COMMUNITY MODEL FOR FOSTERING HEALTH AND WELLBEING FOR ADOLESCENT MOTHERS & THEIR CHILDREN IN MALAWI
With support from Grand Challenges Canada, the Young Women Christian Association of Malawi (YWCA) in collaboration with the Regional Psychosocial Support Initiative (REPSSI) and the World Young Women Christian Association are working on a joint project titled: Community Model for Fostering Health and Wellbeing for Adolescent Mothers and their Children. The project strives to ensure that adolescent mothers and pregnant girls acquire knowledge and skills to care for and nurture their children, including providing stimulating developmental and psychosocial support to them. This intervention is critical during the first 1,000 days of the children as this is a period of great brain activity and development. As such, it is important that the adolescent mothers provide stimulating and developmental support to their children and help them develop accordingly in these crucial early days.
The goal of the project is to improve early child development and well-being of marginalized married adolescent pregnant girls and young mothers in Malawi. It aims to strengthen self-awareness, self-care and provision of psychosocial support to own children by adolescent mothers.
The project will provide safe and inclusive community spaces for married girls and adolescent mothers. YWCA coordinators and champions will hold two dialogue sessions a month at YWCA safe spaces in Mulanje, Blantyre and Machinga. REPSSI Psychosocial Support (PSS) programs will be used to build resilience and self-esteem and build mutual support among girls. The project will seek to empower girls to prioritize their own and their children’s health and wellbeing.
The project will collect data on demographics; physical growth of the youngest child; the child’s development (motor development, cognitive development, language and communication development, social and emotional development, and nutrition); and the mother’s psychosocial well-being (resilience, self-esteem, parental stress, infant-mother interaction, and experiences of Intimate Partner Violence (IPV).
Baseline data was collected from 267 participants across three districts, namely Mulanje, Blantyre, and Machinga. Most respondents came from a rural area. Mothers’ ages ranged from 13-19, with a mean age of 17.56. Most mothers (89.43%) had only given birth to one child, while 10.19% had given birth to more than one. Ages of the children that will be followed through this project ranged from 1 to 36 months with a mean of 12.79 months. The sex of the youngest children were almost equally divided between female and male. Most of the respondents (58.05%) reported being married or in a domestic relationship while 22.47% reported being single, never married. Interestingly, 58 respondents under the age of 18 reported being married or in a domestic relationship (59.18% of respondents under 18). When asked who they live with, most (51.31%) responded that they were living with their husband followed by mother/father (26.59%). Most respondents (47.57%) achieved a Standard 7 or Standard 8 level of education. Only 4.12% reported reaching Form 4 and only 77 (28.84%) of respondents indicated that they had their own source of income.
Most mothers (58.02%) indicated that the father of their child provide material support (such as food, clothing, or shelter) while 53.18% indicated that they provide financial support. Of interest is that 31.09% of the respondents indicated that the father of their child provides no support at all.
Overall, most children (65.24%) fell within the expected levels of physical development (between 15th and 85th percentile) across all indicators. It should be noted that 26.59% were below the expected length for their age, while 22.10% were below the expected BMI. On the other hand, 22.47% were assessed as being above the expected weight for length and 22.10% had an above the expected head circumference.
In relation to the motor, cognitive, social and emotional, and language and communication scores, the average scores show reason for concern. Keeping in mind that a 100% score on these indicators means that the child met all the age-relevant developmental milestones, the children scored on average 61.43% in relation to motor development, 50.23% for cognitive development, 39.14% on social and emotional development, and 28.68% for language and communication development.
Respondents had a mean score of 61.43 for motor development. Only 38.02% of children aged between 6 and 14 months were able to walk with assistance while 76.56% of those between the ages of 4-9 months were sitting without support. Respondents had a mean score of 50.23 for cognitive development. Children between 13 and 24 months reached the cognitive milestones expected of them. However, those aged between 4 and 9 months were doing less well. For example, only 11.54% of 4-6 month olds were reaching for objects and only 20.59% of children between 7 and 9 months were giving, pointing, or showing. Language and communication development seemed to be behind for most age groups. Examples of this include only 3.85% of those between the ages of 4 and 6 months were reported to chuckle and giggle. Only 21.78% of children between 12 and 23 months were able to point to a few body parts when asked. With a mean score of 39.14, social and emotional development also seems to be behind.
