Promoting empowerment or intensifying reproductive burden? Accounts of preconception health adjustments among women trying to conceive.

OBJECTIVE: Women's preconception health is increasingly viewed as playing a critical role in pregnancy and birth outcomes and is becoming an increasing focus of public health messages within the UK and internationally. However, little is known about how women respond to and are impacted by preconception health messages as they try to conceive a baby. METHODS: Reflexive Thematic Analysis was used to analyse 193 responses from women in the UK to a qualitative survey on experiences of trying to conceive. As part of the survey women were asked to reflect on their engagement with preconception health practices. RESULTS: Three themes were generated: 1) Being fit for conception; 2) Preconception health and emotional labour, and 3) Interrogating preconception health expectations. CONCLUSION: The findings demonstrate that whilst engagement with preconception health changes was empowering for some, more troubling implications included: heightened self-surveillance, stress, risks to wellbeing, and feelings of responsibility for poor outcomes. This demonstrates the importance of considering the unintended consequences of preconception health messaging in the shape of increased 'reproductive burden'. Furthermore, future development of preconception health policy and practice must also consider women's access to psychological support when trying to conceive.

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.

'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.

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'.

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 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.