Father involvement in the first year of life: Associations with maternal mental health and child development outcomes in rural Pakistan

Father involvement is a protective factor for maternal mental health in Western Kenya

Depression is a major global health concern especially among mothers of young children in low- and middle-income countries (LMICs). While various risk and protective factors have been well-established, the role of fathers in potentially mitigating maternal depression remains understudied. This study aimed to investigate the association between father involvement and maternal depressive symptoms in rural Western Kenya. We used cross-sectional baseline data collected in February-March 2023 from a cluster-randomized controlled trial evaluating the effectiveness of a community-based parenting program for improving early childhood development. Primary caregivers with children 0-18 months of age were enrolled into the trial across 51 villages in Nyamira and Vihiga counties. We analyzed data from 413 mothers who were in a relationship with a male partner (i.e., father of the young child). Maternal depressive symptoms were measured using the CESD-10. Father involvement was reported using a multidimensional measure of men's engagement in childcare activities, household chores, early learning activities, and affection towards their child. We used multilevel regression models to estimate the adjusted associations between father involvement (overall score and by specific domains) and maternal depressive symptoms. We also conducted exploratory subgroup analyses to assess whether this association differed by child age. Overall, greater father involvement was associated with fewer maternal depressive symptoms. Specifically, fathers' engagement in household chores and childcare activities had the strongest protective associations. Exploratory subgroup analyses revealed larger associations for mothers with younger children under 6 months. Our findings suggest that father involvement is a protective factor for maternal mental health. Engaging fathers in early childhood interventions and encouraging men's involvement in caregiving activities may potentially benefit maternal well-being.

The impact of welfare on maternal investment and sibling competition: evidence from Serbian Roma communities

Siblings compete for limited parental resources, which can result in a trade-off between family size and child growth outcomes. Welfare incentives may improve parental circumstances in large families by compensating for the additional costs of an extra child and increasing the resources available to a family. The improvements in conditions may influence parents to increase their investment, expecting greater returns from the investment in child survival and development, while in turn increase sibling competition for the investment. This study assessed whether welfare benefits have influenced parental investment trade-offs and competition between siblings among Serbian Roma, a population largely dependent on welfare. Using data from the UNICEF Multiple Indicator Cluster Survey 6, this study assessed the associations between maternal investment, child cash benefits, sibship size, and child anthropometry, as an indicator of health, among 1096 Serbian Roma children aged 0 to 59 months. Living in a small family benefited Roma children, while the incentives increased competition between siblings. Maternal investment was negatively associated with incentives, as the improvements brought about were insufficient to influence a change in maternal perceptions about the local setting uncertainty and thus promote an increase in investment.

The Desirable Dad Hypothesis: Male Same-Sex Attraction as the Product of Selection for Paternal Care via Antagonistic Pleiotropy

Same-sex attraction, a heritable trait with a reproductive cost, lacks a comprehensive evolutionary explanation. Here we build on a hypothesis invoking antagonistic pleiotropy, which suggests that genes linked to male same-sex attraction remain in the gene pool because they have conferred some fitness advantage to heterosexual men possessing them. We posit the "desirable dad hypothesis," which proposes that alleles linked to male non-heterosexual orientations increase traits conducive to childcare; heterosexual men possessing same-sex attracted alleles are more desirable mating partners as a function of possessing superior paternal qualities. We conducted three studies to test predictions from this hypothesis. Results were consistent with all three predictions. Study 1 (N = 1632) showed that heterosexual men with same-sex attracted relatives were more feminine than men without, as indicated by self-report measures of femininity (η2 = .007), warmth (η2 = .002), and nurturance (η2 = .004 - .006). In Study 2 (N = 152), women rated feminine male profiles as more romantically appealing than masculine ones (d = 0.83)-but less so than profiles possessing a combination of feminine and masculine traits. In Study 3 (N = 153), women perceived feminine male profiles as depicting the best fathers and masculine profiles the worst (d = 1.56): consistent with the idea that femininity is attractive for childcare reasons. Together, these findings are consistent with the idea that sexual selection for male parental care may be involved in the evolution of male same-sex attraction.

