Individual Mothers Research Articles

Personalized Profiling Reveals Donor- and Lactation-Specific Trends in the Human Milk Proteome and Peptidome

ABSTRACTBackgroundHuman milk is the most genuine form of personalized nutrition, whereby its nutritional and bioactive constituents support the changing needs of the growing infant. Personalized proteome profiling strategies may provide insights into maternal–infant relationships. Proteins and endogenous peptides in human milk play an important role as nutrients for growth and have distinct functionality such as immune defense. Comprehensive monitoring of all of the human milk proteinaceous components, including endogenous peptides, is required to fully understand the changing role of the human milk proteome throughout lactation.ObjectiveWe aimed to investigate the personalized nature of the human milk proteome and peptidome for individual mother–infant dyads.MethodsTwo individual healthy milk donors, aged 29 and 32 y and both of a normal BMI, were longitudinally observed over weeks 1, 2, 3, 4, 6, 8, 10, 12, and 16 postpartum. Milk collection was standardized. Comprehensive variations in the human milk proteinaceous components were assessed using quantitative LC-MS/MS methods.ResultsWe longitudinally profiled the concentrations of >1300 milk proteins and 2000 endogenous milk peptides spanning 16 wk of lactation for 2 individual donors. We observed many gradual and alike changes in both donors related to temporal effects, for instance early lactation was marked by high concentrations of proteins and peptides involved in lactose synthesis and immune development. Uniquely, in 1 of the 2 donors, we observed a substantial anomaly in the milk composition, exclusively at week 6, likely indicating a response to inflammation and/or infection.ConclusionsHere, we provide a resource for characterizing the lactational changes in the human milk proteome, encompassing thousands of proteins and endogenous peptides. Further, we demonstrate the feasibility and benefit of personalized profiling to monitor the influence of milk on the development of the newborn, as well as the health status of each individual mother–infant pair.

Normative beliefs and values that shape care-seeking behaviours for skilled birth attendance (SBA) during birthing by mothers in Africa: a scoping review protocol

BackgroundSkilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. The proposed scoping review aims to map literature on beliefs and values and how mothers are influenced by relational normative motivations in utilisation of SBAs in health facilities.MethodsWe designed and registered a study protocol for a scoping review. Literature searches will be conducted in multiple electronic databases (from January 2000 onwards), including PubMed, EMBASE, Scopus and Web of Science. Grey literature will be identified through searching dissertation databases, Google Scholar, EBSCOhost and ResearchGate. Keyword searches will be used to identify articles. Only articles published in English, related on beliefs and values surrounding childbirth, and on perceptions towards facility delivery or skilled health care providers will be considered eligible for inclusion. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. The study methodological quality (or bias) will be appraised using the Mixed Method Appraisal Tool. A narrative summary of findings will be conducted. We will employ NVIVO version 10 software package to extract the relevant outcomes from the included articles using content thematic analysis. This protocol is registered with the Open Science Framework (osf.io/9gn76).DiscussionUnderstanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible ‘hidden’ barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care-seeking behaviours for skilled birth attendance by mothers in Africa.

A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section

The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference = − 1.19, 95% confidence interval [CI]: − 1.76 to − 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16–3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS.

Previous viral symptoms and individual mothers influenced the leveled duration of human milk antibodies cross-reactive to S1 and S2 subunits from SARS-CoV-2, HCoV-229E, and HCoV-OC43.

ObjectiveThe influence of previous viral symptoms on the level and duration of human milk antibodies reactive to SARS-CoV-2, and common human coronaviruses (HCoVs) was investigated.Study designAntibodies reactive to S1 and S2 subunits from SARS-CoV-2, HCoV-OC43, and HCoV-229E were measured via ELISA in human milk samples collected from March to June 2020 in mothers with and without viral symptoms.ResultsThe presence of viral symptoms influenced the levels of SARS-CoV-2 S2-reactive SIgA/IgA and tended to influence SARS-CoV-2 S1 SIgA/IgA and S2-reactive SIgM/IgM in human milk but did not relate to IgG. HCoV-229E S1 + S2-reactive SIgA/IgA and SIgM/IgM, as well as HCoV-OC43 S1 + S2-reactive IgG were related to the symptoms. The duration of antibody levels in human milk in mothers with viral symptoms varied between 3 and 4 months post maternal report of viral symptoms.ConclusionPrevious viral symptoms and individual mothers may change the antibody cross-reactive levels to SARS-CoV-2 and HCoVs in human milk.

