The analysis of psycho-social and cultural factors during pregnancy, childbirth and early motherhood. From the woman\u2019s psychological disease to the subjective and psychological well-being

Being pregnant and becoming a mother is a challenging transition for women that may be stressful as well as generating an experience of personal growth. Several studies have been undertaken primarily to understand the negative aspects and consequences of the transition to motherhood, but researchers have gradually extended the focus of their analysis to the perinatal well-being concept as a subject for more in depth investigation. However, evidence regarding the positive dimensions of women\u2019s psychological health during the transition to motherhood is still lacking. The overall purpose of this doctoral thesis was to realize an analysis of psycho-social and cultural factors able to affect women\u2019s psychological health during pregnancy, childbirth and motherhood, including both the perspective of psychological disease and that of well-being, with a view to understanding the relationships between positive and negative aspects of women\u2019s perinatal psychological health, and between psychological health and psycho-social aspects. Utilizing both quantitative and qualitative methodologies, the present thesis highlighted how in the study of women\u2019s perinatal psychological health it is important to also focus: on well-being as conceptualized within the positive psychology perspective; on the psycho-social and individual aspects which can promote a good adaptation by the woman to the transition to maternity. This work suggests for intervention programs to promote well-being for pregnant women including paths of reflection on: relations between well-being and ill-being dimensions; the quality of the couple relationship as promotion factor of well-being; the emotional complexity of pregnancy and the role of bodily changes, pursing goals and personal skills for being and feeling well; the dimensions of control in childbirth. Limits and possible future developments were discussed

Transforming gender relations? : Men’s involvement in care for their partners and households at the time of pregnancy in rural and urban Ghana – a qualitative study

