"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine.

BACKGROUND: After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging. AIM: To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. METHODS: Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. RESULTS: We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. CONCLUSIONS: The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.

Childcare burden and changes in fertility desires of mothers during the COVID-19 pandemic.

Objectives: Previous studies have documented a decline in fertility desires and intentions following the COVID-19 outbreak, but the reasons for this decline are not well understood. This study examined whether childcare burden on mothers during the lockdown and quarantines, COVID-related stress, and COVID exposure were associated with a change in the desired number of children. Methods: The survey was conducted online, in Poland from April to July 2021 on a sample of 622 non-pregnant mothers without diagnosed infertility. Results: Associations were observed between childcare responsibilities during the quarantine and fertility desires: mothers who solely or mainly took care of their children during the quarantine(s) were more likely to decrease their desired number of children ([adjusted] aOR = 1.91, 95% CI = 1.16-3.15). Mothers with higher levels of COVID-related stress (aOR = 1.81, 95% CI = 1.48-2.22) and a greater COVID exposure index (aOR = 1.39, 95% CI = 1.12-1.72) were more likely to decrease their fertility desires. Conclusion: Higher childcare burden during quarantines was related to a lower desired number of children among mothers. Both greater COVID-related stress and COVID exposure were associated with fertility desires, regardless of childcare responsibilities during the pandemic.

Investment in the peace of mind? How private services change the landscape of maternity care in Poland.

For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable through public services, continuity of care became commercialized and can be access as a private service. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.

Early-life adversities and later-life reproductive patterns in women with fully traced reproductive history.

One of the most crucial determinants of early-life development is the experience of childhood adversities. However, limited evidence is available for how these experiences shape later-life reproductive outcomes in women. Here we test the association between early-life adversities and reproductive parameters in women. Post-reproductive women (N = 105; mean age = 59.7; SD = 10.09) were recruited at the Mogielica Human Ecology Study Site in Poland within a traditional population with a low prevalence of birth control usage and fully traced reproductive histories. Reproductive parameters, as well as exposure to early-life abuse and neglect, were assessed using questionnaires. Childhood adversity was associated negatively with age at menarche (p = 0.009). Analyses on specific subtypes revealed that compared to women who did not experience any kind of early-life adversities in childhood, those who were exposed to emotional (p = 0.007) and physical (p = 0.023) neglect had an earlier age at menarche, those who experienced emotional abuse reported an earlier age at first birth (p = 0.035), and those who were exposed to physical abuse gave birth to fewer number of sons (p = 0.010). Our results suggest that women exposed to childhood adversities experience earlier physiological reproductive readiness and timing of the first birth, but their overall biological condition might be impaired as they bear fewer sons.

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland.

Background and objectives: Birth is a critical event in women's lives. Since humans have evolved to give birth in the context of social support, not having it in modern settings might lead to more complications during birth. Our aim was to model how emotional factors and medical interventions related to birth outcomes in hospital settings in Poland, where c-section rates have doubled in the last decade. Methodology: We analysed data from 2363 low-risk primiparous women who went into labor with the intention of giving birth vaginally. We used a model comparison approach to examine the relationship between emotional and medical variables and birth outcome (vaginal or c-section), including sociodemographic control variables in all models. Results: A model with emotional factors better explained the data than a control model (ΔAIC = 470.8); women with continuous personal support during labor had lower odds of a c-section compared to those attended by hospital staff only (OR = 0.12, 95% CI = 0.09 - 0.16). A model that included medical interventions also better explained the data than a control model (ΔAIC = 133.6); women given epidurals, in particular, had increased odds of a c-section over those who were not (OR = 3.55, 95% CI = 2.95 - 4.27). The best model included variables for both the level of personal support and the use of epidural (ΔAIC = 598.0). Conclusions and implications: Continuous personal support during childbirth may be an evolutionarily informed strategy for reducing complications, including one of the most common obstetrical complications in modern hospital settings, the c-section.

The age at first reproduction as a potential mediator between facial fluctuating asymmetry and reproductive success in women.