Tubaramure, a Food-Assisted Integrated Health and Nutrition Program, Reduces Child Wasting in Burundi: A Cluster-Randomized Controlled Intervention Trial

BackgroundLittle is known about the impact of food-assisted maternal and child health programs (FA-MCHN) on child wasting. ObjectivesWe assessed the impact of Tubaramure, a FA-MCHN program in Burundi, on child (0 to 24 months) wasting and the differential impacts by socio-economic characteristics and age. The program targeted women and their children during the first 1000 days and included 1) food rations, 2) strengthening and promotion of use of health services, and 3) behavior change communication (BCC). MethodsWe conducted a 4-arm, cluster-randomized, controlled trial (2010–2012). Clusters were defined as “collines” (communities). Impact was estimated using repeated cross-sectional data (n = ∼2620 children in each round). Treatment arms received household and individual (mother or child in the first 1000 days) food rations (corn-soy blend and micronutrient-fortified vegetable oil) from pregnancy to 24 months (T24 arm), from pregnancy to 18 months (T18), or from birth to 24 months (TNFP). All beneficiaries received the same BCC for the first 1000 days. The control arm received no rations or BCC. ResultsWasting (weight-for-length Z-score <2 SD) increased from baseline to follow-up in the control group (from 6.5% to 8%), but Tubaramure had a significant (P < 0.05) protective effect on wasting [treatment arms combined, −3.3 percentage points (pp); T18, −4.5 pp] and on the weight-for-length z-score (treatment arms combined, +0.15; T24, +0.20; T18, +0.17). The effects were limited to children whose mother and household head had no education, and who lived in the poorest households. The largest effect was found in children 6 to 12 months of age: the group with the highest wasting prevalence. ConclusionsFA-MCHN programs in highly food-insecure regions can protect the most disadvantaged children from wasting. These findings are particularly relevant in the context of the economic crisis due to the coronavirus disease 2019 pandemic, which is expected to dramatically increase child wasting.

Screening and Management of Maternal Malnutrition in Nutritional Rehabilitation Centers as a Routine Service: A Feasibility Study in Kalawati Saran Children Hospital, New Delhi.

Background:In India, Nutrition Rehabilitation Centers (NRCs) established at public health facilities provide residential medical nutrition therapy for severe acute malnutrition (SAM) children with complications. A large proportion of their mothers are also malnourished. NRCs do not provide services to such mothers as part of routine practice. However, technical algorithm for delivering Maternal Nutrition (MN) services in facility settings is available.Objectives:To test the practical feasibility of layering the MN services in NRC as a routine service.Methods:The MN services were delivered by a nutrition counselor using a triage approach (assess, classify, supplement/counsel/treat). All mothers received diet, micronutrients, and group counseling, those at nutritional risk received individual counseling and SAM mothers also received catch-up diet during their stay. Program data were collected from mothers during January 1 to August 31, 2019 at the NRC in Kalawati Saran Children Hospital. To gain operational insights, a structured interview with nutrition counselor was conducted.Results:Out of 168 mothers, 8% were found to be pregnant and 89% were at nutrition or medical risk. The prevalence of short stature was 18%, severe/thin 21%, overweight/obese 34%, and anemic 72%. Feedback from the nutrition counselor indicated no operational challenges, however, further efforts to ensure that mothers keep coming back for follow-up visits is needed.Conclusion:The findings indicated that existing staffs were able to deliver the MN services within the time, cost, and regime of the routine NRC. This paper provides four recommendations for layering the MN services in NRCs.

Maternal Depression Affects Infants' Lexical Processing Abilities in the Second Year of Life.

Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the effects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers’ clinical and subclinical symptomatology and their infants’ lexical abilities. Infants’ lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants’ lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants’ individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant differences are emerging in 18-month-old infants’ lexical processing abilities, and this appears to be related, in part, to their mothers’ depression and anxiety symptomatology during the postnatal period.