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster-randomized controlled trial

BACKGROUND

Multicomponent interventions are needed to address the various co-occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes.

METHODS

We conducted a 2×2 factorial cluster-randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard-of-care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference-in-difference approach with intention-to-treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well-being.

RESULTS

Between October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (β = .18 [95% CI: 0.01, 0.36]) and receptive language development (β = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (β = .21 [0.04, 0.38]) and availability of home learning materials (β = .25 [0.07-0.43]) and reduced paternal parenting distress (β = -.34 [-0.55, -0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (β = .45 [0.27, 0.63]).

CONCLUSIONS

Jointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers

AIM

To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes.

DESIGN

Qualitative study using semi-structured interviews.

METHODS

Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis.

RESULTS

Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term.

CONCLUSION

This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period.

IMPACT

The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.

Skin-to-Skin Care and Spontaneous Touch by Fathers in Full-Term Infants: A Systematic Review

A series of studies have shown that mothers' early tactile behaviors have positive effects, both on full-term and preterm infants, and on mothers alike. Regarding fathers, research has focused mostly on paternal skin-to-skin care with preterm infants and has overlooked the tactile behavior effects with full-term newborns on infants' outcomes and on fathers themselves. The current systematic review considered the evidence regarding paternal tactile behaviors with full-term infants, including skin-to-skin care (SSC) and spontaneous touch (ST), during parent-infant interactions, and differentiated biophysiological, behavioral and psychological variables both in fathers and in infants. We also compared fathers' and mothers' tactile behaviors for potential differences. The few available studies suggest that paternal touch-SSC and ST-can have positive effects on fathers and infants alike. They also show that, despite some intrinsic differences, paternal touch is as pleasant as maternal touch. However, given the paucity of studies on the topic, we discuss why this field of research should be further explored.

Father contribution to human resilience

Fathers have been an important source of child endurance and prosperity since the dawn of civilization, promoting adaptation to social rules, defining cultural meaning systems, teaching daily living skills, and providing the material background against which children developed; still, the recent reformulation in the role of the father requires theory-building. Paternal caregiving is rare in mammals, occurring in 3-5% of species, expresses in multiple formats, and involves flexible neurobiological accommodations to ecological conditions and active caregiving. Here, we discuss father contribution to resilience across development. Our model proposes three tenets of resilience - plasticity, sociality, and meaning - and discussion focuses on father-specific contributions to each tenet at different developmental stages; newborn, infant, preschooler, child, and adolescent. Father's style of high arousal, energetic physicality, guided participation in daily skills, joint adventure, and conflict resolution promotes children's flexible approach and social competence within intimate bonds and social groups. By expanding children's interests, sharpening cognitions, tuning affect regulation, encouraging exploration, and accompanying the search for identity, fathers support the sense of meaning, enhancing the human-specific dimension of resilience. We end by highlighting pitfalls to paternal contribution, including absence, abuse, rigidity, expectations, and gender typing, and the need to formulate novel theories to accommodate the "involved dad."

The Day-in-the-Life method for assessing infant caregiving in rural Pakistan

Objective

This manuscript describes the Day-in-the-Life (DIL) method for assessing child caregiving activities, its implementation, and findings regarding family members' roles and associations with maternal depression symptoms.

Background

Infant caregiving activities are most commonly performed by the mother, although there is increasing acknowledgement of others' contribution. Few methods exist to measure the diverse caregiving activities that mothers and others perform.

Method

Method development occurred within the Bachpan Cohort Study in rural Pakistan (N = 1,154 maternal-child dyads) when the child was 3 months old. The DIL was designed as a semi-structured interview in which the mother describes her child's day from their perspective. Regression analyses were then used to explore the correlation between the DIL and depression symptoms, using the Patient Health Questionnaire-9 (PHQ-9) measure.

