Effects of child health on parents’ relationship status

We used data from the Fragile Families and Child Wellbeing Study to estimate the effect of a child's poor health on the presence of thefather. We investigated whether parents lived in the same household 12-18 months after the child's birth and whether their relationships changed along a continuum (married, cohabiting, romantically involved, friends, or not involved) during the same period. We found that within this short period, having a child with poor health decreased the probability that the parents lived together by 10 percentage points. It also increased the probability that their relationship status moved in the direction of less involvement by 6 percentage points. These results indicate that children's health and family structure jointly shape children's long-term health and economic trajectories.     

“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

BackgroundExperiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.AimThis study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.MethodsThis was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.FindingsWomen had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.ConclusionTo improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.     

Providers’ perspectives of barriers experienced in maternal health care among Marshallese women

Problem

Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care.

Midwives’ provision of health promotion in antenatal care: A qualitative explorative study

ProblemStudies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care.BackgroundAntenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important.AimTo explore how Danish midwives experienced antenatal care and practiced health promotion.MethodsMidwives undertaking antenatal care were interviewed individually (n = 8) and two focus groups (n = 10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper’s health promotion practice Framework for midwives were used to analyse the midwives’ health promotion approach.FindingsTwo major themes were highlighted. Theme 1: ‘The antenatal care context for health promotion’ described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: ‘The health promotion approach in antenatal care’ described both midwife-focused and woman-focused approaches to pregnant women’s health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time.DiscussionThe midwives’ experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care.ConclusionMidwives mainly had a midwife-focused approach. To further promote women’s health, midwives need to focus on a woman-focused approach.     

Women’s experiences of health care utilization in cases of early pregnancy loss: A scoping review

BackgroundApproximately 25% of pregnancies end in miscarriage, most occurring within the first trimester (<13 weeks). For many women early pregnancy loss has implications for short- and long- term mental health, and women’s well-being following early pregnancy loss is impacted by their experiences within the healthcare setting. To improve quality of care, it is crucial to understand women’s’ experiences within the healthcare system in cases of early pregnancy loss.QuestionsWhat does the research literature tell us about the experiences of early pregnancy loss within healthcare settings? Are these experiences positive or negative? ‘How can care improve for those experiencing early pregnancy loss?’MethodsA scoping review of the research literature was undertaken. Three research databases were searched for relevant articles published in English since 2009, with key words related to ‘Experience’, ‘Healthcare’ and ‘Early Pregnancy Loss’. A thematic analysis was undertaken to identify and summarize key findings emerging from the research literature.FindingsTwenty-seven (27) articles met our inclusion criteria. Three main themes were identified: (1) issues related to communication, (2) challenges within care environments, and (3) inadequacies in aftercare.DiscussionThe literature suggests that women’s experiences related to healthcare for early pregnancy loss are largely negative, particularly within emergency departments. Recommendations to improve women’s experiences should extend beyond attempts to improve existing care structures, to include emerging environments and providers.ConclusionWomen’s experiences identified within the literature provide further insights on what women are seeking from their care, and how care models can be improved.     

Survey of midwives’ perinatal mental health knowledge,confidence, attitudes and learning needs

Background

Midwives have a primary role in facilitating the first stage of perinatal mental health risk reduction through inquiring about perinatal mental health, identifying risk factors and current perinatal mental health problems, providing support or crisis intervention, referring for treatment and decreasing stigmatisation.

Dimensions of women’s autonomy and the influence on maternal health care utilization in a north indian city

The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.     

The influence of financial, human and social capital on Japanese men’s and women’s health in single- and two-parent family structures

Large-scale demographic changes have been occurring in Japan over the last few decades. During this time, the proportion of two-parent (nuclear) and single-parent families have doubled. Despite this rapid increase, the health of individuals in these family structures have received limited attention, as the focus has been directed towards the health of Japan’s aging society and the health implications related to the decline in multigenerational households. However, researchers and policy planners cannot afford to overlook issues that influence the health of men and women in single- and two-parent family structures, not only because these families have become increasingly common throughout the nation, but also because the western literature has indicated that the health of families are largely influenced by the gender-by-family structure divide. Through logistic regression models, using the 1999 Nationwide Family Survey, this paper examines how financial, human and social capital influences the likelihood of good health among men and women in single- and two-parent families. As was expected, key determinants in predicting good health amongst these four sub-groups of parents were found. While parents in two-parent families were the least influenced by various measures of capital, these same measures were found to be significant in predicting good health amongst fathers, and more so mothers, in single-parent families.

Women’s mental health during pregnancy: A participatory qualitative study

Background/objectives

British public health and academic policy and guidance promotes service user involvement in health care and research, however collaborative research remains underrepresented in literature relating to pregnant women’s mental health. The aim of this participatory research was to explore mothers’ and professionals’ perspectives on the factors that influence pregnant women’s mental health.

Women’s health and pregnancy outcomes: Do services make a difference?

We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained some 50,000 midwives. Between 1993 and 1997 these midwives tended to be placed in relatively poor communities that were relatively distant from health centers. We show that additions of village midwives to communities between 1993 and 1997 are associated with a significant increase in body mass index in 1997 relative to 1993 for women of reproductive age, but not for men or for older women. The presence of a village midwife during pregnancy is also associated with increased birthweight. Both results are robust to the inclusion of community-level fixed effects, a strategy that addresses many of the concerns about biases because of nonrandom program placement.     

