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Background Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0–5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers. Methods We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017–2018 retrospective online survey on social support and infant feeding. Results Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive. Conclusions Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK.

Breastfeeding is championed as an effective way to improve global health, associated with improved health outcomes for children and mothers. Various public health strategies to promote breastfeeding have been developed and implemented for over four decades, yet progress has stagnated, and exclusive breastfeeding rates remain low globally. From an evolutionary anthropological perspective, low breastfeeding rates seem like an 'evolutionary puzzle'; breastfeeding is a behaviour which confers survival and fitness advantage to children and mothers, yet so many mothers do not breastfeed exclusively or at all. Is this a globally maladaptive behaviour? Framing breastfeeding as a maternal investment behaviour, an evolutionary perspective directs us to consider the fitness costs of breastfeeding, together with the role of social learning and cultural norms. Indeed, an evolutionary anthropological perspective provides insights to why some breastfeeding-promotion strategies may have been ineffective, while pointing to potentially promising policies and practices which have been overlooked

Aims This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as “lockdown,” deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice. Subject and methods We conducted online focus groups involving 20 mothers living in London, England, with “lockdown babies,” following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience. Results Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be “trapping” some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering. Conclusions Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing.

Studies show that fathers across Western populations tend to provide more care to sons than daughters. Following a human behavioral ecological framework, we hypothesize that son-biases in fathering may (at least in part) be due to differences in fitness returns to paternal direct investments by child’s sex. In this study, we investigate sex-differences in the associations between paternal caregiving and children’s outcomes in stable, two-parent families. Using data from the Avon Longitudinal Study of Parents and Children, we test whether paternal caregiving in early childhood is associated with different effects on children’s school test scores and behavioral difficulties by children’s sex. Overall, we find that paternal caregiving is associated with higher school test scores and lower behavioral difficulty scores, but the association between paternal caregiving and school test scores was stronger for boys. Our findings highlight possible sex-differences in returns to paternal caregiving for certain domains of child outcomes in England.

Background Postnatal depression (PND) is highly detrimental for both mother and baby, with a pre-COVID-19 estimated prevalence of up to 23% in Europe. Low social support is a key risk factor for developing PND. Social distancing measures designed to limit COVID-19 transmission likely created unprecedented barriers for mothers to access social support. We explore how social support networks existed during the UK’s first national lockdown amongst London mothers with infants, and their associations with postnatal depressive symptoms. Methods Using self-reported social network data from 162 London-based mothers with infants aged ≤6 months collected in May-June 2020 (during the first lockdown), we conduct a concurrent design mixed-method study. We quantitatively describe communication within maternal support networks, using quasi-Poisson regression models to analyse associations with postnatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). In parallel, we thematically analyse open-text data to explore and understand the experiences of mothers with infants during England’s lockdown. Results Quantitative findings: Levels of depressive symptoms were high in our sample, with 47.5% of participants meeting the >=11EPDS cut-off for potential postnatal depression.On average, women kept in contact with 10–11 people remotely (via WhatsApp, Zoom etc), and saw one family member other than their partner, suggesting high compliance with lockdown rules. The number of seen in person, and remote communication with a higher proportion of those not seen, negatively predicted depressive symptoms (RRR = 0.950 – 0.996 across models). However, a higher proportion of relatives seen in person was associated with increased depressive symptoms (RRR=1.003; 95% CI 1.001–1.006), suggesting family members may have broken lockdown rules to support mums in need. Qualitative findings: We identified four themes. Some mothers in our sample felt lockdown ‘protected’ family time which led to better bonding, often facilitated by high levels of support from the partner (theme 1). However, many experienced the ‘burden of constant mothering’ without anyone around to help (theme 2). Mothers felt remote contact was ‘not as good’ and led to reduced or inadequate support (theme 3). Mothers grieved for lost opportunities for them and their baby, and worried about the developmental impact on their baby (theme 4). Overall, these experiences coexisted with feelings of isolation, exhaustion, worry, inadequacy, guilt, and increased stress. Conclusion Results suggest the strict lockdown in the UK may have increased the risk of postnatal depression, reflected in the high levels of PND symptoms and poor maternal experiences in our sample.

