self-efficacy, quality of life (QOL), the relationship with the partner, and the perception that breastfeeding limits time available for father-infant bonding. The current scoping review explores the experiences, roles, and needs of fathers of breastfed infants by synthesizing and discussing the findings from relevant published research studies ( n = 18). Recommendations, drawn from the scoping review findings, are offered to guide primary health providers and services.

Keywords: breastfeeding, fathering, infant feeding, men's health, parenting, paternal experience

For most men, the transition to parenthood is an unquestionably life-changing experience. In fact, research suggests that this transition may impact a man's health considerably ( Garfield, Isacco, & Bartlo, 2010). Fatherhood can have a protective effect on men's health by leading some men to make positive changes to health behaviors ( Garfield et al., 2010). A growing body of evidence suggests some challenges faced by fathers during this transition can result in anxiety, distress, and an increased risk of depression ( Kim & Swain, 2007; Kumar, Oliffe, & Kelly, 2018). Health challenges faced by new fathers are well recognized, wherein many men are compelled to reassess their priorities and time commitments, including work-life balance ( de Montigny, Lacharité, & Devault, 2012). Other challenges fathers face during this transition are less obvious, such as in the context of maternal breastfeeding. Specifically, infant breastfeeding by female partners can negatively affect a father's quality of life (QOL; Chen et al., 2010), parenting self-efficacy, mood, and overall well-being ( Jordan, 1986) . Because studies suggest that a number of men turn to health-care professionals for guidance and support during the first few months of fatherhood ( Thomas, Bonér, & Hildingsson, 2011), further investigation into the experiences and needs of fathers of breastfed infants is necessary to guide primary health-care providers (HCPs) and services. This scoping review offers a synthesis and discussion of the empirical insights focusing on the health impacts of maternal infant breastfeeding on fathers.

Transition to Fatherhood: A Challenging Period for Many Men

In contemporary society, fathers' participation in child-rearing is not only welcomed, it is often expected ( Goodman, 2005), reflecting social discourses that emphasize involved fathering ( Singley & Edwards, 2015). Research identifies that parenthood has diverse effects on the health of men, both positive and negative ( Garfield et al., 2010). Garfield et al. (2010) reported that fatherhood has a protective effect on men's health due to improved nutrition and physical activity and decreased risky behaviors, motivated by the desire to be role models for their children and maintain their health to witness their children grow into adulthood ( Garfield et al., 2010).

Although the transition to parenthood has positive health effects for some fathers, it is also understood as demanding and difficult for some new dads, negatively affecting their health ( Singley & Edwards, 2015). Adjusting to parenthood can be a tumultuous time in the lives of some men, fraught with the increased stress of caring for a newborn, decreased sleep, and role strain and/or gender role conflict ( Singley & Edwards, 2015). The diverse experiences of new fathers include the contrasting feelings of joy and excitement about becoming a new father along with anxieties about the postnatal period and infant care ( Deave & Johnson, 2008) and concerns about relationship changes with their intimate partner ( Chin, Daiches, & Hall, 2011; Deave & Johnson, 2008).

Breastfeeding as a Health Hazard for Fathers

These challenging and, oftentimes, overwhelming adjustments in men's lives have been identified as risk factors for paternal postpartum depression (PPD; Kim & Swain, 2007), and depression is more prevalent among new dads than among the general male population ( Paulson & Bazemore, 2010). Some ecological risk factors for PPD include changes in the conjugal relationship, feelings of exclusion from the mother-infant dyad, and difficulties bonding with the infant ( Kim & Swain, 2007). Risk factors for PPD are also connected to breastfeeding: Some fathers associate maternal breastfeeding with feelings of exclusion from the mother-infant relationship and with negatively affecting father-infant bonding ( deMontigny, Larivière-Bastien, Gervais, St-Arneault, Dubeau, & Devault, 2018). In the past, breastfeeding has been identified as a negative paternal risk factor for father-infant bonding and the marital relationship ( Goodman, 2004). Psychosocial factors such as parenting distress, perceived parenting efficacy, and quality of the spousal relationship also contribute to PPD in fathers of breastfed infants ( deMontigny, Girard, Lacharité, Dubeau, & Devault, 2013). Such evidence provides the basis to further investigate the effects maternal breastfeeding may have on men's health during the transition into fatherhood.

