Go to content

Autonomy, agency and resilience in parenting  


Image: Mads Schmidt Rasmussen / norden.org
This chapter addresses, in line with the domain of the WHO maternal well-being framework on autonomy, agency and resilience, the importance and current state of supporting the transition to parenthood. This domain encompasses maternal and parental autonomy, the development of resilience and the promotion of agency, which refers to the ability to make informed choices and actively shape one’s adaptation to parenthood, including access to parenting education and skills (Le Lez et al., 2025 ).
The literature search revealed the factors shaping psychosocial well‑being during the transition to parenthood, focusing on fathers. In the literature search for this report, comparatively less research paid attention to the transition of mothers to parenthood, with more emphasis placed on risk factors, mental health outcomes and contextual influences than on mothers’ own transitional experiences. The experiences of sexual and gender minorities are addressed in the next chapter. This chapter also highlights the importance of resilience and psychological coping strategies during the perinatal period.

Transition to parenthood

The transition to parenthood is one of the most significant changes in life, affecting individuals on psychological and societal levels, and physically for the birthing parent. This transition can be stressful, often triggering family conflicts that harm relationships and threaten the psychological health of new parents (Xiao et al., 2021).  

Social pressure can make the transition to motherhood challenging

A successful transition to motherhood in the early postnatal period depends on the timely identification and fulfilment of women’s needs. Negative feelings and pressures related to parenthood include unfulfilled role expectations and feelings of hopelessness associated with motherhood (Holopainen & Hakulinen, 2019; McCarthy et al., 2021). Negative body image and bodily changes after childbirth are commonly found to affect the mother’s psychosocial well-being. Both internal and external factors, such as media and cultural norms, play a role (Lee et al., 2023). Unrealistic social norms and expectations contribute significantly to perinatal anxiety and stress, especially when women’s experiences do not match societal ideals (McCarthy et al., 2021). Depressed mothers have reported feelings of negative body image and loss of self-due to changes in their former body (Holopainen & Hakulinen, 2019). Mothers have reported pressure to succeed in breastfeeding, with failure leading to feelings of inadequacy and guilt (Billings et al., 2024).

Fathers need support in their transition to fatherhood

The transition to fatherhood brings significant psychological and social changes, and fathers, just like mothers, may experience increased stress and vulnerability during the perinatal period (Ansari et al., 2021). First-time fathers often report fears related to lifestyle changes that parenthood brings. Becoming a father can give men a sense of fulfilling their role as ‘men’, accompanied by new priorities and responsibilities. While most welcome this change, many express concerns about being a ‘good father’ and doing things ‘right’ (Baldwin et al., 2018).
Fathers experience stress related to gender roles in parenting and contradictions between expectations and actual experiences of pregnancy and childbirth (Chhabra et al., 2020). Father’s stressors during the perinatal period include negative emotions about pregnancy, role limitations, feelings of incompetence and pressures to balance work and family life. Specific anxieties often centre on their partner’s labour and the infant’s well-being (Baldwin et al., 2018; Philpott et al., 2017; Shorey & Chan, 2020). Experienced fathers also report financial stress and concerns about treating children equally (Shorey & Chan, 2020). Stress peaks around childbirth and decreases in the postnatal period (Philpott et al., 2017).  
During the postnatal phase, role strain and conflict are common stressors, as fathers struggle to balance responsibilities at home, work and in relationships, often leading to tension with partners and the extended family. Relationship quality often deteriorates, with fathers reporting neglect of the couple relationship and increased conflict during this period (Shorey & Chan, 2020). Expectations frequently fail to match reality, especially regarding breastfeeding and bonding, which are often more difficult than anticipated (Baldwin et al., 2018). Paternal postnatal mental health is important to maternal and perinatal healthcare (Suto et al., 2017).  Many fathers feel uncertain and excluded during the perinatal period, struggling to find their role. They report feelings of inadequacy, fear, isolation and stress (Baldwin et al., 2018; Shorey & Chan, 2020).
These pressures contribute to increased stress, manifesting as tiredness, irritability and frustration (Baldwin et al., 2018). Elevated stress levels negatively affect fathers’ mental health, leading to anxiety, depression, psychological distress and fatigue (Philpott et al., 2017). Fathers suffering from depression have also reported feeling underestimated and undervalued as parents by their partners (Holopainen & Hakulinen, 2019).
In addition, fathers report a lack of support. Fathers frequently feel undervalued by health professionals and lack resources tailored to men. Peer and workplace support are limited, leaving many without adequate guidance during this critical life stage (Baldwin et al., 2018). Barriers to support increase feelings of exclusion, and fathers often lack knowledge about available help, feeling stigmatised if extra support is needed. At the same time, fathers want to be recognised as important providers of support (Venning et al., 2021).
To cope, fathers often resort to denial or escape behaviours such as smoking, working longer hours or listening to music (Baldwin et al., 2018). Others rely on open communication and teamwork with their partners, seek help from friends, family or healthcare professionals, or adopt indirect strategies such as distraction through work, lifestyle adjustments and acceptance of limitations (Shorey & Chan, 2020).
Despite these challenges, many fathers describe positive aspects of their new role. Bonding with their child is deeply rewarding, and those who embrace change and work collaboratively with their partners adjust more successfully to fatherhood (Baldwin et al., 2018). The co-parenting relationship plays a significant role in family outcomes during this period (Xiao et al., 2021). Good preparation for fatherhood, a good bond with the child and the capability to recognise and accept the life changes that come with fatherhood contribute positively to paternal well-being (Baldwin et al., 2018; Shorey & Chan, 2020).  