OBJECTIVES: The level of fluctuating asymmetry is suggested as a putative signal of developmental stability, thus according to this theoretical framework more symmetric individuals should be in better biological condition and have greater reproductive potential. Here we hypothesize that women with more symmetric faces have more successful reproduction. METHODS: Data were collected from 164 postmenopausal Polish women. Facial photographs were taken and the overall facial asymmetry (OFA) was calculated. The associations between the OFA and reproductive parameters were analyzed using multiple regression models. Furthermore, the mediation analysis was conducted to test for the indirect effects of the OFA on reproductive success. RESULTS: There was a statistically significant relationship between the OFA and the number of children born, which was mediated by the age at first reproduction (p = 0.03), however, the size of the effect was rather low. Women with more symmetric faces had an earlier age at first reproduction and, in consequence, a greater number of children. DISCUSSION: As fluctuating asymmetry is suggested to be established in utero, these findings shed light on the possible life-long importance of developmental conditions in shaping women's reproductive potential and performance.

From January to June: Birth seasonality across two centuries in a rural Polish community.

Seasonality of births is a worldwide phenomenon, but the mechanisms behind it remain insufficiently explored. Birth seasonality is likely to be driven by seasonal changes in women's fecundity (i.e. ability to conceive), which is strongly influenced by their energetic status. We tested whether birth seasonality is driven by high workload and/or low access to food using 200 years of birth data, from 1782 until 2004, in an agricultural rural Polish community. First, we analysed the time series of births and within-annual variance in births, a proxy for the extent of seasonality. Secondly, we tested the hypothesis that a high agricultural workload and/or low access to food decreases number of births. We found seasonality of births throughout more than 200 years of observation in an agricultural Polish population, with a dominant birth seasonality in January and February which gradually shifted towards June in the late twentieth century. The observed pattern does not support the hypothesis that birth seasonality resulted from women's energetic status. We discuss the possible reasons why our results do not support the tested hypothesis and some implications for our understanding of the birth seasonality.

Inflammaging: Blame the sons. Relationships between the number of sons and the level of inflammatory mediators among post-reproductive women.

OBJECTIVES: Reproduction is costly, but sons and daughters differently influence maternal physiology, also in older age. In particular, having sons may negatively influence maternal health and may be associated with a shorter life span of mothers. Sons may also contribute to increased inflammaging, a chronic sub-clinical systemic inflammatory state characterized by elevated levels of serum inflammatory mediators. The aim of this study was to examine the impact of the total number of children, and the number of daughters and sons separately on concentrations of C-reactive protein (CRP), and proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS: The participants were 378 women aged 45-92 who had 3.9 (SD 2.12, median = 4, range = 0-13) children, including 2.1 (SD 1.46, median = 2, range = 0-8) sons and 1.8 (SD 1.44, median = 2, range = 0-7) daughters on average. RESULTS: We found a positive relationship between the overall number of children and IL-6 levels. CRP and IL-6 concentrations were positively associated with the number of sons but not with the number of daughters. Each son increased maternal CRP level by 11%, and IL-6 level by 6%. Neither the total number of children nor the number of daughters or sons were related to the TNF-α concentration. DISCUSSION: Aging-associated inflammation in post-reproductive mothers with a higher number of sons supports the hypothesis of trade-offs between reproduction and health. Furthermore, these results provide new evidence contributing to the idea that having sons may have more detrimental effects on the maternal organism than having daughters.

Digit ratio (2D:4D) is not related to cardiovascular diseases or their risk factors in menopausal women.

OBJECTIVES: Digit ratio (2D:4D) is widely used as a biomarker of prenatal hormonal environment linked to the growing number of adult health and disease-related characteristics. It has been suggested that 2D:4D is a good predictor of cardiovascular diseases (CVD) risk among men, but results in women are still inconclusive. Here we test the relationship between 2D:4D and the incidence of cardiovascular diseases (CVD), and their risk factors in Polish, rural women. METHODS: The participants were 410 women age 50 and older. Structured questionnaire was used to gather personal and medical data, including the history of CVD diagnosed by a medical doctor. Anthropometric measurements of body height, weight, and finger lengths were performed. Right-hand and left-hand 2D:4D, mean 2D:4D, Dl-r , and BMI were calculated afterward. For a subgroup of participants (n = 329) fasting blood sample was collected (in order to assess the lipid profile and glucose levels) and blood pressure was measured. Age, education level and BMI were included as potential covariates. RESULTS: No statistically significant association was observed between 2D:4D markers and the incidence of CVD (eg, heart attack, stroke) or CVD risk factors (dyslipidaemia, dysglycaemia or hypertension), when controlled for age, education and BMI. CONCLUSIONS: The results of our study add to the growing number of studies investigating the sex-difference of the association between 2D:4D and cardiac health. We conclude that from a public health perspective 2D:4D may not be a valuable biomarker of elevated risk of CVDs in women.