Understanding breastfeeding behaviours: a cross-sectional analysis of associated factors in Ireland, the United Kingdom and Australia

BackgroundBreastfeeding is a complex behaviour relying on a combination of individual mother and infant characteristics, health systems, and family, community and professional support. Optimal breastfeeding in high-income countries is particularly low. Despite having similar sociocultural backgrounds, breastfeeding rates between Ireland, the United Kingdom (UK) and Australia vary, thus there is a need to understand whether this is due to individual, sociocultural or policy differences. This research identifies the between-country differences in infant feeding mode and examines if country differences in feeding mode persist once known individual, behavioural and structural factors are considered using socioecological and person-context models.MethodsParticipants were adult women with at least one infant less than 6 months of age, who completed an online survey (n = 2047) that was distributed by social media in June 2016. Within-country differences in infant feeding mode (‘any breastfeeding’ vs. ‘no breastfeeding’) were examined first before hierarchical multivariable logistic regression was used to determine if country differences in feeding mode persisted after adjusting for known factors associated with breastfeeding.ResultsIn this sample, ‘any breastfeeding’ rates were 89, 71 and 72% in Australia, Ireland and the United Kingdom respectively. Within-country differences were evident in Australia, Ireland and the UK. Four factors showed no association with infant feeding mode in Australia while they did in the other countries (maternal age, income, skin-to-skin contact, support from friends and family). Two factors were unique to Australia: the odds of being in the ‘no breastfeeding’ group increased when the baby was delivered via caesarean and when not enough breastfeeding information was available after birth. One determinant was unique to Ireland: the odds of being in the ‘no breastfeeding’ group increased when respondents indicated they were not religious; in the UK this occurred when respondents were living in a town/village. After adjusting for sets of known factors of infant feeding mode based on socioecological and person-context models, country differences remained in hierarchical regressions: the odds of not breastfeeding were higher in both Ireland (AOR 3.3, 95%CI 1.8,6.1) and the United Kingdom (AOR 2.7, 95%CI 1.5, 4.7) compared to Australia.ConclusionsThis study indicates that different levels in the socioecological system are related to infant feeding behaviours. An adequate inter-systems level response would consider the interactions within and between behavioural and structural mechanisms which support breastfeeding behaviour. Optimising infant feeding practices will require an integrated web of interventions that go beyond the individual and focus on addressing factors that will influence families within their communities as they move between systems.

Reproductive natural history of endangered Cook Inlet Beluga whales: insights from a long-term photo-identification study

Beluga whales (Delphinapterus leucas) occur broadly throughout the polar and subpolar regions of the Northern Hemisphere, and as a whole, the species is of low conservation concern. However, some populations, including Alaska’s Cook Inlet beluga whales (CIBW), are in decline for reasons that remain poorly understood. Currently, information on population-specific reproductive parameters of CIBW is non-existent. To address this data gap, we examined long-term photo-identification data of CIBW for insight into the reproductive natural history of this endangered subarctic population. Data are from 438 photo-ID surveys conducted 2005–2017 and over 400 identified individuals, augmented with data from strandings, biopsies, and tagging. During the April–October ice-free field season, we observed neonates July–October but never April-June. We photo-documented three suspected births during July–September. Neonates were present in 30% of groups and encountered and comprised 2% of all belugas observed. Over the course of the 13-year study, the number of calves seen with an individual mother ranged from 1 to 5, with inter-birth intervals ranging from 2 to 13 years. This corresponds to rates of 0.08–0.38 calves per year per mother. Known-aged mothers ranged in age from 13 to 31 years. Skin color was not a reliable indicator of sexual maturity. Calves photographed alongside their mothers were estimated to be 1–8 years old, although most were 1–4 years old. Some mothers (6%) were accompanied by a neonate and an older calf. These summaries of observational data provide critical insight into CIBW reproductive natural history that will inform future population modeling and management decision-making.

Degradation of Proteins From Colostrum and Mature Milk From Chinese Mothers Using an in vitro Infant Digestion Model.

