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Effects of mothers' employment on toddlers'

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DOI: 10.1080/03004430.2010.500059

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 Early Child Development and Care

ISSN: 0300-4430 (Print) 1476-8275 (Online) Journal homepage: http://www.tandfonline.com/loi/gecd20

Effects of mothers’ employment on toddlers’

cognitive development: a study conducted in
Karachi, Pakistan

Salima Moez Meherali , Rozina Karmaliani & Nargis Asad

To cite this article: Salima Moez Meherali , Rozina Karmaliani & Nargis Asad (2011)
Effects of mothers’ employment on toddlers’ cognitive development: a study
conducted in Karachi, Pakistan, Early Child Development and Care, 181:7, 877-890, DOI:
10.1080/03004430.2010.500059

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 Early Child Development and Care
Vol. 181, No. 7, August 2011, 877–890

Effects of mothers’ employment on toddlers’ cognitive

development: a study conducted in Karachi, Pakistan
Salima Moez Meheralia*, Rozina Karmaliania and Nargis Asadb
a
School of Nursing, The Aga Khan University, PO Box 3500, Stadium Road,
Karachi 74800, Pakistan; b Department of Psychiatry, The Aga Khan University Hospital,
Karachi, Pakistan.
(Received 21 April 2010; final version received 7 June 2010)
Taylor and Francis
GECD_A_500059.sgm
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Early
10.1080/03004430.2010.500059
0300-4430
Original
Taylor
02010
00
Ms
salima.moez@aku.edu
000002010
SalimaMeherali
Childhood
&Article
Francis
(print)/1476-8275
Development(online)
and Care

Over the past several decades in Pakistan, an increasing number of women with
young children are joining the workforce, which is one of the biggest social
changes in the later half of the twentieth century. More children are being raised
in households where mothers work for pay as compared with the scenario a
generation ago. This change has prompted concerns about whether maternal
employment poses any risks to children’s cognitive development. The purpose of
this descriptive comparative study was to compare the cognitive development of
toddlers, aged 24–36 months, of working and non-working mothers in Karachi,
Pakistan. The Bayley Mental Scale was used as the primary outcome measure.
Data were analysed using non-parametric statistics. There was no association
between maternal employment status and toddlers’ cognitive development.
Differences were found in cognitive development by demographic characteristics,
which suggested that selected children were more vulnerable, irrespective of their
mothers’ employment status.
Keywords: employment status of mothers; cognitive development of toddlers;
effects of employment

Introduction
Parents play an important role in shaping the lives of their children. Parents’ participation
in the child’s growth and development acts as a catalyst in improving the child’s health
and his/her overall social and mental development (Gregg, Washbrook, Propper, &
Burgess, 2005). In most societies, mothers are assigned, by custom, to be the primary
caregivers of infants and children (Ruhm, 2005). Women also play an important role
as generators of family income. Since the past several decades, there has been an increase
in the number of women with young children in the workforce, which is one of the
biggest social changes that have taken place in the later half of the twentieth century
(Waldfogel, 2002). According to the economic survey 2006–2007, the participation of
the female labour force in Pakistan had increased from 18.9% in 2005–2006 to 33%
in 2007–2008 (Labour Force Surveys 2007–2008 and 2005–2006, press release).
This demographic increase in mothers’ employment has also brought a dramatic
shift in child-rearing styles. More children are being raised in households where
mothers work for pay, as compared with the scenario a generation ago. This change

*Corresponding author. Email: salima.moez@aku.edu

ISSN 0300-4430 print/ISSN 1476-8275 online

© 2011 Taylor & Francis
DOI: 10.1080/03004430.2010.500059
http://www.informaworld.com
 878 S.M. Meherali et al.

in rearing approach has prompted concerns over whether maternal employment poses
any risks to healthy child development (Ruhm, 2005). Since a mother is expected to
be her child’s primary caregiver and to be physically present at all times until the
child’s early school years (Bianchi, 2000; Sayer, Bianchi, & Robinson, 2004, cited in
Hsin, 2005, p. 2), there are many myths and assumptions regarding maternal employ-
ment being detrimental to children, because it takes the mother away from her child.
In the Pakistani cultural context, the majority of the women do not work because of
cultural factors such as the restrictions placed by male members, excessive household
work and non-availability of adequate childcare facilities (Amber, 2005). Women who
work full time experience guilt and anxiety because they have less time to spend with
their child (Baum, 2003). However, so far, no studies have been conducted in the
Pakistani context to delineate the relationship between mothers’ employment and chil-
dren’s cognitive development. In this way, this is a milestone study which aims at
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identifying the effects of mothers’ employment on toddlers’ cognitive functioning.

