Adult Psychological Distress and Child Fosterage in a Rural and an Urban Region of Namibia

Abstract

Amongst Aawambo families in Namibia, the practice of fosterage (i.e., a system whereby a child is raised by family or non-biological relations rather than their biological parents) remains a culturally consistent practice. Scholars have endeavored to understand the implications of this and similar parenting practices in and outside of Namibia, with evidence showing both potential positive and negative outcomes of fosterage for the children who experience this system. What has yet to be studied is the within-culture comparison of those who experience fosterage and those who do not as a correlate of adult psychological distress. These practices span regions of Namibia, with migration from rural to urban regions also interwoven into Aawambo familial structures and parental care. To better understand fosterage and psychological outcomes, the purpose of this study was to compare mental health of Aawambo adults who did and did not experience fosterage as children and live in a rural or urban area of the country at time of data collection. We found no differences in psychological distress by fosterage but did by region, with those in the urban area showing more distress. We discuss these findings with respect to the evolved nest concept of childcare and its implications for functioning in adulthood.

Keywords

Namibia aawambo child fosterage psychological well-being

Evidence from survey data analyzed in the early 2000s showed as many as 36% of Namibian children lived with caretakers other than their biological parents despite one or both of their parental caretakers being alive (Brown, 2009). These data speak to the commonality of child fosterage in Namibia, or okutekula in the Oshikwanyama dialect of Oshiwambo, a process wherein children are raised by caretakers who are not their biological parents for several possible reasons including educational opportunities, gifting children to family members, economics, and social status/esteem (Brown, 2011). Others have also noted regional differences in motivation for fosterage, with fosterage in rural areas also involving labor related reasons that disadvantage the children fostered (Sharley et al., 2020). Brown, summarizing kinship in Namibia, noted “Kinship is an organizing principle in Namibia” (Brown, 2011, p. 161). Yet, kinship therein cannot be seen as uniformly defined by biological connection, given the commonality of these child care arrangements in Namibia, where stakeholders estimate rates of fosterage are far higher than what is reported in national survey data (Sharley et al., 2020). Studies of fosterage paint a complex picture of differences in developmental markers for some children but not others (Brown, 2009) perceptions of disadvantages as well as valued cultural lessons learned (Brown, 2011; Sharley et al., 2020) that are also connected to where fosterage occurs (i.e., urban or rural settings; Brown & Bartholomew, 2014; Sharley et al., 2020). However, this scholarship is yet to examine lasting psychological implications of fosterage for adults in Namibia, especially quantitative assessments. Therefore, the purpose of this study was to examine if child fosterage is associated with adult psychological distress and if fosterage and location of living interact in a manner that contributes to different average psychological distress.

Fosterage Practices

Fosterage has been defined in several ways. In early work in West Africa, Goody (1973) defined it as, “institutional delegation of the nurturance and/or educational elements of the parental role. Fosterage does not affect the status identity of the child, nor the legal rights and obligations this entails. Fosterage concerns the process of rearing” (p.23). Biological parents’ still hold legal rights to children they foster and most continue relationships with the children throughout their time in fostering arrangements with another family. Other definitions exist; with most agreeing that fosterage is the rearing of a child by someone other than the biological parent. Unlike adoption in the Western sense, fostering involves no permanent change in kinship or status and no permanent forfeiting of rights. It is an additive, not a substitutive model of child rearing that allows for biological and social parenting (Bowie, 2004). What makes fosterage unique is the semi permanent yet adjustable nature of the relationship, one of the most distinct elements of African families.

Fosterage is found throughout the world. In an extensive study of adoption and fostering in Oceania, Brady and colleagues (1976) describe a number of ways it is possible to foster. One may make regular contributions of food and clothes, feed another, let another sleep regularly in one’s house. In Oceania, a distinction between fosterage and adoption is made by identifying who is involved in the principal negotiation of the arrangement. In a fostering arrangement, initiation may be by the family of the child being fostered, the one who will care for him/her, or an interested third party not involved in the relationship directly. Adoption, however, is only initiated by the persons wishing to adopt. In this respect, fosterage represents a fundamentally different practice.

