Perinatal Fathers in the Context of the COVID-19 Pandemic and Beyond: Impacts and Implications

Josephine Francis Xavier1, Ramesh Venkatesa Perumal1, Catherine Poornaselvan2, Maisha Adil3

1York University, 4700 Keele St, North York, ON M3J 1P3, Canada

2Middlesex College, Edison, 2600 Woodbridge Ave, Edison, NJ 08837, United States

3University of Waterloo, University Ave W, Waterloo, ON N2L 3G1, Canada

*Corresponding Author’s Email: jxavi27@yorku.ca

ABSTRACT

Introduction: The COVID-19 pandemic introduced unprecedented challenges for fathers during the perinatal period, impacting family dynamics, especially among vulnerable groups such as first-time fathers, low-income fathers, and immigrant fathers. This paper explores these effects and proposes strategies for healthcare professionals and community organisations to ensure inclusive, family-centred care. The review aims to enhance fathers’ well-being and family resilience in both pandemic and post-pandemic contexts. Methods: A state-of-the-art review was conducted using MEDLINE, CINAHL, blogs, and advisory publications. A comprehensive literature search was performed, covering the period from March 2020 to March 2021, with an additional search extending to 2024. The review included 18 studies from the initial search period and 30 studies from the post-pandemic period. Results: Three specific themes emerged: fear of the virus, social isolation, and a mental health crisis. Fathers experienced significant anxiety about spreading COVID-19 to their partners and newborns, which increased stress during prenatal care and childbirth. Restrictions on hospital visits limited their involvement in the child birth process, leading to feelings of helplessness and disconnect during crucial bonding periods. Additionally, fathers faced heightened anxiety, depression, and role ambiguity due to caregiving and financial pressures exacerbated by the pandemic. These themes uniquely impacted perinatal fathers, affecting both paternal and maternal mental health and overall family well-being. Recommendations: The findings suggest several actions: customising training programs for healthcare professionals, promoting inclusive nursing practices, advocating for comprehensive parental leave policies, integrating telehealth services, and implementing father-centric interventions to enhance overall perinatal well-being. These recommendations are appropriate for the post-pandemic era as they address ongoing mental health challenges, ensure continuous support, and promote resilience in healthcare systems. These actions are essential to support perinatal fathers and their families in both current and future disruptions. Conclusion: The pandemic highlighted the need for personalised support for fathers to enhance their mental well-being and family welfare. Strategies such as customised training for healthcare professionals, inclusive nursing practices, comprehensive parental leave policies, and telehealth services are essential. These initiatives are crucial to ensure inclusive family-centred care, fostering fathers’ well-being and family resilience in both pandemic and post-pandemic contexts. Immediate and sustained efforts are needed to support perinatal fathers and improve family resilience.

Keywords: Childbirth; COVID-19; Fathers; Pregnancy; Mental Health; Post-birth; Pandemic

INTRODUCTION

Families have faced unprecedented hardship worldwide since the COVID-19 pandemic was declared in March 2020. The pandemic has disrupted family dynamics and presented unique challenges to families beyond borders. These challenges include difficulties in parental triaging, recurrent nasopharyngeal testing, use of personal protective equipment, fear of infection and transmission, physical proximity and separation, financial burden, and childcare commitments (Cavicchiolo et al., 2020). Additionally, several factors have undermined the family-centred approach to healthcare during the pandemic, such as visitor restrictions, the cancellation of in-person antenatal and postnatal services, and the lack of parental support. Often, fathers have been excluded, causing physical and psychological difficulties for fathers, mothers, and babies alike.

COVID-19 can be considered a multi-demic because it has triggered the emergence of several related crises, such as epidemics of racism, gender-based violence, and information overload, all of which have exacerbated inequities in resource availability and accessibility (Khanlou et al., 2020; Ahmad & Murad, 2020). During this period, families encountered specific challenges with childbirth, as fathers were often excluded from perinatal care, and mothers received minimal support.Mental health plays a crucial role in affecting the quality of perinatal care for both the mother and the infant (Roy, & Roy, 2022).

