A Community Based Intervention Aimed at Improving the Quality of the Mother-Infant Relationship, Infant Attachment and Long Term Child Outcome

Objective: To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in, and long term child outcome in a South African peri-urban settlement with marked adverse socioeconomic circumstances.

Design: Randomised controlled trial.

Setting: Khayelitsha, a peri-urban settlement in South Africa.

Participants:  449 pregnant women.

Intervention: The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team.

Main outcome measures: Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months.

Secondary outcome: maternal depression at six and 12 months.

Results: The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive and less intrusive in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months. 

Conclusions: The intervention, delivered by community health workers had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in low and middle income countries.

Follow up study: We have recently completed the follow up assessment of caregivers and their children – children are now 13 years of age.  Data are currently being analysed and we will present the results of this longitudinal follow up during the symposium with a particular emphasis on child aggression.