The concept of fosterage has been elusive in the literature and appears under several labels. In 1937 Herskovits uses the term ‘quasi-adoption’ to describe the practice in Haiti of “giving” peasant children to wealthier families in the capital. “Giving” of the child was seen as an act of friendship and the child repaid the foster family through housework and chores. Clark (1957) studied Jamaican families and differentiated between fostering/adoption and “schooling-out”. Adoption occurred at an early age while schooling-out occurred later: in both, often children were often sent to strangers of a higher social status or better circumstances and in these circumstances the children were not thought of as equals but rather as servants. Schooling out was a business deal between parents and adults of the recipient household—a child’s maintenance and schooling was exchanged for services. Additional terms used include “child switching” (Goode, 1964), “child loaning” (González, 1969), “child keeping” (Payne-Price, 1981). Carroll (1970) uses the term “adoptive fosterage” to differentiate between adoption in America and adoption practiced in Western Polynesia. This term brings into focus most clearly the problem of trying to derive a single definition to describe the range of practices.

Fosterage in Namibia

In the northern region of Namibia, a country located in Southwest Africa, children are often raised through a practice known as okutekula, or child fosterage and giving (Brown, 2018). While most commonly practiced by the Aawambo people, fosterage is apparent in other Namibian communities as well (e.g., Himba communities; Scelza & Silk, 2014). Fosterage is socially distributed care; the responsibility for raising children is shared across a diverse and wide network of community and family members (Brown, 2018). Unlike the Western approach to childrearing, which involves a focus on independence and individual choice, fosterage as practiced in Namibia values strong family networks, community, and a collective, mutual responsibility (Brown et al., 2024). The intentions behind this relational approach to raising children is usually neither unitary or single minded. Fosterage often strengthen children’s and parents’ social networks and bonds, relieves biological parents from the duties of parenting, and provides children with access to a more robust education, teaches cultural moral lessons of perseverance and tradition, or increases fertility (Pennington, 1991; Brown et al., 2024). In pastoralist communities such as the Himba in Namibia, fostering out children enhances mothers’ fitness, in that fosterage of early-born children is associated with greater maternal reproductive success (Scelza & Silk, 2014).

Despite the positive developmental consequences of the child fosterage system, existing literature underscores the ways in which fosterage may inform potential negative health outcomes across the lifespan (Brown, 2013; Prall & Scelza, 2017). The collective care model adopted by many Aawambo people can become burdensome due to the demands of structural inequalities that exist in Namibia (Brown, 2013). Widespread poverty and cases of disease seep into communities, limiting a given families’ ability to provide adequate and meaningful support to non-biological children (Brown, 2013). When resources are spread thin, fostered children may become less of a priority compared to their biological children counterparts (Anderson, 2005; Brown, 2018). As a result, they are at a greater risk of receiving smaller food portions, reduced medical attention when they become ill, decreased access to educational resources and opportunities, and hindered developmental trajectories with respect to weight and height (Anderson, 2005; Brown, 2018; Scelza & Silk, 2014; Verhoff & Morelli, 2007). These consequences not only compromise the immediate health of fostered children but also contribute to poorer health outcomes across time and into adulthood.

Although the cultural norm in Northern Namibia emphasizes that “all children are treated equally,” and fosterage remains a central part of family and community life, literature has found that the system may also contribute to negative health outcomes across the lifespan (Brown, 2018). When rapid social change permeates community life and well-being, families’ capacity to contribute to the fosterage system becomes increasingly limited (Brown, 2018). The consequence of such disparities leads to the differential treatment of non-biological children, which may contribute to negative health outcomes due to a lack of proper nutrition, educational resources, and medical attention (Brown, 2013). When the basic well-being needs of children are not met, their health suffers. The current literature shows physical health disparities with respect to fosterage; however, researchers have yet to examine its psychological consequences.

Where fosterage happens may also have influence on its outcomes for children. Scholars have drawn explicit attention to concerns about fosterage differing by location: “Risk and vulnerabilities for children were identified, differing between rural or urban areas, including exploitation through farm or domestic work, missed schooling, and the neglect of basic needs” (Sharley et al., 2020, p. 10). Further, Brown and Bartholomew (2014) studied fosterage in situations where non-biological, Aawambo adolescents from Angola were fostered into rural, northern Namibian Aawambo families for the purpose of herding livestock. The adolescent boys interviewed in this study identified some level of acceptance by the fostering family, with one recalling the mother instructing biological children to treat him as a sibling. However, their narratives also noted insecurity and uncertainty about the lasting nature of these non-biological, fostered kinship connections (Brown & Bartholomew, 2014). Such uncertainty speaks to the risk and difficulty Sharley and colleagues (2020) reported for children fostered in rural settings – they may not have the same access to education and basic needs as a function of being needed for labor. As a result, rural fosterage experiences could lead to unique developmental and psychological outcomes; however, this remains statistically untested.

