Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey

Jessica Mackness, John A Gallis, Raymond Kofi Owusu, Mohammed Ali, Safiyatu Abubakr-Bibilazu, Haliq Adam, Raymond Aborigo, John Koku Awoonor-Williams, Margaret Lillie, Elena McEwan, John Hembling, Lavanya Vasudevan, Joy Noel Baumgartner, Jessica Mackness, John A Gallis, Raymond Kofi Owusu, Mohammed Ali, Safiyatu Abubakr-Bibilazu, Haliq Adam, Raymond Aborigo, John Koku Awoonor-Williams, Margaret Lillie, Elena McEwan, John Hembling, Lavanya Vasudevan, Joy Noel Baumgartner

Abstract

Background: Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana.

Methods: This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis.

Results: About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors.

Conclusion: Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development.

Trial registration: Clinical Trials # NCT03665246 , August 29, 2018.

Keywords: Early childhood development; Early stimulation behaviors; Intimate partner violence; Maternal-fetal attachment; Pregnancy.

Conflict of interest statement

Dr. Baumgartner (senior author) reports a contract from Catholic Relief Services (CRS) during the conduct of the study; and five of the authors of this publication (JH, RO, MA, SA, EM) were paid employees of CRS, one of the funders, at the time this study was carried out and assisted with study design, data collection and manuscript preparation. However, no CRS author had access to aggregate study data during data collection, nor was any CRS employee involved with data analysis.

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