Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting: findings from India
Upadhyay and Srivastava BMC Pregnancy and Childbirth
Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting: findings from India
Ashish Kumar Upadhyay 0
Swati Srivastava 0
0 International Institute for Population Sciences , Govandi Station Road, Deonar, Mumbai 400088 , India
Background: According to United Nation Children's Fund, it has been estimated that worldwide about 165 million children were stunted in 2012 and India alone accounts for 38 % of global burden of stunting. This study aims to examine the effect of pregnancy intention and maternal postnatal depressive symptoms on early childhood stunting in India. We hypothesized that effect of pregnancy intention and postnatal depressive symptoms were mediated by social support. Methods: We used data from the first wave of Young Lives Study India. Multivariate logistic regression models (using generalized estimation equation) were used to examine the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting among children aged 5-21 months. The analysis included 1833 children (out of 2011 sample children) that had complete information on pregnancy intention, maternal depression and other variables. Results: Bivariate results indicate that a higher percent of children born after unintended pregnancy (40 %) were stunted than children of intended pregnancy (26 %). Likewise, the proportion of stunted children was also higher among women with high postnatal depressive symptoms (35 %) than the low level of depression (24 %). Results of multivariate logistic regression model indicate that children born after unintended pregnancy were significantly more likely to be stunted than children born after intended pregnancy (AOR: 1.76, CI: 1.25, 2.48). Similarly, early childhood stunting was also associated with maternal postnatal depressive symptoms (AOR: 1.53, CI: 1.21, 1.92). Moreover, the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting were not mediated by social support. Conclusions: The findings of this study provide conclusive evidence regarding consequences of pregnancy intention and postnatal depressive symptoms on early childhood stunting in India. Therefore, there is a need to identify the women with unintended pregnancy and incorporate the promotion of mental health into their national reproductive and child health programme.
Pregnancy intention; Postnatal depressive symptoms; Social support; Childhood stunting; Young Lives Study; India
Background
Childhood stunting, defined as height for age z-score
below -2sd of the median of reference population by the
World Health Organization, is remains one of the
important public health concern throughout the developing
countries [
1
]. According to United Nation Children’s
Fund (UNICEF), it has been estimated that worldwide
about 165 million children are stunted in 2012 and India
alone accounts for 38 % of global burden of stunting in
the world [
2
]. In terms of incidence, India accounts for
more than 60 million stunted children worldwide [
2
].
Recent data from third Indian National Family Health
Survey (INFHS) suggest that about 45 % children under
age 3 year are stunted [
3
]. Such a high prevalence of
stunting is a matter of serious concern because stunted
children are associated with weaker immune system,
higher risk of developing diarrheal disease, acute
respiratory infection, delay in motor skills, cognitive, and social
development during childhood [
4–12
] and more likely
to suffer from high blood pressure, obesity, diabetes and
heart disease during adulthood [
6, 13–15
]. Another
concern related to stunting is it passes from one generation
to another as a grim inheritance [
16, 17
].
Studies have identified several risk factors such as
birth size, mother’s education, mother’s age at birth of
the child, consumption of iron folic acid tablet during
pregnancy and socio economic condition for childhood
stunting in developing countries [
18–20
]. Studies from
India also reported that birth size, mother’s education,
antenatal check-up during pregnancy, serious illness,
drinking water, toilet facility, economic status, place of
residence are statistically associated with childhood
stunting [
21–23
]. A study by World Health Organization
(WHO) suggests that about 50 % of childhood stunting
in India is related with repeated diarrhoea or intestinal
worm infection from unsafe water and poor sanitation
or hygiene [
24
]. However, very few studies have analysed
the cumulative effect of both pregnancy intention and
postnatal depressive symptoms on early childhood
stunting simultaneously in developing countries and perhaps
there was no such study in India.
Pregnancy intention may influence child health
outcomes through increased level of depression, change in
behaviour in parenting, had a greater risk of smoking,
consumption of alcohol, and were less likely to attend
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