Historically, there has been a gendered imbalance within neonatal research, with a focus on mothers' experiences of having a preterm infant. However, this focus is slowly shifting and there is now an emerging body of international evidence that has focused on fathers' experiences in neonatal intensive care (NIC). Nevertheless, in the UK, there is still a paucity of father focused research that lends insight into fathers' experiences in NIC. This gap in knowledge has meant that assumptions have been made about the needs of fathers in NIC and informed the research question: what does it mean to be the father of a preterm infant in a neonatal intensive care unit. The study reported in this thesis adopted a methodology informed by Heideggerian hermeneutic phenomenology. Tape recorded interviews were conducted with eight first time fathers shortly after admission of their infant to NIC. Six of the eight fathers were interviewed a second time shortly before discharge of their infant from the neonatal unit. A Heideggerian framework underpinned the method for data collection and analysis. All interviews were treated as meaningful text and analysis resulted in the identification of four themes that captured the fathers' lived experiences in NIC: (I) anticipatory fatherhood: the challenges of a preterm birth; (2) the emotional roller coaster; first time fathers emotional experiences on the neonatal unit; (3) evolving identity: fathering preterm infants as a work in progress and (4) mobilising resources: juggling paid work with visiting the neonatal unit. The pregnancy initiatives revealed the men's concern for their partner and unborn child; the preterm birth challenged prior expectations of anticipatory fatherhood and life on the neonatal unit was described as a roller coaster of emotional highs and lows. Juggling paid work with visits to NIC meant that the men sometimes felt undervalued as parents. A key concept that emerged directly from the findings was the concept of disrupted biographies in the men's lives. The disruption challenged their taken for granted assumptions about fatherhood and required a mobilising of personal, social and physical resources in order for each to accommodate to becoming the father of a preterm infant. Findings from this research have implications for service users, service providers, educators and policy makers in both midwifery and neonatal care. A number of specific recommendations for policy, practice, education and research are presented in this thesis.

There is limited understanding of how both trends and determinants of neonatal mortality vary from post-neonatal mortality, and more specifically how health care variables are associated with deaths in the first month of life. In particular the association between care at delivery and neonatal mortality is difficult to determine: in developing countries many women only seek skilled care once complications arise, making poor outcomes more probable. It is therefore inappropriate to directly compare outcomes from those who did and did not receive care at delivery due to this heterogeneity between the groups. This three-paper PHD thesis attempts to address some of these issues. Chapter 1 provides an overview of what is known about the determinants of neonatal and child mortality, before developing a conceptual framework for the analysis of neonatal and post-neonatal deaths. Chapter 2 (paper 1) provides a comprehensive analysis of the quality of Demographic & Household Surveys (DHS) data, before describing how trends in neonatal mortality differ from post-neonatal mortality over the short- and medium- term. It then examines how the associations between gross domestic product and neonatal, post-neonatal and early childhood mortality at national level differ using both cross-sectional and longitudinal data. Chapter 3 (paper 2) uses DHS data from Bangladesh to carry out bivariate and multivariate analysis to determine how the determinants of neonatal mortality vary from those of postneonatal mortality. It also tries to identify groups of women who are at ‘high’ or ‘low’ risk from institutional deliveries and compares rates of neonatal mortality. The risk categories are based on socio-economic, maternal health and health care utilisation factors that influence whether or not they are likely to have planned their delivery care or sought hospital care only in the event of complications. Chapter 4 (paper 3) furthers this work using Indian DHS data by examining how the association between health care determinants and neonatal mortality differ by asset quintile, mother’s education and state-level access to professional attendant at delivery. In this chapter I also use instrumental variable methodology to overcome the problem of endogeneity between delivery care variables and neonatal mortality. This technique enables me to examine the association between professional assistance at delivery while adjusting for the heterogeneity between women who do and do not seek such care. Chapter 5 concludes with a summary of key findings, as well as outlining areas for further research in this area.