CULTURALLY RELEVANT GROUP PARENTING PROGRAMMES ON ECD

FINAL REPORT

Department of Child HealthUniversity of the West Indies, Mona

March 31, 2011

Contents

Culturally Relevant Group Parenting Programmes on ECD..........................................................................3

Background..............................................................................................................................................3

The importance of Parenting in Early Childhood Development...........................................................3

Parenting Education & Support...........................................................................................................3

Parenting in Jamaica............................................................................................................................4

Supports for Parents of young children in Jamaica..............................................................................4

METHODOLOGY:......................................................................................................................................6

Sample Selection.................................................................................................................................6

Identification of Participants...............................................................................................................6

Measurements....................................................................................................................................7

Data Collection Process.......................................................................................................................7

Data Entry & Statistical Analyses.........................................................................................................7

Ethical Approval...................................................................................................................................8

RESULTS:..................................................................................................................................................9

Participation Rates...............................................................................................................................9

Geographic Distribution.......................................................................................................................9

Demographic Data.............................................................................................................................10

Previous Parenting Experience..........................................................................................................11

Preparation for Parenting in this Pregnancy......................................................................................12

Parenting Information Seeking Behaviour.........................................................................................13

Women’s Perceptions About Parenting a New Baby.........................................................................15

Women’s Lifestyle Behaviours During Pregnancy:............................................................................16

CONCLUSIONS.......................................................................................................................................17

RECOMMENDATIONS............................................................................................................................20

Study Limitations:..................................................................................................................................21

ACKNOWLEDGEMENTS:.........................................................................................................................22

References.............................................................................................................................................23

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Culturally Relevant Group Parenting Programmes on ECD

Background

The importance of Parenting in Early Childhood Development

A parent is any caregiver who provides nurturance or support for an infant, child, or youth. Research

has indicated that that parenting plays a central role in children’s growth, health, development and well-

being (Shonkoff & Phillips, 2000). Parent–child interactions are particularly significant during the early

childhood years, because important cognitive associations develop during this period (Bruner, 1975).

The development of children’s social and cognitive skills has been consistently shown to be influenced

by the quality of interactions they have with their caregivers (Landry, Smith & Swank, 2003). Consistent

and responsive caregiving is thought to have a special influence on early brain organization and skill

development and provide a foundation that fosters trust, initiative and autonomy in children (Berk,

2006; Rovee-Collier, 1995). Good parenting is hypothesized to place children on a positive

developmental trajectory that sustains beyond the early childhood period (Landry, Smith & Swank,

2003).

This relationship between parenting behaviour and child outcomes highlights the need to direct

resources to promoting and supporting effective parenting practices. In fact, there is mounting evidence

that structured behavioural interventions to promote positive parenting reduce problems for children

(especially young children) and contribute to healthy development (Dumas, Nissley-Tsiopinis, &

Moreland, 2007; Sanders, 2010).

Parenting Education & Support

Parenting support is “…any intervention for parents or carers aimed at reducing risks and/or promoting

protective factors for their children, in relation to their social, physical and emotional well-being”

(Moran, Ghate & van der Merwe, 2004, p. 6). Parenting support can be both formal and informal and

can focus on prevention as well as intervention. Parenting education and support programmes are

based on the assumption that parents who have a better understanding of child development and

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children’s needs are more likely to provide the sensitive, nurturing, and attentive care that promotes

healthy development in children and youth (Brown, n.d.) In fact, the literature on parenting

programmes has shown that parenting support benefits children and families when they are strengths-

based, culturally sensitive and accessible to parents.

Parenting in Jamaica

Research on parenting in Jamaica has shown that although many parents understand the elements that

comprise successful parenting, high levels of stress and economic deprivation affect the caregiver-child

relationship (Ricketts & Anderson, 2009). Similarly, Samms-Vaughan’s (2005) findings confirmed that

Jamaican parents are experiencing high levels of stress (higher than their US counterparts) and this often

reduced their ability to effectively parent their children. There is some evidence that receiving parenting

information significantly defused the stress levels of Jamaican parents (Ricketts & Anderson, 2009).