Consistent guidance supports the whole family

Evidence from a qualitative systematic review by Walker et al. (2019) highlights that many maternity services fail to adequately meet women’s needs, particularly in areas such as postnatal health, newborn care, breastfeeding support and psychosocial well-being. When these needs remain unmet, women face increased risks of physical and emotional health challenges and reduced engagement in their own care.   
Fathers have reported paternal participation and being included in parenting during pregnancy and after birth being a positive factor (Mprah et al., 2023; Suto et al., 2017). Fathers expressed a strong need for practical information on pregnancy, parenting skills and mental health through antenatal classes and small group discussions and highlighted the need for more preparation for fatherhood and support in managing relationship changes.  
Suggested strategies included father-inclusive services, peer support groups and father-friendly resources. They also highlighted the importance of continued professional support after discharge and access to digital resources such as mobile health applications to receive timely guidance (Baldwin et al., 2018; Shorey & Chan, 2020). Further research and interventions are required to provide partners of pregnant women with evidence-based information and support whole families during the perinatal period (Suto et al., 2017). 
Good care for new parents is based on continuity, cultural sensitivity and a family-centred approach. These factors increase feelings of security and reduce risks such as postpartum depression. Consistent and coherent guidance, especially in infant care and breastfeeding, as well as clear information on where to seek help strengthen parents’ confidence and well-being. Support from partners and loved ones, combined with empowering interaction with professionals, improves satisfaction and promotes a successful transition to parenthood (Walker et al., 2019; Wiklund et al., 2018).   

Resilience during the perinatal period

Resilience is a key protective factor for parents during the perinatal period. It reduces the risk of depression, anxiety and PTSD and promotes overall parental and child well-being. Resilience enables parents to develop effective coping mechanisms, seek help when needed and manage stress in ways that support psychological health. Strong resilience is associated with lower psychological distress and better adaptation to life challenges, which is emphasised during pregnancy and the postpartum period, when emotional and physical demands are high (Hajure et al., 2024).

