It took the better part of a century for maternal mortality to be recognized, forgotten, and finally recognized again as a public health emergency in the United States. Instead, research shows that fathers — especially men in their 20s to early 40s — die disproportionately from preventable causes, including suicide, overdose, homicide and accidental injury. However, paternal mortality is rarely examined in relation to the transition to parenthood.
Scientists at Northwestern University are trying to change that.
A new Northwestern study looked at all 130,267 babies born in Georgia in 2017 and tracked whether their fathers died at some point during the next five years, through 2022. Of those fathers who died within five years (796), 60% of the deaths were preventable, which the study authors call “a huge, lost opportunity”. These deaths resulted from homicide (143), accidental injury (142), suicide (102) or overdose (93), while 296 fathers died of natural causes.
The study will be published on May 4 JAMA Pediatrics.
While maternal mortality review committees focus specifically and in depth on maternal deaths in the first year of a child’s life, this is, to the researchers’ knowledge, the first study published in a major medical journal to look at paternal mortality in the years after a child is born.
Our data shows that fathers often die in the first years of their child’s life, and we have no system to understand how we can prevent this. That’s a huge blind spot.”
Dr. Craig Garfield, corresponding author, professor of pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine
The findings echo what maternal mortality research has long shown: Deaths around the transition to parenthood are shaped less by biology than by social vulnerability, and many are preventable — even as paternal deaths remain largely uncounted and unaccounted for. Previous research has shown that paternal involvement is associated with better child and family health outcomes, while paternal absence is associated with a range of adverse outcomes for children.
However, fatherhood appears to be protective
Although fathers in the study died disproportionately from preventable causes, the scientists found that being a father was associated with lower death rates among all men in Georgia between 2017 and 2022.
After age 20, the death rate for fathers is consistently lower compared to men who are not fathers. For example, among 30- to 34-year-olds, the death rate for Georgia fathers was 120 deaths per 100,000 men compared to non-Georgia fathers, whose death rate was 231 deaths per 100,000 men.
“Being a father seems to be protective in this particular group of men,” Garfield said. “We were surprised to see reduced mortality among men who are fathers. Whether this is due to lifestyle changes or a new purpose or new roles and responsibilities, we don’t know, but it certainly deserves further study.”
More about the study
The scientists looked at all births in Georgia between 2017 and 2022 and linked them to death records for fathers listed on birth certificates. They analyzed causes of death, overall mortality rates and whether fatherhood itself seemed to affect the men’s risk of death.
Unnatural deaths were more common among younger fathers. Births with Medicaid and single status were associated with a higher risk of homicide. Fathers who died were more likely to be older, non-Hispanic black, single, live in rural areas, and have Medicaid-paid births. Higher education, Hispanic ethnicity, and births covered by Tricare were associated with fewer deaths.
Experiences in the hospital inspired the work
As a pediatrician at Ann & Robert H. Lurie Children’s Hospital of Chicago, Garfield said he has seen many situations in which mothers in the neonatal intensive care unit were dealing with the death of their partner — whether from a gunshot, car accident or other sudden cause.
“In my experience, this happens more often than the deaths of mothers,” Garfield said. “The death of any parent has a huge impact on a child, and as a pediatrician, I’m most interested in how the death of a parent affects the child, especially in the early years.”
Despite publishing dozens of papers on fathers’ mental and physical health, Garfield said he could find little research looking at fathers’ deaths in the years immediately following a child’s birth.
Why Georgia?
Currently it is not possible to examine paternal mortality at the national level. While birth and death data are collected at the state level, when this data is collected at the national level, personal information is removed and there is no way to determine the individual cause of death, among many other important factors. Garfield and the team accessed the Georgia data through an existing project — the Pregnancy Risk Assessment Monitoring System for Dads (PRAMS for Dads survey) — which they created and first used in the state in 2018.
He hopes the findings will prompt other states to analyze their own data to better understand paternal mortality at the state level and work collectively to create a system for analyzing this important national trend.
“If we don’t measure it, we can’t change it,” Garfield said. “This affects thousands of children.”
Other Northwestern authors include Clarissa D. Simon and Katy Bedjeti.
