SSM - Mental Health 1 (2021) 100030

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SSM - Mental Health

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Maternal and paternal perspectives on parenting stress in rural Tanzania: A

qualitative study
Marilyn N. Ahun a, b, *, Joshua Jeong a, Mary Pat Kieffer c, Mary Mwanyika-Sando d, Aisha
K. Yousafzai a
a
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
b
Department of Social and Preventive Medicine, Universit
e de Montr
eal School of Public Health, Montr
eal, Canada
c
Global Communities, Silver Spring, MD, USA
d
Africa Academy for Public Health, Dar es Salaam, Tanzania

A R T I C L E I N F O A B S T R A C T

Keywords: Parents across the world are faced with many challenges that can increase their levels of stress. Only a handful of
Mothers studies have examined parenting stress in sub-Saharan African contexts, and most have focused only on mothers
Fathers or at-risk populations. There is therefore a significant gap in our understanding of the factors that contribute to
Parenting stress
parenting stress in mothers and fathers in the general population across sub-Saharan Africa and how parents
Support
manage this stress. The objective of this study was to examine parenting-related stress in mothers and fathers with
Tanzania
young children and how parents dealt with this stress in the Mara region of Tanzania. A qualitative phenome-
nological study was employed. Data were collected through in-depth interviews and focus group discussions with
mothers and fathers. Data were analyzed using inductive thematic content analysis. Both mothers and fathers
identified poverty and lack of consistent employment as two major contributors to parenting stress. These factors
strained the marital relationship and impacted child illness and malnutrition, which further contributed to
parenting stress. Parents primarily sought support for childcare, financial, and relationship stressors from their
spouse and extended family members. Although parents commonly participated in formal social groups with
peers, these groups were not a primary source of support in times of parenting stress. Collectively, these findings
informed the development of a framework on the different types of stressors parents in rural Tanzania face and the
interactions between them, the types of support they seek out or receive, and the individuals they turn to for
support. This is the first study to examine both maternal and paternal experiences of parenting stress in a general
population in a sub-Saharan African context. These findings can inform the development of interventions to
promote the wellbeing of parents and families of young children.

1. Introduction Numerous theoretical frameworks have been developed to explore

Parenthood represents a major life change that can significantly
impact men and women's emotional wellbeing. Although being a parent
can be a positive experience, parents are also faced with challenges that
can increase their levels of stress and negatively impact their emotional
wellbeing (Smith, 2010). Parenting stress refers to a mother or father's
perceived psychological distress arising from the demands of being a
parent (Deater, 2004). It involves stressors that are associated with the
context of caregiving and make it more challenging for parents to fulfill
their parenting roles (Crnic and Ross, 2017).
parenting stress, particularly the individual and contextual factors that
contribute to it (e.g., Conger & Donnellan's (Conger and Donnellan,
2007) family stress model) and its role as a determinant of parenting
behaviour (e.g., Abidin's (Abidin, 1992) model on the determinants of
parenting behaviour). Abidin's (Abidin, 1992) model is particularly
helpful for understanding the impact of parenting stress on parents
themselves because it considers the resources parents may use to manage
stress, rather than solely the consequences of parenting stress on
parenting behaviours and child outcomes. This broader perspective is
important because it recognizes how parenting stress affects parents and

* Corresponding author. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith Street, Roxbury Crossing, Boston, MA
02120, USA.
E-mail address: mahun@hsph.harvard.edu (M.N. Ahun).

https://doi.org/10.1016/j.ssmmh.2021.100030
Received 10 June 2021; Received in revised form 1 October 2021; Accepted 1 October 2021
Available online 3 October 2021
2666-5603/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
M.N. Ahun et al.
facilitates our understanding of how parents manage this stress (e.g., by
seeking/receiving support from others or by adopting specific coping
strategies).
Globally, reviews of the parenting stress literature have focused on
parenting stress in clinical (i.e., individuals diagnosed with a medical
condition) or high-risk populations (e.g., caregivers of HIV-infected
children), with a particular interest in its impact on child outcomes
(Barroso et al., 2018; Cousino and Hazen, 2013; Ice et al., 2012; Noma-
guchi and Milkie, 2020; Oburu, 2005). Few studies – particularly in
sub-Saharan African contexts (Cousino and Hazen, 2013; Nomaguchi and
Milkie, 2020) – have adopted Abidin's broader perspective to understand
parents' perceptions of parenting-related stress and how parents manage
these stressors in non-clinical populations (Abidin, 1992). Additionally,
the overwhelming majority of studies have focused on parenting stress in
mothers and there is consequently a dearth of research on fathers' ex-
periences of parenting stress (Cousino and Hazen, 2013; Nomaguchi and
Milkie, 2020). Although mothers are seen as the main caregivers of
young children in many sub-Saharan African contexts, fathers also play
an important role in the wellbeing of their children and the overall family
unit (Jeong et al., 2016, 2021a; Richter et al., 2011). A narrow focus on
parenting stress in mothers alone thus limits our understanding of the
causes of parenting stress and how parents manage it in the general
population, thereby hindering prevention and intervention efforts to-
wards promoting family wellbeing at the population level.
Only a handful of published studies have examined parenting stress in
sub-Saharan Africa, with most focusing on caregivers and/or children
living with HIV. For example, in a sample of caregiver-infant dyads from
an HIV clinic in Johannesburg, Potterton and colleagues (Potterton et al.,
2007) found that household crowding and lower levels of education were
associated with increased parenting stress in female caregivers (mother,
grandmother) of HIV-infected children. Two studies on caregivers
(mothers, grandmothers, grandfathers) of children orphaned by
HIV/AIDS in rural Kenya also identified household crowding as a pre-
dictor of parenting stress, which was associated with higher levels of
child emotional and behavioural problems (Ice et al., 2012; Oburu,
2005). With respect to how caregivers manage parenting stress, one
qualitative study in rural Uganda reported that both married and single
HIV-infected female caregivers turned to family and community mem-
bers when experiencing parenting-related stressors (Augustinavicius
et al., 2019). In the only known community-based study of parenting
stress in the general population, elevated depressive and anxiety symp-
toms in married women from a birth cohort in Ghana and C^ ote d’Ivoire
were associated with higher levels of parenting stress (Guo et al., 2014).
