Maternal Child Care Research Articles

Preventing Mother-to-Child HIV Transmission Among South African Adolescents

Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting maternal—child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision making, and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed.

Maternal Income-Generating Activities, Child Care, and Child Nutrition in Mali

Women in sub-Saharan Africa play a key role in household food security. The income-generating activities of mothers are postulated to be related to the nutritional status of children. The objective of the study was to examine whether maternal income-generating activities, maternal food production, and child care were determinants of the nutritional status of children in rural West Africa. The study hypotheses were that maternal income-generating activities and maternal food production are positively associated with children's dietary intake and anthropometry, and that maternal income-generating activities are not associated with child care. Data were collected from a cross-sectional sample of mother-child pairs on maternal time use, child anthropometry, maternal food production, dietary intake, parasitic infection, and household, maternal, and child determinants of child nutritional status. The children were 12 to 36 months of age and included breastfed and nonbreastfed children. Food intake was assessed by the 24-hour recall method. The data were analyzed by multivariate regression and controlled for confounding variables. Time spent by the mother in income-generating activities was negatively associated with children's animal protein intake and height-for-age (p < .05). Maternal cash crop production was positively associated with children's weight-for-height, whereas maternal staple food production was negatively associated with energy intake from non-breastmilk foods (p < .05). The negative relationships observed for children's animal protein intake and children's height-for-age were not mediated by any child-care variable. Maternal supervision of feeding was a positive predictor of children's animal protein intake. Giardia infection was negatively related to children's weight gain (p < .05). Own-account cash crop farming by mothers benefits children's nutrition. Maternal income-generating activities in the context of extended families, sibling caretaking, and prolonged breastfeeding do not adversely affect child care.

Mulher, Medicina e tecnologia nos discursos de residentes em Obstetrícia/Ginecologia

This study focused on revealing the cultural meanings assigned to womanhood and the health-disease process in women according to the discourse of medical residents in Obstetrics/Gynecology at the Fernandes Figueira Institute, a public reference hospital specializing in maternal-child care in Rio de Janeiro. The research had two components: participatory observation in Ob-Gyn meetings and recording of oral sources. The sign-based method was used to analyze the data. The methodology included qualitative analytical coding of interviews and subsequent semiotic analysis. According to the results: (a) women are seen essentially as mothers, and their illness focuses primarily on their childbearing function; (b) technological evolution, mainly with the increased use of imaging, has reduced the importance of semiology; and (c) within the biotechnological context medicalization is part of the material and semiotic practices.

Factors Affecting Parenting Stress Among Biologically Vulnerable Toddlers

Parenting a child with, or at risk for, a developmental delay or disability can be stressful. Abidin's parenting stress model was used as a framework to examine how several maternal, child, and family factors predict parent stress outcomes. Stepwise regression models revealed that maternal and child factors were significant contributors to parenting stress. However, family factors (income and family functioning) were not retained. Parenting stress was lower when child (cognitive and adaptive ability) and maternal (depression and child care competence) characteristics were more positive. Child cognitive ability was a strong contributor to total parenting stress and two parenting stress subscales. Findings suggest that these parents need stress lowering interventions such as supportive child care, respite relief, and a child behaviour-focused program.

Parental childcare and children's educational attainment: evidence from China

This paper examines the determinants of child educational attainment. In addition to those examined in previous studies, it is found that maternal childcare is another important determinant of child educational attainment. The results are robust after controlling for endogeneity. The IV estimates show that once childcare time is controlled for, child health does not have an effect on school enrolment age. This finding suggests that omitting the childcare time may have biased the estimated effect of child health on school enrolment in previous studies.