Social resources and Arab women’s perinatal mental health: A systematic review

Background

Women’s mental health in the perinatal period is understudied worldwide and in Arab countries especially.

Women’s land ownership and participation in decision-making about reproductive health in Malawi

Given the centrality of land to rural livelihoods and the high rates of fertility in Africa, there is a need for more research that explores the intersection between gendered patterns of land ownership and reproductive health outcomes. Drawing on a household bargaining framework, I hypothesize that women’s land ownership should be associated with increases in women’s decision-making in multiple domains in the household including financial decision-making (the focus of bargaining literature), but also decision-making about reproductive health. Using the 2010 Malawi Demographic Health Survey (DHS), I find women’s ownership of land (sole or joint) is associated with increases in women’s participation in financial decision-making in the household and women’s sole ownership of land is associated with increases in women’s participation in reproductive health decision-making. However, women’s joint ownership of land with spouses is negatively associated with participation in reproductive health decision-making, perhaps because of backlash or intra-household conflict.     

“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

ProblemNational guidelines recommending mental health screening in pregnancy have not been implemented well in routine maternity care. Women of refugee background are likely to have experienced traumatic events and resettlement stressors, yet are not often identified with mental health issues in the perinatal period.BackgroundGlobally, perinatal mental health conditions affect up to 20% of women. Many difficulties in accessing mental health care in pregnancy exist for women of refugee background including stigma, and cultural and language barriers. Technology can provide an efficient and effective method to overcome some of these barriers.AimTo determine if a digital perinatal mental health screening program is feasible and acceptable for women of refugee background.MethodsThis qualitative evaluation study used focus group and semi-structured telephone interviews with refugee and migrant women from four communities. Interpreters were used with women who spoke little or no English. Data were analysed using both an inductive and deductive approach to thematic analysis.FindingsUnder the three key themes: ‘Women’s experiences of perinatal mental health screening in pregnancy’; ‘Barriers and enablers to accessing ongoing mental health care’ and ‘Improvements to the program: the development of audio versions’, women found the program feasible and acceptable.DiscussionScreening using a mobile device offered women more privacy and opened up discussions with midwives on emotional health. Improvements in service coordination and access to further mental health management for women is required.ConclusionPerinatal mental health screening is an acceptable and feasible option for women of refugee background. Integrated models of care, case management, and patient navigators are options for improvements in uptake of referral and treatment services.     

Will boys’ mental health fare worse under a hotter climate in Australia?

A hotter climate is increasingly found to have negative effects on human health, yet the possible impact on children’s mental health is less understood. Our study explored this potential relationship using a national survey of children aged 6–11 across Australia, during the period 2008–2014 (n?=?14,096). It was hypothesised that the negative effects of hotter weather on children’s mental health can occur both directly (e.g. through heat impacts influencing hyperactivity and restlessness) and indirectly (e.g. through reduced participation in organised physical activities). Mediation analysis controlled for a range of other locational, gender, socio-economic and demographic influences. Results indicate that an increase in annual average daily maximum temperature worsened childhood mental health due to a direct and indirect effect through reduced participation in organised physical activities, as measured by the Strengths and Difficulties Questionnaire (SDQ) total score, but the result is only significant for boys (albeit the magnitude of the effect was small). More specifically, temperature differences are driven through the SDQ mental health sub-scales of hyperactivity and peer problems. Gender disparities are also observed in terms of other environmental or locational influences having a significant impact on boys’ mental health, with no significant impact found for girls. Girls’ mental health is more likely influenced by family and individual socio-economic characteristics. There is also evidence of an increased impact of higher temperature on children’s mental health in poorer households, suggesting the need for more targeted children’s mental health policies.     

The colonialism of Canada’s Métis health population dynamics: caught between bad data and no data at all

In the last two decades, Canada’s brand of colonial recognition politics has fueled several social and cultural changes that have, in turn, produced startling growths in the “Métis population” in Canada. Demographers and policy makers alike have expressed dubiousness about the extent to which “non-demographic factors” (that is, factors other than fertility and mortality) are fueling this growth, a dubiousness expressed in the growing use of “ethnic mobility” to explain population growth. In this article I explore the historical contexts within which the idea of a single Métis population took hold as a statistical technology, the kinds of social and cultural juxtaposition that making use of a single population masks, and the impact single population estimates have on the ability of Métis nation policy actors to fashion evidence-based policy relevant to the concerns of the Métis nation. While the dynamics and the data perused in this article are specific to Canada, they possess broader resonances with other nation-states grappling with their colonial histories and longstanding Indigenous peoples as these dynamics relate to official data dynamics.     

Characteristics of China’s Vulnerable Population

Five Major Characteristics of China’s Vulnerable Population: 1. The socially vulnerable population is the main part of the vulnerable population, mainly because it is their position in     

‘The calm before the storm’: A qualitative study of fathers’ experiences of early labour

BackgroundEarly labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour.MethodsOpportunity sample offathers (n = 12) in the UK who had been present during their partner’s labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis.ResultsFathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the ‘calm before the storm’ during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt ‘like a spare part’ during the later stages of labour.DiscussionThe study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing ‘nothing’. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value.