“Had It Not Been For My Mother,What Would I Have Done”? Young Parents’ Engagement With Older Female Relatives in Maternal and Infant Care in Ghana: A Qualitative Study

Abstract

This article investigates young parents’ experiences with the involvement of older female relatives in the care of pregnant women, nursing mothers and infants in urban and rural Ghana. The data are derived from semistructured interviews, focus group discussions, and observations with fathers, mothers and older women. The results indicate that in both rural and urban areas of Ghana, older women provide social and practical support to their pregnant relatives and their relatives with newborns. However, among urban participants, there are instances of friction between parents and older women when parents permit or restrict the aspects of care in which older women should engage. These findings underscore the importance of family and kin, especially older women in maternal and infant care, as part of the communally oriented motherhood and sex complementary roles that are common in precolonial Africa. Although nuclear family structures have become prominent in many Ghanaian settings, the role of kin and family in reproductive care continues. The article concludes that maternal and infant care initiatives could be strategically aligned with locally inspired social relations and provisions for care.

Introduction

Care in the family setting has remained an important topic in local and international development debates and research for more than three decades (Morgan, 2025; Nayak, 2023). Questions about how adults combine employment and care for their children, who gives care to infants when mothers return to work after maternity leave, and how young parents perform their productive and reproductive tasks within the contexts of globalized and market-driven economies have preoccupied both academic and political discourses (Morgan, 2025; Oppong et al., 2012). In their quest to answer these questions, scholars have argued for the redefinition and redistribution of domestic care duties among household members (Barker, 2014; Dery et al., 2025; Nayak, 2023). This suggestion has contributed to intensive propositions for involving men in caregiving as a solution to level the unequal gendered power relations among women and men in both the social and political arenas (Barker, 2014; EU, 2013; Nayak, 2023). Studies have shown that male involvement in domestic care work has the potential to stimulate nonaggressive forms of masculinity, reduce gender-based violence, improve women’s and children’s health in the family setting, strengthen family bonds, and generate gender-equality outcomes for women in the private and public spheres (Adusei et al., 2024; Ampim et al., 2022; Doyle et al., 2014).

Despite the advantages of male involvement in childcare, maternal health experts have argued that imagining that both men and women perform income-creating activities and care work simultaneously is a myth that is disengaged from the realities of people’s lives (Budds, 2021). Young parents need more flexible approaches in which women receive assistance with childcare and childrearing from a variety of sources, including male partners, kin and other members of the community (Sear et al., 2011; Tenaw et al., 2024). Research shows that environments that provide collective support for childcare for mothers reduce maternal and child deaths, improve nutrition for mothers and children and decrease the incidence of postnatal depression among women (Cho et al., 2022; Sear & Mace, 2008). Mothers who have support persons during birth experience less fear and have better mental health outcomes (Nakphong et al., 2024). Among the variety of kin members who support women through childcare, grandmothers have been identified as excellent resources for the survival of mothers and children in many contexts (Aubel, 2012, 2021, 2024; Sadruddin et al., 2019; Sear & Mace, 2008; Sear et al., 2011). Older women in communities have generational competence in caring for mothers and newborns and, in some cases, support new parents with domestic work. At the same time, some advice of older women, rooted in sociocultural beliefs and practices, often poses risks by suggesting reliance on spiritualists over medical care and discouraging exclusive breastfeeding in favor of inappropriate solid foods for newborns (Erzse et al., 2021; Makhado et al., 2024; Olajimbiti, 2023).

In Ghanaian family relations, the matrikin, mostly older female relatives, has held long-standing responsibility for the care of women during pregnancy and after childbirth (Badasu, 2004; Fortes, 1950). Studies on infant care in Ghana in the 1990s revealed the substantial role that grandmothers played in combating malnutrition among infants in urban areas (Davies et al., 2003; Douglass & McGadney-Douglass, 2008). Furthermore, grandmothers recognize early signs of illness that require care, suggest care approaches, and ensure that their daughters comply with medically prescribed care regimes (Douglass & McGadney-Douglass, 2008). In other Ghanaian settings, grandmothers guided pregnant women on the codes and established practices during pregnancy to avoid complications and foster safe birth (Gupta et al., 2015). Similar observations have been made in Ethiopia, Tanzania, and Nigeria, where older female relatives act as core decision-makers and trainers of new mothers in newborn care (Amadiume, 2015; Iganus et al., 2015; Mwakililo et al., 2025).

In contemporary Ghanaian societies, lineage systems and communal living structures have become fragmented due to urbanization and immigration (Badasu, 2004; Kwansa, 2012; Oppong et al., 2012). In their place, the nuclear family structure has bourgeoned (Tagnan et al., 2022) and reduced kin support for child care (Badasu, 2004; Oppong, 2019). Against the backdrop of increasing nuclear family residential patterns in Ghana (Kpoor, 2014), it would be interesting to know how young mothers and fathers combine their productive and reproductive roles. It is also crucial to understand how the shift toward nuclear families impacts the care-giving roles of older women. Many Ghanaian studies have explored the role of older women in caring for pregnant mothers and their newborns, primarily concentrating on unpartnered teenage mothers (Gbogbo, 2020; Gyesaw & Ankomah, 2013; Kotoh et al., 2022), mothers of preterm infants (Adama et al., 2018; Eduku et al., 2024; Tibil & Ganle, 2022), and the healthcare behaviors of mothers and their newborns (Gupta et al., 2015; McGadney-Douglass et al., 2005). However, less attention has been given to the involvement of older women in supporting partnered pregnant women and their newborns in both urban and rural Ghana. Our study aims to fill this gap by addressing the following questions: “How do older female relatives support young parents in maternal and infant care, and how do young parents perceive this support in rural and urban settings?” We adopt a postcolonial perspective on family and social relations in Africa (Mikell, 1997; Oyěwùmí, 2016) to illuminate young urban and rural parents’ experiences with involving older female relatives in maternal and infant care.

