During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

This study addresses modern types of families in the East-Kazakhstan region and their role in the development of population. Using a sample of East-Kazakhstani women interviewed in 2008 in the "Family Transformation survey," this study focuses on continuously married women and women who have been previously married. The purpose of this thesis is analysis of factors influential on the intention to be divorced. Additionally, this thesis investigates issue: how a woman's family life-course (marital status and number of children born in the first marriage) influences the risk of a post-dissolution birth among divorced women. Also this study attempts to analyze how the experience of a marital dissolution affects a woman's cumulated fertility. The results show that women who underwent a marital dissolution have lower fertility than those who remained continuously married, and that repartnering enables this group of women to recapture the fertility lost with the dissolution of the first marriage. With a rise in divorce rates and existing differences of post-dissolution marital behaviors for those who have been previously married, it has become important to account for the type of dissolution (widowhood or divorce) of a union when analyzing partnership formation after the breakdown of a union. Additionally, this...

Black River Memorial Hospital identified obesity as a priority health concern in its rural service area; this concern was in line with the county's needs assessment. It was identified that women of childbearing age affect the lifestyle and health choices of their families and that they are at higher risk for the additional health risks associated with obesity affecting pregnancy and birth. Despite the identification of these risk factors, the factors that affect healthy weight management have not been well understood. Using the life course theory, a qualitative inquiry in the form of a structured interview was developed with local community experts and stakeholders. Sixteen women, aged 18-44, were recruited from the area Women Infant Children (WIC) program, the local food pantry, and area businesses. Audio-taped interviews were conducted. Data were analyzed using open and axial coding. The findings suggest that the health literacy among this sample of women was low with regards to healthy weight (BMI) and the risks posed by obesity. The most cited barriers to healthy nutrition were the cost of healthy food, food preferences, and the time to prepare healthy food. The most cited barriers to healthy activity were lack of motivation, lack of child care and lack of fun, affordable activities, and severe weather. The most common motivators for pursuing a healthy lifestyle were identified as the respondents' children, the encouragement of significant others and friends, and the participation of the family in healthy lifestyle choices. Based on the literature review, knowledge of community resources, and these findings, broad recommendations to enhance the culture of healthy weight management were provided to local community stakeholders to facilitate community planning for a healthier population.

Vitamin A nutrition status was evaluated in 110 pairs of women and their preschool children at rural health posts in two different ecological regions of Northeast Brazil. Serum retinol and carotene, weight, height, tricep skinfold and mid-arm circumference were measured from each mother and child. Nutrition knowledge of mothers, socioeconomic living conditions and consumption of retinol and carotene food sources were assessed. Nine children (8 percent) and one mother had less than acceptable serum retinol (less than 20 μg/dl). Additionally, 21 percent of the children and six percent of the mothers had "low" serum carotene levels. Thirty-seven percent and 57 percent of the children were at or below the tenth percentile for height and weight, respectively, when compared to Brazilian standard tables, and 30 percent were below the tenth percentile of weight for height. When compared to NCHS standard tables, 34 percent were below the tenth percentile for weight/height. Nutrition knowledge was very limited, but opportunities for nutrition education are great as mothers wanted more nutrition and feeding information. Squash, carrots and mangoes were more common sources of vitamin A than were animal sources. Multiple regression models indicated statistical significance among mothers' serum retinol, survey site, and mothers' weight/height percentile and among mothers' vitamin A intake, survey site, and mothers' ages. The data indicate that vitamin A nutrition status is suboptimal in Northeast Brazil, but appropriate food sources exist. Long-term intervention projects need to focus on increasing the production, distribution, and consumption of preformed vitamin A- and carotene-rich foods.