The relevance of this study in 2024 remains high due to the ongoing impacts of the COVID-19 pandemic on perinatal health. Significant developments have highlighted the broader implications of the pandemic on fatherhood experiences, emphasizing the need to understand and support perinatal fathers’ mental health and family dynamics. Changes in healthcare policies, increased awareness of paternal mental health, and shifts in family roles have all influenced perinatal fatherhood experiences. Therefore, this paper discusses the impact of COVID-19 on fathers’ mental health and well-being, with implications for maternal and family well-being during the childbearing period in the post-pandemic era. This article aims to answer the following questions: (1) What are the impacts of the COVID-19 pandemic on fathers during the perinatal period? (2) What are the implications of the COVID-19 pandemic for parental mental health, perinatal education, nursing practice, and research in sustaining perinatal well- being during the post-pandemic period?

METHODOLOGY

In this study, a state-of-the-art review approach is used to address current matters, in contrast to other combined retrospective and contemporary approaches (Grant & Booth, 2009). This approach is similar to a narrative review, allowing for a comprehensive examination of a topic by summarising and synthesising findings from various sources. However, a state-of-the-art review differs from other methods by offering unique insights into current issues, adding to the existing body of knowledge, and proposing research objectives for the future. This review addresses the current state of fathers’ mental health and well-being to provide insights into the effects of the COVID-19 pandemic on paternal mental health during the childbearing period (Grant & Booth, 2009).

Search Strategy

The search strategy involved:

The databases used for this research were MEDLINE and CINAHL, with additional sources including blogs and advisory publications. The keywords utilised in the search were fathers, COVID-19, pandemic, pregnancy, childbirth, postpartum childbearing, and perinatal. The initial search covered the period from March 2020 to March 2021, with an expanded search extending from 2021 to 2024.

Inclusion Criteria

Studies were included if they:

1. Focused on fathers during the childbearing period (pregnancy, childbirth, postpartum).

2. Addressed the impact of COVID-19 on paternal mental health and well-being.

Study Selection

After conducting a title search and abstract review, we identified 18 studies from the initial search period (March 2020 to March 2021) that met the inclusion criteria. Additionally, 30 studies from the expanded search (2021 to 2024) were included. These studies focus on the post-pandemic health of fathers during the perinatal period and the overall well-being of families.

RESULTS

While the COVID-19 pandemic has been broadly concluded, pandemic-related challenges continue to affect perinatal fathers. Lingering consequences encompass heightened levels of stress and anxiety, limited availability of support systems, challenges in mental well-being, shifts in the child birth process, and increased dependence on technology as a resource. From the analysis, the impact of COVID-19 on fathers can be understood through the following themes: (1) fear of COVID-19 and (2) social isolation. As a result, fathers may be vulnerable to mental health challenges and a (3) evolving mental health crisis manifested in physiological parameters, changes in self-concept, role ambiguity, and dependence on social support. This mental health crisis may negatively influence maternal mental health and the overall well-being of families during the childbearing period. The implications for nursing education, practice, and research are considered through strategies which emphasise evidence retrieved from the literature available across the databases. A summary of the articles discussed in this review is provided in table 1.

Table 1: Review Table for Impact of COVID-19 on Fathers During and Post-Pandemic

The Impacts of COVID-19 on Perinatal Fathers

The impact of COVID-19 on dads can be explained by two important themes: (1) dread of COVID-19 and (2) social isolation. These interconnected factors contribute to the increasing mental health crisis, as seen by fathers’ susceptibility to mental health challenges. Childbearing fathers, including single, first-time, NICU, same-sex, and high-risk family fathers, encountered a variety of challenges. The combined effect of dread and isolation has serious mental health consequences for fathers, which affects mothers’ well-being and overall family health. The following section discusses the impacts depicted in Figure 1.

