Health & Illness

November 14, 2023

Work-Family Stressors, Gender, and Mental Health during COVID-19 and Beyond

A briefing paper prepared by Daniel L. Carson, University of Utah, and Melissa A. Milkie, University of Toronto, for the Council on Contemporary Families symposium The COVID-19 Pandemic and the Future of Gender Equality (PDF).

The COVID-19 pandemic was a stressful time for American adults. Indeed, rates of clinical depression and anxiety were 300% higher in the early days of the pandemic than they were the previous year. Not only was there substantial concern and worry about the virus itself, but social measures to stem the virus spread (i.e., lockdowns; school closures) created work-family stressors for many adults, parents especially. Like other impacts of the pandemic, work-family stress was not distributed evenly as US mothers’ mental health appeared most negatively affected. Given pre-existing gender disparities in psychological well-being, the COVID-19 pandemic exacerbated gender inequalities in mental health. This brief focuses on gender differences in psychological distress and its links to work-family stressors during the COVID-19 pandemic. We highlight how the pandemic may have magnified existing differences in well-being between mothers and fathers and conclude with a discussion of interventions that are needed to reduce these inequalities.

COVID and Mental Health

In addition to its obvious costs to life and physical health, the COVID-19 pandemic took a big toll on psychological well-being. In the United States, estimates from the US Census Household Pulse Survey indicate that one-third of the adult population suffered from clinical levels of depression and anxiety during the early days of the pandemic. In contrast, estimates indicate that only 10% of US adults reported clinical levels of anxiety and depression in 2019. Worse yet, the number of depressed and anxious adults increased as the pandemic persisted, rising to more than 2 in 5 by the end of 2020. Today, psychological distress remains elevated compared to pre-pandemic levels. Estimates indicate that as of June 2023, nearly one-third of US adults still suffered from clinical levels of anxiety and/or depression.

Work and Family Roles and Psychological Distress During the COVID-19 Pandemic:

One of the primary reasons psychological distress increased during the COVID pandemic is that it created a great deal of stress in people’s work and family roles. Social distancing measures designed to stem the transmission of COVID (e.g., closures of schools, childcare centers, non-essential services, and changes in work conditions) had numerous impacts. First, many people experienced a reduction in social integration, social support, and loss of potentially valued identities – all of which are central to mental health. Indeed, loneliness and job loss were two of the strongest predictors of mental health during the pandemic. Job loss also threatened mental health through financial hardship.

Second, roles and their responsibilities became increasingly overwhelming, particularly for mothers, due to the loss of childcare, school, and informal parenting supports. Both men and women increased their time in housework and childcare during the pandemic, though women continued doing the majority share of these tasks. Time in both physical and mental domestic labor during the pandemic was positively associated with increases in psychological distress, but primarily for women. Yet, at least for a time, fathers increased their relative share of domestic labor, particularly when they were able to work from home; this increase in equality was associated with perceptions of better relationship quality among mothers. Occupational changes occurred too, with some jobs becoming potentially better due to remote work and less commuting time, and other jobs largely populated by women such as essential service, teaching, and health care work, becoming increasingly difficult due to potential virus transmission, staff shortages, and other problems.

Third, at least in the early days of the pandemic, conflicts between work and family obligations for US parents appear to have worsened, on average. Among those who remained employed during the pandemic, increases in distress were limited largely to parents and tied to work-family conflict and adjustments to paid work schedules. Parents who were essential workers had to worry about facilitating virtual school or arranging care, while remote-working parents faced with the blurring of boundaries between home and work, had to juggle paid work while simultaneously monitoring and educating children. In the US at least, psychological distress was tied especially to interference of domestic responsibilities with paid work and the associated guilt of not meeting obligations for one’s job. Nevertheless, when push came to shove, many parents, but mothers especially, cut back on paid work during the pandemic – likely to alleviate work-family conflict. Alas, altering paid work schedules was also associated with higher levels of distress.

Exacerbated Gender Disparities in Stress and Mental Health?

Gender disparities in mental health in the US grew during the COVID-19 pandemic, due to steeper declines in women’s mental health than men’s. This is likely due, in part, to the fact that women reported more feelings of social isolation, more job loss, more work-family conflicts, and are more susceptible to the negative effects of domestic labor on mental health than men. Though gender inequalities in mental health increased in the US, this was not the case everywhere. Indeed, cross-national examinations of psychological well-being reveal possible reasons why inequalities increased in the US and not in other places and also suggest interventions to protect mental health and reduce mental health disparities moving forward.

