Coresidence with mother-in-law and maternal anemia in rural India

Socio-cultural practices and experience of mothers' post stillbirth and newborn death: a population-based perspective from India

INTRODUCTION

We report on post stillbirth and newborn death socio-cultural experience of women from a population-based representative sample in the Indian state of Bihar.

METHODS

A state-representative sample of 7,270 births between July 2020 and June 2021 was sampled, including 582 stillbirths and 831 newborn deaths. Detailed confidential interviews were conducted with the consenting women with stillbirth and newborn death to understand their post-birth experience.

RESULTS

A total of 501 (86.1% participation) women with stillbirth and 717 (86.3% participation) with neonatal death provided interview. Able to talk to someone about their baby and receiving support to cope with their loss were reported by 369 (74.2%) and 398 (80.2%) women with stillbirth; these proportions were 76.7% and 77.3% for women with newborn deaths, respectively. More than 80% of these women reported spouses as their main source of support. At least one negative experience was reported by 150 (30.9%) and 233 (32.5%) women with stillbirth and newborn death, respectively. The most commonly reported negative experience was receiving insensitive/hurtful comments about the baby (18.6% for stillbirth and 20.4% for newborn deaths), followed by being blamed for the baby's death (14.3% for stillbirths and 15.0% for newborn deaths). The majority of women reported being verbally abused by the mother-in-law for both stillbirth (24, 63.2%) and newborn death (49, 64.5%); while 48 (67.6%) and 66 (61.7%) women were blamed by the mother-in-law for stillbirth and neonatal death, respectively. Most women with stillbirth (72.7%) and with neonatal death (77.1%) were asked to forget about their babies as a means to cope with their loss. Naming, seeing, and holding the stillborn were reported by 56 (11.2%), 229 (45.9%), and 64 (12.8%) women with a stillborn.

CONCLUSION

With one-third women with adverse birth outcome reporting negative experience, this translates into a significant number of women in India as it accounts for high numbers of stillbirths and newborn deaths globally. These population-based data can facilitate in designing interventions to improve post-partum experience for women with adverse birth outcomes in India.

Examining the influence of Mother-in-law on family planning use in South Asia: insights from Bangladesh, India, Nepal, and Pakistan

BACKGROUND

Contraceptive use contributes to improved maternal and child health, education, empowerment of women, slow population growth, and economic development. The role of the family in influencing women's health and health-seeking behavior is undergoing significant changes, owing to higher education, media exposure, and numerous government initiatives, in addition to women's enhanced agency across South Asia. Against this backdrop, this study assesses the relationship between women's living arrangements and contraceptive methods used in selected south Asian countries (India, Pakistan, Nepal, and Bangladesh).

METHODS

Data of currently married women aged 15-49 from the recent round of Demographic and Health Survey (DHS) of four South Asian countries, i.e., Nepal (2016), Pakistan (2017-18), Bangladesh (2017-18), and India (2019-21) had been used. Bivariate and multinomial logistic regression was performed using Stata with a 5% significance level.

RESULTS

Living arrangement of women had a significant association with contraceptive use in South Asia. The Mother-in-law (MIL) influenced the contraceptive method used by the Daughter-in-law (DIL), albeit a country-specific method choice. Modern limiting methods were significantly higher among women living with MIL in India. The use of the modern spacing method was considerably high among women co-residing with husband and/or unmarried child(ren) and MIL in Nepal and India. In Bangladesh, women living with husband and other family member including MIL were more likely to use modern spacing methods.. Women co-residing with the MIL had a higher likelihood of using any traditional contraceptive method in India.

CONCLUSIONS

The study suggests family planning program to cover MIL for enhancing their understanding on the benefits of contraceptive use and modifying norms around fertility. Strengthening the interaction between the grassroots level health workers and the MIL, enhancing social network of DIL may help informed choice and enhance the use of modern spacing methods. Women's family planning demands met with modern contraception, and informed contraceptive choices, must also be achieved to reach the 2030 Agenda for Sustainable Development.

