Cleft-Related Infanticide and Abandonment: A Systematic Review of the Academic and Lay Literature

Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study

BACKGROUND

Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples.

OBJECTIVE

This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P.

METHODS

A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants' demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma.

RESULTS

The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404).

CONCLUSIONS

Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents' education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents' social anxiety, reducing perceived stigma, and preventing depression.

Experiences and perspectives of women who have committed neonaticide, infanticide and filicide: A systematic review and qualitative evidence synthesis

WHAT IS KNOWN ON THE SUBJECT?: The phenomenon of child killing (neonaticide, infanticide or filicide) is a rare event that cannot be fully explained by a single construct as each case involves the unique life circumstances of each woman who committed the act(s). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of women who committed neonaticide, infanticide or filicide regretted the act and regretted not seeking help from family and healthcare professionals. Women who committed neonaticide, infanticide or filicide in the main had complex circumstances characterised by poverty, abusive relationships, poor family and social support or over reliance on family supports and mental health issues. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women may be pathological and require further assessment. Women need to be made aware of the support service pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences to reduce child homicide mortality and support women and their families.

ABSTRACT

INTRODUCTION: Meaning and personal experiences of the acts of neonaticide, infanticide and filicide have rarely been investigated from the perspectives of the women who committed those acts.

AIMS

To identify and synthesise evidence on the perspectives of women directly involved in the complex phenomena of neonaticide, infanticide or filicide from the evidence available on their unique point of view and how these experiences have affected women's lives. To understand how the experiences and perceptions of women who engaged in child killing present similarities or differences according to the child's age at time of death.

METHODS

Qualitative primary studies published in English were included if they explored the experiences of women who engaged in neonaticide, infanticide or filicide. Methodological quality was assessed using the qualitative Critical Appraisal Skills Programme (CASP) checklist. A thematic analysis framework guided the synthesis.

RESULTS

Seven papers reporting on five studies met the inclusion criteria for the review. Three analytical themes were identified: Not ready to be a mother; Intentionality and premeditation in the context of trauma and mental health issues; Sorrow of regret.

DISCUSSION

The majority of women who committed neonaticide, infanticide or filicide had complex psychological, social and personal circumstances and in the main regretted the act and regretted not seeking help from family and healthcare professionals. Healthcare professionals in contact with women during the perinatal period and beyond need to be aware of the profiles of vulnerable women and undertake holistic integrated assessments to identify the woman's personal context, changes in interpersonal relationships, social isolation or over reliance on family supports and changes in mental health status or new onset of mental health conditions.

IMPLICATIONS FOR PRACTICE

Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women might be pathological and require further assessment. Women need to be made aware of the support services pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences of each of the phenomena separately to reduce child homicide mortality and support women and their families.

A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana

OBJECTIVE

The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa.

DESIGN

Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members.

SETTING

A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital.

PARTICIPANTS

Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana.

INTERVENTIONS

Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care.

RESULTS

Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2.

CONCLUSIONS

Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.