Non-maternal caregivers (allomothers) are hypothesised to lighten the mother’s workload, producing human’s specialised life history where multiple dependent offspring are produced over a relatively short time period. Here, using in-depth observational data on who for cares for 78 Agta children (aged 0-6 years, a foraging population in northern Philippines), we explore whether allomaternal childcare substitutes (and thus decreases) maternal childcare. Previous work has investigated the role of fathers, grandmothers and siblings as allomothers, frequently overlooking non-relatives, particularly juveniles providing ‘collective childcare’ in playgroups. We found that mothers’ childcare was reduced by allomothers, but the substitutive effect varied depending on the source and type of care. Playgroups, by playing with children aged 2 and above, consistently predicted a decrease in maternal childcare. While few grandmothers were available, they were nonetheless negatively associated with maternal presence, and thus childcare, as they performed childcare activities, similar to mothers. These results underscore the importance of allomothering in reducing mothers’ childcare workload in the Agta. Mother’s flexibility in obtaining childcare from a range of available sources, including playgroups, may be the key to humans’ life history evolution, underling the necessity of a broad conceptualisation of social support in human childcare.

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Purpose: Postnatal maternal mental health suffered early in the COVID-19 pandemic; here we explore the continuing trajectory of postnatal depressive symptoms in the UK. Methods: We report descriptive statistics from a five-wave online survey. Results: The following percentages of participants met the ≥11 Edinburgh Postnatal Depression Scale cut-off for postnatal depression: 47.5% (May-June 2020), 32.8% (July 2020), 51.3% (late 2020), 54.0% (February 2021), 38.2% (September 2021). Conclusions: Health services must be alert to high support needs of this cohort.

Objectives: Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high-income countries, breastfeeding problems have been attributed to the cultural and individual “inexperience” of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross-cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. Having evolved a cooperative childrearing system, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration. Methods: We run cox models on a sample of 566 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017-2018. Results: Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the type of problem. These relationships were also moderated by informational, practical and emotional support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) significantly reduced the hazard of cessation, as predicted. However, helpful support for reported milk insufficiency increased the hazard of cessation. Conclusions: Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0–108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

Background: Globally, women are at greater risk of common mental health disorders such as depression and anxiety, and physiological differences relating to reproductive hormones have been suggested as one cause. Recent evidence suggests that oral contraceptives alter female hormonal responses, potentially increasing the risk of mental ill health. However, studies to date investigating the effect of oral contraceptives on depression and/or anxiety have produced inconsistent results. Objectives: We test the hypothesis that hormonal oral contraceptive use is associated with higher levels of depression and anxiety related outcomes. Method: We use data from Health Survey England, a nationally-representative cross-sectional survey, collected annually between 2013-2016 (total n=4,428). As the characteristics of oral contraceptive users differ from non-users, we carry out propensity score matching to select a comparable sub-sample of non-users (controlling for age, partnership status, education, profession and survey year). We compare levels of depression and anxiety related outcomes between oral contraceptive users and matched non-users.Results: We did not find statistically significant differences between oral contraceptive users and matched non-users for the Warwick Edinburgh Mental Wellbeing Scale scores, General Health Questionnaire scores, or generalised anxiety disorder. Antidepressant prescription (RR=1.48, 95% CI=1.25-1.71) and depression experience (RR=1.33, 95% CI=1.10-1.55) was higher among oral contraceptive users, as well as a trend indicating an increased history of self-harm (RR=1.43 95% CI=1.01-1.86) and suicide attempt (RR=1.37; 95% CI=0.90-1.83).Conclusion: Our results point to potential negative effects of hormonal oral contraceptives on mental health, and hypothesise that these effects may be concentrated for women vulnerable to depression/anxiety. Further research is required to ensure a detailed understanding of the potential mental health effects of oral contraceptive use.

