Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support?

Abstract

Background and objectives: In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint.

Methodology: We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders.

Results: Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law.

Conclusions and implications: Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.

Keywords: autonomy; household residence; kin dynamics; maternal mental health; parents-in-law; rural Nepal.

Figure 1.

Schematic diagram illustrating the impact of potential paternity uncertainty across two generations (G1, G2) on the genetic association of maternal and paternal grandparents with grandchildren. The terms x, y and z (or zero) indicate the probability of paternity uncertainty for each grandparent in abstract units. Paternity uncertainty in G1 has the same implication for all grandchildren, whereas paternity uncertainty in G2 may vary across each grandchild

Figure 2.

Conceptual framework illustrating potential pathways through which women’s marital household kin (husband and parents-in-law) may generate positive or negative impacts on mental health of the wife/mother. Green boxes indicate positive sources of support, while yellow boxes indicate constraints and demands

Figure 3.

Markers of maternal economic autonomy by parent-in-law and husband co-residence pattern. Figure 3a illustrates the proportion of mothers with greater economic autonomy in household economic decision-making. It shows the proportion of mothers who (a) answered ‘yes’ to whether they made decisions about household expenditures, and on saving, borrowing or lending money, did the food shopping, and received and safeguard household income, stratified by co-residence of Husband (H) only but no Parents-in-law (PIL), neither H nor PIL, both H+PIL, or PIL but no H. Figure 3b illustrates the proportion of mothers with lower economic autonomy reflecting their bargaining power. It shows the proportion of women who reported spending more time on farm work, not earning income, performing more unpaid care work, or resting less, by co-residence patterns. Data are given in Supplementary Table S3.

Figure 4.

Household member involvement in household economics by co-residence pattern. Figure 4 illustrates the frequency of the household member reported by the mother to be the main decision-maker on household expenditures and on saving, borrowing, or lending money, and the main person who did the food shopping, and received and safeguard household income, stratified by the four types of households. The relatives who made decisions included: Mother (M), Husband (H), M and H together, Mother-in-law (MIL), Father-in-law (FIL) or Parents-in-law together (PIL). Results are stratified by co-residence of neither H nor PIL; H, but no PIL; PIL, but no H; both H+PIL. The data clearly show the effect of co-resident and not co-resident PILs on the mother’s decision-making and involvement in household economic activities. Data are given in Supplementary Table S4

Figure 5.

Maternal (a) mental health and (b) economic autonomy by co-residence pattern. Figure 5 illustrates adjusted Log Odds Ratios for the mother reporting that (a) that she had adverse mental health outcomes and (b) that she had decision-making power and bargaining power over household economic activities. The exposures were co-residing with Husband (H) only, with Parents-in-law (PIL) only, or neither H nor PIL. The reference group was co-residing with both H+PIL. Large 95% Confidence Intervals for mothers reporting they were unable to enjoy daily activities were due to very few women answering yes to this question. Models adjusted for: maternal age, maternal marriage age, maternal/husbands’ education, caste, household assets and food security. Data are given in Supplementary Tables S5 and S6