Studies from the US, UK, Canada, and Australia reveal that gender disparities in mental health grew in the US and UK but not in Canada and Australia. Moreover, the pandemic appeared to affect mental health to a lesser extent in Canada and Australia than in the US and UK. One reason for these differences is better government and worker supports in Canada and Australia. Though public policies to deal with job loss (e.g., unemployment insurance) were universally generous cross-nationally and appear central to limiting family financial loss, access to supportive leave and care policies varied. Compared to Canada and Australia, parents in the US and UK had no guaranteed access to paid parental/childcare leave, leaving parents in these countries potentially more financially, emotionally, and psychologically distressed. Domestic responsibilities increased broadly in all four countries, yet in the US and UK especially, parents had fewer resources to help them handle the increase in care and educational responsibilities.

Another reason for increased mental health disparities in the US appears to be individual and cultural beliefs about gender, work, and family. Ideal worker culture is particularly intense in the US compared to many other countries. As such, the existence of family-to-work conflict and family-to-work guilt and its ties to US parents’ distress during the pandemic is unsurprising. Additionally, though both men and women increased their performance of domestic labor during the pandemic, this increase was associated largely with increased distress among mothers only – which may be owed to persistent external and internal pressures toward intensive mothering. Indeed, in the US, beliefs in intensive mothering coupled with a lack of comprehensive public policy to limit the transmission of COVID, placed mothers at the forefront of protecting family health. Worries over COVID were especially associated with maternal stress in the US.

Discussion: What about gender inequalities in mental health beyond pandemic times?

Though the WHO declared an end to COVID-19 as a global health emergency in May 2023, levels of stress and distress in US society are as high today as they were in 2020 when the pandemic started. Questions remain, therefore, as to the long-term impact of the pandemic on mental health and gender disparities in psychological well-being. While the jury is still out as to the full impacts of the pandemic for men versus women, and the longevity of some of the changes and their sequelae, research provides a potential roadmap for how to protect mental health moving forward, especially for parents, and reduce gender disparities.

Given the centrality of work to mental health, job losses during the pandemic likely had significant, long-term impacts. Mothers in less resourced positions may have been the worst off. Women’s labor force participation rates returned to pre-pandemic levels in 2023, though the most disadvantaged mothers lagged behind as of 2022. Efforts to return mothers to the paid labor force, and avoid penalizing them for interruptions to paid work during the pandemic, are essential to promoting gender equality moving forward.

Though rates of labor force participation have returned to normal, one change that is proving to last is remote work, as a much larger portion of workdays are currently done remotely compared to pre-pandemic times. Yet, whether the new climate of remote work reduces or exacerbates gender disparities in mental health may depend on how it is used and by whom. Prior to the pandemic, a substantial proportion of parents reported elevated levels of distress linked to time deficits with their children. During the pandemic, parents were able to spend more time with children in part due to remote work, suggesting that remote work may have somewhat protected mental health, at least for mothers. Potentially, valued time with children could continue in some form post-pandemic for those with increased access to autonomy, remote work, or other expanded control over paid work commitments, leading to improvements in well-being.

At the same time, working mothers managed homeschooling much more so than fathers and were overloaded due to stretched roles of supervision and care while children were locked down. Women experience more work-family conflicts due to high expectations at home and job characteristics (i.e., less autonomy) that don’t provide them enough or the right kinds of freedom or resources. Though being home has benefits by potentially providing more parental fulfillment and easing of managing home demands, remote work by mothers coupled with primary responsibility for domestic labor, without partners also stepping up, would likely exacerbate gender mental health disparities. In contrast, remote work by fathers could reduce gender disparities broadly, including in mental health. Not only does domestic labor have little impact on men’s mental health (vs. the negative effect for women), but men who work remotely also do more domestic labor. This was true both before and during the pandemic.

