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

Abstract

It has long been acknowledged that women with children require social support to promote their health and wellbeing, as well as that of their children. However, the dominant conceptualizations of support have been heavily influenced by Western family norms. The consequence, at best, has been to stifle our understanding of the nature and consequences of support for mothers and children. At worst, it has led to systematic discrimination negatively impacting maternal–child health. To fully engage with the complexities of social support, we must take multidisciplinary or interdisciplinary approaches spanning diverse cultural and geographical perspectives. However, multidisciplinary knowledge-processing can be challenging, and it is often unclear how different studies from different disciplines relate. To address this, we outline two epistemological frameworks—the scientific approach and Tinbergen's four questions—that can be useful tools in connecting research across disciplines. In this theme issue on ‘Multidisciplinary perspectives on social support and maternal–child health’, we attempt to foster multidisciplinary thinking by presenting work from a diverse range of disciplines, populations and cultures. Our hope is that these tools, along with papers in this issue, help to build a holistic understanding of social support and its consequences for mothers and their children. Overall, a multidisciplinary perspective points to how the responsibility of childrearing should not fall solely onto mothers. Indeed, this multidisciplinary issue demonstrates that successful childrearing is consistently an activity shared beyond the mother and the nuclear family: an insight that is crucial to harnessing the potential of social support to improve maternal–child health.

This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

1. Introduction

As we write, in the midst of the third COVID-19 lockdown in England, the need for social support when it comes to raising children has never been so apparent. With schools closed to the majority of children and physical contact severed between households, many families have not been able to access the support they need [1,2]. With evidence that childcare and domestic workloads have disproportionality increased for women during this pandemic, many mothers are struggling with their physical and mental health [1–4]. Further, there is increasing concern about children facing unprecedented levels of loneliness and mental health problems due to social isolation [5]. Many of us through this pandemic are experiencing first-hand how crucial social support is for our health and wellbeing, and this need is particularly acute for mothers and children.

Public health researchers, practitioners and policy makers have long argued that mothers and children need support [6,7]. However, the ultimate aim of support has frequently focused on improving infant and child health, without adequate consideration for supporting mothers in their own right [8]. For example, drawing on our own expertise around breastfeeding, the extensive investment in breastfeeding support in England has primarily been pushed as a way to improve outcomes for infants and young children, with some bonus maternal benefits (e.g. [9]). Past government guidance has included recommendations of ‘raising awareness of the health benefits of breastfeeding—as well as the risks of not breastfeeding’ [10, p. 28]. But the known costs and challenges of breastfeeding [11–13] were barely explained, which one might expect to see more of if breastfeeding was framed as an important determinant of maternal wellbeing, not just that of children. While we cannot be certain why maternal wellbeing in its own right is often overlooked in Western populations, Budds, in this issue, outlines how intensive mothering norms that are pervasive in the West coexist with the expectations of maternal sacrifice [14]: amplified by Bowlby and Ainsworth's Attachment Theory, maternal devotion is often assumed to be crucial for optimal child development, and putting their children first over and above their own wellbeing is fundamental to being ‘good mothers’.

Much of what is felt or believed to be ‘normal’ among researchers, practitioners and policy makers in the West may in fact be comparatively unusual. As Sear and others highlight in this issue [15–18], the human childrearing system evolved to be cooperative, where mothers and children require extensive support from others [19–22]. It is only in relatively recent history that nuclear family norms became so widespread [15] and, cross-culturally, childrearing is still widely shared where mothers and children are supported by a diverse range of individuals [16,17,19–21,23]. The ‘WEIRDness’ of nuclear family focused childrearing—specific to Western, Educated, Industrial, Rich, Democratic [24] ideals—has long been obvious to researchers engaging with different communities and cultures. However, it is yet to be widely acknowledged within Western research dominated by White middle-class norms.

The narrow conceptualizations of the family and who should care for children have perhaps fuelled the view of mothering as an individual responsibility in the West (e.g. see [8,25–29]), coinciding with high levels of research interest in how mothers affect child development [8,14,29]. The consequence has been a much more limited consideration of wider social environments that impact mothers and children [26,29], with policies and interventions in Western populations primarily targeting mothers to improve their parenting practices [8,26–30]. In reality, mothers and children are influenced by a wide range of socioecological factors, including the availability of social support. Support can be provided to mothers and/or children from a range of sources from across their social networks, including fathers, grandparents and friends, as well as ‘professional supporters' such as trained volunteers and health practitioners. Further, support can take different forms, including emotional, affirmational, practical and informational support [13,31]. The impact of support on mothers and children may depend on who provides the support, what support is provided, and the context in which the supportive acts take place [7,13,19,32–34], meaning understanding the pathways between support and maternal–child health is likely to be complex. However, despite theoretical acknowledgement of these complexities [7,33], research into support for mothers and children has rarely approached the topic in this holistic manner.