Rationale for Current Scoping Review

Men are becoming fathers in a world where breastfeeding is strongly encouraged, promoted, and recommended as the gold standard source of nutrition for infants ( World Health Organization [WHO], 2017). Consequently, there is a growing body of research studying fathers in the breastfeeding context that focuses on the influence a father has on a mother's decision to initiate and continue breastfeeding and on interventions to assist fathers to fulfil their role as support providers to their breastfeeding partners ( deMontigny, Gervais, Larivière-Bastien, & St-Arneault, 2018)

Knowledge gaps exist in the literature regarding the lived experiences of fathers and how breastfeeding affects their health ( deMontigny, Gervais, Larivière-Bastien, & St-Arneault, 2018). Given that studies with the objective to improve the health of fathers are limited ( deMontigny, Gervais, Larivière-Bastien, & St-Arneault, 2018), the aim of the current scoping review was to explore the experiences, roles, and needs of fathers of breastfed infants by reviewing the findings from relevant published research studies. Recommendations, drawn from the scoping review findings, are offered to guide primary health providers and services.

Methods

As forms of knowledge synthesis, scoping reviews address exploratory research questions with the goal of informing programs, policy, and clinical practice and directing research priorities for the future ( Colquhoun et al., 2014). Scoping reviews are appropriately undertaken when a summary of the literature that pertains to a specific research question is required in order to address gaps in existing knowledge ( Arksey & O'Malley, 2005). Scoping reviews provide a mechanism for disseminating this knowledge to practitioners, policy makers, and consumers who may lack resources or time to undertake this work independently ( Arksey & O'Malley, 2005). The process used for this current scoping review was guided by the five-stage methodological framework as outlined by Arksey and O'Malley (2005), which included (a) identifying the research question, (b) identifying relevant studies, (c) selecting relevant studies, (d) charting the data, and (e) summarizing and reporting the results.

The current scoping review was undertaken to answer the following research questions: What are the experiences, roles, and needs of fathers of breasted infants? How can HCPs use this knowledge to assist, support, and engage fathers? To explore possible answers to these questions, literature was retrieved from several databases, including CINAHL, MEDLINE, and Google Scholar using the following keyword search terms: father(s), dad(s), men, male, paternal, breastfeeding, breast-feeding, feeding, infant-feeding, lactation, suckling, attitude(s), perception(s), belief(s), feeling(s), role(s), challenge(s), barrier(s), and need(s) in various configurations.

Selecting Relevant Studies

In total, the searches yielded 5,608 articles. Abstracts and titles of each article were reviewed for relevancy based on the following inclusion criteria: empirical studies published in English between 2008 and 2018 with fathers of breastfed infants as the main focus of the study. Articles that focused on breastfeeding preterm/hospitalized infants, maternal experiences with breastfeeding, bottle-feeding, or other types of infant feeding without making explicit mention of fathering in the context of breastfeeding were excluded. Duplicates were also excluded. Eighteen articles met the inclusion criteria for the review.

Charting the Data and Summarizing/Reporting the Results

First, each article was read in full, annotated, analyzed, and compared with the other papers in order to identify key themes derived from the empirical findings. To help organize and compare the reviewed studies, a synthesis matrix was created (please see Table 1). This matrix included features of each study: the geographical location, publication year, author's purpose, study designs or methodology, sample size, pertinent features of the study populations, and empirical findings. By classifying the primary findings in each study, three key themes with subthemes were identified from this analysis ( Thorne, 2016). Theme 1 pertained to fathers' views on the pros and cons of breastfeeding and contained the following subthemes: breastfeeding and father-infant bonding; partner relationships and breastfeeding; and breastfeeding in public. Theme 2 described fathers' involvement in the breastfeeding process and contained two subthemes: initiating breastfeeding and roles in breastfeeding. Theme 3 focused on support interventions for fathers during breastfeeding-what do fathers need?