Fear of COVID-19

The global spike in pandemic-related anxieties, fuelled by health anxiety, concern about loved ones, and media consumption (Mertens et al., 2020), has exacerbated parents' psychological susceptibility, particularly during the transition to motherhood under COVID-19. New mothers were most affected by contagion worries and interrupted postnatal support systems, with delayed prenatal consultations potentially impacting maternal and child health outcomes (Schmid et al., 2023; Mertens et al., 2020). Fathers, despite wanting to support their partners, faced increased stress and anxiety, particularly when dealing with childbirth, balancing work, family duties, and financial pressures. (Taubman-Ben-Ari & Ben-Yaakov, Chasson, 2020; Taubman-Ben-Ari, Ben-Yaakov & Chasson 2021; Mortazavi et al., 2023).

Figure 1: Impact of COVID-19 on Fathers

In addition to the difficulties faced by new moms and fathers, the pandemic disproportionately affected first-time, immigrant, minority, and same-sex fathers, exacerbating their stress and mental health issues (Recto et al., 2020). Asian dads, in particular, reported greater depressive symptoms as a result of online racial discrimination (Goyal et al., 2023), while teenage fathers and same-sex families had severe social and economic challenges (Recto et al., 2020; Kelly et al., 2023). These combined stressors reflected the diverse experiences of fathers from various socioeconomic backgrounds, with high-income fathers spending more time at home and shouldering increased parental responsibilities, and low-income fathers facing job losses or risks from in-person work (Lista & Bresesti, 2020; Marcell et al., 2022). These pressures also influenced adoptive parents, resulting in maladaptive coping patterns (Carroll et al., 2020).

Given the broad usage of media during the pandemic, its significance in informing and aggravating fears cannot be underestimated. This ‘infodemic’ (Ahmad & Murad, 2020) emphasised the necessity of providing fathers with consistent services to boost resilience and prevent burnout (Avery & Park, 2021; Prikhidko, Long & Wheaton, 2020). Additionally, studies have found that involving fathers in prenatal activities, such as assisting with childbirth, can lower stress and improve mental health outcomes, highlighting the importance of including them in maternal healthcare initiatives. (Smith, Pitter & Udoudo, 2024).

Along with the obstacles posed by stress and anxiety, vaccine reluctance has arisen as a major issue among reproductive families. Despite evidence confirming vaccine safety during pregnancy, many fathers reported concerns and reservations about vaccination (Zipursky et al., 2021). This highlights the importance of shared decision-making, which enables families to align their vaccination decisions with their beliefs and priorities (Zipursky et al., 2021).

Overall, the COVID-19 pandemic has introduced unprecedented challenges for parents, affecting their ability to support one another and their children due to heightened fears, healthcare disruptions, and economic strains. These various pressures underscore the importance of comprehensive support systems and targeted interventions to address the ongoing challenges faced by families, ensuring their mental and physical well-being during the pandemic and beyond (Stein & Bloomberg, 2021).

Social Isolation

Social separation and isolation strategies implemented to reduce virus spread have exacerbated social isolation and loneliness, with major mental and physical health consequences for parents (Hwang et al., 2020). Restrictions on maternity care, such as excluding partners from labour, have resulted in missed bonding opportunities and increased psychological discomfort (Campbell-Yeo, 2023; Rice & Williams, 2024). First-time fathers, in particular, struggle to navigate their duties due to isolation and stress associated with early involvement, infant care, and spousal support (Higashio & Sasaki, 2021).

The pandemic has limited fathers’ access to appointments and births, resulting in increasing social isolation and difficulty bonding with their children. This isolation has also intensified fathers’ difficulties in recognising and treating their mental health issues (Das & Hodkinson, 2020). Virtual alternatives such as telehealth and web-based platforms have shown potential in reducing isolation, providing support, and involving fathers in perinatal care, which is consistent with recommendations to incorporate fathers in global perinatal practices (Fisher et al., 2021; Bouchacourt et al., 2023). For divorced fathers, particularly those in nesting arrangements, confusing pandemic practices have resulted in disagreements about how to manage COVID-19 risks, affecting co-parenting relationships. Due to travel restrictions, single and immigrant fathers have encountered obstacles such as limited social support and access to extended family (Iztayeva, 2021).

