tag:theconversation.com,2011:/ca-fr/topics/baby-and-childcare-75648/articlesBaby and childcare – La Conversation2022-04-28T12:18:31Ztag:theconversation.com,2011:article/1784982022-04-28T12:18:31Z2022-04-28T12:18:31ZDiaper need emerges as health indicator during pandemic<figure><img src="https://images.theconversation.com/files/459200/original/file-20220421-11033-2j867q.jpeg?ixlib=rb-1.1.0&rect=0%2C15%2C3490%2C2307&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thirty-six percent of surveyed families with young children said they did not have enough diapers during the pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/baby-aidan-on-changing-table-royalty-free-image/528169224">Tony Arruzza/Corbis Documentary via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>During the first year of the COVID-19 pandemic, more than a third of Massachusetts households with a child under 5 <a href="https://doi.org/10.1089/heq.2021.0093">didn’t have enough diapers</a> to change their child as often as needed, according to our survey. A baby without enough diapers might have <a href="https://www.jpeds.com/article/S0022-3476(20)31360-3/fulltext">more doctor visits</a> for diaper rash and urinary tract infections. But we also found a link between diaper need and other concerns, like depression and chronic illness, that are less obvious and seemingly unrelated. </p>
<p>Our data for this study came from an online survey of Massachusetts residents led by <a href="https://www.gbfb.org/">The Greater Boston Food Bank</a> from October 2020 and to January 2021. Food bank epidemiologist Rachel Zack and data analyst Nick Birk helped us compile, analyze and interpret the survey data. </p>
<p>We looked at more than 3,000 responses from participants in the food bank’s survey. Of those, we selected the 353 respondents who reported having a child age 4 or under using diapers. We then asked them specifically, “If you have children in diapers, do you ever feel that you do not have enough diapers to change them as often as you would like?” </p>
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<img alt="Seven disposable white baby diapers with colorful trim are grouped in a tray with numbers drawn on them in marker." src="https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&rect=17%2C17%2C5973%2C3970&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459157/original/file-20220421-22-w9rf7e.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Homes without enough diapers were also more likely to have depression and chronic illness among family members.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/baby-shower-diaper-decorations-royalty-free-image/537630792">MZiello/iStock via Getty Images Plus</a></span>
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<p>We found that 36% of families with young children went without enough diapers during the pandemic.</p>
<p>But diaper need is about more than bare baby bottoms. We found that in households with the greatest diaper need there is also a greater likelihood of other significant concerns. For example, we found that people who reported diaper need were also more likely to report symptoms of depression or living in a home where someone had a chronic illness. </p>
<p>Previous research has <a href="https://doi.org/10.1177/0003122420977480">highlighted the stress</a> of needing but being unable to get diapers for a baby. The link between diaper need and chronic illness adds substantial evidence that households dealing with health issues are more likely to struggle with other hardships like food insecurity and unmet medical needs.</p>
<p>Among those at greater risk of not having enough diapers are parents or caregivers under 26 years of age, Latino parents or caregivers and people with less than a high school education. This might be related to the relatively limited resources these parents and caregivers have to draw upon to meet their daily needs.</p>
<h2>Why it matters</h2>
<p>Diapers are an essential child care need and a significant expense for families with young children. The <a href="https://nationaldiaperbanknetwork.org/">National Diaper Bank Network</a> defines “diaper need” as “lacking a sufficient supply of diapers to keep an infant or child clean, dry and healthy.” The group estimates that the average cost of a month’s supply of diapers is US$80-$100. Public aid programs for families with low incomes generally do not provide diapers. </p>
<p>We had previously identified links between diaper need and <a href="https://doi.org/10.1016/j.pmedr.2021.101332">food-related hardship</a>. Our newer study sheds light on the situation during the COVID-19 pandemic and brings more income-related findings, such as the fact that diaper need is more common in households where someone lost a job. We also found more need for diapers in households with a 2019 income of less than $50,000 than in those with higher incomes. Speaking of income, our findings show that pandemic diaper need persisted despite most U.S. households’ receiving federal economic stimulus payments and diaper banks’ expanding distribution. Without these factors, there might have been more families in the state without enough diapers.</p>
<h2>What still isn’t known</h2>
<p>We used mathematical weighting to get data representing the Massachusetts population. But we haven’t yet looked into diaper need in other states or nationally.</p>
<p>It’s also not yet clear what the most effective solutions are for families lacking enough diapers for their babies. We have not measured the effectiveness of diaper banks or other diaper distribution models. Legislation proposed in Massachusetts would create a <a href="https://malegislature.gov/Bills/192/S125">diaper distribution program</a> or give qualifying families <a href="https://malegislature.gov/Bills/192/H280">$30 to purchase diapers</a> each month. </p>
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<p>Congress also has considered creating <a href="https://www.congress.gov/bill/116th-congress/house-bill/1846">federal funding</a> for diaper distribution programs, in 2019 and <a href="https://www.congress.gov/bill/117th-congress/house-bill/259">again in 2021</a>. And in February, lawmakers proposed allowing families to <a href="https://www.congress.gov/bill/117th-congress/senate-bill/3660">cover the cost</a> of diapers with health savings or flexible spending accounts. If these programs become reality, studying their impact and effectiveness could prove useful.</p>
<p>Previous research already has found, however, that providing diapers to families needing them has benefits beyond the obvious. In a 2017 study of families with low incomes, life in their <a href="https://doi.org/10.1007/s10995-017-2317-9">households improved</a> when they received diapers from a local diaper bank. Parents reported more positive moods, along with improved health and happiness of their children. Diaper distribution increased family members’ attendance at school, work and child care centers.