In all, the pandemic allowed us to see more closely the problems with work roles, family roles and connection between them that undermine mental health in the US. Both structures and cultures need to change in order to better people’s, especially women’s, lives. Structurally both government and workplace policies matter; the exacerbated gaps between U.S. mothers’ and fathers’ mental health that emerged due to overwhelming demands in roles and work-family conflict could be mitigated by policies such as paid parental/childcare leave, increased autonomy, remote work, low-cost quality child care, a 4-day workweek and so on. Additionally, direct child credits, as well as guaranteed paid time off and vacations could go a long way to reducing work-family conflicts and stressors through provision of financial supports. Yet, despite the pandemic creating a great reflection about our values around time, relationships, and work, the culture of ideal workers and intensive parenting that contributes to higher work-family conflict and pushes mothers out of paid work may be harder to change. Regardless, more awareness and social change toward “work-family justice” is possible. Nonetheless, the conversation surrounding work-family justice and gender equality must also include a discussion of parental well-being. Parents’ mental health is important not only in its own right, but also through those they care for – our future generations. The tolls of the pandemic on mental health and gender disparities in mental health cannot be ignored.

About the Authors

Daniel L. Carlson is Associate Professor of Family and Consumer Studies at the University of Utah and Treasurer of the Council on Contemporary Families. He can be reached at daniel.carlson@fcs.utah.edu. You can follow him on Twitter at @DanielCarlson_1.

Melissa A. Milkie is Professor of Sociology and Chair of the graduate department at the University of Toronto. She’s also Professor Emerita at the University of Maryland, and she served recently as President of the Work and Family Researchers Network. Professor Milkie can be reached at melissa.milkie@utoronto.ca and you can follow her on Twitter at @melissamilkie.

May 31, 2023

Best for Whom? Breastfeeding and Child Development

A briefing paper prepared for the Council on Contemporary Families by Jessica Houston Su, Assistant Professor, Department of Sociology at the University of North Carolina-Chapel Hill

Recent infant formula shortages in the United States have reignited debates about the importance of breastfeeding for child health and development. Major health and medical organizations unanimously recommend that mothers exclusively breastfeed their infants for six months or more, and breastfeeding has become a hallmark of ideal parenting. Children who are breastfed generally have lower rates of child obesity, fewer behavior and conduct disorders in childhood, and higher cognitive test scores compared to children who are not breastfed.

Although over 80% of infants receive some breastmilk, only 26% are exclusively breastfed for the recommended six months. This is partially because breastfeeding is time-intensive and requires a lot of support. As a result, breastfeeding is socially stratified in the United States and is most common among those with the most resources. For example, women with a college degree are twice as likely to exclusively breastfeed for six months compared to those with a high school degree.

Public health initiatives suggest that increasing breastfeeding rates among populations that are less likely to breastfeed is an important strategy for improving children’s health and development. But a growing body of research suggests that benefits of breastfeeding may have been overstated. We cannot conduct randomized controlled trials for breastfeeding, so it’s difficult to tell whether it is directly causing improvements in children’s health, or if breastfed children tend to have better outcomes because of their parent’s other socioeconomic advantages. Studies using sophisticated statistical techniques to account for these complicated dynamics find that, all else equal, the causal effect of breastfeeding is weak or nonexistent. For example, when we compare siblings in the same family who were fed differently (one sibling was breastfed and the other was not, or they were breastfed for different amounts of time), they tend to have very similar physical, behavioral, and cognitive development.

The lack of an average causal benefit of breastfeeding, however, does not mean that it confers no advantages. Averages can obscure substantial variation, particularly for behaviors like breastfeeding that are highly influenced by social and economic factors. In such cases, asking if breast is best is too simplistic a question. Better questions to ask are: Does breastfeeding benefit all children equally? Or do some children reap greater benefits than others?

I conducted a study with my co-authors Kerri Raissian and Jiyeon Kim to answer these questions. Our study analyzed data from a longitudinal nationally representative sample to evaluate the relationship between breastfeeding and a comprehensive set of longer-term developmental outcomes for children ages 4-14. Specifically, we examined body mass index (BMI), three measures of behavioral development, and five measures of cognitive skills. We used statistical techniques to carefully compare children who were breastfed to children who were never breastfed but had very similar characteristics. We also grouped children based on their likelihood of breastfeeding and compared the effects across these different groups to assess whether everyone benefitted equally. We found that breastfeeding provides small benefits for children’s behavioral development, math scores, and academic ability, but only among those that are highly likely to breastfeed. We also found small benefits for children’s reading comprehension and vocabulary, but these effects were concentrated among those who were least likely to breastfeed.

One key takeaway from our study is that breastfeeding does not equally benefit everyone. What explains this variation?