The authors hypothesized that poverty and maternal childcare re-
sponsibility during early childhood could be the causes of parenting
stress. However, there were no qualitative data to shed light on this
hypothesis. Using a qualitative methodology to examine parenting stress
can elucidate how parents ascribe meaning to their experiences of factors
which increase perceived psychological distress and how they manage
this stress in their daily lives.
Only one qualitative study in sub-Saharan Africa has previously
examined parents' experiences of parenting stress in a non-clinical pop-
ulation. Kaye (Kaye, 2008) used the stress and coping model (Kurtz and
Derevensky, 1994) to analyse perinatal parenting stress in a high-risk
population – adolescent mothers, the majority of whom were single
parents – in Kampala, Uganda. Respondents shared how difficulties in
accessing financial and material resources made it harder for them to
support themselves and their children and subsequently increased their
levels of parenting-related stress (Kaye, 2008). Mothers who received
financial support from the father of their baby and those who received
childcare support from their family or their partner's family reported
greater capacities for managing the stresses of being an adolescent
mother (Kaye, 2008). However, this study only provides perspectives on
parenting stress among young single mothers. Considering that many
young children in sub-Saharan Africa live with their mothers and fathers
(e.g., 52.5% in Ghana (Ghana Statistical Service, 2018), 71% in Tanzania
2
SSM - Mental Health 1 (2021) 100030
(Ministry of Health, 2016);), it is necessary to incorporate fathers' per-
spectives to understand whether and how the relationship between
mothers and fathers influences the causes and consequences of parenting
stress.
Overall, these studies suggest that low socioeconomic status, poor
living conditions, and the experience of mental health problems signifi-
cantly contribute to parenting stress – particularly among mothers – in
various contexts across sub-Saharan Africa. Additionally, family mem-
bers appear to be helpful supports for parents in times of stress. Further
research exploring both maternal and paternal experiences of parenting
stress in this region is needed. To our knowledge, no study to date has
examined parenting stress in the general population in the Tanzanian
context.
1.1. Objectives
The aim of this qualitative study was to examine maternal and
paternal perspectives on the causes of parenting stress, how mothers and
fathers managed these stressors, and the interactions between the types
of stressors parents experienced and the different types of support they
sought out or received in rural Tanzania. We broadly defined parenting-
related stressors as factors that made it more challenging for parents to
fulfill their parenting roles. Support was defined as the help parents
sought out and/or received from themselves, their spouses, their family
members, or community members. As part of exploring the interactions
between parenting stress and support, we examined the facilitators and
barriers to seeking out and/or receiving support in times of stress. Based
on our analysis, we generated a local framework of parenting stress and
parents’ support networks that can inform future interventions to pro-
mote family well-being.
2. Methods
2.1. Setting
The study was conducted in Musoma Rural and Butiama districts in
Tanzania's Mara region. This study is embedded in a larger trial,
Engaging Fathers for Effective Child Nutrition and Development in
Tanzania (EFFECTS), which investigates the impacts of early nutrition
and parenting interventions delivered to mothers and fathers (EFFECTS
Study Protocol, unpublished results). The Mara region is a predominantly
rural area located in the north-west, along Lake Victoria. Below are
general demographic and health statistics about this study context. Ac-
cording to the 2015-16 Tanzania Demographic Health Survey (Ministry
of Health, 2016), 25% of men and 20% of women have completed sec-
ondary school, compared to 36% of men and 29% of women in other
regions of northern Tanzania. The majority of households depend on
farming or fishing as the primary source of income. It is common practice
for men to be married to more than one spouse (32%) and spousal
violence is experienced by 78% of women aged 15–49 years, the highest
rate in the country (Ministry of Health, 2016). Men in polygamous
marriages generally reside with their first wife, while second and
co-wives and their children tend to reside in separate or adjacent
dwellings (Lawson et al., 2015). Based on baseline data from the EF-
FECTS trial among 960 households in the same study context, 18.6% of
individuals report being in a polygamous relationship, 80.3% report
being in monogamous marriages, and 1.1% cohabitate (i.e., live together
but are not legally married) (EFFECTS Study Protocol, unpublished re-
sults). Early child nutrition and health indicators are also poor in the
Mara region, with somewhat similar prevalence rates to other parts of
rural Tanzania. Only 20% of children aged 6–23 months consume
4
food groups a day, 29% of children under 5 years are stunted, 34% had a
fever in the past 2 weeks, and 18% had a diarrhoeal episode in the past 2
weeks compared with 21%, 38%, 18%, and 11% in other rural areas,
respectively (Ministry of Health, 2016).
M.N. Ahun et al.
2.2. Study design and sample selection
We used a phenomenological qualitative design to investigate
parenting stress, with a particular focus on understanding which factors
parents perceived as stressful and how they managed this stress. A
phenomenological design is appropriate for exploring the essence of an
experience through studying the lived experiences, perceptions, and
personal meanings of individuals in a specific study context (Creswell
and Poth, 2016). Using an assembled list of villages in Musoma Rural and
Butiama districts, two villages were purposively selected from each dis-
trict. In each of the four study villages, community health workers and
village leaders assisted in identifying households which fit study eligi-
bility criteria (i.e., having a child between 6 and 36 months of age,
mother and father residing together with child in the household for at
least 10 months of the year, and parent providing informed consent) and
considered representation across maternal age (younger vs. older) and
education level (incomplete primary school vs. completed primary school
or higher).