One underlying cause, we argue, is disciplinary silos. The dominant way of working in academia has been for researchers to engage with those of similar training, similar backgrounds, and, inevitably, similar thoughts. This is of course not surprising given the known barriers that disadvantage multidisciplinary collaboration—ranging from communication challenges, poor quality peer reviews, and wider academic structures and policies that focus on distinct disciplines [35–38]. The costs of such constraints include the slowing down of knowledge-building, as opportunities for comprehensive knowledge and creative breakthroughs are stifled [39]. Perhaps more importantly, disciplinary silos can push knowledge-building down the wrong path: the lack of diversity in knowledge, views and experiences leads to a lack of critique of dominant research narratives and a lack of awareness of research bias [39].

This is a real and serious problem. The harmful consequences from the lack of diversity and critique are exemplified by Betti in this theme issue, who critically describes how the dominant assumptions of what a ‘normal’ female pelvis should look like have largely been based on studies of women with European genetic ancestry [40]. This has ultimately led to discriminatory maternal healthcare practices across the globe, particularly disadvantaging women with non-White ethnicities [40]. As we hope to show, engaging with multiple disciplines and perspectives is crucial in achieving research rigour, and is particularly important for a topic that may have profound, real-world implications for the lives of women, mothers, children and their families.

The motivation behind this theme issue on ‘Multidisciplinary perspectives on social support and maternal–child health’ stemmed from an earlier workshop (held in 2019 at University College London) on interdisciplinary approaches to mother–infant support [35]. Drawing on discussions with students, researchers and practitioners from different disciplines, we collated a ‘Practical guide to successful interdisciplinary research’ [35] (see electronic supplementary material). This included the suggestion of topic-focused outlets of research to facilitate multidisciplinary dialogue and knowledge exchange. 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.

2. How to cross disciplinary bridges

Multi- and interdisciplinary research to address complex topics and problems, where ideas are integrated from different fields, has been pushed for decades [45–47], but it is very difficult to accomplish [46]. In addition to the barriers discussed above, it can be challenging for researchers to comprehend unfamiliar concepts, unfamiliar phrases and unfamiliar methods. As outlined in our guide to interdisciplinary research, some barriers are institutional and structural, but some could be addressed at an individual level. From our experience, one common individual-level issue is with knowledge-processing, where it is unclear how different studies from different disciplines relate. As self-identified interdisciplinary researchers with a background in evolutionary anthropology, here we outline two useful epistemological frameworks that have helped us cross disciplinary bridges.

(a). Tip 1: framing diverse research under a scientific approach

A common issue we have observed and experienced first-hand is the dismissal of qualitative work as ‘non-generalizable story-telling’ and quantitative work as ‘complexity-ignoring reductionism’. As particular disciplines tend to use particular methods, these misunderstandings can hinder multidisciplinary engagement. We propose that using a scientific framework can help map out and connect research with different aims and different methods.

Science is often framed as hypothesis-testing, but this is a narrow view of science that overemphasizes confirmatory methods which tend to be, although not exclusively, quantitative [48]. As outlined in figure 1, the scientific method includes both exploratory and confirmatory stages. Carefully detailing and reflecting on the lived experiences of a group of people (exploratory stage), for example, ensures that proposed answers to related questions are well-informed and plausible. Systematically testing these explanations (confirmatory stage) helps us then assess which of the suggested explanations are more likely than others.

Figure 1.

The scientific method as exploratory and confirmatory stages.

While what we present here is a significantly simplified version of science, we hope it helps some readers organize the knowledge presented in this issue. For example, Chang et al. [49] in this issue take an exploratory approach by presenting a systematic review of the views and experiences of partners and family members who provided breastfeeding support [49], describing both similarities and differences in experiences across cultures. Following this, Myers et al. in this issue take a confirmatory approach to test the hypothesis that different types of support from varying sources differentially influence breastfeeding duration and experience [13]. These contributions speak to different aims within the scientific method, and, as such, critiques of story-telling and reductionism are simply not valid.

