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

Abstract

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.

Effects of improved on-farm crop storage on DNA methylation of mothers and their infants: evidence from a randomized controlled trial in Kenya

“…Contrary to expectation, our study revealed increased NR3C1 methylation in mothers in the intervention households compared to those in the control households. However, our findings are consistent with Eichenauer et al [ 30 ], who also reported increased perceived stress in pregnant women from the intervention households. To explain this finding, the authors suggested that in line with Lazarus and Folkman's transactional stress theory [ 59 , 60 ], the improved on-farm storage technology may have elicited feelings of uncertainty, uncontrollability, and threat due to the farmers’ lack of experience in using these bags, thus triggering a stress response.…”

“…Most importantly, a follow-up study should examine whether the altered DNA methylation pattern for NR3C1 persists over time. Since the time of data collection, mothers may have experienced the benefits of the intervention through a significant reduction in food insecurity after the first harvest season [ 28 ], potentially altering their appraisal of the intervention as a "threat" [ 30 ] and resulting in a reduced stress response and thus more favorable methylation patterns.…”

“…Stressful life events experienced in the past year were assessed using questions from the Life Experiences Survey originally developed by Sarason et al [ 35 ] and the Stressful Life Events Questionnaire developed by Cutrona et al [ 36 ], which were adapted to be appropriate for this study population. Perceived stress and coping were assessed using the 4-item version of the Perceived Stress Scale (PSS-4) [ 37 ], which has been used previously in the sample population of the present study [ 30 ]. The Edinburgh Postnatal Depression Scale (EPDS) was used to determine depressive symptoms during pregnancy and the postpartum period [ 38 , 39 ].…”

“…To assess food security status, the farmers received monthly SMS-based mobile phone surveys throughout the intervention period [ 28 ]. The surveys included a question asking whether anyone in the household was currently pregnant, and farmers who replied "yes" to this question received an additional survey asking the pregnant women in these households about their approximate due month, perceived stress, and coping (see Eichenauer et al [ 30 ] for more details). Initially, we planned to include all pregnant women expecting to give birth between January and March 2021 in the study.…”

“…As stated above, food insecurity in Africa is high, especially in Sub-Saharan Africa (SSA), and this is partly due to post-harvest losses, that is, crops lost after harvesting due to improper storage [ 24 – 26 ]. Fortunately, however, post-harvest losses can be minimized through agricultural measures such as hermetic storage technology [ 27 ], with data from randomized controlled trials showing that the administration of hermetic storage bags improves food security for smallholder households [ 28 , 29 ] and also affects the perceived stress levels and perceived coping abilities of pregnant women from these households [ 30 ]. However, to date, no research has examined whether such interventions affect epigenetic changes in HPA axis genes in mothers and their offspring, and how these epigenetic changes relate to maternal mental health and infants’ birth outcomes and growth.…”