Effects of improved on-farm crop storage on perceived stress and perceived coping in pregnant women—Evidence from a cluster-randomized controlled trial in Kenya

Background Food insecurity can be harmful to pregnant women, as pregnancy is a challenging period with increased maternal nutritional requirements to ensure optimal fetal development and health of the mother. Whether food insecurity negatively affects maternal health may depend on how stressful pregnant women perceive this food insecurity to be and how strongly they believe they can cope with it. In Sub-Saharan Africa (SSA), pregnant women from smallholder households suffer from food insecurity due to post-harvest losses (PHL), i.e., loss of crops because of inadequate storage. An agricultural intervention that improves crop storage has been shown to reduce food insecurity. However, it remains to be determined whether this agricultural intervention (treatment) has an additional positive effect on pregnant women’s perceived stress levels and coping abilities. This study examines whether pregnant women from treatment households experience lower perceived stress levels and higher perceived coping abilities compared to pregnant women from control housholds. Methods and findings In a randomized controlled trial (RCT), short message service (SMS)-based mobile phone surveys were conducted to assess the causal effect of a food security intervention (improved on-farm storage of maize) on perceived stress and coping in pregnant women from smallholder households. Pregnant women were identified through these monthly surveys by asking whether someone in their household was currently pregnant. The significant results revealed that pregnant women from treatment households experienced more perceived stress but better perceived coping abilities compared to pregnant women from control households. Uncertainty due to lack of experience, this might have contributed to the higher perceived stress, as the women could not easily judge the benefits and risks of the new storage technology. However, the technology itself is a tangible resource which might have empowered the pregnant women to counteract the effects of PHL and thus food insecurity. Conclusion Our findings indicate that pregnant women from treatment households had higher perceived coping abilities but experienced more perceived stress. More research is needed on how this technology impacts maternal mental health in a broader sense and whether biological mechanisms, such as epigenetics, may underlie this association.

[1]  H. De Groote,et al.  On-farm storage loss estimates of maize in Kenya using community survey methods , 2023, Journal of stored products research.

[2]  Jennifer A. Unger,et al.  Trajectories of Depression Symptoms From Pregnancy Through 24 months Postpartum Among Kenyan Women Living With HIV , 2022, Journal of acquired immune deficiency syndromes.

[3]  Isaac Bonuedi,et al.  Agricultural seasonality, market access, and food security in Sierra Leone , 2021, Food Security.

[4]  S. S. Shah,et al.  Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya , 2021, BMC Psychiatry.

[5]  E. Milner‐Gulland,et al.  The role of nature conservation and commercial farming in psychological distress among rural Ugandans , 2021, bioRxiv.

[6]  K. Markon,et al.  Mood during pregnancy: Trends, structure, and invariance by gestational day. , 2021, Journal of psychiatric research.

[7]  I. Luginaah,et al.  The impact of food insecurity on mental health in Africa: A systematic review. , 2021, Social science & medicine.

[8]  S. Iqbal,et al.  Maternal food insecurity in low-income countries: Revisiting its causes and consequences for maternal and neonatal health , 2021 .

[9]  Nikol Figalová,et al.  The perceived stress scale: Reliability and validity study in the Czech Republic , 2021, Ceskoslovenska psychologie.

[10]  C. Funk,et al.  A slow rainy season onset is a reliable harbinger of drought in most food insecure regions in Sub-Saharan Africa , 2021, PloS one.

[11]  D. Rahut,et al.  Prevalence of household food insecurity in East Africa: Linking food access with climate vulnerability , 2021, Climate risk management.

[12]  D. Olago,et al.  Climate change stressors affecting household food security among Kimandi-Wanyaga smallholder farmers in Murang’a County, Kenya , 2021, Open Agriculture.

[13]  S. Weiss,et al.  Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors , 2020, BMC Public Health.

[14]  T. Bernauer,et al.  Improved storage mitigates vulnerability to food-supply shocks in smallholder agriculture during the COVID-19 pandemic , 2020, Global Food Security.

[15]  S. Young,et al.  Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective , 2020, AIDS and Behavior.

[16]  Silvia L. Vaca,et al.  Psychometric properties of the three versions of the Perceived Stress Scale in Ecuador , 2020, Physiology & Behavior.