The study also identifies the co-relationship between selected demographic variables
and the cognitive status of toddlers.
The purpose of this study was to compare the cognitive development of toddlers,
aged 24–36 months, of working and non-working mothers. The research questions
were:

(1) What is the level of cognitive function of children aged 24–36 months whose
mothers work outside the home as compared with the children aged 24–36
months whose mothers do not work outside the home? (as measured by the
Bayley Mental Scale).
(2) What is the relationship between the selected demographic variables (e.g.
mother’s education level, socio-economic status [SES] and childcare arrange-
ments) and the toddler’s cognitive function?

Literature review
The literature shows that the effects of maternal employment on child’s cognitive
development have been widely studied; however, the results are inconclusive (Moore
& Driscoll, 1997; Vandell & Ramanan, 1992; Zaslow & Emig, 1997; Zaslow,
Rabinovich, & Suwalsky, 1991, cited in Mistry, 2003). Most of these studies have
used the National Longitudinal Survey of Youth (NLSY) or the National Institute of
Child Health and Human Development (NICHD) childcare data. A few researchers
have found that maternal employment has positive effects on toddlers’ cognitive
development. For example, a recent study by Hickman (2006), on identifying the
effects of home versus centre care on child cognition and social adjustment, identified
that children under centre care begin kindergarten with significantly higher cognitive
skills than do children under parental care. Studies by Greenstein (1995) and Moore
and Driscoll (1997) found an insignificant relationship between maternal employment
and Peabody Picture Vocabulary Test (PPVT) and Picture Individual Achievement
Test (PIAT) scores (cited in Bernal, 2003).
Other research studies with positive effects on toddlers suggested that working
parents may be re-allocating their non-labour time in an effort to maximise their time
with children (Bianchi, 2000; Sayer et al., 2004, cited in Hsin, 2005). It has been
observed that employed mothers spend less time on passive childcare activities, such
as performing household work while supervising children, which involves a
 Early Child Development and Care 879

maximum amount of child–parent interaction (Bianchi & Robinson, 1997; Yeung &
Stafford, 2003). Huston and Aronson (2005) have asserted that maternal time with an
infant is important for mother–child relationships and children’s development. These
authors used the Bayley II Mental Developmental Index (MDI). Results indicate that
mothers who spend more time with their children (i.e. they were not employed outside
the home) have children who perform less well on expressive language. Study results
also suggest that mothers who spend more time at work provide a slightly higher qual-
ity home environment than unemployed mothers and that there is no association of
work time with maternal sensitivity or children’s development.
Moreover, employment statistics reveal that women who are employed are more
educated than those who are not working (Naqvi & Shahnaz 2002), which is deemed
to have an impact on children’s cognitive development. Educated mothers are more
sensitive and are able to provide a home environment which gives cognitive stimula-
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tion to their children (Andrade et al., 2005). Another factor that seems to impact
cognitive development of toddlers is the provision of quality childcare. Recent longi-
tudinal evidence on early childcare and development, from developing countries, has
identified that well-designed early childhood care and development (ECCD)
programmes can have significant positive long-term impacts on physical and mental
growth (Myers, 1995; Young, 1996, cited in Glick, 2002). Brooks-Gunn, Han and
Waldfogel (2002) have studied the effects of maternal employment on child cognitive
outcomes in the first three years of life, using the data from the National Institute of
Child Health and Human Development Study of Early Child Care (NICHD-SECC).
The study found that the quality of childcare, the home environment and maternal
sensitivity were all important factors in influencing the cognitive development during
the first three years of life.
Other studies have reported a negative impact of maternal employment on
children’s cognitive development (Baydar & Brooks-Gunn, 1991; Blau & Grossberg,
1992; Desai et al., 1989; Harvey, 1999; Mott, 1991, as cited in Baum, 2003; Bernal,
2003; Ruhm, 2004). These studies have found that the impact of early maternal employ-
ment is more negative if the mothers work for longer hours, if their own care giving
is insensitive and if the children receive care in average-quality childcare centres.
The UK-based study by Ermisch and Francesconi (2000), and the study by Gregg
et al. (2005), identified negative effects on cognitive development in children whose
mothers returned to full-time work before they were 18 months old and whose non-
parental care consisted solely of unpaid care by a friend, relative or neighbours. This
study also identified that children of mothers in the least-advantaged households do
not appear to be harmed by early maternal employment, regardless of when the mother
started work or the type of childcare used. This may be because the importance of
maternal earning for the family’s finances outweighs any negative effects from the
mother’s absence.
In Pakistani cultural context, women have relatively little control over their own
earnings and have no right to direct their incomes to the benefit of their children. This
may lead to negative associations of maternal work and child outcomes (Glick, 2002,
p. 15). In developing countries such as Pakistan, especially in the low socio-economic
group, mothers’ employment reduces girls’ schooling as when women work outside
the home, their daughters are pulled out of school to do the housework (Ray, 2000,
cited in Glick, 2002, p. 18). Therefore, it is important to examine and identify the
effects of mothers’ employment on children’s cognitive development as it will
increase our understanding about the topic, provide evidence on the potential positive
 880 S.M. Meherali et al.

