Fit to conceive? Representations of preconception health in the UK press

The period before conception is increasingly claimed to be of critical importance for pregnancy and birth outcomes, prompting calls for public health advice and interventions to be targeted at women before rather than during pregnancy. Drawing on Foucault’s concepts of governmentality and technologies of the self, this article explores the implications of preconception health messages for women of reproductive age. Following a critical discursive analysis of 57 UK newspaper articles, three dominant representations of preconception health were identified: preconception health as optimizing fertility, as determining infant health, and as point of intervention. I suggest that these representations reflect neoliberal health agendas, positioning women as in control of and responsible for their fertility; the health of their future children, future generations, and of the wider population, all through careful self-policing of their lifestyles. In this way, ‘good’ preconception health is emphasized as an increasingly important form of health citizenship. Furthermore, the analysis highlights the gendered nature of these expectations, with a disproportionate focus on the potential impact of women’s preconception health. Few challenges to these dominant messages were identified, and concerns are raised about the potential impacts on the autonomy and subjectivities of women of reproductive age, regardless of pregnancy intentions

Validating social support and prioritizing maternal wellbeing: beyond intensive mothering and maternal responsibility

In this piece, I reflect on the current model of motherhood that prevails in Western countries, often termed ‘intensive mothering'. I will briefly trace the history of this approach, focusing in particular on how theory from developmental psychology has, to some extent, functioned to reinforce it by foregrounding the mother–child dyad and emphasizing the importance of maternal practices for children's developmental outcomes. I will then consider the particular implications of this cultural approach to motherhood for women's experiences of motherhood and maternal wellbeing. Finally, I reiterate that we need to continue to challenge this western-centric model of motherhood, which risks both isolating and overburdening women, by highlighting the ways in which both women and children benefit from wider social support systems, yet also by making it permissible for women to access social support without compromising a ‘good mother' identity. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health'

‘Surely a little discretion isn’t too difficult’? The discursive construction of discretion in users’ comments on UK newspaper articles about public breastfeeding

Objective This paper explores how discourses of discretion are constructed in online discussions about breastfeeding in public. Method and Measures We analysed 4204 online newspaper comment threads from 15 UK-based publications using Discursive Psychology. We explored how discretion was constructed and mobilised to facilitate discourses of breastfeeding in public. Results Indiscretion was used to construct dispositional traits of mothers typically associated with sexualised, immoral female behaviour and therefore incompatible with ‘good’ motherhood. Responsibility for preventing public upset was placed on breastfeeding mothers, whilst discretion was constructed as easily achievable, and therefore a reasonable expectation. By implication, women who chose not to be discreet, were constructed as deliberately provocative, and so not entitled to claim or protest negative treatment. Notably, within our data the relevance of discretion when breastfeeding in public appeared discursively difficult to reject or challenge. Conclusion Our findings confirm empirically that support for public breastfeeding is constructed as contingent on mothers displaying discretion. Our analysis highlights the challenges for mothers and babies for whom breastfeeding is compromised by an unwillingness to feed in public, perhaps due to pervasive constructions of breastfeeding women as selfish, exhibitionist, inconsiderate and unfit mothers in public discourse. Finally, our findings demonstrate the practical accomplishment in everyday life of the type of constructions of breastfeeding women that have been powerfully conceptualised by previous researchers

“Hang in there mama!”: The role of online parenting forums in maternal mental health

The perinatal period can be challenging and yet reluctance to disclose wellbeing concerns to health professionals is well documented. The current study sought to explore how women use online parenting forums to seek advice and support for maternal mental health concerns. Forum threads (n = 153) from a popular UK parenting website were analysed to explore postpartum mothers’ discussions about their maternal mental health. Through reflexive thematic analysis, four themes were generated: (1) Navigating the motherhood role: unprepared and overwhelmed; (2) ‘I’m struggling, but looking on here I know I’m no way alone!’; (3) Challenging feelings of failure: ‘it doesn’t make you a bad mother’; and (4) Forums facilitate help seeking. There were two main findings; first, forums may act as a potential solution to providing a supportive, reassuring community and safe space for disclosure around maternal mental health concerns. Furthermore, forums are beneficial in providing women with an honest, realistic view and expectation of motherhood, thus supporting their transition to parenthood. Consequently, forums could be utilised to inform training for healthcare professionals to understand disclosure barriers

"There are hundreds of thousands online waiting to hold your hand through difficult times”: experiences of using online parenting forums to support postpartum mental health and wellbeing.