[17]  M. Huss,et al.  Welfare, Nutritional, and Human Health Impacts of Post-Harvest Loss Prevention: A Large-Scale Field Experiment in Kenya (IMPACT) , 2020, AEA Randomized Controlled Trials.

[18]  S. Premji,et al.  Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores across Pregnancy in Kenyan Women , 2020, International journal of environmental research and public health.

[19]  T. Bernauer,et al.  Improved on-farm storage reduces seasonal food insecurity of smallholder farmer households – Evidence from a randomized control trial in Tanzania , 2020, Food Policy.

[20]  B. Piperata,et al.  Tranquility is a child with a full belly: Pathways linking food insecurity and maternal mental distress in Nicaragua , 2020, Ecology of food and nutrition.

[21]  Meghan Miller,et al.  Rural women: Most likely to experience food insecurity and poor health in low- and middle-income countries , 2019, Global Food Security.

[22]  S. Weiss,et al.  Association of differential symptoms of stress to hair cortisol and cortisone concentrations among pregnant women in Kenya , 2019, Stress.

[23]  M. Laudenslager,et al.  Perinatal Food Insecurity and Postpartum Psychosocial Stress are Positively Associated Among Kenyan Women of Mixed HIV Status , 2019, AIDS and Behavior.

[24]  L. Poston,et al.  Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations , 2019, Annals of Nutrition and Metabolism.

[25]  M. Kominiarek,et al.  Food insecurity during pregnancy and gestational weight gain: 288 , 2019, American journal of obstetrics & gynecology MFM.

[26]  Martin Julius Chegere,et al.  Post-harvest losses reduction by small-scale maize farmers: The role of handling practices , 2018 .

[27]  C. Lund,et al.  Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study , 2018, Social Psychiatry and Psychiatric Epidemiology.

[28]  M. Vallejo,et al.  Determining Factors for Stress Perception Assessed with the Perceived Stress Scale (PSS-4) in Spanish and Other European Samples , 2018, Front. Psychol..

[29]  H. Bettiol,et al.  Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort. , 2017, Cadernos de saude publica.

[30]  J. Ochieng,et al.  Adapting to climate variability and change in rural Kenya: farmer perceptions, strategies and climate trends , 2017 .

[31]  C. McCoy,et al.  Understanding the Intention-to-treat Principle in Randomized Controlled Trials , 2017, The western journal of emergency medicine.

[32]  Marijke A. K. A. Braeken,et al.  Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy , 2017, Neuroscience & Biobehavioral Reviews.

[33]  P. Keiser,et al.  Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data , 2017, Anxiety, stress, and coping.

[34]  C. Cooper,et al.  The Handbook of Stress and Health: A Guide to Research and Practice , 2017 .

[35]  N. Schneiderman,et al.  Factor Structure of the Perceived Stress Scale-10 (PSS) Across English and Spanish Language Responders in the HCHS/SOL Sociocultural Ancillary Study , 2017, Psychological assessment.

[36]  N. Mason,et al.  WPS 57 / 2016 Let it Rain : Weather Extremes and Household Welfare in Rural Kenya , 2016 .

[37]  Andri Christodoulou,et al.  Factorial structure of the perceived stress scale and implications for scoring , 2016 .

[38]  Hee-Ju Kim.  Reliability and Validity of the 4-Item Version of the Korean Perceived Stress Scale. , 2016, Research in nursing & health.

[39]  A. Ambelu,et al.  Community Water Improvement, Household Water Insecurity, and Women’s Psychological Distress: An Intervention and Control Study in Ethiopia , 2016, PloS one.

[40]  C. Gilbert,et al.  Seasonality in Local Food Markets and Consumption: Evidence from Tanzania , 2015 .

[41]  D. Hinton,et al.  "Thinking too much": A systematic review of a common idiom of distress. , 2015, Social science & medicine.

[42]  M. al’Absi,et al.  Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design , 2015, BMC Pregnancy and Childbirth.

[43]  M. Wallace,et al.  Use of a resiliency framework to examine pregnancy and birth outcomes among adolescents: A qualitative study. , 2015, Families, systems & health : the journal of collaborative family healthcare.

[44]  R. Cui,et al.  The Effects of Psychological Stress on Depression , 2015, Current neuropharmacology.

[45]  John M Taylor.  Psychometric analysis of the Ten-Item Perceived Stress Scale. , 2015, Psychological assessment.

