Abstract
The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework).
Similar content being viewed by others
References
Abidoye, R. O. 2000 Comparative School Performance through Better Health and Nutrition in Nsukka, Enugu, Nigeria. Nutrition Research 20:609–620.
Anderson, R. N., and B. L. Smith 2003 Deaths: Leading Causes for 2001. National Vital Statistics Reports 52(9). Hyattsville, MD: National Center for Health Statistics.
Arden Miller, C., A. Fine, and S. Adams-Taylor 1989 Monitoring Children’s Health: Key Indicators, second ed. Washington, D.C.: American Public Health Association.
Baksh, M., C. G. Neumann, M. Paolisso, R. M. Trostle, and A. A. J. Jansen 1994 The Influence of Reproductive Status on Rural Kenyan Women’s Time Use. Social Science & Medicine 39:345–354.
Bamji, M. S. 2003 Early Nutrition and Health—Indian Perspective. Current Science 85:1137–1142.
Bamji, M. S., and B. V. S. Thimayamma 2000 Impact of Women’s Work on Maternal and Child Nutrition. Ecology of Food and Nutrition 39:13–31.
Brown, J., P. Cohen, J. G. Johnson, and S. Salzinger 1998 A Longitudinal Analysis of Risk Factors for Child Maltreatment: Findings of a 17-year Prospective Study of Officially Recorded and Self-reported Child Abuse and Neglect. Child Abuse & Neglect 22:1065–1078.
Bundt, T. S., and H. M. Hu 2004 National Examination of Compliance Predictors and the Immunication Status of Children: Precursor to a Developmental Model for Health Systems. Military Medicine 169(1):795–803.
Celedon, J. C., M. E. Soto-Quiros, E. K. Silverman, L. Hanson, and S. T. Weiss 2001 Risk Factors for Childhood Asthma in Costa Rica. Chest 120(3):785–790.
Chan, L. S., and B. Portnoy 1986 Maternal and Child Mortality along the US-Mexico Border. American Journal of Preventive Medicine 2(1):42–48.
Chen, E., and K. A. Matthews 2002 Socioeconomic Differences in Children’s Health: How and Why Do These Relationships Change with Age? Psychological Bulletin 128:295–329.
Chilton, L., J. Bodurtha, M. P. Butterbrodt, et al. 1999 The Prevention of Unintentional Injury among American Indian and Alaska Native Children: A Subject Review. Pediatrics 104:1397–1399.
Clutton-Brock, T. H. 1991 The Evolution of Parental Care. Princeton: Princeton University Press.
Crews, D. E., and J. R. Bindon 1991 Ethnicity as Taxonomic Category in Biomedical and Biosocial Research. Ethnicity & Disease 1(1):42–49.
Curtiss, J. R., and D. Grahn 1980 Population Characteristics and Environmental Factors That Influence Level and Cause of Mortality: A Review. Journal of Environmental Pathology and Toxicology 4(2–3):471–511.
Daan, S., and J. M. Tinbergen 1997 Adaptation of Life Histories. In Behavioural Ecology: An Evolutionary Approach, fourth ed., J. R. Krebs and N. B. Davies, eds. Pp. 311–333. Oxford: Blackwell Science.
Davis, C. L., A. M. Delamater, K. H. Shaw, A. M. La Greca, M. S. Eidson, J. E. Perez-Rodriguez, and R. Nemergy 2001 Parenting Styles, Regimen Adherence, and Glycemic Control in 4- to 10-year-old Children with Diabetes. Journal of Pediatric Psychology 26(2):123–129.
De Navas-Walt, C., B. D. Proctor, and R. J. Mills 2004 Income, Poverty, and Health Insurance Coverage in the United States: 2003. Current Population Reports, P60–226. Washington, D.C.: U.S. Census Bureau.
Dietz, V. J., M. Lewin, E. Zell, and L. Rodewald 1997 Evaluation of Failure to Follow Vaccination Recommendations as a Marker for Failure to Follow Other Health Recommendations. Pediatric Infectious Disease Journal 16(12):1157–1161.
