Category Archives: Swedish Child Health Field

Supporting fathers in the Swedish child health field

I recently published a literature review and meta-ethnography entitled Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals in Acta Paediatrica.

This article received a lot of attention when it was first published. For example, Sverige’s vetenskapsradio first interviewed me on the findings. Then TT picked it up, meaning that the story was in every newspaper, from national to local newspapers. Before being interviewed by a national news program, Rapport.

It was further promoted by different organizations, such as Män för Jämställdhet. And other writers/bloggers talked about it.

What was really cool was that Sven Bremberg was asked by Acta Paediatrica to write an editorial which he called Supporting fathers is essential in the child health field

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So I had my 15 minutes of fame.

Now, a year or so later, I have finally had the time to make my first video. I’ve always wanted to promote my research through videos, but haven’t had the time. I’m highly critical of the final product, both of the video and the content, but it was my first attempt and it was a fun learning experience.

In fact, as a researcher, it’s hard to see your work lose it’s nuance. I thought enough nuance was lost when publishing it, as word counts affected how many details I could say. But trying to make a 5 minute video left very little room for nuance.

What I attempted to do was to show four examples–one from each arena within the child health field: prenatal, labor & birth, postnatal, and child health centers. I wanted to show two positive examples of ways midwives and nurses support fathers and two examples where support could be improved. However the two examples of improved support are more on the organizational/managerial level, rather than critiques of midwives’/nurses’ attitudes and support given to fathers.

Perhaps future videos will be made to provide a more nuanced understanding of the support fathers receive in the different child health arenas. Until then, I have my first overview video.

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Swedish Child Health Centers’ Built Environment: Do They Include Fathers?

Swedish child health centers have historically been a place for new mothers and children. We assessed 31 child health centers’ waiting rooms to see the extent to which they included images of mothers, fathers, and children. 75% did not include fathers…at all. Read the full article here.

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Background: Sweden is trying to create a gender equal country and around 97% of all families in Sweden visit the child health centers for routine check-ups, vaccinations, to monitor their child’s growth and development, and to receive parenting advice, either for their specific child’s problems or via parenting groups.

Study Design:Prior to the study, we defined what constituted a mother, father, and/or child environment (or any combination thereof).

 

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Note: None of the environments were father-mother, father-child, or father centered, so those definitions have been removed.

I then visited and took pictures of 31 child health centers throughout Sweden. I visited centers in rich and poor neighborhoods, urban and rural areas, and private and public child health centers.

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Pictures were taken of everything in their waiting room, magazine titles were written down, and all pamphlets that could be handed out to parents were collected.

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I then met up with two co-researchers, where we independently viewed the waiting room via the pictures and samples to determine if that space included the mother, father, and/or child.

The waiting room was determined to be mother, father, and/or child centered as long as at least 25% of the space consisted of that individual; leaving the last 25% to be aimed at any or all of these types of individuals (neutral items [e.g. abstract art, pictures of nature] did not count for or against any individual family member).

The messages on the bulletin boards were broken down using manifest and latent analysis using semiotic visual analysis.

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The magazine readership was sought out

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Results

31 Child Health Centers

  • 12 = Mother-Child Centered
  • 8  = Family-Centered
  • 6  = Child-Centered
  • 2  = Women-Centered
  • 3  = Neutral

The most common waiting room had lots of items for mothers (e.g. images of mothers, magazines that mothers typically read) and toys and books for children, as well as images of children, but very little or nothing for fathers.

In fact, only one category, family-centered, included fathers, while the rest were composed of mothers and/or children.

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Observations

We also observed parents, mothers and fathers, visiting the child health centers to see what they did while in the waiting room–read books, talk on their cell phone, interact with their child, talk with each other….just sit in their chair.

Mothers’ behavior did not change between environments, but fathers were more likely to play with their child and read the brochures/pamphlets if they were in a non-women centered environment (e.g. either family centered or child centered).

Conclusions: People are affected by their environments–people read in libraries, party at concerts, act posh at fine dining establishments. They don’t typically do the reverse (read at concerts and party in libraries).

The child health centers are no different. Their built environment sends messages on who’s welcomed and how they should act.

To further promote involved fathering in child health, the child health centers should rebuild their environments to be more inclusive of fathers.