Africanist Perspective on Family and Gender

Africanist scholars have demonstrated that social relations in precolonial African realities are organized through kinship, lineage and sex-complementary relationships that operate for the common good of community members (Adomako-Ampofo, 2013; Mikell, 1997). In his philosophical thought of personhood and community in Akan (the largest ethnic group in Ghana), Gyekye (2010) succinctly argued that a person is ontologically complete but socially incomplete. Everyone is believed to be born into a family, lineage, kin group or clan, which forms a community created from individual uniqueness and interpersonal relations (Gyekye, 2010). Similarly, Mikell (1997) suggested that community members are interdependent and expected to maintain harmony and the common interests of all. Some kin groups were believed to be supernaturally ordained to provide political leadership. Individuals, both male and female, from these politically privileged groups rose to positions of leadership in the community, although the roles that males and females played varied from one context to another. However, political positions were not for individual personal interest but for the interest of the kin group and the community (Mikell, 1997).

The crust of society was believed to be shaped by nature, culture and the supernatural, which also framed the roles of men and women in a sex-complementary manner. The role of women was conceived as divinely ordained and integral to the building of the family, lineage, and community, whereas men’s roles revolved around speeches and verbalized ideas (Mfecane, 2018). The women’s roles included birth rituals, marriage, death, and other rites of passage. Among Yoruba, Shona, Ndebele and Zulu, for example, motherhood was constructed as a collective responsibility shared among kin members and others in the community and as a valorized component in the maintenance of the social, political, and economic welfare of present and future generations (Masuku, 2020; Ndlovu, 2015; Oyěwùmí, 2016). In many African contexts, it was stipulated that older women played the exclusive role of caring for younger women immediately after they became pregnant. After birth, the nutritional needs of mothers and newborns, as well as domestic services, are addressed by older maternal female relatives (Amadiume, 2015; Thomas, 2007). Women took their reproductive roles seriously and celebrated the ability to birth and nurture children, and they passionately declined to subordinate this role to other roles (Mikell, 1997, p. 8). In summary, motherhood in precolonial African societies was part of women’s sex-complementary role, the performance of which implied neither social subordination to maleness nor exclusion from economic and political participation (Masuku, 2020; Mikell, 1997).

Colonial rule, missionary activities, and Western education initiated the exposure of indigenous communities to numerous social, political, and economic relations (Masuku, 2020; Miescher & Lindsay, 2003; Nzegwu, 2004). Christian marriages encouraged monogamous unions in which women could inherit from a husband and father irrespective of the system of inheritance present in the local community (Clark, 1999; Miescher, 2005; Nukunya, 2016). Under colonial regimes, marriage became a guarantee for women to access property with accompanying legal frameworks that recognized their individual rights (Mikell, 1997). Ordinary women were left with little support from kin groups and, in some cases, resorted to the courts to request maintenance and upkeep from the father of their children (Allman, 1997; Clark, 1999).

The nuclear family structure that has increasingly become common has been perceived as a strong influence of patriarchal ideologies that do not support communally oriented motherhood and parenting (Oyěwùmí, 2016). Moreover, this structure fosters the subordination of women and arguably accounts for the double burden that women in African societies experience in contemporary times (Adomako-Ampofo, 2013). Women in Africa today are placed at a crossroad of participating in economic activities and raising children individually with little support from kin and the community. Simultaneously, a woman who is framed as unsubordinated is the one who can do it all: she has a full-time career, is married, cares for children and manages the home (Oyěwùmí, 2016). However, even such images of empowered women thrive on the transfer of domestic and child care services to other (mostly poor and marginalized) women. Postcolonial scholars have recommended that attempts to remodel social relations in the family setting and society should emerge from the local understanding of specific communities (Mfecane, 2020; Miescher & Lindsay, 2003; Mikell, 1997; Tamale, 2020). Oyěwùmí Oyeronke suggested that African feminism could rework conceptions of motherhood, its enabling features and communal orientation into the promotion of initiatives designed to enact social and gender justice. She asserts that we need “to convince society that motherhood should not be the responsibility of just one woman or just one nuclear family but should be the bedrock on which society is built and the way in which we organize our lives” (Oyěwùmí, 2016, p. 220).

It is thus important to explore how this could be achieved within the prevailing structures of social relations in nuclear family regimes. In this work, we understand that the participants belong to families, lineages, and communities and investigate the extent to which they can access older female relatives’ expertise and assistance with pregnancy and childcare. First, we present examples of young parents’ engagement with older female relatives in maternal and infant care in rural and urban Ghana. Second, we reflect on the opportunities to (re)negotiate extended family relationships during the period of pregnancy and after childbirth despite the manifestation of weakening kin ties. By highlighting the importance of maternal support systems within evolving family dynamics, our findings contribute to discussions on supporting young parents, particularly women, in fulfilling their reproductive roles efficiently.