Nutritional status of 1 – 3–year–old children and maternal care behaviours in the Orang Asli of Malaysia

It is estimated that worldwide there are at least 300 million indigenous people living in more than 70 countries on 5 continents. In Peninsular Malaysia the indigenous people known as Orang Asli (OA) in the Malay language or original people form the minority constituting less than 1% of the total population of the country. Despite continuous efforts by the government to integrate them into the mainstream economy the OA still live on the fringes of Malaysian society cut off from most social services; they are poorly educated and earn a meagre living. Described as the poorest of the poor the OA continue to have poor nutritional and health status (particularly the children) compared with other ethnic groups in Malaysia The World Declaration on the Survival Protection and Development of Children identified adequate maternal child care practices as important prerequisites to improved child nutrition. Care refers to the practices or behaviours performed by caregivers that affect nutrient intake health and the cognitive development of the child. Together with household food security a healthy environment and control of infections care is recognised at the policy level as a fundamental contributor to the nutritional well being of children. UNICEFs original conceptual model of child health identifies the role of care for the childs survival growth and development. In this model the immediate determinants of good nutrition and survival are adequate dietary intake and health. These are affected by underlying conditions which include household food security health services and care of women and children. Food health and care are in turn influenced by political ideological historical and economic structures. (excerpt)

Le baby blues : caractérisation clinique et influence de variables psycho-sociales

Within days following birth, most women are showing signs of mood changes, commonly named baby blues. Due to the frequency of this condition, baby blues is considered as a physiological state probably associated to biological modifications. Some studies have shown an existing link between the intensity of the baby blues and post-partum mood disorder. Therefore, it seems important to report and explore in more details the clinical background related the condition. The aim of this study was to demonstrate the possibility of a link between the intensity of the baby blues and some specific factors like maternal self-esteem, maternal childcare stress and social background, and also to define the symptoms of the baby blues from core dimensions in mood disorders. Mothers were recruited few hours before giving birth in a teaching hospital. At the third day following birth, an appointment was made to obtain the necessary information (past medical history and social history) and history of previous mood disorders. The mood was evaluated from the scale of the intensity of baby blues from Kennerly and Gath (1989). Moreover, evaluations at day 3 and week 6 post birth of self-esteem in relation to motherhood (Maternal self-report Inventory from Shea and Tronick, 1988), stress in relation with the care of the baby (Childcare Stress Inventory from Cutrona, 1983) and the social support (Social Support scale from Bruchon-Schweitzer, 1998) were undertaken. 95 women were included in the final sample. The intensity of the baby blues was explained by the type of pregnancy (p=0.002), a low maternal self-esteem (p=0.025), high levels of stress in relation to the care of the baby (p=0.074). The basic clinical characteristic of the baby blues seems to be due to an increase in the emotional reaction with a sharp feelings, leading to a lability rather than an affect sad tonality. The baby blues seems to be a physiological process whereby the intensity is influenced by psychological factors. Consequently the diminution of self-esteem with motherhood and the increase of stress in relation to the care of the baby appeared to be significant factors in the intensity of the baby blues. Moreover, the clinical characteristics found in this study implies that the baby blues is more related to hypomania rather than to depression syndrome. This non-pathological state could be the first stage leading to a puerperal psychosis in predisposed women, which is mainly characterized by manic symptoms.

Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style

Background This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth. Method One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined. Results At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms. Limitations Self-report measures were used to measure insecure attachment styles and depression at 12 months. Conclusions Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.

Employment and Child Care Decisions of Women and the Well-Being of their Children

This paper develops and estimates a dynamic model of employment and child care decisions of women after birth in order to i) characterize women's behavior after birth and ii) evaluate the effects of mothers' decisions on children's cognitive ability. I use data from the NLSY to estimate the model. Results indicate that the effects of maternal employment and child care on childen's ability are negative and rather sizeable. One year of maternal full-time work and child care use is associated with a 2% reduction in ability test scores. Finally, I assess the impact of policies related to parental leave and child care on women's decisions and children's outcomes.

Recalled relationships with parents and perceptions of professional support in mothers of infants treated for cleft lip

This study examined whether individual differences in perception of the quality of professional support available at a time of stress may be associated with security of attachment. We developed a new measure of parents' perceptions of emotional and practical support provided by a wide range of professionals involved in the treatment of infants with cleft lip. It showed good internal reliability and stability over 4 months. Mothers of 102 infants with cleft lip, with or without cleft palate, completed the measure at 2 and 6 months, together with the Parental Bonding Instrument and the General Health Questionnaire. Mean scores reflecting how much they could trust or talk frankly, or share their worst fears, with professionals, and the extent to which they saw them as a source of useful information or practical help, were lower among mothers with recollections of low maternal care in childhood, or high control. This was the case at 2 and 6 months, and there were some indications of an increasing contribution of low maternal care from 2 to 6 months. The associations were not explained by current depression. Further research is needed to clarify the role of attachment processes in parents' responses to serious medical conditions in their children, and into the implications for the way professionals in paediatric services provide support.