and negative effects of early maternal employment on children, help in the planning
of high-quality childcare centres and will highlight the implications of the maternity
leave policies in the Pakistani cultural context.

Theoretical framework
The theory which guided the answer to the research question is Piaget’s theory of
cognitive development. In Piaget’s view, early cognitive development involves
processes based upon actions which later progress into changes in mental operations
(Santrock, 2008). A child’s intellectual ability is determined by a combination of two
elements, heredity and environment. Although a child’s genetic inheritance is
unchangeable, there are ways in which parents can enhance their child’s intellectual
development through environmental factors (Santrock, 2008). Piaget divided the
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schemes that children use to understand the world into four main stages (Santrock,
2008). The toddlers in this research study fall under the sensory and the pre-
conceptual stage of the pre-operational stage, as the age range is 24–36 months.
During this time, children begin to move towards understanding the world through
mental operations, rather than purely through actions (Santrock, 2008). Furthermore,
children’s language and intellectual development also starts towards the end of the
second year, and a new kind of psychological functioning occurs.
Operationally, cognitive development is defined in this study as ‘the develop-
ment of intelligence, conscious thought, problem-solving and decision-making, from
childhood through adolescence to adulthood’ (Niccols & Latchman, 2002). Cogni-
tive development involves sensory/perceptual acuities, discriminations and
responses; acquisition of object constancy; memory learning and problem-solving;
vocalisation and beginning of verbal communication; basis of abstract thinking;
habituation; mental mapping; complex language; and mathematical concept forma-
tion of toddlers between 24 and 36 months of age, which was measured by the
Bayley Mental Scale.

Methodology
A comparative descriptive design was used in this study. The study was conducted
in an urban small community setting in Karachi. A convenient sample of 100 mother–
child dyads was used for data collection. For sample recruitment, the following inclu-
sion criteria were used: children between 24 and 36 months of age whose mothers
were employed full time and were working outside the home for remuneration for at
least 7–9 hours in a day and also those whose mothers who were not working for
remuneration; children with normal physical or mental growth and development;
children from any socio-economic or religious background; and children whose
parents consented to participate in this study. The participants who were working part
time or working from their home (e.g. beauty parlour) were excluded from the study.

Measures
Two demographic questionnaires (parent and child) were used to collect relevant
information about the participants. The demographic variables in the data sheet were
identified from the literature as being significant in children’s cognitive development.
To measure toddlers’ cognitive development, the Bayley Scale of Infant Development
 Early Child Development and Care 881

(BSID) was used. The scale has been validated and used worldwide to assess the
development of infants from one to 42 months of age (Bayley, 1996).
Reliability testing was done on 10% (10 mother–child dyads) of the target popu-
lation to establish its face validity and the internal consistency of the instrument/tool
in the cultural context. Modifications were also carried out in the selection of toys
during pilot testing. Approval from the university ethics committee was sought before
initiating the study process. Individual informed consent was also obtained.