Materials and Methods

The data presented here were generated from a research project conducted between 2017 and 2019 (Ampim, 2022) that aimed to explore, in part, the contributions of extended families to maternal and infant care in Ghana. This study examines how extended family members, particularly older female relatives, support mothers and fathers during pregnancy and childbirth, highlighting their roles in providing advice and practical assistance. The study design combined phenomenological (Green & Thorogood, 2018) and ethnographic (Atkinson & Pugsley, 2005) approaches to enable an in-depth exploration of the experiences and perceptions of men and women in relation to the roles of older women in maternal and infant care. To facilitate rural and urban comparisons, data were collected in both urban and rural settings, specifically in Accra, the capital of Ghana, and in a rural community anonymized as Sakora, located in the Afram Plains North District.

Participants and Recruitment

Purposive sampling was adopted to facilitate the recruitment of men, women and older women. The inclusion criteria for men was being first-time expectant fathers and fathers with young children. The inclusion criteria for women were pregnant women, mothers with young children and older women. Participants in Accra were recruited from the maternity and child welfare clinics of a selected hospital. The first author (G.A.A.) recruited pregnant women, male partners, and older women who accompanied their relatives to the maternity clinic through observations and assistance from health workers. In Sakora, a Community Health Planning Services (CHPS) compound was an initial site for identifying pregnant women and their partners during maternity care services. With the help of health workers at the CHPS compound, G.A.A. recruited more participants from the community.

In Accra, 11 men and 24 women participated in the study. The age range of the Accra men was 28 to 39 years, whereas the age range for women, including 2 older women, was 18–51 years. All the men and most of the women from the Accra sample worked outside the home as traders and artisans or as private and public service employees. All participants from the Accra sample lived primarily in nuclear family structures, that is, separate houses, bungalows, flats or apartments designed to accommodate nuclear families (Ghana Statistical Services, 2008). Accra participants had between 0 to 3 children at the time of the study. The participants in Sakora were 11 men and 11 women. The male participants from Sakora were aged 21 to 48 years, and the women, including 3 older women, were aged 18 to 48 years. The participants in Sakora had between 0 and 4 children. Both male and female participants in Sakora were engaged in work outside the home as farmers and traders. The living arrangements in Sakora could be described as both nuclear and extended, as it was common to find numerous small houses on the same compound with shared kitchens, toilets and bathrooms. The small houses were occupied by nuclear families from the same extended family or kin.

Data Collection

The research tools were developed by the authors through a careful selection of topics relevant to the experiences of young parents and the support provided by older female relatives. Semistructured interviews and focus group discussions (FGDs) were designed via an open-ended guide that covered critical areas of inquiry, including the nature and utility of support from older women, community perceptions, and potential conflicts in care approaches. Some specific questions included the following: what do older female relatives do for young parents during and after pregnancy? How are older female relatives’ support useful? How do the community/neighbors perceive older women’s support during and after pregnancy? Are there potential disagreements between young parents and older female relatives over maternal and infant care? The guides were initially prepared in English and then adapted for local understanding through oral translation by G.A.A., who is fluent in both English and Twi. G.A.A. conducted all the interviews and FGDs.

Twenty-two semistructured interviews (15 in Accra and 7 in Sakora) were conducted with men and women. Following Krueger and Casey’s (2009) recommendation on focus group formation, 6 FGDs (5–10 participants per group) were conducted with 5 groups of women (3 in Accra and 2 in Sakora) and 1 group of men in Sakora. All FGDs and interviews lasted an average of 1 hr and were conducted in Twi or English. The interviews and FGDs were conducted according to the availability of participants who met the recruitment criteria. All the participants who met the study’s sample criteria and agreed to participate were subsequently engaged. The interviews and FGDs in Accra were conducted at private locations at the health facility, at the homes of the study participants, and at meeting places in the city. In Sakora, interviews were conducted in study participants’ homes, and FGDs were conducted under a shed in the village square.

The initial plan involved re-interviewing first-time expectant fathers after the birth of their children to delve into their experiences before and after becoming parents. Five first-time expectant fathers in Accra consented to participate in these follow-up interviews. However, in Sakora, it turned out that the majority of the men had already experienced fatherhood, with only one remaining a first-time expectant father. This rendered additional interviews with them less relevant, as they had already shared their experiences of parenthood during the initial interviews.

While FGDs were primarily organized for women, one session was held for men in Sakora. We observed that the men in Sakora were more likely to be forthcoming about their experiences, practices, and perceptions regarding family responsibilities during the FGD than during individual interviews. It seemed that the FGDs created an environment where group members positively influenced one another, making it easier for the men to share personal stories, aligning with insights found in the methods literature (Green & Thorogood, 2018).

Observations were conducted to supplement the interviews and FGDs. In Accra, observations took place over a 7-month period at the maternity and child welfare clinics of the selected hospital and in the homes of some participants. At the maternity clinic, G.A.A. sat near the entrance of the waiting hall and observed attendees coming to the clinic and noted expectant mothers coming in with their partners and relatives. She noted what men and accompanying relatives did and their interactions with health workers and other clients at the clinic. G.A.A. stayed in Sakora for a period of 1 month, participated in community gatherings, went to the market to observe activities, visited the homes of individuals and noted the tasks performed at home. She also engaged random men in informal conversations under sheds of trees when they had returned from the farm in the evenings. These interactions provided insights into the practical daily activities of men and women in the village.

