Understanding fathers’ responses to breastfeeding as a “shared parental task”: a realist evaluation of a Danish breastfeeding support intervention

Fathers’ involvement in breastfeeding has a positive effect on breastfeeding, but fathers can feel uncertain about how to provide support. An intervention was implemented to improve breastfeeding rates by tailoring support to each family, actively involving both parents, and strengthening communication during home visits as part of the Danish universal health visiting program. A key element of the intervention was engaging both parents in breastfeeding as a “shared parental task”. The aim of this study was to investigate how fathers responded to the intervention and to identify the contextual factors necessary to activate paternal engagement.

Using a realist evaluation approach, our study was integrated into a cluster randomized trial implemented in 20 municipalities. In the intervention arm, we observed six home visits delivered by health visitors and conducted nine interviews with fathers. A theoretical perspective applying Standpoint Theory and Gender Schema Theory as middle-range theories was used to grasp the diversity of fatherhood and to understand how contextual circumstances shape it.

The intervention could activate a central mechanism of change by making fathers realize their important role in breastfeeding success, leading them to engage in both the breastfeeding support and practice. Our analysis revealed three patterns in how fathers responded to the intervention: the mechanism was either not activated, partly activated, or strongly activated. Positions shaped by educational level, occupation, rootedness to rural community, ethnicity, and age, as well as perceptions of gender roles and family dynamics influenced whether, and to what degree, the mechanism was activated. Rather than being rigid categories, these patterns should be understood as shifting positions along a continuum that reflects a complex and evolving reality.

The fathers’ dispositions as well as perceptions of gender roles and family dynamics influenced how the fathers responded to the intervention. These findings highlight the importance of recognizing contextual influences on fathers’ engagement in breastfeeding and tailoring breastfeeding support to better address fathers’ diverse backgrounds and perspectives.

Clinical Trials: NCT05311631. First posted April 5, 2022.