To help ensure an inclusive waiting room (for all types of people), we created (in Swedish) a checklist they can use!!!

Click here or on the picture to see the full checklist.

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Swedish Child Health Nurses’ Attitude Toward Fathers

We published a qualitative article in Acta Paediatrica on how Swedish child health nurses felt about fathers coming into the child health centers. While child health nurses accepted and welcomed fathers, they did little to invite, include, or further support fathers (click here to read the full article).

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I interviewed 17 child health nurses from various places in Sweden: north, south, east, west; urban and rural; experienced and inexperienced; young and old. All child health nurses were women–Not uncommon since there are only a handful of men that are child health nurses in the whole country.

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Four themes were discussed in this article.

While child health nurses are experts on children’s health and believe that fathers are attending the child health centers more than ever; they seem to be attending in spite of rather than because of support they receive from the child health nurses.

Child health nurses say that they value mothers to a much greater extent than fathers and provide more support to mothers.

However, child health nurses are in various stages of providing more support to fathers: while some have never thought about actively involving fathers, others have tried to, but feel their hands are tied when it comes to making changes, while others have even tried to make changes (e.g. discuss with their boss about having evening and weekend hours, magazines for fathers, pictures emphasizing fathers). However, no child health nurses that were interviewed had yet made any real changes.

downloadConclusion: If we want mothers and fathers to be equal parents, fathers will need to be accepted and encouraged to participate, just like mothers.

The Swedish child health centers provide great child development advice, host parenting groups, are seen as parenting experts, and are appreciated throughout Sweden.

For example, their services benefit parents…mothers.

The extra support mothers receive aides mothers in continuing to raise their child, at least as far as their child’s health in concerned, since she is the parenting expert because she receives the most support and is the most welcome at the child health centers.

Changing routine practices at the child health centers to further promote and support fathers will aid Sweden’s goal of becoming a gender equal country.

Dissertation (Avhandling) Cover Photo

I’m often asked by fellow PhD students–what should I have on the cover of my dissertation (avhandling) book?

To me, the answer was very clear–I wanted the overall message, the theme, of my dissertation to be front and center on the cover.

If a picture is worth a thousand words, then I should shorten my dissertation 😉

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I had a childhood friend, Kirb Brimstone (also found on Facebook here), do the artwork. I advised him what I wanted and he drew it.

Here’s the significance of my cover art:

Since my dissertation is about how fathers are not provided with an equal chance to parent, both through the Swedish family policies and through the institutions, like the child health field, I had this represented on the cover.

There’s an illustration of Sweden in the background, with a father, presumably from Uppsala University, holding his daughter’s hand as he walks towards a nurse and a preschool teacher.

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The nurse and preschool teacher are both women, signifying the gender difference men/fathers face at the outset of garnering parenting advice from these individuals.

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However, he is stopped at a fence, with a lock, signifying the gatekeeping that is happening as those who have knowledge about young children’s health hold the keys (and therefore the power) to inform or not inform others about young children’s health.

In this case, fathers feel like the gate is closed, and that they have several barriers to break down before they can be fully accepted into the child health world.

Even my own institution highlights the lack of the importance of fathers, as it is aptly named “Women’s and Children’s Health“.

Mainly people in Sweden and around the world believe that Sweden is a very gender equal country. And to its credit, it most certainly is, especially relative to other countries. But that doesn’t mean that there isn’t a vast amount of work still needed before achieving gender equality. While many people work with the struggle for equal rights for women, few pose the argument on ways men/fathers are discriminated against, not the least of which is through the Swedish child health field.

With that in mind, the sign on the gatekeeping fence has a sign saying “Nullius in Verba” which is Latin for “take nobody’s word for it”. In other words, just because people believe Sweden is a gender equal country, and that men/fathers hold all of the power–do not take societies word for it.

Seek out the truth…..by reading my dissertation.

You can find a copy of my dissertation by clicking here.

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One last thing–I gave a tip of my hat to the father-figures in my life: my father (JSW), my two grandfathers (KFE & CRW), and my best childhood friends dad (SP) by having their initials “carved” into the fence on the right-hand side. This was also intended as a symbolic gesture, suggesting that these fathers had reached the gate, but were stopped and couldn’t be as involved in all aspects of childrearing as they might have liked due to the various levels of gatekeeping that they encountered.