Table 1.

Authors/year/Country

Purpose

Design/Methodology

Study Population and Sample Size

Findings

1. Abu-Abbas, Kassab, and Shelash (2016), Jordan

To determine fathers' attitudes/involvement and effect of culture on fathers' BF roles

Quantitative survey
Cross-sectional study design

198 fathers
(piloted on 22)

Overall negative attitudes and poor involvement in BF
Correlation between fathers' attitudes and surrounding cultural effect on involvement and role
Efforts to increase BF should involve fathers

12. Hounsome and Dowling (2018), United Kingdom

To investigate fathers' perceptions of their influence on infant-feeding decisions

Qualitative methodology

6 fathers

Most deferred responsibility of decision to breastfeed to the mother
Some stigma attached to public BF

13. Mitchell-Box and Braun (2012), United States

To explore male partner's perceptions of BF

Qualitative interviews

14 male partners of pregnant women or new mothers

Felt excluded from BF decisions resulting in feelings of exclusion from infant care in general

17. Sherriff and Hall (2011), United Kingdom

To learn about fathers' views on BF

Qualitative interviews

8 White British fathers (aged 28-47 years)

HCPs regarded as important support for fathers
Greater support needs to be directed toward fathers' needs during the BF process

Findings

The 18 international studies that comprised this review consisted of the following methodologies: One (6%) study employed quantitative methodology, 15 (83%) studies relied on qualitative approaches, and 2 (11%) used mixed-method designs. Seven studies (39%) were conducted with fathers in the United Kingdom, five studies (28%) were conducted in North America, and six (33%) were carried out in other countries, including Australia, Pakistan, Jordan, and Taiwan.

Fathers' Views on the Pros and Cons of Breastfeeding

Fathers of breastfed babies expressed both positive and negative attitudes and beliefs about breastfeeding. In over half of the studies ( n = 12), fathers generally viewed breastfeeding as optimal for their child's nutrition and some described it as healthy, natural, pure, and/or essential ( Hansen et al., 2018; Rempel & Rempel, 2011; Sherriff et al., 2009; Sherriff & Hall, 2011). Other perceived advantages to breastfeeding included convenience ( Ayton & Hansen, 2016; Bennett et al., 2016; Brown & Davies, 2014; Hansen et al., 2018), low cost ( Brown & Davies, 2014; Datta et al., 2012; Hansen et al., 2018), freedom from night feedings ( Bennett et al., 2016; Hounsome & Dowling, 2018; Rempel & Rempel, 2011), and health benefits for the child ( Bennett et al., 2016; Brown & Davies, 2014; Datta et al., 2012; Mithani et al., 2015; Rempel & Rempel, 2011) and for the breastfeeding partner ( Bennett et al., 2016; Datta et al., 2012).

Fathers in several studies reported concerns about the perceived insufficiency of breast milk ( Brown & Davies, 2014) and the inconvenience when compared with infant formula ( Henderson et al., 2011; Mitchell-Box & Braun, 2012), and viewed it as challenging for their breastfeeding partners ( Abu-Abbas et al., 2016; Brown & Davies, 2014). In a cross-sectional postal survey in Ireland, most participants ( N = 417; 77.7%) responded with at least one disadvantage of breastfeeding ( Bennett et al., 2016). Common drawbacks included physical pain for the mother ( Banks et al., 2013), difficulties with latching ( Mitchell-Box & Braun, 2012), and the inability to determine precisely how much feed the baby was receiving, leading to concerns about infant weight gain ( Sherriff et al., 2009; Sherriff & Hall, 2011). In one study fathers reported breastfeeding as a burdensome task ( Hansen et al., 2018), while others spoke about difficulties managing the rivalries of non-breastfeeding children for maternal attention ( Bennett et al., 2016).