However, there seems to be uneven access to parenting support and information across the island, with

parents from lower socio-economic brackets and those that lived in rural areas having less exposure to

quality parenting information. Many of the recommendations for parenting support from these studies

focused on strengthening the capacity, scope and coverage of community institutions such as health

centres, schools and churches with respect to the provision of parenting information.

The draft National Parenting Policy (2009) is an effort to address some of the legislative and institutional

gaps for effective parenting in Jamaica. The policy’s vision is that all parents recognise their

responsibility to meet their children’s survival and developmental needs and rights and to help their

children develop to their full potential. The National Parenting Policy (2009) also outlines the

establishment of a National Parenting Support Commission (NPSC) which will be charged with the

responsibility of advising and coordinating the activities and partners on parenting issues in Jamaica.

Supports for Parents of young children in Jamaica

Although there are several institutions and organizations offering initiatives and programmes to

Jamaican parents, less than 30% report that they have had any parenting support provided at all.

Parenting support initiatives must be designed so that they are culturally sensitive and include parents

from all socio-economic brackets. The well child clinic has been identified as good vehicle for such a

programme because children in this age group are seen with their parents some 6 times in the first 18

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months at these clinics and more than 90% of parents attend well child clinics in Jamaica. The delivery

of high quality group parenting programmes at well child clinics would therefore represent a low-cost

investment to improve the quality of early childhood development, through parenting interventions.

However, further research is needed to confirm that parenting support programmes would be the most

effective if delivered through these health services.

This report outlines the results of a research study designed to identify the parenting experience and

practices, existing parenting supports and parenting needs of Jamaican parents across the island. The

information obtained from the research project is critical for the development of culturally relevant

group parenting programmes in Jamaica that appeal to parents from all socio-economic and

demographic groups. In addition, the findings from this study can be used to inform the NPSC on the

current gaps in parenting support in the Jamaican context and the most appropriate format for

delivering effective parenting information.

METHODOLOGY:

Sample SelectionThis proposal was conducted in collaboration with a larger study, the Jamaican Birth Cohort Study 2011

(JBCS 2011), because of the benefits to be obtained. In the short term, these benefits included the

existence of human and administrative resources (e.g. Study Director and Project Manager) and

infrastructure for the study (e.g. existing ethical approval from the University of the West Indies and the

Ministry of Health for the conduct of the study), given the short time period for study completion. In

the future, the benefits include the utilization of the data collected in longitudinal analysis in the JBCS

2011, representing a long term yield from the original research investment.

JBCS 2011 is aimed at improving the health, developmental and behavioural outcomes of children by

obtaining current information to impact national policy development. A birth cohort of children born

between July 1, and September 30, 2011, will be identified when their mothers register for antenatal

care between 20 and 28 weeks of pregnancy during the period March to June 2011. Information will

be obtained on children’s physical and socio-emotional environments to determine the impact of these

on their health, social, developmental and behavioural outcomes for a 2 year period in the initial phase

of JBCS 2011.

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By definition, a birth cohort is a nationally representative sample. The sample of women participating in

this study was a sub-set of the JBCS 2011, and included those women with an expected date of delivery

between July 1 and September 30, 2011 who attended for antenatal care throughout the island during

the month of March 2011.

Identification of Participants Trained nurse interviewers visited antenatal clinics throughout the country. The Antenatal Clinic

Register (Booking Register) was reviewed as far back as January 1, 2011 to identify all women with an

expected date of delivery within the study period of July, 1, 2011 and September 30, 2011.

Demographic information was obtained and documented in a register. Each Clinic Appointment Book

was then reviewed to identify eligible women who would return to clinics for visits during the period of

data collection.

