Mothers Experience of Child Care and Feeding

Our findings highlight that mothers who are the primary caretakers of children are overwhelmed by their multiple roles, especially in a context of fading social support. Due to financial strains and the rising cost of living, the traditional roles of mothers household chores, child care and family food provision are evolving to include work outside the home to support their families (32). Adjusting to the evolving dual role of becoming a working mom, while still shouldering the household re-sponsibilities, leaves mothers stressed (103).

In contrast, other studies have shown that mothers' multiple duties/roles are not associated with stress; rather, that this is associated with increased levels of satisfaction and greater access to resources, especially in the presence of support (104, 105).

Adding to the mothers' stress was the city's frequent reconstruction, which forces families to move away from their familiar surroundings, fragmenting social support systems. Earlier studies have attested to the high social cost associated with the extensive renewal of urban areas in Addis Ababa (91, 106).

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The social support system used to be part of the traditional child caring practice, and is very important to ensure continu-ity of feeding in the absence of mothers/caregivers for a short spell. Its presence has been shown to improve child feeding practices, while its absence is associated with poor diet and nutritional outcomes (3739, 107). The presence of social support alleviates the time pressure, giving mothers time to take care of their children and themselves (36).

Additionally, having social support also means that mothers have the opportunity to work and earn extra income (108), enabling them to pur-chase diverse and healthy food.

Supporting this, other previous studies have shown that those who have social support are more likely to fol-low dietary recommendations, consume animal source food, and eat home-cooked meals (37, 107, 109). On the contrary, for those with low levels of social support, the time limitation may impel them to resort to ultra-processed foods which are less time consuming and cheaper (38), but are implicated with increased risk of malnutrition (39).

Selection of food for children

Our findings show that the food selection process is complex and there are many aspects that mothers deliberate on before making food choices for their children. One of the influences is the child's preferences; busy mothers may opt to simply comply with their child's preference, as they may not have the time nor the energy to cook food that children would later reject (110, 111). This also relates to the state of exhaustion men-tioned earlier, where mothers give in to the child's preferences as they are exhausted.

Another important driver for food choice was access to financial re-sources. Our findings showed that mothers with access to financial re-sources were able to have a planned diet. Studies have also shown that people purchase and consume food they prefer if they can afford (112), however, when there are financial limitations, they resort to foods that are less desirable, compromising on quality and/or quantity (112, 113). The importance of having access to adequate financial resources for an improved diet was further supported by the analysis in Paper VI, where we observed an association between both affordability and wealth with the consumption of the different food groups.

Although mothers were aware of the nutritional recommendations, including the importance of exclusive breastfeeding, initiation of com-plementary foods and a balanced diet, there were gaps in their practice and understanding of what constituted a balanced diet. The confusion on what constitutes a healthy food has been observed in other settings as well (114). Having nutrition-related awareness may not always trans-late to the desired behaviour (115).

Partly, this is because food choices are based on a complex set of factors that vary across individuals, cul-tures, and contexts (116). As mentioned earlier, the cost of food, and the maternal state of being, also influence the decision-making process; another important element that the mothers in our study raised is the concerns they had about the safety of the food. Mothers' concerns about food safety influence the type of food they give their child. Their concerns are substantiated by earlier studies from different parts of Ethiopia which indicated the presence of contaminants in some of the fresh produce as well as in the ready-to-eat foods (117, 118). Food safety issues are severe in many low-income countries where regulatory mechanisms and institutions are weak.