South African Mothers Research Articles

Knowledge, attitudes and support practices related to breastfeeding promotion of doctors and nurses in Motheo district, Free State province, South Africa

Background: Breastfeeding is widely acknowledged as the optimal method of infant feeding. However, the percentage of South African mothers who exclusively breastfeed remains alarmingly low. Healthcare workers (HCWs) are pivotal in promoting breastfeeding; however, a deficiency in their knowledge, negative attitudes, and unfavourable practices can impede the promotion and support of breastfeeding. Aim: To assess the knowledge, attitudes, and support practices related to breastfeeding promotion of HCWs in the Motheo district, Free State province, compared with the 2016 WHO Guideline updates on HIV and infant feeding and 2018 Mother-Baby Friendly initiative guidelines. Methods: A quantitative analytical cross-sectional study involving paediatricians, obstetricians, general practitioners (GPs), and midwives was conducted using a self-administered questionnaire. Results: Over half of the HCWs (59%) were able to define exclusive breastfeeding (EBF), with a significant majority of GPs (76.1%) and midwives (78.6%) recommending EBF up to six months, compared with only 10% of paediatricians and 25% of obstetricians (p < 0.001). Some 11.1% of the total group of HCWs reported that breastfeeding is contraindicated for HIV-infected mothers, while 15.4% were unsure of the recommendation for breastfeeding among HIV-infected mothers. A higher proportion of midwives, compared with other HCWs, felt highly confident in providing breastfeeding advice (p < 0.001). Additionally, more than half (56%) of HCWs had not completed the 20-hour WHO Lactation Management Training, and 55% believed their prior breastfeeding training was not sufficient to support and educate breastfeeding mothers. Conclusion: Regular breastfeeding training of HCWs on the latest breastfeeding guidelines is necessary to equip HCWs with the knowledge and competence to successfully promote, protect, and support breastfeeding.

Intimate Partner Violence Among Adolescent Mothers Living With and Without HIV: A Pre- and During–COVID-19 South African Cohort Analysis

PurposeAdolescent mothers face heightened economic and social vulnerabilities, which can place them at increased risk of intimate partner violence (IPV), prepandemic, and during COVID-19. However, few studies examine this population, and even less disaggregate findings by HIV status. MethodsWe analyzed data from 834 South African adolescent mothers, 35% living with HIV (LHIV), who reported on physical, psychological, and sexual IPV exposure at two interviews: 2018-2019 (prepandemic) and 2021-2022 (during COVID-19). We estimated lifetime prevalence of IPV, disaggregating by HIV status. We used inverse weighted probability multivariate mixed-effects logistic regression to examine changes in IPV between the two periods and if changes in IPV differed by HIV status. ResultsA quarter of adolescent mothers had experienced any IPV during COVID-19, quadruple prepandemic levels (24.7% vs. 6.0%). The increase was driven by surges in physical (+15.7%) and psychological (+11.2%) IPV. In both periods, psychosocial and physical IPV were the most prevalent forms and the most common combination among those who had experienced multiple forms of IPV. Exposure to any IPV was significantly more prevalent among those LHIV compared to those without HIV, prepandemic (9.5% vs. 4.1%, p = .026) and during COVID-19 (31.8% vs. 20.6%, p < .001). Adjusted models revealed an 18.2% significant increase in the average predicted probability of reporting IPV during COVID-19 compared to prepandemic, with no differential effect by HIV status. DiscussionAdolescent mothers experienced a significantly higher burden of IPV during COVID-19 than prepandemic, with those LHIV experiencing the highest level. Initiatives to reduce IPV need to reach adolescent mothers, particularly those living with HIV.

Levels and Determinants of Bisphenol Concentrations in Breast Milk Samples Collected from South African Mothers and Associations with Infant Growth

Levels and Determinants of Bisphenol Concentrations in Breast Milk Samples Collected from South African Mothers and Associations with Infant Growth

Judging Gender: The Sentencing of South African Mothers Who Murder Their Children

Judging Gender: The Sentencing of South African Mothers Who Murder Their Children

“I wonder if you will be sad?”: Employing the concept of mentalization psychosocially with low-income mothers

We demonstrate the value of a rapprochement between psychoanalytic work aimed at supporting marginalized mothers and discursive accounts of low-income mothers, providing a psychosocial analysis of data from an interview study with six low-income South African mothers. Employing discourse analysis, we show how instrumental mothering is a dominant and precarious construction in these mothers’ talk. We use the concept of mentalization to track the affective work that accompanies the interactional emergence of this instrumental mothering discourse in a particular interview encounter. The implications of the research are discussed in the light of increasing demands for sociocultural responsive research and clinical practice.