Measurements

Questionnaires administered to study participants were designed to obtain two aspects of data:

Parenting Data and Demographic and Socio-Economic Data.

1. Parenting DataA Questionnaire entitled “My Expectations of My Pregnancy, My Parenting and My Partner” was specifically developed to obtain detailed information on parenting practices. The questionnaire had four sub-sections:

a. Previous Parenting experienceb. Preparation for pregnancy and delivery in this pregnancyc. Preparation for parenting in this pregnancyd. Partner relationships and expectations

2. Demographic and Socio-Economic DataAspects of a socio-economic questionnaire designed for the JBCS 2011 were utilised in this study to obtain demographic and socio-economic data. The demographic questions utilised were those that indicated mother’s age, marital status and parish of residence (to determine urban-rural status) The socio-economic questions utilised were those reflecting consumption data of the household in which the mother lived. Consumption data has been identified in previous Jamaican Birth Cohort Studies as the indicator that is best correlated with socio-economic status. Additionally, the consumption questions used in this study are also those utilised in the annual national household survey, the Jamaican Survey of Living Conditions.

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Questionnaires were piloted using a small sample of pregnant women who were not eligible to participate in the study, by virtue of their expected date of delivery. Only minor adjustments were made to the questionnaires based on information obtained from piloting.

Data Collection Process Trained nurse interviewers attended clinics on days when antenatal clinic services were scheduled.

General study information was given to all pregnant women awaiting antenatal clinic services during the

regular antenatal clinic talks given prior to antenatal service delivery. Study mothers were then

identified and more detailed discussions had with them, prior to obtaining informed consent to

participate in the study. Interviews were then conducted to complete questionnaires. In view of the

relatively low literacy rate, questionnaires were not self-administered.

Data Entry & Statistical AnalysesData from questionnaires were entered on computer and verified. Range and logic checks were

undertaken. Descriptive statistics, frequencies and cross tabulations were utilized for data analysis.

Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), Version 12.0.

Ethical ApprovalEthical approval for the conduct of the study was obtained from the UWI/UHWI Ethical Committee of

the Faculty of Medical Sciences Ethical Committee and the Jamaican Ministry of Health. Informed

consent was obtained from all participants. All members of the study team, who by virtue of their

seniority, have responsibility for supervision and training of field staff, were trained and certified in

Research Ethics.

RESULTS:This report focuses specifically on the parenting aspects of the questionnaire, specifically on previous parenting experience and preparation for parenting in this pregnancy.

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Participation RatesA total of 251 women consented to participate in the study. The refusal rate was estimated from the clinic that had the most accurate data available in the Clinic Booking Register, the University Hospital of the West Indies Clinic. A refusal rate of 20% was identified.

Geographic Distribution The distribution of participants in the study, compared with the distribution of women who attended for antenatal services in 2010 is presented by the geopolitical divisions of parish and by region, in Tables 1 and 2 respectively.

Table 1

Parish Distribution of Study Participants

PARISH Study Participants (no. and %) Antenatal Attenders (2010) (no. and %)Kingston / St. Andrew

106 44.7 10,500 26.0

St. Thomas 5 2.1 1283 3.2Portland 28 11.8 755 1.9St. Mary 15 6.3 1840 4.6St. Ann 3 1.3 3540 8.9Trelawny 2 0.8 561 1.4St. James 3 1.3 4387 10.9Hanover 8 3.4 474 1.2Westmoreland 1 0.4 2376 5.9St. Elizabeth 4 1.7 1442 3.6Manchester 3 1.3 4474 11.1Clarendon 28 11.8 2726 6.7St. Catherine 31 13.1 6032 14.9TOTAL 237 100.0 40,390 100.0

Table 2

Regional Distribution of Study Participants

Region No. (Study) % (Study) No (2010) % (2010)South East 142 59.9 17,815 44.1North East 46 19.4 6,135 15.2Western 14 5.9 7,798 19.3South 35 14.8 8,642 21.4TOTAL 237 100.0 40,390 100.0

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The distribution of study participants by parish shows significant variation when compared with births

by parish reported by the Ministry of Health (MOH) in 2010 Disaggregation of this very small sample

into fourteen parishes can exaggerate these variations. When analysed by region, the data shows that

the study identified women from all regions of the country in proportions not vastly dissimilar to that

reported by the MOH in the South East and North East regions. There were relatively fewer women

identified in the Western region. This was due to this being the last region in which training sessions

were completed, by virtue of distance from the Study Centre in Kingston.