Biomarkers of fetal conditions: Finger ridge-counts, facial fluctuating asymmetry, and digit ratio (2D:4D)-are they correlated in women?

OBJECTIVES: Fetal environmental conditions are crucial for life-long health. Direct measurements of developmental conditions are limited in humans; thus, several biomarkers of those conditions have been proposed: that is, finger ridge-counts, level of facial fluctuating asymmetry (FA), and digit ratio (2D:4D). Since all of these biomarkers share a similar gestational time of formation, we hypothesize that their values are significantly correlated. MATERIALS AND METHODS: Data were collected at the Mogielica Human Ecology Study Site in southern Poland among 234 women. Finger ridge-counts, level of facial FA, and 2D:4D have been measured. The two-step analyses included Pearson's correlations of simple values of the biomarkers and correlations of composite variables calculated based on principal component analysis. RESULTS: We did not find any statistically significant correlations between finger ridge-counts, FA, and 2D:4D in women. Similarly, we did not observe any correlations between three composites created from the biomarkers. DISCUSSION: Our results indicate that there are no relationships between the biomarkers, suggested as proxies of the quality of prenatal conditions, in a single population. This is the first study analyzing three different markers simultaneously. The lack of correlations may indicate that the tested biomarkers reflect, in fact, different environmental conditions, occurring in separate "critical windows" of development, or that the biomarkers are not valid as proxies of developmental conditions.

Season of birth and biomarkers of early-life environment.

OBJECTIVE: Early-life conditions play an important role in human development, affecting health status and survival. Conditions in utero partly depend on the external environment and thus vary in relation to the season of birth. The aim of this study was to investigate if people born in different seasons of the year differ in values of biomarkers that reflect conditions during fetal development. METHODS: The study was conducted among Polish rural women recruited at the Mogielica Human Ecology Study Site. The participants were 234 women aged 45 to 92 (mean = 60.2; SD = 10.44). The indicators of early-life environment analyzed in the study were: Absolute Finger Ridge Count (AFRC), the difference between mean number of ridge counts in both thumbs and both little fingers (Md15), overall facial fluctuating asymmetry (OFA), central facial asymmetry (CFA), right and left hand 2D:4D. RESULTS: Values of biomarkers of fetal development did not vary among groups of women born in different seasons of the year. CONCLUSIONS: Lack of differences in values of biomarkers according to birth season may indicate that: (a) season of birth is not a good indicator of early-life conditions; (b) tested biomarkers do not reliably reflect the prenatal environment; (c) season of birth does not fully overlap with the sensitive periods of biomarker development and thus fails to capture differences in developmental conditions.

Accelerated senescence as a cost of reproduction: Testing associations between oxidative stress and reproductive effort in rural and urban women.

OBJECTIVES: Oxidative stress is hypothesized to contribute to age-related somatic deterioration. Both reproductive and ecological context may necessitate tradeoffs that influence this outcome. We examined whether measures of lifetime reproductive effort were related to levels of oxidative stress biomarkers in peri- and post-menopausal women and whether associations were moderated by rural or urban residence. METHODS: We surveyed 263 healthy women (age 62.1 ± 10.0 SD) from rural (N = 161) and urban Poland (N = 102), collecting sociodemographic data and urine samples to analyze biomarkers of oxidative stress (8-oxo-2'-deoxyguanosine, 8-OHdG) and antioxidative defense (copper-zinc superoxide dismutase, Cu-Zn SOD). Linear regression models, adjusted for residence, were used to test for associations between reproductive effort and 8-OHdG and Cu-Zn SOD. RESULTS: Univariate models demonstrated significant associations between gravidity and the biomarkers of oxidative stress (8-OHdG: R2  = 0.042, P ≤ .001; Cu-Zn SOD: R2  = 0.123, P ≤ .001). Multivariate models incorporating potential confounding variables, as well as cross-product interaction terms, indicated that gravidity was associated with 8-OHdG (P < .01, R2 adj  = 0.067) and Cu-Zn SOD (P = .01, R2 adj  = 0.159). Residence (ie, urban vs rural) did not significantly moderate the associations between the biomarkers and reproductive effort. CONCLUSIONS: Higher lifetime reproductive effort contributes to increases in oxidative stress and antioxidative defenses. Our results provide evidence of potential mechanisms underlying the physiological tradeoffs influencing senescence for women with high reproductive effort. We illustrate the value of applying an evolutionary perspective to elucidate variation in human health and senescence.