Downs, B. 2003 Fertility of American Women: June 2002. Current Population Reports, P20–548. Washington, D.C.: U.S. Census Bureau.
Ehrlich, R. I., D. Du Toit, E. Jordaan, M. Swarenstein, P. Potter, J. A. Volmink, and E. Weinberg 1996 Risk Factors for Childhood Asthma and Wheezing: Importance of Maternal and Household Smoking. American Journal of Respiratory and Critical Care Medicine 154(3, Pt. 1):681–688.
Fields, J. 2003 Children’s Living Arrangements and Characteristics: March 2002. Current Population Reports, P20–547. Washington, D.C.: U.S. Census Bureau.
Flaskerud, J. H., and P. Y. Liu 1991 Effects of an Asian Client-Therapist Language, Ethnicity and Gender Match on Utilization and Outcome of Therapy. Community Mental Health Journal 27(1):31–42.
Flores, G., E. Fuentes-Afflick, O. Barbot, et al. 2002 The Health of Latino Children: Urgent Priorities, Unanswered Questions and a Research Agenda. Journal of the American Medical Association 288:82–90.
Frisbie, W. P., F. D. Bean, and D. L. Poston 1985 Household and Family Demography of Hispanics, Blacks and Anglos: Final Report to the National Institute of Child Health and Human Development. Austin: Population Research Center, University of Texas.
Froom, J., and L. Culpepper 1991 Otitis-Media in Day-Care Children—A Report from the International Primary Care Network. Journal of Family Practice 32(3):289–294.
Fuchs, V. R. ed. 1982 Economic Aspects of Health. Chicago: University of Chicago Press.
Gerner, J. L., and C. D. Zick 1983 Time Allocation Decisions in Two-Parent Families. Home Economics Research Journal 12(2):145–158.
Greenland, S., and J. M. Robins 1986 Identifiability, Exchangeability and Epidemiological Confounding. International Journal of Epidemiology 15:413–419.
Haddon, W., Jr., and S. P. Baker 1981 Injury Control. In Preventive and Community Medicine, D. W. Clark and B. MacMahon, eds. Pp. 109–140. Boston: Little, Brown.
Haig, D. 2004 Evolutionary Conflicts in Pregnancy and Calcium Metabolism—A Review. Placenta 25(Suppl. A):s10-s15.
Harms, T., D. Cryer, and R. M. Clifford 1998 Early Childhood Environment Rating Scale, revised ed. New York: Teachers College Press.
Harms, T., D. Cryer, and R. M. Clifford 2003 Infant/Toddler Environment Rating Scale, revised ed. New York: Teachers College Press.
Harpending, H., and P. Draper 1986 Selection against Human Family Organization In On Evolutionary Anthropology: Essays in Honor of Harry Hoijer, 1983, B. J. Williams, ed. Pp. 37–76. Malibu: Undena.
Haskins, R., and J. Kotch 1986 Day Care and Illness—Evidence, Costs, and Public Policy. Pediatrics 77(6):s951-s982.
Haub, C. 1993 Births per US Woman? Depends on Race, Ethnicity. Population Today 21(9, Pts 6–7):9.
Heck, K. E., and J. D. Parker 2002 Family Structure, Socioeconomic Status, and Access to Health Care for Children. Health Services Research 37:173–186.
Hobel, C., and J. Culhane 2003 Role of Psychosocial and Nutritional Stress on Poor Pregnancy Outcome. Journal of Nutrition 133:1709s-1717s.
Hofhuis, W., J. C. de Jongste, and P. J. F. M. Merkus 2003 Adverse Health Effects of Prenatal and Postnatal Tobacco Smoke Exposure on Children. Archives of Disease in Children 88:1086–1090.
Hrdy, S. B. 1992 Fitness Trade-offs in the History and Evolution of Delegated Mothering with Special Reference to Wet-Nursing, Abandonment, and Infanticide. Ethology and Sociobiology 13:409–442.
Hurtado, A. M., and K. R. Hill 1992 Trade-offs between Female Food Acquisition and Child Care among Hiwi and Ache Foragers. Human Nature 3:185–216.