Regarding breastfeeding knowledge, one study reported that some fathers were reasonably well informed ( Datta et al., 2012). Participants in other studies were unable to clearly articulate the specific benefits of breastfeeding ( Henderson et al., 2011; Sherriff et al., 2009; Sherriff & Hall, 2011). Fathers in two studies had minimal knowledge of the challenges to establish successful breastfeeding ( Bennett et al., 2016; Sherriff et al., 2009) and were surprised that breastfeeding "did not just happen" with ease ( Bennett et al., 2016, p. 172).

Fathers' Roles in the Breastfeeding Process

Support Interventions for Fathers During Breastfeeding-What do Fathers Need?

Fathers of breastfed infants reported requiring diverse resources. Many of the men in these studies sought guidance from HCPs, breastfeeding literature, antenatal support groups, father-father mentorship groups, the Internet, and other modes of technology. With reference to support provided by HCPs, some fathers felt inundated with information ( Ayton & Hansen, 2016) that was often conflicting ( Banks et al., 2013), whereas others were disappointed with the lack of programming and supports specifically tailored for them ( Banks et al., 2013; Bennett et al., 2016; Tohotoa et al., 2009). Few fathers reported receiving information directly from HCPs and most indicated that information had been passed to them through their partner in the form of pamphlets or perhaps did not reach them at all ( Brown & Davies, 2014). Conversely, some men who were provided antenatal guidance by HCPs felt the information provided was helpful ( Hounsome & Dowling, 2018; Mitchell-Box & Braun, 2012). Regarding formal antenatal programs, some fathers indicated these were useful, especially for first-time fathers, as long as they were specifically tailored to their needs ( Mitchell-Box & Braun, 2012; Tohotoa et al., 2009). A number of fathers highlighted that access to these services was often limited especially when organized groups occurred during working hours ( Sherriff et al., 2009; Sherriff & Hall, 2011). In several studies, fathers who did attend programs felt these services were generally targeted toward mothers ( Ayton & Hansen, 2016; Mithani et al., 2015; Tohotoa et al., 2009) and reported feeling alienated and dismissed by HCPs, as though their role was tokenistic and/or delinked from breastfeeding ( Brown & Davies, 2014). In one study fathers reported feeling patronized when communicating with HCPs, for example, by the demeaning suggestion that they needed to be convinced that breastfeeding was worthwhile by thinking about the personal benefits ( Brown & Davies, 2014,), such as their partner gaining breast size or not having to participate in night feedings ( Brown & Davies, 2014). Fathers also suggested that some HCPs were too authoritative and pressured women to breastfeed ( Datta et al., 2012; Hansen et al., 2018), and they were dismayed by the guilt placed on mothers who did not breastfeed ( Brown & Davies, 2014). Fathers suggested that an overload of information placed additional pressure on new parents who often already struggled with a lack of practical support once the baby arrived ( Brown & Davies, 2014).

Fathers noted the need for consistent, specific, and practical advice with regard to breastfeeding informational materials ( Bennett et al., 2016; Brown & Davies, 2014), such as troubleshooting information when difficulties arose, including latching problems, mastitis, blocked ducts, and diet recommendations for the mother ( Bennet et al., 2016; Mitchell-Box & Braun, 2012). Other types of useful information identified by fathers included knowing how and when to wean the infant, strategies for supporting their partner when breastfeeding was unsuccessful, and help managing feelings of exclusion or jealousy over the mother-infant bond created through breastfeeding ( Bennett et al., 2016). The Internet was also reported as an important resource wherein several fathers learned more about breastfeeding and other types of feeding methods online ( Bennett et al., 2016; Mitchell-Box & Braun, 2012). Alongside practical guidance and procedural information, fathers wanted insight about the realities of breastfeeding and what they could really expect from the experience ( Brown & Davies, 2014). Fathers in the United Kingdom felt the educational literature was mostly aimed toward mothers, including materials intended for "parents" ( Sherriff & Hall, 2011). These fathers suggested the literature be more tailored by including positive imagery of fathers with their infants and by providing information on the emotional aspects that both parents may experience during the process ( Brown & Davies, 2014; Sherriff & Hall, 2011).