Demographic Data Maternal Age, Parity and Socio-Economic Status:

The mean maternal age was 26 years (SD 6.6) with a mode of 22 years. Maternal age distribution is

presented in Table 3. The distribution presented is similar to that currently existing in Jamaica. Not

unexpectedly, maternal age was significantly associated with parity and with urban rural distribution.

Younger mothers were more likely to be having their first child (p<0.001) and to reside in rural areas

(p<0.01).

Table 3

Maternal Age Distribution

Maternal Age Range (yrs)

No. %

12-19 41 19.620-24 59 28.225-29 46 22.030-34 40 19.1> 35 23 11.0TOTAL 209 100.0

Socio-Economic Status was determined using consumption data. Twenty five different household items were enquired of, ranging from small and relatively inexpensive items such as a radio and a fan to larger and more expensive items such as air conditioners, generators, electric stoves and cars. A simple tally of items in the possession of the household was utilized for the analysis.

The mean number of possessions was 9.9 (SD 4.3); the minimum number of possessions was 1 and the maximum number was 21. The number of possessions relative to the number and proportion of participants in quintiles is presented in Table 4.

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Table 4

Distribution of Possessions by Quintiles

Category of Possessions (Quintiles)

No. %

0-6 38 17.47-8 36 16.49-11 49 22.412-14 45 20.515-25 51 23.3TOTAL 219 100.0

Previous Parenting ExperienceWomen reported on their previous parenting experience in a question format that allowed multiple

responses. A third of participants gave multiple responses. Only 17% of pregnant women reported that

they had no parenting experience whatsoever. More than a half of respondents (54%) reported that

their prior parenting experience was obtained from parenting their own children. Parenting younger

brothers and sisters and other child relatives accounted for parenting experience for 22.2 and 20.4% of

participants, respectively.

Of those women who had previous parenting experience as the sole or main caregiver of a child or

children, the majority of this experience was obtained through interactions with their own children

(68.7%), other child relatives (18.3%), siblings (13.9%) and partner’s children. Of those women who had

previous parenting experience, between 40 and 50% of women had parenting experience with children

under the age of 12 years, with the greatest proportion (approximately 50%) reporting experience with

children ages 2-5 years . Over 70% of participants reported that their experience in parenting was with

either one gender or another, with each gender being approximately equally represented.

Only a half of women who had provided previous parenting care to children reported attempting to

obtain parenting information then. Using the multiple response format, the 104 women who reported

seeking parenting advice to parent children under their care, gave 306 responses as to their source of

previous parenting experience. The main sources of previous parenting experience were their mothers

(60.6%), reading books (46.2%), health professionals (45.2%), female friends (37.5%), watching

television (33.7%) and other female relatives (32.7%). Few women obtained parenting advice from their

partners (12.5%) and very few from parenting classes (2.9%).

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Of these, the best sources of parenting information were identified as mothers (39.6%), health

professionals (33.0%) and books and magazines (30.8%). Sources that were least likely to be identified

as a good source of information were partners, newspapers and parenting classes, with each of these

identified by less than 4% of participants.

Only 55 of the 100 women who sought previous parenting advice reported sources that they thought

did not provide them with good parenting information. Just under a fifth of women (18.2%) reported

their friends were not a good source of advice. Between 10% and 15% of participants reported reading

newspapers, reading books and magazines and talking to their mothers as sources that did not good

advice. Just over a half of this sub- sample of women (51.3%) was pregnant for the first time.