(b). Tip 2: framing diverse research under Tinbergen's four questions

Another issue we commonly encounter is the misinterpretation of research findings from different disciplines as conflicting, rather than complementing. Often, this is due to the lack of understanding that different disciplines are frequently addressing different types of questions. Tinbergen, an ethologist known to many in the field of biology, clarified in 1963 that questions around behaviour could be broken down into four categories: ontogeny, or how the behaviour develops during the individual's lifetime; mechanism, or how the behaviour is caused; phylogeny, or the evolutionary history of the behaviour; and current utility, or the adaptive function of the behaviour relating to fitness (i.e. survival and reproduction) [50,51]. The first two, ontogeny and mechanism, address proximate-level questions that serve to clarify how a behaviour exists. The last two, phylogeny and current utility, address ultimate-level questions explaining why the behaviour exists in the first place.

Therefore, again drawing on breastfeeding as an example, ultimate-level adaptive explanations around how breastfeeding influences maternal fitness do not replace or conflict with proximate-level mechanistic explanations around how norms influence breastfeeding behaviour (table 1); both can be true. Indeed, for us to truly understand a social phenomenon, we must engage with all four questions [50]. In this issue, for example, Gettler et al. investigate the mechanism of how paternal provisioning influences child psychobiology in the BaYaka [44], revealing the pathways of how social support can impact child fitness. The fitness consequence, or the current utility, of social support is explored by Schacht et al. using a historical dataset from Utah, evidencing how the flexibility of family formations after parental death buffers children from mortality risks [18]. As we demonstrate through this theme issue, exploring social support from different levels encourages diversity in perspectives, leading to a comprehensive understanding of ‘who cares’ for mothers and children and its consequences.

Table 1.

Understanding breastfeeding using Tinbergen's four questions.

	proximate-level explanations
	ontogeny/development	mechanism/causal pathways
Q. How does breastfeeding exist?	A. Development of mammary glands. Learning to breastfeed through observation/teaching.	A. Hormonal changes & milk production. Reactions to crying. Cultural norms.
	ultimate-level explanations
	phylogeny/evolutionary history	current utility/adaptive value
Q. Why does breastfeeding exist? (evolutionary questions)	A. Humans are mammals, and like all mammals we produce milk to feed babies. Evolved >200 Ma.	A. Mothers provide babies with nutrients and energy, which increases their fitness (survival + reproduction).

We hope these tips are helpful for researchers to engage in multi- and interdisciplinary research. However, as briefly referred to above, this of course does not address systemic and institutional barriers that hinder collaboration. The core of multi-/interdisciplinary research is diversity in perspectives, but this is difficult to achieve in a system where diverse voices and experiences are not heard. The lack of social, cultural, ethnic and gender diversity within many research communities [52–54] and the lack of geographical and cultural diversity in current research [24] lead to the dominance of Western White middle-class narratives in academia. Achieving diversity in research more broadly is an important issue in itself, but we should also acknowledge that the lack of diversity hinders knowledge production [55,56], which costs us all. Indeed, one of our regrets about this issue is the over-representation of researchers based in Western institutions despite our efforts to diversify. One important action is for those in more privileged positions to connect with, listen to, step aside for, and amplify the voices of scholars from diverse backgrounds and perspectives from across the globe. While the issues are legion, as we outline in our practical guide to interdisciplinary research (electronic supplementary material), it is important that we ‘don't do it alone’.

3. Understanding this theme issue

Now that we are better equipped to cross disciplinary bridges, let us outline key points of this theme issue. First, this issue focuses on presenting research and commentary on support for mothers with infants and/or young children, reflecting the predominant norms and expectations of mothers as primary caregivers [14,15]. This is not to say that other caregivers are not important; in fact, we argue the opposite. 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. While we recognize that macro- and community-level factors are also key determinants of maternal and child health, this focus stems from how we define support: from an evolutionary anthropological perspective, we conceptualize support as investments directly or indirectly transferred to a person, which ‘cost’ the actor some form of time, energy or resource [19]. As outlined by McLeish & Redshaw [31] and Myers et al. [13] in this issue, such support is diverse, spanning practical, informational, emotional and affirmative support.

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. These papers, while important contributions in their own right, are presented to complement one another and build a broad understanding of the multifaceted nature of social support across diverse settings.