And families were also able to divert household finances toward other basic needs, including utilities and medical care.</p><img src="https://counter.theconversation.com/content/178498/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily H. Belarmino receives funding from the U.S. Department of Agriculture and the University of Vermont Gund Institute for Environment and Office of the Provost and Vice President.</span></em></p><p class="fine-print"><em><span>Lauren A. Clay receives funding from the National Science Foundation, National Academies of Science, Engineering, and Medicine Gulf Research Program, and Tufts University. </span></em></p>Researchers find that households without enough diapers for their children are more likely to struggle with other hardships.Emily Belarmino, Assistant Professor of Public Health Nutrition, University of VermontLauren A. Clay, Associate Professor of Emergency Health Services, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1464112020-10-05T15:05:25Z2020-10-05T15:05:25ZPlaytime in Soweto: what mothers said about activity for toddlers<figure><img src="https://images.theconversation.com/files/358567/original/file-20200917-20-1242n6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Play is a crucial element of children's development.</span> <span class="attribution"><span class="source">DisobeyArt/Shutterstock</span></span></figcaption></figure><p>Physical activity, sleep and rest time are important for young children. They <a href="https://pubmed.ncbi.nlm.nih.gov/29219071/">ensure</a> healthy growth and development. And the best way to get children physically active is to get them playing.</p>
<p>South Africa has created <a href="https://pubmed.ncbi.nlm.nih.gov/31877557/">guidelines</a> that map the ideal levels of physical activity for children in their first five years of life. These state that infants should have daily “tummy time” and floor based play; they shouldn’t be restrained in a car seat or high chair for extended periods of time. It’s advised that toddlers should play actively for 180 minutes a day. The guidelines recommend that infants and toddlers shouldn’t have any screen time.</p>
<p>In the first two years of life, of course, babies don’t have much autonomy over their behaviours. So they rely on their caregivers to give them opportunities for play. But what happens if caregivers aren’t aware of how important playing is?</p>
<p><a href="https://link.springer.com/epdf/10.1186/s12887-020-02321-4?sharing_token=DOnJdB-RVn_or5Npebkkx2_BpE1tBhCbnbw3BuzI2RNjXX4RWhNmCvhv7l3n4xiKuvSNlmOOaPHkTlmM0zkpHcl0oK6Kg4NBrTuGLyppjOCabimlsqYsWnH1wUhc0o5JpIT1WAlZ7sn4msBoRq_jGAxHsBSLFUTIZ304kBiIa6A%3D">We conducted a qualitative study</a> to try and understand what mothers in Soweto, Johannesburg, think about play and physical activity during the first two years of life. We also wanted to understand whether and how they promote this behaviour. This is the first study in South Africa examining these important concepts.</p>
<p>Soweto is a large, densely populated urban township which comprises one third of Johannesburg’s population. It was chosen because we <a href="https://theconversation.com/young-women-in-soweto-say-healthy-living-is-hard-heres-why-118198">already know</a> that young women in the area struggle to keep active themselves; they are limited by their environment, including a lack of space and resources to keep healthy. Given how big it is, Soweto is also representative of a large majority of the population. We focused on mothers because it is established that most children under 2 in South Africa live with their mother, while <a href="http://webcms.uct.ac.za/sites/default/files/image_tool/images/367/South%20African%20Child%20Gauge%202018%20-%20Nov%2020.pdf">less than 40% live with their fathers </a>.</p>
<p>We found that mothers were worried about how playing outdoors might put their children at risk of injuries or becoming victims of crime. They also didn’t have enough money to buy toys or books, or to pay for their children to go to creche. This isn’t to suggest they weren’t playing with their children: it just happened in an unstructured way, through singing, dancing and talking. They also knew that play was important, although they didn’t see it as an independent behaviour to be encouraged or promoted.</p>
<p>These findings offer useful insights into how to promote play among children, specifically those in poorer settings. Caregivers could be encouraged to let infants have daily <a href="https://pediatrics.aappublications.org/content/145/6/e20192168?casa_token=J5lQq5hm9d8AAAAA%3A0FMuq22CpPxdNCeNmz-qyKbvGp7lnd-iepvDyvp6j62ABXcypUFYN9OAhz1XyBkWanhfLXXwcSw4">tummy time</a> (lying on their stomach so that they can start to develop neck muscles and motor skills to lift their head and eventually sit up and crawl), and to play with babies through dancing and singing, storytelling, playing with a ball, and allowing babies to crawl, walk or run as much as possible without restricting their movements.</p>
<h2>What mothers told us</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/26062040/">Research has shown</a> that outdoor play is essential for childhood development.</p>
<p>The mothers in our study said it was dangerous for their children to play outside. They worried that their child might hurt themselves outside, might fall in the communal outdoor toilet (which raised both safety and hygiene concerns), might land up on the streets (yards are not always fenced), and might get hit by cars. Another major fear was that their child might be abducted, kidnapped or raped. Sadly, these anxieties are borne out by South Africa’s <a href="https://www.crimestatssa.com/">high crime rates</a>.</p>
