Double Trouble: The Burden of Child-rearing and Working on Maternal Mortality

Relational vulnerability in motherhood-an existential perspective on pain and exhaustion among women

Introduction

Stress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women's sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women's suffering. But knowledge on women's experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood.

Methods

Ricoeur's interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion.

Results

These women's experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women's suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

Gender in the disclosure of loneliness on Twitter during COVID-19 lockdowns

Introduction

Loneliness has been shown to affect both mental and physical health, and was a major concern even before the COVID-19 pandemic. During the COVID-19 distancing measures, millions of people took to social media to express their feelings and seek social support.

Methods

In this mixed-methods study, we examine the self-disclosure of loneliness by users identifying as male or female (via self-disclosed naming conventions) on Twitter before and during the COVID-19 "lockdowns."

Results

We show that in the first two months of COVID-19 restrictions, self-disclosure of loneliness on this platform rose dramatically, and also have changed qualitatively. We find that female accounts tend to post more loneliness self-disclosures compared to male ones, even before COVID. Female disclosures more often center around pregnancy, family, and close relationships, whereas those posted by the male ones are more related to leadership, video gaming and sex. During COVID lockdowns, female accounts turn to online messaging apps and hobbies, and male become increasingly vocal in seeking partners.

Discussion

The insights of this study have important implications for the design of interventions for lessening the burden of loneliness in the current digitized world.

Does Early Childhood BCG Vaccination Improve Survival to Midlife in a Population With a Low Tuberculosis Prevalence? Quasi-experimental Evidence on Nonspecific Effects From 32 Swedish Birth Cohorts

The Bacillus Calmette-Guérin (BCG) vaccine for tuberculosis (TB) is widely used globally. Many high-income countries discontinued nationwide vaccination policies starting in the 1980s as the TB prevalence decreased. However, there is continued scientific interest in whether the general childhood immunity boost conferred by the BCG vaccination impacts adult health and mortality in low-TB contexts (known as nonspecific effects). While recent studies have found evidence of an association between BCG vaccination and survival to ages 34-45, it is unclear whether these associations are causal or driven by the unobserved characteristics of those who chose to voluntarily vaccinate. We use the abrupt discontinuation of mandatory BCG vaccination in Sweden in 1975 as a natural experiment to estimate the causal nonspecific effect of the BCG vaccine on cohort survival to midlife. Applying two complementary study designs, we find no evidence that survival to age 40 was affected by the discontinuation of childhood BCG vaccination. The results are consistent among both males and females and are robust to several sensitivity tests. Overall, despite prior correlational studies suggesting large nonspecific effects, we do not find any population-level evidence for a nonspecific effect of the BCG vaccine discontinuation on survival to age 40 in Sweden.

Fertility Intention and Influencing Factors for Having a Second Child among Floating Women of Childbearing Age

In recent years, an increasing number of women participate in population mobility and most of them are of childbearing age. With the continuous expansion of the population size of this group, their fertility intention will have a great impact on the development of China's population. Therefore, the aim of this study was to evaluate the fertility intention and influencing factors on having a second child in floating women. This study employed the data from the 2018 National Migrants Dynamic Monitoring Survey data. A self-designed questionnaire was used to collect information, such as socio-demographics and fertility intention. Descriptive statistical analysis was carried out to obtain the basic characteristics of the main variables. Chi-square and ANOVA tests were used to analyze the differences in the basic characteristics between three groups of women (with intention, without intention and unsure about having a second child). Multinomial logistic regression was employed to analyze influencing factors associated with fertility intention among the floating women. The results of this study indicated that only 13.07% of the floating women had the intention to have a second child, while 67.73% had no intention of having another child. In the multivariate analysis, age, gender and age of the first child, reproductive health education, employment status and medical insurance were found to be significant influencing factors of fertility intention (p < 0.05), while education level and household registration type were not associated with the desire to have a second child (p > 0.05). Overall, after the implementation of the universal two-child policy, floating women of childbearing age have reduced intention to have a second child. Reproductive health education and medical insurance play an important role in ensuring the fertility of floating women. This reminds government departments to consider the above factors comprehensively when formulating the next work plan.

Vulnerability and the Ethics of Human Germline Genome Editing

The concept of vulnerability has played an important role in theoretical bioethics as well as in numerous authoritative guidelines on research ethics. The concept helps to identify situations in which research participants and other individuals may be at a heightened risk of experiencing harm. However, existing guidance documents on the ethics of human germline gene editing largely fail to make any reference to considerations of vulnerability. In this article, we discuss this oversight and we highlight the role that vulnerability can play in ethical debates about human heritable genome editing. Future guidance documents on germline gene editing should pay attention to considerations of vulnerability and reference these appropriately.

Higher Rates of Twinning Among Repeat Vs First-Time Teenage and Young Adult Mothers in the United States, 2009-2018

STUDY OBJECTIVE

Few studies examining predictors of twinning consider younger mothers who do not use assisted reproductive technologies (ART). Higher parity is associated with greater odds of having a twin birth, but it is unclear whether this association is present among young women. We tested the hypothesis that the rates and odds of twinning would increase with parity among teenage and young adult mothers who did not use ART.

DESIGN, SETTING, AND PARTICIPANTS

We conducted a retrospective, population-based cohort study using 2009-2018 United States National Vital Statistics data on 11,383,370 (58.94% first, 41.06% repeat) births to adolescent and adult women aged 15-24 years.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Rates and odds of twinning by parity among teenage (15-19 years) and young adult (20-24 years) mothers.

RESULTS

The adjusted twin birth rate among first-time teenage mothers was 13.28 per 1000 births compared to 16.62 twins per 1,000 births among repeat teenage mothers. This difference by parity was present but smaller among mothers aged 20-24 (18.31 vs 21.44 twins per 1000 births for first-time and repeat young adult mothers, respectively).

CONCLUSION

Repeat young mothers, particularly teenage mothers, are a high-risk group in terms of infant and maternal health outcomes; their higher rate of twinning puts them at an additional risk for adverse birth outcomes. Practitioners may counsel young mothers at risk for subsequent unintended pregnancy on elevated risk of twinning.

Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Background

Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries.

Methods

This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors.

Results

Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28).

Conclusion

Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03780-y.