Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Oct 7.
Published in final edited form as: Infant Ment Health J. 2024 Nov 30;46(1):85–94. doi: 10.1002/imhj.22146

Maternal self-efficacy during infancy: Investigating the roles of depression and social support among mothers in rural Pakistan

Allison Frost 1, Ashley Hagaman 2,3, Sarah Haight 4, Naira Ikram 5, Liz Turner 6,7, Sonia Bhalotra 8, Siham Sikander 9,10, Joanna Maselko 1,4
PMCID: PMC13640801  NIHMSID: NIHMS2206565  PMID: 39614836

1 |. INTRODUCTION

Maternal self-efficacy is a mother’s belief in her own ability to meet her child’s needs, interact with her child, and respond to childcare challenges. Maternal self-efficacy during infancy is essential for supporting sensitive caregiving, encouraging a strong parent-child relationship, and promoting healthy child development during infancy and beyond (Leerkes & Crockenberg, 2002; Sanders & Woolley, 2005; Teti & Gelfand, 1991). In addition, high maternal self-efficacy is associated with increased parental satisfaction and decreased parental stress (Leahy-Warren & McCarthy, 2011). However, maternal self-efficacy can be disrupted by maternal mental health difficulties, such as depression. Depression during the perinatal period, or within one year birth, is characterized by feelings of sadness, loss of interest in activities, and sleeping and eating disturbances, among other symptoms. Depression is relatively common among perinatal women, with prevalence estimates around 11% globally and 13% in low- and middle-income countries (Woody et al., 2017). Research shows that mothers experiencing depressive symptoms report lower maternal self-efficacy (i.e., confidence in their ability to care for their children) as compared to mothers without depressive symptoms (Azmoude et al., 2015; Goodman et al., 2022; Kuhn & Carter, 2006). Mothers with depressive symptoms may report decreased self-efficacy due to global negative self-evaluation, feelings of hopelessness, or behavioral avoidance of parenting tasks and subsequent lack of rewarding parenting experiences (Goodman et al., 2022).

Social support may be an important protective factor that promotes maternal self-efficacy during infancy (Azmoude et al., 2015; Shorey et al., 2014; Suzuki et al., 2009). Many studies have documented the benefits of a strong support network for mothers (Balaji et al., 2007; Gjerdingen et al., 1991), especially mothers who experience depressive symptoms (Hagaman et al., 2021; Milgrom et al., 2019). Social support may refer to emotional support, meaning the mother has close, trusting relationships and people with whom she can discuss her problems and gain information or advice. Social support may also come in the form of practical childcare support, such as having someone who helps with daily childcare tasks (e.g., feeding and bathing) or can provide childcare when the mother is busy. This type of support may decrease stress in mothers and provide modeling of childcare tasks, which then supports self-efficacy (Crnic & Ross, 2017; Matvienko-Sikar et al., 2018). However, research documenting the impact of childcare support on maternal self-efficacy is scarce and inconclusive. Some studies suggest that having help with childcare tasks is associated with improved maternal well-being (Morita et al., 2021; Mugweni et al., 2019), whereas other studies show no association with maternal outcomes (Hagaman et al., 2021; Shenk et al., 2021).

For mothers experiencing depression, both emotional and practical social support may be particularly important for increasing self-efficacy. Mothers with depression may be more likely to struggle with childcare demands due to their depressive symptoms, which may then decrease their confidence around parenting (Lovejoy et al., 2000). Having practical childcare support may provide help that enables an improvement in depressive symptoms, which then may improve maternal self-efficacy. Mothers with depression may also perceive their own self-efficacy as low due to general low self-esteem or a negative bias when evaluating themselves (Gerdes et al., 2007). Having emotional support may be especially beneficial for helping these mothers feel more confident about their parenting skills. These mechanisms are reflected in prior work demonstrating that depressive symptoms are associated with lower levels of both emotional and practical social support (Balaji et al., 2007; Leahy-Warren & McCarthy, 2011).

