“It’s free, it’s available, and it’s healthy”: a cross-sectional, qualitative study of fathers’ preferences for breastfeeding in American Samoa and their desire for father-specific, practical breastfeeding education

Introduction: Prior research on the determinants of infant feeding practices in the Pacific has focused on mothers’ knowledge, attitudes, and beliefs. In American Samoa, however, mothers often receive familial support for infant feeding and care, but little is currently known about the role of the father in this setting. Aim: Using a qualitative approach, we aimed to understand American Samoan fathers’ current roles in infant feeding and to determine whether there is a need/desire for additional infant feeding education specifically targeted to fathers in this setting. Methods: Fifteen fathers completed longitudinal semi-structured interviews (before their infant’s birth and six-weeks after) focusing on their roles in infant care and feeding, knowledge and beliefs about breast- and formula feeding, preferences for infant feeding, and interest in further infant feeding education. A thematic analysis identified salient themes in the qualitative data related to these topics. Results: Fathers reported a high level of involvement in infant care and ‘partnership’ with their child’s mother. They had strong preferences for breastfeeding but were pragmatic about the associated challenges and reported ultimately deferring to their partner’s preference. Fathers unanimously requested further infant feeding education and wanted help to identify practical ways in which they could support their partners to begin and continue breastfeeding. Conclusions: Given the benefits of sustained exclusive breastfeeding, providing targeted infant feeding education for fathers could be an important health promotion strategy.