This study provided insights into the degradation of human milk proteins in an in vitro infant digestion model by comparing colostrum (week 1) and mature milk (week 4) of 7 Chinese mothers individually. In this study, we adapted the exiting INFOGEST in vitro model, to conditions representative to infants (0 to 3 month-old). The level of undigested proteins was analyzed by LC-MS/MS after gel-electrophoretic separation and in-gel digestion. The BCA protein assay showed that the total undigested milk protein content decreased from the start to the end of digestion with variations between mothers, especially in the gastric phase (25–80%). Undigested proteins could also still be found after the intestinal phase, ranging from 0.5 to 4.2% of initial protein content. Based on LC-MS/MS analysis, milk protein digestion varied between the mothers individually, especially during the gastric phase. No differences could be observed between protein digestion from colostrum and mature milk after the intestinal phase. The highest levels of proteins remaining after intestinal digestion can be linked to the group immune-active proteins, for all mothers. The level of protease inhibitors and total protein content in the milk did not correlate with the overall proteolysis during digestion. The results also showed that milk serum proteins partly remained after the gastric phase, with 33% remaining from colostrum and 37% remaining from mature milk. More than 40 milk serum proteins were detected after the intestinal phase. Some of the highly abundant milk serum proteins (lactoferrin, serum albumin, bile salt-activated lipase, immunoglobulins, α1-antichymotrypsin) were still partially present intact after the intestinal phase, for all mothers. Caseins were also not completely digested in the gastric phase, with 35% remaining from colostrum and 13% remaining from mature milk. Caseins, on the other hand, were almost completely digested after the intestinal phase. The complete degradation of caseins into peptides might be related to their structural features. Overall, this study showed that digestion differed for the various human milk proteins by adapting an in vitro digestion model to infant physiological conditions, with the main differences between digestion of the milk from individual mothers being observed after gastric digestion.

Predicting adult lifespan and lifetime reproductive success from early-life reproductive events

Fitness is a product of survival and fecundity, which arise from a host of individual traits that vary among individuals. Estimating fitness is central to many research programs in ecology and evolution. Yet, because researchers are rarely able to track individuals through a complete lifetime, they typically rely on proxies of reproductive success. Because it can be readily measured, the number of offspring produced at first reproduction has been used as a proxy for fitness in some studies, including some on the marine copepod Tigriopus californicus. However, to date, no validation of the accuracy of this metric has been completed. We tracked the lifetime reproductive success of T. californicus mothers to test whether the number of offspring in a mother’s first clutch is a reliable indicator of lifetime reproductive success. We used a repeated measures design to quantify variation in reproductive metrics among individual mothers and within each mother across her lifetime. We found positive associations between first clutch size, adult lifespan, and lifetime reproductive success. We detected negative effects on clutch size, offspring body size and offspring survival due to aging and the increase in reproductive bouts over time. Finally, we observed a trade-off between clutch size and offspring body size. These results indicate that first clutch size is a good predictor of lifetime reproductive success and may serve as a suitable fitness proxy in T. californicus copepods. The observed decline in female reproductive traits over time may underscore an emphasis on early reproduction due to the variable conditions this species endures in the wild or, alternatively, may result from resource limitations imparted on females that must mate only once per lifetime.

Assessment of genetic variability in Acacia catechu willd

The present investigation entitled “Assessment of genetic Variability in Acacia catechu Willd.” was carried out in the Department of Tree Improvement and Genetic Resources, Y.S Parmar University of Horticulture and Forestry. Field survey was carried out across the populations of Acacia catechu throughout HP to select well represented ten seed sources viz. S1 (Badlech), S2 (Dhaulakuan) S3 (Maryog) S4 (Bhojnagar) S5 (Dilman) S6 (Subathu) S7 (Hamirpur) S8 (Kangra) S9 (Jacch) and S10 (Bilaspur). The seed collection from individual trees was done to study variability status of individual mother trees selected. Progenies of individual tree were raised in Randomized Block Design to assess growth performance with respect to seedling height, collar diameter and number of branches and number of leaves. The data analyzed by RBD revealed that there was significant variation between seed sources was observed. Significant high gain obtained for variation between most of the seed sources on mean value basis. Similarly progeny performance revealed significant variation within seed source, suggesting scope for single tree selection.