A health equity issue in paternity leave has been observed, with pandemic relief initiatives like the CARES Act and CERB failing to appropriately support fathers, particularly those with racial and ethnic disparities (Montez, Thomson & Shabo, 2020). This has disproportionately impacted mothers. However, the possibility of fathers working from home after the pandemic may improve family relations and baby bonding (Andrews, Ayers & Williams, 2022).

Fathers’ Mental Health Crisis

The COVID-19 pandemic has spurred a rise in mental health research, revealing significant challenges in healthcare, particularly mental health. The pandemic’s effects have emphasised the need to address these challenges and promote well-being (Suryasa, Rodríguez-Gámez & Koldoris, 2022). Despite these difficulties, many fathers showed resilience and maintained firm commitments to their families (Deslauriers & Kiselica, 2024). COVID-19 policies, such as social distancing and stay-at-home orders, blurred work and home boundaries, reduced social connections, and resulted in fatigue. These factors negatively affected the mental well-being of both mothers and fathers (Avery & Park, 2021). The pandemic’s widespread consequences have created a global crisis in paternal mental health.

Fathers experienced increased rates of peripartum anxiety and depressive symptoms during the pandemic (Goyal et al., 2023; Higashio & Sasaki, 2021; Kelly et al., 2023; Obikane et al., 2023). Paternal depression, particularly during the perinatal period, can have long-term effects on children’s language development (Clifford, Rainey & Eggum, 2024). In Japan, factors like fear of COVID-19, low family functionality, and intimate partner violence increased the risk of paternal depression, highlighting the need for interventions (Obikane et al., 2023). Fathers also struggled with early parental roles, such as handling child crying and supporting partners (Higashio & Sasaki, 2021). Separation from partners and infants during the pandemic had adverse effects on fathers’ mental health, particularly in the U.K. (Kelly et al., 2023; Andrews, Ayers & Williams, 2022).

Prior to the pandemic, research focused mostly on female perinatal depression, but new studies show that men are also at an increased risk of depression during fatherhood. For example, during the pandemic, new moms in Portugal had higher depression rates than fathers, although both suffered increased depression relative to pre-pandemic levels (Pereira et al., 2023). According to Dachew, Heron and Alati (2023), meta-analysis discovered a link between parental depression and subsequent depression in offspring, emphasising the necessity of family interventions.

The prevalence of paternal perinatal depression during the pandemic highlights an underrecognized mental health issue (Cameron, Sedov & Tomfohr-Madsen, 2016; Vogel, 2011). Fathers’ anxiety and depression are often compounded by a lack of screening and are linked to maternal depression, affecting their ability to support partners during pregnancy and postpartum (Fisher et al., 2021). Pre-pandemic paternal perinatal depression was estimated at 4% to 25%, with Cameron, Sedov, & Tomfohr-Madsen, (2016) reporting 8.4%. The pandemic caused a significant rise, with 22.4% of fathers experiencing comorbid depression and anxiety in the first year postpartum (Dennis et al., 2022). In Wuhan, China, paternal postpartum depression (PPD) peaked during the human-to-human transmission announcement of COVID- 19, influenced by family income and smoking behaviours (Sun et al., 2021). A systematic review by Mazza et al. (2022) validated paternal perinatal depression as a distinct clinical condition, underscoring its importance for family health.

The pandemic impact on parental mental health has been significant (Cameron et al., 2023). Studies have shown increased rates of anxiety and depression in mothers during pregnancy and postpartum and highlighted the importance of addressing negative thoughts related to motherhood (Schmid et al., 2023; Pereira et al., 202). Additionally, the exclusion of partners from childbirth has affected maternal mental health, emphasising the need for comprehensive perinatal care (Rice & Williams, 2024; Mortazavi et al., 2023). Positive pre-pandemic co- parenting has been linked to mitigating infant regulatory issues during COVID-19 (Pinto & Figueiredo, 2023). Globally, fathers in the U.S. reported higher stress-related physical symptoms, sleep changes, and increased alcohol consumption. At the same time, no significant differences in parental distress were observed between mothers and fathers in Israel (American Psychological Association [APA], 2021). In Canada, lockdown measures brought positive outcomes for some families, leading to more family time and healthier habits (Carroll et al., 2020).