Psychological Distress & Social Factors in Namibia

Researchers have explored psychological distress in Namibia, including attention to its etiological causes and cultural construction. For example, researchers have connected evidence of depression risk or emotional distress to orphanhood (Ruiz Casares et al., 2009), interpersonal violence (Kalomo et al., 2020), and HIV status and stigma (Gentz et al., 2018; Kalomo, 2018). These findings, alongside attention to suicide (Bartholomew et al., 2025; Boulton, 2020) and culturally consistent concepts of mental illness like eemwengu or madness among the Ovambo (Bartholomew, 2017, 2020; Fumanti, 2018) make clear the concerns about mental illness and its prevalence in post-apartheid Namibia. Gentz et al. (2018) also showed that food insecurity is associated with adolescents’ emotional distress in Namibia. Though these studies do connect psychological distress to health, social relationships, financial difficulties, witchcraft, and other sources, they are not explicitly connected to cultural practices like fosterage that many Namibians experience at an early age. Perhaps, if children who are fostered face more food insecurity or lack of nutritional resources (e.g., Brown, 2013), they, in turn, endure more related psychological distress as well.

Qualitative evidence within Aawambo communities has also drawn particular attention to the role of families as support systems for those who endure mental illness, again calling into focus the need to understand various kinship structures and psychological outcomes. Some Aawambo people have contended mental illness is less common because families exist to support and prevent symptom manifestation (Bartholomew, 2017) and families play an integral role in supporting individuals who receive psychological care by, for example, choosing types of treatment or taking individuals to treatment, whether that be westernized interventions of culturally consistent treatment (Bartholomew, 2018, 2020; Bartholomew & Gentz, 2019; Fumanti, 2018). What, then, may be the implications for fosterage where adults who were fostered report negative experiences and an absence of belongingness in their fosterage experience (Brown, 2011)? In a series of 11 life history interviews with Aawambo speakers, participants who were fostered in childhood, shared themes of sibling group coherence, moral education, and lack of agency and voice to be central to the experience of fosterage. Perhaps, absent a strong familial support system in a context where family plays a crucial role in alleviating psychological distress, children who experienced fosterage lack that built in support and are at risk for distress in adulthood. On the other hand, the cultural logic and prevalence of fosterage may offer the needed support by extending kinship and resources across families. Thus, examining the implications of fosterage for adult psychological distress is crucial.

The Present Study

Given that fosterage is common, especially in northern Namibia (Brown, 2009; Sharley et et al., 2020), it may vary in its scope in rural and urban areas (Sharley et al., 2020), and fosterage are related with some indices of development (Brown, 2009, 2011, 2013; Brown & Bartholomew, 2014; Prall & Scelza, 2017), we set out to examine if fosterage experiences during childhood are associated with psychological outcomes during adulthood. Scholars have documented concern about treatment of children and their developmental opportunities or trajectories in the fosterage system (e.g., Brown, 2013; 2018; Brown & Bartholomew, 2014; Prall & Scalza, 2017 Prall & Scelza, 2017). This, however, does diverge from quantitative evidence using national survey data that has shown orphaned children do not significantly differ from non-orphaned children with respect to education and health markers (Brown, 2009). This introduces an important consideration – are individual differences for those who experience child fosterage measurable or better captured from a more culturally-grounded method?

As such, further scholarship is needed to examine if fosterage has implications for psychological outcomes, especially knowing some family systems (e.g., families with orphaned children) may be related to psychological well-being for Namibian children (Ruiz Casares et al., 2009). The conflation of findings in the literature inhibits capacity for formal hypothesis making; therefore, we asked the following research questions:

(1) Is fosterage experience during childhood associated with psychological outcomes in Aawambo adults?

(2) Are psychological outcomes for Aawambo adults different by geographical region (i.e., urban vs. rural)?

(3) Do area of living and fosterage experiences interact in a way that contributes to significant differences in psychological outcomes for Aawambo adults?