Individual resources are intertwined with social factors

A range of internal and external factors contribute to strengthening resilience. Internal capacities such as coping skills, self-esteem and reflective functioning are relevant for parents with adverse childhood experiences (ACEs) or perinatal depression. These strengths support effective coping, prevent PTSD and depression, and promote secure attachment with their child (Atzl et al., 2019; Evans & Bullock, 2012). Optimism as a personality trait has also been identified as a promising protective factor against perinatal depression (Evans & Bullock, 2012).
Psychosocial resources further enhance resilience. Positive cognitive appraisal, gratitude, a sense of mastery, and healthy family functioning promote mental well-being and reduce psychological strain. These resources help parents adapt to challenging life situations and maintain emotional stability (Hajure et al., 2024). After traumatic experiences, parents often rely on active coping strategies. Following traumatic births, strategies such as open discussion, seeking information and turning to faith promote healing and support emotional recovery (Shorey et al., 2022). For parents facing severe mental illness or social isolation, strength-based and family-focused support helps prevent exclusion, supports continuity of care and promotes emotional security (Harries et al., 2023). Trusting relationships with healthcare providers are essential for parents with trauma histories, fostering safety and supporting coping during the transition to parenthood (Chamberlain et al., 2019).

Sense of coherence is closely linked to resilience

A sense of coherence, which refers to the ability to use available resources to manage stress and maintain control, is closely linked to resilience. It improves mental well-being, reduces stress and contributes to better relationship quality and positive birth experiences. It also helps parents in managing bodily changes after childbirth and recovering from unexpected crises such as natural disasters (Khatri et al., 2019; Lee et al., 2023; Shorey & Ng, 2020). Factors associated with a sense of coherence include maternal age, marital status, education, income level, an immigrant status, smoking habits and attitudes toward childbirth and pregnancy planning (Shorey & Ng, 2020).

External conditions shape resilience

Resilience is influenced by external conditions. Social support from family, partners and professionals is consistently recognised as a protective factor that buffers against stress and promotes resilience, especially when parents experience emotional strain or feelings of inadequacy (Lancaster et al., 2010; McCarthy et al., 2021). A stable and secure environment, including housing, employment and community support, promotes resilience and positive parenting in contexts of socioeconomic stress (Atzl et al., 2019). Financial support and access to services mitigate the impact of financial insecurity and housing difficulties, help parents cope and prevent depression (Heer et al., 2024).
In addition to structural and social factors, cultural and spiritual resources contribute to resilience. Spirituality and belonging to a religious community provide emotional security, reduce isolation and support psychological well-being in situations of financial insecurity and a risk of stigmatisation (Aiyar et al., 2023; Evans & Bullock, 2012; Hajure et al., 2024; Shorey et al., 2022). Maintaining cultural practices also promotes emotional well-being and strengthens identity (Aiyar et al., 2023).

Factors associated with low resilience

Low resilience is associated with feelings of a loss of control over life circumstances and is linked to postpartum depression and increased vulnerability to PTSD (Ayers et al., 2016; Holopainen & Hakulinen, 2019). Risk factors for lower levels of resilience include a history of depression, prior psychiatric problems, poor sleep quality, preterm delivery, low family income, unemployment, a young partner age and strong fear of childbirth (Hajure et al., 2024). Negative childhood experiences and heightened anxiety further weaken the coping capacity during the perinatal period. Pregnant women tend to be more resilient than postpartum women, and parental self-efficacy plays an important role in overall family well-being (Albanese et al., 2019; Hajure et al., 2024).

Findings from the psychosocial intervention review for the autonomy, agency and resilience domain