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'.

Exploring Unknown Predictors of Maternal Anemia Among Tribal Lactating Mothers, Andhra Pradesh, India: A Prospective Cohort Study

Introduction

Anemia is a serious public health issue in India, especially among women, adolescent girls, and young children. Tribal people reside mostly in remote underserved regions with little or no basic civic amenities which makes them a highly vulnerable group of Indians. The study aimed to identify unknown risk factors for anemia among tribal lactating mothers.

Methodology

It was a mixed method prospective cohort study for 10 months carried out among 340 scheduled tribes (ST) mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection using a questionnaire, 24 hours dietary recall, anthropometric measurement, and hemoglobin estimation was done. Weekly local recipe talk in the mother’s kitchen, informal group discussions, was conducted for 12 weeks after baseline data collection. The audio and video tapes of the weekly local recipe talk in the mothers kitchen were transcribed verbatim and then translated into English. The individual responses were grouped as barriers related to acceptability, availability, accessibility, use and utilization, appropriateness, and nutrition environment.

Results

A total of 340 mothers were enrolled initially of which 315 mothers were studied in an end-line survey with an attrition rate of 7.3%. Over 80% mothers belonged to Yerukula, Yenadis, Lambadi/Sugali tribes, respectively. A total of 345 weekly local mother kitchen recipe talks were conducted in 10 clusters. In the present study, only few mothers mentioned food accessibility and availability issues. Surprisingly, lack of skill to cook the commonly consumed local food item among Indian mothers were recorded. Lack of time for cooking, lack of knowledge of nutritious benefits of food, and use of ready to eat food were other important key findings.

Conclusion

The study documents initiation of transition of the tribal lactating mothers towards urbanization. The lack of knowledge of cooking, coupled with lifestyles of urban areas exposes the early aged, poor, low literate mothers to the trap of anemia.

Women living with their mothers-in-law

Background

Many studies have documented the impacts mothers-in-law have on daughters-in-law living in the same household, but few have quantified the scale of this co-residence.   This study aims to estimate the proportion of married women living with their mothers-in-law across countries and time. 

Methods

Using household rosters from 250 Demographic and Health Surveys in 75 countries, this paper uses the “relationship to head of household” question to identify households where married women live with their mothers-in-law.  For select countries with large changes, we decompose changes in rates into changes in the age structure of married women and the rate of women living with their mothers-in-law by age.

Results

This paper finds large variation in family structure around the globe, from 1% of married women in Rwanda to 49% in Tajikistan living with their mother-in-law.  Many countries with high co-residence in the 1990s continue to see high and increasing numbers today, especially in Central and Southern Asia, while some North and sub-Saharan African countries experienced substantial declines.  Decomposing changes by age and rates shows that changes in the age structure of married women is not driving changes in co-residence, but rather the rates are changing across age groups. 

Conclusions

These findings show the large variation in women living with their mothers-in-law across the globe.  The authors provide publicly available code and future research ideas to encourage others to further our understanding of the impact of living with her mother-in-law on a woman’s life.

What stops us from eating: a qualitative investigation of dietary barriers during pregnancy in Punjab, Pakistan

OBJECTIVE

Adequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in Pakistan is poor, with 14 % being underweight (BMI < 18·5) and 42 % experiencing Fe deficiency anaemia. This may stem from beliefs, practices and other barriers influencing dietary intake. This qualitative study seeks to determine which factors impact dietary intake during pregnancy in rural Punjab.

DESIGN

In-depth interviews and focus group discussions were conducted and then analysed using thematic analysis.

SETTING

Three purposively selected rural districts (Sahiwal, Okara and Pakpatan) with the highest prevalence of maternal and child malnutrition in the province of Punjab, Pakistan.

PARTICIPANTS

Mothers with children under age two (n 29) and healthcare providers with at least 5 years of experience working in the district (n 12).