Results

The DIL method was easy to administer and displayed excellent interrater agreement. The findings indicated that instrumental caregiving was mostly provided by the mother alone, others in the household tended to contribute more to infant social interactions, and there was more support from others when the mother was less able to provide care (e.g., when ill). Depression symptoms were higher among women who experienced less contribution from family members when the mother was less able to provide care.

Conclusions

The DIL can be deployed to measure infant caregiving activities and associations with maternal mental health.

Implications

This method is promising for researchers interested in disentangling the contribution of multiple family members toward child caregiving and its impacts on maternal and child health.

Mother and father interaction with their 3-month-old infants: Similarities and differences in parenting behaviour in well-resourced parents

Infancy is characterized by intensive parenting which may affect later child development. However, little is known about similarities and differences in maternal and paternal parenting behaviour, as the majority of the studies have mainly focused on mothers. The present study investigated similarities and differences in mothers' and fathers' parenting behaviour during parent-infant interaction in 56 mothers and 56 fathers of 3-months-old infants in a good-resourced sample. Parent-child interactions were videotaped and coded by the Global Rating Scales. Results suggested similar parenting behaviour in terms of maternal and paternal sensitivity, intrusiveness and remoteness. Moreover, regardless of sex infant's behaviour was similar during interactions with mothers and fathers. The low-risk and non-clinical nature of our sample may have had a positive influence on mother-child and father-child dyadic exchanges. These findings suggest including family system models in research and clinical practice.

The association between paternal childcare involvement and postpartum depression and anxiety among Chinese women-a path model analysis

Depression and anxiety are among the most common morbidities during the perinatal period. Very few studies have been conducted to examine the association between paternal childcare involvement and postpartum depression (PPD) and anxiety (PPA) in East Asian cultures. This study aims to examine the association between fathers' involvement in childcare and mothers' mental health and explores the potential mediating effects of the mother and child's health among a national sample of Chinese women. This is a cross-sectional, self-administered online survey of maternal women (N = 778) within 1 year after childbirth in China. The questionnaire comprised of sociodemographics, fathers' childcare involvement, child and mother's physical health, and mothers' postpartum mental health status. A path analysis model was constructed to examine the correlation between paternal childcare involvement and maternal depression and anxiety within 1-year postpartum. The mediating effect of the mother and child's physical health was also explored in the model. Paternal involvement in childcare was significantly associated with lower PPD (β =  - .36, p < 0.001) and PPA (β =  - .29, p < 0.001) levels of mothers after covariates were adjusted. Furthermore, women's physical health partially mediated the association between paternal involvement and PPD, and child's health partially mediated the association between paternal involvement and PPA and PPD. Our findings emphasize the essential role of father's childcare involvement and the need to promote culturally tailored intervention programs, which may improve the mental health status among Chinese postpartum mothers.

Mothering Ideology: A Qualitative Exploration of Mothers' Perceptions of Navigating Motherhood Pressures and Partner Relationships

Good mother ideology refers to beliefs that women are only 'good' mothers if they adhere to the tenets of dominant parenting discourse, such as intensive mothering ideology, which prioritizes children's needs and child-raising above all else. Undergirded by this ideology, mothers' attempts to navigate the transition to motherhood are fraught with pressures, and the transition is associated with negative health outcomes for mothers and children; yet existing research gives little attention to the quality or dynamics of the partner relationship as part of this transition. The current study examined motherhood pressure and the impact on partner relationships through individual, semi-structured interviews with 19 mothers living in Australia who were 18 years or older in a heterosexual relationship with at least one child under the age of five. Thematic analysis revealed four key themes: discourses on motherhood: criticisms of mothers and internalised guilt; transformation of identity; entrenchment of gender roles through childrearing; and positive relationship dynamics: supportive fathers and challenging gender roles. This study contributes to the larger body of literature highlighting the complexity of dominant mothering ideology and its entanglement with and impact on partner relationships. Further, this study includes mothers' perceptions of how they navigate these pressures within the relationship with their partner and the family unit. These findings have implications for programs to support mothers and other caregivers, as well as challenge unrealistic standards for motherhood.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11199-022-01345-7.