Preparation for Parenting in this PregnancyParenting Information Seeking Behaviour prior to the Current Pregnancy:

As shown in Table 5 below, just under 40% of women sought parenting information in preparation for

the current pregnancy, while another 47% did not seek parenting information. The main reason for not

seeking information was the belief among mothers that they did not need to. Fourteen percent of

women did not have the opportunity to seek parenting information prior to becoming pregnant as their

pregnancy was unplanned.

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Table 5

Parenting Information Seeking Behaviour

Parenting Information Behaviour No. %Sought information a lot of the time 39 16.7Sough Information some of the time 44 18.8Sought information a little of the time 8 3.4Didn’t want to seek information 37 15.8Didn’t have time to seek information 13 5.6Didn’t need to seek information 49 20.9Didn’t seek information, other reason 11 4.7Didn’t seek information, unplanned pregnancy 33 14.1TOTAL 234 100.0

Parenting Information Seeking Behaviour did not vary by urban rural distribution, or by socio-economic

status, but there was a significant difference by parity. Two-thirds of women who had a previous

pregnancy reported seeking parenting information, while only a third of first time mothers did (p<0.01).

Sources of Parenting Information

Prior to the current pregnancy, the most frequent source of information was health professionals

(48.4%), followed by mothers (44.4%), books and magazines (37.3%) and talking to friends (34.9%).

Between 20 and 26% of women reported obtaining parenting information from partners, other female

relatives and reading newspapers. Other sources of information, including parenting classes, were

reported by just under 5% of women. The best sources of information were identified as health

professionals (33.4%), mothers (27.9%) and books and magazines (20.2%). All other sources were

reported as providing the best information by less than 10% of mothers. Attending parenting classes

was reported as providing the best information by only 2.3% of women.

Sources reported as not providing good parenting information were newspapers (19.3%), partners and

television (14.8% each).

Since the pregnancy, health professionals were identified as the main source of parenting information

by almost two-thirds of women (63.9%). Other important sources were mothers (37.5%), female friends

(29.9%), books and magazines (29.0%), other female relatives (25.9%), television (25.0%) and partner

(21.4%). Only 1.3% reported attending parenting classes as a source of information. As with earlier

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information, the best source of information during the pregnancy was provided by health professionals

(53.4%), mothers (26.9%) and other female relatives (10.4%). All other sources of information were

reported as among the best by less than 10% of mothers, with parenting classes reported by only 0.5%.

Talking with friends (18.0%), reading the newspaper (17.0%) and watching television (13.0%) were

reported as sources that did not provide good parenting information.

Once they became pregnant, women of higher socio-economic status, as indicated by number of

possessions, were significantly more likely to obtain parenting information from watching television

(p<0.01) and to a lesser extent reading newspapers (p<0.05). Women in urban areas were somewhat

more likely to obtain parenting information from health professionals (p<0.05), and by reading books

and magazines (p<0.05) and newspapers (p<0.05). Women who had a previous pregnancy were

significantly more likely to seek parenting advice from their female friends during the pregnancy

(p<0.001) and their mothers before the pregnancy (p<0.05).

Women’s Knowledge of ParentingTwenty percent of women reported increasing their knowledge of parenting during pregnancy. Prior to

pregnancy, 43.4% reported they knew a lot about parenting. During pregnancy, this increased to 64.2%.

However, at least a third of women still report they know nothing or know only a little about parenting.

Table 6 reports women’s perceptions about caring for a new baby. The majority of women felt strongly

(almost always or often response) that they should provide stimulation to babies through smiling,

hugging, talking and reading to them. However, there is still a significant minority of women who do not

report that stimulation of babies is important.

Women often reported that they perceive that their lives will be impacted on by caring for a new baby,

in terms of responses to questions regarding babies needing to adapt to parents’ lifestyles, getting

babies to feed and sleep in a regular pattern and having to give up activities they like doing.

