Revisiting the childcare-attachment question: under what conditions is childcare participation associated with mother-child attachment security?

Decades have passed since the controversy regarding the putative risks of childcare for mother-child attachment broke out. Yet, some uncertainty remains, as relevant studies have produced inconsistent evidence. Some have proposed that those conflicting findings may be due to the fact that the effects of childcare are conditioned on parenting. Accordingly, this study examined whether relations between childcare participation and mother-child attachment vary according to maternal sensitivity and autonomy support. In this sample of 236 mother-child dyads, there was no indication of main effects of childcare participation on attachment. There were, however, some interactive effects, such that the children who showed the least secure attachment behaviors were those who did not attend childcare and had either less sensitive or less autonomy-supportive mothers. The findings suggest that the effects of childcare on mother-child attachment are best understood in light of the parenting children receive at home.

Maternal autonomy and prenatal harm.

This paper offers an account of why prenatal harms seem particularly objectionable. It identifies structural similarities between key cases of prenatal harm and the recently characterized "all-or-nothing" problem from Joe Horton. According to the account defended by the paper, a willingness to parent incurs a duty to protect the fetus from harm. This implication provides independent support for so-called "voluntarist" or "intentionalist" accounts of parental role obligations, according to which, roughly, a mother's autonomous choice to parent a child suffices for having the obligations distinctive of parenthood toward the child.

Public health insurance and maternal health care utilization in india: evidence from the 2005-2012 mothers' cohort data.

BACKGROUND: The introduction of Janani Suraksha Yojana (JSY) in India, a conditional cash transfer program which incentivized women to deliver at institutions, resulted in a significant increase in institutional births. Another major health policy reform, which could have affected maternal and child health care (MCH) utilization, was the public health insurance scheme (RSBY) launched in 2008. However, there is a noticeable lack of studies that examine how RSBY had impacted on MCH utilization in India. We used data from a cohort of mothers whose delivery had been captured in both the 2005 and 2011/12 rounds of the Indian Human Development Survey (IHDS) to study the impact of health insurance (in particular, the public insurance scheme versus private insurance) on MCH access. We also investigated whether maternal empowerment was a significant correlate that affects MCH utilization. METHODS: We used the multilevel mixed-effects ordered logistic regression model to account for the clustered nature of our data. We derived indexes for women's empowerment using Principal component analysis (PCA) technique applied to various indicators of women's autonomy and socio-economic status. RESULTS: Our results indicated that the odds of mothers' MCH utilization levels vary by district, community and mother over time. The effect of the public insurance scheme (RSBY) on MCH utilization was not as strong as privately available insurance. However, health insurance was only significant in models that did not control for household and mother level predictors. Our findings indicated that maternal empowerment indicators - in particular, maternal ability to go out of the house and complete chores and economic empowerment-were associated with higher utilization of MCH services. Among control variables, maternal age and education were significant correlates that increase MCH service utilization over time. Household wealth quintile was another significant factor with mothers belonging to upper quintiles more likely to access and utilize MCH services. CONCLUSIONS: Change in women's and societal attitude towards maternal care may have played a significant role in increasing MCH utilization over the study period. There might be a need to increase the coverage of the public insurance scheme given the finding that it was less effective in increasing MCH utilization. Importantly, policies that aim to improve health services for women need to take maternal autonomy and empowerment into consideration.

Balancing risks: making decisions for maternal treatment without data on fetal safety.

Challenges arise when treatment to improve maternal health brings the possibility of risk to fetal health. The coronavirus disease 2019 (COVID-19) vaccine is the most recent, but hardly the only, example. Because pregnant patients are often specifically excluded from trials of new therapies, this is often the dilemma that patients and providers face when considering new treatments. In this study, we used the COVID-19 vaccine as an exemplar to question the broader issue of how society, in general, and obstetricians, in particular, should balance obligations to pregnant women's right of access to new therapeutic agents with the physician's desire to protect the fetus from potential risks. We will argue that in almost all circumstances (with few exceptions, as will also be discussed), maternal benefit and respect for autonomy create the uncertainty that absent safety data bring. Consequently, if pregnant women choose to try new interventions and treatments, such as the COVID-19 vaccination, they should be offered those new regimens and their decision supported. In addition, we will argue that the right solution to avoid the dilemma of absent data is to include pregnant individuals in clinical trials studying new treatments, drugs, and other therapies. We will also discuss the basis for our opinion, which are mainstream obstetrical ethics, precedents in law (supreme court ruling that forbids companies to exclude women from jobs that might pose a risk to the fetus), and historic events (thalidomide). The ethical framework includes the supposition that sacrifice to improve fetal outcome is a virtue and not a mandate. Denying a pregnant patient treatment because of threats to their life can create absurd and paradoxical consequences. Either requiring abortion or premature delivery before proceeding with treatments to optimize maternal health, or risking a patient's own life and ability to parent a child by delaying treatment brings clear and significant risks to fetal and/or neonatal outcomes. With rare exceptions, properly and ethically balancing such consequential actions cannot be undertaken without considering the values and goals of the pregnant patient. Therefore, active participation of both the pregnant patient and their physician in shared decision making is needed.