First (book chapter) publication: Using Semiotics to Research Father Involvement in Sweden Child Health Care Centers

In the summer of 2008, I flew over to Sweden for the first time. In fact, I flew the day I graduated from Ohio State University with my master’s degree in Human Development and Family Science.

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I was offered a 3 month summer job doing fatherhood research for Dr Anna Sarkadi (see her blog here), Uppsala University.

I was quickly assigned to travel around Sweden in order to see why fathers weren’t visiting the Child Health Centers (Barnavårdscentral [BVC] in Swedish) as often as mothers. I went to 6 different counties; heading into cities like Stockholm, Gothenburg and Uppsala to rural areas like Tanumshede and in between places like Mora and Leksand.

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I set off to find out what some of the barriers and obstacles might be by interviewing nurse from the Child Health Centers on how they involve fathers, as well as assessed the waiting room environment.

Assessing the waiting room was quite novel and unique. We used a process called semiotics, which helps people to understand a picture at both its manifest and latent level. The manifest level tells exactly what’s seen in a picture, while the latent analysis tells what is meant by that picture.

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So for example, when looking at gender differences:  At the manifest level, these pictures on the bulletin board shows a woman running (physical activity), while a man is smoking (tobacco habits). The other two pictures are not of people, and therefore are excluded from this analysis. Latent: These pictures convey a positive health message about women and a negative health message about men.

Before this analysis, semiotics was just used to describe one picture. What we’ve since done was to say that an entire environment can be assessed using this technique. So we (Jonas Engman, Anna Sarkadi, and myself) analyzed each picture of men, women, and children (differentiating men from fathers and women from mothers if there were or were not children in that picture) and then tallied them up to see how many messages on the manifest level were there related to men/fathers, women/mothers, and children and then how many of those were positive or negative.

If the room was mostly equal between these three groups, then it was termed Family Oriented, meaning that all members of the family were welcome. However, if one of the family members was missing, then different terms were used such as, mother-child oriented, woman oriented, and child oriented. A fifth group was termed neutral, as there were no pictures of people on the wall within the waiting room.

My first book chapter was published with co-author Jonas Engman in the Swedish-written book Föräldrastöd i Sverige idag – Vad, När, och Hur? (Parental Support in Sweden today – What, When and How?

The book chapter is linked in here: BVC Book Chapter

My chapter

The English article is published in the journal Semiotica.

If you analyzed this picture, what would be the manifest and latent analysis (viewing only the picture, not the words):

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Literature Review on Parental Leave in Sweden and Their Child Health Centers

‘Do Father-Friendly Policies Promote Father-Friendly Child-Rearing Practices? A Review of Swedish Parental Leave and Child Health Centers’ was published in the Journal of Child and Family Studies (2012). We reviewed the literature on how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers.

Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents to take 480 days off of work, receive 80% of their pay for the first 15 months, and divide their leave however they see fit, barring that both parents receive 2 months of parental leave that is exclusive to them. Additionally, fathers are permitted to take the first ten working days off to be at home with his family.

Most parents, especially mothers, use parental leave throughout their infant’s first year. During the parents’ time off from work, nearly all Swedish parents (95–99%) utilize the Child Health Centers between 11 and 13 times during the infant’s first year of life. The Child Health Centers help to monitor a child’s growth and development, provide parenting support, immunizations, health education, health screenings, and provide referral sources if the child has any special needs. However, fathers only use 22% of all parental leave days.

Studies have pointed out that fathers may not use parental leave because of corporate, maternal, and financial attitudes. Despite the Child Health Centers’ policy of including both parents, fathers do not utilize the Child Health Centers to the same extent as mothers, because they are mainly only open during normal working hours, they are dominated by females (staff and mothers), and many conversations during the child’s first year are directed towards mothers (i.e. breastfeeding).

Swedish fathers have barriers to utilizing parental leave and have barriers at the Child Health Centers; therefore, fathers may not learn about their child’s health (i.e. growth and development) during the most formative years. This empowers mothers, since they are learning about their child’s health, and therefore become the child’s health expert and have formed relationships with the Swedish child health nurses. This may discourage fathers from taking an active role in their child’s health care; thus barriers need to be removed so that fathers can participate more in their young child’s health, if the Swedish health care system is to be more egalitarian.