Social support, nutrition and health among women in rural Bangladesh: complex tradeoffs in allocare, kin proximity and support network size

Abstract

Malnutrition among women of reproductive age is a significant public health concern in low- and middle-income countries. Of particular concern are undernutrition from underweight and iron deficiency, along with overweight and obesity, all of which have negative health consequences for mothers and children. Accumulating evidence suggests that risk for poor nutritional outcomes may be mitigated by social support, yet how social support is measured varies tremendously and its effects likely vary by age, kinship and reproductive status. We examine the effects of different measures of social support on weight and iron nutrition among 677 randomly sampled women from rural Bangladesh. While we find that total support network size mitigates risk for underweight, other results point to a potential tradeoff in the effects of kin proximity, with nearby adult children associated with both lower risk for underweight and obesity and higher risk for iron deficiency and anaemia. Social support from kin may then enhance energy balance but not diet quality. Results also suggest that a woman's network of caregivers might reflect their greater need for help, as those who received more help with childcare and housework had worse iron nutrition. Overall, although some findings support the hypothesis that social support can be protective, others emphasize that social relationships often have neutral or negative effects, illustrating the kinds of tradeoffs expected from an evolutionary perspective. The complexities of these effects deserve attention in future work, particularly within public health, where what is defined as ‘social support' is often assumed to be positive. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health'.

Children are important too: juvenile playgroups and maternal childcare in a foraging population, the Agta

“…Further investigation should explore the relationship between allomothering, environmental pressures, activity budgets and fertility trends. It is important to reinforce that childcare, like any form of social support, cannot be assumed to produce positive outcomes, as highlighted by Shenk et al [60] when looking at women's nutritional condition and Myers et al's [61] exploration of the length of breastfeeding dependent on the type of support. The mechanisms by which support impacts maternal behaviour are key and, thus, require further investigation.…”

Childcare support and child social development in Japan: investigating the mediating role of parental psychological condition and parenting style

“…Factors, such as the quality of childcare support, or conflict among potential caregivers (e.g. [73]) were not carefully considered within this study. While our study was designed to test broad associations between childcare support and both children's outcomes and parental characteristics, future studies should examine both cooperation and conflict within the family, different alloparental effects by maternal/ paternal grandmothers/grandfathers (e.g.…”

Who cares for women with children? Crossing the bridge between disciplines

“…Many authors in this issue, us included, highlight the importance of non-maternal caregivers and extended social support across cultures. This includes fathers [13,23,44,49,57], grandmothers and other relatives [13,16,17,23,43,49], as well as non-kin in both informal and formal settings [16,18,23,31,58]. Second, we primarily focus on the individual-level and specific acts of support rather than wider supportive environments.…”

“…With this focus, we present commentaries and research papers on: understanding the need for mother-infant support [15,58]; supporting pregnancy and childbirth [31,40,57]; supporting maternal mental health [14,41,42]; supporting maternal physical health [16,17,43]; supporting infant feeding [13,49] and supporting child survival and development [18,23,44]. These topics bring together diverse literature on multiple elements of social support and maternal-child health, moving past a primary focus on child outcomes.…”

“…While our theme issue is by no means comprehensive, it presents work from scholars with backgrounds in public health, midwifery, psychology, human biology, demography and evolutionary anthropology, to name a few. The research in this issue also spans cultures and communities, with research participants from the UK [13,31], Japan [23], Australia [41], the Thai-Myanmar border [42], Bangladesh [43], BaYaka foragers from the Congo Basin [44], Agta foragers from the Philippines [16], and more. We hope this issue provides an example of facilitating broader discussions, drawing on multiple perspectives.…”