Male participation in antenatal care and its influence on their pregnant partners' reproductive health care utilization: insight from the 2015 Afghanistan Demographic and Health Survey.

Afghanistan has made remarkable progress in reducing maternal mortality over the past few decades, and male participation in their pregnant partner's reproductive health care is crucial for further improvement. This study aimed to examine whether male attendance at antenatal care (ANC) with their pregnant partners might be beneficially associated with the degree of utilization of reproductive health care by the pregnant partners. Data for 2660 couples (women aged 16-49 years) were taken from the 2015 Afghanistan Demographic and Health Survey (AfDHS). Bivariate and multivariate logistic regression models were employed to explore the association between male attendance at ANC with their pregnant partners and reproductive health care utilization outcomes, including adequate utilization (four or more visits) of ANC services, ANC visits during the first trimester (up to 12 weeks) of pregnancy, rate of blood and urine testing during pregnancy, rate of institutional delivery and utilization of postnatal check-up services. The results indicated that the rate of male attendance at ANC with their pregnant partners was 69.4%. After controlling for covariates, pregnant partners who were accompanied to ANC by their male partners were more likely to adequately utilize ANC services (AOR=1.42; 95% CI: 1.18-1.71), commence ANC visits even during the first trimester (AOR=1.21; 95% CI: 1.03-1.42), give birth at a health facility (AOR=1.23; 95% CI: 1.03-1.47) and present themselves for postnatal check-ups (AOR=1.24; 95% CI: 1.04-1.47) than those who were not accompanied by them. The study demonstrated that participation of male partners in ANC was positively associated with their pregnant partners' utilization of reproductive health care services in Afghanistan. The findings suggest that, to improve maternal and child health outcomes in the country, it would be worthwhile implementing interventions to encourage male partners to become more engaged in the ANC of their pregnant partners.

Need Satisfaction as a Mediator of Associations between Interparental Relationship Dimensions and Autonomy Supportive Parenting: A Weekly Diary Study.

Guided by the self-determination theory, this weekly diary study tested a process model in which week-to-week mother-reported interparental conflict and perceived partner responsiveness were associated with maternal autonomy support by means of maternal psychological need satisfaction. During six consecutive weeks, 258 mothers (Mage  = 41.71 years) and their 157 adolescents (51.4% females, Mage  = 14.92 years) from Turkey provided weekly reports of the study variables via an online survey. Multilevel analyses showed that maternal need satisfaction was predicted by lower levels of interparental conflict and greater levels of perceived partner responsiveness. Maternal need satisfaction, in turn, was positively associated with maternal and adolescent reports of maternal autonomy support. Further, these week-to-week associations were partly moderated by maternal perfectionism. The results underscore the dynamic nature of the intra-family relationships, the important role of particular conditions in which mothers may become more autonomy supportive, and the necessity to consider mother's personal characteristics while examining these dynamics.

Guided by the self-determination theory, this weekly diary study tested a process model in which week-to-week mother-reported interparental conflict and perceived partner responsiveness were associated with maternal autonomy-support by means of maternal psychological need satisfaction. During 6 consecutive weeks, 258 mothers (Mage = 41.71 years) and their 157 adolescents (51.4% females, Mage = 14.92 years) from Turkey provided weekly reports of the study variables via an online survey. Multilevel analyses showed that maternal need satisfaction was predicted by lower levels of interparental conflict and greater levels of perceived partner responsiveness. Maternal need satisfaction, in turn, was positively associated with maternal and adolescent reports of maternal autonomy-support. Further, these week-to-week associations were partly moderated by maternal perfectionism. The results underscore the dynamic nature of the intra-family relationships, the important role of particular conditions in which mothers may become more autonomy supportive, and the necessity to consider mother's personal characteristics while examining these dynamics.

Predictors of early childhood undernutrition in Nigeria: the role of maternal autonomy.