One potential answer is that people experience the costs of breastfeeding differently. Although breastmilk is “free,” breastfeeding is not costless in American society. Breastfeeding is associated with prolonged earnings losses for women, in part due to lack of paid parental leave and time out of the workforce. This economic penalty may be more easily absorbed by women who are financially secure but is a more significant hardship for low-income or single women. Lack of economic resources may offset some of the benefits of breastfeeding for these children who are less likely to breastfeed. This could explain why we found that breastfeeding is related to better behavior, math scores, and academic ability among those who are most likely to breastfeed.

Another potential source of variation is that people experience the benefits of breastfeeding differently. If more advantaged parents are already providing an optimal home environment or parenting in ways that promote their children’s health or cognitive skills, they may not receive an additional boost from breastfeeding. For example, the American Academy of Pediatrics recommends that all parents read to their children from birth through kindergarten, and it is possible that parents who adopt this practice are also likely to follow the AAP recommendations for breastfeeding. If parents who are less likely to breastfeed do not engage in these early literacy activities to the same extent, the benefits of breastfeeding could be amplified among this group. This might explain why we found that breastfeeding is linked with better reading comprehension and vocabulary among children who are least likely to breastfeed. Parents may be less equipped to compensate for quantitative skills given that we did not find this pattern for math scores.

The second key takeaway is that the benefits of breastfeeding are modest. For example, among children who were least likely to breastfeed, those who breastfed for 6 months or more had about 30% of a standard deviation higher reading comprehension score than those who were never breastfed. In comparison, four extra days of mother-child shared reading time per month increases reading achievement by 32% of a standard deviation. On a broader scale, expansions in Universal Pre-K are linked with larger increases in letter-word identification (79% of a standard deviation) and spelling scores (64% of a standard deviation).

To be clear, we are not saying that breastfeeding isn’t an ideal source of nutrition for infants, or that other parenting practices or policies are direct substitutes. Rather, parents and policymakers should consider breastfeeding as one potential tool among others that may provide comparable or larger benefits for longer-term child development. This is especially useful information given the very real tradeoffs that many mothers make. It may also help to relieve some of the stigma and shame that some mothers experience when they are unable to breastfeed.

Our study provides insights for public policy. We highlight socioeconomic and racial inequality in breastfeeding within the United States. The US provides a weak safety net for parents of young children and offers no federal paid family leave. Factors such as race/ethnicity, socioeconomic status, education, income, marital status, and employment are strongly related to the likelihood that a mother will breastfeed.

Furthermore, we demonstrate that the social context not only shapes who breastfeeds in American society, but also who benefits most. Efforts to increase breastfeeding rates among populations that are least likely to breastfeed are unlikely to close disparities in child development. The benefits of breastfeeding are largely concentrated among the populations that are already likely to breastfeed. To level the playing field, rather than merely telling mothers that “breast is best,” policies should focus on reducing structural barriers and economic costs for mothers who want to breastfeed. For many mothers in the United States, breastfeeding is ideal but unattainable.

For More Information, Please Contact:

Jessica Houston Su
Assistant Professor, Department of Sociology
University of North Carolina-Chapel Hill
jessica.su@unc.edu

Links

Brief report: https://sites.utexas.edu/contemporaryfamilies/2023/05/31/breastfeeding-and-child-development-brief-report/
Press release: https://sites.utexas.edu/contemporaryfamilies/2023/05/31/breastfeeding-and-child-development-press-release/

About CCF

The Council on Contemporary Families, based at the University of Texas-Austin, is a nonprofit, nonpartisan organization of family researchers and practitioners that seeks to further a national understanding of how America’s families are changing and what is known about the strengths and weaknesses of different family forms and various family interventions For more information, contact Stephanie Coontz, Director of Research and Public Education, coontzs@msn.com.

May 31, 2023

January 21, 2021

Why Families Need More Financial Support during the COVID-19 Pandemic

January 21, 2021

A fact sheet prepared for the Council on Contemporary Families by Lawrence Stacey and Kristi Williams, The Ohio State University

Despite the important temporary relief provided to many families by the March 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provided $1,200 to qualifying adults and $500 to their dependent children, millions of American families are experiencing financial hardship as we enter the new year. Data from the U.S. Census Bureau’s Household Pulse Survey reveal that as of December 2020, U.S. households with children continued to face serious financial challenges in meeting basic needs:

55.7% of families have experienced a reduction in household employment income since March 13, 2020.

23.1% of households with children describe paying for household expenses as “very difficult” and an additional 22.3% report that it is “somewhat difficult.”

