One author SK speaks and writes Sindhi, and another SP speaks Urdu and Katchi a dialect of Sindhi , hence they were able to coach the field workers during training interviews.
The research team also accompanied the field workers during the initial 3 or 4 interviews. All interviews were included in the analysis. To confirm the validity of the themes, 2 research team members independently reviewed and analyzed data. During this process, transcripts were reviewed again to confirm themes and ensure the meanings are informed by the data. Both verbal and written consent were obtained from the participants prior to each interview and focus group.
Since qualitative research is a situated activity [ 18 ], we wish to provide some salient observations about engaging the participants. Semi-structured interviews intend to allow interviewees to provide additional information where needed, while ensuring broad themes and ideas are explored [ 19 ].
This technique proved more successful with fathers, who often explored their answers in detail. The women, especially mothers, often answered with just a few words. Mothers frequently struggled answering broad questions, sometimes needing questions to be re-phrased and more specific. Fathers and grandmothers often provided more elaborate answers including information about the context in which these families live e. While it was challenging to encourage mothers to express themselves, adequate data was gathered for thematic analysis.
Themes that emerged are described below in relation to each research question. Mothers are the primary care givers of infants, but all participants explained that families work closely together to raise an infant. All together we do it.
Fathers provided situational support:. I help my wife a lot…When [the child] cries [at night] a lot, then I take her from her mother and I take her outside for a round. Father 3. One reason families work together to raise their infant is that parenting competencies are built and taught within the families. My parents have taught me…Nobody is born learned…we will learn these worldly matters.
Father 5. Furthermore, participants had confidence in knowledge transferred from one generation to the next, as they had survived and grown because of this care. Our mother taught us this that how to take care of child that how to feed child…When mother took care of us and made us grown so today also she knows that how to take care of child.
Consequently, mothers were encouraged to breast feed. Persistent crying, on the hand, was a sign of illness and prompted parents to seek guidance to problem solve next steps of care:.
Yes, understand that [baby] cries too much then I goes to tell [the grandmother] that she is crying so she looks after that what has happened then she tells me that feed her or give medicine. Mother 3. Although some mothers indicated that they only breast fed their baby, upon further probing, mothers disclosed use of home remedies and supplementation:. Mother 1. Supplementing also occurred during other critical time, generally identified as after 40 days, to promote growth of the child.
Fathers shared their perspectives on hunger and supplementation:. Then we bring those foods that the doctors prescribes. We bring cerelac. Extended family members, especially paternal grandmothers, were a significant source of support for parents in problem solving the care needs of their infant:. Our elders know more than us, they have raised us; so we will consult them.
Father 4. Fathers also acknowledged other supportive family members. Initially, most mothers conveyed independent decision-making for their infant or children, but it became clear with further probing that both mothers and fathers needed some form of permission in order to make decisions for the health of their infant:.
No, I [make a decision] after asking from elders. Advice from elders is pivotal to the decision-making process. I just go and sit down silently. For some, the desire to do everything for the child meant going against the elders:. God has given huge power to the doctor, so they treat the patient well. Then life is in the hands of God. It is very effective. One grandmother indicated that it is difficult to determine the health needs of the infant prior to the 40 days:. Then he will touch his ear again and again, then we will say that he has earache.
Grandmother 2. Elder women used to sell home remedies. Nowadays, even if something minor happens, [mothers] take the child to the doctor. Grandmother 4. Whatever doctor prescribes they treat child accordingly.
There is conflict between the ways in which the community cares for infants and the recommendations from the medical professionals. Now the children of new generation like to have new and prepared products…. Regardless of the approach to care i.
All participants were deeply affected by the health of their infant, compelling them to do anything for their child. Additionally, fathers verbalized a deep love for their infant, acting as a motivating factor:.
It seems as if my child is my heart, he is my soul and a part of mine. The way a father cares for his child, I care for him that way only. The child is a part of the parent. Anybody who cares for his child does everything he can for the child.
Father 9. Despite the deep love for their child, fathers also expressed difficulties in caring for their families because of their financial status:. I am a poor man, whatever I earn and all the efforts that I can do, I will do those for my child, and I will not let my child suffer for anything.
In the event that parents needed financial assistance in caring for their ill child, working together was also important. When the child has constipation, then we give him or her water with sugar mixed in it; they say that the sugar water is good for constipation. We do not have anything else at home. Father 6. The interviews were a rich source of information about the cultural practices intended to improve infant health, described in Table 2.
Although the mothers strived to take care of their babies in the best way possible, some of the mothers had little or no knowledge about the ingredients used in the natural remedies. If there is too much problem, then we will take baby to the hospital Grandmother 3. Another grandmother indicated that traditional remedies are sometimes chosen at night time when going to the doctor is not an option:.