Hurtado, A. M., K. Hawkes, K. Hill, and H. Kaplan 1985 Female Subsistence Strategies among Ache Hunter-Gatherers of Eastern Paraguay. Human Ecology 13:1–28.
Hussain, T. M., and J. F. Smith 1999 The Relationship between Maternal Work and Other Socioeconomic Factors and Child Health in Bangladesh. Public Health 113:299–302.
Ichino, A., and A. S. de Galdeano 2005 Reconciling Motherhood and Work: Evidence from Time Use Data in Three Countries. In The Economics of Time Use, D. S. Hamermesh and G. A. Pfann, eds. Pp. 263–288. Boston: Elsevier.
Jacobs, D. E., R. P. Clickner, J. Y. Zhou, S. M. Viet, D. A. Marker, J. W. Rogers, D. C. Zeldin, P. Broene, and W. Friedman 2002 The Prevalence of Lead-Based Paint Hazards in U.S. Housing. Environmental Health Perspectives 110(10):A599-A606.
Kalmuss, D. S., and P. B. Namerow 1994 Subsequent Childbearing among Teenage Mothers—The Determinants of a Closely Spaced Second Birth. Family Planning Perspectives 26(4):149–153, 159.
Kaufman, J. S., and R. S. Cooper 2001 Commentary: Considerations for Use of Racial/Ethnic Classification in Etiologic Research. American Journal of Epidemiology 154:291–298.
Khan, J., J. A. Khan, M. Akbar, and D. G. Addiss 1990 Acute Respiratory Infections in Children—A Case-Management Intervention in Abbottabad District, Pakistan. Bulletin of the World Health Organization 68:577–586.
Kotch, J. B., D. C. Browne, V. Dufort, and J. Winsor 1999 Predicting Child Maltreatment in the First Four Years of Life from Characteristics Assessed in the Neonatal Period. Child Abuse & Neglect 23(4):305–319.
Kovsted, J., C. C. Portner, and F. Tarp 2002 Child Health and Mortality: Does Health Knowledge Matter? Journal of African Economies 11(4):542–560.
Launer, L. J., J. Villar, E. Kestler, and M. de Ollis 1990 The Effect of Maternal Work on Fetal Growth and Duration of Pregnancy: A Prospective Study. British Journal of Obstetrics & Gynaecology 97(1):62–70.
Leslie, J., and M. Paolisso, eds. 1989 Women, Work and Child Welfare in the Third World. AAA Selected Symposium 110. Boulder: Westview Press.
Louhiala, P. J., N. Jaakkola, R. Ruotsalainen, and J. J. K. Jaakkola 1995 Form of Day-care and Respiratory Infections among Finnish Children. American Journal of Public Health 85:1109–1112.
Mangel, M., and C. W. Clark 1989 Dynamic Modeling in Behavioral Ecology. Princeton: Princeton University Press.
Mansfield, M., and G. Yohe 2003 Microeconomics: Theory and Applications, eleventh ed. New York: WW Norton.
Maslennikova, G. Y., M. E. Morosova, N. V. Salman, S. M. Kulikov, and R. G. Oganov 1998 Asthma Education Programme in Russia: Educating Patients. Patient Education & Counseling 33(2):113–127.
McNamara, J. M., A. Houston, and E. J. Collins 2001 Optimality Models in Behavioral Biology. SIAM Review 43(3):413–466.
Miller, B. D., and R. C. Strunk 1989 Circumstances Surrounding the Deaths of Children Due to Asthma: A Case-Control Study. American Journal of Disease in Children 143:1294–1299.
Miller, P. A., H. J. Binns, and K. K. Christoffel 1996 Children’s Bicycle Helmet Attitudes and Use: Association with Parental Rules. Archives of Pediatrics & Adolescent Medicine 159:1259–1264.
Miller, R. G., Jr. 1981 Simultaneous Statistical Inference, second ed. New York: Springer Verlag.