A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section.

Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared with normal vaginal delivery. Pregnancy-related sepsis was listed as a top-six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended-spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections. To investigate the effect of perioperative administration of kefazolin alone compared with kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa. All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline. A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups. The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.

Early online.

Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared to normal vaginal delivery. Pregnancy-related sepsis was listed as a top six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections Objectives. To investigate the effect of perioperative administration of kefazolin alone compared to kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital. All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline. A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups. The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.

The pandemic and working mothers: perspectives from American and South African working mothers

The purpose of the current study was to examine the effects of the COVID-19 pandemic on working mothers from the United States and South Africa. This study sought to highlight both cross-cultural similarities and differences. American and South African working mothers took part in online interviews. Eighteen participants were included in the sample, ten participants lived in the United States, while eight participants currently resided in South Africa. The age range of the participants’ children was from 0 to 21 years old. Each participant met individually with the researcher and answered a series of open-ended questions regarding their experiences of being a working mother during the COVID-19 pandemic. Researchers analyzed interviews using thematic analysis. Common themes emerged in the interviews with both American and South African working mothers. Mothers in the United States and South Africa both noted the need for flexible work schedules as well as expressed difficulty balancing roles as mothers and professionals during the pandemic. Increased motivation and resiliency as well as lack of representation of women leaders were themes specific to South African mothers in this study. Conversely, feelings of decreased interest in pursuing leadership opportunities was a theme specific to American mothers in this study. The current study adds to the growing body of literature documenting the effect of the pandemic on working mothers, and builds on this research by including a qualitative component to gain knowledge from working mothers themselves. The narratives collected in the current study highlight commonalities as well as differences in the experiences of working mothers in the United States and South Africa, which holds important implications for how workplaces and the broader community can best attend to the unique needs of working mothers.

Motherhood, role conflict, and identity: South African mothers’ experiences amid a pandemic

ABSTRACT This qualitative study aimed to explore and describe the role conflict that working South African mothers experienced during the COVID-19 pandemic in relation to their maternal and work roles and examine the mothers’ descriptions and experiences of their individual and maternal identities. The phenomenon of work-life conflict is not new; however, the COVID-19 pandemic provided new research opportunities since the lockdown restrictions created unprecedented working and living circumstances within the home environment. Work-life conflict was explored within the context of motherhood and its subsequent role fulfilment, gaining a deeper understanding of the experience and integration of maternal and individual identities. Semi-structured interviews with nine mothers were analysed using reflexive thematic analysis. The analyses revealed that mothers experienced increased role conflict during the COVID-19 pandemic. Participants emphasized that they experienced particular challenges, including social isolation, limited time for self-care, re-evaluations of work and maternal roles, and subsequent influences on their personal and maternal identities. This study provides insight into the complexities and nuanced experiences of mothers’ work and family conflict within the unknowns and uncertainty of an overwhelming pandemic.

Birth stories of South African mothers of children with albinism: A critical human rights analysis

BackgroundThe genetic condition of oculocutaneous albinism is disproportionately present in Africa. Little research has addressed the experiences of mothers impacted by albinism, even though they are more likely to be impacted by human rights violations. MethodsA qualitative study was designed to examine the resilience of mothers affected by albinism in South Africa. Virtual and in-person fieldwork was conducted with the facilitation of community-based researchers and local cultural liaisons. FindingsGiving birth to a child with albinism in South Africa, as in many parts of sub-Saharan Africa, was a life-defining moment for mothers and their families, setting them on a trajectory of health-related stigma, gender inequalities, reduced access to social determinants of health, and other human rights violations. Mothers engaged in sense-making processes shaped by the responses of birth attendants and families, and that reflected social discourses. Their resilience was impacted by access to health teaching, genetic counselling, and health and social services, which were often incomplete or absent all together. Civil society organizations, peer groups, and faith communities were vital in filling these gaps. ConclusionsThe experience giving birth to a child with albinism was both the same and different compared to mothers forty years earlier. What varied was the digital availability of health information; progressive health and social policies and resourcing; and human rights instruments. These transformations point to best practices to support mothers’ resilience.

South African single mothers' experiences of raising a child with a disability.

