Supporting adolescent mothers in El Salvador

INTERVENTION: The intervention is a home visiting program developed and evaluated by Peter Cooper and Lynne Murray in Khayelitsha, South Africa (Cooper et al, 2009), targeted at first‐time mothers aged 10‐19 in the last stage of pregnancy and up to 6 months post‐partum. A total of 64 first‐time adolescent mothers will be recruited to participate in the study, during their last trimester, and will be randomly assigned to either control (32) or intervention groups (32) at the time of recruitment using a random number generator. All participants will be screened for maternal depression and gender‐based violence. Control group: Participants will receive standard postpartum care consisting of regular checkups with obstetricians and pediatrician. Intervention group: In addition to standard care, participants will receive a home visiting program provided by community workers (CW). Each mother will be visited by the CW 16 times, two visits in the late antenatal period, weekly visits in the first eight postnatal weeks, followed by a visit every two weeks for a further two months and then monthly visits for two additional months up to six months postpartum. The visits will follow a fully specified manual that covers topics related to mother’s support structure, the birth process, infant care and early child development. In the context of a supportive counseling framework, CW will provide will provide support to the first time mothers, seeking to enhance maternal sensitivity to infant communication and development. In addition, mothers will be given support in sympathetically managing infant behavioral problems (sleeping, feeding and crying) and encouraged to talk to their babies and to engage in play. Other caregivers, particularly fathers, will be strongly encouraged to participate in the intervention sessions. The total duration of the intervention could range between 8‐6 months depending on the delivery date of each participant. All participants (control and intervention groups) will CONDITION: 1. Early childhood care and development 2. Gender based violence ; Not Applicable ; 1. Early childhood care and development 2. Gender based violence PRIMARY OUTCOME: 1. Maternal style (sensitivity and intrusiveness) is rated from the mother‐infant face‐to‐face interaction task using the Global Rating Scale at 6 months; 2. Infant emotion regulation is rated from the mother‐infant face‐to‐face still‐face (FFSF) task using the Regulatory Scoring System at 6 months; SECONDARY OUTCOME: 1. Maternal Depression is measured using the Edinburgh Postnatal Depression Scale at baseline, 3 and 6 months; 2. Gender Based Violence is measured using the GBV screening protocol (IPPF/WHR, 2004) at baseline and 6 months INCLUSION CRITERIA: 1. Adolescents between 10 and 19 years of age. 2. Primiparous women in their third trimester of pregnancy 3. Lack of medical complications during pregnancy 4. Delivery not before 36 weeks gestation 5. Women who have a permanent residency so that they are available for the duration of the project (up to 6 months of age of the infant) 6. Resident in urban and rural communities of the municipalities of Nahuizalco, Acajutla, Izalco and Juayúa, Sosonate province 7. Willing and capable to give their written consent (informed consent for minors will be obtained according to the specific age limits of the country)