Montgomery, L. E., J. L. Kiely, and G. Pappas 1996 The Effects of Poverty, Race, and Family Structure on US Children’s Health: Data from the NHIS, 1978 through 1980 and 1989 through 1991. American Journal of Public Health 86:1401–1405.
Morrongiello, B. A., C. Midgett, and K. L. Stanton 2000 Gender Biases in Children’s Appraisals of Injury Risk and Other Children’s Risk-Taking Behaviors. Journal of Experimental Child Psychology 77:317–336.
Mull, D. S., P. F. Agran, D. G. Winn, and C. L. Anderson 2001 Injury in Children of Low-Income Mexican, Mexican American, and Non-Hispanic White Mothers in the USA: A Focused Ethnography. Social Science and Medicine 52:1081–1091.
Muñiz, E. 1989 Maternal Education and Child Survival in the Dominican Republic. Ph.D. dissertation, Department of Population Planning and International Health, University of Michigan.
Oliveti, J. F., C. M. Kercsmar, and S. Redline 1996 Pre-and Perinatal Risk Factors for Asthma in Inner City African-American Children. American Journal of Epidemiology 143:570–577.
Parker, G. A., and J. M. Smith 1990 Optimality Theory in Evolutionary Biology. Nature 348(6296):27–33.
Parkin, P. C., A. Khambalia, L. Kmet, and C. MacArthur 2003 Influence of Socioeconomic Status on the Effectiveness of Bicycle Helmet Legislation for Children: A Prospective Observational Study. Pediatrics 112:E192-E196.
Pelletier, D. L., E. A. Frongillo, and J. P. Habicht 1993 Epidemiologic Evidence for a Potentiating Effect of Malnutrition on Child Mortality. American Journal of Public Health 83:1130–1133.
Petridou, E., A. Skalkidou, I. Lescohier, and D. Trichopoulos 1998 Car Restraints and Seating Position for Prevention of Motor Vehicle Injuries in Greece. Archives of Disease in Childhood 78:335–339.
Phelan, K. J., J. Khoury, D. C. Grossman, D. Hu, L. J. Wallace, N. Bill, and H. Kalkwarf 2002 Pediatric Motor Vehicle Related Injuries in the Navajo Nation: The Impact of the 1988 Child Occupant Restraint Laws. Injury Prevention 8(3):216–220.
Polednak, A. P. 1989 Racial and Ethnic Differences in Disease. Oxford: Oxford University Press.
Popkin, B. M., and F. Solon 1976 Income, Time, the Working Mother and Child Nutriture. Journal of Tropical Pediatrics & Environmental Child Health 22(4):156–166.
Rachlin, H., R. Battalio, J. Kagel, and L. Green 1981 Maximization Theory in Behavioral Psychology. Behavioral & Brain Sciences 4:371–388.
Revich, B. A. 1994 Child Health Level in Moscow as Related to Ambient Air Pollution. Science of the Total Environment 148:57–60.
Rosenblum, L. A., and G. Sunderland 1982 Feeding Ecology and Mother-Infant Relations. In Parenting: Its Causes and Consequences, L. W. Hoffman, R. J. Gandelman, and H. R. Schiffman, eds. Pp. 75–110. Hillsdale, New Jersey: Lawrence Erlbaum Associates.
Ruhm, C. J. 2000 Parental Leave and Child Health. Journal of Health Economics 19:931–960.
Sachar, R. K., J. Verma, V. Prakash, S. Dhawan, and U. Sachar 1990 Childhood Malnutrition and Development—A Paradox. Indian Journal of Maternal and Child Health 1(1):8–11.
Schmid-Hempel, P. 1987 Efficient Nectar-Collecting by Honeybees, I: Economic Models. Journal of Animal Ecology 56:209–218.
Scholer, S. J., E. F. Mitchel, and W. A. Ray 1997 Predictors of Injury Mortality in Early Childhood. Pediatrics 100:342–347.
Schor, E. 1987 Unintentional Injuries: Patterns within Families. American Journal of Diseases of Children 141:1280–1284.
