[Photo credit: Sikhula Ndawonye]
Submitted by Tamaryn Crankshaw1 and Elizabeth Dartnall2
HEARD UKZN1 , SVRI2
The links between exposure to violence and maltreatment in childhood and poor educational attainment as well as the child later in life being a perpetrator or victim of violence are well documented. 1,9-12 We don’t really know how these relationships work and the differential impacts over a lifespan of a child growing up in harsh environments. But given how widespread child maltreatment and sexual and intimate partner violence is in South Africa and many other places in the world, identifying effective, affordable and scalable primary prevention interventions is critical. Effective interventions for the prevention of violence across the lifespan are needed, starting with parenting programmes.
Why parenting interventions?
Promoting responsive and sensitive parenting is protective against harsh parenting. Research shows us that there are strong associations between harsh parenting and reduced positive parenting and in turn later child aggression and violence. Social contexts of poverty and community violence are also significant risk factors for later child aggression and violence, but their effect may be mediated by processes of parenting. Parenting programmes have been found to prevent child aggression – a key predictor of later violence. Parenting interventions also have the potential to increase responsive and sensitive parenting and are a potentially valuable addition to the violence prevention intervention toolkit.
Components of effective parenting interventions.
Evidence for effective parenting interventions in Low and Middle-Income Countries (LMICs) is relatively sparse, though the evidence base is growing. Available research show us that effective parenting programmes need to:
- teach positive parent-child interactions,
- build emotional communication,
- teach the importance of parenting consistency,
- provide opportunity for parents to practice new skills with their children during parent training sessions.27
- take into account the developmental stages of children
- adopt a generational approach (including parents, children, siblings, and grandparents) so that the broader ecological context of the family is considered.28
- where possible provide assistance to parents with socioeconomic difficulties,29,30
- consider the immediate and broader context as well as the bi-directional influences of parent-to-child and child-to-parent.
Short interventions with a clear focus show the most promise, particularly those involving one-on-one interactions between a trained facilitator and parent, which have been shown to improve maternal mood and aspects of infant outcome. 31,32
Sikhula ndawonye – developing an early parenting intervention for women with infants <12 months of age
To build evidence in low and middle income countries on primary prevention of violence, the SVRI created the SVRI Grant. Through this grant mechanism, a multi-disciplinary team of experts were supported to develop an early parenting intervention in partnership with mothers of children under 12 months.
Sikhula ndawonye is one of the few early parenting programmes designed in a developing world context, using a rigorous participatory process, to promote responsive parenting skills and maternal coping, while recognising the multiple contextual challenges caregivers face on a daily basis. Research was used at every stage of the process to develop the intervention. To inform the content of the programme and how and when the programme is delivered, programme developers asked mothers about their understandings of parenting and parenting experiences and for input on the content and presentation of the programme to ensure the intervention is culturally acceptable and appropriate for the local setting. Forty-five (45) mothers were interviewed by the researchers and different groups of mothers participated in discussions and feedback throughout the intervention development process.
Feedback from these mothers highlighted the importance of engaging parents in exploration and play as ways in which babies learn about their world, and drawing attention to the role of responsive parenting which shapes a child’s development and life skills from birth. The study mothers also taught developers that locally many mothers are housebound for the first three months after the baby’s birth. Given that the first three months of a baby’s life is a crucial time for parent child bonding and a great time to promote positive parenting, the developers needed to strategize around how to reach mothers in this period. The study also showed us the limited role of fathers to be a parent in a young infants life, with mothers view of parenting as a woman’s responsibility. Parenting programmes need to challenge this conceptualisation and provide space for a father to be a supportive caregiver. Another important contribution by the mothers interviewed was the recommendation to include financial savings advice and/or an economic livelihoods component to the intervention recognising how many of the struggles caregivers face relate to these wider social challenges.
Sikhula ndawonye – the intervention
Taking lessons from the mothers, the team developed - Sikhula ndawonye - a locally relevant, culturally appropriate parenting programme that aims to promote effective parenting practices and maternal coping skills, both of which have been shown to be related to the treatment (or maltreatment) of children.
Sikhula ndawonye involves five three hour facilitator led participatory sessions with mothers of children under age of 12 months. Each session is divided into three modules.
Content of each session:
Session 1: My child’s future starts now: How do I feel about having a baby; what happens to me happens to my child and anticipating the arrival of my baby.
Session 2: A brighter future for me and my child: The journey of my life; our future and who can support me?
Session 3: Babies learn fast from the moment they are born: What we have learnt so far; The newborn baby is aware and responsive and Interacting with my baby;
Session 4: Babies learn through play and communication: Babies learn through play and exploration; Calming a baby and Calming myself
Session 5: Protecting my child’s future: Protecting my child from harm; positive parenting and planning for the future.
These sessions may be delivered in either a group or an individual setting, at home or an appropriate community setting, which is safe, comfortable, relatively quiet and easily accessible to pregnant mothers and mothers with babies. Two of the sessions are delivered antenatally and the remaining three sessions are delivered after the baby is born. The intervention pack consists of a facilitator intervention manual and 5 short films, each conveying a key intervention message.
Violence is preventable. By working with mothers and fathers, teaching them how to read their baby’s signals and positively interact and play with them can promote the development of healthy interactions between caregivers and their children. Such positive relationships in early childhood can reduce childhood aggression and help prevent violence in adulthood.
For more information contact Tamaryn Crankshaw, email@example.com.