Parental experiences and understandings of stunting in children aged 1-36 mo in the Northern Province of Rwanda.

OBJECTIVES: Childhood stunting remains a major public health problem in the Northern Province of Rwanda, where approximately 27.1% of children aged 1-36 mo are stunted. While many risk factors have been documented, less is known about social and parenting processes in high-risk conditions of undernutrition for children. In this study, we aimed to explore parental experiences and understandings of the risk of childhood stunting in the Northern Province of Rwanda.

METHODS: We conducted a qualitative study using focus group discussions with 120 parents-mothers and fathers separately-of children aged 1-36 mo across all five districts of the Northern Province of Rwanda. Data were analyzed using a reflexive thematic analysis approach.

RESULTS: Parents described interconnected household and caregiving processes perceived to influence children's nutrition and growth. Thematically, household power struggles and resource diversion, vulnerabilities during the first 1000 d, a paradox whereby food and livestock assets did not always benefit children, and fragile substitute care arrangements when mothers needed to go out for work highlighted how intrahousehold allocation of resources, caregiving practices, and competing economic priorities shaped children's nutritional environments. The themes indicate that parents see intrahousehold resource allocation and caregiving as affecting the link between food resources and child growth.

CONCLUSIONS: Parents in Rwanda's Northern Province see childhood growth as shaped by interconnected household power relations, caregiving, and resource allocation practices in the first 1000 d. Policies should provide more decision-making power and resources that benefit infants by promoting shared household decisions, empowering mothers, aligning livestock and market incentives with infant nutrition, and restoring reliable substitute care through public platforms.