Grandmother 1. Alternatives to home remedies i. Another mother explained:. My husband forbids me. Our first child expired after taking medicines, when he received injection. So that means he dies. Mother 7. Regardless of when a family seeks medical attention for their child, they are acting in the best way they know how. Loving care necessitates acquiring knowledge and skills related to infant care including seeking home remedies when the infant in unwell. The silence embodies quiet acceptance of decisions by the extended family members, especially the paternal grandmother, regarding seeking health care and having faith in God for good health outcomes for her newborn.
Participants described a multigenerational approach to decision-making concerning infant care, including parents, grandparents, aunts and uncles, and sometimes the community. Parents deferred to elders when the infant was unwell, consistent with the cultural value of gaining experience and knowledge through practice.
Parents learned to be caregivers as they raised their infants. When parents had successfully raised their children and overcame adversity, they then reached a status allowing involvement in decision-making and in teaching future generations.
One factor which may be protective for child mortality [ 20 ] is how families work together to care for their infant; paradoxically at times, may put the infant at risk of death. This rich support network offers much help for the parents to improve health knowledge and care. However, women were also bound by social ties, unable to act autonomously or have a voice in care decisions.
This may be unsettling to mothers, raising confusion, guilt, and uncertainty about their mothering practices [ 21 ]. In a study of Pakistani women, perceived lack of social support was a risk factor for postnatal depression [ 22 ]. If mothers are unable to articulate their opinions, both their health and the health of their infant may be compromised. Conversely, fathers would do anything for their child, sometimes going against the elders, particularly when traditional approaches were not improving the health of their infant.
Having the understanding and support of the community and all family members is pivotal to designing culturally appropriate, effective community-based interventions. Participants were concerned with the physiological, safety, and comfort needs of the infant, although limited consideration was given to supportive caregiving e.
Participants relied on late hunger cues i. Furthermore, both mothers and fathers expressed little knowledge of parenting skills. Moreover, the content and focus of what people talk about in their conversations also vary across cultures. As early as infancy, mothers from different cultures talk to their babies differently. Mothers of the African tribal group Nso, on the other hand, focus more on social context.
This early exposure affects the way children attend to themselves or to their relationship with others — forming their self image and identity. In Asian, African, Southern European and South American countries, however, children describe themselves more often around their relationship with others and social roles. Because children in different cultures differ in how they think about themselves and relate to others, they also memorise events differently.
For example, when preschoolers were asked to describe a recent special personal experience, European-American children provided more detailed descriptions , recalled more specific events and stressed their preferences, feelings and opinions about it more than Chinese and Korean children. The Asian children instead focused more on the people they had met and how they related to themselves.
Typically, parents are the ones who prepare the children to interact with wider society. European-American children frequently provide long, elaborative, self-focused narratives emphasising personal preferences and autonomy.
Their interaction style also tends to be reciprocal, taking turns in talking. They often take a more passive role in the conversations. Race and other identities are often sites of discrimination and oppression in societies; as such, they can have a tremendous impact on childhood development. The United States is a very racialized society, and children—especially children of color—often become aware of the dynamics of racism at a very young age.
Children are taught the stereotypes that go along with their particular race s , as well as the races of others, and these stereotypes can have a strong influence on their development. Stereotypes and racialized expectations often contribute to stereotype threat , in which a child experiences anxiety or concern in a situation that has the potential to confirm a negative stereotype about his or her social group.
Importantly, stereotype threat has been shown to be something of a self-fulfilling prophecy—not because the negative stereotype is accurate, but because fear of fulfilling that stereotype can lead to additional anxiety, which in turn can reduce performance. For example, stereotype threat can lower the intellectual performance of black students taking the SAT, due to the stereotype that they are less intelligent than other groups, which may cause them to feel additional pressure and anxiety.
Intersectionality is the study of the intersections, or the relationships, between different forms or systems of discrimination or oppression. This theory suggests that—and seeks to examine how—various biological, social, and cultural categories such as gender , race, class, ability, sexual orientation , religion, caste, and other areas of identity interact and contribute to various forms of social inequality.
Intersectionality holds that different forms of discrimination—such as racism, sexism, biphobia, ableism, transphobia, and classism—do not act independently of one another; instead, they interrelate and create a system based on multiple forms of discrimination.
All of these factors are important to keep in mind when examining the cultural influences of such discrimination on child development. For example, the experience of growing up as an African-American girl in the United States cannot be understood only in terms of being black or of being female; instead, the ways in which these identities interact and frequently reinforce each other must be examined.
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