This post is part of “Mental Health: The Missing Piece in Maternal Health,” a blog series co-hosted by the MHTF, the Mental Health Innovation Network at the London School of Hygiene and Tropical Medicine and Dr. Jane Fisher of Monash University.
Early Childhood Care and Development (ECCD) programmes frequently depend upon the capacity of the primary caregiver, more often than not, the mother, to provide optimal care for her young child. Increasingly, early childhood strategies recognize the importance of addressing the caregiving context, both challenges and enablers, which influence the quality of care that a mother provides for her young child:
- What education has the mother received?
- What time constraints does the mother face?
- Does the mother receive social support
- To what extent is the mother able to make informed choices for her own and her child’s wellbeing?
- Does the mother have access to and control over resources?
- Is the mother respected in the family?
- Is the mother physically healthy, is the mother depressed?
These factors conspire to moderate the emotional availability a mother has to respond to her young child’s needs as well as the availability of resources she has to invest in herself and her child.
ECCD programmes offer an opportunity to address both maternal and child needs. In Jamaica, a home visiting programme designed to promote children’s mental development through play reported a decrease in maternal depressive symptoms among mothers who received at least 25 visits. It is likely that a regular home visit at a sensitive time in the mother’s life enabled a trusting relationship to be established. The quality of the relationship between the home visitor and the caregiver is an important feature of programme effectiveness.
In recent years, integrated packages of early childhood interventions with components intended to support both mother and child are receiving more attention. For example, the ‘Thinking Healthy’ programme helped community health workers counsel mothers with empathetic listening, family engagement, guided discovery using pictures, behavioural activation and problem solving. This approach, trialed in Pakistan, was beneficial for the mother’s own mental health as well as for the care she provided for her young child.
Social support strategies have also proven beneficial; for example, in Pakistan, mothers who participated in parenting groups delivered by Lady Health Workers reported feeling less stressed due to the opportunity provided by the group to share daily challenges with friends and neighbours. Topics that focused on the mother, such as helping mothers feel confident about caregiving, were included in the series of group sessions. Mothers reported that they felt empowered as they acquired new knowledge to help their child to explore his or her environment and learn new things. However, participation in the groups was dependent upon permission from family elders and/or their husband.
A lack of maternal autonomy (freedom of movement and decision making) is a barrier to the potential success of ECCD programmes. A mother might be well informed about appropriate infant and young child feeding, but unable to control what food is purchased for the household. A mother might wish to enroll her child in a preschool, but not have the authority to do so. A mother might receive financial support through social protection and welfare services, but not control how the money is used. In households where mothers may have some say, the value placed on her opinion may be lower than that of other household members. A lack of maternal autonomy may further compound poor maternal mental health and efficacy. In contrast, mothers with greater autonomy will have more access to, and control over, resources that benefit their mental health and wellbeing and that of their families.
Interventions in maternal and child health need to recognize maternal autonomy as a critical moderator of programme success, which is often not explicitly considered in intervention design nor evaluated. A gender sensitive lens is needed to understand whether programmes intended to benefit women are supportive and empowering or adding additional burden in their lives. Early childhood interventions may provide a platform in which to leverage opportunities to empower mothers through a common agenda of the child, which families and communities can rally around.
Enjoyed this post about maternal mental health? Read more posts in the Mental Health: The Missing Piece in Maternal Health blog series.
Photo: “A woman pictured with her children, recovering from malnutrition at a health clinic in southern Ethiopia” © 2011 Tanya Axisa/Department for International Development, used under a Creative Commons Attribution license: http://creativecommons.org/licenses/by/2.0/