Social connectedness through father-to-father mentorship was viewed as an important resource that helped provide reassurance to men in breastfeeding families ( Ayton & Hansen, 2016; Brown & Davies, 2014). Fathers participating in a mixed-methods study in the United Kingdom ( Brown & Davies, 2014) placed value on mentorship and learning about breastfeeding from more experienced fathers, particularly how to support their partners in the breastfeeding process ( Brown & Davies, 2014). Similarly, a study involving young Australian fathers under the age of 24 years reported that connecting with other fathers gave them confidence and helped them cope with the demands of young parenthood ( Ayton & Hansen, 2016).

Discussion

The findings of the current scoping review demonstrate that the experiences, perspectives, and needs of fathers in the context of partners' breastfeeding have important implications for HCPs and services. For some fathers, finding a space for themselves as important members of breastfeeding teams can be challenging. Men may feel inadequate due to a lack of breastfeeding knowledge or a belief that their concerns and needs are secondary to those of their partner. HCPs must address these concerns, especially considering many men are reluctant to ask for help or explicitly ask for information ( Tohotoa et al., 2009). To respond effectively, it is essential that HCPs recognize and affirm the important roles fathers play in the breastfeeding process.

DeMontigny, Larivière-Bastien, Gervais, St-Arneault, Dubeau, and Devault, (2018) suggest that parental self-efficacy may be enhanced if HCPs engage in dialogue with fathers and attempt to normalize the range of their feelings and experiences during the breastfeeding process. For instance, fathers can be encouraged to form rituals, such as bathing, or schedule designated specific one-on-one time after feeding or before bedtime to foster the development of stronger and earlier father-infant bonds.

This review reveals a need for pragmatic education in which HCPs support parents by reinforcing an approach that recognizes although breastfeeding is a natural and normal process, it can also be challenging. Preparing families with realistic expectations of how breastfeeding may impact them as individuals, as a couple, and as a family unit can help them manage these challenges and foster success with breastfeeding ( Jordan & Wall, 1990). HCPs must ensure that support provided to fathers is communicated in a manner that is clear, consistent, culturally sensitive, inclusive, nonjudgmental, and nonpatronizing. Factors such as age, ethnicity, and socioeconomic status should also be considered to provide tailored breastfeeding education that addresses the specific needs of different family backgrounds.

Overwhelmingly, the studies included in the current scoping review revealed the need for targeted strategies to reach men regarding their potential roles in breastfeeding. Father-focused interventions can assist fathers in learning about breastfeeding; however, their roles in the process must be practical, specific, and detailed, with the ultimate goal of expanding the breastfeeding dyad of mom and babe to a triad including dad. Father-centered interventions should include information about the basic aspects of breastfeeding, such as health benefits to the mother and infant and the differences with infant formula and should clarify any misunderstandings or myths about breastfeeding. Advanced breastfeeding information should also be provided, such as how to troubleshoot common breastfeeding problems, assess milk supply, facilitate breastfeeding (e.g., the importance of skin-to-skin contact), and techniques and positions for successful latching. Guidance on how to support their partners, whether practically, such as helping with household tasks and managing other children, or emotionally, such as providing a comforting touch and words of encouragement is also critical. DeMontigny, Gervais, Larivière-Bastien, and St-Arneault (2018) posit that HCPs first assess the type of support the mother requires to help the father respond to her needs effectively, while simultaneously recognizing and communicating his own. HCPs can also provide advice on how to maintain intimacy within relationships during a time when some men feel the loss of sexual or physical connection with their partners. Providing suggestions, such as planning a weekly date night or simply making the time to connect with each other one-on-one every evening may help to maintain closeness between couples.

