Paternal Mortality Is a Family Health Crisis. Georgia’s Legitimation Law Makes It Worse.

By Kenneth Braswell, CEO, Fathers Incorporated

A child can lose a father in more than one way.

Sometimes, the loss is emotional. A father is alive, but distance, conflict, poverty, incarceration, shame, untreated trauma, or a broken co-parenting relationship keeps him from being fully present. Sometimes, the loss is legal. A father is biological, known, named, and even financially responsible, but the law still doesn’t recognize him as a full parent. Sometimes, of course, the loss is final. A father dies while his child is still too young to remember his voice, his hands, his laugh, his way of entering a room. 

That last type of loss now has a name we must begin saying out loud: paternal mortality. “Paternal Mortality During Early Childhood,” a research letter published in JAMA Pediatrics by Craig F. Garfield, MD; Clarissa D. Simon, PhD; Chris Harrison, MPH; Michael Woods, MD; Katy Bedjeti, MS; and John T. Carter, PhD, offers us this language, along with new data and urgency. 

The article describes a study examining Georgia births recorded in 2017 and matched those birth records to death certificates from 2017 through 2022 to understand when and how fathers died during the first five years of a child’s life. The researchers identified 796 fathers who died during those early childhood years. Of those deaths, 296 were from natural causes, but 480, or 60.3%, were from preventable causes, including homicide, unintentional injury, suicide, and drug overdose.

That number should stop us.

Paying Attention to Both Paternal Mortality and Maternal Health

For years, we have rightly elevated maternal mortality as a public health crisis. According to the CDC, for example, more than 80 percent of pregnancy-related deaths are preventable. In response, we have built surveillance systems, public campaigns, and policy conversations around the reality that mothers are dying in preventable ways and tasked Maternal Mortality Review Committees with examining maternal deaths to determine cause, preventability, contributing factors, and recommendations for action.

We should not retreat from that work. We should deepen it. And if we’re serious about family health, child well-being, and early childhood stability, we must also ask: What happens when fathers die?

In the JAMA Pediatrics article, Dr. Garfield and his colleagues make clear that paternal mortality is not simply a men’s health issue. It’s also a family and public health crisis. The paper notes that paternal involvement is associated with better child and family health outcomes, while paternal absence is associated with a range of poorer child outcomes. Yet, while maternal health surveillance receives national and state attention, there is no equivalent system to track the impact of paternal loss early in a child’s life. That silence matters.

When a father dies during the first five years of a child’s life, the child not only loses the person, but also income, housing stability, emotional security, family history, health history, cultural inheritance, and access to an entire side of the family. The mother may lose a co-parent, a source of support, a financial contributor, a decision-making partner, or even a complicated but still essential member of the parenting team. Grandparents, siblings, cousins, and kin networks may be pushed into grief without legal clarity about access to the child. Systems that already struggle to recognize fathers often become even more confused once the father is gone. 

That’s why paternal mortality must enter the public vocabulary, but not as a competition with maternal mortality, not as a distraction from the urgent crisis facing mothers (especially Black mothers), not as a way to minimize women’s pain, and also not to shift attention away from childbirth, postpartum care, or reproductive health. Paternal mortality must enter the conversation because children don’t experience loss in categories designed by policymakers. A child doesn’t say, “This is a maternal issue” or “This is a paternal issue.” A child simply feels the absence.

The Georgia data points in the JAMA Pediatrics article make the racial and social dimensions even more urgent:

• Compared with living fathers of young children, the fathers who died were more likely to be older, non-Hispanic Black, living in rural areas, insured by Medicaid, and unmarried. 
• Among deceased fathers, non-natural causes of death were more common at younger ages. 
• Non-Hispanic Black fathers had significantly higher odds of homicide, with an adjusted odds ratio of 3.14 compared with non-Hispanic White fathers. 
• Unmarried status was also associated with increased odds of homicide, with an adjusted odds ratio of 2.87.

These statistics signal something important. They point us toward the conditions surrounding too many fathers: economic instability, neighborhood violence, limited access to health care, rural isolation, untreated trauma, fragile support systems, and systems that often see men more clearly as risks, payers, defendants, or problems than as parents.

Dr. Garfield and his colleagues also found that fathers of young children had lower death rates than comparable Georgia males across several age groupings, suggesting that fatherhood itself may be associated with reduced mortality. In other words, connection may be protective. The role of father may help anchor men to life, responsibility, and purpose.

These findings should shape policy. When fathers are connected, children benefit. When fathers are supported, families benefit. When fathers are recognized, systems have a better chance of intervening before a crisis becomes a tragedy. 