Method

Participants

Convenience sampling led to data being collected from 201 participants, with 100 coming from an urban region and 101 coming from a rural region of Namibia. All participants identified ethnically as Aawambo, were over 18 years old (M_age = 31.73, SD = 10.18), and lived in either the rural or urban region where data were collected. Most participants identified as woman (n = 100), with nearly the same number identifying as men (n = 91) and the remainder not reporting gender. Over half of the sample identified as not having experienced child fosterage (n = 129; 64.18%) compared to 72 (35.82%). Fosterage was determined by participants indicating they were raised by family members other than their biological parents. Forty-two of the fostered participants reported with whom they grew up, which we coded as best as possible by kin/non-kin category. A slight majority reported being fostered by grandparents (n = 23, 40.35%) followed by with aunts or uncles (n = 21, 36.84%) and a non-biologically related person (n = 13, 22.81%).

Measures

Demographics

All participants completed the same demographic survey. This measure included gender identification, fosterage experiences (when growing up did you live with your biological parents), age, and other factors. Each demographic question was written in English, translated into Oshiwkanyama (a common Aawambo dialect) by a fluent speaker, and translated back into English by another fluent speaker to be certain of the quality of translations.

Psychological Distress

General Health Questionnaire – 28 (GHQ-28; Goldberg & Hiller, 1979). This measure contains subscales that allow for assessment of depressed mood, health concerns, and suicide ideation. This measure was specifically chosen because of prior research establishing the psychometric viability of the scale with Oshiwambo respondents (Haidula et al., 2003). The scale consists of four subscales: (a) somatic, (b) anxiety, (c) social dysfunction, and (d) depression. For the current study, the internal consistency of the total scale score was adequate, α = 0.97. The subscales also demonstrated adequate internal consistency: Somatic, α = 0.91, Anxiety, α = 0.93, Social Dysfunction, α = 0.91, Depression, α = 0.93. We subjected the scale to confirmatory factor analysis testing with these four subscales and found overall adequate fit (RMSEA = 0.086, SRMR = 0.061, CFI = 0.891, TLI = 0.880). The depression subscale of the GHQ also contains 3 specific questions that address suicide ideation. Given social concerns and rates of suicide in Namibia, we opted to pull these items out and consider them as a measure of suicide ideation. We treated this as a distinct variable in that it afforded us an opportunity to evaluate frequency of suicide thought in the sample.

Procedures

Data were collected in two locations by a single research assistant. She collected data in public settings, including vocational centers and community centers, in a rural, northern part of Namibia as well as the country’s capital city, Windhoek, and the surrounding metropolitan area. Participants were approached and asked to complete a series of questions including demographic information and details about their psychological health. All participants completed the survey in-person, using pencil and paper. Participants were given the option to complete the survey in English or Oshikwanyama. Data collection for this study was approved by the first author’s IRB and third author’s university ethics committee.

Data Analysis

To answer the broad research questions of the study, we began with preliminary analysis testing of gender and age as factors related to the GHQ-28 subscales/total scale. For the purpose of examining different fosterage experiences with what data were available, we also examined if mental health differed by whom a fostered participant was raised. Thereafter, we used a 2 × 2 factorial ANOVA to account for the main effects of fosterage and region as well as their potential interaction.

Results

Preliminary Analysis

We first examined demographics across the GHQ subscales and suicide items, finding age was only significantly related to the somatic subscale of the GHQ (r = − 0.16, p = 0.03). GHQ total, subscales, and suicide items measures of central tendency for the entire sample are presented in Table 1 along with correlations between these variables.

Table 1.

Correlations Between Variables and Measures of Central Tendency for Total Sample

Variable	2	3	4	5	6	M	SD
1. GHQ-total	0.89*	0.91*	0.86*	0.88*	0.84*	78.45	20.14
2. GHQ-somatic	—	0.79*	0.71*	0.69*	0.68*	19.77	5.57
3. GHQ-anxiety		—	0.62*	0.72*	0.66*	18.99	6.17
4. GHQ-SD			—	0.70*	0.67*	19.53	5.43
5. GHQ-Dep				—	0.94*	20.53	5.69
6. GHQ-SI					—	8.87	2.67

* = p < 0.001.

We then considered their potential mean difference by gender. Total GHQ scores did vary significantly, with women reporting more distress (M_women = 81.35, SD = 17.96, M_men = 74.31, SD = 22.07, F(1, 149) = 4.67, MSE = 398.63, p = 0.032). With respect to subscales, women also reported significantly more somatic concerns (M_women = 20.76, SD = 4.69, M_men = 18.49, SD = 6.24, F(1, 168) = 7.26, MSE = 29.86, p = 0.008) and anxiety though the anxiety difference was at the upper limit of significance (M_women = 19.57, SD = 5.49, M_men = 17.93, SD = 6.56, F(1, 178) = 3.88, MSE = 36.38, p = 0.05).