Background to the study: Involving men in the care for their pregnant partners has been described as an opportunity for initiating new fatherhood norms and masculinities that do not thrive on the subordination of women. This understanding implies that male inclusion in the care for pregnant partners could inspire more gender-equal practices. Starting with a brief historical account of family structures and gender orders, the study focuses on current trends in household gender relations and masculine expectations in Ghana to analyse the gender-transformative potential of men’s involvement in the care for their pregnant partners. Study aims: This study was guided by the following aims, which were addressed in three peer-reviewed articles: to explore how social expectations and actual practices of fatherhood interact with conceptions and norms of manhood and masculinity; to shed light on men’s experiences of antenatal care services and how these experiences are influenced by hegemonic masculine expectations and the gendered construction of space; to investigate how increased male participation in domestic work during pregnancy relate to and possibly challenge cultural expectations of manhood and womanhood. Methods: A qualitative study combining phenomenological and ethnographic approaches was conducted in Accra and the Afram Plains North District of Ghana. Thirty-one semistructured interviews with fathers, mothers, health workers and background informants, seven focus group discussions with mothers, fathers and community health nurses, and various observations over seven months in Accra and one month in Afram Plains were conducted. Semistructured interviews and focus group discussions used a topic guide that centred on the following key areas: fatherhood and masculine norms and expectations in the Ghanaian social context; men’s roles and responsibilities during pregnancy; men’s practical daily routines during the time of pregnancy; men’s experiences of maternal health services; and social support for expecting nuclear families. Thematic analysis was used to process and analyse the data material. Findings: Article I: This first article explores the transition of young men from boyhood to manhood and its connections to the expectations of becoming and being a father. The findings were framed within the analytical discussion of hegemonic masculinity, postcolonial perspectives of masculinities in Africa, and emergent masculinities. The findings showed that boys are expected to become men by maintaining intimate relationships, providing for their nuclear families and kin, and having biological children. This expectation was described as synonymous with what postcolonial scholars have called adult masculinity. The article further argued that since adult masculinity appeared to be highly valued by the young fathers studied, it could be referred to as the hegemonic masculinity. The narratives additionally indicated that it is becoming expected for men to carry out household chores, show respect and affection for their partners and spend time with their nuclear families. These additional expectations were analysed as elements of involved fatherhood and emergent masculinities. Article II: This second article illuminates the experiences of men who accompanied their expectant partners to antenatal care (ANC) services in Accra. The findings showed that most men who attended ANC with their partners were reluctant to stay in the waiting area of the maternity clinic where services were ongoing because they were shy and uncomfortable about being in a space where women outnumbered men. Men talked about their motivations for attending ANC, which were to learn and remind their partners of essential health messages and to show love, support and respect to pregnant partners. Health workers did not have specific guidelines about the inclusion of men in ANC services, except for giving preferential treatment to women accompanied by men. Discussing the findings with the concept of space, place and gender suggested that the maternity clinic has been constructed as a feminine space over time, limiting men’s integration and participation in the activities that unfold during ANC. Article III: This third article investigates alterations in gendered division of household labour during the time of pregnancy and the potential resistance to permanent changes in conventional gender norms. The findings indicated that men increased their participation in housework during their partner’s pregnancy. Nonetheless, both men and women maintained that men should not carry out most or all the housework because doing so could inspire laziness among women. Thus, both men and women accentuated that men’s participation in domestic work should be a form of support given to expectant mothers when they were tired or experiencing complications, but should not become normative. Using the theories of ‘(un) doing gender’, the article suggested that men’s involvement in housework is a temporary response to a specific life change, which does not seem to imply a possible permanent transformation in the gendered division of household labour. Discussion: The findings of the thesis demonstrate multifaceted involvement of men in the care for their pregnant partners, norms of involved fatherhood, elements of masculinities that do not thrive on the subordination of women, and tentative modifications in the gendered division of household labour during the time of pregnancy. Men played a plethora of roles in the households and in the health facility setting to promote positive health outcomes for their pregnant partners, such as providing financial resources and increasing participation in housework. Male participants also practised or imagined themselves enacting elements of involved fatherhood, which means providing hands-on care for their children, playing with them, and spending quality time with their nuclear families. Hegemonic masculinity, coined as adult masculinity, persisted and is exemplified in the expectation for adult males to maintain stable intimate relationships, provide for their nuclear families, and have biological children. Moreover, men’s roles during pregnancy, like providing financial resources and attending ANC to remind their partners of important health messages and ask questions that their partners could not ask, appeared as further