The availability of emotional and practical social support and the impact of such support on mothers may differ based on economic and cultural context. For instance, in low-resource settings, mothers may be responsible for a higher proportion of household tasks than mothers in high-income settings, suggesting that decreasing their burden through childcare support may be particularly beneficial (Treas & Tai, 2016). In South Asian contexts, families are more likely to live in intergenerational households, which may increase the burden of household tasks, but also the availability of emotional and childcare support for mothers (Aubel, 2021). In Pakistan, where this study takes place, extended family members are often involved in childcare tasks (Chung et al., 2020; Lingam et al., 2014). Older family members, such as grandmothers, are seen as experienced caregivers who can offer advice and support to mothers (Aubel, 2012, 2021). Indeed, qualitative work in Pakistan has shown that women seek emotional social support from such family members during the perinatal period (Rowther et al., 2020). However, older women are also highly involved in household and childcare decision-making, often to the exclusion of mothers (Mumtaz & Salway, 2007). Similarly, fathers in Pakistan may provide practical support via childcare activities, especially in situations when mothers are unable to care for their children (Jeong et al., 2018). Fathers are also typically responsible for making decisions around child-rearing (Jeong et al., 2018). Mothers in Pakistan may benefit from having childcare help from both fathers and extended family. Having such help may increase their knowledge and comfort around caregiving, thus supporting their maternal self-efficacy. However, involvement from family members may limit mothers’ decision-making authority, which may ultimately interfere with self-efficacy. Identifying the associations among maternal depression, both emotional and practical social support, and maternal self-efficacy in low resource, South Asian settings is understudied and important for expanding the evidence base around maternal well-being during infancy, as well as increasing our understanding of how to best support mothers during this period.

In the current study, we investigate the associations between depression, social support (including both emotional and childcare support), and maternal self-efficacy among mothers of infants in rural Pakistan. We also test whether both types of social support moderate the association between depression and maternal self-efficacy. We hypothesize that depression will predict lower maternal self-efficacy, and that both emotional and childcare support will predict higher maternal self-efficacy. In addition, we predict that depression and social support will interact such that the effects of social support on maternal self-efficacy will be stronger for mothers experiencing depression.

2 |. MATERIALS AND METHODS

2.1 |. Study design and sample

Participants included 885 mothers assessed at 3 and 6 months postpartum. Data for this study were drawn from the Bachpan Cohort study with an embedded cluster randomized control trial of a maternal depression intervention (Sikander et al., 2019). This study was approved by the institutional review boards at the University of North Carolina Chapel Hill, Duke University, and the Human Development Research Foundation. Mothers were recruited during their third trimester of pregnancy and screened for depression using the Patient Health Questionnaire (PHQ-9) (Gallis et al., 2018; Kroenke et al., 2001). Women who screened positive for depression (by scoring 10 or above on the PHQ-9) were randomly assigned to receive a maternal depression intervention or enhanced usual care as per the village cluster allocation. In addition, a sample of women who did not screen positive for depression were recruited to serve as a comparison sample. Mothers provided written informed consent (or witnessed verbal consent if they were illiterate) prior to study participation. The intervention was delivered from pregnancy through 5 years postpartum, with weekly and biweekly sessions delivered from the third trimester of pregnancy through 6 months postpartum and monthly/bimonthly sessions delivered from 6 months onward. Sessions were delivered by lay peers in the community and focused on behavioral activation, problem solving, and peer support (Atif et al., 2017). Past research has demonstrated intervention effects on maternal depression and perceived emotional support at 3 months postpartum (Baranov et al., 2020; Vanobberghen et al., 2020), with mothers in the intervention group reporting lower depressive symptoms and increased emotional support. Trial arm was included as a covariate in all analyses. Pregnancy (baseline) data for this study were collected from October 2014 to February 2016.

2.2 |. Measures

2.2.1 |. Depression

Depression was measured at 3 and 6 months postpartum using the Structured Clinical Interview for the DSM-IV (SCID) module for assessing a Major Depressive Episode (First et al., 2002). The SCID is a semi-structured interview used to diagnose psychiatric disorders. This measure has been adapted for use with pregnant and postpartum women across cultures (Gorman et al., 2004). Interviewers determined whether participants met criteria for a current depressive episode at the time of the interview. Interviewers were extensively trained in administering the SCID and participated in regular supervision sessions with field coordinators to discuss findings and troubleshoot any difficulties. This diagnostic measure was preferred over the depression screening tool PHQ-9 for this paper as a more robust measure.

2.2.2 |. Emotional support

The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure mothers’ emotional support among friends, family, and their significant others at 3 months postpartum. The scale included 12 items assessing mothers’ perception that they had someone with whom they could share their joys or sorrows, find comfort, and discuss their problems. Each item was rated on a scale from 1 (strongly disagree) to 5 (strongly agree) and all items were averaged, such that higher scores on this measure indicate higher perceived emotional social support (α = .92). To align with the original version of the MSPSS, the scores were weighted to create a score from 1 to 7. The MSPSS has been validated for use with women in Pakistan (Akhtar et al., 2010; Sharif et al., 2021).

