Engaging fathers for improved care and feeding: A qualitative examination of fathers’ roles and supportive practices among families affected by HIV in Lusaka, Zambia

<strong>Background</strong> <span style="font-weight: 400;">Male engagement in maternal, infant, and young child nutrition (MIYCN) programming has significant potential to enhance support for breastfeeding and caregiving, particularly for children who are HIV-exposed but uninfected (CHEU). These children face increased risks of compromised growth, health, and development compared to their HIV-unexposed and uninfected counterparts. Despite avoiding HIV transmission, CHEU infants remain highly vulnerable to adverse health outcomes. Therefore, family-centered approaches, particularly those involving partner and spousal support, hold promise for increasing exclusive breastfeeding (EBF) rates, improving caregiving practices, and ultimately resulting in improved health outcomes for both mothers and children.</span> &nbsp; <strong>Objectives</strong> <span style="font-weight: 400;">This secondary analysis aimed to explore the father-child relationship in the breastfeeding process by examining fathers' perceived and actual involvement in four categories of care: roles, spousal support, breastfeeding, and infant care.</span> <strong>&nbsp;</strong> <strong>Methods</strong> <span style="font-weight: 400;">Fifteen interviews with fathers and WLWH from a formative qualitative research study using Trials of Improved Practices (TIPS) methodology in Lusaka, Zambia were analyzed thematically using Atlas.ti.</span> &nbsp; <strong>Results</strong> <span style="font-weight: 400;">Participants in this analysis included 15 fathers and 23 women living with HIV. Fathers in this study perceived that caregiving and parenting responsibilities rest jointly with both parents. Prior to counseling, fathers identified their primary support practices as providing financial assistance, procuring food and household supplies, and encouraging both breastfeeding and antiretroviral therapy (ART) adherence. With regard to infant care, fathers engaged in diverse activities with their children, including playing games, reading stories, outdoor exploration, singing songs, bathing, and carrying the baby. Following counseling sessions, all fathers exhibited a reinforced conviction that both parents share responsibility for child-rearing and involvement in the care and feeding process. Financial provision for the family remained the most prominent role for fathers, followed by encouraging or reminding mothers to breastfeed and reinforcing that exclusive breastfeeding (EBF) constitutes the optimal practice for properly nourishing CHEU during their first six months of life.</span> &nbsp; <strong>Conclusion</strong> <span style="font-weight: 400;">Fathers&rsquo; descriptions of their parental roles included encouraging and facilitating breastfeeding, engaging in infant care and development, providing financial assistance, procuring food, and promoting adherence to antiretroviral therapy (ART), which aligned with the support mothers reported receiving. Fathers described significant involvement and interest in EBF promotion during the first six months of life, highlighting positive influence on continued breastfeeding practices and routine child growth and development for vulnerable populations like CHEU. Future prevention of mother-to child transmission (PMTCT) programs and interventions should be developed utilizing a family systems lens and capitalize on the promising potential of paternal and spousal support to enhance rates of optimal care and feeding practices while simultaneously improving ART adherence for concordant and discordant couples.</span>