Does maternal grandmother's support improve maternal and child nutritional health outcomes? Evidence from Merida, Yucatan, Mexico

Effects of household composition on infant feeding and mother-infant health in northern Kenya

BACKGROUND

Households with alloparents, individuals other than the mother who care for an infant, can shift members' roles and affect mother-infant health.

AIMS

To investigate how household composition relates to infant feeding and infectious disease risk in mother-infant dyads, the team utilized data from breastfeeding dyads (n 208) surveyed during a prolonged drought and food scarcity in northern Kenya.

METHODS

Households were classified by the presence/absence of potential alloparents, distinguishing non-siblings and siblings of the infant. Regression models for breastfeeding frequency, complementary feeding status, and recent infections (n 83) evaluated these outcomes' associations with household type while accounting for food insecurity, adjusted for infant age, infant sex, and maternal age.

RESULTS

Household type was unassociated with breastfeeding frequency, but the presence of non-sibling alloparents interacted with food insecurity, predicting increasing breastfeeding frequency as food insecurity intensified among dyads living with non-sibling alloparents. Households with non-sibling alloparents were also inversely associated with complementary feeding but had no association with infection. Households with siblings were inversely associated with (protective against) infant and maternal infection.

CONCLUSION

Further research is needed to understand the interactive influence of household social and food ecologies on mother-infant diet and health under diverse cultural rules and norms for alloparenting.

Adoption, Fostering, and Parental Absence in Vanuatu

Alloparenting, wherein people provide care to children who are not their biological offspring, is a key aspect of human child-rearing. In the Pacific, many children are adopted or fostered by custodial alloparents even when both biological parents are still alive. From a behavioral ecology perspective, such behaviors are puzzling: why parent someone else's child at your expense? Furthermore, little is known about how these arrangements are made in Pacific Islander societies today, who provides care, and what kinds of outcomes fostered children experience. A better understanding of these proximate factors may help reveal the ultimate drivers behind custodial alloparenting. Here, we report findings from a survey carried out with the caregivers of 282 children in rural areas of Vanuatu, an island nation in Melanesia. Most fostered and adopted children lived with relatives such as aunts, uncles, and grandparents (87.5%) rather than unrelated caregivers, with a strong preference for maternal kin. The most common reasons for these arrangements were that the parents had separated (16.7%), were engaging in labor migration (27.1%), or a combination of both (27.1%). Results for investment in children's education and their educational outcomes were mixed, although children removed from crisis situations did more poorly than children removed for aspirational reasons. Our findings suggest that custodial alloparenting helps families adapt to socioeconomic transitions and changing marriage practices. Outcomes may depend on a range of factors, such as the reason children were transferred out of the natal home to begin with.

Examining the Role of Quality of Institutionalized Healthcare on Maternal Mortality in the Dominican Republic

The main study objective was to determine the extent to which the quality of institutionalized healthcare, sociodemographic factors of obstetric patients, and institutional factors affect maternal mortality in the Dominican Republic. COM-Poisson distribution and the Pearson correlation coefficient were used to determine the relationship of predictor factors (i.e., hospital bed rate, vaginal birth rate, teenage mother birth rate, single mother birth rate, unemployment rate, infant mortality rate, and sex of child rate) in influencing maternal mortality rate. The factors hospital bed rate, teenage mother birth rate, and unemployment rate were not correlated with maternal mortality. Maternal mortality increased as vaginal birth rates and infant death rates increased whereas it decreased as single mother birth rates increased. Further research to explore alternate response variables, such as maternal near-misses or severe maternal morbidity is warranted. Additionally, the link found between infant death and maternal mortality presents an opportunity for collaboration among medical specialists to develop multi-faceted solutions to combat adverse maternal and infant health outcomes in the DR.

Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support?

Background and objectives

In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint.

Methodology

We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders.

Results

Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law.

Conclusions and implications

Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.

Discrepancies in infant feeding recommendations between grandmothers and healthcare providers in rural Mexico

BACKGROUND

Infant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them.

METHODS

Qualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers.

RESULTS

Grandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow.

CONCLUSIONS

There are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.

Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico

OBJECTIVES

Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital.

METHODS

We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale.

RESULTS

Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score.

DISCUSSION

Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding.

The Effects of Living Environment, Health Status of Family Members, and Migrant Elderly following Children’s Attitude about Care on Grandchildren’s Health Status in Weifang, China

As urbanization is growing quickly in China, many migrant elderly following children (MEFC) migrate to big cities to care for their grandchildren (grandchildren of MEFC=GMEFC). This study aimed to explore the effects of the living environment, health statuses of family members, and MEFC’s attitude regarding the care of their children (children of MEFC=CMEFC) for their GMEFC on GMEFC’s health statuses in Weifang, China. Multistage cluster random sampling was used to select the participants, and 613 MEFC were included in total. Descriptive analysis, univariate analysis and binary logistic regression were used to investigate the association between the related variables and GMEFC’s health statuses. It was found that 74.9% of the GMEFC had excellent health statuses. The GMEFC who had siblings, the CMEFC with excellent health statuses, and the MEFC with excellent health statuses were more likely to have excellent health statuses. Moreover, the GMEFC who were female, elevators occasionally malfunctioned, the MEFC who were dissatisfied with the CMEFC’s time spent on caring, and the MEFC who did not understand or forgive the CMEFC’s limited time on caring were less likely to have GMEFC with excellent health statuses. The results indicated that a better living environment, better health statuses of family members, and a positive attitude of the MEFC regarding the care of CMEFC for GMEFC would result in a better health status of GMEFC.