<p>So, the women either kept their children inside where play was limited because of space constraints and was often substituted by a TV, or allowed them to play in a locked yard under supervision if they had access to such space. </p>
<p>Financial constraints were another issue. One mother of an 18-month-old boy said:</p>
<blockquote>
<p>Sometimes like if you’re at the mall and your baby wants a ball but you don’t have money and a ball keeps your baby active it’s a problem.</p>
</blockquote>
<p>Most of the mothers did not read to their children, or even own a book. Reading in the early years when brains are rapidly developing <a href="https://files.eric.ed.gov/fulltext/ED567231.pdf">is important</a> for cognitive and language development, as well as later school placement. But <a href="https://theconversation.com/south-africas-reading-crisis-is-a-cognitive-catastrophe-89052">research</a> has shown that South Africans generally don’t read much or at all. The mother of a seven-month-old girl told us:</p>
<blockquote>
<p>No I don’t read, I don’t even own a book</p>
</blockquote>
<h2>Screen time</h2>
<p>We found that many of the mothers used TV as a “babysitter”. Most seemed to believe that their babies were able to decide how much TV to watch and when to watch; they said the TVs were constantly on in their homes. Often, children watched TV because their mothers or the rest of the family were watching, or because their mothers needed to do something else, like clean or cook. </p>
<p>Some mothers in the sample believed that TV time is beneficial. However, <a href="https://pubmed.ncbi.nlm.nih.gov/18460044/">studies</a> have found that TV time is associated <a href="https://pubmed.ncbi.nlm.nih.gov/23820003/">with language delay</a> in infants – that is, it took them longer than their peers to learn to speak.</p>
<p>Limiting screen time may be particularly difficult for mothers who are looking after children on their own and may have limited resources or time to find alternatives.</p>
<p>Our findings are useful because they offer insight into the realities that keep caregivers from playing more or in a structured way with their children.</p><img src="https://counter.theconversation.com/content/146411/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alessandra Prioreschi receives funding from the NIH funded VECD Fogarty Global Health programme, as well as from the DST/NRF centre of excellence in human development. </span></em></p>The women in our study knew that play was important, although they didn’t see it as an independent behaviour to be encouraged or promoted.Alessandra Prioreschi, Associate Director and Researcher at the Developmental Pathways for Health Research Unit (DPHRU), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1354392020-04-02T07:02:15Z2020-04-02T07:02:15ZFree child care to help nearly one million families, especially workers in essential services<p>The government will provide free child care in a move aimed at ensuring parents, especially in essential services, are able to keep working.</p>
<p>Without a rescue package large parts of the industry could have collapsed, leaving health and other workers finding it difficult or impossible to keep doing their jobs. </p>
<p>More than 945,000 families with 1.3 million children will benefit.</p>
<p>The new arrangement will scrap, after Sunday, the present funding system – including the means test and the activity test - and instead the government will pay half the sector’s revenue up to the existing hourly rate cap.</p>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>The plan will cost the government $1.6 billion over three months - compared with $1.3 billion if current revenues and subsidies had continued, based on the existing system and the big reductions in enrolments that have taken place.</p>
<p>The funding will be paid direct to the centres, with the condition they remain open, so parents do not have the disruption of having to seek out another provider. There are some 13,000 childcare and early leaning services. The new arrangements will also extend to after school and school holiday services.</p>
<p>Priorities will be set for access, with the first in line being working parents, vulnerable and disadvantaged children, and parents with existing enrolments.</p>
<p>Centres should “re-engage with those parents who have taken their children out of care, to see whether they can be accommodated as necessary as well,” Education Minister Dan Tehan said.</p>
<p>“But there is a clear priority list that we want centres to take into account, and the most important of those are those essential workers and the vulnerable children.”</p>
<p>Scott Morrison said: “In this ‘new normal’ that we’re living in, it’s no longer about entitlement. It’s about need.</p>
<p>"And we’re calling on all Australians to think about what they need, and to think about the needs of their fellow Australians who may have a greater need when it comes to calling on the many things that are being provided.” </p>
<p>For parents who have removed their children from childcare, centres can waive the gap fee, dating back to March 23.</p>
<p>The payment to centres will start to be made in a week’s time, and will run initially for three months, after which it may be extended.</p>