2.3. Data collection
Data were collected between July and August 2018 using semi-
structured topic guides. The development of the tools and the training
of research assistants was co-led by the second author and a senior
technical advisor at the non-government partner organization – Global
Communities. Both individuals supported the team during data collec-
tion, with the senior technical advisor and a project manager overseeing
the day-to-day field work. Training was conducted over 10 days and
included teaching on nurturing care and child health, development, and
nutrition and practice sessions of in-depth interviews (IDIs) and focus
group discussions (FGDs), including how to transcribe and manage data.
The IDI topic guides included questions that covered various core topics,
including maternal and paternal roles and responsibilities in the house-
hold, sources of stress for mothers and fathers, and how they managed
these stressors. For the FGDs, questions were developed to address the
same broad objectives as the IDIs and also sought to understand attitudes
and norms pertaining to how parents managed stress. Three separate
topic guides were created and organized thematically for the series of
three FGDs, which – in line with the objectives of the larger trial within
which our study is embedded – broadly focused on care for nutrition,
parenting, and family relationships and emotional wellbeing. Each
question in the topic guides included several probes to encourage a
deeper understanding of the issues at hand. Each focus group included 8
participants who reconvened as a group over three separate sessions to
discuss topics that were organized thematically (session #1 on nutrition,
session #2 on parenting, session #3 on parenting challenges). Data from
all IDIs and FGDs were included in this analysis to explore experiences of
parenting stress across various domains of caregiving. A team of 10
Tanzanian research assistants confirmed participant eligibility, admin-
istered informed consent procedures, and conducted the interviews in
Kiswahili. Each IDI and FGD was conducted by a pair of research assis-
tants, with one research assistant as the lead interviewer and the other as
the notetaker. The IDIs were conducted with one parent per household in
a private setting of the participant's home. Each IDI lasted approximately
1.5–2 h. The FGDs were also conducted with one parent per household, in
a private setting at a central location in the village (e.g., village leader's
office). The groups reconvened in the same location every 1–2 weeks for
a total of three FGD sessions, with each lasting approximately 2 h. Spe-
cific questions regarding parenting stress were only included in one of the
three FGDs each parent group attended.
The IDIs and FGDs were audio-recorded, transcribed verbatim, and
translated by the research assistants soon after the data were collected
and concurrently to the completion of fieldwork. The second author and
the senior technical advisor at Global Communities supervised the data
collection team via biweekly teleconference meetings to discuss in real-
time emerging findings or any challenges and to determine whether a
3
SSM - Mental Health 1 (2021) 100030
point of saturation (i.e., no new ideas in the form of codes or potential
themes were being discussed in the IDIs or FGDs) had been reached. To
ensure clarity and accuracy of translations, a randomly selected subset
(10%) of each interview transcript was reviewed against the audio
recording by an external research assistant who was not involved in the
study. Any discrepancies in translation were discussed and corrected
accordingly.
2.4. Data analysis
Data were analyzed between May and August 2020 using thematic
content analysis (Schreier and Flick, 2014). The first author initially
reviewed a random sample of 10 IDI and FGD transcripts, writing memos,
describing preliminary thoughts on thematic categories and their in-
teractions, and discussing emerging concepts with the second and senior
authors. Throughout these initial stages the first author developed a
codebook, based on the inductively identified codes. This codebook was
iteratively refined together with the second author based on independent
reviews of additional transcripts, emerging themes in the data, and
recurring discussions with the senior author. The first and second authors
then used the final version of the codebook to independently conduct
line-by-line coding of each transcript in NVivo software (Version 12
(Bazeley and Jackson, 2013)), with supervision from the senior author. In
addition to assigning codes, the analysts documented memos while
reviewing each transcript. Fortnightly meetings were held throughout
the analysis process over a four-month period to confirm code agreement,
resolve any disagreements, review memos, and discuss emerging themes.
Supporting evidence was reviewed for each code and between multiple
codes to generate and contextualize themes that were discussed in
meetings through a consensus building process. Finally, themes were
analyzed and the perspectives of fathers and mothers were triangulated
to validate, compare, and contrast findings by sex of parent.
2.5. Research team and reflexivity
The EFFECTS trial, from which this data were collected, was designed
and supervised by a multidisciplinary team of early child health and
development, gender studies, nutrition, and implementation science re-
searchers, including the second (male Korean-American Research Asso-
ciate with expertise in fatherhood research), third (female European-
American Senior Health Director of an international NGO with exper-
tise in maternal child health and nutrition interventions in sub-Saharan
Africa), fourth (female Tanzanian medical doctor with expertise in
maternal and child health research), and senior (female British-Pakistani
Associate Professor of Global Health with expertise in parenting and early
child development) authors. The first author – a female Ghanaian Post-
doctoral Fellow with expertise in maternal mental health and early child
development and experience conducting qualitative research in sub-
Saharan Africa – was responsible for the conception of this study and
the initial review of transcripts to identify emerging concepts. The in-
terviews were conducted by a team of 10 Tanzanian research assistants
and a project manager with prior experience in qualitative research,
community health, nutrition, or early education programs.
During meetings among the first, second, and senior authors
throughout the analysis process, differences in researcher perspectives
became apparent as certain findings seemed more salient to different
researchers. The first author was particularly interested in understanding
maternal and paternal descriptions of aspects of caregiving which they
found particularly stressful. The second author, who spent some time in
the field site supervising data collection, expanded on this to identify
aspects of the mother-father relationship, which could also influence
parenting stress, as well as differences in maternal and paternal de-
scriptions of parenting stress. In addition to this, the senior author – who
has extensive experience conducting qualitative research in Eastern Af-
rica – encouraged reflections on how broader family and community
factors could contribute to parents’ experience of stress in their
M.N. Ahun et al.
caregiving roles. The third and fourth authors reviewed the findings and
provided comments based on their professional and lived experience in
Tanzania or similar contexts in the region. Overall, these differences in
experiences and perspectives across members of the research team yiel-
ded a thorough and balanced interpretation of the data.