High-Throughput Rapid Yeast Chronological Lifespan Assay.

The budding yeast is a valuable model system for discovering molecular mechanisms underlying cellular aging. This is due to the ease of performing genetic manipulations in yeast and the vast number of evolutionarily conserved genes that have been found to regulate cellular health and lifespan from yeast to humans. Lifespan assays are an essential tool for examining the effects of these genes on longevity. There are two ways lifespan is measured in yeast: replicative lifespan (RLS) and chronological lifespan (CLS). RLS is a measure of how many divisions an individual mother cell will undergo. CLS measures the length of time nondividing cells survive. Previously described CLS assays involved diluting and plating cells of a culture and counting the colonies that arose. While effective, this method is both time and labor intensive. Here, we describe a method for a high-throughput rapid CLS assay that is both time- and cost-efficient.

Recruitment of a genotyped Quercus robur L. seedling cohort in an expanding oak forest stand: diversity, dispersal, and performance across habitats

Few studies have linked the origin of dispersed tree seeds with their post-dispersal fate. We show that habitat-dependent mortality in a pedunculate oak ( Quercus robur L.) seedling cohort reshapes the effective fecundity of individual mother trees but has little effect on the cohort’s genetic diversity. Initial tree recruitment plays a key role in forest regeneration, yet little is known on how patterns of recruit mortality feed back on the fecundity of reproducing trees. To investigate how among-habitat variation in seedling arrival and survival alters initial patterns of genetic diversity and maternal reproductive success. We genotyped a pedunculate oak seedling cohort (n = 809) and monitored it over 3 years. The mother trees of 81% of the seedlings were identified through parentage analysis. Seedlings were assigned to one of three habitats (broadleaved forest, pine plantation, or open area). Broadleaved forest received most seedlings (≈ 65%) but their survival was reduced by a third compared with pine plantations or open areas. Thus, mother trees dispersing many descendants to broadleaved forest suffered a disproportionate reduction of their reproductive success. Genetic diversity did not vary among habitats, nor over the monitoring period. The quality of seed dispersal, in terms of delivery sites, can considerably influence the reproductive success of individual mother trees without affecting the overall genetic diversity of the recruits.

Mating System in a Native Norway Spruce (Picea abies [L.] KARST.) Stand-Relatedness and Effective Pollen Population Size Show an Association with the Germination Percentage of Single Tree Progenies

Norway spruce differs little in neutral genetic markers among populations and provenances often reported, but in terms of putative adaptive traits and their candidate genes, some clear differences have been observed. This has previously been shown for crown morphotypes. Stands with mostly narrow crown shapes are adapted to high elevation conditions, but these stands are scattered, and the forest area is often occupied by planted stands with predominantly broad crowned morphotypes. This raises questions on whether this differentiation can remain despite gene flow, and on the level of gene flow between natural and planted stands growing in close neighbourhood. The locally adapted stands are a valuable seed source, the progeny of which is expected to have high genetic quality and germination ability. The presented case study is useful for spruce plantation by demonstrating evaluation of these expectations. Immigrant pollen and seeds from planted trees could be maladaptive and may alter the genetic composition of the progeny. This motivated us to study single tree progenies in a locally adapted stand with narrow crowned trees in a partial mast year at nuclear genomic simple sequence repeat (SSR) markers. Spruce is a typical open-pollinated conifer tree species with very low selfing rates, which were also observed in our study (s = 0.3–2.1%) and could be explained by efficient cross-pollination and postzygotic early embryo abortion, common in conifers. The estimated high amount of immigrant pollen found in the pooled seed lot (70.2–91.5%) is likely to influence the genetic composition of the seedlings. Notably, for individual mother trees located in the centre of the stand, up to 50% of the pollen was characterised as local. Seeds from these trees are therefore considered to retain most of the adaptive variance of the stand. Germination percentage varied greatly between half-sib families (3.6–61.9%) and was negatively correlated with relatedness and positively with effective pollen population size of the respective families. As pollen mostly originated from outside the stand and no family structures in the stand itself were found, germination differences can likely be explained by diversity differences in the individual pollen cloud.