Many women going through the menopausal transition experience vasomotor symptoms (VMS), and research has shown that there is a large amount of variation in their frequency and severity. Many lifestyle factors have been found to co-vary with VMS, including the level of social support received by the woman, and how stressed she is. Stress is well documented to worsen menopause symptoms, and there is some evidence that support eases them; however, there is little research into whether support is an effective buffer against the negative effects of stress on VMS. Using nine years of data from the Study of Women’s Health Across the Nation (n = 2718), we use multilevel Poisson regression with random effects to test: 1) if more social support is associated with decreased VMS frequency, 2) if increased life stress worsens VMS, and 3) if support acts as a buffer against stress. After adjusting for age, marital status, smoking, self-perceived overall health, ethnicity, and menopausal status, we find that stress increases the frequency of VMS. Contrary to our hypothesis, we did not find strong evidence that emotional support led to lower VMS frequency, or that support buffers against the effects of stress. Experience of a stressful event, but not amount of social support, was included in the best fitting model; with the degree to which the woman was upset by the life stressor having the largest effect on menopause symptoms. Here, women who said they were currently upset by a stressful event experienced 21% more VMS than women who had experienced no life stressor. This research highlights that social factors may impact the menopausal transition.

The COVID-19 pandemic has brought science into the public eye and to the attention of governments more than ever before. Much of this attention is on work in epidemiology, virology and public health, with most behavioural advice in public health focusing squarely on ‘proximate’ determinants of behaviour. While epidemiological models are powerful tools to predict the spread of disease when human behaviour is stable, most do not incorporate behavioural change. The evolutionary basis of our preferences and the cultural evolutionary dynamics of our beliefs drive behavioural change, so understanding these evolutionary processes can help inform individual and government decision-making in the face of a pandemic.Lay summary: The COVID-19 pandemic has brought behavioural sciences into the public eye: Without vaccinations, stopping the spread of the virus must rely on behaviour change by limiting contact between people. On the face of it, “stop seeing people” sounds simple. In practice, this is hard. Here we outline how an evolutionary perspective on behaviour change can provide additional insights. Evolutionary theory postulates that our psychology and behaviour did not evolve to maximize our health or that of others. Instead, individuals are expected to act to maximise their inclusive fitness (i.e, spreading our genes) – which can lead to a conflict between behaviours that are in the best interests for the individual, and behaviours that stop the spread of the virus. By examining the ultimate explanations of behaviour related to pandemic-management (such as behavioural compliance and social distancing), we conclude that “good of the group” arguments and “one size fits all” policies are unlikely to encourage behaviour change over the long-term. Sustained behaviour change to keep pandemics at bay is much more likely to emerge from environmental change, so governments and policy makers may need to facilitate significant social change – such as improving life experiences for disadvantaged groups.

Local physical and social environmental factors are important drivers of human health and behaviour. Environmental perception has been linked with both reproduction and parenting, but links between subjective environmental experiences and breastfeeding remain unclear. Using retrospective data from an online survey of UK mothers of children aged 0&ndash, 24 months, Cox-Aalen survival models test whether negative subjective environmental experiences negatively correlated with any and exclusive breastfeeding (max n = 473). Matching predictions, hazards of stopping any breastfeeding were increased, albeit non-significantly, across the five environmental measures (HR: 1.05&ndash, 1.26) Hazards for stopping exclusive breastfeeding were however (non-significantly) reduced (HR: 0.65&ndash, 0.87). Score processes found no significant time-varying effects. However, estimated cumulative coefficient graphs showed that the first few weeks postpartum were most susceptible to environmental influences and that contrary to our predictions, mothers with worse subjective environmental experiences were less likely to stop breastfeeding at this time. In addition, the hazard of stopping exclusive breastfeeding declined over time for mothers who thought that littering was a problem. The predicted increased hazards of stopping breastfeeding were only evident in the later stages of any breastfeeding and only for mothers who reported littering as a problem or that people tended not to know each other. Perceived harsher physical and social environmental conditions are assumed to deter women from breastfeeding, but this may not always be the case. Women&rsquo, s hazards of stopping breastfeeding change over time and there may be particular timepoints in their breastfeeding journeys where subjective environmental experiences play a role.

