To have or not to have? Australian women’s childbearing desires,expectations and outcomes

Australia’s low fertility rate is commonly attributed to deliberate decisions by women to avoid having children. Existing theoretical explanations of fertility decision-making mostly view childbearing as a rational, voluntary process and focus on the ‘costs’ to women of having children. Although this may help explain why women do not have children, it contributes very little to understanding why women do have children. This study describes childbearing desires, expectations and outcomes in a population-based sample of 569 30–34-years-old Australian women recruited from the Australian Electoral Roll in 2005. Most women surveyed wanted to have children, and their childbearing outcomes were associated with biological, psychological and social factors including the lack of a partner and adverse health conditions. The factors and their relative importance varied by parity. Most women had fewer children than they desired, and many would have children, or more children, if their circumstances were different. These data challenge prevailing assumptions about women’s childbearing behaviour that women are able to choose when and if they have a child. Based on the findings, a conceptual framework of childbearing behaviour is proposed which builds on existing theoretical explanations to explain why women do and do not have children, differences by parity, and the role of circumstances in women’s childbearing behaviour. The findings and conceptual framework have implications for public policies, and indicate that multiple approaches are required which are sensitive to and address the barriers women face in family formation.     

Social adversity in pregnancy and trajectories of women’s depressive symptoms: A longitudinal study

Background

Sound evidence has linked the experience of adversity with depression. Less is known about this association over time.

Australian heterosexual women’s experiences of healthcare provision following a pregnancy loss

Background

Despite increased awareness of the psychological impact of pregnancy loss, a lack of recognition continues with regards to women’s experiences. Healthcare professionals have an important role to play in supporting women following a pregnancy loss, yet to date only a relatively small body of research has examined women’s experiences with healthcare providers.

Witnessing a body in decline: Men’s and women’s perceptions of an altered physical appearance

ABSTRACT

There has been a tendency within the literature to ignore how men and women who are very ill and at the end of life perceive and experience their visibly altered bodies. This article aims to provide new insights about this matter. A qualitative research approach was adopted. In-depth interviews were conducted with 10 hospice patients, 20 family members, and 20 members of hospice staff. Findings reveal that because of masculine and feminine norms, physical appearance is more a matter of concern to women than to men who are close to death. This contradicts theories that suggest that patients experience a disinvestment on their sense of masculinity and femininity alongside the process of bodily deterioration and decay prior impending potential death.     

Do more-schooled women have fewer children and delay childbearing? Evidence from a sample of US twins

Using data on monozygotic (MZ) (identical) female twins from the Minnesota Twin Registry, we estimate the causal effect of schooling on completed fertility, probability of being childless, and age at first birth using the within-MZ twins methodology. We find strong cross-sectional associations between schooling and the fertility outcomes, and some evidence that more schooling causes women to have fewer children and delay childbearing, though not to the extent that interpreting cross-sectional associations as causal would imply. Our conclusions are robust when taking account of (1) endogenous within-twin pair schooling differences due to reverse causality and (2) measurement error in schooling. We also investigate possible mechanisms and find that the effect of women’s schooling on completed fertility is not mediated through husband’s schooling but may be mediated in part through age at first marriage.     

Development of a survey instrument to evaluate women’s experiences of their maternity care

BackgroundThe process of developing a survey instrument to evaluate women’s experiences of their maternity care is complex given that maternity care encapsulates various contexts, services, professions and professionals across the antenatal, intranatal and postnatal periods.AimTo identify and prioritise items for inclusion in the National Maternity Experience Survey, a survey instrument to evaluate women’s experiences of their maternity care in the Republic of Ireland.MethodsThis study used an adapted two-phase exploratory sequential mixed methods design. Phase one identified items for possible inclusion and developed an exhaustive item pool through a systematic review, focus groups and one to one interviews, and a gap analysis. Phase two prioritised the items for inclusion in the final item bank through a Delphi study and consensus review.FindingsFollowing iterative consultation with key stakeholder groups, a bank of 95 items have been prioritised and grouped within eight distinct care sections; care during your pregnancy, care during your labour and birth, care in hospital after the birth of your baby, specialised care for your baby, feeding your baby, care at home after the birth of your baby, overall care and you and your household.ConclusionRobust and rigorous methods have been used to develop a bank of 95 suitable items for inclusion in the National Maternity Experience Survey.     

How do family planning workers’ visits affect women’s contraceptive behavior in bangladesh?