Child care, women's employment, and child outcomes

This paper reviews the evidence on the impact of child care and maternal employment in the pre-school years on child outcomes. This topic has long been of interest to economists, developmental psychologists, and scholars from other disciplines, and has been the focus of increased attention in recent years, as research has provided additional evidence about the processes of development in the earliest days, weeks, and years of life.1 In this paper, I review the evidence on two broad sets of questions: what we know about the potential benefits of early intervention child care programs, and what we know about the effects (whether positive or negative) of maternal employment and child care in the first years of life. The evidence reviewed in this paper suggests that we now know a good deal about both sets of questions. But, this review also suggests that there are important gaps in our knowledge that future work by economists could fruitfully address.

The Impact of Paternal Involvement and Maternal Childcare Anxiety on Sociability of Three-Year-Olds : Two Cohort Comparison.

The Impact of Paternal Involvement and Maternal Childcare Anxiety on Sociability of Three-Year-Olds : Two Cohort Comparison.

Facilitators and regulators: maternal orientation as an antecedent of attachment security

The contribution of maternal childcare orientation to infants' attachment security was examined in 79 non-risk dyads. Maternal orientation was defined by a distinction between the facilitator, who believes that she should adapt to her baby, as opposed to the regulator, who believes that the baby should adapt to her. Mothers completed the facilitator-regulator questionnaire when the infants were 6 months old; at 12 months, the Strange Situation procedure was administered. The results indicated that secure infants were more likely to have mothers who maintained a facilitator rather than a regulator orientation. It is concluded that a facilitating attitude contributes to a secure infant-mother attachment relationship.

On the alert for pregnancy-induced hypertension.

Increasing the skills of maternal-child home care nurses can identify early incidences of pregnancy-induced hypertension (PIH) for medical intervention, resulting in the prevention of hospitalization and decrease of potential complications. This article describes one agency's approach to teaching staff these important skills.

Facilitators and regulators: Maternal orientation as an antecedent of attachment security

The contribution of maternal childcare orientation to infants' attachment security was examined in 79 non-risk dyads. Maternal orientation was defined by a distinction between the facilitator, who believes that she should adapt to her baby, as opposed to the regulator, who believes that the baby should adapt to her. Mothers completed the facilitator-regulator questionnaire when the infants were 6 months old; at 12 months, the Strange Situation procedure was administered. The results indicated that secure infants were more likely to have mothers who maintained a facilitator rather than a regulator orientation. It is concluded that a facilitating attitude contributes to a secure infant-mother attachment relationship.

Work or welfare? Assessing the impacts of recent employment and policy changes on very young children

We explore the implications of the rapid influx of low-income mothers into the workforce and PRWORA work requirements during the middle to late 1990s for the well-being of young children. Our premise is that some families with young children will be better off, while others will be worse off than low-income cohorts from a decade ago. We focus on six policy provisions from the 1990s that are likely to influence the well-being of young, low-income children in the coming decades: (a) work requirements for mothers of young children; (b) education requirements for teenage mothers of young children; (c) child care subsidies; (d) child care regulations; (e) family leave; and (f) the Earned Income Tax Credit. For each of these provisions, we discuss the actual policy as well as the implementation (i.e. practice) of the policy at the state level. We then consider what policy-relevant research has to say about the possible impact of early maternal employment, income, and child care on young children, highlighting research on low-income families where possible. Much of the research we review is based on data collected prior to the rapid changes in the proportion of low-income mothers in the workforce and in state and federal requirements and programs that occurred in the mid-1990s. Thus, we conclude with speculations on how the current trends in workforce participation and welfare and other policies may impact young children in the coming decades.

Parental 'affectionless control' in adolescent depressive disorder.

