Chicago pediatrician Craig Garfield noticed a few years ago that mothers in the neonatal unit where he works were often dealing with the sudden death of a partner, whether from a car accident, shooting, a drug overdose, or another cause. He wondered whether this reflected a larger pattern, and whether there might have been a way to intervene. While maternal mortality is closely tracked today, paternal mortality is not. And so, Garfield and some colleagues at Northwestern University decided to launch one of the first studies of paternal mortality in Georgia, where they’d already begun collecting data on fathers.
They found that of 130,000 men who became new fathers between 2017 and 2022, almost 800 died during that same 5-year period, and 60 percent of those deaths were from potentially preventable causes like homicide, accidental injury, and suicide. Though it’s not an apples to apples comparison, Georgia's maternal death rate reached 37.9 deaths per 100,000 live births between 2019 and 2023. These are deaths that occurred in the first year after birth, as opposed to the first five years. (Georgia’s maternal mortality rate is much higher than the national average.) On the other hand, Garfield and his team found, fatherhood seems to be protective of men’s health overall, as fathers died at a lower rate than non-fathers. They published their results in JAMA Pediatrics.
I spoke with Garfield about why understanding these numbers better is important for families, whether the deaths among new fathers are somehow linked to paternity or just a reflection of the higher rates of death among men more broadly, and what hospitals and pediatricians might be able to do about it.
Garfield told me that he doesn’t want to take resources away from maternal healthcare, but believes fathers are essential to the health of families, too. New fatherhood could serve as a point of intervention. Or as he put it, “From the pediatrician’s perspective of the child, both mother and father are really important to the health of the child and the family.”
What inspired you to study paternal mortality?
I’ve been a pediatrician for 25 years. A lot of my research looks at how to support families. We have a program called the Family Child Health Innovations Program, and our motto is, “Children Thrive When Families Thrive.” I spend a lot of time thinking about what thriving is and also what a family is and how we think about families.
Fathers are an area that we’ve been focusing on and thinking about—the role of fathers and how to support them. Also, I learned a lot from looking at how we think about mothers and how we think about supporting mothers. One of the newer things that’s come into public health are maternal mortality review committees, or MRCs, multidisciplinary groups at state or local level that review all deaths that occur within a year of childbirth.
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But oddly enough, in my clinical experience—and I work in a neonatal intensive care unit—it’s more common to come across a family where the partner has died during pregnancy or after the birth of the baby, as opposed to the mother. I got to thinking that no one really has looked at that. This concept of paternal mortality is really novel. This is one of the first studies to use that term. One reason for that is that maternal mortality is often something where we’re looking at pregnancy-related complications or ways the healthcare system failed the mother.
We also know that men are less likely to be in the healthcare system in general, but particularly at child-rearing ages. It’s a travesty when a mother with young children dies, for sure. But it’s a travesty when a father dies, also. And no one has really put numbers to it.
You described certain kinds of death—homicide, suicide, unintentional, and drug overdose—as preventable. What do you mean by preventable in that context?
Yes, so natural causes include if someone develops cancer and they’re not responsive to treatment, and so they die. There’s very little that we could do to prevent that. But preventable or largely preventable causes include if someone is shot and killed, or if someone dies by suicide or by overdose.
You might imagine that there might have been somewhere along the line that, collectively as a society or as public-health practitioners, we could have intervened. Maybe mental-health screening of fathers, the way we do with mothers, could have caught someone who was suicidal and needed some help. We might have different ways to protect against other accidents or drug overdoses.
With this study, the hope is that people will realize that maybe there is something that we can be doing for these fathers, but also for the children and the families more broadly.
Do you think the causes of these preventable deaths might have some relationship to the fact that these men had just become fathers?
It’s a little bit of both. This is publicly available public-health data. It’s population-level data. We don’t know the individual stories of the 800 dads that died. By comparison, the MRCs do get into the details of why that particular mother died within a year after the birth of a child. It would be great to have that kind of data for fathers, to think about preventative actions that we could take.
But the other interesting finding of the study was that fatherhood was actually protective. At all ages, from 25 up until almost 60, when you looked at men who are fathers and compared them with men who are not fathers, the death rate for men who are fathers was lower or better than it was for men who are not fathers. There seems to be something protective about becoming a father, and yet, there’s still a sizable number of men who are dying when their children are still young. That’s going to have a really negative impact on the family and on the child.
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Is your hypothesis that the causes of death change after fatherhood or more that this is a point of contact, where the healthcare system could make a difference? Because you talk about paternal mortality as a crisis, but if fatherhood is actually protective, then are these deaths related to paternity or just to being a man?
Those are the right questions to be asking. We don’t have answers because we haven’t looked at this before. This study is a place to start. But there might be something we could be doing in the healthcare system, since dads are least likely to be in the health system, but they do come in with their partners when children are born, and they come in as a chaperone to their child. There may be missed opportunities there.
Our research has shown that for many dads, that transition to fatherhood is a real awakening. It changes their priorities and their view of the future. In long semi-structured interviews, they describe an idea of wanting to be there when their baby enters kindergarten. They want to be there when their baby goes to middle school or graduates high school. As a result, some men start to try to reduce their risks in the general community. This isn’t a study of causality. But clearly, there are more dads who are dying than moms who are dying. And this was only in one state.
What do the data tell us about the impact of the death of a father in the first five years of a child’s life?
The death of a parent is a major adverse childhood experience, right? It’s one of 10 circumstances included on a standardized clinical survey of major adverse childhood experiences. We know that it puts kids at risk. There’s a tremendous amount of research also on the benefit of father involvement with the child in terms of development and language development. We know that it’s beneficial for mothers. When they have a partner, they get more and earlier prenatal care, more appropriate care over the time of their pregnancy. It can be protective for maternal mental health, too. The research on the benefits of father involvement has been out for a while. This study gives at least a data point of how many dads may be dying. I think it’s going to lead to more research down the line.
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What will you study next?
To me, it’s even more important that we do PRAMs for dads. We started in one state—in Georgia in 2018—and now we’re in 10 different states. We have over 10,000 fathers surveyed in that transition to fatherhood period right now, and we’re expanding. In that survey, we do some screening for depression and anxiety symptoms, substance use—all the things that we worry about from a public-health perspective and all the positive things, too. How is dad supportive of breastfeeding? How is dad supportive of safe sleep behaviors? That’s an ongoing study, and we’re always looking for more states that are interested in taking this holistic approach to families.
We can’t change what we don’t measure, and we don’t know what we don’t know, so let’s at least get some measurement going so we can understand what exactly is happening.
We’re just about to publish a study about where we can reach dads in the whole continuum of healthcare. Could you recruit fathers in the newborn nursery after the baby’s born where it’s getting real for the dad? Like, “Oh wait, this baby’s really here. I didn’t study. I didn’t read the book. I didn’t watch the YouTube video. What do I need to know?” We came up with a series of short videos with a real dad and his two-week-old baby where we filmed different things like how to deal with crying, how to deal with car seat safety, safe sleep behaviors, breastfeeding support, that sort of thing. We did it as an intervention. We wanted to know: Could you recruit dads in the nursery, would they watch these videos, and would they learn from these videos? And it turns out you totally can. They’re interested. They wanna be involved. They will watch the videos and learn from them.
Taking a holistic approach to the best outcomes for children really requires that you think about what’s happening with the non-birth partner, and how we might engage them in this. The data shows that if fathers feel comfortable and confident early on, they’re more likely to be involved later on, as well. 
Lead image: sonyachny / Adobe