Results
Demographic characteristics
The total number of participants for the study was 100 (mother–child dyad). The mean
age of the children was 30 months ± three months. Out of 100 children, 54% were
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male and 46% were female. The mean age and standard deviation (SD) of the partic-
ipants’ mothers and fathers was 33.57 ± 4.5 and 36.72 ± 6.6 years, respectively. SES
as reported in the Government of Pakistan Economic Survey of Pakistan 2001–2002
was low (earnings 5000–10,000 PKR), middle (earnings 10,000–50,000 PKR) and
high (earnings 50,000 PKR and more), (Ministry of Finance, 2002). Almost half of the
participants (54%) were in the middle-income group, 30% of the participants were in
the low socio-economic group and the remaining, only 16%, were in the high socio-
economic group. Thirty-seven percent of both the parents had no or minimal educa-
tion, 34% of the parents were undergraduates and 29% of the parents were graduates
or held professional degrees (Table 1).

Study outcomes with respect to research question 1

The results show that there was no significant effect of maternal employment
on toddlers’ cognitive development (p > .10). Table 2 presents the status of toddlers’
cognitive development with respect to maternal employment and non-employment
status.

Study outcome with respect to research question 2

The study also identified the relationship between the selected demographic variables
(e.g. mothers’ education level, SES, childcare arrangements etc.) and the toddler’s
cognitive function. A total of 13 variables were used to identify this relationship. Out
of 13, nine variables showed a significant impact on children’s cognitive develop-
ment. For this paper, three major variables are being presented and discussed, which
include mothers’ education levels, SES and childcare arrangements. These variables
seem to have had the most significant impact on children’s cognitive development and
are very common variables within the Pakistani cultural context. Table 3 presents the
effects of these variables on the cognitive outcomes of toddlers of employed and non-
employed mothers.

Discussion
The present study has compared the mental development of toddlers, aged 24–36
months, of working and non-working mothers and has also identified the relationship
 882 S.M. Meherali et al.

Table 1. Demographic profile of the participants (n = 100).

Characteristics Frequency %
Child’s age, in months
30.08 ± 3 (mean age ± SD)
25–30 months 53 53
31–35 months 47 47
Gender
Male 54 54
Female 46 46
Family structure
Nuclear 48 48
Extended 52 52
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Mother’s age, years (mean age ± SD) 31.57 ± 4.5

Father’s age, years (mean age ± SD) 36.72 ± 6.6
Mother’s employment status
Unemployed 50 50
Employed 50 50
Socio-economic status
Low 30 30
Middle 54 54
High 16 16
Educational level of both parents
No education/below primary level 37 37
Undergraduate 34 34
Graduate and above 29 29
Childcare arrangements
Day-care centres 19 19
At home with relatives 27 27
At home with maids 4 4
Mental developmental index
Accelerated performance (115 and above) 31 31
Within normal limits (85–114) 48 48
Mildly delay performance (70–84) 20 20
Significantly delayed performance (69 and below) 1 1.0

Table 2. Cognitive development of toddlers of employed and non-employed mothers.

Mildly Significantly
Accelerated Normal delayed delayed
performance performance performance performance Total p value
Mother’s
employment status
Non-employed 17 (34%) 23 (46%) 10 (20%) 0 50 .712
Employed 14 (28%) 25 (50%) 10 (20%) 1 (2%) 50
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Table 3. Association of toddlers’ cognitive development with demographic characteristics.