<p>Morrison and Tehan said in a statement the plan would provide “planning certainty to early childhood education and care services at a time where enrolments and attendance are highly unpredictable”.</p>
<p>Childcare centres can also get assistance under the JobKeeper program announced this week and the cash and loan schemes also available for businesses.</p>
<p>The Australian Childcare Alliance, the peak body for early learning services, welcomed the announcement as “extraordinary”. It said an overnight survey it had done had shown 30% of providers “faced closure this week due to as massive, shock withdrawal of families - either from fear or unemployment – and another 25% were not sure they could ever recover, even once the virus crisis has passed”.</p>
<p>But with the new financial measures , plus the JobKeeper payment and other existing support mechanism the early learning sector should be able to continue to play its essential role, ACA said.</p><img src="https://counter.theconversation.com/content/135439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The government will provide free child care in a move aimed at ensuring parents, especially in essential services, are able to keep working. More than 945,000 families with 1.3 million children will benefit.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1266292019-11-19T17:33:51Z2019-11-19T17:33:51ZResearch into pregnancy, birth and infant care is historically underfunded – and women are paying the price<figure><img src="https://images.theconversation.com/files/302450/original/file-20191119-111655-13zszdw.jpg?ixlib=rb-1.1.0&rect=45%2C7%2C5086%2C3372&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lack of research is affecting the choices women make during pregnancy, childbirth, and caring for their baby. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-partner-having-4d-ultrasound-155730335?src=b5b38814-0a4a-4fa6-9495-cc01de8153cf-1-79">Monkey Business Images/ Shutterstock</a></span></figcaption></figure><p>Research in the UK is overwhelmingly male – male participants, male researchers, and male topics, despite <a href="https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/male-and-female-populations/latest">51% of the population being female</a>. The lack of research on, by, and for this half of humanity has many detrimental effects – not least on the decisions women have to make during <a href="https://www.washingtonpost.com/national/health-science/long-overlooked-by-science-pregnancy-is-finally-getting-attention-it-deserves/2019/03/06/a29ae9bc-3556-11e9-af5b-b51b7ff322e9_story.html">pregnancy, childbirth, and child rearing</a>. In my latest book, <a href="https://www.pinterandmartin.com/informed-is-best">Informed is Best</a>, I explore the impact of incomplete and biased research in this area, and try to guide parents, and those supporting them, on how to read and judge the evidence that does exist. </p>
<p><a href="https://www.theguardian.com/lifeandstyle/2012/dec/16/mothers-fighting-against-birth-intervention">Despite many women feeling the pressure</a> to accept interventions during childbirth without question, there are often gaps in the evidence to support their treatment. For example, few studies have explored whether giving antibiotics to women with <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007467.pub4/full">group B strep</a> during labour can prevent the infection being passed to their baby. There’s also little research into whether <a href="https://www.sarawickham.com/research-updates/fetal-monitoring-and-cherry-picking-evidence/">electronic foetal monitoring</a> – where a baby’s heart rate is continually monitored during labour – accurately identifies babies being deprived of oxygen. Or if <a href="https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/">conducting frequent cervical examinations</a> during labour improves birth outcomes. </p>
<p>In an absence of good evidence, a tendency to “err on the side of caution” means that many women have <a href="https://www.voanews.com/science-health/who-alarming-spike-unneeded-medical-interventions-healthy-pregnant-women">unnecessary interventions during childbirth</a>. Others have to fight to prove that their preferred option is safe, even when this is a biologically normal behaviour <a href="https://www.sciencedirect.com/science/article/pii/S0277953619306434">such as breastfeeding</a> or safely <a href="https://www.huffingtonpost.co.uk/zion-lights/parenting-advice_b_5597376.html">sleeping with their baby</a>. </p>
<h2>Unequal research</h2>
<p>This evidence is exacerbated by historic inequalities in which research is conducted and by whom. For many years, <a href="https://www.theguardian.com/lifeandstyle/2019/nov/13/the-female-problem-male-bias-in-medical-trials">women were often excluded</a> from clinical trials because their bodies were seen as too complex due to hormonal fluctuations. Yet those findings from all-male trials were used to determine treatment for everyone.</p>
<p>Research that benefits men is still more likely to be conducted. For example, <a href="https://www.independent.co.uk/news/science/pms-erectile-dysfunction-studies-penis-problems-period-pre-menstrual-pains-science-disparity-a7198681.html">five times more research</a> is conducted into erectile dysfunction – a condition that affects 19% of men – compared with premenstrual syndrome, which affects 90% of women. </p>