Eleven universal parenting programmes evaluated as effective in psychosocial intervention information portals aimed to ensure that parents would have accessible and equal possibilities for support for their parenting skills during the perinatal period. These psychosocial interventions emphasize autonomy and resilience, primarily targeting mothers. Most of these psychosocial interventions are supporting the transition to parenthood and are often directed at mothers or parents expecting their first child, or those with a newborn as the firstborn.
Two of the mapped interventions in this domain were clearly directed at preventing maternal stress and increasing confidence as a parent (Marte Meo and Parent–Child Interaction Therapy). Two psychosocial interventions with a Nordic effectiveness evaluation were directed at young mothers or parents (Minding the Baby and Nurse Family Partnership), and five more were identified in additional international portals. In addition, many interventions targeted at different risk groups (eight of the interventions in this domain), for example mothers with depression, also aim at supporting adaptation to motherhood due to the overlapping nature of these factors. Only one of the interventions (PCIT) in this domain was therapeutic intervention.
Table 11. Identified effective psychosocial interventions in the Parental autonomy, agency and resilience domain.
Intervention
Parental autonomy, agency & resilience*
Low resilience
and ability to cope 
Parents with disabilities
Negative body image 
 Young mothers/
parents
Transition to parenthood  
nordic effectiveness grading
ICDP 
 
 
 
 
X
Incredible Years
 
 
 
 
X
Marte Meo
X
 
 
 
X
Minding the Baby® (MTB) 
 
 
 
X
X
Neonatal Behavioural Assessment Scale (NBAS)
 
 
 
 
X
Newborn Behavioural Observation (NBO)
 
 
 
 
X
Nurse Family Partnership (NFP)
 
 
 
X
X
Parent–Child Interaction Therapy (PCIT)
X
 
 
 
 
Supporting parent-child interaction
 
 
 
 
X
Triple P – Positive Parenting Program® (Triple P for Baby) 
 
 
 
 
X
VIG 
 
 
 
 
X
 
effectiveness grading onliy in the UK/USA  
Adolescent Parenting Program (APP)
 
 
 
X
X
Computer-Assisted Motivational Intervention (CAMI)
 
 
 
X
 
Family Foundations (FF) (eFF)
 
 
 
 
X
Family Growth Center, The (FGC)
 
 
 
X
 
Family Nurse Partnership
 
 
 
X
 
Family Spirit®
 
 
 
X
X
Parenting Together Project (PTP) 
 
 
 
 
X
Parents as first Teachers /Parents as teachers (USA)
 
 
 
 
X
Solihull Approach Antenatal Parenting Group
 
 
 
 
X
Universal prevention Targeted at risk groups Therapeutic interventions
*) Reminder: The selected portals only include interventions that have been evaluated within the assessment systems according to specific criteria, with an emphasis on research-based evidence of effectiveness. The interventions that demonstrate at least some research-based evidence of effectiveness are presented.  The assessment systems operate dynamically, and the information presented in this report may therefore be updated quite rapidly. Regular monitoring of the relevant portals of these assessment systems is recommended. See chapter Mapping of psychosocial intervention information portals
The checkmarks reflect what was indicated as the primary target group or objective in the portal descriptions of each intervention. Many interventions have multiple secondary goals and effects, so additional checkmarks could apply in practice.
Studies in the review demonstrated that universal preventive parenting programmes appear to be effective, especially for first-time parents. Providing universal parent education interventions that focus on enhancing parents’ self-efficacy may be protective against the detrimental effects of fatigue (Amin et al., 2018). Some study findings suggest that web-based interventions have the potential to improve self-management, acceptance of pregnancy/motherhood and social support. Providing convenient and potentially anonymous access to effective treatment may also be useful (Ashford et al., 2016). It can additionally be a way to reach vulnerable pregnant women and mothers with barriers to health information and facilitate access to healthcare services.

Key observations from Nordic expert discussions concerning the autonomy, agency and resilience domain

Nordic experts emphasised the need for clear, evidence‑based guidance on parenting while simultaneously supporting parents' inherent capabilities and resilience. This dual approach is essential for reducing stress and building confidence.
Preventive measures must meet the needs of diverse families, combining universal and targeted support. For parents with different cultural or linguistic backgrounds, tailored preventive approaches are increasingly necessary and link closely to the domain of culture and values.
Experts highlighted the need for more research on high parenting‑related stress among young women, body‑image changes during pregnancy and fear of childbirth. There is a lack of national guidance on addressing these issues, which often relate to tensions between parental autonomy and societal pressures. Unrealistic expectations can heighten anxiety and reduce resilience.