OBJECTIVE: To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged <2 years in Nigeria, considering the cultural context and sociodemographic factors. DESIGN: Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling. SETTING: 2013 Nigerian Demographic Health Survey. PARTICIPANTS: Children aged between 3 and 24 months (n 7532). RESULTS: Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity. CONCLUSIONS: Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

"Just a little help": A qualitative inquiry into the persistent use of uterine fundal pressure in the second stage of labor in Spain.

INTRODUCTION: Uterine fundal pressure, or the Kristeller maneuver (KM), is a non-evidence-based procedure used in the second stage of labor to physically force the fetus to delivery. Even though officially banned, the KM is practiced in 25% of vaginal deliveries in Spain. METHODS: Using semi-structured interviews (N = 10 women, N = 15 midwives, N = 3 obstetricians), we sought to understand how providers justify using the KM, and to describe the current circumstances in which the KM is practiced. Women described their preexisting knowledge of and experiences with the KM; providers described how they learned and practiced the KM. We used framework analysis to analyze the transcripts, and we consensus-coded across three independent investigators. RESULTS: Providers reported practicing a new, gentler Kristeller to which official policy did not apply. Providers knew the KM posed risks, but they assumed the risks resulted from poor technical training. Providers did not learn the KM through standard means, and they practiced it in secret. Women knew about the KM before delivery, and many had planned to refuse the procedure. Providers made women's refusal more difficult by offering the KM in coded terms as "just a little help." Women did not experience the KM as gentle, and the force of the procedure made their refusal nearly impossible. CONCLUSIONS: The normal birth policy has failed to achieve its objectives due to maternity care providers' unique logic surrounding a new KM technique. Women's ability to refuse the Kristeller is limited.

Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet).

More than 3 decades ago, a small group of physicians and other practitioners active in what they called "fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety.

Is competence enough to enable Kenyan mothers to make good infant and young child feeding decisions?

The aim of this study was to explore factors associated with maternal infant and young child feeding motivation in urban and rural Kenya. We conducted 18 focus group discussions with mothers of children 0 to 23 months of age and healthcare workers. The data were transcribed, translated, and explored following the principles of content analysis. We first explored and coded the data inductively and categorized it according to emerging themes representing the most relevant topics for young child feeding. After this, these themes were theorized into an explanatory framework. Finally, the results yielded seven themes integrated into self-determination theory's three basic motivation-building pillars: autonomy, competence, and relatedness. We found that maternal intrahousehold autonomy on child feeding was substantial. However, this autonomy was lost for a period of time while in close contact with the healthcare staff. The authority of the healthcare workers was at its peak when the child was born and faded gradually as the child grew. Building maternal competence is important for child-feeding outcomes, but our data showed that the health education methods used by the healthcare workers were inadequate to improve maternal to improve the motivation. The competence of Kenyan healthcare workers should be improved in the area of complementary feeding counseling, and they should be trained to provide practical and emotional support as a way of increasing maternal motivation on infant and child feeding.

Quantitative Methodologies Reveal a Diversity of Nutrition, Infection/Illness, and Psychosocial Stressors During Pregnancy and Lactation in Rural Mam-Mayan Mother-Infant Dyads From the Western Highlands of Guatemala.

BACKGROUND: The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together. OBJECTIVES: To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother-infant dyads. METHODS: Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored. RESULTS: Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts. CONCLUSIONS: The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother-infant dyad.

Implementation of shared decision-making about rooming-in: A before and after an audit of breastfeeding in Taiwan.

BACKGROUND: The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. METHODS: A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. RESULTS: A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. CONCLUSIONS: Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment.

Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5.

Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study found that the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack of access to a bank or a savings account, and lack of mobile phone ownership were found to be significant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.

Maternal Autonomy Support in a Randomized Controlled Trial of the Reminiscing and Emotion Training Intervention.

Objective: The Reminiscing and Emotion Training (RET) intervention targets and improves maltreating mothers' elaboration and sensitivity in reminiscing (conversations about past emotional events), as well as children's emotion knowledge. However, in previous studies of RET, improvements in mothers' elaborative and sensitive reminiscing did not explain improvements in children's emotion knowledge. Thus, we evaluated whether RET is associated with improved maternal autonomy support during reminiscing and whether improved autonomy support is associated with enhanced child emotion knowledge after RET. Methods: The sample included 248 mothers (165 maltreating and 83 nonmaltreating) and their 3- to 6-year-old children involved in a randomized controlled trial of RET. At baseline, we assessed maternal and child receptive language, dyadic reminiscing, and children's emotion knowledge. Then, maltreating mothers were randomized either to receive RET or participate in an active control condition including case management and written parenting materials. Nonmaltreating mothers did not receive intervention and participated as an additional control group. Families then completed an eight-week follow-up assessment. Results: Maltreating mothers displayed significantly less baseline autonomy support during reminiscing than nonmaltreating mothers (partial eta squared = .028). Contrary to hypotheses, RET did not significantly improve autonomy support. However, baseline autonomy support was significantly and positively correlated with children's emotion knowledge at baseline (r = .20) and follow-up (r = .18). Conclusion: Autonomy support during reminiscing may play a role in the development of emotion knowledge. Implications for developmental theory and clinical practice are discussed.