<p>Meanwhile, research into <a href="https://report.nih.gov/categorical_spending.aspx">birth and parenting</a>, receives much less funding. Data from the US shows that although 10% of women become pregnant each year, <a href="https://www.washingtonpost.com/national/health-science/long-overlooked-by-science-pregnancy-is-finally-getting-attention-it-deserves/2019/03/06/a29ae9bc-3556-11e9-af5b-b51b7ff322e9_story.html">just 2% of research funding</a> is spent on pregnancy research. Likewise, a recent review identified that perinatal health research <a href="https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf">is still underfunded</a>. </p>
<p>And when it is conducted, it’s not conducted equally. Despite being disproportionately affected by adverse pregnancy outcomes, research often <a href="https://www.ncbi.nlm.nih.gov/pubmed/31021935">ignores the needs of women of colour</a> – including black women, who are <a href="https://www.bbc.co.uk/news/uk-england-47115305">five times more likely to die during pregnancy and birth</a> in the UK. </p>
<p>These inequalities are only worsened depending on who has the opportunity to conduct research. In the UK those who are <a href="https://www.independent.co.uk/news/education/education-news/university-black-minority-ethnic-pay-gap-academics-professors-ucu-staff-a9155451.html">white</a>, <a href="https://theconversation.com/are-working-class-students-and-academics-avoiding-top-universities-114041">middle class</a> and <a href="https://www.timeshighereducation.com/news/one-in-three-uk-universities-going-backwards-on-female-professorships">male</a> are more likely to gain senior academic posts and funding. Around <a href="https://www.ecu.ac.uk/publications/equality-higher-education-statistical-report-2018/">68% of all professors are white men</a>, and only 0.1% are black women. </p>
<p>When female academics seek research funding, they face further barriers. A <a href="https://mitsloan.mit.edu/ideas-made-to-matter/who-gets-grant-money-gendered-words-decide">recent study</a> showed that funding applications containing words such as “vaccination”, “children” and “health” were 16% less likely to receive a high review score than grants using words such as “detection”, “bacteria”, and “drug”. Women were more likely to use the first set of words and men the latter. </p>
<p>One area where <a href="https://www.nature.com/news/gender-balance-women-are-funded-more-fairly-in-social-science-1.18310">women are more equally funded</a> is in the social sciences. But the discipline’s <a href="https://esrc.ukri.org/about-us/what-is-social-science/qualitative-research/">focus on qualitative methods</a>, such as interviews and observations, is <a href="https://blog.efpsa.org/2012/05/20/is-qualitative-research-still-considered-the-poor-relation/">sometimes taken less seriously</a>. Many instead consider randomised controlled trials <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235704/">the best way</a> to conduct research, as the element of behavioural choice and any associated demographic factors, such as age, gender or race, are removed. </p>
<p>However, conducting trials in birth and parenting research can have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481528/">ethical implications</a>. For example, you cannot randomise mothers to have a vaginal or cesarean birth, or to breast or formula feed. Also, qualitative methods are often better able to understand <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194906">what is important to women</a>, such as understanding their experiences of <a href="https://www.sciencedirect.com/science/article/pii/S187757561500049X">having labour induced</a> rather than simply physical outcomes. </p>
<h2>Research costs money</h2>
<p>Another issue is who funds research. Research costs money – money which often comes from an industry that stands to benefit from the findings. This means that research that doesn’t promote the use of a particular product is further disadvantaged, skewing what data is published. Alternatively, funding sources may be available but ethical issues arise. For example, although the formula milk industry may offer funding to <a href="https://www.nestlenutrition-institute.org/research-center/human-milk-research">research breastfeeding</a>, many researchers are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821317/">ethically opposed to taking such funding</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302455/original/file-20191119-111650-13s43w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Formula feed companies often fund research, which may cloud the study’s credibility.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-woman-choosing-milk-powder-632850146?src=a293333f-9287-48a7-825b-55cedfbc6c96-1-6">Virojt Changyencham/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Although industry has played an important part in many health discoveries, <a href="https://www.iflscience.com/health-and-medicine/industryfunded-drug-trials-produce-more-positive-findings/">research funded by industry</a> is more likely to have outcomes that benefit it. This theoretically <a href="https://apps.who.int/medicinedocs/en/d/Js8109e/6.11.html">shouldn’t make a difference</a> in how research is conducted, but funders can control the release of findings, skewing the balance in their favour. For example, <a href="https://www.bmj.com/content/351/bmj.h5683">one famous industry-funded study</a> examining whether specific infant formulas could prevent allergies, was found to have falsified data and was subsequently withdrawn. </p>