2.2.3 |. Childcare support

The Day in the Life (DiL) measure was used to assess the amount of practical help mothers received around childcare at 3 months postpartum. The DiL is a semi structured interview that captures the distribution of childcare activities in the home and was developed in Pakistan (O’Donnell et al., 2022). Mothers were asked to describe their child’s typical day with a focus on childcare tasks across three domains. The domains included instrumental (feeding, bathing, changing diapers, and putting to sleep), social (soothing, playing with the infant), and support (taking care of the infant if the mother is sick, working outside the home, or otherwise unavailable). For each task, the interviewer recorded who was responsible, with response options including: (1) the mother completed it alone, (2) the mother completed it with someone else, (3) someone else completed it, or (4) no one completed it. The number of tasks for which mothers had help (i.e., mothers reported they completed the task with someone or someone else completed it) was tallied. In these analyses, the instrumental and social domains were combined, resulting in one measure of daily childcare support (i.e., number of tasks in the instrumental/social domain for which mothers reported having help) and childcare support when needed (i.e., number of items for which mothers reported having help in the support domain). The instrumental/social domain had a possible score from 0 to 15 and the support domain had a possible score from 0 to 6. For both domains, higher scores indicate increased support on childcare tasks.

2.2.4 |. Maternal self-efficacy

Maternal self-efficacy was measured at 6 months postpartum using the maternal self-efficacy scale (Teti & Gelfand, 1991). This scale included 10 items assessing mothers’ perceptions of how well they complete various childcare activities, such as soothing their infant or understanding their infant’s needs. Mothers rate each item on a scale from 1 (“not good at all”) to 4 (“very good”) and all items are summed to create a single self-efficacy score ranging from 10- to 40 (α = .86). Higher scores on this measure indicate increased maternal self-efficacy. The maternal self-efficacy scale has been used extensively in South Asia (Taneja et al., 2020; Upadhyay et al., 2021).

2.2.5 |. Covariates

Additional variables of interest included trial arm (intervention, control, and non-depressed), maternal age during pregnancy, whether the target child is the mother’s first child, the family structure (i.e., nuclear or non-nuclear family in the home), maternal years of education, and family socioeconomic status. Socioeconomic status was assessed with a measure of household assets, including land ownership, the presence of certain household items (e.g., television), and access to water and sanitation (Rustein & Johnson, 2004). All covariates were collected at the pregnancy (baseline) assessment. For models with depression at 3 months as a predictor, depression at 6 months was included as an additional covariate.

2.3 |. Statistical analyses

Generalized estimating equations were used to estimate the longitudinal associations between depression, social support, and their interaction and maternal self-efficacy. First, the association between depression at 3 months and self-efficacy at 6 months was tested, controlling for depression at 6 months. Then, we tested the association between each type of social support (emotional support, daily childcare support, and childcare support when needed) at 3 months and maternal self-efficacy at 6 months. Social support at 6 months was not included as a covariate in these models because social support was stable between 3 and 6 months postpartum. Finally, we tested whether each type of social support moderated the association between depression at 3 months and maternal self-efficacy at 6 months, while controlling for depression at 6 months. All models control for trial arm (intervention, control, and non-depressed), maternal age, whether the target child is the mother’s first child, family structure, maternal years of education, and family socioeconomic status, all measured during pregnancy. Analyses were conducted in Stata 17. Unstandardized estimates are presented.

3 |. RESULTS

Sample characteristics are presented in Table 1. Mothers were on average 26.65 years old and had anywhere from 0 to 6 children at the baseline pregnancy assessment. Approximately half the sample (52.42%) reported less than a secondary education and the majority of participants lived in non-nuclear households (e.g., extended, joint/multiple households). We tested the association between depression at 3 months postpartum and self-efficacy at 6 months postpartum while adjusting for a range of covariates, including depression at 6 months postpartum. Model results are presented in Table 2. We did not find evidence of an association between depression at 3 months and self-efficacy at 6 months (B = −.68, 95% CI: −1.54, .18, p = .12). Notably, in model 1, there was an association between concurrent depression at 6 months and self-efficacy (B = −1.42, 95% CI: −2.21, −.62, p < .001). This suggests that mothers who met criteria for depression at 6 months postpartum scored 1.42 points lower on the self-efficacy scale compared to mothers who did not meet criteria for depression.

TABLE 1.

Sample characteristics (n = 885).