2.6. Ethical considerations
The research protocol for this qualitative study was reviewed and
approved by the Institutional Review Boards of the Harvard T.H. Chan
School of Public Health and the National Institute for Medical Research
in Tanzania. Informed consent forms were read aloud in Kiswahili by the
research assistants to all participants. Participants either signed the
consent forms or gave their fingerprint to indicate consent.
3. Results
A total of 100 participants were interviewed. Individual IDIs were
conducted with 11 fathers and 9 mothers. A total of 10 FGDs were con-
ducted: 4 father-only (n ¼ 32; 8 fathers/group); 4 mother-only (n ¼ 32; 8
mothers/group); and 2 with fathers and mothers from different house-
holds (3 fathers and 5 mothers; 4 fathers and 4 mothers). The mean
paternal age was 45.2 years and the mean maternal age was 31.8 years.
On average, fathers had higher levels of education than mothers, with
28.9% versus 16.3% completing secondary school. The majority of par-
ticipants (89.7%) reported farming as the primary source of household
income. The median monthly household income was 20,000 TSH
(approximately $9 USD). The mean index child's age was 19.2 months
(range: 6–36 months) and 42% were boys.
Across the IDIs and FGDs both mothers and fathers were asked about
factors that made it more difficult for them to care for their children.
These questions were open-ended, therefore allowing parents to share
any circumstances that contributed to parenting stress and the people
they turned to and/or received support from (i.e., themselves, their
spouse, family members, or community members) in times of stress. We
identified two key themes in parents’ responses: contributors to
parenting stress (stressors) and sources of support (support). There were
four sub-themes within each theme indicating the nature of the stressor
(financial [e.g., lack of money or employment], relationship, child-
related, resource-related [e.g., lack of health and sanitation services])
or support (family, spousal, community, individual). Based on our anal-
ysis, we generated a framework of the different types of stressors parents
face and the interactions between them, the types of support they seek
out or receive, and the individuals they turn to for support (Fig. 1).
Fig. 1. Types of stressors, the interactions between them, and the types and sources of support that contribute to levels of maternal and paternal parenting stress in
rural Tanzania.
4
SSM - Mental Health 1 (2021) 100030
3.1. Stressors
According to mothers and fathers, contributors to parenting stress
included poverty, interpersonal difficulties in the marital relationship,
lack of access to nutritious food, and children becoming ill. The specific
sub-themes are presented below according to how often they were
mentioned. Financial stressors (i.e., factors that hindered parents' ability
to earn money to provide for their child(ren)'s needs) were the mostly
frequently identified source of parenting stress and most parents dis-
cussed these in relation to each of the other stressors.
3.1.1. Financial stressors
Almost every parent mentioned that difficulty finding consistent
employment or earning enough money for daily living made it harder for
them to provide for their child:
“The greatest challenge that parents face is the income problem so that they
can meet the child's needs such food, clothes, and shelter. Sometimes the
income of father and mother may be so low leading to even the children
getting sick” (Father FGD-1.2).
This stress was particularly salient in fathers, who were viewed by
both parents as the main financial provider of the family. Given that
financial provision was seen as a father's primary contribution to child-
care, it was particularly stressful for fathers when they did not have
enough money:
“Fathers get stressed if they do not have money for taking care of his
children, so he may say that ‘If I could have money I could take care of my
children but now I do not have money what should I do?’” (Mother FGD-
2.3).
Financial stress was also strongly related to relationship stressors
within marriages. Since mothers relied on fathers to financially provide
for the family, when there was miscommunication (e.g., arguments)
between couples, mothers felt stressed because they were unable to
purchase food for their children. For example, one mother shared that her
partner became angry and yelled at her when she asked him for money to
provide for their child's needs.
3.1.2. Relationship stressors
In addition to finances, many parents identified interpersonal diffi-
culties as another significant contributor to parenting stress. Almost all
parents focused on interpersonal difficulties in the marital relationship,
with both mothers and fathers highlighting how miscommunication and
a lack of understanding between spouses became a source of stress:
M.N. Ahun et al.
“The things that contribute the father to see the parenting is difficult is lack
of capital, second is marriage if you are living with the woman in a bad
way, again the parenting will be difficult” (Mixed FGD-3.3).
Specific factors that contributed to this stress included fathers
neglecting their childcare and household responsibilities. Many mothers
lamented that fathers did not significantly contribute to caring for chil-
dren or maintaining the household and that this burden fell to them,
subsequently affecting their mental health:
“On the challenge to me I see, if the work was supposed to be done by my
husband and if he doesn't do it, I real feel very bad and you find I don't
have peace and I ask myself a lot of questions … and you find you have
been psychologically disturbed and get unnecessary stresses.” (Mother
FGD-1.3).
This issue was also raised in father FGDs, where fathers recognized
that neglecting their childcare and household responsibilities was a
source of stress for mothers:
“It is when the father is absent for most of the times and he does not provide
for the family, so the mother is relied upon on [for] everything … so
parenting becomes so difficult and brings differences between father and
mother.” (Father FGD-2.3).