Sears, M. R., D. T. Jones, P. A. Silva, A. Simpson, and S. M. Williams 1982 Asthma in Seven-Year-Old Children: A Report from the Dunedin Multidisciplinary Child Development Study. New Zealand Medical Journal 95:533–536.
Senturia, K. D. 1997 A Woman’s Work Is Never Done: Women’s Work and Pregnancy Outcome in Albania. Medical Anthropology Quarterly 11:375–395.
Sosin, D. M., J. J. Sacks, and K. W. Webb 1996 Pediatric Head Injuries and Deaths from Bicycling in the United States. Pediatrics 98:868–870.
Stearns, S. C. 1992 The Evolution of Life Histories. New York: Oxford University Press.
Stephens, D. W., and J. R. Krebs 1986 Foraging Theory. Princeton: Princeton University Press.
Stone, P. J. 1973 Childcare in Twelve Countries. In The Use of Time, S. Szalai, ed. Pp. 249–265. The Hague: Mouton.
Tirosh, E., T. Becker, Y. Mansour, A. Cohen, and M. Jaffe 2000 Sleep Position, Bedding and Heating Practices in High- and Low-Risk Ethnic Groups for Unexpected Death in Infancy (UDI). European Journal of Epidemiology 16:281–286.
van Odijk, J., L. Hulthen, S. Ahlstedt, and M. P. Borres 2004 Introduction of Food during the Infant’s First Year: A Study with Emphasis on Introduction of Gluten and of Egg, Fish and Peanut in Allergy-Risk Families. Acta Paediatrica 93:464–470.
Victora, C. G., S. R. A. Huttly, F. C. Barros, C. Lombardi, and J. P. Vaughan 1992 Maternal Education in Relation to Early and Late Child Health Outcomes: Findings from a Brazilian Cohort Study. Social Science & Medicine 34:899–905.
Weinreb, L., C. Wehler, J. Perloff, R. Scott, D. Hosmer, L. Sagor, and C. Gundersen 2002 Hunger: Its Impact on Children’s Health and Mental Health. Pediatrics 110(4):E41.
Yoos, H. L., H. Kitzman, and A. McMullen 2003 Barriers to Anti-inflammatory Medication Use in Childhood Asthma. Ambulatory Pediatrics 3(4):181–190.
Zuckerman, B. S., and J. C. Duby 1985 Developmental Approach to Injury Prevention. Pediatric Clinics of North America 32(1):17–29.
Author information
Authors and Affiliations
Corresponding author
Additional information
The research was funded by a Faculty Scholars Award from the William T. Grant Foundation to A. Magdalena Hurtado.
A. Magdalena Hurtado, Ph.D., is an associate professor in the Department of Anthropology, University of New Mexico. Her research interests include the origins of the sexual division of labor, epidemiology of indigenous peoples, disease susceptibility, the development and intergenerational transmission of antigens and immune defense, immune function and allergic sensitization, and trauma. She also works on public health interventions, biological capital and poverty, and land tenure and human rights in native communities of South America.
Carol Lambourne, M.Sc., is a doctoral candidate in the Department of Anthropology, University of New Mexico. Her research interests are evolutionary models of child and adolescent development, life history theory, family composition and investment patterns, pubertal timing and psychosexual maturation, juvenile stress, and infanticide.
Kim Hill, Ph.D., is a professor in the Department of Anthropology, University of New Mexico. His research interests are modern hunter-gatherers, including extensive fieldwork in lowland South America. Current topics of interest include human evolution, economic strategies, life history theory, the evolution of cooperation, and the emergence of social norms enforced by punishment. He is also involved in economic development, health and education projects with lowland South American native populations.
Karen Kessler received her M.S. in Anthropology from the University of New Mexico in 1996. Her research interests are the application of mathematical modeling to the prevention of diabetes and other causes of morbidity and mortality in historical populations.
Rights and permissions
About this article
Cite this article
Hurtado, A.M., Lambourne, C.A., Hill, K.R. et al. The public health implications of maternal care trade-offs. Hum Nat 17, 129–154 (2006). https://doi.org/10.1007/s12110-006-1014-y
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12110-006-1014-y