Maternal Mental Health and Child Feeding Behaviors in Eastern DR Congo: A Qualitative Study

Abstract

Maternal mental health problems are associated with poor child growth and sub‐optimal child feeding practices, yet little qualitative research has been conducted to assess mothers' perceptions on how psychological distress impacts their ability to care for and feed their children. The current study took place in South Kivu, DR Congo, and was nested within a larger evaluation of a USAID‐funded food security program. The overall objective was to understand the stressors mothers faced and how feelings of psychological distress impacted their daily functioning, particularly their child feeding behaviors. Mothers of children five years of age or younger who had participated in a mental health assessment conducted previously were eligible. The mental health assessment measured symptoms of depression and anxiety using the Hopkins Symptom Checklist‐25 and symptoms of post‐traumatic stress disorder using the Harvard Trauma Questionnaire, and a mean score was calculated (range 0–3). A purposive sampling strategy was used, with participants selected from those who had high (mean score > 1.55) or low (mean score < 0.83) levels of psychological distress. Participants were stratified by geographic territory and intervention group. Twenty in‐depth interviews and two focus group discussions were conducted, with a total of 35 mothers participating. Five health workers participated in key informant interviews. Interviews and focus groups were audio‐recorded and transcribed in Swahili, and transcripts were translated to French by bilingual research assistants. The analysis was conducted using an approach adapted from Grounded Theory, with transcripts coded by the first author, and codes were then grouped according to theme. Major themes to emerge were that women's husbands were a significant source of stress and “hurting heart,” with husbands' infidelity, abandonment, and lack of financial support commonly mentioned by participants. Participants reported that psychological distress made them lose their appetite or lose weight, and their poor nutritional status made it difficult to breastfeed their children. They also felt that psychological distress was associated with milk insufficiency, and a decrease in affection towards their children. Overall, participants perceived that women experiencing stressful life events and psychological distress would have difficulty functioning. The results of this study point to the need for greater psychosocial support for mothers of young children, particularly in times of stress. Family‐focused interventions targeted at fathers may be beneficial for both maternal mental health and child nutrition outcomes.Support or Funding InformationThe parent study was funded by the Adventist Development and Relief Agency. This funding was made available through a USAID Office of Food for Peace Cooperative Agreement (AID‐FFP‐A‐11‐00006).