Accelerated Normal Mildly delayed Significantly delayed
Demographic characteristics performance performance performance performance Total p value
1. Socio-economic status
Employed mothers
Low 0 6 (24%) 10 (100%) 1 (100%) 17 (34%)
Middle 7 (50%) 10 (40%) 0 0 17 (34%)
High 7 (50%) 9 (36%) 0 0 16 (32%)
Total 15 (100%) 25 (100%) 10 (100%) 1 (100%) 50 (100%)
Non-employed mothers
Low 0 4 (17.4%) 9 (90% 0 13 (26%) .000
Middle 17 (100%) 19 (82.6%) 1 (10%) 0 37 (74%)
High 0 0 0 0 0
Total 17 (100%) 23 (100%) 10 (100% 0 50 (100%)
2. Mother’s educational level
Employed mothers
No education/below primary level 0 8 (32%) 10 (100%) 1 (100%) 19 (38%) .000
Undergraduate 3 (21.4%) 3 (12%) 0 0 6 (12%)
Graduate and above 11 (78.6%) 14 (56%) 0 0 25 (50%)
Total 14 (100%) 23 (100%) (100%) 1 (100%) 50 (100%)
Non-employed mothers
No education/below primary level 1 (5.9%) 10 (43.5%) 10 (100%) 0 21 (42%) .000
Undergraduate 13 (76.5%) 13 (56.5%) 0 0 26 (52%)
Graduate and above 3 (17.6%) 0 0 0 3 (6%)
Total 17 (100%) 23 (100%) 10 (100%) 50 (100%)
Early Child Development and Care
883
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Table 3. (Continued)
884

Accelerated Normal Mildly delayed Significantly delayed

Demographic characteristics performance performance performance performance Total p value
3. Childcare arrangements
Day-care centre 6 (19.4%) 13 (27.1%) 0 0 19
At home with relatives 4 (12.9%) 12 (25%) 10 (50%) 1 (100%) 27 .005
At home with maids 4 (12.9%) 0 0 0 4 (8%)
Child stay at home (non-employed mothers) 17 (34%) 23 (47.9%) 10 (50%) 0 50 (100%)
S.M. Meherali et al.
 Early Child Development and Care 885

between the selected demographic variables/characteristics and the toddler’s cognitive

development. The results, comparing the MDIs of children of working and non-
working mothers, found no significant association between maternal employment and
toddlers’ cognitive development. However, the study found a significant association
between the selected demographic variables such as mothers’ education level, SES
and childcare arrangements and toddlers’ cognitive development.
Several evidences also suggest that effects of mothers’ employment on children’s
mental functioning are not significant when children are young. Baum’s (2004) study
results suggested that effects of mothers’ employment were not significant when chil-
dren were quite young, as these could generally be covered through maternity/parental
benefits and could be offset by using high-quality childcare. However, other studies
show that maternal employment reduces maternal input towards the children and that
affects a child’s cognitive development. Studies using the data from the National
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Longitudinal Survey of Youth–Child Supplement (NLSY-CS) and from the NICHD-

SECC have generally found negative effects of first-year maternal employment on
children’s later cognitive outcomes (Baum, 2003; Han, Walldfogel, & Brooks-Gunn,
2001; Hill, Waldfogel, Brooks-Gunn, & Han, 2001; Ruhm, 2002a, 2002b, 2004;
Verropoulou & Joshi, 2007).
The participants in the study were toddlers, and in Pakistan, Montessori education
for toddlers (less than three years of age) is very common; there are schools that offer
play group programmes as well. In addition, the concept of a home-based Montessori
programme is also quite common in the Pakistani society (home-based Montessori is
a Montessori run by trained or untrained people within their home and where children,
approximately aged 18–36 months, go for about 2–3 hours and learn basic Montessori
skills before they start their schools). Therefore, most of the parents enrol their chil-
dren in these home-based Montessori programmes when the children are only 18 or
24 months old. More than half (55%) of the study participants were also going to a
Montessori centre where they were learning different cognitive skills which really
helped in enhancing the toddlers’ cognitive development. This might be the reason
why the present study has not identified any apparent effects on the mental function-
ing level of children of working and non-working mothers. In addition, because of
smaller sample size, it was not possible to test the associations and estimate the precise
effects within the subgroups.
The study also identified a strong association between mothers’ educational level
and children’s cognitive outcomes, for both employed and non-employed mothers
(p < .01). The higher the mother’s educational level, the better her child’s perfor-
mance. The present study also found that employed mothers were more qualified as
compared with non-employed mothers. Fifty percent of the employed mothers were
graduates and were holding professional degrees, whereas only 6% of the non-
employed mothers were graduates and had professional qualifications. Some of the
previous studies also support this trend that employed mothers are more educated and
are highly conscious about their child’s growth and development and thus the day-care
facilities that they are using, and the home environment that they are providing, are
highly stimulating for their child’s mental development (Baum, 2003; Brooks-Gunn,
Han, & Waldfogel, 2002; Ermisch & Francesconi, 2002; Verropoulou & Joshi, 2007).
The study also found a significant association between a family’s SES and a
toddler’s MDI (p < .01). It has also been inferred from the study that the families where
mothers are working are economically stable, as compared with traditional single
bread-earner families. A major difference identified in the study is that more than 50%
 886 S.M. Meherali et al.