Effectiveness of Early Physiotherapy Interventions for Weight Gain in Low Birth Weight Neonates

Background: Prematurity is a leading cause of death in Indian scenario. There are lack of studies done on early physiotherapy interventions in neonates. Early care interventions in premature newborns show positive effect. Growth retardation and demineralisation of bones in newborn are thought to be caused by prolong immobilisation or lack of physical activities. In this study we are going to give combination of massage, passive movements, facilitatory techniques, joint compression and kangaroo mother care, which has not been done before. Indeed this made us to study the effectiveness of early physiotherapy intervention on weight gain in low birth weight neonates. Objectives: To determine the effectiveness of early physiotherapy intervention on weight gain in moderate premature neonates (32–37 weeks), very premature (28–32 weeks) and extremely premature neonates (less than 28 weeks). Methods: Individuals fulfilling the inclusive criteria were selected. Written consent was taken from parents and care taker of neonates. Total 20 low birth weight neonates were taken. They were differentiated into moderate premature, very premature and extremely premature neonates. The weight was measured and breast feeding frequency was noted before treatment. Then the neonates were given massage, passive movements, proprioception stimulation by individual joint compression, oral stimulation and kangaroo mother care. This was given for 25-30 minutes each session for two times per day for 7 days. After that again weight and breast feeding frequency was checked to see progression. Later evaluation and interpretation was done using statistical analysis. Results: The early physiotherapy intervention is effective in low birth weight baby for improving weight in pre mature neonates. Conclusion: On the basis of result it can be concluded that the early physiotherapy is effective in improving weight, breast feeding frequency in low birth weight neonates. Hence, early physiotherapy interventions should be considered to decrease the morbidity and mortality rate of LBW neonates.

'I wanted to go, but they said wait': Mothers' bargaining power and strategies in care-seeking for ill newborns in Ethiopia.

To prevent the 2.6 million newborn deaths occurring worldwide every year, health system improvements and changes in care-taker behaviour are necessary. Mothers are commonly assumed to be of particular importance in care-seeking for ill babies; however, few studies have investigated their participation in these processes. This study explores mothers' roles in decision making and strategies in care-seeking for newborns falling ill in Ethiopia. A qualitative study was conducted in Butajira, Ethiopia. Data were collected during the autumn of 2015 and comprised 41 interviews and seven focus group discussions. Participants included primary care-takers who had experienced recent newborn illness or death, health care workers and community members. Data were analysed using thematic analysis. Choices about whether, where and how to seek care for ill newborns were made through cooperation and negotiation among household members. Mothers were considered the ones that initially identified or recognised illness, but their actual opportunities to seek care were bounded by structural and cultural constraints. Mothers' limited bargaining power, contained by financial resources and gendered decision making, shaped their roles in care-seeking. We identified three strategies mothers took on in decision making for newborn illness: (a) acceptance and adaptation (to the lack of options), (b) negotiation and avoidance of advice from others, and (c) active care-seeking and opposition against the husband's or community's advice. While the literature on newborn health and parenting emphasizes the key role of mothers in care-seeking, their actual opportunities to seek care are shaped by factors commonly beyond their control. Efforts to promote care-seeking for ill children should recognise that mothers' capabilities to make decisions are embedded in gendered social processes and financial power structures. Thus, policies should not only target individual mothers, but the wider decision making group, including the head of households and extended family.

Demographic and Psychosocial Correlates of Exclusive Breastfeeding Duration in Indonesia