articulations of hegemonic masculinity. Concurrently, men’s expression of the value of conjugal fidelity, the importance they give to showing love and affection for partners, spending time with the nuclear family, and their willingness to perform some amount of housework show emergent masculinities and norms of involved fatherhood. Men and women’s participation at ANC shows that the maternity clinic has been constructed as a feminine space and a ‘third place’ for expectant mothers during the period of pregnancy. Women create social networks and connections during ANC services and discuss their health without the interference of male partners. Although men’s attendance at ANC services is recognised as important for providing physical and emotional support to expectant mothers, policies that incentivise men by giving preferential treatment to women accompanied by their partners are discriminatory against women who attend ANC alone. Hence, men’s active participation in ANC remains a dilemma. Increased men’s attendance and active participation in ANC services may dissolve the maternity clinic as a space where expectant mothers connect with each other and exercise autonomy over their health. At the same time, ineffective engagement of men at ANC services may marginalise men who want to be actively involved and likewise hinder the opportunity to garner men’s support as allies and equal caregivers to pregnant partners. The conceptual framework of ‘(un)doing gender’ was employed to interpret findings concerning transformations of gender relations. Examples of both ‘doing’ and ‘undoing gender’ were encountered in the study findings. Normative gender expectations that were understood as scripts for ‘doing gender’ described men as the key breadwinners and women as responsible for housework, even if women were engaged in income generating activities outside the home. However, during the period of pregnancy, both urban and rural men were willing to intensify their participation in domestic work, which suggests some amount of ‘undoing gender’. There was opposition to prospective long-term adjustments in gender norms. Participants contended that men should not do all or most of the housework because it could generate misunderstandings in intimate relationships and destabilise harmony in the household. It appeared that it is still essential for men and women to accomplish gender in conformity to the male breadwinner and female domestic-caregiver model. Nonetheless, men’s participation in housework during their partner’s pregnancy implies that they may become more skilful and competent in performing housework, and subsequently, perform domestic chores more easily, thereby reducing women’s burden of combining domestic and waged labour. Conclusion: The likely resistance to permanent change in gender norms and practices in the household, even during the time of pregnancy, suggests that involving men in the care for their pregnant partners may not radically transform gender relations. Yet the manifestation of emergent masculinities and norms of involved fatherhood indicate a gradual process of change towards dismantling the unequal gender system.Studiens bakgrunn: Det å involvere menn i omsorgen for sine gravide partnere har blitt beskrevet som en mulighet for å initiere nye farskapsnormer og maskuliniteter som ikke er basert på undertrykkelse av kvinner. Denne forståelsen innebærer at mannlig inkludering i omsorgen for gravide partnere kan inspirere til større likestilling. Studien starter med en kort historisk redegjørelse av familiestrukturer og kjønnsforhold og fokuserer på aktuelle trender for husholdningenes kjønnsrelasjoner og maskuline forventninger i Ghana for å analysere det kjønnstransformerende potensialet for menns engasjement i omsorgen for sine gravide partnere. Studiens mål: Denne studien er styrt av følgende mål som ble tatt opp i tre fagfellevurderte artikler: Å utforske hvordan sosiale forventninger og faktiske farskapspraksiser samhandler med oppfatninger og normer for manndom og maskulinitet; å belyse menns erfaringer med prenatale svangerskapstjenester, og hvordan disse erfaringene påvirkes av hegemoni-baserte maskuline forventninger og kjønnsrelatert konstruksjon av rom; å undersøke hvordan økt mannlig deltakelse i husarbeidet under svangerskapet er relatert til og muligens utfordrer kulturelle forventninger til manndom og kvinnelighet. Metodikk: En kvalitativ studie som kombinerer fenomenologiske og etnografiske tilnærminger ble utført i Accra og Afram Plains North District i Ghana. Det ble gjennomført 31 halvstrukturerte intervjuer med fedre, mødre, helsearbeidere og bakgrunnsinformanter, sju diskusjoner i fokusgrupper med mødre, fedre og helsesøstre, og ulike observasjoner over en periode på sju måneder i Accra samt én måned i Afram Plains. Halvstrukturerte intervjuer og diskusjoner i fokusgrupper brukte en temabasert veiledning som fokuserte på følgende hovedområder: farskap og maskuline normer og forventninger i en sosial sammenheng i Ghana; menns roller og ansvar under svangerskapet; menns praktiske daglige rutiner i løpet av svangerskapet; menns erfaringer med helsetjenestene i forbindelse med svangerskapet og sosial støtte til å skape kjernefamilier. Tematisk analyse ble brukt til å behandle og analysere datamaterialet. Resultatene: Artikkel I: Denne første artikkelen utforsker overgangen unge menn gjennomgår fra barndom til manndom, og sammenhengen denne har til forventningene om å bli og være far. Resultatene ble rammet inn av den analytiske diskusjonen om hegemonisk maskulinitet, postkoloniale perspektiver på maskuliniteter i Afrika og fremvoksende maskuliniteter. Resultatene viste at det forventes at gutter skal bli menn ved å opprettholde nære relasjoner, sørge for kjernefamilien og slektninger og få biologiske barn. Denne forventningen ble beskrevet som synonymt med hva postkoloniale forskere har kalt voksen maskulinitet. Artikkelen hevdet videre at siden voksen maskulinitet så ut til å være høyt verdsatt av de unge fedrene som var med i undersøkelsen, kunne det bli referert til som den hegemoniske maskuliniteten. Fortellingene indikerte i tillegg at det er i ferd med å bli forventet at menn skal utføre husarbeid, vise respekt og hengivenhet ovenfor sine partnere og tilbringe tid med kjernefamilien. Disse ekstra forventningene ble analysert som elementer av involvert