The social ecology of maternal infant care in socially and economically marginalized community in southern Israel

This study aims to better understand the social ecology of infant care (IC) as experienced and perceived by mothers living in a deprived Arab Bedouin community in Israel, where children's health indicators are poor. We used the integrative model of García Coll et al. (García Coll C, Lamberty G, Jenkins R et al. An integrative model for the study of developmental competencies in minority children. Child Dev 1996; 67: 1891-914) and constructs of the Health Beliefs Model as a study framework for conducting focus groups with 106 mothers in 2007. Results show that mothers believe IC and infant well-being are high priorities. However, distal barriers, including land disputes, a transition from herding to low-paid labor and lifestyle changes have interacted with proximal barriers in Bedouin families, including poor living conditions, poverty and weakened familial relations to inhibit adequate IC practices. Specifically, distal and proximal barriers affect IC directly (e.g. lack of nearby clinics) or indirectly (mothers' self-efficacies) to limit mothers' choices and control over IC, thereby posing threats to infant health. Our findings demonstrate the importance of understanding the complexity of social context in shaping IC among marginalized minority mothers and suggest new ground for addressing proximal and distal barriers through policy interventions. Without contending with both, interventions to strengthen mothers' self-efficacy will have limited success in improving the environment of IC and, consequently, infant health.