<p>These layers of <a href="https://ebn.bmj.com/content/17/4/100">power and bias</a> in who funds and conducts research are happening across every area of science. But in the case of birth and parenting research, women are already <a href="https://www.sciencedirect.com/science/article/pii/S0266613810001178">fighting a system</a> that often focuses on risk, intervention and medical authority. It’s especially important that any research used to inform their care is as free from bias and as full a picture as possible.</p>
<p>It’s also worth noting that a lack of research evidence <a href="http://www.jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%2011%20-%20Issue%203/Editors-Desk-Absence-of-Evidence.pdf">isn’t necessarily proof</a> that something is not important. <a href="https://www.bmj.com/content/327/7429/1459">One famous example</a> argued that because there were no randomised controlled trials showing whether jumping out of a plane with a parachute or not had any benefit, there was no evidence that parachutes were necessary.</p>
<p>Although satirical, it had a very important point. Continuing to research and gain an understanding of how to better support new parents, particularly <a href="https://www.jove.com/video/56220/a-novel-method-for-involving-women-color-at-high-risk-for-preterm">including those from under-served communities</a>. Research will always be important. But it’s also important to recognise that it’s not always a full picture – and this can have a serious impact on those affected.</p><img src="https://counter.theconversation.com/content/126629/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received research funding from the ESRC, NIHR, Public Health Wales, the Breastfeeding Network and First Steps Nutrition Trust. She is author of four books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' , 'The Positive Breastfeeding Book' and "Informed is best'</span></em></p>Although research can provide us with useful evidence to help inform our decisions, underfunded research areas still mean that women are being left in the dark.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1232852019-09-18T13:41:46Z2019-09-18T13:41:46ZMalawi study highlights the importance of men in childcare and nutrition<figure><img src="https://images.theconversation.com/files/292204/original/file-20190912-190050-159bra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman and baby on a bicycle taxi in Salima, Malawi. Some Malawian men are becoming more involved in childcare. </span> <span class="attribution"><span class="source">EPA-EFE</span></span></figcaption></figure><p>In Malawi, as in many other societies, women have historically been responsible for housework, food and childcare. Women’s household responsibilities have often left them with heavier workloads than men. </p>
<p>A recent <a href="http://www.nsomalawi.mw/index.php?option=com_content&view=article&id=209&Itemid=97">report</a> showed that the time Malawian women spent caring for children was six times higher than men. The women’s multiple roles and responsibilities typically prevented them from participating in activities to earn income. </p>
<p>Past <a href="http://ebrary.ifpri.org/cdm/ref/collection/p15738coll2/id/127110">studies</a> have also shown that women spend more of their income on food and children’s education than men do. </p>
<p>But times are changing. Malawian men are increasingly becoming involved in maternal and child health as well as household chores such as growing, buying and preparing food.</p>
<p>Other <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-8-36">studies</a> show that changes in the role of men in mother and child health are gaining momentum, particularly with increased government efforts in the country’s northern and central regions. Many of these changes are driven by health sector policies.</p>
<p>Walking into a local clinic in Malawi, you will likely find posters with images calling on men to take a more active role in housework and children’s and mother’s health. Such messages have become a common feature, attesting to changing times in the country. </p>
<p>Our study of one community in rural central Malawi set out to investigate how interventions by NGOs, the Ministry of Health and traditional leaders – which aim to involve men in mother and child health – are changing the role of men in growing, cooking and buying food for the household.</p>
<p>As the custodians of culture, traditional leaders in Malawi have been central to influencing changes in household roles and responsibilities. They play an important role in assisting in policy implementation in the areas they oversee.</p>
<p>Our study began by reviewing international as well as Malawian policy documents to understand how men’s participation in mother and child health emerged. We conducted in-depth interviews and focus group discussions with both men and women, as well as with policymakers.</p>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221623">findings</a> show that some men are becoming more involved in looking for food and cooking. They are also helping women with other chores, including cleaning and caring for children.</p>
<p>What has led to this change?</p>
<h2>Findings</h2>
<p>We found that while not all men are willing to become involved in women’s and children’s health, there are specific situations that force them to take on “women’s work”. For example, regulations passed by clinics and traditional leaders encourage women to stay at <a href="https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/MSM_96_21/en/">maternity waiting homes</a> from their eighth month of pregnancy.</p>