We welcome the comments by Harpur and Haddon (2020) on our paper on the typologies of social support and its associations with breastfeeding at two months in a UK sample. We share their concerns around the under-acknowledged costs of breastfeeding, and the need for a truly family-centred approach to breastfeeding support. However, they are mistaken to assume we do not view breastfeeding problems as an important cost of breastfeeding: We explicitly comment on breastfeeding challenges within our paper, and such challenges are theoretically incorporated into the “costs of breastfeeding” following an evolutionary anthropological framework. They are also incorrect in their statement that we recommend breastfeeding promotion messages to wider family members. In fact, we outline in our manuscript that breastfeeding promotional messages can have negative consequences for mothers, and are unlikely to be supportive. What we do suggest is a family-centred approach that recognises that women interact with, and may be supported by, a wide range of individuals (including fathers and grandmothers); and the importance of taking a nuanced approach to support without assuming that all types of support necessarily leads to “more breastfeeding.” We hope our response is useful in clarifying the key points of our paper.

There is extensive evidence to suggest that social support improves breastfeeding outcomes. Building on this evidence-base, public health services and interventions aiming to improve breastfeeding rates have primarily targeted informational and emotional support to mothers, reflecting an individual behaviour-change approach. However, mothers exist within a wider social network, and the characteristics of their broader support networks may be an important predictor of breastfeeding outcomes. Here we explore the typologies of postnatal support for mothers in the UK; a population with one of the lowest breastfeeding rates in Europe. Using retrospective data from an online survey (data collection period December 2017 - February 2018), we carry out a latent class regression (n = 432) to identify “clusters” of postnatal support in our data. Mothers in our sample were most likely to report receiving practical and emotional support from partners and maternal grandmothers, and breastfeeding information from health professionals. We identify three distinct typologies of postnatal support: 1) Extensive support, where mothers received support from a wide range of supporters including partners, maternal grandmothers, friends and health professionals, but mothers were the only ones to feed the infant; 2) Family support, where mothers received support from partners and maternal grandmothers, including with infant feeding, but less likely to receive support from health professionals; and 3) Low support, where mothers primarily received support from partners. 94% of women with extensive support were predicted to be breastfeeding at two months, followed by 48% of mothers in the low support group, and 13% in the family support group. Our findings highlight the complexities of family support and its potential impact on breastfeeding, as well as the significance of professional support. Overall, our results hint at the potential value for health professionals to engage with wider family in order to achieve extensive support for mothers., Highlights We identify three types of postnatal support networks in our sample of UK mothers. “Extensive support” mothers were supported by family, friends and professionals. “Family support” mothers were mainly supported by family; less so by professionals. “Low support” mothers reported lower support across all potential supporters. Mothers who breastfed for > two months were most likely to report extensive support.

Purpose The Children in Need Census (CIN) is a case-based administrative dataset on children referred to social care services in England. CIN includes information on the ‘needs’ of children, and whether they received social care support. Local and national government bodies in England currently use CIN for evaluation purposes. Data are accessible to researchers under certain conditions, allowing researchers to investigate the health implications of adverse childhood experiences. However, CIN suffers from lack of metadata, meaning it can be challenging for researchers to process and interpret data, particularly if researchers are unfamiliar with the English children’s social care system. To address this issue, we provide the background to CIN and describe the available data from 2008 to 2016. Participants CIN is derived from case records held by English local authorities on all children referred to children’s social care for a ‘needs assessment’, regardless of whether they are eventually assessed as ‘in need of social care support’. Local authorities submit these case records to the UK Department for Education for collation. CIN holds information on an estimated 2.76 million children from October 2008 to March 2016. Since 2013/2014, just under 900 000 children have been recorded in the CIN annually, equivalent to around 8% of children in England (annual prevalence). Approximately, 650 000 children enter or renter the dataset each year, equivalent to 5% of children in England (annual incidence). Data summary Of the estimated 2.76 million children in the data, 50% are male and 47% female. 45% are referred to children’s social care services due to abuse or neglect. 10.7% of children in CIN went onto a child protection plan, meaning they were judged to be (at risk of) suffering significant harm. Future plans CIN data collection is annual and ongoing. Data from the most recent census period typically become available for researchers in the following Spring.