farskap og fremvoksende maskuliniteter. Artikkel II: Denne andre artikkelen belyser erfaringene til menn som fulgte sine gravide partnere til svangerskapstjenestene i Accra. Funnene viste at de fleste menn som deltok på disse tjenestene sammen med partnerne sine, var motvillige til å bli igjen i venteområdet på fødeklinikken der tjenestene pågikk siden de var ukomfortable med å være i et rom der kvinner var i flertall. Menn snakket om sine motivasjoner for å delta på svangerskapstjenestene, som var å lære om og minne sine partnere på viktige helserelaterte meldinger samt vise kjærlighet, støtte og respekt til gravide partnere. Helsearbeidere hadde ikke spesifikke retningslinjer for inkludering av menn i svangerskapstjenestene, bortsett fra å gi fortrinn til kvinner som ble ledsaget av menn. Å diskutere resultatene med begrepet rom, sted og kjønn tilsa at fødeklinikken har blitt konstruert som et feminint område over tid, noe som begrenser menns integrasjon og deltakelse i aktivitetene som utfolder seg under svangerskapstjenestene. Artikkel III: Denne tredje artikkelen undersøker endringer i kjønnsrelatert oppdeling av husarbeid under svangerskapet og potensiell motstand mot varige endringer i konvensjonelle kjønnsnormer. Resultatene indikerte at menn økte sin deltakelse i husholdningen under partnerens svangerskap. Likevel hevdet både menn og kvinner at menn ikke skulle utføre det meste eller alt av husarbeid, fordi det kunne føre til latskap blant kvinner. Dermed fremhevet både menn og kvinner at menns deltakelse i hjemmearbeid skulle være en form for støtte gitt til gravide, når de var slitne eller opplevde komplikasjoner, men ikke skulle være det normale. Ved hjelp av teoriene om å «oppheving/skaping av kjønn» antydet artikkelen at menns engasjement i husarbeid er et midlertidig svar på en bestemt livsendring, som ikke synes å innebære en mulig permanent transformasjon i den kjønnsdelte fordelingen av husarbeidet. Diskusjon: Resultatene i avhandlingen viser en involvering av menn med mange fasetter i omsorgen for sine gravide partnere, normer for involvert farskap, elementer av maskuliniteter som ikke blomstrer ved underordning av kvinner, og foreløpige modifikasjoner i kjønnsdelt oppdeling av husarbeid i svangerskapet. Menn hadde en rekke roller i husholdningene og på helseinstitusjonen for å fremme positive helseutfall for sine gravide partnere, for eksempel å stille med økonomiske ressurser og øke deltakelsen i husarbeid. Mannlige deltakere praktiserte eller forestilte seg også at de deltok i et involvert farskap, noe som betyr å gi praktisk omsorg for barna sine, leke med dem og tilbringe kvalitetstid med kjernefamilien. Hegemonisk maskulinitet, også kalt voksen maskulinitet, vedvarte og er eksemplifisert i forventningen om at voksne menn skal opprettholde stabile nære forhold, sørge for kjernefamilien og få biologiske barn. Videre viser menns roller under svangerskapet, som å gi økonomiske ressurser og delta på svangerskapstjenester for å minne sine partnere om viktige helsemeldinger og stille spørsmål som partnerne deres ikke kunne stille, som ytterligere artikulering av hegemonisk maskulinitet. Samtidig viser menns uttrykk for verdien av troskap i ekteskapet, viktigheten de gir til å vise kjærlighet og hengivenhet til partnere, tilbringe tid med kjernefamilien og deres villighet til å utføre en viss mengde husarbeid fremvoksende maskuliniteter og normer for involvert farskap. Menns og kvinners deltakelse på svangerskapstjenestene viser at fødeklinikken er bygget som et feminint område og er en «tredje plass» for gravide mødre i svangerskapsperioden. Kvinner skaper sosiale nettverk og forbindelser under svangerskapstjenester og diskuterer helse uten innblanding fra mannlige partnere. Selv om menns deltakelse på svangerskapstjenestene er anerkjent som viktig for å gi fysisk og emosjonell støtte til vordende mødre, er virkemidler som oppfordrer menn ved å gi fordeler til kvinner som er ledsaget av partneren, diskriminerende ovenfor kvinner som kommer til svangerskapstjenestene alene. Derfor er menns aktive deltakelse i svangerskapstjenestene fortsatt et dilemma. Økt oppmøte fra menn og aktiv deltakelse i svangerskapstjenestene kan føre til at fødeklinikken ikke lenger blir en arena der gravide kvinner får kontakt med hverandre og tar kontroll over egen helse. Samtidig kan svak engasjering av menn i svangerskapstjenestene føre til at menn som ønsker å være aktivt involvert, blir marginalisert og på samme måte hindre muligheten til å sørge for at menn bidrar med støtte og er allierte og likeverdige omsorgspersoner til gravide partnere. Det konseptuelle rammeverket «oppheving/skaping av kjønn» ble brukt til å tolke funn relatert til transformasjoner av kjønnsrelasjoner. Eksempler på både «oppheving» og «skaping av kjønn» ble i funnet studien. Normative kjønnsforventninger som ble forstått som manuskript for å «skape kjønn», beskrev menn som hovedforsørgerne og kvinnene som ansvarlige for husarbeid, selv om kvinner også var engasjert i inntektsgivende aktivitet utenfor hjemmet. Men i svangerskapsperioden var menn både i byer og på landsbygda villige til å øke sin deltakelse i husarbeidet, noe som antyder en viss mengde «oppheving av kjønn». Det var motstand mot potensielle langsiktige tilpasninger av kjønnsnormer. Deltakerne mente at menn ikke skulle gjøre hele eller det meste av husarbeidet fordi det kunne føre til misforståelser i nære forhold og gå utover harmonien i husholdningen. Det så ut til at det fortsatt er viktig for menn og kvinner å sørge for kjønnsrelasjoner som er i tråd med at menn er hovedforsørgeren, mens kvinnen er den primære omsorgspersonen i hjemmet. Likevel innebærer menns deltakelse i husarbeid under partnerens graviditet at de kan bli mer dyktige og kompetente til å utføre husarbeid og deretter utføre husarbeid lettere. Dette vil igjen redusere kvinners byrde med å kombinere arbeidet hjemme med lønnet arbeid. Konklusjon: Den sannsynlige motstanden mot varig endring av kjønnsnormer og praksis i husholdningen, selv under svangerskapet, tyder på at det å involvere menn i omsorgen for sine gravide partnere kanskje ikke radikalt vil forvandle de etablerte kjønnsrollene. Likevel indikerer uttrykket av fremvoksende maskuliniteter og normer for involvert farskap en gradvis endringsprosess og et skifte mot en endring av det skjevdelte kjønnssystemet.Doktorgradsavhandlin