In surveys conducted between December 9 and December 21, slightly more than half of U.S. households with children reported food insufficiency in the previous 7 days—a 12 percentage point rise relative to pre-pandemic times. Of these more than 40 million families, 34.6% said that their children sometimes or often did not eat enough because food was unaffordable.

11.6% of Americans disclosed that they were late on mortgage payments—a figure more than double that of households without children. The situation is even worse for families who rent: 24.5% reported making late rental payments and 19.4% indicated they had no confidence that they would be able to pay next month’s rent. Of those behind on housing payments, more than 52% of renters and nearly 19% of homeowners indicated that it was somewhat or very likely that they would be evicted or experience foreclosure in the next two months.

In an earlier report, CCF noted how the chronic household stress associated with such economic scarcity and insecurity has been shown to pose long-term risks to children, including deficits in cognitive and behavioral functioning and mental and physical health that extend well into adulthood. It is clear that the Coronavirus Response and Relief Supplemental Appropriations Act of 2021, which authorized $600 payments to eligible adults and each of their qualifying children, will fall far short of improving the economic condition of families as COVID-19 cases continue to surge and job losses continue to hit mothers hard. Although both stimulus packages have provided much-needed relief, American families need more support.

FOR MORE INFORMATION, PLEASE CONTACT:
Lawrence Stacey, Ph.D. candidate, Department of Sociology, The Ohio State University, stacey.37@osu.edu

Stephanie Coontz, Director of Research and Public Education, Council on Contemporary Families, coontzs@msn.com

LINKS AND ABOUT:
Fact sheet: https://contemporaryfamilies.org/family-financial-support-covid-fact-sheet/

—

The Council on Contemporary Families, based at the University of Texas-Austin, is a nonprofit, nonpartisan organization of family researchers and practitioners that seeks to further a national understanding of how America’s families are changing and what is known about the strengths and weaknesses of different family forms and various family interventions.

The Council helps keep journalists informed of notable work on family-related issues via the CCF Network. To join the CCF Network, or for further media assistance, please contact Stephanie Coontz, Director of Research and Public Education, at coontzs@msn.com, cell 360-556-9223.

Read our blog CCF @ The Society Pages – https://thesocietypages.org/ccf/

January 21, 2021

June 19, 2018

Transgender Youth Allowed to Use Their Chosen Name Have Fewer Mental Health Problems

A Research Brief Prepared for the University of Texas at Austin Population Research Center Research Brief Series

Download a PDF of the Brief

Stephen T. Russell, Amanda M. Pollitt, Gu Li, and Arnold H. Grossman

Introduction

Transgender people-people whose gender identity does not align with their sex assigned at birth-are at higher risk of poor mental health than those who are not transgender. While society is growing more accepting of transgender people with more support being shown and TS Dating increasing as more people accept them, they still face backlash in their day to day lives which massively affects their mental health.

Being able to use a “chosen name,” that is, a name different from their birth name that more closely aligns with their gender identity, is part of the social transition process for transgender people that allows them to align their gender presentation with their gender identity. However, many transgender and gender nonconforming youth are not able to use their chosen name. For example, families or peers may refuse to use the chosen name, and medical practitioners or schools may require a legal name change before calling youth by their chosen name.

Transgender youth whose gender expression and names do not appear to match may be vulnerable to unintended disclosure, or “outing,” and to discrimination or victimization. This mismatch, therefore, can lead to mental health problems. This brief examines the relationship between chosen name use-which is a proxy for youths’ gender affirmation in various contexts-and mental health among transgender youth.

Using data from a community cohort sample of lesbian, gay, bisexual, transgender, queer youth, and youth with same-sex attractions, transgender youth were asked if they were of they were able to go by their chosen name at home, school, work, or with friends. The authors then compared these responses to levels of depression, suicidal ideation, and suicidal behavior.

Key Findings

Transgender youth who were able to use their chosen names at home, in school, at work, and with friends had lower levels of severe depression, suicidal ideation, and suicidal behavior (see figure).

Policy Implications

Schools, community organizations, workplaces, healthcare providers, and other institutions could institute policies and regulations that allow for the use of transgender youths’ chosen names. Information systems can be updated so that youths’ chosen names are used whenever legal names are not required. Allowing for the use of chosen names across multiple contexts will likely improve the mental health of transgender youth.

Reference

Russell, S.T., Pollitt, A.M., Li, G. & Grossman, A.H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health.

Suggested Citation

Russell, S.T., Pollitt, A.M., Li, G. & Grossman, A.H. (2018). Transgender youth allowed to use their chosen name have fewer mental health problems. PRC Research Brief 3(7). DOI: 10.15781/T21Z4299R.

