Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey.

Journal Article (Journal Article)


Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana.


This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis.


About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors.


Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development.

Trial registration

Clinical Trials # NCT03665246 , August 29, 2018.

Full Text

Duke Authors

Cited Authors

  • Mackness, J; Gallis, JA; Owusu, RK; Ali, M; Abubakr-Bibilazu, S; Adam, H; Aborigo, R; Awoonor-Williams, JK; Lillie, M; McEwan, E; Hembling, J; Vasudevan, L; Baumgartner, JN

Published Date

  • January 2021

Published In

Volume / Issue

  • 21 / 1

Start / End Page

  • 4 -

PubMed ID

  • 33397319

Pubmed Central ID

  • PMC7784360

Electronic International Standard Serial Number (EISSN)

  • 1471-2393

International Standard Serial Number (ISSN)

  • 1471-2393

Digital Object Identifier (DOI)

  • 10.1186/s12884-020-03476-9


  • eng