Background
There is increasing attention on the importance of engaging with men to improve the health of men themselves, as well as the health families and households in which they live. In South Africa, male mortality has risen sharply in recent years due to AIDS and high levels of accidental and violent deaths. Male adult mortality, measured by the probability that a 15 year old will not live to the age of 60 years, is estimated nationally to be 61% in men. Health interventions to prevent HIV and premature death in men are therefore an important goal of health research. In addition to interventions targeting mens’ health, there is increasing recognition of the importance of including men in family-based interventions seeking to promote the health and wellbeing of families, in particular of children. However, whilst considerable experience has been built about how to successfully promote maternal family involvement, far less is known about how to support the positive involvement by fathers and other men. An additional health benefit of including men in family-based interventions is evidence that involvement has positive effects on men’s own health and wellbeing.  

Research question
The study objectives are to examine: 1) The diversity and patterns of men’s involvement in family life, particularly with respect to fatherhood and fathering involvement. 2) The role of men in families as both biological and social fathers. 3) The impact of fatherhood on men’s health (mortality, self-reported health) and health risk behaviours (alcohol and drug use, unprotected sex).

Data Source
The Africa Centre has been conducting a three year study with the aim of the project is to strengthening the evidence base on men’s involvement in families and the impact of fatherhood on men’s health and health behaviours (Wellcome Trust-funded, Hosegood PI). The study uses existing longitudinal population-based data on father involvement and men’s health collected by ACDIS (2000-2009) and in-depth interviews with community informants, fathers, and family members.

Findings
We have completed papers that describe in detail the living arrangements of children and their biological fathers in the first five years of life, and identify factors associated with fathers’ social and residential connectedness with their children, and measured the impact of fathers’ presence on child survival and child migration. We have published a study describing men’s experiences of ART treatment and examined the influence of gender on enrolment, disclosure and provider attitudes. Papers have the impact of the HIV epidemic on families and households including the consequences of paternal orphaning and widowing, and a commentary on the role of families, including men, in efforts to strengthen support for children affected by HIV and AIDS. Two recently submitted papers discuss the conceptual and measurement issues in the collection of high quality data about, and from, fathers in household surveys and longitudinal population studies. Future analyses will examine the relationship between paternity and men’s risk of premature mortality using ACDIS data, and investigate father identity, attitudes and behavior using in-depth, qualitative data. The findings from this study have been used to inform the development of a new application to improve the measurement of parenting and caregiving in population studies to provide high quality data for studies of the determinants of child health and efforts to design and evaluate family-based health interventions.