Polygamy was prevalent in the study region and a number of parents –
especially mothers – shared how this marriage structure negatively
impacted the mother-father relationship and made it more difficult for
them to care for their children. For example, some mothers expressed
feeling abandoned by their spouse in childcare activities because he spent
most of his time with another spouse. This not only contributed to ar-
guments between the couple, but it also made it more difficult for fathers
to financially provide for all their children. Some fathers acknowledged
this problem, highlighting how the polygamous structure may contribute
to mothers’ parenting stress by placing the burden of childcare on them:
“The main challenge that mothers face in village areas is that, most of the
time mothers are the main care givers and you may find that they are not
together with the fathers, they play two roles as a father and a mother …
And concerning living with the father, most of the time fathers in our village
are having more than one household (multiple wives) that makes it difficult
for them to provide for both families and especially for young children, you
may find both houses are having young children so that is a challenge to
mothers caring for young children.” (Father FGD-1.2)
Some women, especially those in polygamous marriages, found an
alternative source of income apart from their male partners to financially
provide for their children. However, this sometimes led to further marital
problems as fathers perceived this financial independence as a “separa-
tion” in the marriage which made it more difficult for both parents to
collaboratively care for their child:
“Another challenge that the fathers face is having many wives. You find the
father has 3 to 4 wives and the income is low, so being responsible in that
family becomes difficult, but another challenge that makes it difficult for
development is the separation between the father and the mother, so
sometimes parents separate thinking they can be able to look after the
family separately because there are women in the village who think they
can take care of the family after just accessing 200,000 they think they can
run any project so separation brings a lot of challenges.” (Father FGD-
1.2).
Another stressor related to mothers having their own source of in-
come was intimate partner violence, whereby some fathers used physical
force to take the mother's money, sometimes spending it on alcohol:
“The challenges we get mothers are many you find father is not doing all
the house responsibilities, you get your labor/day job you go to do. After he
realize you have done labor when he comes back he asks for the money you
5
SSM - Mental Health 1 (2021) 100030
have get from the labor you did, if you refuse he beats you and he takes the
money.” (Mother FGD-1.3)
“Most of the fathers are an alcoholic, even if mother has her money, when
he sees it, he take it and go drinking, when you try tell him he beats you up
… and sometimes you can ask him money for buying some food for the
family and he say he don't have, but when he goes in the bar you can find
him drinking with people, so what mostly cost us for our husbands is
alcoholism.” (Mother FGD-2.2)
Some fathers were also violent towards their children. Even if
mothers felt that their spouse's disciplinary practices were too harsh, they
rarely intervened out of fear that their spouse might then beat them:
“A child may urinate at the bed, father beats a child like he is an adult … If
mother interferes is beaten too. If you say why are you beating a small child
and is swollen like this, then sticks return to a mother … It happens a lot
and you cannot say anything … You will carry the punishment.” (Mother
FGD-1.3).
3.1.3. Child-related stressors
Children's illness and lack of nutritious food were the primary sources
of child-related stressors. Parents expressed how difficult it was to see
their child(ren) unwell, whether from malnourishment or illness:
“First, there is nothing bad like seeing your child losing weight, that thing is
stressing the heart.” (Mother IDI-1).
As with relationship stressors, child-related stressors were strongly
linked with financial stressors. Both mothers and fathers acknowledged
the stress of not having the financial means to provide healthcare or
nutritious food for their children when they were unwell:
“Fathers can be stressed in the times you find your child has fallen sick, you
have no income or money to take him to the medical services, you must get
a lot of stresses because you have no [money] to touch.” (Father FGD-
2.3).
Child-related stressors were also related to relationship stressors. For
example, some parents – mostly mothers – shared that having children
had put a strain on their marriage and increased their domestic
responsibilities:
“… as my fellows said, mother start to feel it's difficult to be a parent and
starts to regret due to father's problems. You might find when they got
married they loved each other indeed. Even when father comes back from
work he will ask a mother “yes my wife, what do you need?“. But when
they start getting children and domestic needs increases then father starts to
be harsh and not sympathetic. If a mother asks for anything father will just
shout and leave the children with their mother. So, mother starts to regret
that “these children are now a cause of problems to me, because before
getting them we had a good life” So mother starts to regret on bearing the
children.” (Mother FGD-2.3).
Other child-related stressors included challenges in breastfeeding
(e.g., not having enough milk or enough time to sit and feed) and having
to constantly watch young children to keep them from dangerous situa-
tions (e.g., eating dirt, playing with sharp objects).
3.1.4. Resource-related stressors
Parents identified resource-related factors (at the family and com-
munity levels) that also made it more challenging for them to fulfill their
parenting roles. The lack of resources such as clinics, adequate water
sources, and improved sanitation within the community contributed to
parenting stress. For example, when children were sick, parents had to
travel long distances to access healthcare, often having to pay for
transportation to reach the nearest clinic:
M.N. Ahun et al.
“Another [challenge] may be when the child become sick to take him/her
to the hospital, it means to take the child to the hospital you have to incur
cost, use the transport, to hire the motorbike.” (Father FGD-2.1).
This stressor was further exacerbated by household poverty, thus
preventing parents from being able to provide their children with
adequate healthcare. Mothers and fathers also explained that because
many parents in the community lacked the appropriate parenting re-
sources (i.e., general parenting knowledge), they did not feel equipped to
fulfill their parenting roles:
“… yes I get some hardship because if I'm educated more on raising a child
I will not see any hardship. For now, I'm just guessing but it is needed that
the society must be educated [on raising children] someone comes and
educates the people on how they should raise the children.” (Mother IDI-
2).
3.1.5. Summary of stressors
Overall, financial stressors were strongly linked to each of the other
stressors (relationship, child-related, resource-related) parents identified
(Fig. 1). The lack of a steady source of income not only prevented parents
from having access to nutritious food and healthcare for their children, it
also created tensions in marriages, sometimes leading to intimate partner
violence. Financial stressors were particularly salient in fathers, due to
their perceived role – by fathers and mothers – as the main financial
provider of the family. Both mothers and fathers identified interpersonal
difficulties as a contributor to parenting stress; however, mothers were
more likely to perceive polygamous marriages as a source of stress. Child-
related stressors were also related to relationship stressors, with some
mothers sharing that the difficulties of caring for their children had
contributed to more argumentative communication with their spouses.
This section shows that each of these stressors, both independently and
interactively with one another, contributed to maternal and paternal
psychological distress arising from the demands of being a parent.