<p>These maternity waiting places are located close to the hospital to prevent women travelling long distances when they are in labour. The waiting homes have played a central role in reducing mother and child deaths.</p>
<p>But women who stay at these facilities frequently leave other children at home, forcing men to take responsibility for cooking, cleaning and looking after children. Such interventions are unravelling the typical roles men and women are expected to play.</p>
<p>Along with <a href="http://menengage.org/regions/africa/malawi/">messages</a> from the government and NGOs on gender equality, these interventions are helping undo traditional beliefs about the roles men and women play. </p>
<p>Men who accompany their spouses to antenatal visits are provided with information on the importance of helping women with housework when they are pregnant. As a result, more men are now actively helping women to grow, prepare and buy food.</p>
<p>These interventions are increasing cooperation between men and women, which is important for building well-functioning families.</p>
<p>Besides participating in general housework, men also take children to the hospital and attend antenatal visits with their partners. Thus, men and women in the community work together to make sure that their families are healthy and have food. One woman said,</p>
<blockquote>
<p>We work together with our husbands in order to make ends meet. If we see that the food, we have harvested is not enough, we make decisions together with our husbands to say that we should buy some food to top up.</p>
</blockquote>
<h2>Positive changes</h2>
<p>A new understanding of the concept of gender equity is emerging in this community. Gender equality is understood as men and women working together, as opposed to the common misconception that gender initiatives target only women.</p>
<p>Although the men are becoming involved in “women’s work”, when women are pregnant, these changes offer opportunities for policymakers to harness the potential of men in meeting the food needs of the household, and addressing gender equality at the same time.</p>
<p>Although other <a href="http://www.fao.org/3/a-i2050e.pdf">studies</a> have suggested that women play a central role in food and nutrition, both women and men in our study felt that it was also men’s responsibility to look for food. In many ways this resonates with the traditional hunter role of men. So food, nutrition and agriculture policies that pay attention only to women overlook the important role men can play in promoting their families’ well-being.</p>
<p>Interventions implemented in Malawi’s health sector are creating positive changes in the way in which men and women interact. Agriculture, food security and nutrition policies need to leverage these changes to increase the capacities of men and women to work together in ensuring that their families have access to food.</p>
<p>The important role men play in food and nutrition has long been neglected. Harnessing the complementary role of men could improve food security and gender equality at the same time. This is particularly important as <a href="https://www.unicef.org/media/55921/file/SOFI-2019-full-report.pdf">hunger</a> increases globally.</p><img src="https://counter.theconversation.com/content/123285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Mkandawire receives funding from the USAID Feed the Future Programme. </span></em></p><p class="fine-print"><em><span>Sheryl L Hendriks receives funding from the USAID Feed the Future Programme. She is affiliated with the Malabo Montpelier Panel. </span></em></p>While not all men are willing to become involved in women and children’s health, some situations force them take on ‘women’s work’.Elizabeth Mkandawire, Postdoctoral Fellow and Coordinator: UN Academic Impact Hub for SDG2, University of PretoriaSheryl L Hendriks, Professor in Food Security; Director, Institute for Food, Nutrition and Well-being, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1223772019-09-06T11:15:26Z2019-09-06T11:15:26ZDr. Spock’s timeless lessons in parenting<figure><img src="https://images.theconversation.com/files/289740/original/file-20190828-184207-1f64lbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Author and physician Dr. Benjamin Spock in NYC in 1974.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Watchf-AP-A-NY-USA-APHS370107-Dr-Benjamin-Spock/b5d4e170afdf4041867cf1104ba668fc/4/0">AP Photo/Jerry Mosey</a></span></figcaption></figure><p>The book ignited a revolution, breaking free from conventional wisdom that said children required schedules, discipline and little affection. Instead, “<a href="https://doi.org/10.1136/bmj.b2839">The Common Sense Book of Baby and Childcare</a>,” written by <a href="https://www.basicbooks.com/?s=benjamin+spock">Dr. Benjamin Spock</a> and published in 1946, encouraged parents to think for themselves and to trust their instincts.</p>
<p>Spock’s book was a huge best-seller, second in the U.S. only to the Bible. It sold more than 50 million copies and was translated into more than 40 languages. It helped to usher in a fundamental shift in how Americans approached parenting. </p>
<p>My wife and I are pediatric health professionals, but when our children were born, we rushed to buy Spock’s book. I have also researched <a href="https://doi.org/10.1007/s00247-019-04446-w">Dr. Spock’s leadership</a> in the field of pediatrics.</p>
<h2>Before and after Spock</h2>