In relation to nutrition, over half of those whose child was younger than six months were exclusively breastfed (59.32%). More than half of the mothers (67.79%) reported that their child is being breastfed along with consuming other foods. Less than a fifth of the mothers (17.60%) reported that their child does not drink soft drinks (high in sugar). Most mothers reported that their child eats porridge with groundnuts while just under half said that their child eats nsima (hard porridge) with relish e.g. beans, eggs, meat, vegetable.
When exploring the resilience of the mother, nearly three quarters of the mothers (74.39%) agreed or strongly agreed that they tend to bounce back quickly after hard times. However, 65.75% agreed or strongly agreed that it is hard for them to snap back when something bad happens. More than half of the mothers (63.77%) agreed or strongly agreed that they have a hard time making it through stressful events. In relation to self-esteem, almost all of the mothers (93.72%) agreed or strongly agreed that they take a positive attitude towards themselves. However, several mothers agreed or strongly agreed that they could have more respect for themselves (96.62%) and that they do not have much to be proud of (71.49%).
Over 80% of mothers agreed or strongly agreed that they enjoy spending time with their child and that their child is an important source of affection for them. On the other hand, some mothers agreed or strongly agreed that they sometimes worry whether they are doing enough for their child (73.43%) and that caring for their child sometimes takes more time and energy than they have to give (63.29%). Finally, 42.03% of the mothers agreed or strongly agreed that if they had to do over again, they might decide not to have a child.
The Mother-Infant Interaction seemed to be positive overall. Most mothers’ (37.56%) predominant maternal mood/affect was characterised by shifting expression of pleasure or tenderness; shifts expression in response to Infant behaviour, prolonged visual regard, smiles at Infant. Mother’s attention may be briefly distracted by events in room, but Mother’s overall focus is on Infant. Most mothers (35.75%) spoke to their child with affection and expressing approval. Almost half of the children (46.15%) presented as pleasant, relaxed, and appeared interested. It should be noted however, that 18.55% of the mothers presented with a flat, angry, or annoyed expression, spending little time looking at Infant, may have read or engaged in activities, which diverted attention from Infant.
Most mothers expressed feeling safe or completely safe in their home (73.41%) and in their community (75.28%). However, around a quarter of respondents reported feeling completely unsafe or unsafe in their homes and in their communities. The forms of IPV reported by the highest number of mothers were “My partner told me I was crazy, stupid or not good enough” (24.53%); “My partner blamed me for causing their violent behaviour” (21.05%); and “My partner made me perform sex acts that I did not want to perform” 17.11%).
There was a strong positive correlation between Social and Emotional Score and Language and Communication Score. The Social and Emotional Score explained 36% of the variation in the Language and Communication Score. There was a moderate positive correlation between Cognitive Development Score and Motor Development score, with the Cognitive Development Score explaining 24% of the variation in the Motor Development score.
There were significant differences between districts in relation to: the Child’s Language and Communication Score, the Child’s Social and Emotional Score, the Mother’s Parental Stress Score, the Mother Infant Interaction Score, the IPV Mother Experienced, and IPV Child Witnessed. Rural mothers had significantly higher means (average) on the Child’s Language and Communication scores, the Child’s Social and Emotional Score, and Child’s nutrition score. On the other hand, mothers from peri-urban areas had significantly higher Mother’s Parental Stress Scores, reported a significantly higher number of IPV types experienced by the mother and witnessed by the child. These results seem to indicate that mothers from rural areas and their children are doing better than those living in peri-urban areas.
There was a significant difference on the Child’s Cognitive Development Score and Mother Infant Interaction Score for mothers with their own source of income. These results suggest that a mother having her own source of income can lead to increased cognitive development for their child and an improvement in the quality of the mother-infant interaction.
The results obtained through this baseline study seem to justify the need for projects such as these for this group of vulnerable mothers and children. It also highlights the need to look beyond the growth indicators when thinking about child development. Most of the children did well on these but then struggled to meet the basic indicators in relation to motor, cognitive, social and emotional, and language and communication development. This project goes even further by looking at issues such as nutrition, the infant-mother interaction, exposure to IPV, and the psychosocial well-being of the mother. This will provide a more holistic picture of both mother and child over the period of the project. It is hoped that both the mother and the child will show improvements in relation to development (for the children) and psychosocial well-being (for the mothers).