3.2. Support
In addition to identifying parenting-related stressors, we examined
how mothers and fathers managed under conditions of stress, and in
particular from whom mothers and fathers sought out or received sup-
port and the nature of this support. While our interview guides were
more structured towards understanding the potential supportive roles of
other people in managing an individual's stress, we found that parents
also shared actions and coping strategies for managing stress on their
own. Overall, parents most commonly mentioned seeking or receiving
support for parenting-related stressors from family members, followed by
their spouse, then peers, and lastly through individual support or coping
strategies. In this section, we describe each of these four types of support
in the context of parenting stress.
3.2.1. Family support
Parents most frequently mentioned seeking out or receiving support
from other family members beyond their spouse. Specifically, grand-
parents and older children helped parents manage child-related stressors
by giving parents advice when their child was sick and playing with and
teaching children:
“To raise/care for the younger child, we get support from parents or
grandfather. When a child is sick – e.g., has fever, or a disease or a child
change his/her body condition – it is difficult for parents, and if it is the first
child, to recognize direct his/her body changes. But when we go to older
people they will help us and recognize, “this child change”, we can ask for
advice, things like that.” (Father FGD-1.3)
In addition to childcare support, family members were also a source
of relationship support. Both mothers and fathers turned to their siblings,
parents, or other relatives (e.g., in-laws, aunts/uncles) for relationship
6
SSM - Mental Health 1 (2021) 100030
advice or to help resolve marital conflicts:
“When the father is in stress, he looks for relatives. Like my young brother
is a friend of mine, so I have to go and tell him that your sister in-law has
done this bad. And he will say, ‘Brother take it slowly, if you do that I will
not understand you, am sorry’. Now that my young brother has advised me
that then those thoughts will go away” (Father FGD-2.3).
Finally, family members were turned to and provided parents with
economic support, especially in times of financial hardship and in order
to provide food for the child. Mothers and fathers specified that male
family members were the ones who primarily provided economic
support.
3.2.2. Spousal support
Spousal support was also very commonly mentioned by both parents.
Across the IDIs and FGDs, mothers and fathers emphasized how their
spouses supported them in childcare responsibilities:
“Raising the child is an issue of working together. Me and the mother are
raising our child together to raise our child. If one parent is not at home,
then another parent is responsible to take care of the child, washing, and
making sure he has eaten. And even if we are both present, then if we see
our child went somewhere dangerous then one of us who is near the child
stop the child from harm.” (Father IDI-1).
Parents expressed how they valued providing and receiving support
from their spouses and how this mutually supportive dynamic made them
feel that “we are together” in times of stress. However, there were some
differences in how mothers and fathers reported this. While fathers
unanimously and more strongly underscored the importance of their
spouses for their primary roles in raising their child and providing them
with childcare support, many parents shared how fathers supported their
spouses in two primary ways: financial support to meet children's needs
and childcare support, often when mothers were busy or sick. Fathers'
financial support for mothers included purchasing and providing food for
the family, paying for healthcare services, and investing in children's
future education. In a few exceptional cases, parents shared how mothers
provided financial support to fathers when they were unable to by
“looking for money”. Fathers' childcare support included helping with
household chores and monitoring and feeding the child. However, fa-
thers' childcare support was almost always mentioned under circum-
stances when mothers were busy or ill:
“Interviewer: at what condition you can do things that normally done
by your partners?
Respondent: it's a period when your partner is sick. It will force me to look
for a child for example washing clothes, bathing a child, preparing food to
a child, and when the clinic day reaches while my partner is sick, I will send
a child to clinic. It's a right for a child to go the clinic in order to know the
development of the child may be she is decreasing or increasing the weight
and what condition he is at.” (Father IDI-5).
Nevertheless, some mothers expressed a lack of support from their
spouses – covering financial, childcare, and emotional support. A barrier
to fathers' childcare support that was frequently mentioned by both
parents was that fathers were away from home working for long periods
of time. Mothers and fathers also cited gender (i.e., patriarchal gender
norms surrounding childcare) and sociocultural (i.e., polygamy) norms
as perceived barriers to fathers’ childcare and financial support,
respectively.
“… concerning the issue of child cleanliness for the side of father and
mother about their child, there are still others who hold patriarchal beliefs.
When child defecates, they call, “mama your child here has helped him-
self”, but is the responsibility of the mother to assist the child even though
he is near and then calls the mother. For this, education is needed for the
M.N. Ahun et al.
father to assist the child, but because of patriarchy, the responsibility is left
to the mother.” (Father FGD-1.1).
Finally, men's alcohol use was also mentioned as a cross-cutting
barrier to paternal financial, childcare, and emotional support for their
spouses:
“Another challenge is the alcoholism. You find fathers stopped at the bar,
after they come home they don't remember if something is not available.
There is no food for the child, there is no food for those people, so you find
when it comes to remember the time has passed or sometimes you find he
has spent all money on alcohol. So it becomes a problem when he comes
back home. The mother doesn't understand them for sure.” (Father FGD-
1.3).
3.2.3. Community support
Both mothers and fathers were actively involved in social (e.g., reli-
gious, economic support, gardening) groups within their communities.
However, parents rarely mentioned seeking out or receiving support
from these social groups in times of parenting-related stress. Parents
explained that they were hesitant to seek support for parenting stress
from peers because they believed that issues within the family should
only be discussed with their spouse or other family members. For
example, one mother shared in an interview that it would be inappro-
priate to discuss any difficulties she was experiencing as a parent with her
neighbour because it would be gossiping. Fathers echoed this sentiment,
with some even sharing that they prohibited their spouses from seeking
and/or receiving support from peers because they feared that friends
could turn their spouse against them:
“… even us men we don't like them to go to their neighbours, because we
believe that when the woman is her fellow women there, they infect each
other behaviour that is not good … we avoid them that ‘your issues are here
at home’ …” (Mixed FGD-3.3).