of the children who belonged to middle-class families and whose mothers were not
employed scored well as compared with those from the same socio-economic group
but with employed mothers. Numerous studies also support this finding that in middle-
and high-income families, children have more to lose from their mother’s absence
(Gregg, Washbrook, & ALSPC Study Team, 2003; Han, Waldfogel, & Brooks-Gunn,
2001; Waldfogel, 2002). Ruhm (2002b) identified that in middle-class families, the
additional income is not a significant determinant of children’s cognitive development,
perhaps, because the net increase in household income from maternal employment is
not large. The study also identified that children from the low socio-economic group
did not score well irrespective of the fact of whether their mothers were employed or
not. According to Verropoulou and Joshi (2007), mothers with low income were more
likely to be emotionally distressed, as a result of economic pressure, and more likely
to be less supportive and use punishment such as spanking. The researchers’ assump-
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tion, however, is that because of economic pressures and stress, these mothers cannot
provide cognitive stimulation to their children, which results in low MDIs.
Moreover, one more assumption is that these less-advantaged children are not
cognitively delayed; the children were not exposed to the assessment materials that
were used to test the mental/cognitive development of toddlers before, and this was
the first time they were doing these activities. Therefore, the time these children were
taking to complete the task was more than the available time and they were getting no
credit for it.
The childcare arrangements for children of employed mothers have been classified
into three categories: day-care centres, at home with relatives and at home with non-
relatives (maids or nanny), and these have been compared with arrangements for non-
employed mothers’ children who are taken care of by their mothers only. Care
provided by relatives was the most used childcare arrangement, accounting for 54%
of all categories. Day-care centre-based arrangements accounted for about 38%, and
the remaining 8% was accounted for by care provided by maids.
Interestingly, the effect of childcare provided by relatives is negative and statisti-
cally significant, while care provided by non-relatives and in formal day-care centres
does not have any significant negative effect on the toddler’s mental development (p <
.001). Very often, in the Pakistani cultural setting, the relatives are the paternal or
maternal grandparents of the child who live in the same household, and most of them,
except the few who belong to the high SES, are just there in the house, without provid-
ing any stimulating environment for the child. On the other hand, non-relatives and
formal types of childcare centres tend to be more effective in providing a stimulating
environment for the child, and these are the children who belong to the middle and
high SES. Studies conducted on the effects of home versus centre care on the child’s
cognitive development suggest that children who are placed in care centres have, over-
all, higher cognitive levels than those who are not (Fuller, Holloway, & Liang, 1996;
Hofferth, Brayfield, Deich, & Holcomb, 1991; Singer, Fuller, Keiley, & Wolf, 1998;
as cited in Hickman, 2006).

Limitations of the study

One of the limitations of the study was the small sample size of children; with a larger
sample size, it might have been possible to test the associations within different
demographic variables and to estimate the precise effects within the subgroups. In
addition, recruiting the participants was also a challenge faced by the researcher.
 Early Child Development and Care 887