Maternal characteristics (baseline/pregnancy) % (n) or Mean (SD) Range
Study arm
 Intervention 25.2% (n = 223)
 Enhanced usual care 23.85% (n = 211)
 Non-depressed (at baseline) 50.96% (n = 451)
Age 26.65 (4.47) 18–40
Number of children 1.48 (1.39) 0–6
Education
 None 13.67% (n = 121)
 Primary (1–5) 19.77% (n = 175)
 Middle (6–8) 18.98% (n = 168)
 Secondary (9–10) 25.42% (n = 225)
 Higher Secondary (11–12) 10.28% (n = 91)
 Tertiary (12+) 11.86% (n = 105)
Family structure
 Nuclear 12.66% (n = 112)
 Non-nuclear 87.34% (n = 773)
Outcome (6 m postpartum)
 Maternal self-efficacy 37.41 (3.34) 22–40
Predictors (3 m postpartum)
 Depression (%) 15.25% (n = 135)
 Emotional support 4.72 1–7
 Daily childcare support 2.80 (2.45) 0–15
 Childcare support when needed 4.42 (2.04) 0–6
Open in a new tab

Note: Emotional support is measured through the Multidimensional Scale of Perceived Social Support. Daily childcare support is measured through the Day in the Life (DiL) Instrumental/Social scales and childcare support when needed is measured through the DiL Support Scale.

TABLE 2.

Generalized estimating equations with depression and social support at 3 months postpartum predicting maternal self-efficacy at 6 months postpartum.

Maternal efficacy at 6 months postpartum
Unstandardized
B SE 95% CI p
Model 1: Depression
 Depression at 3 months −.68 .44 (−1.54, .18) .12
 Depression at 6 months −1.42 .41 (−2.21, −.62) <.0001
 Socioeconomic status .12 .08 (−.05, .28) .16
 Age −.01 .03 (−.07, .05) .79
 First time parent .04 .10 (−.16, .23) .71
 Education −.02 .03 (−.08, .05) .58
 Nuclear family .35 .32 (−.29, .98) .29
 Trial arm
 Control (Reference)
 Intervention .41 .27 (−.12, .94) .14
 Non-depressed .47 .24 (−.01, .95) .05
Model 2: Emotional support
 Emotional support at 3 months .45 .11 (.24, .66) <.001
 Socioeconomic status .09 .08 (−.07, .24) .28
 Age .01 .09 (−.05, .06) .86
 First time parent .01 .09 (−.16, .19) .88
 Education −.02 .03 (−.08, .05) .61
 Nuclear family .36 .33 (−.29, 1.01) .28
 Trial arm
 Control (Reference)
 Intervention .51 .24 (.03, .99) .04
 Non-depressed .61 .23 (.15, 1.06) .01
Model 3: Daily childcare support
 Daily childcare support at 3 months −.00 .05 (−.10, .10) .96
 Socioeconomic status .14 .09 (−.03, .31) .10
 Age .00 .03 (−.06, .06) .93
 First time parent .01 .10 (−.18, .19) .93
 Education −.01 .04 (−.07, .06) .87
 Nuclear family .31 .34 (−.35, .98) .36
 Trial arm
 Control (Reference)
 Intervention .53 .27 (.00, 1.06) .05
 Non-depressed .78 .25 (.29, 1.27) .002
Model 3: Childcare support when needed
 Childcare support when needed at 3 months .05 .06 (−.06, .16) .36
 Socioeconomic status .14 .09 (−.03, .31) .10
 Age .00 .03 (−.05, .06) .88
 First time parent .01 .10 (−.18, .20) .92
 Education −.01 .04 (−.08, .06) .85
 Nuclear family .37 .33 (−.28, 1.02) .27
 Trial arm
 Control (Reference)
 Intervention .54 .27 (.01, 1.06) .04
 Non-depressed .77 .25 (.28, 1.26) .002
Open in a new tab

Note: Daily childcare support is measured through the Day in the Life (DiL) Instrumental/Social scales and childcare support when needed is measured through the DiL Support Scale.

In model 2 examining emotional social support, we found that emotional support at 3 months was associated with self-efficacy at 6 months (B = .44, 95% CI: .24, .66, p < .001) suggesting that increased emotional support predicted increased maternal self-efficacy 3 months later. In Model 3, we tested the association between daily childcare support at 3 months and maternal self-efficacy at 6 months and found no association (B = −.00, 95% CI: −.10, .10, p = .96). We also did not see an association between childcare support when needed and maternal self-efficacy in model 4 (B = .05, 95% CI: −.06, .16, p = .36).

