Associations between maternal capabilities for care and nurturing care behaviours among mother-child dyads in Malawi and South Africa

Adequate nurturing care behaviours, including feeding practices, health-seeking and psychosocial stimulation, are crucial for the optimal health, growth and development of young children. However, several factors, recognised as maternal ‘capabilities for care’, can influence a mother’s capability to provide adequate care, namely knowledge/beliefs, physical health and nutritional status, mental health, autonomy, reasonable workload/time availability and social support. As part of the Khula birth cohort study, we aimed to investigate if maternal capabilities for care are associated with nurturing care behaviours among mother-child dyads in Malawi (n = 122) and South Africa (n = 206). When children were 10–16 months of age, mothers competed a series of self-reported sociodemographic, child diet and health and psychosocial questionnaires. Six maternal capabilities for care were considered: haemoglobin concentration, mental health, employment, decision-making autonomy, support for childcare and social support. The nurturing care behaviours were feeding practices, complete immunisation status appropriate to chid age and psychosocial stimulation within the home environment. Regression modelling assessed associations between maternal capabilities for care and each care behaviour, adjusting for child sex, maternal age and education level and household socioeconomic status. Associations between maternal capabilities for care and nurturing care behaviours differed by care behaviour and setting. Maternal employment and decision-making as measures of autonomy, support with childcare as a measure of reasonable workload and reported social support were the maternal capabilities most consistently associated with feeding practices, complete immunisation status and stimulation practices, although the direction of associations differed between settings. Maternal haemoglobin and mental health were associated with one care behaviour each (stimulation and feeding practices, respectively). Measuring and understanding how various maternal capabilities influence caregiving across contexts is essential for empowering caregivers to provide optimal care. Interventions, programmes and policies that seek to improve child health, growth and development through enhanced nurturing care practices should strengthen multiple maternal capabilities.