However, some parents did turn to their peers in times of parenting-
related stress, especially those who did not have any family living close
by:
“I'm an orphan. I don't have a father or mother. When I get stress I see my
friend and talk after two hour she usually directs me slowly which makes to
reduce stress which makes me feel I'm ok.” (Mother FGD-1.3).
Some families also received general support in caring for their child
from the community:
“We are getting support from the community. If we do not have food, they
help us.” (Father IDI-4).
3.2.4. Individual support
As mentioned earlier, few parents indicated that they relied on
themselves for support when facing parenting-related stress. Of those
who did, most shared that they relied on themselves when coping with
financial stressors. This included looking for work and doing everything
they could to find money to care for their children:
“… it brings a relief when you work and you can be able to help your
children, some people are idle and they just wait for their relative to bring
something for them to eat or waiting for their neighbors to give them
anything, when you are working it helps to provide for your children.”
(Father FGD-1.1).
Some parents also identified their faith as a means of coping with
parenting stress:
“First person to consult is myself, I find a cool place and sing a song while
singing I will also pray …” (Father IDI-4).
Spending time alone was another way in which parents coped with
7
SSM - Mental Health 1 (2021) 100030
stress. One mother found this helpful as it allowed her to calm her mind
and focus on positive things and one father used it as a means of cooling
off after an argument with his spouse:
“First, I stay alone, and I don't prefer to count on the losses. Even if I don't
have money, I will act like I have money and allow my mind to settle.”
(Father IDI-4)
“… if he is too angry he leaves you … [he says] “let me go and if my temper
goes down I will come back” (Mother IDI-1).
Finally, both mothers and fathers shared that fathers turned to alcohol
to cope with their parenting stress, with some using it as a last resort
when they could not find support elsewhere:
“… this is what makes most of the fathers to engage in alcohol because he
has searched for advice things are hard and does not know what to do he
goes to the bar with his fellows and ask for local brews, thinking he is
reducing stress but reality he is adding stress” (Mixed FGD-3.3).
However, this form of coping sometimes further exacerbated paternal
and maternal stress:
“… a father when have stress he usually go to drink beer to reduce stress
when come he just comes with new issues.” (Mother FGD-1.3).
3.2.5. Summary of support
Mothers and fathers primarily sought out and received support from
their spouses and extended family members when faced with parenting
stress. This included childcare, financial, and emotional support. Most
parents – especially fathers – were hesitant to seek support from peers
because it was perceived as inappropriate to share family issues with
those outside of the extended family. However, for some parents who did
not have any family living nearby, friends and neighbours were a source
of support in times of parenting stress. Regarding spousal support, fathers
were more likely to receive childcare support from their spouses whereas
mothers mostly received financial support from spouses. Importantly,
mothers were more likely to share that polygamy and alcohol use were
barriers to spousal support. Neither mothers nor fathers mentioned
seeking out or receiving support for resource-related stressors.
4. Discussion
In this qualitative study, mothers and fathers in rural Tanzania
identified factors that made it more challenging for them to fulfill their
parenting roles and discussed how they managed these stressors. Poverty
and lack of consistent employment were identified as the most significant
contributors to parenting stress. This financial stress exacerbated the
psychological distress parents experienced. It also amplified parenting
stress when children were sick or malnourished, as parents lacked the
necessary financial means to provide for their children. These individual
and family-level stressors occurred in the context of resource-related
stressors (e.g., inadequate community services), which made it even
more challenging for parents to care for their children. In the face of these
stressors, parents turned to their spouses for support. They also sought
out and received support, especially with childcare, from their extended
family as they preferred to keep their issues within the family. Although
both mothers and fathers were actively involved in social groups within
their communities, they rarely turned to their peers when dealing with
parenting stress. Overall, these findings align with previous qualitative
findings of poverty and lack of material resources as a source of parenting
stress (Kaye, 2008). They also build on prior work by highlighting the
interactions between factors that contribute to parenting stress in
mothers and fathers and identifying the individuals parents turn to for
support as well as the types of support they seek out or receive, as shown
in our framework (Fig. 1).
Over the past decade, researchers have worked with local
M.N. Ahun et al.
collaborators to promote sensitive and responsive parenting practices in
the first few years of life (Aboud et al., 2016; Aboud & Yousafzai, 2015;
Jeong et al., 2021b). These behavioural interventions have successfully
improved child outcomes by supporting parents and enriching the
parent-child relationship; however, there is little evidence that they
improve parents' emotional wellbeing, including parenting stress (Aboud
& Yousafzai, 2015; Jeong et al., 2021b). Our findings, consistent with a
previous study from sub-Saharan Africa (Guo et al., 2014), suggest that
parents' ability to care for their child is influenced by stressors beyond the
parent-child relationship. Interventions may therefore be more successful
in improving parental emotional wellbeing if they address these stressors
and empower parents to use efficient coping strategies and leverage
support networks to manage them. The Nurturing Care Framework
further emphasizes this point by highlighting the importance of pro-
moting the enabling caregiving environment, including the mental
health and wellbeing of parents, in addition to addressing the holistic
needs of children in parenting programmes and health services (WHO,
2018). For example, interventions which have combined parenting pro-
grammes with conditional cash transfers have found significant im-
provements in children's developmental outcomes and parenting
behaviours (Bliznashka et al., 2021; Fernald et al., 2017; Knauer et al.,
2016). However, there is currently little evidence that these in-
terventions are beneficial for parents' emotional wellbeing.