The mother-daughter Shared Agency in Weight Management Scale (SAWMS): development, validation, and implications for body dissatisfaction.

BACKGROUND: Much research suggests that mothers play an important role in shaping daughters' body image, yet less is known about how mother-daughter relationship dynamics in weight management affect daughters' body dissatisfaction. The current paper described the development and validation of the mother-daughter Shared Agency in Weight Management Scale (SAWMS) and examined its associations with daughter's body dissatisfaction. METHODS: In Study 1 (N = 676 college students), we explored the factor structure of the mother-daughter SAWMS and identified three processes (control, autonomy support, and collaboration) whereby mothers work with daughters in weight management. In Study 2 (N = 439 college students), we finalized the factor structure of the scale by conducting two CFAs and assessing the test-retest reliability of each subscale. In Study 3 (same sample as Study 2), we examined the psychometric properties of the subscales and their associations with daughters' body dissatisfaction. RESULTS: Combining results from EFA and IRT, we identified three mother-daughter dynamics in weight management-maternal control, maternal autonomy support, and maternal collaboration. However, based on various empirical results indicating poor psychometric properties of the maternal collaboration subscale, we removed it from the mother-daughter SAWMS and only evaluated the psychometric properties of the remaining two subscales (i.e., control and autonomy support). They explained a significant amount of variance in daughters' body dissatisfaction over and above the effect of maternal pressure to be thin. Maternal control was a significant and positive predictor of daughters' body dissatisfaction; maternal autonomy support was a significant and negative predictor. CONCLUSIONS: Results suggested that maternal control in weight management was associated with daughters' increased body dissatisfaction, whereas maternal autonomy support in weight management was associated with daughters' lower body dissatisfaction. These specific ways in which mother work with daughters in weight management provide nuances in understanding young women's body dissatisfaction. Our SAWMS offers new ways to examine body image among young women through the mother-daughter relationship dynamics in weight management.

The current study described the procedure of developing a new measurement­the mother­daughter Shared Agency in Weight Management Scale (SAWMS). This scale aims to measure the different ways in which mothers work with their cisgender daughters in weight management. Based on self-reported survey data from cisgender female college students, we identified two ways whereby mothers work with their daughters in weight management­maternal control and maternal autonomy support. To better understand these mother­daughter dynamics, we also examined their relations with daughter's body dissatisfaction. We found that daughters whose mothers were more controlling when it comes to weight management reported higher levels of body dissatisfaction. On the other hand, daughters whose mothers were more autonomy-supportive in weight management reported lower levels of body dissatisfaction. Our results have important implications for understanding how mother­daughter relationship dynamics in weight management may contribute to the development of body image and perceptions among young women.

Challenges in Conducting Therapeutic Trials in Pregnancy: Emphasizing Recent Lessons Learned.

Pregnant people have traditionally been excluded from therapeutic research by restrictions intended for fetal protection. Despite a movement toward inclusion, concerns for the feasibility and safety of including pregnant people in studies continue to limit this research. This article reviews the history of research guidelines in pregnancy and illustrates ongoing challenges, as seen in the development of vaccines and therapies during the coronavirus disease 2019 pandemic and investigation of statins for preeclampsia prevention. It explores new approaches that may be used to improve therapeutic research in pregnancy. A major cultural shift is needed to balance potential maternal and/or fetal risks with potential benefits from participation in research, as well as harm from withholding treatment or providing one that is not evidence-based. Finally, it is important to honor maternal autonomy in decision-making regarding participation in clinical trials.

Maternal autonomy but not social support is a predictor of child feeding indicators in the Northern Region, Ghana.