Lastly, we tested for differences in mental health by fosterage experiences as possible with these data (e.g., participants reports of who raised them; gender). This afforded us the chance to consider some heterogeneity in fosterage experiences prior to research question testing. Using ANOVA, we found participants did not significantly differ in total GHQ (M_grandparents = 77.05, SD = 16.23, M_aunt/uncle = 70.69, SD = 24.02, M_{non-biological} = 68.00, SD = 24.58, F(2, 39) = 0.66, MSE = 436.27, p = 0.52).

Location & Fosterage MANOVA

Our research questions (i.e., regarding location and fosterage experiences) were examined using a 2 × 2 factorial MANOVA. Total GHQ was removed from the MANOVA due to collinearity (see Table 1 for correlations). The model, overall, was significant, Wilk’s lambda = 0.774, F(3, 154) = 2.69, p = 0.001. The model showed an overall significant effect for location, Wilk’s lambda = 0.85, F(1, 154) = 5.48, p < 0.001; however, there was no overall significant effect for fosterage experience, Wilk’s lambda = 0.97, F(1, 154) = 0.90, p = 0.482. There was also no significant interaction between location and fosterage in the overall model, Wilk’s lambda = 0.98, F(1, 154) = 0.67, p = 0.643. Thus, it appears fosterage status is not associated with mean differences in GHQ scores and this null finding does not vary by where participants live in Namibia (Tables 2 and 3).

Table 2.

Means From MANOVA

Variable	Fostered	Not fostered
GHQ-somatic
Urban	22.42 (2.46)	20.77 (3.99)
Rural	17.60 (6.76)	17.45 (6.22)
GHQ-anxiety
Urban	20.93 (4.44)	19.41 (5.85)
Rural	17.33 (7.14)	17.97 (5.95)
GHQ-SD
Urban	21.98 (3.75)	20.45 (4.51)
Rural	17.98 (6.09)	17.13 (5.77)
GHQ-Dep
Urban	21.96 (4.29)	21.55 (5.12)
Rural	19.35 (5.71)	18.55 (6.95)
GHQ-SI
Urban	9.55 (2.09)	9.59 (2.63)
Rural	8.33 (2.65)	8.06 (3.20)

Note. All interaction effects tested here are non-significant. See Table 3 for main effect of location for each tested variable.

Table 3.

Main Effects of Location for Each GHQ Subscale and Suicide Ideation Items

Dependent variable	F(1, 154)	MSE	p
GHQ-somatic	21.98	26.86	<0.001
GHQ-anxiety	6.27	35.13	0.013
GHQ-SD	17.63	26.29	<0.001
GHQ-Dep	9.07	29.99	0.003
GHQ-SI	9.67	6.74	0.002

With respect to the main effect of location, however, participants in the urban region reported significantly higher rates of psychological distress across each subscale of the GHQ and the suicide ideation items.

Discussion

These findings highlight mental health problems both in women and people living in urban settings among Aawambo participants in Namibia. The findings, however, do not find a connection between people’s experience with fosterage as a child and adult mental health problems. Western attachment theory would predict that fosterage and the assumed breaking of the primary parent-child bond would be traumatic and lead to later mental health problems (Mikulincer et al., 2015). Past literature does find that degree of relatedness to head of household as well as gender is associated with lower level of education, height and weight, with biological children having higher levels of all markers (Brown, 2009; Scelza & Silk, 2014; Anderson, 2005). But what might it mean that fosterage, as a practice and within the scope of these data and this sample, is not related to adult psychological problems?