Data Analysis

With the permission of the study participants, all interviews and focus group discussions were audio-taped. After the first interview, G.A.A. transcribed and read the transcript thoroughly to study the patterns of the interview and the core issues that were important to the participants. A research assistant who speaks and writes both Twi and English fluently was subsequently engaged to transcribe all tape-recorded audio verbatim. Upon completing all the transcripts, G.A.A. audited and reviewed them to ensure that the use of terms and meaning from the original language was correct and consistent. This process was effective since she conducted all the interviews and discussions.

Field notes were used to record events at the maternity clinic, at the homes of the study participants during interviews and at other locations in the village. Field notes were analyzed alongside interviews and focus groups in four ways, as recommended by Phillippi and Lauderdale (2018). They were used to provide thick descriptions of the context, inserted as additions to interviews and discussions, mainly on the top page of transcripts before the actual text and to record the reflections, feelings and thoughts of the researcher during field work. Finally, field notes were analyzed through an analytic memo that was updated each time a new idea was encountered from observation, interviews, and discussions. The analytic memo became a resource for the coding process upon transcription.

After the audio-recorded tapes were transcribed, the next phase involved reading and familiarizing ourselves even more with the data. As suggested by Nowell et al. (2017, p. 4), the researchers presented the preliminary findings and interpretative thoughts to colleagues at the University; this process of debriefing was significant in shaping coding decisions. We then printed one interview transcript and coded it on paper. Using this coded transcript and the analytic memo, a coding manual with codes and their descriptions was formulated to guide the remaining coding process. In line with Saldaña’s (2016) coding recommendations, the material was coded on the basis of significant excerpts of the meaning unit rather than coding every sentence. Some of the initial codes include the following: the condition of the woman; emotional support; advice; hands-on care; lazy woman; male personality; and female attitude, among others. After this process, all the data were transferred into the QSR NVivo software, where more codes were applied to meaningful chunks of the texts.

The next step in the thematic analysis process involved reviewing the codes to identify patterns and themes. Following Braun and Clarke’s recommendation for thematic analysis, codes with similar or related meanings were merged into themes (Braun & Clarke, 2013). The themes were then defined and refined into sub-themes and main themes, ensuring that each theme effectively represented a significant aspect of the participants’ experiences and perspectives. Throughout this stage, we revisited the original data to validate that the themes aligned well with the narratives and that no crucial information was overlooked. The main theme presented in this paper, “extended family support during pregnancy and after childbirth,” provided a deep, consistent and meaningful presentation of a prevalent pattern in the data that captures what older female relatives did to support young parents during the time of pregnancy and after childbirth and how young parents perceived the support.

Both authors come from Ghana and possess academic backgrounds in history and gender studies and sociology, which we continuously reflect upon to recognize and mitigate potential biases in our interpretations. To further minimize bias in the analysis, we actively sought feedback from a diverse group of peers, consisting of both Ghanaian and non-Ghanaian academics, ensuring that multiple perspectives were considered. This commitment to transparency and collaboration not only enhanced the analysis but also strengthened the credibility of the study.

Ethics

This study observed the directives of the Norwegian Agency for Shared Services in Education and Research (SIKT) and was approved by the University of Ghana, College of Health Sciences Ethical Committee. In addition, the ethical principles of informed consent, confidentiality, anonymity, and voluntariness were observed as continuous processes during the research (Kvale & Brinkmann, 2009). First, the study proposal was presented to the administration of the hospital in Accra and the leadership of its maternity and child welfare clinics where the participants were recruited. In the rural area, the study protocol was presented to the Health Directorate of the Afram Plains North District and the leadership of the CHPS compound in Sakora. The hospital in Accra, the District Health Directorate and the CHPS compound consented to participate in the study and permitted the recruitment of their staff and observations at their premises.

Informed consent was a continuous process of discussion between the researcher and participants, as articulated by Goodwin et al. (2020). G.A.A. provided repeated written and oral information about the purpose, objectives and ethical principles of the study to all potential participants during recruitment and consistently reminded them of voluntary participation. Some potential participants in both Accra and Sakora refused to participate. With participants who agreed to participate, G.A.A. obtained oral or written informed consent prior to the scheduling of the interviews and FGDs. On the day of the scheduled interview or FGD, each participant was informed again, and their right to withdraw at any time and stage of the process without experiencing any consequences was repeatedly emphasized. Both G.A.A. and the participants agreed to maintain confidentiality and to refrain from discussing the interviews and FGDs with persons outside the group. Additionally, it was agreed that the participants in the FGDs should not mention peoples’ names when giving examples. None of the information gathered was shared with other participants or people outside the group. Audio-tapes that only the researchers had access to were stored separately from the transcripts. Anonymized data were stored on a password-protected computer. The data presented in this paper and elsewhere are all anonymized, and the participants are given pseudonyms.

Findings

In this section, we present the data generated on the experiences of young parents in rural and urban Ghana with respect to the inclusion of older female relatives in maternal and infant care in three subsections.