About the Authors

Stephen T. Russell (stephen.russell@utexas.edu) is a professor in the Department of Human Development and Family Sciences and a faculty research associate in the Population Research Center at The University of Texas at Austin;Amanda M. Pollitt is a National Institute of Child Health and Human Development postdoctoral fellow in the Population Research Center. Gu Li is a Postdoctoral Research Fellow at the University of British Columbia. Arnold H. Grossman is a professor of Applied Psychology at New York University.

Acknowledgements

This research uses data from the Risk and Protective Factors for Suicide Among Sexual Minority Youth Study, designed by Arnold H. Grossman and Stephen T. Russell and supported by Award R01MH091212 from the National Institute of Mental Health. Infrastructure support for the Population Research Center at The University of Texas at Austin was provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD042849). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health.

May 16, 2018

The Impact of the Zika Epidemic on Women’s Reproductive Intentions and Behaviors in Brazil

A Research Brief Prepared for the University of Texas at Austin Population Research Center Research Brief Series

Download a PDF of the Brief

Letícia J. Marteleto, Abigail Weitzman, Raquel Zanatta Coutinho, and Sandra Valongueiro Alves

Introduction

The epidemic caused by the Zika virus has been a major public health shock for Brazil, particularly for reproductive-age women. The virus is transmitted via mosquito, sexual intercourse, blood transfusions and amniotic fluid. Infection at any point during pregnancy can have deleterious effects on fetal development and lead to birth defects such as microcephaly and other types of congenital Zika syndrome, looking into other birth defect causes could raise awareness to those that are pregnant and possibly decrease birth defect rates. Despite its wide range of potential symptoms, Zika virus infection can often be asymptomatic, allowing it to go unnoticed or to be unknowingly transmitted.

The only ways to guarantee against Zika-related birth defect, at least until a vaccine is developed, the epidemic subsides, or an effective treatment becomes available are to avoid becoming pregnant or to terminate a pregnancy. However, the ability to prevent pregnancy is not equally shared among women of different social statuses. Indeed, women of lower socioeconomic status (SES) are more likely to have an unintended pregnancy while women with greater economic resources are typically more successful in preventing unwanted pregnancy, regardless of the Zika epidemic. Likewise, abortion in Brazil, where its access is highly restricted, is easier for wealthier women to obtain.

Moreover, women living in the Northeast region of Brazil may be at higher risk of contracting the Zika virus than those living in other regions; they are also more likely to know others who have been affected by the virus. A combination of lower overall levels of economic development than in richer parts of the country such as the Southeast region, high temperatures, stagnant water, and sanitation problems are possible explanations for why the Northeastern region was affected first and most severely by the Zika virus epidemic.

This research brief reports on a study that explores how and why the Zika virus affects reproductive processes in Brazil. The authors pay special attention to the ways women’s socioeconomic status and geographic location are related to their responses to the epidemic. In eight focus groups conducted with women in Recife, Pernambuco (Northeast region) and eight focus groups in Belo Horizonte, Minas Gerais (Southeast region) approximately 18 months after the epidemic began in Brazil, the interplay of women’s desires, behaviors, and healthcare access and use are examined. Within each city, half of the focus groups were conducted with women of low socioeconomic status and half with women of high socioeconomic status. Each focus group consisted of six to eight women between the ages of 18 and 49 years for a total of 114 women in the study.

Key Themes

See table for representative quotations for these key themes

Reproductive Intentions

Women in both cities and both SES groups were motivated to postpone pregnancy. However, older high SES women in both cities had no desire to postpone pregnancy if they had not yet reached their ideal number of children.
Low SES women in both cities felt a limited sense of control over their fertility. In contrast, high SES women in both cities felt a sense of control over their reproductive intentions.
Women in both cities and both SES groups expressed a willingness to seek an abortion to avoid giving birth to child with microcephaly.