The study reviewed the provision of childbirth and parenting education in the ACT for indicators of effectiveness and needs. Users (n = 207) and providers (n = 7) were surveyed for information on educational and administrative aspects of the service. An original design questionnaire was based on the PRECEDE framework (predisposing, reinforcing and enabling factors in educational diagnosis and evaluation) and the social model of health. Items were drawn from the relevant literature, concerning individual, social and service delivery elements of the health fields concept interpreted for pregnancy, childbirth and parenting. Individual factors were related to Maslow's hierarchy and the valuing approach to health education. The provider survey covered information on organisational elements, comprising inputs, processes, products, outputs and outcomes of childbirth education. The study comprised a literature review, cross-sectional non-experimental surveys of users and providers, and a needs assessment combining information from each of the three sources. Descriptive statistical techniques, analysis of variance and valuing analysis were used to extract information on effectiveness indicators and needs from the user data. Comparisons were made between present and past users, and between women of different ages, experience of pregnancy and preferences for public or private methods of education for childbirth. No evidence was found of individual differences in the women's attitudes, beliefs and values that could be attributed to education. However, users expressed strong approval and positive views of the service and its providers. The level of personal health skills, confidence and emotional preparatiqn they achieved through childbirth and parenting education did not fully meet their expectations. The survey also found that the organisation of childbirth and parenting education has not developed professionally like other health services. Service goals and objectives are ill-defined; planning and coordinating are inadequate for an integrated maternal health care system. The service's main resources are its highly motivated and dedicated teachers and clients. Several recommendations are made for educational and administrative measures to enhance service effectiveness within present organisational constraints, based on the needs identified by the study.

From conception the dynamic balance between nutritional and activity factors play a role in the accumulation of risk for future disease. Maternal nutrient balance and the subsequent dietary pattern of the family set the path for the growth and development of the individual and therefore also for their offspring. There is strong evidence from studies in India that mothers who have a low vitamin B12 status, but high folate, will have children with higher adiposity and more cardiovascular risk factors than those with adequate B12. The B12 status is closely linked to the dietary pattern particularly the consumption of red meat which has a high B12 content. In New Zealand there are an increasing number of Indian migrants. Vegetarianism is also practiced by an increasing number including young women. In addition, there is a high rate (up to 60%) of unplanned pregnancies in New Zealand. In the 1997 New Zealand National Nutrition Survey (NNS97) report, vitamin B12 intake appeared adequate for the New Zealand population and breakfast cereals were reported as one major dietary source of B12. Cereals in New Zealand however, were not fortified with B12 and there was an error in the FOODfile™ data entries for B12 in some cereals. The raw data of reported B12 intakes in the 24-hour diet recall (24HDR) of NNS97 was reanalysed at the individual level by subtracting the B12 derived from breakfast cereals and applying the 2005 revised estimated average requirement (EAR) value. The possible prevalence of B12 insufficiency was 2.4 times that originally reported by the NNS97, translating into a prevalence of up to 27% of the population sampled. This analysis was limited as it was not adjusted for day-to-day variance or to the New Zealand population. This apparently high prevalence of risk for inadequate B12 intake in the surveyed individuals required confirmation that the B12 intake from 24HDR and also a 7-day diet diary (7DDD) was a valid assessment of B12 status. The group of particular interest is women of childbearing age (18-50y) with a range of eating patterns. Thirty eight women aged 19-48y; 12 non-red-meat-eaters (5 Indians vs. 7 non-Indians) and 26 red-meat-eaters (1 Indian vs. 25 non-Indians) participated in this validation study. Anthropometry and hand-to-foot bioelectrical impedance (BIA) were measured on the same day as a 24HDR was recorded. Fasting serum lipids, glucose, haematological parameters, and serum B12, holotranscobalamin II (holo-TC II, a specific B12 biomarker), and folate concentrations were measured. Foods eaten and time spent in physical activity during the following 7 days were extracted from 7DDD and 7-day physical activity diary (7DPAD). There was no significant correlation between dietary intake (24HDR or 7DDD) and biomarkers for B12 status. Indians reported lower mean daily B12 intakes in 7DDD than non-Indians (1.6 vs. 4.5 μg/day, p<0.001) and this was confirmed by Indians’ significantly low serum B12 (203 vs. 383 pmol/L, p=0.04) and holo-TC II (35 vs. 72 pmol/L, p=0.02) concentrations compared to non-Indians. A similar pattern was found between non-red-meat-eaters and red-meat-eaters in daily B12 intake in 7DDD (2.3 vs. 4.8 μg/day, p<0.001) and in B12 biomarkers (serum B12, 263 vs. 397 pmol/L, p=0.01; holo-TC II, 43 vs. 77 pmol/L, p<0.005). Non-red-meat-eaters reported significantly higher daily folate intake in 7DDD (359 vs. 260 μg/day, p=0.01) than red-meat-eaters but no significant difference was found in serum folate concentration between these groups (29 vs. 24 pmol/L, p=0.10). Indians/non-red-meat-eaters also reported lower daily protein intake and higher percentage of total energy from carbohydrate in 7DDD compared to non-Indians/red-meat-eaters but total reported energy intake tended to be under-reported and physical activity over-reported when assessed against estimated basal metabolic rate (BMR). Body composition varied by dietary pattern. Indians/non-red-meat-eaters had higher body fat percentage (BF %) and weaker grip strength than non-Indians/red-meat-eaters. In addition, Indians had a significantly higher waist-to-hip ratio (WHR) than non-Indians. Overall, the whole group reported that they were inactive. The median time spent in moderate, high and maximal intensity activities was only 19 minutes a day, which did not meet the NZ guideline for adults of 30 minutes a day. In this small study nutrient analysis of diet by 24HDR or 7DDD, was not a reliable or accurate way to assess B12 insufficiency. Questions about dietary patterns such as “do you eat red meat”, and taking ethnicity into account could more easily identify the at risk population. Supplementation and/or fortification of B12 should be considered before pregnancy.