Support and Guidance From Older Female Relatives in Maternal and Infant Care

During observation at the maternity clinic in Accra and the CHPS compound at Sakora, G.A.A. often met extended family members who had accompanied women for maternity services. Except one case in which G.A.A. observed a pregnant woman attending the prenatal clinic with her brother-in-law, most relatives who accompanied pregnant women and nursing mothers to the clinic were older female relatives of the couple. At the maternity clinic in Accra, female relatives were more visible than were the male partners of pregnant women. It was common to see women experiencing labor brought to the hospital or CHPS accompanied by another female relative, with the male partner arriving later. One explanation for this observation is that most delivery rooms in Ghana are not designed to accommodate men since many women may give birth at the same time. Another justification relates to availability; it is more likely that a female relative, especially an older woman, will be available than a male partner who might be at work. At the child welfare clinic in Accra, it was common to see men drive the mother, the newborn and an older woman to the clinic and then leave. The participants reported that their older female relatives were a source of support and advice during pregnancy and after childbirth. To receive this support, pregnant women sometimes lived with their family and kin, as one man described:

When the pregnancy was approximately 7 months, she decided to visit and stay with her mother because sometimes I travel outside to supply products, so there wouldn’t be anyone at home with her. That is why she decided to go and stay with her mother in case she needed anything, and I agreed. (Derrick, 32 years old, Father, Accra).

Derrick and his partner arranged for her to return home after childbirth and then his mother will take over, as illustrated in the following quote:

My mum will come. She will leave her mother’s place and return home. She doesn’t like talking. Where she is, is a compound house. There are many people there, so she doesn’t get enough rest. Therefore, we have decided to let her come back home very soon. We haven’t given birth before. We don’t know how to bathe a baby. That is why we have invited my mother, so we can learn from her. (Derrick, 32 years old, Father, Accra).

In this narrative, both mothers of the couple are recognized as key resources in supporting them during pregnancy and after the birth of their child. The kinds of support implied in this excerpt relate to knowledge of newborn care, with which the couple had no experience.

Notably, older female relatives were described as endowed and influential counselors who could inspire men’s involvement in housework and child care. Owusua, for example, explained,

He [male partner] wakes up early to wash stuff, cook and do all sorts of things. Because my mother says if you have two kids and you don’t help your wife with chores, the pressure on the woman will make her appear disorganized. Therefore, he bathes the child, and he even knows how to braid hair, so he braids the child’s hair. When the child is going to school or church, he braids her hair. When people ask me who did it, I proudly mention my husband’s name. (Owusua, 28 years old, Mother, Accra).

Like participants in Accra, participants in rural areas recognized the usefulness of older women’s care practices during pregnancy and after childbirth. In Sakora, it was common for first-time expectant young mothers who were not in a stable relationship with the father of the unborn child to live with the man’s relatives. In such situations, the man’s family took both financial and social responsibility for maternal and infant care. One participant in Sakora, Doris, had recently become a grandmother and recounted how she supported her son’s partner when she was pregnant, including coaching her on labor and child birth:

When she [daughter in-law] began experiencing signs of labor, I encouraged her to prepare banku [a local Ghanaian meal], and afterward, I sent her to the river to fetch water. I taught her how to hide her pain on the road to the riverside so that others do not ask her questions, which she did very well. Upon her return home from the riverside, she gave birth at home very easily. (Doris, 45 years old, Grandmother, Sakora).

This “know-how” about maternal and newborn care was supported by other women in Sakora:

Immediately after delivery, my mother comes to help us at home for several weeks, after which we continue with our normal routine. When a woman delivers, she needs some sort of care and some special food for her to gain energy. The old women know a lot about these things, so it is good to allow them to take care of the woman for a few weeks. (Julie, 30 years old, Mother, Sakora).

The narratives of the participants demonstrate that older female relatives provide support and advice on labor, childbirth, and how male partners should support their female partners.

Hands-On Involvement of Older Female Relatives in Maternal and Infant Care

The participants in both rural and urban areas emphasized that expectant and new parents need practical support in the home, including cooking, heating water for a bath, cleaning, fetching water, shopping, and washing. For example, Derrick described how his mother cooked meals for them. He explained how difficult it was for his wife to cook her own meals and that she preferred meals cooked by his mother even though she lived with her own mother. This assistance shows how the two families worked together to provide care to their pregnant relative jointly. Other participants talked about receiving both practical and financial help from their mothers. Owusua, for example, said,

My mother comes around after delivery [] Had it not been for my mother, what would I have done? My mother is truly helpful. Can you imagine, she even calls to tell us she is sending us money for the children’s upkeep? I always wonder and ask why she, the old woman, is the one who does all these. She even brings us food from the village. (Owusua, 28 years old, Mother, Accra).

The participants’ examples suggested that although practical support from older female relatives reduced women’s burden in the household after childbirth, it could also unintentionally influence men’s prospects of engaging in housework and childcare. The participants in Accra mentioned that some female relatives usually do not allow men to perform housework when they visit to support the family. Akua, for example, said, “Sometimes they don’t allow the men to do those chores at home when they come around. My husband sees it as normal. He is always happy when the old woman comes to help” (Akua, 36 years old, Mother, Accra).

Among the rural participants, practical care emerged in numerous ways that were both similar and different from the examples in Accra. Doris described what she did to support her daughter-in-law, who lived with her:

I fetch water for them [mother and child]. I tell the woman to use some to wash, cook and bathe the baby. When she is about to eat and the baby is worrying her, I take the baby and leave her to eat. Afterward, I give the baby back when she is less busy. First-time mothers and parents truly need help, so I do my best. (Doris, 45 years old, Grandmother, Sakora).