<p>The timing of “Baby and Childcare” could hardly have been better. Two historical events had led Americans to put off childbearing: the Great Depression and World War II. With the war’s end in 1945, Americans began reproducing at an unprecedented rate – more than 76 million babies, <a href="https://www.prb.org/justhowmanybabyboomersarethere/">the baby boom generation</a>, were born from 1946 to 1964. </p>
<p>Child-rearing experts in the early 1900s promoted conformity and detachment in raising children. In 1928, <a href="https://books.google.com/books/about/Psychological_care_of_infant_and_child.html?id=BadqAAAAMAAJ">John B. Watson</a>, one of the founders of behaviorist psychology, argued that children should be treated as adults. Mothers should habituate their children to strict schedules, let them cry themselves to sleep and avoid too much love and attention. In his 1930 book, “Behaviorism,” he wrote:</p>
<p>“Never, never hug and kiss them, never let them sit in your lap. If you must, kiss them once on the forehead when they say goodnight. Shake hands with them in the morning.” </p>
<p>Spock advocated a radically different approach. He believed that children come into the world with distinct needs, interests and abilities, and that the core of good parenting is attending carefully to what each child requires at each stage of development. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289771/original/file-20190828-184192-120l1ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Spock believed good parenting meant loving and nurturing your child every step of the way.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/784242322">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Parents needed to trust themselves – or, as he wrote in the book’s first edition, “You know more than you think you do.” Human beings, after all, had been bearing and raising children long before John Watson, the invention of the printing press and the introduction of writing. </p>
<p>Spock emphasized parenting as a voyage of discovery. He treated mistakes as learning opportunities. True to his word, his own views evolved over time. In later editions of the book, he stopped treating parenting as “mothering,” introduced gender-neutral language for children and admitted that he had been wrong to warn against allowing babies to <a href="https://theconversation.com/preventing-infant-deaths-the-abcs-of-safe-baby-sleep-105723">sleep on their backs</a>.</p>
<h2>A good start in life</h2>
<p>Spock was born in 1903 in New Haven, Connecticut, where his father was a successful attorney. He attended elite institutions including Phillips Andover Academy and Yale University. While at Yale, the 6'4" Spock rowed on the crew team, which represented the United States in the 1924 Olympic Games in Paris and won a <a href="https://www.sports-reference.com/olympics/summer/1924/ROW/mens-coxed-eights.html">gold medal</a>. </p>
<p>He attended Yale School of Medicine before transferring to Columbia, where he graduated first in his class in 1929. While attending medical school, he married his first wife, Jane, who would later collaborate on his book. In addition to his pediatric training, Spock, who believed that the emotional aspects of child life were underemphasized, also trained in psychoanalysis.</p>
<p>During World War II, Spock joined the medical corps of the U.S. Navy Reserves and wrote “The Commonsense Book of Baby and Child Care.” He then took faculty positions at the University of Minnesota, the University of Pittsburgh and Case Western Reserve University, lecturing and appearing in popular media all over the world. In 1976, Spock married his second wife, Mary. In 1998, he died at the age of 94.</p>
<h2>Anti-war activism and a legacy</h2>
<p>During the 1960s, Spock became a political activist, opposing the Vietnam War and nuclear proliferation and supporting civil rights. In 1968, he was arrested for promoting nonviolent military draft resistance, although his conviction was overturned the following year. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=796&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=796&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=796&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1000&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1000&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289773/original/file-20190828-184229-1edtq9h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1000&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Spock protested the Vietnam War and was arrested for encouraging military draft evaders, a conviction that was later overturned.</span>
<span class="attribution"><a class="source" href="http://apimages.com/6810151750">apimages.com</a></span>
</figcaption>
</figure>
<p>Despite Spock’s extraordinary popularity, he was not without detractors. Some attacked him for his political views, and others accused him of promoting excessive permissiveness. Others argued that he created unreasonable expectations for maternal dedication. Critics on both sides of the political spectrum complained that he had largely ignored fathers.</p>
<p>Spock’s most enduring legacy was his love of children. He said that if he had a fault as a pediatrician, it was his tendency to “whoop it up too much with children.” Above all, he dreamed of a world in which children would be “inspired by their opportunities for being helpful and loving.”</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/122377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The man whose book outsold all others, except the Bible.Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.