Adults with depressive disorder report high rates of sub-optimal maternal care in childhood. Despite the greater salience of relationships with parents earlier in life, associations with parenting style have not yet been systematically studied in adolescent onset disorder. A six-wave, 3-year study of adolescent health in 2032 Australian secondary school students provided an opportunity to undertake a two-phase study of early onset depression. Between waves 2 to 6, a self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used to generate a first phase diagnosis of ICD-10 depressive episode. Each subject with a CIS-R-defined depressive episode was selected for second phase assessment together with two subjects from the CIS-R non-cases in each school. Second phase assessment included a second diagnostic assessment using the depression and hypomania modules of the Composite International Diagnostic Interview (CIDI) and assessment of paternal and maternal style using the Parental Bonding Instrument. A total of 1947 out of 2032 subjects in the sampling frame (95.8%) participated in the cohort study (phase 1) at least once; 406 (94%) of the 435 selected subjects completed second phase assessment. One hundred and nineteen subjects fulfilled criteria for depressive episode on the CIS-R at one or more waves. Over the 30-month study period, 69 subjects (10 male, 59 female) fulfilled both CIS-R and CIDI definitions of depression at the same wave and were classified as 'definite depressive disorder'. Low maternal and paternal care held independent associations with both definitions of depression, with the effects clearest in those in the lowest quartile of reported care. After adjusting for low parental care, the associations between high parental control and depression were small. Sub-optimal parenting is associated with depressive disorder in adolescents. Low maternal and paternal care are each associated with a two- to three-fold higher rate of depressive disorder. These findings are consistent with an effect of sub-optimal parenting on the onset rather than course of disorder. Whether sub-optimal parenting is associated with a risk for the onset of depression outside the adolescent years has yet to be clarified.

Poor Maternal Schooling Is the Main Constraint to Good Child Care Practices in Accra

Life in urban areas presents special challenges for maternal child care practices. Data from a representative quantitative survey of households with children < 3 y of age in Accra, Ghana were used to test a number of hypothesized constraints to child care including various maternal (anthropometry, education, employment, marital status, age and ethnic group) and household-level factors (income, availability of food, quality of housing and asset ownership, availability of services, household size and crowding). Three care indices were created as follows: 1) a child feeding index; 2) a preventive health seeking index; and 3) a hygiene index. The first two indices were based on data from maternal recall; the hygiene index was based on spot-check observations of proxies of hygiene behaviors. Multivariate analyses (ordinary least-squares regression for the child feeding index and ordered probit for the two other indices) showed that maternal schooling was the most consistent constraint to all three categories of child care practices. None of the household-level characteristics were associated with child feeding practices, but household socioeconomic factors were associated with better preventive health seeking and hygiene behaviors. Thus, poor maternal schooling was a main constraint for child feeding, health seeking and hygiene practices in Accra, but the lack of household resources was a constraint only for health seeking and hygiene. The programmatic implications of these findings for interventions in nutrition education and behaviors in Accra are discussed.

The impact of grandparental proximity on maternal childcare in China.

This paper investigates the impact of the proximity of grandparents' residence on mother's childcare involvement in contemporary China. Drawing on data from the 1991 China Health and Nutrition Survey, we find that the presence of grandparents in the household significantly reduces a mother's involvement in childcare. Nearby residence of grandparents also decreases mothers' childcare involvement, but only in the case of paternal grandparents not maternal grandparents. These findings suggest the importance of grandparents as childcare substitutes and the strong legacy of a patrilineal culture. Our results point to the importance of taking into account kinship ties that extend beyond the household boundary.

Relationship with Family of Origin Scale (REFAMOS). Interrater reliability and associations with childhood experiences.

Family relationships in the transition from childhood to adult life may be important mediators of risk and resilience for adult psychopathology. To develop a reliable and valid measure of the quality of relationships with each parent in young adults. Interrater reliability of the Relationship with Family of Origin Scale (REFAMOS) was assessed from audio-taped interviews with 59 subjects. Age-related trends and associations with recalled childhood relationships were examined in survivors of childhood cancer and their controls (n = 178). Intraclass correlation coefficients were in the range 0.69-0.95, and kappa values 0.80-0.82. Indices of current closeness to mothers were negatively correlated with age of subject and positively correlated with recalled maternal care in childhood. Negative qualities in current relationships were correlated with recalled overprotection. The REFAMOS has good interrater reliability, and shows the predicted age-related trends in scores and associations with recalled childhood relationships.