Grandmothers: Central scaffolding sources impacting maternal and infant feeding practices in Colombia

Intrahousehold power inequalities and cooperation: Unpacking household responses to nutrition-sensitive agriculture interventions in rural India

Nutrition-sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed-methods design to describe the links between household dynamics-specifically intrahousehold power inequalities and intrahousehold cooperation-and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster-randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross-sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision-making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family-centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate.

Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers' perspectives

BACKGROUND

Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed.

AIM

To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices.

METHODS

A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers' narratives.

FINDINGS

Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers' differing views and positions on infant feeding practices and their influence on breastfeeding.

CONCLUSION

This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers' influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.

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.

Beyond the mother-child dyad: Is co-residence with a grandmother associated with adolescent girls’ family planning knowledge?

Background

In South Asian countries, adolescent girls are generally embedded in multigenerational households. Nevertheless, public health research continues to focus on the nuclear family and overlook the role of grandmothers in adolescent socialization and the transfer of health information. This study compares family planning knowledge of adolescent girls in households with and without a resident grandmother. Two main types of family planning knowledge were assessed: (1) modern contraceptive knowledge and (2) healthy timing and spacing of pregnancy knowledge.

Methods

This study is a secondary data analysis of the 2017 Suaahara II cross-sectional survey in 16 of Nepal’s 77 districts. Family planning knowledge among 769 adolescent girls was assessed and compared between those living with a grandmother (n = 330) and those not living with a grandmother (n = 439). An analysis of the relationship between co-residence and family planning knowledge was carried out using multivariate logistic regression, adjusting for potential confounders and clustering. Additionally, we used the same method to analyze the association between grandmothers’ family planning knowledge and that of co-resident adolescents.

Results

The odds of correct adolescent modern family planning knowledge were 1.81 (95% CI = 1.27,2.58) times higher in households with a grandmother. The study also identified higher odds of adolescent knowledge of modern contraceptives in households where grandmothers also had correct knowledge (OR 2.00, 95%, CI = 0.97,4.11), although this association was not statistically significant at the 0.05 alpha level. There was insufficient evidence to support the association between grandmother’s co-residency and correct adolescent knowledge of the healthy timing and spacing of pregnancy.

Conclusion

This study provides support for expanding adolescent reproductive health to include the role of senior women in promoting and transmitting health care knowledge to younger women in the household.

Relative power: Explaining the effects of food and cash transfers on allocative behaviour in rural Nepalese households

We estimate the effects of antenatal food and cash transfers with women's groups on household allocative behaviour and explore whether these effects are explained by intergenerational bargaining among women. Interventions were tested in randomised-controlled trial in rural Nepal, in a food-insecure context where pregnant women are allocated the least adequate diets. We show households enrolled in a cash transfer intervention allocated pregnant women with 2-3 pp larger shares of multiple foods (versus their mothers-in-law and male household heads) than households in a control group. Households in a food transfer intervention only increased pregnant women's allocation of staple foods (by 2 pp). Intergenerational bargaining power may partly mediate the effects of the cash transfers but not food transfers, whereas household food budget and nutrition knowledge do not mediate any effects. Our findings highlight the role of intergenerational bargaining in determining the effectiveness of interventions aiming to reach and/or empower junior women.