These responses were not impacted by having had a previous child. However, some aspects were

impacted on by socio-economic status. Women of higher socio-economic status were less likely to

report that a baby should fit into parents’ routines (p<0.05), were less likely to think that babies should

be left to develop naturally and more likely to report that talking frequently to babies is important to

their development. There were some urban rural differences. Rural women were more likely to report

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that babies do not need anyone to talk to them (p<0.05) and more likely to report that babies should be

left to develop naturally (p<0.05).

Though the majority of women did not report difficulties in raising one gender or another, women had

clear gender preferences. Some 51.9% of women reported wanting a girl, 25.3% reported wanting a boy

and only 22.7% reported that they had no gender preference. There were no gender preferences by

parity or socio-economic status, but more women from rural areas reported wanting boys (p<0.05).

Table6

Women’s Perceptions About Parenting a New BabyFeelings about caring for a new baby Almost Always /

Often (%)a) Babies should be picked up whenever they cry 34.6

b) Babies should be allowed to cry until they calm themselves 16.4

c) It is important to get babies to develop a regular sleeping and feeding pattern as early as possible 90.9

d) Babies should sleep whenever they wish and be fed whenever they are hungry 84.5

e) Parents need to adapt their lives to the baby’s demands 78.4

f) A baby should fit into its parents’ regular routine 58.1

g) Babies need to be stimulated if they are to develop well 88.6

h) Babies should be left to develop naturally 42.5

i) Babies do not need anyone to talk to them; they do not understand 30.4

j) Talking frequently to even very young babies is important for their development 95.3

k) Hugging babies a lot is very important for them to develop well 87.4

l) Hugging babies a lot will spoil them 12.4

m) Reading to babies is a waste of time 12.4

n) Reading to babies helps them to learn about things around them and develop well 94.4

o) Being a mother means giving up some things that I like doing 73.0

p) Being a mother gives me new opportunities and interests (new things to look forward to) 85.0

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Feelings about caring for a new baby Almost Always / Often (%)

q) It is hard to look after a baby; they can’t tell you how they feel 31.3

r) A baby talks to you through smiling and crying 89.0

s) Babies don’t usually understand when people smile and talk with them 36.8

t) Babies learn a lot from people who smile and talk with them 90.2

u) Boy babies are more difficult to look after than girls 19.0

v) Girl babies are more difficult to look after than boys 13.8

Women’s Lifestyle Behaviours during PregnancyMore than three quarters of women reported being careful about specific aspects of their lifestyle

during pregnancy. Women reported almost always or often resting (78.0%), being careful about what

they do (85.4%), being careful about where they go (80.5%), being careful about sexual activity (79.7%)

and attending antenatal care regularly (95.0%). Women were less likely to eat only healthy foods

(71.5%) and much less likely to exercise during pregnancy (26.3%).

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CONCLUSIONS

The reasonably similar geographical distribution of study participants by region and distribution by

maternal age suggest that this sample was a reasonably representative sample of mothers throughout

Jamaica. The sample consisted almost equally of women having their first child and women with

previous children.

Four out of every five Jamaican women when pregnant report having some previous parenting

experience. While the majority of women report this experience from their own children, parenting

siblings and other relatives frequently provided parenting experience for mothers. Pregnant mothers

with the greatest experience, by virtue of being the sole or main caregiver for children previously,

typically had most of their parenting experience from parenting younger children. Very surprisingly,

women reported previous parenting experience to be very gender specific, though the genders were

equally represented among the sample.

Less than half of women reported preparing for parenting prior to the pregnancy, by seeking parenting

information. Almost 50% of women who did not seek parenting information felt that they had no need

to. Interestingly, women who had previous children were those more likely to seek parenting advice

before pregnancy.