Fosterage, the Evolved Nest, and Psychological Distress

Child fosterage has evolved as a culturally normative practice in the north of Namibia. One that emerges from a worldview that is at its core relational, interconnected and interdependent (Brown et al., 2024). Ideas of Ubuntu (in South Africa) and Onuno (Namibia) center the metaphor and philosophy of family and social life. Fosterage allows, in times of crisis, a culturally normative and rich space for children to land. During the HIV and AIDS crisis in the 1990-2000’s, families reported that many children were moved in normative ways and did not experience their parents’ suffering firsthand. But fosterage exists not as a solidary practice but one that theorists like Darcia Narvaez (2014) describes as a component of the human’s evolved nest. Evolved nests are developmental systems tailored to nurture psychological, social, physical, and neurobiological needs in a species-unique manner. For humans, the evolved nest is the set of processes and structures that provide children with the social and ecological microenvironment perfectly tailored for optimal growth and health. It includes near-constant physical closeness, responsive caregiving, play with mixed-aged groups, positive social support for mothers and babies, and cooperative childcare. This ancestral nurturing system, supported by evolutionary science, promotes psychological, social, and physical well-being, cooperation, and resilience. Fosterage and alloparental care is part of the nest. Although raising another’s child seems non-normative from a Western lens where the nuclear family is the center of family life, in our species typical evolved human nest, the optimal human development context, human infants and children need alloparental care. Multiple nurturers are how we have evolved (Hrdy, 2009). In one observational study of the Efe in Cameroon (Tronick et al., 1992), anthropologists noted that older toddlers spent less than 40% of their time with their mothers. Although mother was around, the rest of the time the child chose to be with allomothers—those who were sensitively responsive to the child.

We also propose that the other components of the evolved nest, while not measured in this study, are found among Aawambo parents and may be acting as protective factors against negative childhood experiences. The additional non-negotiable neurobiological needs that comprise the evolved nest are, soothing perinatal experiences, moving, positive touch, welcoming social climate, nature connection, regular healing practices, child directed social play, child directed breast feeding, and responsive relationships. Through this lens, alloparental care (fosterage) is protective and necessary for optimal human development, not detrimental to development and may account for the lack of mental health problems in adults who were fostered.

The Evolved Nest and Rural/Urban Differences

Though we did not find differences by fosterage experience, the regional differences we identified are contextually meaningful. Other research in Namibia has evoked a sense of rural Aawambo people being treated differently as a function of their rurality; that is, rural Aawambo people, including those living in southern Angola, may be seen as less modern and more traditional compared to Aawambo people living in urban areas of Windhoek (Brown & Bartholomew, 2014). Similar notions have been raised with respect to mental health, with Aawambo respondents suggesting that younger generations lean more towards westernized psychological care than do older generations (Bartholomew, 2018). Such differences may also manifest in region, as westernized psychological care (e.g., counseling) is more available in urban areas of Windhoek, and evidence shows suicide rates, for example, are higher in the rural area of our study than they are in the urban area (Namibian Ministry of Health and Social Services [MoHSS], 2018). Thus, there exists clear narrative about cultural differences in rural and urban Aawambo people (Brown & Bartholomew, 2014) and their mental health (Bartholomew, 2018) that is accompanied by real rates in different outcomes of psychological distress (i.e., suicide; MoHSS, 2018). Yet, the findings from this study show more distress in the urban area than in the rural area for Aawambo participants.

Meta-analytic data have shown that people living in urban areas are more likely to report psychiatric distress than those in rural areas (e.g., Peen et al., 2010), and this is supported in our regional comparison despite a lack of interaction between location and fosterage status. Still, rates of suicide have been higher in the rural part of the country where these data were collected, suggesting divergent narratives: (a) Aawambo people in a rural area may be more likely to attempt death by suicide, but (b) Aawambo people in an urban area of Namibia seem more distressed overall. Perhaps, the evolved nest serves as a protective factor in the rural north. Tvedten (2004) argued “increasing urban poverty weakens [relational] links as people cannot fill them with material content and live up to social and cultural expectations in their relations with the rural areas” (p. 396). Central to her point, Aawambo Namibians who migrate to urban areas could struggle financially and lose connection to traditionally existing support systems in the rural environment. Plausibly, the evolved nest is supportive in these rural, traditional spaces where connection to nature, and work that does not separate mother and infant, (both components of the evolved nest) are also more abundant (Tarsha & Narvaez, 2019). Migration to or living in an urban area may evoke an ‘un-nested’ experience that severs ties to one’s support system and contributes to manifestation of psychological distress as is evident in significant differences in this study.