Finally, we tested whether each type of social support moderated the association between depression at 3 months and maternal self-efficacy at 6 months. These models controlled for all the same covariates as previous models (trial arm, maternal age, first child, family structure, education, socioeconomic status, and depression at 6 months). We found no evidence of interaction effects between depression and emotional social support (B = .39, 95% CI: −.12, .91, p = .13) or depression and daily childcare support (B = .06, 95% CI: −.44, .32, p = .75) in predicting maternal self-efficacy (see Figure 1). There was weak evidence of an interaction between depression and childcare support when needed, although the confidence interval for this estimate crosses the null (B = .25, 95% CI: −.04, .55, p = .09). For mothers without depression, there was no association between childcare support and self-efficacy (B = −.03, 95% CI: −.15, .09, p = .62). For mothers with depression, there was a comparatively stronger positive association between childcare support and maternal self-efficacy, however this estimate was imprecise and the confidence interval crossed the null (B = .22, 95% CI: −.05, .49, p = .10).

FIGURE 1.

FIGURE 1

Open in a new tab

Association between emotional support (Panel a), daily childcare support (Panel b), and childcare support when needed (Panel c) and maternal self-efficacy by depression status. DiL, Day in the Life measure.

4 |. DISCUSSION

The goal of the current study was to characterize the associations between depression, social support, and maternal self-efficacy in the first 3–6 months postpartum, as well as whether social support moderates the association between depression and maternal self-efficacy. Results suggest that depression at 3 months was not associated with self-efficacy at 6 months, but there was a strong association between concurrent depression and self-efficacy at 6 months. This suggests that current depression, rather than previous depression, is an important correlate of self-efficacy and that mothers with depression who go on to recover may not see lingering effects of depression on their self-efficacy months later. Current depression may be associated with maternal self-efficacy due to feelings of low self-worth that interfere with confidence around child-rearing (Azmoude et al., 2015). Importantly, our results suggest that these associations are transient and recovery from depression may support improved maternal self-efficacy.

We also found that perceived emotional support at 3 months was associated with increased maternal self-efficacy at 6 months. This suggests that having close, trusting relationships may support maternal confidence around infant care. Mothers who have strong emotional support networks may benefit from advice around parenting, as well as a feeling of security that they have the necessary support to provide for their child (Azmoude et al., 2015; Puspasari et al., 2018). This aligns with previous qualitative work among women in Pakistan showing that new mothers value emotional support from their husbands and family members in alleviating postpartum anxiety (Rowther et al., 2020). Results from this study suggest that having this type of support during early infancy can have benefits for maternal self-efficacy months later.

We found that daily childcare support at 3 months postpartum was not associated with self-efficacy at 6 months postpartum, suggesting that having help with daily childcare tasks does not predict maternal self-efficacy longitudinally. We also found that, for mothers with depression, there was weak evidence that childcare support when needed (i.e., when the mother is unavailable or sick) at 3 months was associated with increased maternal self-efficacy at 6 months. Previous research with women in Pakistan has shown that some mothers value emotional support over practical support (i.e., help with household chores) in the perinatal period (Rowther et al., 2020). Other studies show that mothers may feel over-burdened with childcare tasks and that finding safe, affordable childcare is a major concern, especially for mothers who work outside the home (Lingam et al., 2014; Travasso et al., 2014). Mothers of infants may benefit from feeling like they have a “safety net” of childcare support that will provide for their child if they cannot. This feeling may support their confidence in parenting, especially among mothers who have depression.

These results have several implications for developing interventions to support mothers in low-resource contexts during the infancy period. Decreasing depressive symptoms and increasing perceived emotional support and would be beneficial for supporting self-efficacy in all mothers (Azmoude et al., 2015). A sustained decrease in depressive symptoms may be necessary for supporting self-efficacy over time, as our results suggest that concurrent depression is highly associated with self-efficacy. In addition, building a strong emotional support system in the initial postpartum months may have powerful protective effects for maternal self-efficacy longitudinally. In terms of childcare, these results suggest that, rather than harnessing support to assist in daily childcare tasks, mothers may benefit from leveraging their support structure to create a “safety net” of individuals that can provide care during instances when they are unavailable (Balaji et al., 2007; Lingam et al., 2014).

This study benefitted from several strengths, including a fine-grained measure of childcare support. By including the DiL, we were able to capture mothers’ daily experiences of childcare responsibility. In addition, capturing daily support and support “as needed” was valuable in understanding the nuances around social support availability and maternal self-efficacy. In addition, our sample resided in rural Pakistan, which allowed us to understand these associations in a low-resource, South Asian context. Our study also included several limitations. First, some of our results, including the association between childcare support and self-efficacy among depressed mothers, have imprecise estimates with wide confidence intervals; these results should be interpreted with caution and replicated in future studies. In addition, all our measures were self-report, which is subject to bias. In particular, mothers’ depressive symptoms may have influenced their perceptions of available emotional and childcare support. Future studies may benefit from including multi-informant or observational measures of social support in families. Future studies may also benefit from assessing self-efficacy and social support among other caregivers (e.g., fathers, grandmothers, and other relatives) in this setting to better understand how the dynamics within a household may contribute to caregiver mental health. Finally, although outside the scope of this manuscript, it will be important to examine child outcomes associated with maternal self-efficacy in future work.