An Analysis of Physical Wellness During Pregnancy

There is a lack of proper physical wellness increasing in society. This qualitative phenomenological study explored physical wellness during pregnancy using the theoretic framework of Social Cognitive Theory to show perceptions and lived experiences of women who are pregnant or who have been pregnant in the past three years. Three research questions were the focus of this qualitative study. RQ1: what aspects of physical wellness are important to women who are pregnant? RQ2: what are women’s physical wellness experiences during pregnancy? RQ3: how are women who are pregnant educated about physical wellness? Ten women in central Florida who are pregnant or have been pregnant in the past three years were used for the sample size. Open-ended semi structured interview questions were used to collect data. The interview was conducted over virtual Teams meeting. The data collected was analyzed by using thematic analysis method for identifying, analyzing, and reporting patterns within data. The results from this study described similar women’s perceptions and experiences of physical wellness during pregnancy. This study is significant because it brings awareness to the importance of physical wellness during pregnancy. This study also adds to the gap in the literature on physical wellness during pregnancy

A Phenomenology of Spiritual and Religious Supports for Female Victims of Intimate Partner Violence

The purpose of this phenomenological study was to understand the lived experiences of Christian female victims of intimate partner violence as they engaged with their religious and spiritual supports through online interviews, journal entries, and focus groups. In this study, existential theory assisted in shaping an understanding of how victims of intimate partner violence interact with spiritual and religious supports to find meaning in their suffering and to identify what Christian women victims of intimate partner violence (IPV) describe as building their resilience and posttraumatic growth. Semi-structured interviews of 9 Christian women over 18 who experienced intimate partner violence were conducted. Secondly, journal entries were collected from the interviewees who were willing to respond to a journal prompt. Lastly, a focus group of 5 of the women who were previously interviewed was conducted in order to gain deeper insights from the participants. Responses from the interviews were coded and a list of significant statements by the participants was developed. Insights from the participants were summarized to offer greater understanding to helpers of intimate partner violence victims

Salutogenesis for thriving societies

Settings are defined by the World Health Organization (1998) as “the place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and well-being.” Such settings range from small-scale home/family to (international) organizations and large cities and thus differ in size, in their degree of formalized organization and their relationships to society. The chapters in Part V review how salutogenesis has been applied to health promotion research and practice in a broad range of settings: organizations in general, schools, higher education, workplace, military settings, neighborhood/communities, cities, and restorative environments. The following synthesis demonstrates that applying salutogenesis to various settings and linking salutogenesis with other models established in these settings has the great potential to generate ideas on how to advance the general salutogenic model

The Handbook of Salutogenesis

This open access book is a thorough update and expansion of the 2017 edition of The Handbook of Salutogenesis, responding to the rapidly growing salutogenesis research and application arena. Revised and updated from the first edition are background and historical chapters that trace the development of the salutogenic model of health and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence that differentiate salutogenesis from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts. Many new chapters emphasize intervention research findings. Readers will find numerous practical examples of how to implement salutogenesis to enhance the health and well-being of families, infants and young children, adolescents, unemployed young people, pre-retirement adults, and older people. A dedicated section addresses how salutogenesis helps tackle vulnerability, with chapters on at-risk children, migrants, prisoners, emergency workers, and disaster-stricken communities. Wide-ranging coverage includes new topics beyond health, like intergroup conflict, politics and policy-making, and architecture. The book also focuses on applying salutogenesis in birth and neonatal care clinics, hospitals and primary care, schools and universities, workplaces, and towns and cities. A special section focuses on developments in salutogenesis methods and theory. With its comprehensive coverage, The Handbook of Salutogenesis, 2nd Edition, is the standard reference for researchers, practitioners, and health policy-makers who wish to have a thorough grounding in the topic. It is also written to support post-graduate education courses and self-study in public health, nursing, psychology, medicine, and social sciences