Mother-in-law childcare and perinatal depression in rural Pakistan

BACKGROUND

Mothers-in-law often provide key childcare support to daughters-in-law during the perinatal period that may enhance maternal mental health. Yet, poor mother-in-law/daughter-in-law relationships may be associated with maternal depression. The extent to which mother-in-law childcare involvement affects perinatal depression may differ across contexts of family conflict.

OBJECTIVE

We explored the relationship between mother-in-law childcare and daughter-in-law perinatal depression in rural Pakistan across contexts of family conflict.

METHODS

Data on 783 women came from the Bachpan Cohort, a birth cohort in Pakistan. Maternally-reported mother-in-law childcare was assessed at 3 and 12 months postpartum using a 24-h recall and categorized into no, low, and high involvement. Major depression was captured at 3 and 12 months using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV. Family conflict was captured using three items from the Life Events Checklist. Log-Poisson models were used to estimate cross-sectional associations between mother-in-law childcare and perinatal depression, stratified by family conflict.

RESULTS

Mother-in-law childcare was common in the first year postpartum. The association between mother-in-law childcare and perinatal depression differed by the presence of family conflict and postpartum timing. At 3 months postpartum, low and high mother-in-law childcare (vs no involvement) were associated with a lower prevalence of depression regardless of family conflict. At 12 months postpartum, among families with no conflict, low mother-in-law childcare (vs no involvement) was associated with lower perinatal depression; however, among families with conflict, high mother-in-law childcare was associated with increased perinatal depression.

CONCLUSION

Our findings highlight the complexities of associations between mother-in-law childcare support and perinatal depression in the first year after birth. Mother-in-law childcare in the immediate postpartum period was beneficial for mothers. Understanding the source, amount, timing, and context of social support is necessary to inform research and interventions that aim to improve maternal mental health.

Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh

Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives.

Analysis of narratives of nutrition‐promoting, rural Bangladeshi community health workers (CHWs) suggest that behavior change communication (BCC) strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers‐in‐law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos.

CHW communication strategies are useful in developing persuasive narratives that capture influential family members’ value beliefs and outcome expectancies and promote behavior change. However, additional programmatic efforts are needed to discourage use of unscientific narratives by CHWs.

Healthcare-Based Interventions to Improve Parenting Outcomes in LMICs: A Systematic Review and Meta-Analysis

OBJECTIVES

Although a number of early childhood development (ECD) interventions in healthcare settings in low- and middle-income countries (LMICs) have been developed to improve parent-directed outcomes and support ECD, their impact have yet to be established. This review assesses the effectiveness of healthcare-based ECD interventions in LMICs on the following key evidence-informed parenting outcomes affecting ECD: (1) responsive caregiving (2) cognitive stimulation and (3) parental mental health. Impacts on parental knowledge regarding ECD and parenting stress were also assessed.

METHODS

PubMed, PsycINFO, Scopus, CINAHL and Embase were searched. We included randomized controlled trials reporting effects of healthcare-based ECD interventions in LMICs on parent-directed outcomes in the first five years of life. Data extraction included study characteristics, design, sample size, participant characteristics, settings, intervention descriptions, and outcomes. Meta-analyses were conducted using random effects models.

RESULTS

8 articles were included. Summary standardized mean differences demonstrated significant benefits of healthcare-based interventions in LMICs for improving: (1) cognitive stimulation (n = 4; SMD = 0.32; 95% CI: 0.08 to 0.56) and (2) ECD knowledge (n = 4; SMD = 0.44; 95% CI: 0.27 to 0.60). No significant effects were seen on maternal depression and parenting stress; only one study assessed parent-child interactions in the context of responsiveness. Limitations included small number of studies for moderation analysis, high heterogeneity, variability in measures used for outcomes and timing of assessments.