In summary, this study suggests that a nuanced approach to the study of depression, social support, and maternal self-efficacy can lead to important insights that may benefit mothers of young infants. Helping mothers achieve sustained reductions in depressive symptoms, building up emotional social support networks, and creating a “safety net” of childcare support can be beneficial for improving maternal self-efficacy, which may then support sensitive parenting and healthy child development.

Key Findings.

  • Among mothers in rural Pakistan, emotional social support at 3 months postpartum predicted higher maternal self-efficacy at 6 months post-partum, but support with daily childcare tasks did not.

  • Depression at 3 months postpartum did not predict self-efficacy at 6 months when taking concurrent depression into account.

  • There was weak evidence that having childcare support when mothers were unable to care for their children (e.g., when mother was sick or unavailable) was associated with increased maternal self-efficacy among mothers with depression.

Relevance for Infant and Early Childhood Mental Health.

  • Maternal self-efficacy is important for supporting sensitive caregiving and fostering a secure mother-child attachment, which can predict infant and child mental health. The results of this study increase our understanding of how to engender maternal self-efficacy during infancy among mothers in rural Pakistan.

ACKNOWLEDGMENTS

We would like to thank the team at the Human Development Research Foundation (HDRF) including Rakshanda Liaqat, Tayyiba Abbasi, Maria Sharif, Samina Bilal, Anum Nisar, Amina Bibi, Shaffaq Zufiqar, Ahmed Zaidi, Ikhlaq Ahmad, and Najia Atif. Finally, we are very grateful to the families who participated in the study. The Bachpan cohort study received funding from the National Institute of Mental Health (U19MH95687) and National Institute of Child Health and Development (R01 HD075875; PI: Joanna Maselko). In addition, this research was supported in part by a training grant from the National Institute of Child Health and Development (T32 HD52468).

Footnotes

CONFLICT OF INTEREST STATEMENT

The authors have no relevant financial or non-financial interests to disclose.

DATA AVAILABILITY STATEMENT

Data for this study are available at https://doi.org/10.7910/DVN/IJE2PC.