Reproductive Behaviors

Women in low SES groups in Recife more commonly recounted improving contraceptive behaviors because of high exposure to the risk of contracting the Zika virus. In contrast, high SES women in both cities reported continuing their nearly perfect contraceptive use (use that resulted in few or no unintended pregnancies) as they had before the Zika outbreak.
Low SES women in both cities reported inconsistent contraceptive use and an inability to get a desired sterilization.
Low SES women in both cities described more limited bargaining power with sexual partners on condom use compared to high SES women.
Low SES women noted two primary barriers to obtaining contraceptives from public clinics: multiple violations of their medical privacy and limited access to contraceptive methods.
Both low and high SES women in Recife felt a tangible risk of Zika because of their greater media and personal exposure to individuals affected by the virus.
Women in both cities and both SES groups described obtaining an abortion to avoid giving birth to a Zika-infected child. On the other hand, high SES women had better access to safe abortion and could wait longer than low SES women before deciding to get an abortion. Moreover, the high SES women were more likely to have a safe abortion if they chose one.

Click here to expand page 1 of table

And here to expand page 2 of table

Policy Implications

One of the main recommendations put forth by Brazilian health officials is for women of reproductive age to postpone pregnancy until the Zika epidemic has subsided. Yet half of pregnancies in Brazil are unintended, suggesting that women face many obstacles to controlling their fertility. It is therefore critical for state ministries to reduce barriers to contraceptive use. This could be achieved by subsidizing all methods of contraception and making all methods available at public health clinics, extending the type of sexual and reproductive health services offered at clinics, and creating an accountability system that reduces the extent to which patient privacy is violated.

In addition, policymakers must address longstanding disparities in reproductive health services that put low-income women at disproportionate risk of an unwanted pregnancy during the epidemic. Specific steps include conducting sensitivity trainings aimed at reducing racial and socioeconomic discrimination among healthcare workers; widely disseminating information about forms of contraceptive use beyond condoms, pills, and sterilization—the most commonly used methods; and offering long-acting reversible forms of contraception in public clinics.

For women who are still unable to prevent pregnancy, legalizing abortion would help prevent women from having to carry unwanted pregnancies to term. Considering that many women report seeking abortion despite its illegal status and demand for abortion has increased during the epidemic, continuing to restrict access and thus push women to illegal channels will likely have unnecessary, undesired health outcomes among women, such as hemorrhage, secondary infertility, and death. This is particularly true among the poorest, most vulnerable women who have the least access to private, high quality doctors.

Finally, policymakers should remain conscientious of the fact that some women still want to become pregnant during the epidemic. Healthcare workers should respect these women’s desires and refrain from stigmatizing these women and their future children. Failure to do so could inadvertently jeopardize the health and wellbeing of women who actively pursue pregnancy during the Zika epidemic.

Reference

Marteleto, L. J., Weitzman, A., Coutinho, R., Valongueiro, S. (2017). Women’s reproductive intentions and behaviors during the Zika epidemic in Brazil. Population and Development Review 43(2), 199-227.

Suggested Citation

Marteleto, L. J., Weitzman, A., Coutinho, R., Valongueiro, S. (2017). The Impact of the Zika epidemic on women’s reproductive intentions and behaviors in Brazil. PRC Research Brief 2(12). DOI: https://doi.org/10.15781/T2TB0ZB20.

About the Authors

Letícia J. Marteleto (marteleto@prc.utexas.edu) is an associate professor of sociology and Abigail Weitzman is an assistant professor of sociology; both are faculty research associates in the Population Research Center, The University of Texas at Austin. Raquel Zanatta Coutinho is assistant professor of demography at the Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais, Brazil. Sandra Valongueiro Alves is a researcher at the School of Social Medicine, Federal University of Pernambuco and Microcephaly Epidemic Research Group (MERG), Brazil.

Acknowledgements

Funds for this research were provided by a seed grant from the Population Research Center (NICHD, R24HD042849) and the Population Health Initiative at the University of Texas at Austin.

May 16, 2018

What are the Effects of Mothers’ and Fathers’ Depression and Thoughts of Death on Their Children’s Level of Parental Connectedness?

A Research Brief Prepared for the University of Texas at Austin Population Research Center Research Brief Series

Susan De Luca, Yan Yueqi, and Yolanda Padilla

Introduction

Mental health outcomes such as depression are often passed down in families. While links between the mental health symptoms of parents and their children have been established, there is a limited understanding of these outcomes over time and the impact that mothers and fathers have on their children independently. Understanding the mechanisms within families that lead to positive health outcomes is important for designing interventions to improve children’s lives. Feeling close to others-knowing that others care and are there during times of distress-is protective for many mental health conditions. The family’s way of life also needs to be considered when tackling this issue because every family has a different dynamic and belief system. For example, a religious family would probably find the best treatment at a Christian depression treatment center whereas a non-religious one may prefer medication as treatment. There is also a factor of how close each parent is to their child as every parent subconsciously has a favorite, no matter what walk of life they’re from. This brief focuses on parent-child connectedness, which has been shown to both decrease children’s distress and strengthen their social coping resources.