The main sources of parenting information prior to pregnancy were health professionals; mothers;

reading books and magazines and talking to friends. During pregnancy, health professionals were even

more dominant as the main source of parenting information, with mothers, books and magazines and

other female relatives and friends also providing a fair amount of parenting information. Health

professionals, mothers and reading books and magazines were repeatedly identified as the best sources

of information. Though women often sought information from friends, they also reported that friends

were not a good source of parenting information. Information from partners and attending parenting

classes were rare sources of parenting information.

Health professionals are likely identified as the best sources of information because of a number of

reasons. First, they have frequent contact through visits to antenatal clinics. It should be noted

however that the group of women interviewed were all prior to 28 weeks gestation and would not yet

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be attending clinics frequently for antenatal care. Another important consideration is the status that

health professionals have in communities as a respected and knowledgeable professional group. An

unknown, but important aspect to be investigated, is the parenting training that health professionals are

provided with, given the regard that women have for them in providing parenting information.

Reading the newspaper and watching television were not generally reported as good sources of

information; this may be due to literacy levels and access to these sources. There were socio-economic

associations that impacted accessing parenting information, with women of the higher socio-economic

groups and urban women more likely to obtain this information from television, newspapers and books

and magazines. This is likely due to access and educational level, as indicated earlier.

About a fifth of women increased their knowledge of parenting during the early months of their

pregnancy, but overall as much as a third of pregnant women felt they knew only a little or nothing at all

about parenting, identifying huge gaps in parenting information service delivery for this important

group.

The majority of pregnant women felt that babies should be provided with stimulation of various types,

but a significant minority still did not understand the importance of stimulation for babies. For example,

almost a third reported that babies do not need to be spoken to as they will not understand and one

eighth felt that hugging babies and reading to babies was a waste of time. There were social class

associations in parenting information, with women from the higher social classes more likely to report

the importance of talking to babies, and less likely to think that babies should be left to develop

naturally.

A much more widespread feeling about parenting a new baby was the impact this would have on the

mother’s activities. More women therefore reported that babies needed to adapt to parents’ lifestyles

and needed to develop regular patterns of sleeping and feeding quickly. While women reported that

their own enjoyable activities would be restricted, women also seemed to look forward to new

experiences occasioned by having a baby.

In preparation for having a baby, women reported altering their lifestyles, particularly attending

antenatal care regularly and being careful about what they did and where they went. However, women

did not seem to exercise regularly, probably because of fear of doing harm to their babies.

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Women did not report either of the genders as being more difficult to manage, but there was a

predominant wish for girls, regardless of social class or parity. Rural women were significantly more

likely to wish for boy babies.

This study though there were limitations, as described below, has been able to provide important

information to guide the delivery of parenting programmes in Jamaica as indicated below.

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RECOMMENDATIONS

The recommendations from this study are being made to guide policy and programme development in parenting in Jamaica. In particular, this report will be disseminated to the emergent National Parenting Support Commission of Jamaica, for its use.

1. There are huge gaps in delivery of parenting information to a very important sector of the population, pregnant women and therefore tremendous room for the development of additional parenting information sources, such as parenting support and education programmes for pregnant women.

2. The health professional has been identified as the most important and highest quality source of parenting information. Parenting advice for pregnant women is typically delivered in large groups when women are waiting to be seen for health care. It will be important to assess the perception of the health professional in increasing their ability to provide parenting information, given the huge gaps. It will also be important to assess the training that health professionals currently have for the provision of parenting information.

3. As at the time of data collection women had completed from a half to two thirds of the pregnancy period, with large proportions knowing very little or nothing about parenting. The importance of the health professional and the limited time available for provision of further parenting support through antenatal clinics suggest that the well child clinics could be a viable option for continuing this support. Women attend well child clinics for immunisation and other primary care services for their children some five to six times during the first year of their children's lives.

4. The relatively infrequent reports of parenting information from parenting classes suggest that there may be inadequate access to such services. Delivering parenting support and education programmes at health centres, with the participation of health professionals may also be a viable option for parenting support programmes. This would reduce the work load on health professionals, but also take into account the high regard of such personnel by mothers.