Sons May Be Bad for Maternal Health at Older Age: New Evidence for Costs of Reproduction in Humans.

High investment in reproductive processes at the expense of other physiological functions may result in poor maternal health. Health status at older age can be reliably assessed by self-rated health, which is a strong predictor of mortality. We investigated trade-offs between reproduction and health by analysing relationships between self-rated health and the total number of children ever born by a woman, and the number of her sons and daughters among 559 post-reproductive women aged 45-92 from Poland. The number of sons, but not the number of daughters or the total number of children, was significantly associated with self-rated health, adjusted to potential confounders (age, education, marital status, current smoking, and body mass index). Each son increased the odds of reporting poor health by 11% (odds ratio = 0.89; 95% confidence interval = 0.81-0.99). Sons are more energetically and immunologically demanding for the maternal organism which may explain why having sons has more negative influence on maternal health in older age than having daughters. In order to understand trade-offs between reproduction and maternal health not only the total number of children but also sex of the children should be taken into account.

Early-life environment and differences in costs of reproduction in a preindustrial human population.

Reproduction is predicted to trade-off with long-term maternal survival, but the survival costs often vary between individuals, cohorts and populations, limiting our understanding of this trade-off, which is central to life-history theory. One potential factor generating variation in reproductive costs is variation in developmental conditions, but the role of early-life environment in modifying the reproduction-survival trade-off has rarely been investigated. We quantified the effect of early-life environment on the trade-off between female reproduction and survival in pre-industrial humans by analysing individual-based life-history data for >80 birth cohorts collected from Finnish church records, and between-year variation in local crop yields, annual spring temperature, and infant mortality as proxies of early-life environment. We predicted that women born during poor environmental conditions would show higher costs of reproduction in terms of survival compared to women born in better conditions. We found profound variation between the studied cohorts in the correlation between reproduction and longevity and in the early-life environment these cohorts were exposed to, but no evidence that differences in early-life environment or access to wealth affected the trade-off between reproduction and survival. Our results therefore do not support the hypothesis that differences in developmental conditions underlie the observed heterogeneity in reproduction-survival trade-off between individuals.

Age difference between parents influences parity and number of sons.

OBJECTIVES: Among couples, women usually prefer slightly older men, and men tend to choose much younger partners. Age difference between partners has been shown to influence their parity; however, results of previous studies are inconsistent. This study analyzed relationships between husband and wife age difference and their total number of children, and number of daughters and sons in a contemporary, rural Polish population. METHODS: Demographic and reproductive data were collected from 384 postmenopausal women from rural Poland who were married only once. Regression models were used to evaluate the impact of the age gap between partners on total number of children and on number of daughters and sons. Women's age, age at marriage (as an indicator of reproductive value), and years of education were used in analyzes as potential confounders. RESULTS: There was an inverted U-shape association between parental age difference and number of children and also the number of sons. The highest number of children and sons was observed when men were approximately 6.5 years older than their wives. There was no significant relationship between parental age difference and number of daughters. CONCLUSIONS: Age difference between partners is important for reproductive success (with younger wives having higher reproductive potential) and is also related to number of sons. Older husbands might provide more resources for the family, thus facilitating production of well-nourished male offspring. Future research should evaluate not only number of children but also their biological condition, health, and lifetime achievements in relation to the age difference between their parents.

Costs of reproduction are reflected in women's faces: Post-menopausal women with fewer children are perceived as more attractive, healthier and younger than women with more children.

OBJECTIVES: The costs associated with reproduction (i.e., gestation, lactation, childcare) have long-term negative consequences by elevating risk of disease and reducing lifespan. We tested the hypotheses that high parity, and thus high reproductive costs bear by women, is perceived by other people when they evaluate facial appearance of health, attractiveness and age of mothers. MATERIALS AND METHODS: Using computer software we created average facial images based on real photographs of post-menopausal women with varying number of children; 3 parity categories were created (1-2, 4-5, and 7-9 children). Study participants (N = 571) were asked to choose the face they perceived as more attractive, younger and healthier via two-alternative forced choice questions asked in three randomized blocks. RESULTS: Women who had given birth to fewer children were judged both by men and women as more attractive, younger and healthier than women with more children. In each category the lowest scores were received by women from highest parity category (7-9 children). DISCUSSION: Mechanisms behind the observed variation in facial appearance are not known but higher levels of oxidative stress among women with high parity may explain their faster aging and lower attractiveness in older age. These results suggest that costs of reproduction might affect women's physical appearance.