One concrete way interventions can improve parental mental health
and emotional wellbeing – in addition to child outcomes – is by guiding
parents on how to problem solve and use strategies for overcoming
common parenting challenges. Yet, a review of parenting interventions in
low- and middle-income countries found that few of them used this as a
behaviour change technique (Aboud & Yousafzai, 2015). One of the few
parenting interventions in sub-Saharan Africa to use problem-solving as a
behaviour change technique was Singla and colleague's (Singla et al.,
2015) community-based cluster randomized trial in Uganda. In addition
to group sessions on psychosocial stimulation, the trial included
mother-only, father-only, and joint parent group sessions which dealt
with interpersonal conflicts and parenting-related challenges and how to
resolve them (Singla et al., 2015). Although the intervention content
addressed stress arising from beyond the demands of being a parent (e.g.,
marital conflict), they found that improved maternal perceptions of
spousal support mediated intervention effects on maternal emotional
wellbeing at endline; data on paternal outcomes were not collected
(Singla et al., 2015). Another parenting intervention in Liberia included
sessions on parent stress management, with a focus on how to manage
negative emotions and improve positive thinking skills (Puffer et al.,
2015). Qualitative analyses showed that both mothers and fathers
experienced improved emotion regulation and less conflict in marital and
family relationships (Giusto et al., 2017).
These results are in line with both our findings and that of prior
qualitative analyses of parenting stress in sub-Saharan Africa (Augusti-
navicius et al., 2019; Kaye, 2008). Female caregivers from an at-risk
group (HIV-infected (Augustinavicius et al., 2019)) and the general
population (Kaye, 2008) also reported that the father of the child and the
extended family were important sources of support in times of stress. In
our setting, parents explained that this was because issues surrounding
parenting and childcare were only supposed to be discussed with their
spouse or the extended family. These findings suggest that family-based
programmes which leverage spousal and family support networks may
help alleviate parenting stress.
Our findings also highlight the role of gender norms and attitudes as
exacerbators of parenting stress and barriers to parents seeking out and
receiving support, particularly from their spouses. In our sample, the
practice of polygamy was described both in the contexts of relationship
and financial stressors and as a barrier for mothers to seek out/receive
spousal support. On the one hand, polygamy contributed to paternal
parenting stress in that fathers felt burdened by their responsibility to
financially provide for multiple households. On the other hand, some
mothers felt neglected by their spouses and were burdened with fulfilling
8
SSM - Mental Health 1 (2021) 100030
both parental roles for their child while their spouse spent more time
with his other spouse(s) and children. Additionally, the belief that caring
for children was primarily a woman's responsibility further exacerbated
maternal parenting stress and hindered spousal support in childcare re-
sponsibilities. Emerging evidence from across sub-Saharan Africa sug-
gests that gender-responsive and gender-transformative interventions
which promote men's engagement in caregiving and healthier couple
relations can lead to increased participation of men in childcare and
household activities and decrease rates of intimate partner violence
(Abramsky et al., 2014; Doyle et al., 2018; Hossain et al., 2014; Wagman
et al., 2015). In a qualitative study from one of these interventions, fa-
thers shared that participating in and sharing childcare tasks more
equitably with their spouses led to improvements in their marital rela-
tionship (Doyle et al., 2014). However, neither the qualitative nor
quantitative studies assessed intervention impacts on parenting stress.
Furthermore, although studies have examined the impact of polygamy on
child outcomes across cultural contexts, there is a dearth of research on
how it influences parenting behaviours and parenting stress (Al-Sharfi
et al., 2016; Elbedour et al., 2002). Further intervention research is
needed to examine how specific gender norms impact parental charac-
teristics and the potential role gender-responsive and
gender-transformative interventions can play in promoting parental
wellbeing.
This study has many strengths, including its examination of both
maternal and paternal experiences of parenting stress in a low-income
context, the inclusion of parents with children under the age of 3
years, – a period which can be particularly stressful for parents – and the
development of a framework of parents' lived experience of parenting
stress. However, it is not without its limitations. First, our findings are
specific to Tanzania's Mara region and results are not necessarily
generalizable to other settings in Tanzania or other countries across sub-
Saharan Africa. Nevertheless, the convergence of our findings with
qualitative and quantitative studies from other sub-Saharan African
contexts suggest that our findings may be relevant for research in other
settings. Second, this study only included couples and thus does not
address parenting stress in the context of single parenthood. Finally,
interview guides for the IDIs and FGDs were part of a larger investigation
and covered a breadth and variety of topics, which may have limited in-
depth analyses of specific themes.
5. Conclusion
We developed a framework of the causes of maternal and paternal
parenting stress in rural Tanzania. Poverty and marital conflict were
significant contributors to parenting stress in mothers and fathers, and
parents primarily sought support from their spouses and extended fam-
ilies to manage these stressors. Emerging evidence from across sub-
Saharan Africa underscores the importance of empowering parents to
problem solve, engaging them in gender-transformative programmes,
and leveraging spousal and family support networks as a means of pro-
moting parent, couple, and family wellbeing. Further research is needed
to better understand the lived experiences of parenting stress in both
mothers and fathers in the general population across different contexts in
sub-Saharan Africa. This work can inform the development of pro-
grammes to improve parental emotional wellbeing.
Funding sources
Dr. Ahun was supported by a MITACS Globalink Research Award
Abroad and a Vanier Canada Graduate Scholarship from the Social Sci-
ences and Humanities Research Council.
Declaration of interest
The authors declare no competing interests.
M.N. Ahun et al.
CRediT authorship contribution statement
Marilyn N. Ahun: Conceptualization, Formal analysis, Writing –
original draft, Funding acquisition. Joshua Jeong: Conceptualization,
Methodology, Formal analysis, Writing – original draft. Mary Pat
Kieffer: Conceptualization, Methodology, Writing – review & editing.
Mary Mwanyika-Sando: Conceptualization, Methodology, Writing –
review & editing. Aisha K. Yousafzai: Conceptualization, Methodology,
Supervision, Writing – review & editing.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
The authors wish to acknowledge the EFFECTS project funders, the
Eleanor J. Crook Foundation, and the Conrad N. Hilton Foundation, and
project partners: Global Communities (Prime), Purdue University, Har-
vard T.H. Chan School of Public Health, and the African Academy for
Public Health. Contents are solely the responsibility of the authors and do
not necessarily reflect the views of Global Communities, its donor, or
partners.
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