CONCLUSIONS FOR PRACTICE

Our results demonstrate statistically significant effects of healthcare-based interventions in LMICs on improving key evidence-based parenting outcomes and offers one promising strategy to support children reach their full developmental potential.

Maternal depressive symptoms and children's cognitive school readiness: the role of gene-environment interplay

Maternal depressive symptoms are a robust risk factor for poor cognitive outcomes in children, yet the role of gene-environment interplay in this association is not well understood. The objective of this study was to evaluate gene-environment interaction in the association between maternal depressive symptoms and children's cognitive school readiness. Data come from a population-based birth cohort of 538 twin pairs. Maternal depressive symptoms were self-reported (Centre for Epidemiologic Studies Depression Scale) when children were aged 6 and 18 months (a mean score was used). Children's cognitive school readiness was assessed using the Lollipop Test when children were aged 5 years. Analyses were conducted with structural equation modeling. Maternal depressive symptoms were correlated with children's cognitive school readiness (r = -0.10). Shared environmental factors explained most of the variance in children's cognitive school readiness (52%). The remaining variance was accounted for by genetic (30%) and nonshared environmental factors (18%). As the level of maternal depressive symptoms increased, the relative contribution of nonshared environmental factors to the variance in children's cognitive school readiness increased (0.14 [95% CI: 0.04 to 0.24]), whereas the relative contribution of genetic factors decreased (-0.28 [-0.64 to 0.08]). In contexts of elevated maternal depressive symptoms, environmental - and potentially modifiable - factors may be especially important for shaping children's cognitive outcomes. This suggests that interventions to improve the early childhood environment of children exposed to maternal depressive symptoms may improve their cognitive outcomes.

Father involvement and early child development in a low-resource setting

Evidence on the role of father involvement in children’s development from low-resource settings is very limited and historically has only relied on maternal reports of father’s direct engagement activities such as reading to the child. However, fathers can also potentially influence their children’s development via greater positive involvement with the mother, such as by offering interpersonal support or sharing decision-making duties. Such positive intrahousehold interactions can benefit maternal mental health and wellbeing, and ultimately children’s development. We use data collected from mothers, fathers and children in the context of the cluster randomized controlled trial evaluation of Msingi Bora, a responsive parenting intervention implemented across 60 villages in rural western Kenya, to explore the various pathways through which fathers may influence their children’s outcomes. In an endline survey in Fall 2019 among a sample of 681 two-parent households with children aged 16–34 months, fathers reported on measures of their behaviors towards children and with mothers, mothers reported on their wellbeing and behaviors, and interviewers assessed child cognitive and language development with the Bayley Scales. In adjusted multivariate regression analyses we found that greater father interpersonal support to mothers and greater participation in shared household decision-making were positively associated with children’s development. These associations were partially mediated through maternal wellbeing and behaviors. We found no association between fathers’ direct engagement in stimulation activities with children and children’s outcomes. Inviting fathers to the program had no impact on their involvement or on any maternal or child outcomes, and fathers attended sessions at low rates. Overall, our results show the potential promises and challenges of involving fathers in a parenting intervention in a rural low-resource setting. Our findings do highlight the importance of considering intrahousehold pathways of influence in the design of parenting interventions involving fathers.

Paternal investment, stepfather presence and early child development and growth among Serbian Roma

Research on paternal investment and child growth and development is limited outside of high-income countries. Using nationally representative data from low-resource Serbian Roma communities, this study examined father investment (direct care), its predictors and the associations between paternal investment, stepfather presence and child physical growth and early development. The sample included 1222 children aged 35-59 months, out of which 235 were living with biological fathers. Child outcomes included height-for-age Z-scores, stunting and early child developmental score. Roma paternal investment was relatively low. There was a positive association of father investment and children's height, and no association with developmental score. The presence of father vs. stepfather did not exert any influence on children. Instead, maternal and child characteristics explained both the overall development and height for Roma children. Thus, older children, born to literate, lower parity mothers of higher status and greater investment had better developmental and growth outcomes; girls were the preferred sex, owing to expected fitness benefits. Reverse causality emerged as the most likely pathway through which the cross-sectional association of father direct care with child growth may manifest, such that Roma fathers tend to bias their investment towards taller, more endowed children, because of greater fitness pay-off.