Limitations

Though our findings speak to implications of child fosterage for adult mental health and adult mental health in different regions of Namibia, this work is not without limitations. Our quasi-experimental design inhibits causal assertions being drawn from the data, and we sampled only Aawambo participants. Other ethnic groups in Namibia may practice similar familial systems that evoke the evolved nest, and urban-rural differences may manifest uniquely in different groups as well. Of particular note, our research lacks individualized lived experiences that may be captured through qualitative or ethnographic work. Though such work exists elsewhere in the extant literature about fosterage in Namibia (e.g., Brown, 2011; Brown, 2103; Brown & Bartholomew, 2014), the data in this study lack such depth and focused attention on the contexts of caretaking for participants in the current study. Narratives of fosterage could be further examined to better consider mental health and its relationship to fosterage and the evolved nest in Namibia. The absence of such data also inhibits our ability to robustly explore heterogeneity in fosterage experiences. This requires substantial future scholarship that is qualitative or ethnographic in nature to consider the scope of fosterage by factors like age of fosterage initiation, to whom a person was fostered, for how long fosterage occurred, sizes of households, distance between foster family and family of origin, quality of child care, and other such factors that intersect to create unique fosterage experiences for Namibian adults. Thus, our findings are limited in their generalizability and should not be taken to speak to the Namibian population as whole.

Conclusion

Fosterage, as an example of an evolved nest practice, wherein care is spread and supportive of psychological, social, and physical well-being, may not be associated with different psychological outcomes amongst Aawambo respondents; however, Aawambo respondents in urban areas do report more psychological distress than those in the rural north of the country. Future research should more carefully examine the elements of the evolved nest unstudied with these data to better understand why these differences (regional) and lack of differences (fosterage) exist. Such research could also be longitudinal in scope as well; that is, how do adults who experienced fosterage parent as adults themselves, how might gender or similar demographics influence long-term outcomes of fosterage, and what aspects of the evolved nest are protective or not over the course of one’s lifespan. Optimal future research should include qualitative data that emphasize psychological well-being for adults who experience fosterage and explicitly examine concepts like social trust as well as experiences of attachment to better understand how fosterage influences long-term human development. Moreover, future scholarship must address divergent narratives presented from these and other data: rural respondents report less distress but have shown higher rates of suicide (MoHSS, 2018). Perhaps, this is due to different conceptualizations of suicide causes amongst Aawambo respondents (see Bartholomew et al.,. 2025), but this notion requires further exploration. These data do speak to preliminary evidence suggesting the psychologically protective value of connection to an evolved nest amongst Aawambo respondents, with strong familial networks that may also be more apparent in rural parts of Namibia.

Footnotes

ORCID iD

Theodore T. Bartholomew

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Biographies

Theodore Bartholomew, Ph.D. is a professor in the Departments of Psychology and Africana Studies at Scripps College. Dr. Bartholomew is also an Associate Editor of Journal of Cross-Cultural Psychology, the co-Editor of the Society for Global Psychology's book series Global Psychology in Action, the Past President of the Society for Cross-Cultural Research, and a board member of the NGO Kalahari People’s Fund. He conducts research in Namibia, within resettled communities in the United States, and with international students in the United States. He studies cultural conceptualizations of mental illness, suicide, and treatment as well as psychotherapy process and outcome from cultural and positive psychological perspectives and the use of qualitative and mixed methods designs in psychological research.

Jill Brown PhD is a Professor and Psychologist at Creighton University in the US. She also serves as the Executive Director of the Kalahari People Fund. Jill studies childcare, kinship and worldview and is currently collaborating tostudy the cultural logic of sharing in sub Saharan Africa.

Shelene Gentz, Ph.D. is an Associate Professor in the Psychology and Social Work Department at the University of Namibia, where she teaches on both the undergraduate and Master ’s programmes in Clinical Psychology. Her research advances knowledge in the areas of child and adult mental health and cross-cultural psychology, focusing specifically on child well-being and investigating factors such as the effects of HIV, parenting practices, and child trauma. Drawing on her prior experience as a clinical psychologist in child protection, trauma, and community psychology, Shelene integrates practitioner insights directly into her teaching and research methodologies. She currently serves as the Vice Chairperson of the Social Work and Psychology Board of Namibia, contributing to professional governance and standards across the nation.

Eden Sweet is a research assistant at the Center for Autism Research and Treatment at UCLA in Dr. Lord’s lab. She recently graduated from Scripps College with a B.A. in Psychology, where her research focused on autism spectrum disorder, social development, and co-occurring conditions. Her clinical and research experience includes work at the Claremont Autism Center facilitating social skills interventions for autistic children and young adults. Eden plans to pursue a career in clinical psychology, with a specific emphasis on autistism-focused clinical research.

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