Abstract: Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.
Keywords: Cooperative breeding Breastfeeding Grandmothers Maternal and child health
Discussion
Grandmothers have long been touted as one among a suite of important alloparents in the human cooperative breeding system (Hrdy 2005; Kramer 2010). But despite their prominence in the literature, data demonstrating positive effects of grandmaternal support is somewhat equivocal. For food sharing and intergenerational transfers, grandmothers in some places play a critical role (Hawkes et al. 1997; Hooper et al. 2015), but in others their efforts are outweighed by other helpers (Kramer 2005; Kramer and Veile 2018). Similarly, the amount of direct care provided to infants and toddlers by grandmothers, compared with other allomothers, is quite variable (Kramer 2010). Despite this disparate evidence, reviews demonstrate strong and consistent patterns showing an association between presence of the maternal grandmother and improved child survival (Fox et al. 2010; Sear and Mace 2008). Taken together, these lines of evidence suggest that supplemental provisioning and childcare are just two pieces of the grandmothering puzzle. Other elements of the grandmaternal niche remain to be systematically investigated. Here we emphasize how multifaceted perinatal support has the potential to improve the health and well-being of mothers and their babies, not only expanding our understanding of grandmothers but bridging to other constructs of human evolution such as the role of emotional support and perinatal care during the difficult childbirths and challenging transitions to motherhood experienced by humans (Trevathan 2017).
Social Learning in the Perinatal Period
Here we explored the perinatal period embedded in the context of subsistence nutrition, disease ecology, energy balance, kin networks, traditional knowledge, and maternal-infant dynamics atypical of WEIRD populations (Henrich et al. 2010). Populations characterized by predominant subsistence activities and traditional sociocultural practices reveal aspects of adaptive reproductive ecology often disrupted in industrialized contexts. Importantly though, no present-day subsistence culture or population represents the human past nor exclusively occupies the environments in which humans emerged (Crittenden and Schnorr 2017; Lee 1992). From an infant’s perspective, however, the “normalized” breastfeeding dynamic of the mother-infant dyad represents the adaptively relevant environment in which the human neonate evolved. Our findings about breastfeeding difficulties and other maternal anxieties counter widely held perceptions, expectations, and attitudes suggesting that breastfeeding and infant care are intrinsic to womanhood, easily learned through exposure and observation, and only become difficult in contexts where these pathways are disrupted.
Among Himba, breastfeeding is “normalized”; breastfeeding initiation is universal and sustained for many months, nursing is on demand, and clothing does not cover breasts so nursing is highly visible. This is the cultural context in which Himba grow up. But despite this normalization and ubiquity of breastfeeding, Himba women often reported struggling in the early postpartum period following their first births. The women we interviewed spontaneously described difficulties typically encountered by women living in industrialized settings, including nipple/breast pain, difficulty with latch, and concerns about insufficient milk production (Bergmann et al. 2014; Lamontagne et al. 2008; Waller 1946; Williamson et al. 2012). While their struggles are similar, we argue that the consistent, multifaceted support and teaching that Himba grandmothers provide during the first weeks after a birth seems to have an appreciable impact on women’s ability to overcome these difficulties, going on to successfully breastfeed for months and years to come. Similarly, Himba women’s descriptions of the fear and anxiety they experienced during the early postpartum period and their lack of knowledge about basic infant care (e.g., how to hold an infant) further counter common tropes about motherhood in its “natural state.” Again, the main difference appears to be one of timescale. The consistent support that Himba women receive during the perinatal period helps them to overcome difficulties and quell their anxieties in a matter of days, whereas it is not uncommon for women in WEIRD settings to struggle for weeks, or even months, after a birth.
The rapid learning curve that Himba women describe, combined with an intensive period of perinatal co-residence and support, leads us to suggest that social learning from grandmothers and other female kin may be critical to facilitating women’s ability to successfully breastfeed and provide infant care. In some cases, Himba grandmothers were reported to provide very direct instruction. Women reported that their mothers physically and gesturally showed them how to position their babies for improved latch, provided detailed guidance on how often to feed, and explained techniques to protect infants, such as putting them to sleep on their backs and to nurse sitting up rather than lying down. Others described techniques that have presumably been developed and fine-tuned over generations, such as the postpartum steam “bath” described above, or knowledge about which foods and herbs serve as lactogogues. Our findings mirror those of other studies that have similarly shown how the presence of cultural practices and beliefs, acquired through social learning, can positively impact reproductive health. For example, several studies of pregnancy food taboos have been shown to map closely onto species that pose particular dangers to pregnant women and their fetuses (Henrich and Henrich 2010; McKerracher et al. 2016; Placek et al. 2017). Other studies have shown the importance of ideational factors, shared within groups and socially learned, to the practice of early infant care (Hadley et al. 2010; Wutich and McCarty 2008).
Further study might enhance our understanding of perinatal care as a case of social learning and answer questions we are unable to address with our current data. For example, we rely here on self-reports, which have the potential for bias and are not useful for quantifying behavior beyond coarse categories. Observational data would provide exceptional insight into the prevalence of teaching and learning behaviors and would be less subject to bias; however, such data would be very difficult to obtain. The scenarios we describe take place in intimate settings, often during the night in a private sleeping space. Nighttime observations are notoriously rare in time allocation data and present logistical and ethical challenges (Scaglion 1986). Other, less direct types of data could speak to some of these issues. For example, repeated measures of infant health and maternal pain and anxiety could track the effectiveness of grandmothers’ help, particularly in a case-control design comparing women who are and are not co-resident with their mothers after a first birth. Focal follows that concentrate on the first week or two after a birth (particularly first births) would also be extremely useful, as this would increase the chances of capturing otherwise rare instances of potential teaching and provide greater insight into how new mothers learn to breastfeed and care for their infants.