But when fathers are invisible, their deaths become invisible, too, and this is where Georgia must look hard at itself.

Legitimation and Paternal Mortality

Georgia’s legitimation law already creates a painful and unnecessary divide between biological fatherhood and legal fatherhood. Under Georgia law, a “legal father” includes a man who has adopted a child, was married to the mother at the time of birth, later married the mother and recognized the child, or has legitimated the child. The biological father of a child born out of wedlock may legitimate his relationship to the child only by petitioning the superior court.

That may sound procedural, but for fathers and families, it’s deeply consequential.

In Georgia, a father can sign a birth certificate, acknowledge paternity, pay child support, love his child, show up to school events, attend doctors’ appointments, and still not have the full legal standing he believes he has if legitimation has not occurred. “Georgia State Legitimation, Father Engagement and Youth Academic Outcomes,” a brief from Fathers Incorporated (FI), explains that Georgia treats paternity and legitimation as separate administrative and legal actions. Paternity can establish financial responsibility, but legitimation is what establishes the father’s legal rights related to decisions such as medical care and school choices.

Now, place paternal mortality inside that reality.

A father dies. His child is three years old. His name may be known. His family may know the child. The mother may know the relationship mattered. The father may have contributed financially or emotionally. But if the child was never legitimated, the legal relationship may not reflect the biological and emotional relationship that existed. What happens then?

What happens to inheritance? What happens to Social Security benefits? What happens to access to the paternal family? What happens to medical history? What happens when a child grows older and learns not only that their father died, but that the law had never fully recognized the relationship in the first place?

That’s not a paperwork problem. It’s a wound.

FI’s “Legitimation in the State of Georgia: A Comprehensive Guide for Unmarried Fathers” guide names the consequences plainly: Without legitimation, fathers may be unable to seek custody or visitation, lack legal authority over education and health care decisions, and be unable to pass on inheritance rights and Social Security benefits to the child.

Paternal mortality makes the cost of that legal gap impossible to ignore.

The argument against Georgia’s legitimation structure has often been framed around access: Fathers need the ability to parent, visit, make decisions, and participate. That remains true. But the recent JAMA Pediatrics paper forces us to add another layer. 

In the event of paternal death, legitimation is a child protection issue. It’s about what remains legally intact when a father is no longer alive to argue, petition, explain, prove, or correct the record.

A child shouldn’t have to lose a father twice: once to death and a second time to an outdated law.

The lesson from “Paternal Mortality During Early Childhood” isn’t only that fathers die. We already knew that. The lesson is that we haven’t been tracking what their deaths mean for children, families, and systems. We haven’t built the public health infrastructure to ask the next questions:

• Were these fathers connected to health care? 
• Were they screened for depression, suicide risk, substance use, or violence exposure? 
• Were they employed? 
• Were they insured? 
• Were they engaged with their children? 
• Were they legally recognized? 
• Did their children receive benefits after death? 
• Did their families know what rights existed? 
• Did the paternal family remain connected?

Georgia shouldn’t wait for another study to begin asking these questions and finally reform legitimation.

Policy Reforms Related to Paternal Mortality

We need a paternal mortality review process, or at a minimum, a father-inclusive expansion of existing family mortality review structures. We need hospitals, pediatric practices, child support agencies, courts, schools, fatherhood programs, public health departments, and community organizations to understand that fatherhood is a point of intervention. If a father is showing up for a birth certificate, a pediatric appointment, a child support hearing, a legitimation workshop, a Head Start event, or a fatherhood class, that’s a moment to engage him not only as a payer or visitor, but as a parent whose health and survival matter to the child.

We need Georgia to modernize its legitimation law. We need public education so unmarried fathers and mothers understand the difference between paternity and legitimation. We need automatic legal pathways that do not punish children because their parents were unmarried at birth.

We need health systems to recognize fathers during pregnancy, delivery, postpartum, and early childhood.

We need policymakers to stop treating father engagement as sentimental language and start treating it as family infrastructure.

For more than two decades, FI has said that there is no such thing as a fatherless child. Every child has a father. The question is where he exists: in the home, outside the home, in memory, in grief, in law, in absence, or in the systems that either made room for him or erased him.

This new paper adds a new question: When fathers die during their children’s early childhood, what have we failed to see?

For Georgia, the answer is painfully clear. We have failed to see that a father’s mortality, a child’s legal identity, and a family’s stability are connected. We have failed to see that paternal health is not separate from maternal health, and father engagement is not separate from child well-being. We have failed to see that when the law doesn’t recognize a father early enough, death can turn a legal delay into a lifelong consequence.

Paternal mortality is now part of the conversation, and Georgia should have the courage to respond.