REFERENCES

  1. Akhtar A, Rahman A, Husain M, Chaudhry IB, Duddu V, & Husain N. (2010). Multidimensional scale of perceived social support: Psychometric properties in a South Asian population. Journal of Obstetrics and Gynaecology Research, 36, 845–851. [DOI] [PubMed] [Google Scholar]
  2. Atif N, Krishna RN, Sikander S, Lazarus A, Nisar A, Ahmad I, Raman R, Fuhr DC, Patel V, & Rahman A. (2017). Mother-to-mother therapy in India and Pakistan: Adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme. BMC Psychiatry [Electronic Resource], 17, 79–79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Aubel J. (2012). The role and influence of grandmothers on child nutrition: Culturally designated advisors and caregivers. Maternal & Child Nutrition, 8, 19–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Aubel J. (2021). Grandmothers—A neglected family resource for saving newborn lives. BMJ Global Health, 6, e003808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Azmoude E, Jafarnejade F, & Mazlom SR (2015). The predictors for maternal self-efficacy in early parenthood. Journal of Midwifery and Reproductive Health, 3, 368–376. [Google Scholar]
  6. Balaji AB, Claussen AH, Smith DC, Visser SN, Morales MJ, & Perou R. (2007). Social support networks and maternal mental health and well-being. Journal of Women’s Health, 16, 1386–1396. [DOI] [PubMed] [Google Scholar]
  7. Baranov V, Bhalotra S, Biroli P, & Maselko J. (2020). Maternal depression, women’s empowerment, and parental investment: Evidence from a randomized controlled trial. American Economic Review, 110, 824–859. [Google Scholar]
  8. Chung EO, Hagaman A, LeMasters K, Andrabi N, Baranov V, Bates LM, Gallis JA, O’Donnell K, Rahman A, & Sikander S. (2020). The contribution of grandmother involvement to child growth and development: An observational study in rural Pakistan. BMJ Global Health, 5, e002181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Crnic K, & Ross E. (2017). Parenting stress and parental efficacy. In Deater-Deckard K, & Panneton R. (Eds.), Parental stress and early child development: Adaptive and maladaptive outcomes (pp. 263–284). Springer International Publishing. [Google Scholar]
  10. First MB, Spitzer RL, Gibbon M, & Williams JB (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version (patient ed.). SCID-I/P. [Google Scholar]
  11. Gallis JA, Maselko J, O’Donnell K, Song K, Saqib K, Turner EL, & Sikander S. (2018). Criterion-related validity and reliability of the Urdu version of the patient health questionnaire in a sample of community-based pregnant women in Pakistan. PeerJ, 6, e5185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gerdes AC, Hoza B, Arnold LE, Pelham WE, Swanson JM, Wigal T, & Jensen PS (2007). Maternal depressive symptomatology and parenting behavior: Exploration of possible mediators. Journal of Abnormal Child Psychology, 35, 705–714. [DOI] [PubMed] [Google Scholar]
  13. Gjerdingen DK, Froberg DG, & Fontaine P. (1991). The effects of social support on women’s health during pregnancy, labor and delivery, and the postpartum period. Family Medicine, 23, 370–375. [PubMed] [Google Scholar]
  14. Goodman SH, Simon H, McCarthy L, Ziegler J, & Ceballos A. (2022). Testing models of associations between depression and parenting self-efficacy in mothers: A meta-analytic review. Clinical Child and Family Psychology Review, 25(3), 471–499. [DOI] [PubMed] [Google Scholar]
  15. Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain F, Kammerer MH, Klier CM, Rosi S, Seneviratne G, & Sutter-Dallay A-L (2004). Adaptation of the structured clinical interview for DSM-IV disorders for assessing depression in women during pregnancy and post-partum across countries and cultures. The British Journal of Psychiatry, 184, s17–s23. [DOI] [PubMed] [Google Scholar]
  16. Hagaman A, LeMasters K, Zivich PN, Sikander S, Bates LM, Bhalotra S, Chung EO, Zaidi A, & Maselko J. (2021). Longitudinal effects of perinatal social support on maternal depression: A marginal structural modelling approach. Journal of Epidemiology and Community Health, 75(10), 936–943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jeong J, Siyal S, Fink G, McCoy DC, & Yousafzai AK (2018). “His mind will work better with both of us”: A qualitative study on fathers’ roles and coparenting of young children in rural Pakistan. BMC Public Health [Electronic Resource], 18, 1274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kroenke K, Spitzer RL, & Williams JB (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kuhn JC, & Carter AS (2006). Maternal self-efficacy and associated parenting cognitions among mothers of children with autism. American Journal of Orthopsychiatry, 76, 564–575. [DOI] [PubMed] [Google Scholar]
  20. Leahy-Warren P, & McCarthy G. (2011). Maternal parental self-efficacy in the postpartum period. Midwifery, 27, 802–810. [DOI] [PubMed] [Google Scholar]
  21. Leerkes EM, & Crockenberg SC (2002). The development of maternal self-efficacy and its impact on maternal behavior. Infancy, 3, 227–247. [DOI] [PubMed] [Google Scholar]
  22. Lingam R, Gupta P, Zafar S, Hill Z, Yousafzai A, Iyengar S, Sikander S, Haq Z. u., Mehta S, & Skordis-Worrel J. (2014). Understanding care and feeding practices: Building blocks for a sustainable intervention in India and Pakistan. Annals of the New York Academy of Sciences, 1308, 204–217. [DOI] [PubMed] [Google Scholar]
  23. Lovejoy MC, Graczyk PA, O’Hare E, & Neuman G. (2000). Maternal depression and parenting behavior. Clinical Psychology Review, 20, 561–592. [DOI] [PubMed] [Google Scholar]