In other cases, older female relatives lived separately from the couple but still supported them with housework. Boatema and Asiedu were a couple in the village who were expecting their third child. Boatemaa’s mother supported them until she relocated to a different village:

When she [mother] was around, she used to help us here at home, but she has now moved to Maame Krobo. Therefore, instead, she sends us things. She used to warm water for me, bathe the child and cook for us, and warm water for me again. (Boatemaa, 27 years old, Mother, Sakora).

At the time of this study, Boatemaa’s mother-in-law, who lived in the community, helped them with housework, as her husband described: “She [his mother] comes during the day to visit and help and leaves after she is finished with what she came to do” (Asiedu, 32 years old, Father, Sakora). Among other participants in the village, older female relatives took turns helping with work in the house during the day. One older female relative would visit in the morning, and another would visit in the evening.

As in Accra, the period of newborn care when older female relatives helped young parents with housework sometimes resulted in a lack of men’s participation in housework and childcare in Sakora. One example illustrates how older female relatives do not allow men to perform housework and childcare. Another participant described a similar situation in which men were not prepared to engage in housework and newborn care and thus sent their partners to the matrikin in the later stages of pregnancy:

When men realize that they do not have anyone who will help them at home, they leave all the responsibilities for the woman. That is why most of them take their wives to their mother’s home until they deliver. They give them [women] money and all that they would need. (Julie, 30 years old; Mother, Sakora).

These examples show that involving female relatives in maternal and infant care was a prominent part of the lives of young parents. However, there were occasions when female relatives’ support could trigger misunderstandings in the family, as discussed in the next section.

Navigating Tensions With Older Female Relatives in Maternal and Infant Care

In both Accra and rural areas, couples receive help from their families or anticipate sending female partners to the matrikin at a later stage of pregnancy. Although most participants reported positive experiences of older female relatives’ engagement in maternal and infant care, the findings indicate pockets of negative experiences. Disagreements between young parents and older women in relation to maternal and infant care were recorded only among participants in Accra. This difference could be connected to rural–urban residential differences. Whereas in rural areas, older relatives lived in the same community and sometimes in the same compound and did not have to relocate to the couple’s residence, in Accra, older female relatives had to move temporarily to the young parents’ home because they lived in another part of the city or outside the city. Misunderstandings ensued because of the differences between contemporary and locally based ideas of infant care. One such distinction is exemplified below:

The thing is that the mothers [older women] come to our homes when we give birth, mainly to teach us how to take care of the babies in their old ways. However, what they have refused to understand is that things have changed now and that the old ways of taking care of the babies are over. (Vida, 31 years old, Mother, Accra).

Another woman shared how her husband nearly physically assaulted her because of her mother’s methods of bathing her baby:

When I gave birth to my first child, my mother came to stay with us. She used very hot water to bathe the baby and massage his head. My husband almost slapped me because he was not happy at all with that. Therefore, I told her not to bathe the child again. It brought up many family issues. For this baby, I am expecting, we have agreed that no one should come into our home again. We will do it ourselves. (Cecilia, 32 years old, Mother, Accra).

This extract illuminates the friction between generational and contemporary ideas of maternal and infant care. The participants also noted disagreements related to the types of tasks that older female relatives engaged in during their visits. Some emphasized that older female relatives should only be involved in tasks related to the care of the newborn and nothing beyond that. One participant said,

If you truly need the help of an in-law, just let her do the work she came to do, such as taking care of some needs of the child, washing the child’s dresses and all that. That should be it. Nothing more. Do not let her be the one to take control of your kitchen and other stuff in your home. Do not let her be the one to visit the market, the one to wash your clothes and do everything in the house. It makes her even know the amount of money your husband gives you for upkeep in a day. (Vida, 31 years old, Mother, Accra).

From this quotation, it can be extrapolated that older female relatives may be overburdened with household chores during their visits. In addition, this excerpt may be linked to decision-making in the household during the time when older women are engaged in maternal and infant care. Finally, this statement evokes reflections on boundaries between nuclear and extended family relationships in terms of the areas of family life in which members outside the immediate household should be engaged.

Male participants in Accra had varying encounters with older women in maternal and infant care. Some men remained indifferent to the support and decisions made by their mothers-in-laws, others valued the support but wanted to discuss and have a guiding standard for care, while others were no longer interested in engaging older female relatives in maternal and infant care. One father, Eric, recounted how his mother-in-law began feeding their daughter food supplements without his consent and subsequently suggested that they continue feeding her with baby formula instead of breastmilk. Eric was unhappy about this decision and talked about the financial burden as well as the nutritional problems it presented to their daughter. However, he remained indifferent to this situation and decided not to discuss it with his mother-in-law to avoid conflict.

Joseph was a man who had regularly participated in prenatal classes to learn how to support his partner at home and care for their newborn. Although he was satisfied with the support from his mother-in-law, he believed that his wife and her mother did not follow health workers’ recommended feeding methods and was keen on discussing standards of care to avoid disagreement:

With that one [referring to infant feeding], I have told her [wife] about it on several occasions, but she and her mother don’t want to agree to it. So I have to work harder on that because if I don’t get her to understand its importance, I would go to work, and they would decide to do what they want. I don’t like conflicts, so I would sit them down and talk it through. That is why I always wanted to come to the pregnancy school and the antenatal clinic to learn a lot and then make sure that we all abide by these guiding rules. (Joseph, 32 years old, Father, Accra).