RESULTS

We identified a combination of physiological, socio-cultural and structural barriers that inhibited healthful dietary intake during pregnancy. The primary physiological barriers to optimal dietary intake and dietary practices included food aversions and food cravings. Food classification, fear of a difficult childbirth, fear of high blood pressure and household food politics were the principal socio-cultural barriers. Additionally, two structural barriers, inadequate antenatal counseling and a lack of affordable food options, were identified.

CONCLUSIONS

Our study demonstrates that complex barriers prevent pregnant women in the Punjab area from consuming adequate dietary intake and that antenatal health education programmes and structural interventions are needed to support healthful dietary practices during this critical period.

Cross-lagged Models of Marital Relationships and Intergenerational Conflicts during Transition to Parenthood: Effect of Patrilineal Coresidence

The transition to parenthood is one of the most stressful intra- and interpersonal adjustment periods for new parents. Bidirectional associations among intergenerational relationships during the transition to parenthood have received limited attention, and the complexity of reciprocal relationships varies in accordance with living arrangements. The objectives of this study were to explore (1) the bidirectional associations between marital relationships and conflicts with in-laws during the transition to parenthood and (2) the moderation of patrilineal coresidence on the aforementioned relationships. A three-wave prospective longitudinal design was adopted for 359 married mothers. The Dyadic Adjustment Scale and Stryker Adjustment Checklist were used to assess marital relationships and conflicts with parents-in-law. Cross-lagged panel analysis was applied to examine reciprocal relationships, and multigroup analyses were employed to determine whether these relationships exhibited different patterns in accordance with the individuals' living arrangements. The two cross-lagged models revealed the presence of a bidirectional relationship between marital distress and conflicts with parents-in-law during the mid- to late pregnancy stages. Meanwhile, the multigroup analyses suggested that conflicts with parents-in-law triggered marital distress during pregnancy in the coresidence group, whereas conflicts with fathers-in-law could intensify marital distress during late pregnancy to the postpartum period in the noncoresidence group. These findings shed light on cross-lagged associations with intergenerational conflicts. Healthcare professionals need to ensure that intergenerational relationships are positive during the transition to parenthood. This study enriches our understanding of the effect of patrilineal coresidence and can guide the future development of interventions based on culturally specific multidimensional approaches.

Is fatigue a cue to obtain iron supplements in Odisha, India? A mixed methods investigation

OBJECTIVES

This study aims to understand if fatigue, the main symptom of anaemia, is a health concern that cues women and their referent groups to obtain iron folic acid supplements.

DESIGN

This is a mixed methods study that consisted of a cross-sectional perceptual mapping and card sorting activity along with 16 focus group discussions with women of reproductive age, mothers-in-law and men. Participants of the perceptual mapping and card sorting activity were asked to compare images of anaemia-related items and concepts. Participants in the focus group discussions were asked about their daily life, aspirations and concerns among women and perceptions of anaemia and iron supplementation in the community. The quantitative data were analysed through multidimensional scaling and analyses of variance in SPSS. The qualitative data were analysed through applied thematic analysis using NVivo.

SETTING

Bhubaneswar, Odisha, India.

PARTICIPANTS

Women of reproductive age (n=30), mothers-in-law (n=30) and married men (n=30) were randomly selected to participate in the perceptual mapping and card sorting exercise. A separate sample of each group was randomly selected for the focus group discussions (n=148).

PRIMARY AND SECONDARY OUTCOME MEASURES

We collected perceptions of dissimilarity between anaemia-related items, including fatigue and medical items; the extent to which these items were perceived as important to health or likable; and qualitative information about gender norms.

RESULTS

Cognitive maps and card sorting revealed that fatigue was conceptualised distinctly from items related to medical treatment and that perceptions around fatigue's importance to health were low. Women from the focus groups reported that fatigue is a regular part of their daily life.

CONCLUSION

Our results indicate that fatigue is currently not an adequate cue to seek treatment, perhaps due to the normalisation of fatigue as a part of women's daily life.