Maternal Beliefs, Mental Health, and Economic Resources on Human Capital Accumulation in Early Life

The study will provide three interventions through the Kapasia Model of Maternal and Child Health (henceforth, Kapasia Model): 1) In treatment 1, project officers employed by the research team, who will be located in study area, will provide information over the phone to each treated household on their eligibility (yes or no) of government’s cash and food transfer programs, as well as where and how to enrol, and assistance with enrolment for eligible mothers. Treatment 2 involves providing information to pregnant mothers and their families on the importance of the early-life environment, and especially the 9-month in utero period, in laying the foundations for a child’s lifelong success. Eligible and willing participants who would be randomly assigned to receive this treatment will be contacted by our project officers, and the officer will provide the following information over the phone: “A healthy pregnancy, wherein mothers take care of themselves and their children during their pregnancy, is extremely important for their children health and economic outcomes. Starting from as early as the 9th week of pregnancy, mothers who eat nutritious food and think positively give birth to healthier children who grow up to be healthier adults. A healthy diet during pregnancy such as this one, (this is based on study conducted in a similar setting, see: https://bmjopen.bmj.com/content/bmjopen/7/8/e015393.full.pdf) can protect a child against low birth weight and stunting (short height) in infancy, and psychological problems, and diabetes or hypertension in adulthood. In contrast, children of mothers who suffer from long periods of stress during pregnancy can develop future health problems when they become adults themselves. Therefore, taking nutritious food regularly, managing stress, and thinking positively from the earliest stages of pregnancy are important for the child in the near- as well as in the long-term. It’s never too early to incorporate these positive changes to your routine.” The third intervention involves offering psychological counselling based on Cognitive Behavioural Therapy, which will be provided by trained counsellors from Moner Bondhu (https://www.monerbondhu.org/). The content will follow the World Health Organization (WHO)-adopted and evidence-based programme called Thinking Healthy, specifically focusing on only the early (pre-delivery) sessions. Thinking Healthy has already been translated and adapted to Bengali (with the full manual for the management of perinatal depression available for free from the WHO website here: https://apps.who.int/iris/bitstream/handle/10665/152936/WHO-MSD-MER-15.1-ben.pdf?ua=1&ua=1. Eligible and willing participants who would be randomly assigned to receive this treatment will be contacted by an officer from Moner Bondhu. Participants will be invited to take part in 4 group counselling sessions, each lasting approximately 1-1.5 hours. The group will consist of other pregnant women from the same village enrolled in this study. We anticipate the groups will be approximately 22 women or less. Counsellors from Moner Bondhu will identify an appropriate venue with comfortable furnishing and privacy to hold the sessions. The sessions will use narratives, or stories, to engage women and then open the floor to discussion on the issues of (1) mother’s physical health, (2) coping with stress, (3) and mother’s relationship with the people around her. They will be modelled after the Thinking Healthy Programme (THP) intervention (https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30467-X/fulltext, specifically see Chapter 2 in the THP Manual, https://www.who.int/publications/i/item/WHO-MSD-MER-15.1). However, we will adapt the sessions to include a focus on identifying and coping with stressors.