Parental Well-Being and Child Development

Abstract An estimated 43 percent of children under age 5 in low- and middle-income countries (LMICs) will not reach their full developmental potential due to poverty, stunting, or inadequate psychosocial stimulation. Parenting interventions that promote responsive caregiving can effectively improve early childhood development (ECD) outcomes in LMICs, at least in the short-term. Yet to date, 93 percent of parenting interventions globally have exclusively focused on mothers, and longer-term follow-ups show early impacts fade out over time. Parenting interventions that that solely target mothers overlook the potential gains from engaging fathers, who can influence children’s outcomes directly, via increases in responsive caregiving and reductions in harsh discipline, and indirectly, via improvements in maternal and family wellbeing stemming from increased emotional support and participation in household tasks, and reduced intimate partner violence (IPV). Engaging couples to achieve whole-family behavioral changes could lead to larger program impacts than engaging only mothers, given that fathers are often the household head with significant decision making power and influence on family dynamics in LMICs. Since familial support can play a key role in supporting long-term behavior change, interventions that engage both parents may also stand the best chance to sustain impacts over time. Our proposal asks: Does engaging both parents as couples lead to larger and more sustained improvements in parenting behaviors and ECD outcomes relative to engaging only mothers? We will develop and experimentally test Msingi Bora Familia (MBF), a responsive parenting and family wellbeing intervention that integrates father- inclusive, gender-equitable and family-focused curricula into Msingi Bora (MB), a NICHD-funded responsive parenting intervention by our team. MB significantly improved short-term maternal parenting behaviors and ECD, but impacts after two years were smaller. We will test MBF in a 3-arm cluster randomized controlled trial in which 120 villages and 1,200 households with young children from rural Kenya will be randomly assigned to: (1) a control group; (2) mothers-only; or (3) “couples” (though we allow for myriad family configurations). We will test the relative effectiveness and cost-effectiveness of treating only mothers versus engaging both parents. We will collect baseline and follow-up surveys on measures of child cognitive and socioemotional outcomes, paternal and maternal caregiving behaviors and mental health, experience of IPV, attitudes towards gender roles, social norms, and quality of the couple’s relationship. A second follow-up survey two years later will test for sustained impacts on parental and family measures, as well as ECD outcomes. We will collect cost data during implementation to estimate the relative cost-effectiveness of each intervention model, and explore the mediating pathways of change to inform the generalizability and sustainability of the different intervention models. The goal of our study is to produce rigorous evidence on the distinct role of fathers on children’s development, and to test if their inclusion improves the effectiveness and sustainability of parenting interventions in LMICs.