Suchergebnisse

We evaluate the medium-term impacts of treating maternal depression on women's mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world's largest psych otherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women's mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women's financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations. (JEL G51, I12, J16, O15)

In traditional settings where early marriage and early childbearing persist, decisions about age at marriage are often made by parents, and mothers‐in‐law tend to have considerable influence in hastening the initiation of childbearing. This study analyzes data from a 2002 survey in six villages in rural Bangladesh to test the hypothesis that daughters of women with more education marry later and that daughters‐in‐law of more educated women initiate childbearing at a slower rate. Using Cox proportional hazard models, we find significant associations between the educational level of mothers and the age at marriage of their daughters and between the educational level of mothers‐in‐law and the timing of first birth among their daughters‐in‐law, although the association between the former attenuates when controlling for other variables. We also find that these associations do not appear to be mediated by the senior women's level of empowerment. We conclude that in rural Bangladesh there is a significant relationship between female education in one generation and the timing of marriage and childbearing in the next.

Abstract
We investigate the importance of subjective expectations of returns to and effort costs of the two principal investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in rural Pakistan in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and that this contributes to explaining heterogeneity in investments. We find no significant differences across women in preferences for child developmental outcomes. We simulate the impact of alternative policies on investments. Our findings highlight the relevance of interventions designed to address maternal depression and reduce perinatal fatigue alongside interventions that increase perceived returns to investments.

AbstractObjectiveThis manuscript describes the Day‐in‐the‐Life (DIL) method for assessing child caregiving activities, its implementation, and findings regarding family members' roles and associations with maternal depression symptoms.BackgroundInfant caregiving activities are most commonly performed by the mother, although there is increasing acknowledgement of others' contribution. Few methods exist to measure the diverse caregiving activities that mothers and others perform.MethodMethod development occurred within the Bachpan Cohort Study in rural Pakistan (N = 1154 maternal–child dyads) when the child was 3 months old. The DIL was designed as a semi‐structured interview in which the mother describes her child's day from their perspective. Regression analyses were then used to explore the correlation between the DIL and depression symptoms, using the Patient Health Questionnaire‐9 (PHQ‐9) measure.ResultsThe DIL method was easy to administer and displayed excellent interrater agreement. The findings indicated that instrumental caregiving was mostly provided by the mother alone, others in the household tended to contribute more to infant social interactions, and there was more support from others when the mother was less able to provide care (e.g., when ill). Depression symptoms were higher among women who experienced less contribution from family members when the mother was less able to provide care.ConclusionsThe DIL can be deployed to measure infant caregiving activities and associations with maternal mental health.ImplicationsThis method is promising for researchers interested in disentangling the contribution of multiple family members toward child caregiving and its impacts on maternal and child health.

BACKGROUND: Perinatal depression is a common condition of pregnancy and the postpartum period. Depression negatively affects engagement in HIV care, but systematic screening for perinatal depression is not done in most sub-Saharan African countries. Estimating the burden and timing of perinatal depression can help inform medical programs with the current scale-up of HIV care for pregnant women. METHODS: Women (n=299) initiating antiretroviral therapy for HIV were recruited from a government antenatal clinic in Malawi in 2015-2016 into a cohort study. Probable perinatal depression was assessed at enrollment and at 6 weeks and 3, 6, and 12 months postpartum with the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9). We estimated point prevalence and incidence of depression as well as concordance between EPDS and PHQ-9 scores. RESULTS: One in ten women screened positive for probable antenatal depression, whereas 1-6% screened positive postpartum. Sensitivity analyses to account for loss to follow-up suggested that postpartum depression prevalence could have ranged from 1-11%. At postpartum time points, 0-3% of participants screened positive for incident probable depression. EPDS and PHQ-9 scores were concordant for 96% of assessments during antenatal and postpartum visits. LIMITATIONS: Lack of diagnostic psychiatric evaluation precludes actual diagnosis of major depression, and social desirability bias may have contributed to low postpartum scores. CONCLUSIONS: Probable depression was more common during the antenatal period than postpartum among our participants. Given the association between depression and negative HIV outcomes, screening for depression during pregnancy should be integrated into antenatal HIV care.

OBJECTIVE: To estimate the association of probable antenatal depression with postpartum HIV care engagement among pregnant women in Malawi. DESIGN: We conducted a prospective cohort study of 299 women who were initiating antiretroviral therapy (ART) through Option B+ at a government antenatal clinic in Malawi. METHODS: Probable antenatal depression was assessed on the day of ART initiation with the validated Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS). We estimated crude and adjusted risk differences (RD, aRD) of visit attendance and prevalence differences (PD, aPD) of viral suppression through 12 months post-ART initiation comparing women with versus without probable antenatal depression. RESULTS: One in ten women had probable antenatal depression. Most women were engaged in care through 12 months post-ART initiation: 85% attended all scheduled ART visits, and 81% were in care and virally suppressed. Women with and without probable antenatal depression had a comparable probability of attending all scheduled visits (RD: −0.02; 95%CI −0.16–0.12; aRD: −0.04; 95%CI −0.18–0.10), and of viral suppression (PD: −0.02; 95%CI −0.17–0.13; aPD: −0.01; 95%CI −0.17–0.15) in crude and adjusted analyses. CONCLUSION: Probable antenatal depression was not associated with engagement in HIV care through 12 months post-ART initiation. In a population with high HIV care engagement, antenatal depression may not impair HIV-related outcomes.