Monday, 30 November 2015

JHRU researchers on the impacts of fertility and infertility

This article was originally published in International Innovation Issue 186.

Dr Karin Hammarberg and her colleagues were featured recently in International Innovation with a special focus edition on maternity, fertility and child health research. Dr Hammerberg and colleagues make up an innovative partnership that addresses gaps in knowledge about women’s health in relation to fertility, infertility and childbearing issues. Here, they discuss some of the most interesting aspects of their work.

Q: Could you begin by introducing the partnership and outlining some of its benefits?

Professor Jane Fisher: The Jean Hailes Research Unit (JHRU) is an innovative formal partnership between the School of Public Health and Preventive Medicine at Monash University and a community-based not-for-profit organisation – Jean Hailes for Women’s Health – which provides knowledge translation and multidisciplinary clinical care. Staff and students are drawn from diverse disciplinary backgrounds including biological sciences, education, epidemiology, gender studies, implementation science, nursing, clinical and health psychology, psychiatry, pharmacy, public health, sociology and statistics.

Dr Janet Michelmore: The partnership enables research to factor in community perspectives, which are translated to inform national policy and practice, and made accessible in multiple formats to women, their families and their healthcare providers.

Q: What have you found in your work to elucidate and respond to mental health problems among women who have recently given birth and their partners?

Dr Jane Fisher: Mental health problems, including depressive, anxiety and adjustment disorders, are experienced by about one in five women who have recently given birth in high-income countries, and are predominantly socially determined. We have found that unsettled infant behaviours including prolonged crying, difficulties in settling to sleep and frequent waking contribute to diminished confidence, severe fatigue and lowered mood among mothers. This predicament is made worse if the intimate partner is regarded as critical, lacking in empathy and holding rigid gender stereotypes.

Dr Karen Wynter: Our research has identified that almost one in five new fathers report adjustment difficulties in the first six months after birth. New fathers who perceive their partner as critical and controlling are more likely to experience psychological difficulties and feel less emotionally attached to their baby.

Q: Can such mental health problems be prevented?

Dr Jane Fisher: We have developed a gender-informed psycho-educational programme called ‘What Were We Thinking!’ to prevent mental health problems among first-time mothers and fathers by addressing modifiable risk factors directly.

Dr Heather Rowe: The programme has two components: About Babies teaches parents how to understand infant crying and sleeping and to use sustainable settling strategies; About Parents teaches parents how to understand each other’s changed needs and to renegotiate roles and responsibilities without conflict.

Parents evaluate the programme as highly relevant, useful and understandable. Importantly, there are fewer mental health problems in the first six postpartum months among those who have completed it compared to those who receive the usual care.

Q: You have conducted research on the impact of maternal mental health in resource constrained settings. What have you found?

Dr Thach Tran: We have a research programme in Vietnam to provide local evidence and inform interventions. Our research found that common mental disorders are far more prevalent among women who are pregnant or have recently given birth in low-income countries. Risks include poverty and family violence. Women with these problems are significantly less likely to use the recommended supplements to combat micronutrient deficiencies.
Our 15-year programme has brought this burden to the attention of policy makers and is informing local strategies to integrate mental health into pregnancy and primary healthcare programmes.

Dr Karin Hammarberg: The consequences of childlessness are very severe in low-income countries, especially for women. We are contributing to a collaborative effort to establish the first reproductive health centre in a public hospital in Addis Ababa, Ethiopia. The centre will provide comprehensive reproductive healthcare which will include infertility care and low-cost assisted reproductive technologies treatment.

Q: Part of your team has undertaken a project called ‘Understanding fertility management in contemporary Australia’. Could you introduce this work?

Dr Sara Holton: To inform health promotion, policy and clinical practice we partnered with Victoria’s Department of Health, Family Planning Victoria, Melbourne IVF and the Royal Women’s Hospital to investigate how people manage their fertility over a lifetime and to use that knowledge to develop relevant health promotion strategies.
We collected comprehensive quantitative and qualitative data about reproductive experiences and outcomes and identified inequalities in effective fertility management that are amenable to change. For example, the experience of unintended pregnancy was associated with rural residence and lower socioeconomic position.

Dr Maggie Kirkman: In interviews, we have heard people’s accounts of a range of fertility related experiences including infertility, unintended pregnancy, abortion, miscarriages and childbearing. Women have told us about sexual abuse that has made it hard for them to have a relationship in which they can trust enough to have enjoyable sex and to contemplate conception.

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