Historically, in South Africa (SA), single motherhood has been part of the landscape and continues to increase. Disability in children is also increasing, yet it remains under-researched. Mothers are often left to raise their children with a disability alone, yet their voiced maternal experiences continue to largely be unheard, particularly in SA. This study aimed to explore the lived experiences of single mothers raising a child with a disability in SA. Furthermore, the aim was to explore how these mothers navigate their complex realities and practice of mothering, and to amplify the voices of mothers. Finally, the study sought to shed light on the particular contextual factors that affect single maternal experiences in caring for a child with a disability. Twelve South African single mothers raising a child with a disability between the ages of 7 years and 18 years were individually interviewed in this exploratory interpretivist study. Thematic analysis was utilised on the data. The four themes highlight the complex, multi-level strain of raising a child with a disability, which has had a significant impact on the social, financial and emotional facets of single mothers' lives. The findings of the study are important for developing a thorough understanding of the needs of single mothers in this specific context as well as their daily experiences as mothers of children with disabilities. These needs include the necessity of psychosocial support and equipping single mothers with accurate knowledge about their child's disability so that they can make better accommodations for themselves and their child.

Changing Motherhood in the South African Middle-Class Context

Parenting has been found to be highly contextually and culturally determined and there have been calls to research parenting within culture as it is lived. Due to changing social and economic factors, middle-class South African mothers face unique challenges in relation to the navigation of culture and class in child-rearing. Foregrounding the complexity of acculturation, this paper uses social constructionist theory in the analysis of maternal narratives and responses to video-recordings of their interaction with their infants, of a group of middle-class South African mothers from various cultural and racial groups, with an aim to understanding how mothering is changing amongst middle-class South African mothers. The findings suggest that acculturation is complex and influenced by a combination of socioeconomic status, geographical location, contact with other cultural groups and personal emotional experiences of having been parented within a particular culture.

Motherhood, Childcare and Work: Exploring the Multilayered Challenges of Finding Paid Work among Young Mothers in South Africa

ABSTRACT Most young South African mothers continue to face obstacles that impact their decision to participate in paid work. The responsibility to provide care to young children is one of the obstacles that influence their labour force participation. Drawing on qualitative data from 20 young mothers, this study explores how the availability and nature of childcare affects the ability to take part in paid work among young mothers. The findings suggest that most mothers with young children are unemployed and mainly rely on social grants. Many of them could not afford to pay for childcare; hence, providing childcare remained their responsibility with support from close family members and neighbours. This study highlights the need for policies and interventions aimed at providing subsidised childcare for poor mothers that could relieve the burden of unpaid work as well as encourage participation in paid work and thus narrow the gender-income gap.

'Yebo, it was a great relief': How mothers experience their children's autism diagnoses.

There is an emerging body of knowledge on the lived experiences of parenting a child with autism from a maternal perspective. Mothers' reactions to their children's autism diagnoses have been identified as a key factor influencing their children's long-term outcomes. This qualitative study aimed to explore how South African mothers experience their children's autism diagnoses. Telephonic interviews were conducted with 12 mothers from KwaZulu-Natal to understand their experiences prior, during and following their children's autism diagnoses. The data were analysed thematically according to the values of ubuntu, social support, culture, tradition, interpersonal relationships, interconnectedness and continuity and compared to the existing scholarship, employing an Afrocentric theoretical lens. The participants held strong cultural and religious beliefs which influenced the entire diagnosis process. Some, who waited a long time, turned to traditional healers or religious leaders. While some reported feeling relieved after the diagnosis, in the sense of at least having a name for their child's condition, they also reported feeling overwhelmed by the realisation that there is no cure for autism. Over time, mothers' feelings of guilt and anxiety declined, and they became increasingly resilient and empowered as their understanding of the meaning of their children's autism diagnosis deepened, but many continued to pray for a miracle. Future research should focus on how to enhance support for mothers and their children during each of the three phases of autism diagnosis: prior, during and following their children's autism diagnoses. The study highlighted the crucial role of community-based religious and cultural organisations in providing appropriate support to mothers and their children diagnosed with autism, aligned to the values of ubuntu, social support, culture, tradition, interpersonal relationships, interconnectedness and continuity.