BACKGROUND: Child malnutrition may be mediated by poor infant and young child feeding (IYCF) practices. This study sought to explore if maternal social support or autonomy was related to IYCF indicators in Northern Region, Ghana. METHODS: An analytical cross-sectional study was conducted with 395 randomly sampled mother-child pairs from 8 health facilities. Data were collected on socio-demographic characteristics, social support and autonomy statuses of mothers, and dietary intake and anthropometry of children. Maternal social support and autonomy statuses were derived and classified into tertiles and IYCF and child growth indicators were derived based on WHO protocol. Logistic regression analysis was used to explore the association of maternal social support and autonomy statuses to IYCF indicators and child nutritional status. RESULTS: The mean age of the women was 27 (± 5.10) years and most belonged to the lowest tertile of social support (52.4%), and autonomy (44.1%). About half of the children, 53.2% and 44.6%, received Minimum Dietary Diversity (MDD) and Minimum Acceptable Diet (MAD) respectively but the majority (72.9%) received Minimum Meal Frequency (MMF). About a fifth of the children, 21.0%, 24.1%, and 20.5%, were wasted, stunted, and underweight respectively. Maternal autonomy was associated with IYCF but not growth indicators of young children. Compared to children of mothers of richest autonomy tertile, children of women of middle autonomy tertile were 67% less likely to receive MDD [Adjusted Odds Ratio (AOR): 0.33; 95% Confidence Interval (CI): 0.18-0.59], and 56% less likely to receive MAD (AOR: 0.44; 95% CI: 0.24-0.77). Also, children belonging to mothers of poorest autonomy tertile were 56% less likely to receive MMF compared to children of richest maternal autonomy tertile (AOR: 0.44; 95% CI: 0.23-0.84). CONCLUSION: Maternal autonomy and not social support is associated with IYCF indicators of children in Northern Ghana; child survival programmes should incorporate or strengthen women empowerment interventions to improve child nutrition.

French ambulatory cesarean: Mother and newborn safety.

OBJECTIVE: To evaluate mother and newborn child safety after French ambulatory cesarean (FAUCS). METHODS: Prospective comparative cohort study in Tunisia (January-June 2018). Pregnant women indicated for primary or repeat cesarean at term underwent FAUCS or Misgav Ladach cesarean (MLC). Surgical outcomes, overall morbidity, and maternal autonomy during recovery were compared. RESULTS: Among 112 deliveries, 60 were performed by FAUCS and 52 by MLC. FAUCS was feasible in all cases; surgeons achieved a completely extraperitoneal approach in 39 (65.0%) cases. The main difficulty experienced was fetal extraction. Longer operative procedures were recorded in the FAUCS group; however, women in the FAUCS group reported lower pain scores (3 [2-5] vs 4 [3.7-5], P<0.001) and were more likely to decline analgesics (10 [17.0%] vs 0 [0%], P<0.001). They experienced greater autonomy during recovery (median [interquartile range] time to standing, 2 [1.0-2.5] vs 12.8 [8.9-17.9] hours, P<0.001; time to full meal, 4 [3-6[ vs 26.5 [21-31] hours, P<0.001; effective time to hospital discharge, 1 [1, 2] vs 2 [2, 3] days; P<0.001). CONCLUSION: Implementation of the FAUCS technique was safe and successful, and improved maternal condition after cesarean. These short-term results need long-term validation by randomized trials.

Ethical challenges in invasive maternal-fetal intervention.

The field of maternal-fetal intervention is rapidly progressing and with it comes new and often complex ethical considerations that must be addressed. The purpose of this article is to review the ethical issues that arise in maternal-fetal intervention. We will provide two clinical scenarios and discuss the ethical issues related to each scenario and how they were addressed. We will also provide a list of recommended resources that any institutional offering maternal-fetal intervention should have in place to meet the ethical obligations of such work.

Individual and community levels of maternal autonomy and child undernutrition in India.

OBJECTIVES: Investigate the relationship between maternal autonomy at multiple levels and the risk of child stunting, underweight, and wasting in India. METHODS: Data were from a 2005-2006 nationally representative, cross-sectional sample of 51,555 children under 5 years from 29 states in India. Multilevel, multivariable, logistic regression analyses were used to estimate the odds of child stunting, underweight, and wasting in relation to maternal autonomy in healthcare, movement, and money at the individual level and community level, while adjusting for several child, maternal, and household factors. RESULTS: When only adjusting for child age and sex, children in communities with a high proportion of women with autonomy in healthcare, or movement, or money, separately, had a lower risk of being stunted, underweight, or wasted, separately. However, adjusting for other explanatory factors attenuated these relationships and made them statistically insignificant. Individual maternal autonomy in any of the three domains was not associated with any of the outcomes. CONCLUSIONS: The results suggest that caution should be taken when interpreting the direct relevance of maternal autonomy at both individual and community levels to measures of child undernutrition.