Coverage and Determinants of Infant Postnatal Care in Nigeria: a Population-based Cross-sectional Study

Background: In 2019, Nigeria had the most under-5 child deaths globally, many of which occurred within the neonatal period, especially in the first week after birth. Despite the effectiveness of infant postnatal care (PNC) attendance recommended by the World Health Organization (WHO), this problem persists. Therefore, the study examined coverage and determinants of infant PNC attendance in Nigeria. Methods: Nigeria Demographic Health Survey (NDHS) 2018 data were used to evaluate infant PNC coverage and determinants. Infant PNC was defined as receipt of care within two days of birth. Children delivered up to two years before the 2018 NDHS were included. We examined predictors of infant PNC with Poisson regression models to estimate relative risks (RR).Results: The national coverage of infant PNC was 37.3% (95% CI: 35.8%–38.7%). Significant heterogeneity in PNC attendance exists at state and regional levels. Facility delivery was strongly associated with uptake of PNC (RR: 6.07; 95% CI: 5.60–6.58). Greater maternal education, maternal employment, urban residence, female head of household, and greater wealth were also associated with increased likelihood of PNC visits. Conclusions: Uptake of infant PNC in Nigeria is low. Interventions are urgently needed to promote equity in access and increase demand.

Perception of Working Mothers on Child Development: A Qualitative Study from Pakistan

The inclusion of women in the workforce is imperative for the advancement of every country in the world. In Pakistan the role of women is undergoing dynamic transformation which can have considerable influence on the mother-child relationship and child development. This research attempts to understand the influence of out-of-home maternal employment on the development of child. The study is qualitative in nature using snowball sampling. A total of six working mothers were interviewed from Lahore, Pakistan. Thematic analysis technique has been used to analyze the data. The following themes were identified: (i) Child Neglect; (ii) Strained Child-Parent Relationship; (iii) Child Aggression; (iv) Low Academic Achievement; and (v) Independence and Sense of Responsibility. The study concludes that working mothers need family and employer support to ensure child development in Pakistan. Some of the key reforms that are needed include respect for women’s triple role in society and employment benefits for working mothers.

Parental Educational Attainment and Frequency of Marijuana Use in Youth: Hispanics’ Diminished Returns

Background: While socioeconomic status (SES) indicators such as parental educational attainment show robust associations with health behaviors such as substance use, the protective effects of these indicators may differ across racial groups. This phenomenon of weaker associations between SES indicators and health outcomes for marginalized and minoritized groups relative to non-Hispanic White people has been labeled “Marginalization-related Diminished Returns” (MDRs). Here, we test both whether parental educational attainment is associated with marijuana use frequency in youth as well as whether we observe racial and ethnic variation in this association consistent with MDRs. Methods: This study used data from the cross-sectional 2019 Monitoring the Future survey (MTF 2019). Participants included 29,230 youth who were either Hispanic (24.1%), non-Hispanic Black (16.1%), or non-Hispanic White (59.9%). We used weighted logistic regression models to test for (1) associations between maternal educational attainment and youth cannabis use frequency as well as (2) moderation of this association by race/ethnicity, while adjusting for the complex sample design of the MTF 2019 data. Age, sex, father presence, and maternal employment were entered into models as covariates. Results: Overall, children born to mothers with higher educational attainment reported less frequent marijuana use than peers born to mothers with lower educational attainment. However, this association was significantly weaker in Hispanic versus non-Hispanic White youth. Conclusion: The strength of the association between parental educational attainment and youth marijuana use frequency appears to differ across ethnic groups. Specifically, we observed that whereas non-Hispanic White youth from high-SES families tend to report less marijuana use than peers from lower-SES families, Hispanic youth report roughly equal levels of use across the full SES spectrum. This finding is in line with the MDRs framework and may reflect factors such as structural racism, social stratification, and the marginalization of ethnic minority families in the US.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys

Background Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. Methods In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. Results Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 – 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 – 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 – 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 – 3.243), richer (RRR = 1.908, 95 % CI 1.145 – 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 – 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 – 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 – 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 – 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 – 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 – 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 – 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. Conclusions Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia

Background One of the most cost-effective interventions to enhance child health with the potential to reach families of all economic backgrounds is breastfeeding. Despite the many benefits optimal breastfeeding has, its practice is low due to various barriers among which maternal employment is mentioned repeatedly. Accordingly, this study has explored the experience of employed mothers with regards to breastfeeding, employment, and work environment in Addis Ababa Ethiopia. Methods and findings A descriptive Phenomenology strategy was employed among 17 mothers drawn from different organizations, conveniently, that offer accommodation of six months maternity leave or onsite child care center or had only three months maternity leave. Data were collected through in-depth interviews until information saturation was reached. Recorded interviews were transcribed and translated and the information obtained was then organized and coded to generate overarching themes. Two themes on facilitators and barriers, and addressing barriers were generated after analysis. Mothers recognize the importance of breastfeeding for children but returning to work at three months is expressed as a major barrier to continuous breastfeeding. Mothers who have access to supporting conditions at their workplace expressed better breastfeeding practice and better satisfaction with their job. Conclusions Providing employed mothers with a supporting environment helps them work with better stability, motivation, and satisfaction. This however requires a suitable accommodation with a focus on the different kinds of work environments of the mothers and the different risks related to each respective environment via scaling up and monitoring breastfeeding interventions and calling upon institutions to remove structural and societal barriers to breastfeeding.

Family Benefits and Services

This chapter examines welfare-state support for families with children in the context of low fertility, increasing rates of childlessness, and a general move away from the breadwinner model of the family. Welfare-state spending on families is explored, and, although most countries, with few exceptions, spend more on older people, spending on children varies between countries, as does spending to encourage mothers into employment. Adopting the model family method to compare the package of policies to support families with children at different earning levels, the chapter shows varying results of generosity, depending on whether we compare low or average earners. The chapter also provides evidence that family policies matter for outcomes—with stronger spending on services increasing both fertility and maternal employment, spending on both services and benefits increasing child well-being, and generosity of transfers lowering child poverty rates.

Prevalence of exclusive breastfeeding practice and its association with maternal employment in Ethiopia: a systematic review and meta-analysis

Background Exclusive breastfeeding is defined as the practice of providing only breast milk for an infant for the first 6 months of life without the addition of any other food or water, except for vitamins, mineral supplements, and medicines. Findings are inconsistent regarding the prevalence of exclusive breastfeeding in Ethiopia. Full-time maternal employment is an important factor contributing to the low rates of practice of exclusive breastfeeding. Empowering women to exclusively breastfeed, by enacting 6 months’ mandatory paid maternity leave can increase the rate of exclusive breastfeeding in the first 6 months of life up to 50%. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with full-time maternal employment in the first 6 months of life for infants in the context of Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. All observational studies reporting the prevalence of exclusive breastfeeding and its association with maternal employment in Ethiopia were considered. The search was conducted from 6 November 2020 to 31 December 2020 and all papers published in the English language from 1 January 2015 to 31 December 2020 were included in this review. Results Forty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI 55.81, 65.02) at 6 months in Ethiopia. Those full-time employed mothers in the first 6 months were 57% less likely to practice exclusive breastfeeding in comparison to mothers not in paid employment in Ethiopia (OR 0.43; 95% CI 0.31, 0.61). Conclusions Full-time maternal employment was negatively associated with the practice of exclusive breastfeeding in comparison to unemployed mothers. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. The Ethiopian government should implement policies that empower women. The governmental and non-governmental organizations should create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.