Breastfeeding literature for fathers should also include positive imagery of fathers as part of the breastfeeding team. Furthermore, any antenatal literature for fathers would benefit by including the term "father" instead of "parent," a term that has often been interpreted by men as being synonymous with "mother" ( Sherriff & Hall, 2011). The need for accessible antenatal services for working fathers is also highlighted by this review, since work commitments was the primary reason men cited for not attending classes ( Sherriff & Hall, 2011; Tohotoa et al., 2011). Some fathers may also benefit from attending antenatal education sessions that are held within informal or casual settings, such as pubs or sports clubs; engaging men through conventional health services is often challenging ( Robertson, Witty, Zwolinsky, & Day, 2013). Mobile antenatal services where HCPs travel to workplaces of expecting or new fathers and provide education during break times may also be a viable option to increase accessibility of education for working fathers ( Robertson et al., 2013).

Mentorship and social connectivity appeared to be important avenues of support for fathers and interventions focused on peer connectedness might assist men with concerns they may have about breastfeeding and the transition into fatherhood in general. Men-only sessions have been reported to promote camaraderie with father peers ( Nash, 2018) and give fathers the opportunity to share opinions or experiences they would otherwise feel uncomfortable sharing with their partners. deMontigny, Gervais, Larivière-Bastien, and St-Arneault (2018) suggested that guidance from peers in father-only sessions may help men to have these difficult conversations with their partners. Furthermore, Gamble and Morse (1993) highlighted the use of mentors in antenatal sessions as a way of normalizing fathers' feelings and experiences while assuring them that the relationship with their infant will not be adversely affected in the long term by breastfeeding.

The idea of breastfeeding in public caused men in a number of studies to feel anxious, embarrassed, and concerned. According to Bennett et al. (2016), a conflict seems to exist between the natural and intimate process of breastfeeding from the perspective of progressive values and tradition-based conservative values. HCPs might thoughtfully consider fostering an environment where breastfeeding in public is promoted as an essential, normative, everyday activity that can complement family-based values ( Bennett et al., 2016). HCPs can inform and influence parents to exercise their rights to breastfeed and provide suggestions on breastfeeding discretely to encourage being comfortable ( Bennett et al., 2016). For example, a nursing cover can create a symbolic "private" space during public breastfeeding that may also desexualize the act of breastfeeding ( Owens, Carter, Nordham, & Ford, 2018).

In terms of limitations, the approach to men's health in this scoping review focused on fathers' instrumental roles and the pragmatic means whereby men can adjust to and participate in breastfeeding their infant. Though previous research (i.e., Goodman, 2004) has identified PPD as a significant health challenge for new fathers, the findings drawn from the current scoping review did not provide evidence about potential linkages between men's mental health or PPD and fathers' breastfeeding roles and experiences. This knowledge gap should be addressed by future research as a means to thoughtfully consider targeted interventions. The international breadth of this review might also be regarded as a limitation due to the diverse societal values represented; however, this diversity can also be argued as a strength demonstrating how fathers' involvement in breastfeeding is a universal topic of concern and interest to men around the world regardless of local gender norms and values.

Conclusion

The current scoping review highlights the need for comprehensive breastfeeding antenatal support and education tailored for fathers of breastfed infants and a wider need to support involved fathering in infant nutrition as this may act as a catalyst for long-term involvement of fathers in their children's nutrition. A concerted effort on the part of HCPs who wish to engage fathers to be active members of their breastfeeding teams must first recognize the wide array of fathers' needs and experiences in order to make these efforts effective. Supporting fathers in their various roles within the breastfeeding context and recognizing them as fundamental members of the breastfeeding triad may also help overcome feelings of inadequacy and exclusion and facilitate health promotion for men, affording a range of important benefits for the entire family.

Acknowledgments

I would like to acknowledge my sister, Mandev, for her editing assistance. I am gratefully indebted to her for her help on this project. I must express my gratitude to my parents and to my husband, Amen, for providing me with unfailing support and continuous encouragement throughout my years of study and through the process of completing this project.

Footnotes

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by Movember (Grant number #11R18296).

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