5. Grandmothers should be especially included in programmes for parent facilitator training, because of their existing status among pregnant mothers.

6. Specific targeting to attract first time mothers to parenting programmes is necessary. As many women who have had children seek out parenting support, programmes should be designed to take into account their prior experience and existing challenges.

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7. Specific targeting to attract partners is also necessary as they were only infrequently identified as sources of parenting information for mothers. It is quite possible that partners also have significant parenting information, but this is not perceived to be so by mothers. Parenting programmes may also have to provide support for father’s self esteem in order to support mothers.

8. Parenting programmes for pregnant mothers should have a special focus on the importance of exercise in pregnancy. Additionally responsive parenting (e.g. responding to babies’ crying , smiling and adjusting to babies’ schedules) and the importance of stimulation for babies (talking with and reading to) should be a focus of parenting programmes.

9. Parenting programmes should address mothers’ concerns about the impact of parenting on their previous lifestyle.

10. The gender preference for girl babies should be further investigated, to determine whether this choice is associated with later gender specific parenting behaviour. UNICEF’s MICS data on Jamaica (2009) had suggested that there are differences in care and provision by gender in the first few years of life.

Study Limitations:

1. Limited Sample SizeThe number of completed interviews was less than projected due to challenges experienced in data collection in the field. Nurse interviewers were present in clinics identifying mothers and participating in study tasks throughout the entire period of data collection. Despite their efforts, the challenges as indicated below prevented as high a sample size yield as anticipated.

i) Late booking for antenatal care. This reduced the sample of eligible women available for interview during the one month study period.

ii) Initial participation refusal rate of 20%. Many women indicated that they would need the consent of their partners to participate. Others were willing to participate at another time, but had time constraints. Still others were fatigued by travelling to the clinic and completing the usual clinic processes. The reasons given for refusal suggest that participation was likely to occur in the future. Initial refusal rates often reduce with time as public education messages using the media reach a wider audience, and as persons who participate spread the word among those who have not yet consented that there are no significant risks to participation. Additionally, completing some interviews in the home setting would address time constraints and participant fatigue at clinics.

iii) Duration of time for interview process. The detailed questions being obtained on parenting, have required more time than anticipated. Mothers often request breaks

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during questionnaire administration. Breaks are also necessary to allow women to complete administrative and clinical processes associated with their antenatal care visits.

iv) The limited period of data collection allowed for the identification of study limitations, but did not allow for interventions to be undertaken

2. Identified Biases

i) The refusal rate determined from a single clinic may not be an accurate representation of the national refusal rate, particularly as the clinic was the University Hospital Clinic (UHWI). This refusal rate could potentially be higher as the clinic population at the UHWI is more highly motivated, as mothers are required to register for antenatal clinic at an earlier gestational age than other clinics. However, the rate could also potentially be lower as this clinic population is identified as being of higher socio-economic status than other clinic; higher socio-economic status has been found to be associated with lower participation rates in the previous Jamaican Birth Cohort Study of 1986.

ii) A greater proportion of study participants was identified from the UHWI clinic. This is linked to the earlier gestational age at booking required at this clinic. As indicated earlier, this may be biased towards participants of higher socio-economic status.

iii) There was a geographical bias, with fewer participants from the Western region due to somewhat later training of interviewers occasioned by distance.

3. Unidentified BiasesThere may be biases inherent to the study design that have not been identified by the study team

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ACKNOWLEDGEMENTS:The Research team wishes to acknowledge the financial support provided by DFID for the conduct of this important study, and the administrative and technical support provided by the World Bank, and in particular, Ms. Cynthia Hobbs, The team also acknowledges the guidance of Harold Alderman, formerly of the World Bank, who provided support from its outset.

Finally, the team thanks its administrative staff, field staff, data entry staff and the pregnant women, without whom this report and the important recommendations provided, would not be possible.

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