Fathers' perception of child health: a case study in a squatter settlement of Karachi, Pakistan

This study looks at child health from a father’s perspective. While the close relationship between children and mothers has been acknowledged, and brought about the concept of Mother and Child Health (MCH), little attention has been paid to the role of fathering. In Pakistan, where the study was undertaken, a high infant and under-five mortality coincides with a low acceptance of MCH services and a tradition of female seclusion, , which severely limits women’s movements in public. Purdah is often cited as an important cause for the low MCH-coverage, indicating an inappropriate design of established MCH-services with its exclusive focus on mothers, and prompting the questions taken up in this study: what is the role of fathers in child health, how do they define child health needs and how do they participate in child care? The study was undertaken in the squatter settlement Orangi in Karachi where the Aga Khan University is involved in a PHC program. A set of qualitative methods was used including key informant interviews, focus group interviews with fathers, group interviews with women and community health workers with a total of 61 informants, and observation of father-child interaction. Apart from their basic role as breadwinners, most fathers participate directly in child care. As far as working hours allow, fathers spend time with their children by taking them out or playing with them. Among 174 cases of child holding in roads and places, 75 per cent were carried by the father; this was yes for the majority of children even in the mother’s presence. One-third of children brought to general practitioners were accompanied by the father. Fathers help their wives in child care in activities like feeding, soothing, bathing and giving medicine; a considerable minority even changes nappies. In the socio-cultural context, the high level of male involvement especially in caretaking outside the house can be seen as a coping mechanism with the tradition of female seclusion. The qualities of fathers as key decision-makers and second line caretakers and mothers’ role as primary caretakers call for a two-pronged approach to child health, addressing and involving both parents