What is 'adolescence'? This is a question we put to 28 teenagers aged 14-18 this summer. On the 28th of June 2018, a group of teenagers and researchers came together at a workshop at UCL to share their views and opinions about what adolescence means to them. The result was a day of likely conversations, brilliant ideas and stimulating reflections. This summary report outlines the key views and opinions shared with us during the workshop, focusing on two themes: Meanings of 'Adolescence' and Communicating Adolescence.

Fathers in Western populations tend to provide more care to sons than daughters. Following a Human Behavioural Ecological framework, we hypothesise that son-biases in fathering may (at least in part) be due to differences in the “returns to paternal caregiving” on children’s outcomes by sex. In this study, we investigate possible sex-differences in the associations between paternal caregiving throughout early childhood and children’s outcomes in stable, two-parent families. Using data from the Avon Longitudinal Study of Parents and Children, we test whether paternal caregiving is associated with different effects on children’s school test scores and behavioural difficulty by children’s sex. Overall, we find that paternal caregiving is associated with higher school test scores and lower behavioural difficulty scores, but the association between paternal caregiving and school test scores were stronger for boys. Our findings highlight possible sex-differences in returns to paternal caregiving for certain domains of child outcomes in England.

Background Referral rates from Health service to Children’s Social Care (CSC) services vary across England. In 2019, the National Audit Office (re)iterated the urgent need to understand the drivers of such variation. Methods Using administrative data (Children in Need Census, 2013–16), we calculated annual referral rates from Health to CSC services (Health referral rate) by Local Authority (LA) areas. We used multilevel linear regression to investigate the relationship between age-adjusted Health referral rates and local need (demand factors) and local practice/systems (supply factors). We present a tool to compare unadjusted and adjusted LA rates. Results There was high LA variation in Health referral rates, particularly for infants (mean = 29.0/1000 children < 1 y; range = 6.5–101.8; sd = 12.4). LA variation persisted after age-adjustment. Child poverty (local need) and overall referral rate (local practice/systems) explained 60% of variation in age-adjusted Health referral rates. Overall referral rate was the strongest predictor. Adjusted referral rates were substantially different from unadjusted rates. After adjustment, 57.7% of LAs had higher/lower Health referral rates than expected. Conclusions While higher levels of local need are associated with higher Health referrals, some areas have high Health referrals irrespective of local need. Our tool demonstrates the benefits of using adjusted rates to compare LAs.

In contemporary developed populations, stepfather presence has been associated with detrimental effects on child development. However, the proximate mechanisms behind such effects are yet to be fully explored. From a behavioural ecological perspective, the negative effects associated with stepfathers may be due to the reduced quantity and quality of investments children receive within stepfather households. Here, we build on previous studies by investigating whether the effects of stepfather presence on child outcomes are driven by differences in maternal and partner (i.e., father or stepfather) direct investments. We use data from the Avon Longitudinal Study of Parents and Children to explore stepfather effects on children’s educational achievement and behavioural difficulties at age 7. Our results indicate that, for educational achievement, stepfather effects are due to the lower levels of direct investments children receive. For behavioural difficulty, stepfather effects are due to multiple factors whereby stepfather presence is associated with greater difficulties independent of investment levels, and direct investments from stepfathers are ineffective. Our results suggest that the negative effects of stepfathers on child outcomes can be explained, in part, by the reduced quantity and the ineffectiveness of direct investments children receive from stepfathers. Furthermore, the effects of stepfather direct investments seem to vary between child outcomes.