Over the past few decades, teen pregnancy has been framed as one of society’s most pressing ills. It has been understood as a “crisis” by The National Campaign to Prevent Teen and Unplanned Pregnancy and a number of other cultural, religious, and governmental institutions. In this thesis, I analyze three constructions of teen pregnancy: 1) the construction of teen mothers as social “burdens” 2) the construction of teens as “unfit” to be parents 3) the construction of teen mothers as collectively “rational” actors reacting to contexts of structural inequality. While the first and second constructions draw upon the conception of teen pregnancy as a costly, national epidemic often reproduced by the irresponsible and “deviant” behavior of teens, the last construction rejects this discourse, and posits adolescents as “rational” actors that make “rational” decisions given a context of structurally-produced inequality. In that early childbearing may serve as a “collective adaptive” strategy in contexts of poverty, this construction of teen pregnancy has attempted to deconstruct the notion that teens become pregnant due to their “irrationality,” or their inability or unwillingness to recognize the harsh repercussions of early childbearing.4 In that this third construction favors “empowerment” policies that provide women with the “knowledge and means to exercise reproductive freedom,” it does not narrowly promote prevention policy as a single approach to teen pregnancy, and escapes the promotion of punitive approaches that seek to scare and discipline teens into abstaining from non-marital sex. 4 Arline T. Geronimus, “Teenage Childbearing and Social Disadvantage: Unprotected Discourse,” Family Relations (April 1992): 245.

Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

In this study, I conduct a multiple method content analysis of literature on postpartum depression (PPD) from two on-line sources, Medline and LexisNexis. The purpose of the study is to determine how the medical profession defines and frames PPD, and to consider the implications of its movement into the medical model. I use the theories of Foucault, Gramsci, critical constructionism, and postmodern feminism to examine the effect of the medicalization of PPD on women’s lives. Using both simple descriptive statistics and qualitative analysis, I show the expansion of medical control over women’s bodies in the childbearing years beyond the physical to include the emotional and psychological aspects as well, which results in standardized maternal behaviors and emotions that tighten the boundaries of motherhood.

The aim of this dissertation is to explore various dimensions of work–life balance in Europe. I examine the extent to which institutional factors, working conditions and individual resources influence individuals’ capabilities to have a family and engage in family life. The theoretical framework is inspired by Amartya Sen’s capability framework, a multi-dimensional approach that provides a deeper understanding of the relationship between institutional contexts and individual capabilities. Four studies have been conducted. The first study focuses on women’s short-term childbearing intentions in ten European countries and finds that the association between such intentions and economic uncertainties varies by the policy support for work-family reconciliation in the country as well as individual factors, such as her educational level, and her number of children. The second study addresses the impact of family-friendly working conditions on young adult women’s childbearing behaviour in Sweden, showing the importance of family-friendly working condition for the transition to motherhood of less educated childless women with low income, and for second births of low educated mothers. The third study analyses gender differences in perceived work–home conflict in ten European countries, and the importance of work-family policies and gender norms. I find that gender differences are more pronounced in countries with weaker support for work-family reconciliation and more traditional gender norms. The fourth study focuses on tensions between work and family demands that parents in Hungary and Sweden experience, and on their capabilities to make claims for work–life balance. We find greater agency inequalities for Hungarian parents for claims making for and achievement of work-life balance, in contrast to a strong sense of entitlement to exercise rights to care among Swedish parents, which reflect country variations in policy supports for work−life balance, working time regimes and social norms regarding work and care. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Submitted. Paper 2: Submitted. Paper 3: Submitted.</p>