Family disputes can also occur when women stay with their matrikin during pregnancy and after childbirth. This is evidenced in the experience of Charles. In the first interview, he said,

This is her first time, so when she delivers, she will go to her mother’s place for a couple of months. I can’t do anything about it (laughing). When the baby develops a little bit, then I can handle it. (Charles, 30 years old, Father, Accra).

At the time of the second interview, Charles and his wife were expecting another child. He mentioned that his wife and her mother had too many conflicts during her stay after childbirth. Therefore, they jointly decided to manage on their own without support from older female relatives. Their decision could also be interpreted as having gained the skills of newborn care; they no longer needed guidance as they did with their first childbirth experience.

Discussion

This study critically examines the experiences of young parents in both rural and urban Ghana regarding the involvement of older female relatives in maternal and infant care. The findings reveal a nuanced picture of intergenerational caregiving, highlighting how older female relatives contribute practically and provide guidance to young pregnant relatives throughout the period of maternity and newborn care. Their presence was not only comforting but also experiential knowledge for young parents and was influential in shaping maternal care behaviors and paternal involvement.

The reliance on older female relatives can be contextualized within broader sociocultural dynamics, as evidenced by prior studies that highlight the continuing relevance of familial support systems in maternal and infant care across various African settings (Aubel, 2012, 2021, 2024; Budds, 2021; Douglass & McGadney-Douglass, 2008; Sadruddin et al., 2019; Sear & Mace, 2008). This underscores a paradox: despite a global trend toward nuclear family structures (Badasu 2004; Tagnan et al., 2022), our findings and other evidence (Adama et al., 2018; Gupta et al., 2015) suggest that in Ghana, older female relatives, also members of the extended family, remain a vital asset, particularly for young parents. The interdependence fostered by these familial bonds is essential for reproductive success, particularly in ensuring that women fulfill culturally assigned maternal and child care roles.

However, the dynamics of support can complicate gender roles within these family structures. The dominant role of older women in domestic tasks during the maternity and newborn periods often diminishes opportunities for male partners to engage meaningfully in housework and child care. While men can engage in equitable divisions of labor in isolated nuclear settings, the presence of older female relatives may lead to a regression into normative gender roles and risk perpetuating gender inequalities in household responsibilities (Ampim, 2022).

The evidence further suggests that engaging older women in maternal and infant care can yield positive health outcomes, such as improved nutritional status and mental health for mothers (Cho et al., 2022; Davies et al., 2003; Douglass & McGadney-Douglass, 2008; Nakphong et al., 2024). Simultaneously, older women’s practices can result in potentially dangerous practices, such as those exemplified by Doris’s advice to her pregnant daughter-in-law during labor to collect water from the river. Although Doris’s guidance resulted in the easier birth that she described, her daughter-in-law’s health could have been compromised if events did not unfold as anticipated. Other studies indicate that grandmothers usually suggest traditional and spiritual health care for their grandchildren and use modern health services only when the former approach fails (Adama et al., 2021; Gupta et al., 2015). In line with our findings, research has shown that older women often discourage exclusive breastfeeding by advising mothers to feed newborns porridge and solid food, which are inappropriate for their age (Nsiah-Asamoah et al., 2020).

The decision-making processes in these caregiving contexts reflect broader societal trends toward collective family dynamics and communal-oriented motherhood. The persistence of intergenerational decision-making signifies a commitment to communal harmony over individual preferences (Gyekye, 2010). However, young parents’ attempts to navigate these social structures – by establishing boundaries around older female relatives’ involvement – signal a desire for autonomy in caregiving practices that is inconsistent with normative expectations. In urban areas, where exposure to biomedical and contemporary parenting advice is relatively common, generational clashes occur when older women insist on using “outdated” caregiving methods. Such disagreements occasionally lead to frustration, disengagement, and a desire for autonomy among young couples. Male participants, in particular, reported feeling excluded from caregiving decisions and burdened by the financial demands of practices suggested by older female relatives. As young couples gain more experience and confidence in parenting, some decide to minimize external involvement to prevent conflicts and exercise greater control over their family dynamics. The navigation of this tension highlights the evolving nature of familial roles, suggesting that while older women hold significant power within childbirth and maternal care, young parents increasingly seek to redefine what that involvement looks like.

The engagement of older women in maternal and infant care may elicit a form of maternal gatekeeping that authenticates a mothering identity and perpetuates distinctions in the roles of men and women in the family setting (Allen & Hawkins, 1999). An alternative interpretation of older female relatives’ involvement could be situated within sex-complementary roles of women manifested in precolonial African contexts (Mikell, 1997). Older women were responsible for performing birth rituals and providing care for younger pregnant women, new mothers and newborns, and they passed on family traditions to younger women. It could thus be claimed that older women recall the performance of their assigned duties while preserving longstanding cultural knowledge and contributing to future generations of their families through their engagement in maternal and infant care (Oyěwùmí, 2016; Thomas, 2007).

