Changes in work and care trajectories during the transition to motherhood

In most mid- and high-income countries, there have been significant demographic, structural, and cultural changes in the past decades. However, we know little about how these changes have shaped women's work patterns during a key life stage: the transition to motherhood. Using longitudinal data from Chile, covering over 30 years of employment histories and three periods of first births (1980–2010), I conduct sequence analysis to identify women's work-care trajectories during an eight-year period of the transition to motherhood. Over time, I find that continuous care work at home has declined, for which education plays a key role, while the chances of working continuously have not changed over time. Instead, I find an increasing trend of unsteady paths that combine paid work with either caretaking or unemployment. I discuss how these changes, as well as their association with education, have important implications for both gender and social inequality.     

Dealing with context in logic model development: Reflections from a realist evaluation of a community health worker programme in Nigeria

Logic models (LMs) have been used in programme evaluation for over four decades. Current debate questions the ability of logic modelling techniques to incorporate contextual factors into logic models. We share experience of developing a logic model within an ongoing realist evaluation which assesses the extent to which, and under what circumstances a community health workers (CHW) programme promotes access to maternity services in Nigeria. The article contributes to logic modelling debate by: i) reflecting on how other scholars captured context during LM development in theory-driven evaluations; and ii) explaining how we explored context during logic model development for realist evaluation of the CHW programme in Nigeria. Data collection methods that informed our logic model development included documents review, email discussions and teleconferences with programme stakeholders and a technical workshop with researchers to clarify programme goals and untangle relationships among programme elements. One of the most important findings is that, rather than being an end in itself, logic model development is an essential step for identifying initial hypotheses for tentative relevant contexts, mechanisms and outcomes (CMOs) and CMO configurations of how programmes produce change. The logic model also informed development of a methodology handbook that is guiding verification and consolidation of underlying programme theories.     

Mothers' work patterns and Children's cognitive achievement: Evidence from the India Human Development survey

As female labor force participation increases globally, the relationship between maternal employment and children's development remains unclear. Using data from the India Human Development Survey (2005), we investigate the link between maternal employment and children's arithmetic and reading achievement. We develop a work pattern typology that goes beyond standard measures of employment and captures work intensity and its compatibility with child-rearing in a transitional economy. We find that the relationship between maternal employment and children's outcomes is not unidimensional. For example, children of self-employed mothers are not disadvantaged compared to those with stay-at-home mothers, but maternal employment in salaried jobs or wage work outside the home is negatively associated with cognitive skills in children. However, this negative association is reversed at higher levels of maternal education, suggesting greater access to resources and flexibility associated with better jobs mitigate the negative aspects of maternal employment posed by time constraints. Additionally, maternal employment is associated with maternal involvement in schoolwork and financial investment in academic activities, providing evidence that both time and resources devoted to children's education are significant.     

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners’ meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.     

Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study

BackgroundIn Ethiopia, maternal health service utilization is still unacceptably low. The societal and cultural factors that constrain women from attending these services have not yet been sufficiently explored. Using qualitative methods, we aimed to explore the factors that delay maternal health service utilization in eastern Ethiopia.MethodA total of 13 audio-recorded focus group discussions were conducted comprising 88 participants. We conducted separate group discussions with reproductive aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers to capture their knowledge, practices, feelings, thoughts and attitudes towards maternal health service utilization. The recorded sessions were transcribed into the local language and then translated into English for analysis.ResultThe study identified a number of factors that may delay maternal health service utilization. Factors were grouped using the Three Delays model as a framework. Low level of awareness regarding need, poor involvement of husband, perceived absence of health problems, social power, community misperceptions and cultural restrictions, negative attitudes towards male midwives, acceptance of traditional birth attendants and poor social networking were Delay One factors. Lack of physical accessibility and high transportation costs were categorised as Delay Two factors for skilled birth care attendance. Perceived or experienced poor quality of care were categorised as Delay Three factors for both skilled birth and postnatal care utilization.ConclusionDespite the ongoing government measures to improve maternal health service utilization in Ethiopia, numerous factors continue to contribute to delays in service use, which in turn contribute to high maternal mortality.     

Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia

Optimal feeding practices can establish lifelong, transgenerational and global health benefits. Migration and cultural factors impact infant feeding practices and the support mothers receive for optimal infant feeding. This qualitative study explored support for infant feeding among Arabic and Chinese speaking migrant mothers in Australia.Semi-structured focus groups were conducted in language with 24 Arabic and 22 Chinese-Mandarin speaking migrant mothers with children under five years of age. Individual interviews were conducted in English with 20 health professionals working with Arabic or Chinese speaking migrant families. Data were thematically analysed using the framework method.Traditional family networks and trusted bi-cultural doctors were influential infant feeding supports for mothers. Health professionals perceived maternal and child health services to be poorly understood, and some mothers who accessed services felt they were not always culturally sensitive. Mothers sought additional information and support through online sources and peers. Both mothers and health professionals recognised the challenges of managing conflicting infant feeding advice and seeking best-practice support.The findings of this study highlight opportunities for health professionals to better support migrant mothers’ infant feeding practices, for example through engaging families and working with doctors. There is a need for greater cultural sensitivity within maternal and child health services and culturally relevant programs to support healthy infant feeding practices among migrant communities.     

Providers’ perspectives of barriers experienced in maternal health care among Marshallese women

Problem

Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care.

Apron strings of working mothers: Maternal employment and housework in cross-national perspective

This paper asks whether maternal employment has a lasting influence on the division of household labor for married women and men. Employing multi-level models with 2002 ISSP survey data for 31 countries, we test the lagged accommodation hypothesis that a long societal history of maternal employment contributes to more egalitarian household arrangements. Our results find that living in a country with a legacy of high maternal employment is positively associated with housework task-sharing, even controlling for the personal socialization experience of growing up with a mother who worked for pay. In formerly socialist countries, however, there is less gender parity in housework than predicted by the high historical level of maternal employment.