This study extends the current understanding of the relationship between parental mental health and child outcomes by evaluating the impact of parents’ patterns of depression and thoughts of death on their children’s appraisals of how connected they feel to each of their parents separately. This study analyzes data from the Fragile Families and Child Wellbeing Study, which followed 4,706 children born to mostly unmarried parents until age nine. Parental depression and thoughts of death were measured when the child was ages one, three, five, and nine. Mothers and fathers were asked if, during the previous 12 months, they had feelings of sadness/depression for two or more weeks. Those who reported sadness/depression were also asked if they “thought a lot about death during those two weeks.” Children reported on their connectedness to their parents-how close they felt to each parent and how well they shared ideas with each parent-when they were nine years old. In data analyses, the authors explore the effects of the mothers’ and fathers’ chronic and episodic depressive symptoms and thoughts of death on their children’s level of parental connectedness at age nine.

Key Findings

Children felt less connected to both their mothers and fathers with mental health symptoms but the effects varied somewhat based on the sex of the parent.

Parental Depression and Thoughts of Death

Both mothers and fathers reported similar rates of depression over time. This is surprising because women tend to report higher levels of depression than men.
Parents’ self-reported levels of depression peaked at over 15% when children turned three years old and declined steadily as children grew older to roughly 10% when children were nine years old.
A similar percentage of mothers and fathers reported thoughts of death, ranging from 3% to 5% over time.

Parent-Child Connectedness, According to Children at Age Nine

Sixty-three percent of nine-year-old children reported feeling “extremely” or “quite” close to their mothers compared to 50% who felt that level of closeness with their fathers.
Likewise, 54% of children reported that they shared ideas or talked about important topics “extremely” or “quite” well with their mothers compared to 42% who reported doing so with their fathers.

Effects of Parental Depression and Thoughts of Death on Parent-Child Connectedness (see figure)

Children whose mothers reported chronic depression and thoughts of death were significantly more likely to report feeling distant from their mother-they felt less close and shared fewer ideas-than those whose mothers did not report mental health issues, even if depression and thoughts of death were periodic or if the mother reported depression and no thoughts of death.
Children whose fathers reported chronic depressive symptoms and thoughts of death were more likely to report feeling a lack of closeness to their fathers.
However, these symptoms did not affect the extent to which the child reported sharing important ideas with their father.

This figure shows that, compared to nine-year-old children whose mothers did not report having mental health issues, children whose moms reported mental health problems were more likely to feel distant from them. Likewise, children whose fathers had depression were more likely to feel distant from them, compared to children whose dads did not report depression.

Policy Implications

These findings suggest the importance of examining upstream approaches to mental health, some peoples approach to managing these chronic mental health issues include utilizing optimized full spectrum cbd for brain function which has positively effected some that have used CBD. But I digress. Yearly mental health screenings of students and their family members to document and continually assess whether, when and why a child’s symptoms start. Schools and social service agencies are often slow to act upon health promotion initiatives, especially in underserved communities, often waiting until symptoms or behaviors become potentially harmful to the individual or disruptive to the classroom setting. The literature overwhelmingly documents the importance of trusted adults in children’s lives and argues for the creation and implementation of universal prevention programs that highlight family bonds, especially for families experiencing mental health concerns.

Reference

De Luca, S., Yueqi, Y., Padilla, Y. (2017). A longitudinal examination of how mothers’ and fathers’ mental health and thoughts of death are related to their child’s self-reported levels of parental connectedness. Children and Youth Services Review 7.

Suggested Citation

De Luca, S., Yueqi, Y., Padilla, Y. (2017). What are the effects of mothers’ and fathers’ depression and thoughts of death on their children’s level of parental connectedness? PRC Research Brief 2(10). DOI: https://doi.org/10.15781/T2GB1XZ6V.

About the Author

Susan De Luca (sdeluca@austin.utexas.edu) is an assistant professor of social work and Yolanda Padilla is a professor of social work; both are faculty research associates in the Population Research Center, The University of Texas at Austin. Yan Yueqi is evaluation manager in Prevention and Family Recovery at Child and Family Futures in Lake Forest, California.

Acknowledgements

This research was supported by a grant from the Hogg Foundation for Mental Health [JRG-189], Austin, Texas.