  24. Matvienko-Sikar K, Murphy G, & Murphy M. (2018). The role of prenatal, obstetric, and post-partum factors in the parenting stress of mothers and fathers of 9-month old infants. Journal of Psychosomatic Obstetrics & Gynecology, 39, 47–55. [DOI] [PubMed] [Google Scholar]
  25. Milgrom J, Hirshler Y, Reece J, Holt C, & Gemmill AW (2019). Social support—A protective factor for depressed perinatal women? International Journal of Environmental Research and Public Health, 16, 1426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Morita M, Saito A, Nozaki M, & Ihara Y. (2021). Childcare support and child social development in Japan: Investigating the mediating role of parental psychological condition and parenting style. Philosophical Transactions of the Royal Society B, 376, 20200025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mugweni E, Goodliffe S, Adams C, Walker M, & Kendall S. (2019). I’ll look after the kids while you go and have a shower”: An evaluation of a service to address mild to moderate maternal perinatal mental health problems. Journal of Mental Health, 28, 324–330. [DOI] [PubMed] [Google Scholar]
  28. Mumtaz Z, & Salway SM (2007). Gender, pregnancy and the uptake of antenatal care services in Pakistan. Sociology of Health & Illness, 29, 1–26. [DOI] [PubMed] [Google Scholar]
  29. O’Donnell KJ, Gallis J, Turner E, Hagaman A, Scherer E, Sikander S, & Maselko J. (2022). The day in the life approach for assessing infant caregiving practice in rural Pakistan. Family Relations, 72(3), 1–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Puspasari J, Rachmawati IN, & Budiati T. (2018). Family support and maternal self-efficacy of adolescent mothers. Enfermeria Clinica, 28, 227–231. [Google Scholar]
  31. Rowther AA, Kazi AK, Nazir H, Atiq M, Atif N, Rauf N, Malik A, & Surkan PJ (2020). “A woman is a puppet.” Women’s disempowerment and prenatal anxiety in Pakistan: A qualitative study of sources, mitigators, and coping strategies for anxiety in pregnancy. International Journal of Environmental Research and Public Health, 17, 4926. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rustein SO, & Johnson K. (2004). The DHS wealth index. DHS Comparative Reports No. 6, Calverton, Maryland. https://www.measuredhs.com/pubs/pdf/CR6/CR6.pdf [Google Scholar]
  33. Sanders MR, & Woolley M. (2005). The relationship between maternal self-efficacy and parenting practices: Implications for parent training. Child: Care, Health and Development, 31, 65–73. [DOI] [PubMed] [Google Scholar]
  34. Sharif M, Zaidi A, Waqas A, Malik A, Hagaman A, Maselko J, LeMasters K, Liaqat R, Bilal S, Bibi T, Ahmad I, Sikander S, & Rahman A. (2021). Psychometric validation of the multidimensional scale of perceived social support during pregnancy in rural Pakistan. Frontiers in Psychology, 15(12), 601563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Shenk MK, Morse A, Mattison SM, Sear R, Alam N, Raqib R, Kumar A, Haque F, Blumenfield T, & Shaver J. (2021). Social support, nutrition and health among women in rural Bangladesh: Complex tradeoffs in allocare, kin proximity and support network size. Philosophical Transactions of the Royal Society B, 376, 20200027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Shorey S, Chan SWC, Chong YS, & He HG (2014). Maternal parental self-efficacy in newborn care and social support needs in Singapore: A correlational study. Journal of Clinical Nursing, 23, 2272–2283. [DOI] [PubMed] [Google Scholar]
  37. Sikander S, Ahmad I, Atif N, Zaidi A, Vanobberghen F, Weiss HA, Nisar A, Tabana H, Ain QU, & Bibi A. (2019). Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: A cluster randomised controlled trial in Pakistan. The Lancet Psychiatry, 6, 128–139. [DOI] [PubMed] [Google Scholar]
  38. Suzuki S, Holloway SD, Yamamoto Y, & Mindnich JD (2009). Parenting self-efficacy and social support in Japan and the United States. Journal of Family Issues, 30, 1505–1526. [Google Scholar]
  39. Taneja S, Sinha B, Upadhyay RP, Mazumder S, Sommerfelt H, Martines J, Dalpath SK, Gupta R, Kariger P, Bahl R, Bhandari N, Dua T, Abbasi F, Panwar V, Nagpal S, Shekhar M, Ghosh R, Kaur J, Dube B, & for the ciKMC development study group. (2020). Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial. BMC Pediatrics, 20, 150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Teti DM, & Gelfand DM (1991). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62, 918–929. [DOI] [PubMed] [Google Scholar]
  41. Travasso SM, Rajaraman D, & Heymann SJ (2014). A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India. BMC Women’s Health, 14, 22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Treas J, & Tai T. (2016). Gender inequality in housework across 20 European nations: Lessons from gender stratification theories. Sex Roles, 74, 495–511. [Google Scholar]
  43. Upadhyay RP, Taneja S, Ranjitkar S, Mazumder S, Bhandari N, Dua T, Shrestha L, & Strand TA (2021). Factors determining cognitive, motor and language scores in low birth weight infants from North India. PLoS ONE, 16, e0251387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Vanobberghen F, Weiss HA, Fuhr DC, Sikander S, Afonso E, Ahmad I, Atif N, Bibi A, Bibi T, Bilal S, De Sa A, D’Souza E, Joshi A, Korgaonkar P, Krishna R, Lazarus A, Liaqat R, Sharif M, Weobong B, . . . Rahman A. (2020). Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan. Journal of Affective Disorders, 265, 660–668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Woody C, Ferrari A, Siskind D, Whiteford H, & Harris M. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86–92. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data for this study are available at https://doi.org/10.7910/DVN/IJE2PC.

RESOURCES