Recommendations
Overall, the study results have some important policy implications. Maternal
employment has harmful effects on children only if certain risk factors are present,
and, virtually all of these factors can be moderated by appropriate policy interven-
tions. One clear implication is the need to develop quality childcare facilities, as the
results confirm that quality care matters. Both the parents and the children, especially
those in the low-income families, suffer from inadequate availability of childcare in
Pakistan. Parents need affordable, reliable and quality childcare to secure and main-
tain successful employment, and children need high-quality childcare to grow up to be
healthy and well-developed adults.
The study results also suggest that the chances of a woman being a properly paid
and productive member of the society increase with education, and this improves
significantly for the better-educated women. Education empowers women to take
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decisions about their own lives and to participate more fully in their development.
Thus, the focus on women’s education is not only important to start the virtuous cycle
of higher human capital, lower fertility, better care of children and so on but is an
investment for pushing forward the boundaries of the country’s production possibility
curve and of having a higher gross domestic product (GDP).
The Pakistani society is a predominantly Muslim society; therefore, noble inten-
tion and policy statements, in the light of Islamic principles, are needed from the
government for women in the spheres of socio-economic development. Since women
constitute half the population of Pakistan, there is a need for operational policies that
would focus mainly on maternity leave, women’s hours of work and monitoring their
working conditions. Furthermore, adequate facilities such as suitable accommodation
near the place of work, nurseries and day-care centres for the working women, and
facilities for breast feeding for very young children will further increase their partici-
pation in socio-economic development.
Fathers’ role in household work and in the child-rearing process needs to be
emphasised because in a male-dominated society such as Pakistan, women still have
more responsibility for household work and childcare, whether they are employed or
not. This increases their workload, tiredness and stress and may influence children’s
cognitive development. In the interest of equality, both women and men should
participate equally in all areas of family responsibility, including child rearing and
household work. The strong norms that forbid males from taking part in household
chores must be changed. Efforts to more effectively involve men in safe and respon-
sible parenthood and to emphasise men’s and women’s shared responsibility are
needed. This responsibility includes control of, and contribution to, family income and
children’s education, health and nutrition.
A longitudinal study to identify the effects of maternal employment on different
stages in a child’s life and its long-term effects not only on cognitive development but
on the overall growth and socio-emotional development in the Pakistani cultural
context is required with a larger sample size.

Conclusion
Maternal employment has become so common in recent years that there has been a
concern about the large adverse impacts that it may have on children’s development;
however, the results of this study are somewhat reassuring. These results highlight the
 888 S.M. Meherali et al.

importance of both quality parental care and quality non-parental care in determining
the overall impact of maternal employment. Whether a child is disadvantaged by
maternal employment depends on the quality of care that the child receives, as related
to that which would be provided by the mother. However, the overall analysis of the
study suggests that there is no association between maternal employment status and
the toddler’s cognitive development.

Notes on contributors
Salima Moez Meherali works in the nursing faculty at the School of Nursing, The Aga Khan
University. Her area of interest is early childhood development and critical care nursing. Her
master’s thesis was a descriptive comparative study to compare the cognitive development of
toddlers of working and non-working mothers. She has also done researches in the area of crit-
ical care nursing and teaching learning in the field of nursing. At present she is involved in a
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research study titled: ‘Socio-cultural influences on newborn health and survival in the first 6
weeks of life: A socio-ecological and feminist perspective’, funded by Aga Khan University
Research Council.

Rozina Karmaliani is interim dean, at the School of Nursing, and an associate professor at the
School of Nursing and Community Health Sciences at the Aga Khan University, Karachi. She
is the first AKU Alumni to complete a PhD and return to her Alma Mater in 2001. She has
done a MPH in public health administration in 1995, MScN in public health nursing in 1997
and a PhD in nursing in 2000 from University of Minnesota, USA. Dr Karmaliani received the
Juran Fellowship Award for Leadership in Quality, towards PhD thesis in 1998 and Distin-
guished Leadership Award for Internationals in 2003 at the University of Minnesota. In
November 2009, based on her academic and professional achievements and the impact that
she had on health care and society, she was selected for recognition as one of the School of
Nursing’s 100 distinguished alumni at University of Minnesota, USA. She has researched for
a range of funders including National Institute of Child Health Development (NICHD),
USAID, Agency Frencaise de Developpement (AFD), Ministry of Health, The Aga Khan
Foundation and World Health Organization, DFID, Proctor and Gamble, and Ministry of
Health, Government of Pakistan.

Nargis Asad is a clinical psychologist and assistant professor with the Department of Psychia-
try at the Aga Khan University Hospital. She is the chair for a voluntary group at the University
named Aga Khan University Working Group for Women (AKU-WGW), the primary mandate
of which is awareness regarding gender inequalities and women’s rights. Her primary research
interests are women’s mental health inclusive of intergenerational effects and reproductive
mental health.

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