Covid-19 is freaking out fathers. And rightly so.
Whether it’s an expectant father trying not to contract Covid-19 ahead of his newborn’s birth or an essential worker who comes home every night fearful of spreading the virus to his family, fathers are more stressed than ever about how their health affects their families.
And there are reasons to be concerned. Long before the pandemic, men were fighting an uphill health battle. For more than a century, men have trailed women in life expectancy, with current estimates placing men five years behind women. Compared to women, men are less likely to have a regular doctor, less likely to keep up with regular doctor appointments, and more likely to engage in risky health behaviors. These behaviors can put fathers at risk for contracting Covid-19 and not seeking the appropriate health care, which can increase the risk of spreading infection to their partners and children.
Covid-19 has only exacerbated these risk factors. Men are at increased risk of contracting and dying from the virus, have higher hospitalization rates once compromised, and have weaker immune responses to infection and vaccination. All of this influences how well they can care for their families while sick, and whether they will be available to do so.
Fathers, who comprise nearly two-thirds of the adult male population, influence the health of mothers and children. Yet when it comes to monitoring the health of families, public health surveillance — which collects, analyzes, and interprets health-related data — focuses only on mothers and children. That needs to change, something the Covid-19 pandemic is highlighting.
We can start this change by focusing on subgroups of fathers who are at higher risk of being affected by this pandemic and putting their families and children at increased risk:
Prospective and new fathers. The transition to fatherhood is full of changes in biology, new relationship dynamics, and increased stress. As hospital regulations and health care provider visits continue to change in light of Covid-19, many fathers find themselves unable to attend prenatal visits or visit their newborns in hospital nurseries, and are limited from visiting their children if they need hospitalization. This means the education and anticipatory guidance many fathers receive from medical professionals are drastically reduced or nonexistent. Even more, social isolation has created reductions in the social and family supports that new parents typically get. While the potential for adverse mother and infant outcomes due to Covid-19 are the subjects of intense study, understanding the short- and long-term impacts of it on the usual transition to fatherhood has not been part of the conversation
High-risk men, fathers, and families. Social determinants of health play an especially significant role in the health of fathers and all men. Current data on hospitalizations due to Covid-19 show excessive risk among people of color, with 33.1% of hospitalized patients being Black and 8.1% Hispanic/Latino. Less access to care and testing, the availability of health insurance, and neighborhood crowding for many fathers of color may increase risks. Men of color are disproportionately economically disadvantaged, which presents additional risk factors for becoming sick.
The economic turmoil of the pandemic is heightening existing socioeconomic disparities. Men with jobs that offer limited flexibility or no opportunity to work from home increase the vulnerability of the entire family to Covid-19, both because men employed in these jobs will be less available to take care of their children, placing a disproportionate burden on mothers, and because these “essential” types of jobs are often place men in high-risk Covid-19 situations with low or minimal benefits.
Among the highest group at risk are incarcerated men living in crowded conditions with reduced health care access. Fifty-one percent of men in state prison and 63% of men in federal prison are fathers with minor children. Upon their release, being reunited with their families may increase within-family risks for partners and children due to disease exposures in prison.
The social isolation brought on by the pandemic has increased stress for fathers and families while making it more difficult to obtain help to address these stresses and anxieties. With a reduction in available social services, fathers who may be responsible for domestic violence and families living with domestic violence — including intimate partner violence and child abuse — have considerably less access to treatment options. Fewer encounters with teachers and health care professionals leads to reduced reporting opportunities, placing children and families at greater risk for abuse.
Unmarried and non-residential fathers. According to census data, one-quarter of fathers are unmarried and one-fifth do not live with their children due to divorce, separation, or non-partnership with their child’s mother. Non-residential fathers are at higher overall risk of poor physical and mental health. Given the transmissibility of SARS-CoV-2, the virus that causes Covid-19, children who travel from one parent’s home to another may be at increased risk, or they may spend less time with their fathers due to isolation in a single household.
Given the disproportionate impact of Covid-19 on men, the essential role of fathers in families, and the precise and distinct downstream influences of Covid-19 on fathers’ health behaviors and outcomes, which can harm their families, public health surveillance needs to include men and fathers to curtail unanticipated spread of the disease and optimize family health outcomes.
Short-term measures such as widespread testing of all at-risk members of the family unit and increased access to telemedicine, which may appeal to men, are worthwhile first steps. For new and prospective fathers, a focus should be on paternal education and support before and after the birth of their children to prepare them for taking primary child rearing responsibilities for fathers who are raising children alone or should mothers become infected, and to mitigate the current gap between knowledge and need in infant care. Long term, supportive, meaningful, and comprehensive public health surveillance focusing on men’s health and fatherhood is necessary.
The pandemic has changed nearly every aspect of our lives, family life among them. Covid-19 should be viewed not through the lens of individual susceptibility but rather through an expanded view of family health, optimal contact tracing, and transmission reduction. As we celebrate Father’s Day in this time of uncertainty, acknowledging the role of men and fathers is integral to ongoing public health surveillance and interventions that best support maternal, child, and family health.
Clarissa Simon is a health scientist in the Family and Child Health Innovation Program at Ann & Robert H. Lurie Children’s Hospital of Chicago. Craig Garfield is a pediatrician at Lurie Children’s Hospital and professor of pediatrics at Northwestern University Feinberg School of Medicine.