In Bangladesh, family planning workers' visits reduce the costs of contraception and may increase the demand. If visits increase demand or if workers are targeting their visits, past visits by family planning workers should have a positive and significant effect on later probabilities of adopting contraceptive methods. Longitudinal data show that past visits are not significant in hazard models for adoption of contraceptive methods, whereas visits in the current round are significant. Therefore family planning workers' visits affect women's contraceptive behavior by decreasing the costs of contraception. Results of contraceptive discontinuation hazard models further support this hypothesis.     

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.     

Pregnant adolescent women’s perceptions of depression and psychiatric services in the United States

Problem

Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.

‘…And one for the country’ The effect of the baby bonus on Australian women’s childbearing intentions

In 2004, at a time when the nation was experiencing the lowest fertility trends in its history, the Australian Federal Government introduced the offer of a cash payment of 3,000 to all women on the birth of a new baby. The maternity payment, commonly known as the baby bonus, was increased to3,000 to all women on the birth of a new baby. The maternity payment, commonly known as the baby bonus, was increased to 4,000 in 2006 and to $5,000 in 2008. While not explicitly declared a pronatalist policy at the time of its introduction, the baby bonus was later credited with helping to halt the decline of the nation’s aggregate birth rates. This paper examines the effect of this policy on Australian women’s childbearing intentions from 2001 to 2008, using panel data from the Household, Income and Labour Dynamics (HILDA) Survey. The results indicate that the introduction of the baby bonus coincided with a statistically significant increase in women’s childbearing intentions. More specifically, the strongest increase occurred among women from lower-income households, potentially implying that the policy had the strongest effect on women who, given their current characteristics, are relatively likely to be reliant on welfare assistance to raise their children over the long term. The inferences drawn from the paper’s findings raise concern over the capacity of the baby bonus policy to reduce aggregate dependency rates.     

Pregnant women’s choice of birthing hospital: A qualitative study on individuals’ preferences

Objective

To investigate pregnant women’s decision making in relation to their choice of birthing hospital and, in particular, their priorities regarding hospital characteristics.

My quitting stories: A qualitative study exploring Aboriginal women’s experiences of smoking cessation and preventing relapse in the context of pregnancy

BackgroundMost women who give up smoking during pregnancy relapse to smoking postnatally. Evidence on strategies that are helpful in maintaining smoking cessation during and beyond pregnancy is limited.AimThis paper aims to explore Aboriginal women’s experiences of quitting smoking, relapsing, and preventing relapse, focusing on the strategies they applied for attaining and maintaining abstinence and the support they received.MethodsQualitative interviews were conducted between October 2020 and June 2021, in urban New South Wales, Australia, with 12 Aboriginal women who either smoked tobacco or quit smoking and had been pregnant in the last five years. Aboriginal Research Assistants recruited participants, participated in data collection and data analysis. Data were thematically analysed.ResultsMajor themes that emerged from the data include: a) aspiration to be abstinent; b) strong mindset; c) strategies to stay smoke-free; d) supports received; and e) service and policy recommendations. Protecting children from second-hand smoke had salience for the maintenance of abstinence. Having a strong mindset was perceived as a prerequisite to staying smoke-free. Use of multiple coping strategies in combination was frequently expressed. Knowledge about tobacco-related harms, the way nicotine dependence works, and the available support options was empowering and enabled informed decision making and actions around smoking cessation.ConclusionThis qualitative study conducted with 12 Aboriginal women revealed that Aboriginal women employ multiple strategies (cognitive, behavioural and social) to quit smoking and stay smoke-free. The strategies warrant further exploration with different Aboriginal communities across Australia and consideration of inclusion in smoking cessation care.     

Unblurring the lines: a qualitative exploration of young women’s opinions on popular music

Music is an important part of the human experience, arguably contributing to identity and the formation of relationships and group memberships. However, the way women are portrayed in music has been identified as harmful and disempowering. Past research relating music to these trends has often failed to “give voice” to participants by asking them what think about the music they listen to, which is in itself disempowering. Therefore, the aim of this study was to gain an understanding of young women’s perspectives of popular music. Face-to-face, in-depth, semi-structured interviews were conducted with 10 young women. Causal layered analysis was used to deconstruct participants’ understandings of popular music. Findings revealed that for participants, music can both reflect and contribute to conflicting worldviews regarding women’s freedom of expression and sexual conservatism. Music also acted as a conduit for discussion of the social construction of women; participants articulated that female artists are seen rather than heard, reduced to body parts and commodified. Findings indicate that participants are cognizant of gendered power differences in music, rendering popular music in particular a mechanism for the oppression of women, but also a useful means to monitor and challenge problematic cultural attitudes directed at women.     