Law, South African Mothers Living in Poverty and the COVID-19 Pandemic

Sometimes being a mother in tough economic times can be a challenge. Socio-economic demands occasioned by the COVID-19 pandemic have been especially cumbersome for mothers already living under conditions of poverty. Since the beginning of 2020 the pandemic has further exacerbated the daily struggles of the poor during periods of economic uncertainty, disease and death. Conscious of this additional socio-economic pressure and to lessen the financial burden carried by mothers living in poverty, the South African state introduced a COVID-19 relief Child Support Grant to assist during this trying period. This article explores the role played by law in poverty discourse where mothers are concerned. It is suggested here that the conceptualisation of poverty in law, at least where mothers are concerned, is limited by law's neglect of the socio-political identity of women as mothers, which is rooted in history. This failure reaffirms that law is implicated in contemporary socio-economic inequalities

Severe acute malnutrition outcomes for children of South African compared to foreign-born parents admitted to a rural regional hospital in South Africa: a retrospective cohort study.

Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa. A retrospective cohort study was conducted including children &lt;5 years admitted to Worcester Provincial Hospital during 2015-17 with SAM (WHO weight-for-height Z score &lt;-3, presence of nutritional oedema, mid-upper-arm-circumference of &lt;11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records. Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8-18) vs. 10 (8-13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13-21.06) for in-hospital SAM-associated mortality. In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.

Influence of Maternal Childhood Trauma on Perinatal Depression, Observed Mother-Infant Interactions, and Child Growth.

Mothers who have experienced childhood trauma may be at increased risk for disruptions in caregiving behavior, with potential consequences for early child development. However, assessments of caregiving behavior tend to be self-reported, which may bias results, and have been limited in lower-resource settings. In an overall sample of 256 South African mothers followed across the perinatal period, this longitudinal study used structural equation modeling to test pathways of association between maternal childhood trauma and depressive symptoms on observed mother-infant interactions at 3.5months and subsequent child growth outcomes at 1 year. On average, mothers with childhood trauma histories tended to show lower rated overall interactions with their infants (B = -0.16, p = .013), which in turn was associated with reduced child growth at 1 year (B = 0.17, p = .046). When this model was adjusted for maternal age and relative socioeconomic status (SES), maternal SES strongly explained child growth (B = 0.31, p < .001) such that the direct effect of mother-infant interactions was no longer significant. For child growth in a lower-resource setting, quality of mother-infant interactions could be a relevant predictor but more strongly explained by maternal SES factors, suggesting a need for broader approaches that not only improve dyadic relationships but also address maternal ecological resources.

Contextual Ghosts in the Nursery: Systemic Influences on Sensitive Maternal Responsiveness in a Low to Middle Income Country

The influence of trauma on parenting behavior and “sensitive responsiveness” is well documented. However, these trauma experiences are often conceptualized on an individual, historical and intergenerational level, rather than a systemic level. In this study, eight South African mothers, who were residing in a Johannesburg Township and raising at least one child under the age of six, were interviewed about their parenting practices. The interviews were analyzed using a combination of a psychoanalytically informed interpretive analysis and a social constructionist analysis. Using this approach, the author attempted to develop a contextually-based understanding of current parenting practices within this setting. Across the interviews, three prominent contextual factors were seen to consciously and unconsciously impact parenting practices, namely threats to safety, poverty, and loss or absent parents. These contextual factors were found to play a role in hypervigilance, maternal control and intrusiveness, and dismissiveness in parent-infant interactions. On the back of these findings, the importance of considering contextual trauma when engaging in infant mental health theory, research, and interventions with similar populations, is briefly discussed.

Food habits and beliefs about Moringa oleifera among South African student mothers: a qualitative study

The problems of malnutrition constitute a major challenge in South Africa, particularly affecting the underprivileged populations of the Eastern Cape and Limpopo provinces. The present study aimed to gain an understanding of how to improve the nutritional intake of South African university student mothers and their children by the introduction of Moringa oleifera in their food. Focus Group Discussion was implemented at two previously historically disadvantaged universities with predominantly black student populations, namely the University of Fort Hare and the University of Limpopo. Findings from the participants’ discussion about food habits and barriers to healthy eating show that there is a gap between healthy eating knowledge and eating habits. Despite the high level of awareness of the importance of nutritional intake, most of the study participants and their children consume less healthy foods. Due to the high cost of healthy food and their limited income, student mothers face substantial financial constraints when trying to make healthy changes in their food habits. Moreover, student mothers’ positive beliefs about the nutritional benefits of Moringa are insufficient to encourage its consumption. Finally, student mothers agree about using Moringa as a nutritional supplement. Maize porridge (pap) appears to be the preferred staple food for Moringa supplementation because of its palatability, satiating power, availability, affordability, and ease of preparation.

Macronutrient and Energy Content of Breast Milk from South African Mothers of Preterm Infants: An Exploratory Study

Macronutrient and Energy Content of Breast Milk from South African Mothers of Preterm Infants: An Exploratory Study