Background and aims: Internet use in new mothers is common, with increasing numbers of women seeking support online in lieu of consulting health professionals. The current study sought to explore women’s experiences of using online parenting forums to seek advice and support for their maternal mental health. Although benefits of virtual support have previously been highlighted, little research has examined any potential harmful consequences of utilising online forum support for mental health concerns. Methods: New mothers (n=70) completed an online survey as a qualitative account of their motivations for, and experiences of, using online forums. Additionally, mothers were questioned about their experiences of healthcare professional support. Findings: Through reflexive thematic analysis, four themes were generated: (1) The value of shared experiences and empathy; (2) Forum dynamics – a double edged sword; (3) Contextual challenges and opportunities; and (4) Inconsistency of HCP support – the need for an instant solution. Findings emphasised the importance, and effectiveness, of this kind of virtual peer support that forums provide. For many, the responses indicated that forums have a great potential to foster an atmosphere of supportive and helpful feedback, creating a (self-reported) positive impact on postnatal mental health. However, the fact that some women experienced negative feedback led to feelings of motherhood failure on some occasions, and avoidance of posting through fear of negative responses. Conclusion and implications: These findings could inform future decisions made by both parenting website providers and healthcare professionals in making support for mothers more effective and accessible. These may include considerations around the integration of online and offline support services, and the potential increase in trained peer supporters working with mothers

A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis

BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women’s QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms ‘EHP30’, ‘EHP5’, ‘EHP-30’, ‘EHP-5’, ‘endometriosis health profile 30’, and ‘endometriosis health profile 5’. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs’ robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the ‘control and powerlessness’ domain post-intervention, followed by ‘pain’. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research

Transformation, adaptation and development: relating concepts to practice

In recent years there has been a growing number of academic reviews discussing the theme of transformation and its association with adaptation to climate change. On the one hand this has stimulated exchange of ideas and perspectives on the parameters of transformation, but it has also given rise to confusion in terms of identifying what constitutes a non-incremental form of adaptation on the ground. What this article aims to do instead is help researchers and practitioners relate different interpretations of transformation to practice by proposing a typological framework for categorising forms of change that focuses on mechanisms and objectives. It then discusses how these categorisations link to the broader conceptions and critiques noted above, with the idea that this will enable those who seek to analyse or plan adaptation to better analyse what types of action are potentially constitutive of transformation. In doing so, it should equally assist in the identification and specification of critical questions that need to be asked of such activity in relation to issues of sustainability and equity. As the term transformation gains ground in discussions of climate change adaptation, it is necessary to take a step back, review quite what commentators mean when they use the word, and consider the implications on people, especially the most vulnerable and marginalised, of “doing” or promoting transformation in its different forms

Applying Critical Discursive Psychology to Health Psychology Research: A practical guide

This paper outlines a qualitative methodological approach called Critical Discursive Psychology (CDP), considering its applicability to health psychology research. As applied to health psychology, the growth of discursive methodologies within the discipline tends to be located within a critical health psychology approach (Lyons & Chamberlain, 2006; Murray, 2014) where CDP and others enable a consideration of how wider societal discourses shape understandings and experiences of health and illness. Despite the increasing usage of CDP as a methodology, little has been written on the practical application of the method to date, with papers instead focusing on the theoretical underpinnings of a CDP approach. This paper seeks to address that gap and offers a step by step guide to the key principles and analytic stages of CDP before giving a worked example of CDP applied to a health topic, in this case ‘baby-led weaning’ (BLW). As we discuss, a key strength of CDP, particularly in relation to health psychology, is in its attempts to understand both macro and micro levels of data analysis. By doing so it offers a nuanced and richer understanding of how particular health topics are working within context. Therefore, CDP is a readily applicable analytic approach to contested and complicated topic areas within health research

Later life sex and Rubin’s ‘Charmed Circle'

Gayle Rubin’s now classic concept of the ‘charmed circle’ has been much used by scholars of sexuality to discuss the ways in which some types of sex are privileged over others. In this paper, I apply the concept of the charmed circle to a new topic– later life – in order both to add to theory about later life sex and to add an older-age lens to thinking about sex hierarchies. Traditional discursive resources around older people’s sexual activities, which treat older people’s sex as inherently beyond the charmed circle, now coexist with new imperatives for older people to remain sexually active as part of a wider project of ‘successful’ or ‘active’ ageing. Drawing on the now-substantial academic literature about later life sex, I discuss some of the ways in which redrawing the charmed circle to include some older people’s sex may paradoxically entail the use of technologies beyond the charmed circle of ‘good, normal, natural, blessed’ sex. Sex in later life also generates some noteworthy inversions in which types of sex are privileged and which treated as less desirable, in relation to marriage and procreation. Ageing may, furthermore, make available new possibilities to redefine what constitutes ‘good’ sex and to refuse compulsory sexuality altogether, without encountering stigma