4. Final thoughts

This theme issue could not have been produced without the hard work and collaboration of all our authors and reviewers, and all the unseen supporters who made this work possible during the current pandemic. It has taken a heroic amount of effort from many, juggling care for children and others, supporting students and colleagues, and more—for which we are very grateful. Our hopes for this special issue are twofold. First, to foster multidisciplinary understandings of support for mothers and children, informed by findings from different cultures. Second, to evidence that the responsibility of childrearing should not—nor cannot—fall solely onto mothers, and indeed, successful childrearing is consistently an activity shared beyond the nuclear family.

As we discuss above, narrow, ideological conceptualizations of motherhood reinforced by unchallenged ‘scientific’ assumptions have led to harmful implications for maternal wellbeing. The assumption that mothers are, and evolved to be, sole caregivers, and that motherhood should come at the expense of all other domains of womanhood, contrasts and conflicts with the realities of raising children across the globe.

This point, while it may seem obvious to many of us, must be reinforced. During the present COVID-19 pandemic, in the UK Western notions of intensive mothering have arguably resulted in delayed policy change to allow for childcare support during lockdown (e.g. [59]), instances of fathers and other key supporters being excluded from antenatal appointments and births (e.g. [60]), economic support packages being tailored towards ‘working men’ [61], and widespread rhetoric in popular media encouraging a gendered division of childcare labour (e.g. [62]). Cultural norms that mothers should sacrifice their time, energy and careers in order to be ‘good mothers’ have resulted in overburdening women, reinforcing current gender inequalities and damaging maternal wellbeing. And of course, these assumptions disadvantage fathers and other caregivers too, as those who want to provide care and support are by extension excluded from the domain of childrearing.

To challenge the ‘truth’ behind these assumptions, we must work together as a research community. We hope this themed issue is approachable and accessible to a broad audience, encouraging researchers to look beyond disciplinary boundaries when considering social support and maternal–child health. In the end, it is not just who cares that matters, but how we care together.

Biographies

Guest Editors' biographies

Sarah Myers is a senior teaching assistant in Biological Anthropology at UCL Anthropology and a guest member of the BirthRites Independent Max Planck Research Group at the Max Planck Institute for Evolutionary Anthropology. She received her PhD in Anthropology from the University of Kent in 2017, following a BA(hons) in Human Sciences from the University of Oxford and an MPhil in Biological Anthropology from the University of Cambridge. Her research focuses on maternal behaviour and wellbeing in the postnatal period, and she received the International Society for Evolution, Medicine, and Public Health's George C. Williams Prize in 2017 for her work on postnatal depression. Seen here with Laurie, one of her favourite allochildren.

Abigail E. Page is an MRC Research Fellow in the Department of Population Health at the London School of Hygiene and Tropical Medicine. A BA in Anthropology from the University of Durham and an MSc in Medical Anthropology from University College London left Abigail interested in social and biological explanations of human behaviour, especially related to mothers and young children. This led to a PhD in Biological Anthropology at University College London, focused on evolutionary approaches to health, demography and informal childcare in a small-scale population in the Philippines, the Agta. Since her PhD, Abigail has remained interested in social support for mothers with young children but expanded her research to high-income contexts, focusing on support for breastfeeding. Seen here with her two children, Finley and Rémy.

Emily H. Emmott is a lecturer in Biological Anthropology at UCL Anthropology. She grew up being cared for by her parents and extended family between Japan and England, which fostered her appreciation for alloparents and cross-cultural perspectives. The inability to decide what she wanted to study about humans led her to take a BSc in Human Sciences at University College London, which introduced her to evolutionary anthropology. She went on to receive an MSc in Cognitive and Evolutionary Anthropology from the University of Oxford, and a PhD in Anthropology from University College London. Perhaps inspired by her early life experiences, Emily's research focuses on extended caregiving and support in post-industrial populations, and its impact on parenting behaviour and children and young people's health and wellbeing. She works to inspire the next generation of interdisciplinary researchers by teaching biosocial anthropology, applied anthropology and mixed methods research at UCL Anthropology.

Data accessibility

This article has no additional data.

Authors' contributions

E.H.E., S.M. and A.E.P. planned the paper. E.H.E. drafted the paper, and S.M. and A.E.P. edited the paper.

Competing interests

We declare we have no competing interests.

Funding

A.E.P. is funded by the Medical Research Council (grant no. MR/P014216/1).