Women with more feminine digit ratio (2D:4D) have higher reproductive success.

OBJECTIVES: Prenatal development has a long-lasting influence on biological condition and health. Second-to-fourth digit ratio (2D:4D) is suggested as an indicator of sex hormone exposure during fetal development, and it is likely that women with a more feminine digit ratio were exposed to higher prenatal estrogen levels. Therefore, we tested if 2D:4D was related to a woman's reproductive characteristics. METHODS: We studied 319 women aged 46-92, who went through a natural menopause and whose husbands were alive at least until their menopause were studied. Women were recruited at the Mogielica Human Ecology Study Site located in rural Poland. RESULTS: Women with more feminine 2D:4D had a higher number of children (P = 0.002), gave birth to their last child at a later age (P = 0.02), and had a longer reproductive lifespan (P = 0.04) than women with more masculine 2D:4D. Age and number of years of education were included as potential confounders in the analyses. CONCLUSIONS: The results indicated that women with more feminine 2D:4D had higher reproductive success. While the exact mechanisms were not known, and the relationship between 2D:4D and adult sex hormone levels was questioned by previous studies, there might be other biological pathways explaining the observed results, that is, via behaviors that were indirectly related to fertility. Am J Phys Anthropol 160:549-553, 2016. © 2016 Wiley Periodicals, Inc.

Why do women stop reproducing before menopause? A life-history approach to age at last birth.

Evolutionary biologists have long considered menopause to be a fundamental puzzle in understanding human fertility behaviour, as post-menopausal women are no longer physiologically capable of direct reproduction. Menopause typically occurs between 45 and 55 years of age, but across cultures and history, women often stop reproducing many years before menopause. Unlike age at first reproduction or even birth spacing, a woman nearing the end of her reproductive cycle is able to reflect upon the offspring she already has--their numbers and phenotypic qualities, including sexes. This paper reviews demographic data on age at last birth both across and within societies, and also presents a case study of age at last birth in rural Bangladeshi women. In this Bangladeshi sample, age at last birth preceded age at menopause by an average of 11 years, with marked variation around that mean, even during a period of high fertility. Moreover, age at last birth was not strongly related to age at menopause. Our literature review and case study provide evidence that stopping behaviour needs to be more closely examined as an important part of human reproductive strategies and life-history theory. Menopause may be a final marker of permanent reproductive cessation, but it is only one piece of the evolutionary puzzle.

The Paternal Provisioning Hypothesis: effects of workload and testosterone production on men's musculature.

OBJECTIVES: Testosterone supports male reproduction through a broad range of behavioral and physiological effects, including the maintenance of sexually dimorphic muscle used in male-male competition. Although it is often assumed that a persistent relationship exists between men's testosterone production and musculature, most studies either fail to find evidence for such a relationship, or document very weak associations. In nonhuman primates, by contrast, correlations between testosterone and muscle mass are higher. Here, we propose the "Paternal Provisioning Hypothesis," which predicts that men's skeletal muscle is less dependent on the effects of androgens than that of other primates, and more sensitive to the physical demands of men's work. This permits human fathers to downregulate testosterone, which has negative impacts on pair-bonding and parenting effort, but without sacrificing the strength and musculature necessary to provision mates and offspring. METHODS: We tested predictions of the Paternal Provisioning Hypothesis by assessing parental status, salivary testosterone levels, anthropometry, and strength among 122 men (ages 18-78) at the Mogielica Human Ecology Study Site in rural Poland. We chose this population because men practice subsistence agriculture, regularly engaging in physically demanding labor. Grip and chest strength were assessed using a dynamometer, and upper-body musculature was estimated from arm muscle circumference. RESULTS: In this population, testosterone showed no association with measures of strength or musculature, and was lower in older men and pair-bonded fathers. Marital and parental status and workload, by contrast, were positive predictors of muscle mass and strength measures. DISCUSSION: These findings offer support for the Paternal Provisioning Hypothesis.