The Neural Basis of Human Fatherhood: A Unique Biocultural Perspective on Plasticity of Brain and Behavior

With the growing involvement of fathers in childrearing and the application of neuroscientific tools to research on parenting, there is a need to understand how a father's brain and neurohormonal systems accommodate the transition to parenthood and how such neurobiological changes impact children's mental health, sociality, and family functioning. In this paper, we present a theoretical model on the human father's brain and the neural adaptations that take place when fathers assume an involved role. The neurobiology of fatherhood shows great variability across individuals, societies, and cultures and is shaped to a great extent by bottom-up caregiving experiences and the amount of childrearing responsibilities. Mechanisms of mother-father coparental brain coordination and hormonal correlates of paternal behavior are detailed. Adaptations in the father's brain during pregnancy and across the postpartum year carry long-term implications for children's emotion regulation, stress management, and symptom formation. We propose a new conceptual model of HEALthy Father Brain that describes how a father's brain serves as a source of resilience in the context of family adversity and its capacity to "heal", protect, and foster social brain maturation and functionality in family members via paternal sensitivity, attunement, and support, which, in turn, promote child development and healthy family functioning. Father's brain provides a unique model on neural plasticity as sustained by committed acts of caregiving, thereby affording a novel perspective on the brain basis of human affiliation.

Measurement tools and indicators for assessing nurturing care for early childhood development: A scoping review

Nurturing care encompasses five components that are crucial for supporting early childhood development: good health, adequate nutrition, opportunities for early learning, responsive caregiving, and safety and security. While there has been increasing attention in global public health towards designing and delivering programs, services, and policies to promote nurturing care, measurement has focused more on the components of health and nutrition, with less attention to early learning, responsive caregiving, and safety and security. We conducted a scoping review to identify articles that measured at least one nurturing care outcome in a sample of caregivers and/or children under-5 years of age in low- and middle-income countries (LMICs). We systematically searched five electronic bibliographic databases for peer-reviewed articles published from database inception until November 30, 2020. We first classified outcomes to their respective nurturing care component, and then applied an inductive approach to organize key constructs within each nurturing care component and the specific measures and indicators used across studies. We identified 239 total articles representing more than 50 LMICs for inclusion in the review. The majority of included studies reported a measure of nutrition (N = 166), early learning (N = 140), and health (N = 102), followed by responsive caregiving (N = 78) and lastly safety and security (N = 45). For each nurturing care component, we uncovered multiple constructs relevant to children under-5: nutrition (e.g., anthropometry, complementary feeding), early learning (e.g., stimulation practices, early childhood education), health (e.g., birth outcomes, morbidity), responsive caregiving (e.g., parental responsivity, parent-child interactions), and safety and security (e.g., discipline, inadequate supervision). Particularly for outcomes of early learning and responsive caregiving, there was greater variability with regards to the measures used, reported indicators, and analytic construction of variables than the other three nurturing care components. This study provides a comprehensive review of the current state of measurement of nurturing care. Additional research is needed in order to establish the most optimal measures and indicators for assessing nurturing care, especially for early learning and responsive caregiving.

Patterns of Father Involvement and Child Development among Families with Low Income

This study examined patterns of father involvement and their relations with social, behavioral, and cognitive development among low-income children < 5 years. Latent class analysis on data from 2650 fathers (Mage = 29.35 years) in the Supporting Healthy Marriages program revealed four father involvement patterns: (1) High positive involvement (48%); (2) engaged but harsh discipline (42%); (3) low cognitive stimulation (8%); and (4) lower involvement (2%). The low cognitive stimulation pattern was associated with greater father- and mother-reported child behavior problems and lower child socioemotional and cognitive functioning. The engaged but harsh discipline pattern was associated with more father-reported child behavior problems. These findings highlight the need for active engagement of fathers in parenting interventions to promote child development.

Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach

BACKGROUND

Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.

METHODS

This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

RESULTS

High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI.

CONCLUSIONS

This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.

Father involvement, maternal depression and child nutritional outcomes in Soweto, South Africa

Father involvement in South Africa is low, despite evidence that it can improve maternal and child health and wellbeing. Within a larger randomised controlled trial, we assessed whether father involvement during and after pregnancy increased birth weight and exclusive breastfeeding through improved maternal mental health. At 6-week postnatal, mothers completed questionnaires on birth, feeding practices, social support, father involvement and postnatal depression. Father involvement during pregnancy was measured by their attendance at antenatal care and the study intervention, whereas postnatal involvement was measured by attendance at antenatal care and type of paternal support provided. Structural equation modelling was used to identify associations between father involvement, maternal depression, low birth weight and exclusive breastfeeding. Among the 212 mother-baby pairs, father involvement was very low with only 43%, 33% and 1% of partners attending early ultrasound, antenatal care and the birth of the child, respectively. Twenty-nine percent of the mothers showed signs of depression during pregnancy, compared with 7% after birth. Eighteen percent of the infants were born low birth weight, and 57% of mothers reported exclusively breastfeeding at 6 weeks. Father involvement was directly associated with postnatal depression, but it did not directly or indirectly impact exclusive breastfeeding or low birth weight. We conclude that postnatal father involvement can improve postnatal maternal depression and that men would benefit from specific guidance on how they can support mothers during and after pregnancy.

Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample

Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa.

Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample.

Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor.

Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%).

Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery.

Systematic review of the concept 'male involvement in maternal health' by natural language processing and descriptive analysis

INTRODUCTION

Experts agree that male involvement in maternal health is a multifaceted concept, but a robust assessment is lacking, hampering interpretation of the literature. This systematic review aims to examine the conceptualisation of male involvement in maternal health globally and review commonly used indicators.

METHODS

PubMed, Embase, Scopus, Web of Science and CINAHL databases were searched for quantitative literature (between the years 2000 and 2020) containing indicators representing male involvement in maternal health, which was defined as the involvement, participation, engagement or support of men in all activities related to maternal health.

RESULTS

After full-text review, 282 studies were included in the review. Most studies were conducted in Africa (43%), followed by North America (23%), Asia (15%) and Europe (12%). Descriptive and text mining analysis showed male involvement has been conceptualised by focusing on two main aspects: psychosocial support and instrumental support for maternal health care utilisation. Differences in measurement and topics were noted according to continent with Africa focusing on HIV prevention, North America and Europe on psychosocial health and stress, and Asia on nutrition. One-third of studies used one single indicator and no common pattern of indicators could be identified. Antenatal care attendance was the most used indicator (40%), followed by financial support (17%), presence during childbirth (17%) and HIV testing (14%). Majority of studies did not collect data from men directly.

DISCUSSION

Researchers often focus on a single aspect of male involvement, resulting in a narrow set of indicators. Aspects such as communication, shared decision making and the subjective feeling of support have received little attention. We believe a broader holistic scope can broaden the potential of male involvement programmes and stimulate a gender-transformative approach. Further research is recommended to develop a robust and comprehensive set of indicators for assessing male involvement in maternal health.

Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar

Few studies have investigated fathers’ roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers’ involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6–23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers’ involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers’ involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers.

Maternal mental health during the COVID-19 lockdown in China, Italy, and the Netherlands: a cross-validation study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic had brought negative consequences and new stressors to mothers. The current study aims to compare factors predicting maternal mental health during the COVID-19 lockdown in China, Italy, and the Netherlands.