The COVID-19 pandemic has intensified fathers’ risks of depression, anxiety, and role ambiguity, creating a mental health crisis that continues to unfold. Disrupted support systems and increased caregiving responsibilities worsened these issues. This silent epidemic, particularly affecting vulnerable fathers, calls for urgent mental health interventions to support fathers and improve family well-being. Comprehensive research and accessible interventions are needed to address the long-term effects on paternal mental health and its impact on maternal and infant health.

DISCUSSION

Overall, the COVID-19 pandemic has highlighted the vital role that fathers play in their families and communities as they work to provide support and stability during this difficult time. The COVID-19 pandemic has significantly affected fathers, with many expressing concerns about the threat of the virus to their family’s well-being, finances, and employment status. Across families, fathers continued to work during the pandemic despite the risks of becoming infected with COVID-19, as providing for their families was their main priority. In addition, the pandemic has brought about many hardships for fathers, including increased stress, anxiety and uncertainty. Despite these challenges, many fathers have found strength in their families and remained hopeful, overcoming the novel challenges brought about by the pandemic. This resilience aligns with findings showing that fathers, despite challenges, maintained firm commitments to their families, particularly during the pandemic (Deslauriers & Kiselica, 2024).

Research has shown that the pandemic has had a unique impact on fathers, with many experiencing varied emotions related to their roles as parents and providers (Andrews, Ayers & Williams, 2022; Campbell-Yeo, 2023; Marcell et al., 2022). In most instances, fathers had to adapt to new work arrangements, such as working from home or dealing with job loss, while supporting their families through the challenges of the pandemic. Nevertheless, fathers demonstrated their resilience and ability to overcome adversity. The paper highlights the impact of the COVID-19 pandemic on paternal mental health within the perinatal period. Preventing and addressing adverse mental health outcomes among fathers is critical, given its effects on long-term maternal and child mental health outcomes (Clifford, Rainey & Eggum, 2024).

Figure 2 illustrates the implications for perinatal practice and education in the post-pandemic era, emphasizing shared decision-making, social support, and inclusive policies for parents. It highlights the need for comprehensive education, stress management, and culturally inclusive training for health professionals. Nursing courses must include instruction on the pandemic’s mental health impact on fathers. This should focus on comprehensive care for both parents, resolving COVID-19-related anxieties, reducing social isolation, and providing individualised assistance for fathers while taking cultural considerations into account (Marcell et al., 2022). Training and mentoring programs should highlight the father’s involvement in perinatal care (Erdei & Liu, 2020). According to research, professional and partner support improves father- infant bonding, especially for first-time fathers, highlighting the importance of targeted support in nursing training (Wells, Giannotti & Aronson, 2024). These aspects should be included in the perinatal nursing curriculum to improve fathers’ well-being (Yazdanpanahi et al., 2022).

Policy advocacy is essential for establishing a pro-fathering culture, including mental health and perinatal father assistance. This includes pushing for affordable health insurance and childcare laws for low-income and single men, as well as paid leave for fathers during childbirth (Andrews, Ayers & Williams, 2022). Policy changes should also prioritise personalised care for fathers’ mental health during the postpartum period (Schobinger et al., 2024).

Figure 2: Implications for Perinatal Practice and Education: Post-Pandemic Era

Promoting a pro-fathering culture in prenatal nursing requires stress management, greater father engagement during labour, and shared decision-making to prevent stress contagion (Erdei & Liu, 2020; Smith, Pitter & Udoudo, 2024). Virtual visits and personalised NICU restrictions can help reduce tension, while online training has proven effective in lowering anxiety for fathers and couples during the pandemic (Merih, Karabulut & Sezer, 2021). Virtual prenatal education programs should prioritise accessibility and address fathers’ unique concerns, offering tailored support (Marcell et al., 2022). Parenting apps like the Supportive Parenting App (SPA) boost fathers’ knowledge, confidence, and self-efficacy, with lasting benefits beyond the pandemic (Shorey et al., 2021; Avery & Park, 2021).