“It’s my body,my future”: Older women’s views of their interactions with physicians

ABSTRACT

Based on data obtained from in-depth, qualitative interviews conducted with 30 older Canadian women, this article examines older women’s experiences with, and views of, physicians. The research participants report a very high level of satisfaction with the patient–physician relationship; however, they also report physician shortcomings. Findings indicate that participants’ satisfaction with the patient–physician relationship was influenced by “stories about other doctors,” rationalizations and justifications, and a high level of patient assertiveness.     

Being in the shadow of the unknown — Swedish women’s lived experiences of pregnancy during the COVID-19 pandemic,a phenomenological study

BackgroundThe COVID-19 pandemic has had a profound effect on the emotional well-being of expecting mothers. Sweden’s unique strategy for managing COVID-19 involved no national lockdown. Emphasis was instead placed on limiting crowding and asking citizens to practice social distancing measures.AimTo gain a deeper understanding of how women not infected by SARS-CoV-2 experienced pregnancy during the COVID-19 pandemic in Sweden.MethodsThis was a qualitative study with a reflective lifeworld approach. Fourteen women that had not contracted COVID-19 and who were pregnant during the first and second wave of the pandemic were interviewed. Data were analysed with a phenomenological reflective lifeworld approach.FindingsThe essence of the women’s experiences of being pregnant during the COVID-19 pandemic was best described as being in the shadow of the unknown, where the COVID-19 pandemic could at times totally overshadow the experience of being pregnant, while at other times, rays of sunlight pierced through the clouds. The experience was characterised by having to deal with the uncertainties caused by the pandemic and feelings of being in an information echo. Women felt socially isolated and had to face maternal check-ups without the support of their partners. There was, however, a strong trust in maternal health-care services despite the lack of information available.ConclusionBeing in the shadow of the unknown represents the uncertainties posed by the COVID-19 pandemic on the experience of pregnancy. Sufficient information, a companion of choice and screening for emotional well-being are important factors in maternity care during pandemics.     

Does parents’ valuation of children’s health mimic their valuation of own health?

A single latent variable model of health status and therapeutic health care utilization is estimated for parents and own children of 6,557 US households. The equation system that identifies latent health status simultaneously determines a number of indicators of general health, including presence of morbidity symptoms, mobility limitations, medication needs, and utilization of therapeutic health care services. The main goal of the paper was to obtain an unbiased estimate of parents’ marginal substitution rate between own and child health. Results indicate that parents’ valuation of their children’s health exceeds their valuation of own health by almost twofold on average.

A tale of two pregnancies: A Critical Interpretive Synthesis of women’s perceptions about delayed initiation of antenatal care

Background

Delayed access to antenatal care in high income countries is associated with poor maternal, fetal and neonatal outcomes. The aim was to synthesise the diverse body of evidence around women’s views of early antenatal care and barriers to attendance in such countries. Critical Interpretive Synthesis integrates the process of systematic review with the qualitative methods of meta-ethnography and grounded theory, with a focus on theory generation to inform policy, practice and future research.

Knowing how to help: Grandmothers’ experiences of providing and receiving support following their child’s pregnancy loss

ProblemPregnancy loss is a distressing experience for parents, however no research has addressed grandmothers’ experiences of grief and support following a child’s pregnancy loss.BackgroundNo research has specifically addressed grandmothers’ experiences of support and bereavement care following pregnancy loss.AimThis study seeks to understand three key areas: (1) the support grandmothers provide to their child; (2) the support they received themselves following pregnancy loss, and; (3) supports desired by grandmothers. The study aims to contribute insights into actions midwives could take to support grandmothers following pregnancy loss.MethodsSemi-structured interviews were conducted with 14 grandmothers to understand their support experiences. Interviews were analysed using Braun and Clarke’s approach to thematic analysis.FindingsThemes related directly to the three research questions: one: providing support, comprising two themes — being strong, protecting their family and the challenges of knowing how to help. Two, receiving support, also comprised two themes — lack of professional support offered to grandmothers and informal support and self-support strategies. Three, desired support, comprised three themes — I had no idea: increasing knowledge of pregnancy loss, peer support helps: they know how it feels, and honouring our grandchildren, making meaning.DiscussionGrandmothers may give extensive support to their child following pregnancy loss but lack confidence and face challenges in doing so. Few formal supports are available to grandmothers themselves, with grandmothers relying on their social networks for their own support.ConclusionsGrandmothers need early access to information and guidance from midwives and hospital bereavement services, as well as ongoing peer support with flexible delivery options.     

“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.