METHODS

The sample consisted of 900 Dutch, 641 Italian, and 922 Chinese mothers (age M = 36.74, s.d. = 5.58) who completed an online questionnaire during the lockdown. Ten-fold cross-validation models were applied to explore the predictive performance of related factors for maternal mental health, and also to test similarities and differences between the countries.

RESULTS

COVID-19-related stress and family conflict are risk factors and resilience is a protective factor in association with maternal mental health in each country. Despite these shared factors, unique best models were identified for each of the three countries. In Italy, maternal age and poor physical health were related to more mental health symptoms, while in the Netherlands maternal high education and unemployment were associated with mental health symptoms. In China, having more than one child, being married, and grandparental support for mothers were important protective factors lowering the risk for mental health symptoms. Moreover, high SES (mother's high education, high family income) and poor physical health were found to relate to high levels of mental health symptoms among Chinese mothers.

CONCLUSIONS

These findings are important for the identification of at-risk mothers and the development of mental health promotion programs during COVID-19 and future pandemics.

The contribution of grandmother involvement to child growth and development: an observational study in rural Pakistan

INTRODUCTION

Early childhood interventions primarily focus on the mother-child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is a paucity of research on grandmother caregiving in low-income and middle-income countries. We examined the role of grandmother involvement on child growth and development in the first 2 years of life cross sectionally and longitudinally in rural Pakistan.

METHODS

We used data from the Bachpan Cohort, a longitudinal birth cohort in rural Pakistan. Maternally reported grandmother involvement in daily instrumental and non-instrumental caregiving was collected at 3 and 12 months. A summed score was created and categorised into non-involved, low and high. Outcomes included 12-month and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development and 24-month Ages and Stages Questionnaire-Socioemotional. We used multivariable generalised linear models to estimate mean differences (MD) at 12 months (n=727) and 24 months (n=712). Inverse probability weighting was used to account for missingness and sampling.

RESULTS

In our sample, 68% of children lived with a grandmother, and most grandmothers were involved in caregiving. Greater 3-month grandmother involvement was positively associated with 12-month weight z-scores; however, greater involvement was associated with lower 24-month weight z-scores. High 12-month grandmother involvement was associated with improved 12-month cognitive (MD=0.38, 95% CI -0.01 to 0.76), fine motor skills (MD=0.45, 95% CI 0.08 to 0.83) and 24-month socioemotional development (MD=-17.83, 95% CI -31.47 to -4.19). No meaningful associations were found for length z-scores or language development.

CONCLUSION

In rural Pakistan, grandmothers provide caregiving that influences early child development. Our findings highlight the complex relationship between grandmother involvement and child weight, and suggest that grandmothers may positively promote early child cognitive, fine motor and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform caregiving interventions.

Father Involvement in Infant Parenting in an Ethnically Diverse Community Sample: Predicting Paternal Depressive Symptoms

Early paternal involvement in infant care is beneficial to child and maternal health, and possibly for paternal mental health. The purpose of the present study was to examine the relationship between fathers' involvement in early infant parenting and their depressive symptoms during the infant's first year in a sample of 881 low-income Black, Hispanic, and White fathers recruited from five sites in the United States (urban, mixed urban/suburban, rural). Home interviews at 1 month after birth assessed three concepts based on prior research and community input: (1) time spent with the infant, (2) parenting self-efficacy, (3) material support for the baby. Paternal depressive symptoms at 1, 6, and 12 months after the birth of a child were assessed with the Edinburgh Postpartum Depression Scale. Generalized estimating equations tested whether the three indicators of father involvement at 1 month after birth predicted lower subsequent paternal depressive symptoms controlling for social and demographic variables. For fathers, greater time spent with the infant, parenting self-efficacy, and material support were all significantly associated with lower paternal depressive symptoms during the first year. When risk of depression (scores > 9) was examined, only parenting self-efficacy among fathers was associated with higher likelihood of clinical depression. Findings have implications for future research on mechanisms linking paternal involvement and paternal mental health, and for possible paid paternal leave policies in the future.