[46]  C. Borgemeister,et al.  Unpacking Postharvest Losses in Sub-Saharan Africa: A Meta-Analysis , 2015 .

[47]  M. Hindin,et al.  The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural Southwestern Ethiopia , 2013, BMC Pregnancy and Childbirth.

[48]  Ivar Krumpal.  Determinants of social desirability bias in sensitive surveys: a literature review , 2013 .

[49]  B. Mvumi,et al.  Postharvest agriculture in changing climates: its importance to African smallholder farmers , 2013, Food Security.

[50]  Eun-Hyun Lee,et al.  Review of the psychometric evidence of the perceived stress scale. , 2012, Asian nursing research.

[51]  T. Belachew,et al.  Rapidly rising food prices and the experience of food insecurity in urban Ethiopia: impacts on health and well-being. , 2012, Social science & medicine.

[52]  E. Gibney,et al.  Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. , 2012, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[53]  G. Ice,et al.  Stress associated with caregiving: an examination of the stress process model among Kenyan Luo elders. , 2012, Social science & medicine.

[54]  T. Tefera.  Post-harvest losses in African maize in the face of increasing food shortage , 2012, Food Security.

[55]  L. Ivers,et al.  Food insecurity: special considerations for women. , 2011, The American journal of clinical nutrition.

[56]  George P. Chrousos,et al.  Perceived Stress Scale: Reliability and Validity Study in Greece , 2011, International journal of environmental research and public health.

[57]  Sandeep K. Gupta,et al.  Intention-to-treat concept: A review , 2011, Perspectives in clinical research.

[58]  Julius H. Kotir,et al.  Climate change and variability in Sub-Saharan Africa: a review of current and future trends and impacts on agriculture and food security , 2011 .

[59]  Z. Mahfoud,et al.  Validation of the Arabic version of the Cohen perceived stress scale (PSS-10) among pregnant and postpartum women , 2010, BMC psychiatry.

[60]  R. Hodges,et al.  FORESIGHT PROJECT ON GLOBAL FOOD AND FARMING FUTURES Postharvest losses and waste in developed and less developed countries: opportunities to improve resource use* , 2010 .

[61]  T. Lam,et al.  Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke , 2010, BMC public health.

[62]  Gary King,et al.  The essential role of pair matching in cluster-randomized experiments, with application to the Mexican Universal Health Insurance Evaluation , 2009, 0910.3752.

[63]  Dean S. Karlan,et al.  Small individual loans and mental health: a randomized controlled trial among South African adults , 2008, BMC public health.

[64]  Miriam Bruhn,et al.  In Pursuit of Balance: Randomization in Practice in Development Field Experiments , 2008 .

[65]  Donald R Mattison,et al.  Environmental Exposures and Adverse Pregnancy Outcomes: A Review of the Science , 2008, Reproductive Sciences.

[66]  A. Lartey.  Maternal and child nutrition in Sub-Saharan Africa: challenges and interventions , 2008, Proceedings of the Nutrition Society.

[67]  G. Ice,et al.  Measuring Stress Among Luo Elders: Development of the Luo Perceived Stress Scale , 2005 .

[68]  H. V. van Praag,et al.  Can stress cause depression? , 2005, Progress in neuro-psychopharmacology & biological psychiatry.

[69]  V. Patel,et al.  Cultural factors and international epidemiology. , 2001, British medical bulletin.

[70]  N. Kabeer.  Resources, Agency, Achievements: Reflections on the Measurement of Women's Empowerment , 1999 .

[71]  P E Shrout,et al.  Socioeconomic status and psychiatric disorders: the causation-selection issue. , 1992, Science.

[72]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[73]  R. Lazarus.  Psychological stress and the coping process , 1970 .

[74]  S. Folkman,et al.  Stress: Appraisal and Coping , 2020, Encyclopedia of Behavioral Medicine.

[75]  Un Desa.  Transforming our world : The 2030 Agenda for Sustainable Development , 2016 .

[76]  C. Hammen.  Stress and depression. , 2005, Annual review of clinical psychology.

[77]  C. G. Hudson,et al.  Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. , 2005, The American journal of orthopsychiatry.

[78]  Sheldon Cohen.  Perceived stress in a probability sample of the United States , 1988 .

[79]  S. Folkman.  [Personal control and stress and coping processes: a theoretical analysis]. , 1988, Kango kenkyu. The Japanese journal of nursing research.