The contribution of grandmother involvement to child growth and development: an observational study in rural Pakistan

BMJ Global Health (2020), 5(8)

Chung, E., Hagaman, A., LeMasters, K., Andrabi, N., Baranov, V., Bates, L., Gallis, J., O'Donnell, K., Rahman, A., Sikander, S., Turner, E., Maselko, J.

Early childhood interventions primarily focus on the mother-child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is paucity of research on grandmother caregiving in low-income and middle-income countries. In this study, conducted in rural Pakistan, 68% of children lived with a grandmother. This study uncovered relationships between grandmother involvement for infants at 3-months old with infant weight at 12-months and 24-months, such that weight was positively associated with grandmother involvement at 12-months and negatively associated at 24-months. Furthermore, high 12-month grandmother involvement was associated with improved 12-month cognitive, fine motor skills, and 24-month socioemotional development. 

Association of maternal depression and home adversities with infant hypothalamic-pituitary-adrenal (HPA) axis biomarkers in rural Pakistan

Journal of Affective Disorders (2020), 276

Hagaman, A., Baranov, V., Chung, E., LeMasters, K., Andrabi, N., Bates, L., Rahman, A., Sikander, S., Turner, E., Maselko, J.

Each year, almost 35% of children are exposed to maternal depression and more grow up in persistent poverty, increasing the risk for stress-related disease and other socio-developmental deficits later in life. These impacts are likely related to chronic stress via the hypothalamic-pituitary-adrenal (HPA) axis. However, there is little evidence relating early windows of child HPA axis activity to multiple exposures. This study did not yield associations between infant cortisol and maternal depression or home adversities. Contrastingly, infants exposed to maternal depression during pregnancy and those with mothers who experienced multiple types of IPV within one year of post-partum had lower dehydroepiandrosterone (DHEA) levels. Furthermore, higher socioeconomic-status had a significant positive association with infant DHEA levels and depression severity and chronicity at one year postpartum had near significant associations with infant DHEA. 

Maternal depression in rural Pakistan: the protective associations with cultural postpartum practices

BMC Public Health (2020), 20(68)

LeMasters, K., Andrabi, N., Zalla, L., Hagaman, A., Chung, E., Gallis, J., Turner, E., Bhalotra, S., Sikander, S., Maselko, J.

Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study found that chilla was inversely associated with both major depressive episodes and depression symptom severity at 6 months postpartum above and beyond social support. 

Maternal Depression, Women's Empowerment, and Parental Investment: Evidence from a Randomized Control Trial

American Economic Review (2020), 110(3)

Baranov, V., Bhalotra, S., Biroli, P., Maselko, J.

This paper investigates the medium-term impacts of treating maternal depression on women's mental health, financial empowerment, and parenting decisions. In order to investigate hypothesized associations, this study leverages variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world's largest psychotherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, impacts on women's mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women's financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations.

Our team had three Bachpan related presentations at the Interdisciplinary Association for Population Health Science meeting in Seattle

























Our work has been profiled in The Economist: 

How psychotherapy improves poor mothers’ finances

This study evaluated the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leveraged variation induced by a cluster-randomized control trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psychotherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17% reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time and money intensive parental investments.

A Novel Adaptation of the HOME Inventory for Elders:

The Importance of the Home Environment Across the Life Course

Int. J. Environ. Res. Public Health 2019, 16(16)

Hale K., Østbye T., Perera B., Bradley R., Maselko J.

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka and the subsequent relationship between adapted domains and indicators of health. Higher quality physical home environment was found to be related to improved cognitive, but not psychological outcomes. Additionally, the variety of stimulation available was linked with both better cognitive outcomes and lower psychological distress.

Father involvement in the first year of life:

Associations with maternal mental health and child development outcomes in rural Pakistan

Social Science & Medicine 237 (2019)

Maselko J., Hagaman AK., Bates LM., Bhalotra S., Biroli P., Gallis JA., O'Donnell K.,

Sikander S., Turner EL., Rahman A.

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. This study characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Among present fathers, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. Higher father involvement was found to be associated with improved child socioemotional development. Additionally, trends were observed between higher father involvement and improved developmental milestones as measured by the BAYLEY scales and lower levels of maternal depressive symptoms.​


The relationship between responsive caregiving and child outcomes:

evidence from direct observations of mother-child dyads in Pakistan

BMC Public Health (2019) 19:252

Scherer E., Hagaman A., Chung E., Rahman A., O'Donnell K., Maselko J.

Responsive caregiving, or interactions in which caregivers give appropriate responses to a child’s signals, is linked to improved psychosocial, cognitive and physical outcomes in children. This study examined predictors of maternal responsive caregiving and investigated how those interactions were associated with children’s development using a novel observational tool, the Observation of Maternal-Child Interaction (OMCI) measure. Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Additionally, higher total OMCI scores were associated with positive child socioemotional outcomes. These findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development.

Ashley Hagaman, a recent post-doctoral fellow who recently started a faculty position at Yale, presented a poster on risk factors for suicide ideation. 

Esther Chung, a PhD student in Dr. Maselko’s lab presented her paper on grandmother involvement and child development.

Katherine LeMasters, a PhD student in Dr. Maselko’s lab presented her paper on cultural post-partum practices and maternal depression.

© 2018 by Joanna Maselko. Proudly created with

  • Facebook Clean Grey
  • Twitter Clean Grey
  • LinkedIn Clean Grey