Abstract Objectives In Indonesia, exclusive breastfeeding practices are followed by only 46% of mothers, resulting in USD $118 million in health costs annually [2, 3]. Though previous studies have addressed demographic factors related to breastfeeding [5, 6], few studies have examined the relationship between exclusive breastfeeding duration and mother's psychosocial characteristics [5, 6, 7, 8]. Our study used the Indonesian Family Life Survey 5th Wave survey (IFLS5) from 2014–2015 to evaluate if demographic and psychosocial factors are associated with exclusive breastfeeding duration among Indonesian mothers [7, 8]. Methods Our study included mothers (n = 3024) with children &amp;lt;8 years of age. We stratified breastfeeding duration (0, 1–3, 4–6 and &amp;gt;6 months) according to WHO standards [1]. We described individual mother's characteristics including age, education level, socioeconomic status, and psychosocial factors by these breastfeeding categories. We developed binary breastfeeding duration variables by those never breastfeeding or breastfeeding ≤4 months to perform binary logistic regression models. Finally, we examined differences between categories of breastfeeding duration using multinomial logistic models. Results Mothers with primary and secondary education had lower odds of having breastfed exclusively for ≤4 months (OR 0.43 [0.30, 0.60] and 0.64 [0.46, 0.89]), respectively, compared to mothers with higher education. Mothers with primary education were also 2.21 [1.05, 4.50] times as likely to have never breastfed relative to breastfeeding exclusively for 4–6 months compared to highly-educated mothers. Compared to younger mothers (30–39 years), older mothers (40 + years) had a greater likelihood of never exclusively breastfeeding, relative to exclusively breastfeeding for 4–6 months (RR 3.28 [1.80, 5.96]). Finally, mothers who had lower perceived life-satisfaction had a lower likelihood (RR 0.60 [0.45, 0.77]) of exclusively breastfeeding &amp;gt;6 months compared to mothers with very high satisfaction. Conclusions Our results can help to inform policy makers about disparities in exclusive breastfeeding practices to better tailor services to underserved mothers within Indonesia. Funding Sources NSF IRES US-Indonesian Research Experience #182,693.

Barriers to practice of critical newborn care behaviours: findings from a qualitative assessment in rural Madhya Pradesh, India

Background: In India, the state of Madhya Pradesh has one of the highest infant mortality rates (IMR) as compared to the national average. About two out of every three infant deaths in Madhya Pradesh, are of neonates. Given the high neonatal mortality rate in the state, this study aimed to explore the perceptions, practices, barriers and enablers related to critical newborn care behaviors, such as cord-care, thermal care, skin-to-skin care, and early initiation of breastfeeding, in the first 24 hours of life.Methods: In-depth interviews and focus group discussions were conducted with 53 respondents including mothers and fathers of the newborn, mothers-in-law, elected community and tribal leaders, local NGO representatives, and frontline health workers, in two districts of Madhya Pradesh.Results: Few mothers knew about the benefits of cord care, thermal care and early initiation of breastfeeding. Fathers lacked knowledge and perceived newborn care as the mother’s responsibility. Skin-to-skin care was rarely practiced; and was perceived across respondent groups as necessary only for weak infants. Older women, influential in decision making in the household, held misconceptions about thermal care and breastfeeding practices. Traditions and social norms emerged as major barriers while institutional delivery served as an enabling factor for the practice of correct newborn-care behaviors.Conclusions: To increase adoption of critical newborn behaviours, health care providers will have to move beyond mere interpersonal communication with individual mothers at facility or household levels towards a community and societal approach. A strategic behaviour change communication program that addresses deep-rooted traditional and social norms is required to help the state reduce infant deaths.

Good mother, bad mother?: Maternal identities and cyber-agency in the primary school homework debate

ABSTRACT Primary homework in England is widespread and contentious, yet research largely ignores its gendered impact on families. This netnographic study locates mother perspectives online to explore whether participation in mother-focused forums affords maternal cyber-agency in the homework debate. Findings suggest that many women, positioning themselves as ‘good’ mothers, perform their maternal identity online by upholding an ideology of good mothering which expects maternal support for homework. Alternative homework practices are critiqued as ‘bad’ mothering. Although other perspectives emerge, individual mothers’ abilities to create new homework narratives in anonymous online spaces are restricted by the forums’ alignment towards dominant mothering ideologies and their normative practices. These findings question assumptions of maternal empowerment, support and cyber-agency, in online spaces which operate as communities of collective, hegemonic knowledge. Teachers also infiltrate the forums, directing maternal homework behaviours using good mothering. Good mothering’s impact on maternal cyber-agency and forum homework discussion is therefore highlighted.