Perinatal nursing should focus on the father’s mental health and provide support beyond standard mother care. Active listening and empathy are examples of therapeutic communication that help fathers create a secure space to express their emotions. Simple assistance from family, healthcare providers, and the community can aid in the early detection of paternal mental health problems. Given the prevalence of paternal depression and anxiety, routine Couvade syndrome screening is advised (Lambregtse-van den Berg & Quinlivan, 2021). Paternal mental illness can have long-term consequences for children’s mental health and development, necessitating tailored services.

Integrating telehealth options for mental health support is crucial to meet the increased demand for counselling and emotional help for perinatal fathers (Shorey et al., 2023). Healthcare professionals should assist fathers in finding coping strategies, considering the significant changes in healthcare delivery due to the shift towards telemedicine. While telemedicine has made healthcare more accessible, it also presents challenges that must be addressed, such as concerns about intimacy, treatability, and documentable care under current regulations (Kurimay et al., 2022). The pandemic has necessitated revisiting existing paternal support practices and exploring alternative methods to address the disparity between fathers’ needs and current support practices (Higashio & Sasaki, 2021; Kurimay et al., 2022).

Incorporating mental health care into healthcare curricula is critical for improving structural competency, particularly understanding how social variables influence disenfranchised parents (Waite & Hassouneh, 2021). To better support perinatal fathers, nurses should additionally receive Mental Health First Aid (MHFA) training utilising the ALGEE technique (Poornaselvan, 2020). Tele-mental health services are advised for pregnant parents in NICUs (Geller et al., 2021), and father-specific assessments should be utilised to identify mental health issues and give tailored care (Yazdanpanahi et al., 2022). Fathers must actively participate in perinatal care as major contributors to family well-being.

Limitations

The discussion points addressed in this article may have specific limitations in terms of generalizability. Only English-language studies are cited, and valuable insights published in other languages should be addressed in future research. The articles used were not systematically reviewed for quality due to limited evidence on fathers’ mental health during the initial phases of COVID-19. Therefore, the quality of the evidence may be variable, and there may be a risk of bias in the selection of articles and the potential for overlooking necessary studies or conflicting evidence. Additionally, the information discussed is from published articles, blogs, and advisories during the initial phases of COVID-19 and the immediate post- pandemic phase, which may not replicate the complexity of real-life situations across the globe and cultures.

CONCLUSION

The pandemic had notable impacts on the mental health of fathers and highlighted the need for personalised support to enhance their paternal well-being and positive family dynamics. Strategies such as customised training for healthcare professionals, inclusive nursing practices, comprehensive parental leave policies, and telehealth services are essential. These initiatives are crucial to support inclusive family-centred care, fostering fathers’ mental well-being in both pandemic and post-pandemic contexts. Immediate and sustained efforts are needed to support perinatal fathers and improve family resilience, aligning with the study’s objective to enhance family resilience and well-being in both current and future disruptions.

Future research should explore the long-term effects of these interventions on paternal mental health and family dynamics. There is a need for innovative, culturally sensitive programs adaptable to diverse healthcare settings. The potential of digital health tools and telehealth services should be further investigated, particularly for underserved communities. Policymakers should consider flexible, inclusive parental leave policies that align with the evolving roles of fathers in the post-pandemic era. Longitudinal studies should assess how these initiatives contribute to sustained family resilience and well-being, ensuring that fathers’ needs are consistently met to foster healthier, more resilient families.

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The authors are thankful to Dr. Nazilla Khanlou for her general guidance and encouragement, as well as Allan Galli Francis for his support in creating the figures used in this paper.

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