Older women’s relentless dominance in birthing practices is suggestive of the inclination to avoid subordinating this role to other roles in society (Amadiume, 2015; Mikell, 1997). Through rituals and practices, older women claim power and authority that permeate both the private and public spheres (Dumbaugh et al., 2014; Thomas, 2007). This position of older women, however, appears to be threatened on the basis of the expectations of the participants in this study. As demonstrated by the data, young parents value the guidance and practical assistance of older female relatives; however, particularly in urban areas, they aspire to gain this privilege on their own terms. This is represented in the participants’ claims of limiting their involvement to the practical needs of the child, establishing care guidelines and excluding them from family decision-making. These new developments could eventually constrain the claims of older women to power attached to the reproductive arena.

Postcolonial gender scholars have advocated for feminism that aligns with social relations in Africa, is pro-natal and thrives on family-oriented, kin-oriented, and communally oriented forms of motherhood and parenting (Mikell, 1997; Oyěwùmí, 2016). Some scholars argue that African feminism could re-envision the formulations of motherhood, its endowing features, and communal orientation into the promotion of initiatives designed for social transformation (Muwati et al., 2011; Ndlovu, 2015; Oyěwùmí, 2016; Vo, 2024). Decolonial researchers have equally asserted that childcare in Africa should be reconceptualized along communal notions of personhood that persisted in preimperialist African societies (Kithinji Kiambi, 2022; Mokhutso, 2022). It is arguably quite ambitious to perform productive and reproductive duties efficiently without the involvement of family and kin, as shown by both urban and rural experiences. The urban narratives in the present study, however, suggest a blending of individual and communal practices that support the desire of young parents to govern the engagement of their families. This is illustrative of contemporary nuclear family practices, which are associated with individualistic rather than communalistic elements of society. Attempts to modify gender and social relationships should emerge from the local understanding of specific communities (Mfecane, 2020; Miescher & Lindsay, 2003; Mokhothu & Musingafi, 2023). A reinvigoration of social relations in settings such as those examined in this study requires the synthesis of elements of the nuclear and extended family.

Strengths and Limitations of the Study

The strengths of the study are highlighted by the comprehensive data collection across two distinct contexts – rural and urban – allowing for comparative analysis of the insights gathered. The researchers engaged in sustained interactions with participants, particularly in rural areas, fostering a nuanced understanding of the community dynamics involved. By incorporating multiple participant groups and employing various data collection methods, the study benefits from triangulation, enhancing the reliability and depth of the findings. With the authors’ strong background in social sciences, we brought expertise and local knowledge to the study, facilitating a more informed analysis. Furthermore, the presentation of findings to colleagues fostered collaborative discussions, enabling the integration of diverse perspectives and enriching the overall interpretation of the data, ultimately contributing to a rigorously conducted study.

Despite the strengths highlighted above, the study is limited in scope, breadth, and depth concerning the roles of older female relatives in supporting young parents in maternal and infant care. The research was conducted in two locations with a limited number of participants, which cannot be considered representative of the entire spectrum of Ghanaian family relations. Another limitation pertains to the type of material that forms the foundation of our study. The data primarily consists of narratives from men, women, and a few older women. However, these narratives may not necessarily reflect actual practices; the reality of how older female relatives perform their roles in daily life may differ from the reported experiences.

Moreover, it appears that there is a disparity in the volume and quality of observational data collected from different locations in the study. In the village where G.A.A. was present for a period of 1 month, the data collection was more comprehensive and enriched by a variety of interactions. Conversely, in Accra, the data gathering was constrained primarily to hospital settings and a limited number of participants’ homes during interviews, which may not fully represent the broader context of the participants’ experiences. This imbalance could affect the overall findings and interpretations of our study, as the rich data from the village may not be easily comparable to the more limited data from Accra. Nevertheless, interviews and FGDs with diverse groups of participants in both locations enhance a balanced understanding of involving older women in maternal and infant care.

Implications for Maternal and Infant Care Initiatives

The evidence presented in this article aligns with research from other sub-Saharan African contexts that highlight the role of older women in maternal and infant care (McLean, 2020; Powis, 2022). From a policy perspective, the relationship between maternal health initiatives and familial support structures calls for a re-evaluation of care models. We recommend that the Ghana Health Service actively involve older women in community health programs focused on maternal and child health to ensure that their practices are safe, scientifically sound, and culturally relevant. The implementation of educational initiatives for both older women and young parents can bridge the gap between cultural practices and modern healthcare recommendations, emphasizing the importance of professional medical advice alongside intergenerational knowledge.

Advocating for gender justice frameworks tailored to Ghana’s unique sociocultural context can help develop policies that honor traditional roles while promoting equality in caregiving and decision-making. This approach leverages the involvement of older women while empowering young parents to set boundaries that foster their desired caregiving roles, balancing individual and communal parenting methods. It aligns with postcolonial feminist perspectives that advocate for reimagining motherhood through culturally relevant lenses (Mikell, 1997; Oyěwùmí, 2016).

Future research should aim for a more extensive and diverse sample across various geographic and socioeconomic contexts in Ghana to capture the full range of family dynamics in maternal and infant care and to evaluate the practical implications of intergenerational caregiving. Such studies could also explore strategies to encourage equitable divisions of caregiving responsibilities among men and women, particularly in contexts where older female relatives may reinforce normative gender roles, thereby strengthening paternal involvement and supporting shared parenting.