Maternal Responsiveness, Parenting Self-efficacy, and Economic Empowerment: Determinants of Infant Development in Pakistan

OBJECTIVE: Maternal responsiveness and parenting self-efficacy may be constrained by a woman's ability to make household decisions. We evaluated if maternal responsiveness and parenting self-efficacy were associated with infant development. We further examined economic empowerment as a potential effect modifier of these relationships. METHOD: Data for this cross-sectional substudy included 400 participants of the 1,200 total participants included in the Happy Mother-Healthy Baby study investigating a cognitive behavioral therapy-based intervention among Pakistani women with anxiety symptoms conducted from 2019 to 2022. We examined the relationships between maternal responsiveness and parenting self-efficacy with 5 domains of child development at 6 weeks postpartum. We performed logistic regression analyses to assess these relationships and used interaction terms to examine economic empowerment as an effect modifier. RESULTS: A 10-point increase in responsiveness score was associated with a 40%, 36%, and 32% reduction in the odds of developmental delay in communication (aOR = 0.60, 95% confidence interval [CI]: 0.42-0.85), problem-solving (aOR = 0.64, 95% CI: 0.46-0.88), and personal-social skills (aOR = 0.68, 95% CI: 0.47-0.98). A 4-point increase in the score for self-efficacy was related to a 30%, 45%, and 37% decrease in the odds of developmental delay in gross motor (aOR = 0.70, 95% CI: 0.51-0.96), problem-solving (aOR = 0.55, 95% CI: 0.40-0.74), and personal-social skills (aOR = 0.63, 95% CI: 0.45-0.87). For fine motor and personal-social domains, self-efficacy played a protective role against infant developmental delay among non-empowered women, but not in empowered women. CONCLUSION: Maternal responsiveness and parenting self-efficacy were beneficial for infant development in Pakistani women, particularly among women with limited household-level economic empowerment. This study was prospectively registered at ClinicalTrials.gov (identifier NCT03880032) on March 19, 2019.