Background: Breastfeeding has the potential to significantly improve public health. As part of UK government policy peer support interventions have been recommended to increase breastfeeding rates but the evidence base for this is of low quality. Methods: The aim of this thesis was to investigate the effect of breastfeeding peer support on initiation though a systematic review; on continuation through an RCT and a systematic review; and to explore women’s experiences through a qualitative study. Results: Universal peer support to improve breastfeeding initiation was ineffective. Peer support for breastfeeding continuation in both the RCT and review findings appears to be effective in low/middle income countries; when provided in an intensive schedule of contacts (>5 contacts); and given in the postnatal period. Women’s experience of peer support is generally positive and those interviewed gave several suggestions to how current local services may be modified. Conclusions: Peer support per se, in any format in the UK-setting, has not been supported. Targeted and intensive peer support may improve breastfeeding rates in the UK but this must be evaluated using high-quality methodologies. Peer support appears to be effective in the developing world, were it is intensive and targeted to those already considering breastfeeding.

This thesis makes clear British women’s experiences of the international between 1945 and 1975. It analyses how international development came to feature at the centre of British women’s organisations’ international programme by the late 1950s. The origins of this process date back to the immediate post-war years. Inspired by a new sense of duty and internationalism, British women embraced the new international institutions that formed after the War with a newfound sense of purpose. In the late 1940s, world peace was taken up by a broad spectrum of British women’s organisations as a potentially powerful means of bringing women together from diverse political, social and cultural backgrounds to co-operate on both national and international levels. The failure of peace to unite women across social and political lines in the face of the ‘red scare’ in the early 1950s forced British women to look for an ‘apolitical’ means of promoting human relations. The UN technocratic approach positioned international development as the convenient space for British women to act out these new post-war international commitments. However, the results of this new international priority were informed directly by histories of imperial power, leaving assumptions about priorities and Western superiority uncontested until the 1980s.

This thesis is a discussion of the ethical issues surrounding the allocation of donated sperm and eggs to patients at fe1iility clinics. It adopts an empirical bioethics approach in which traditional philosophical analysis is combined with the collection and analysis of empirical data in order to ensure that the views of those involved in the field are represented. Following the preliminary philosophical analysis, the second section of this thesis presents the results of a qualitative study, which was undertaken with fertility clinic staff and other relevant professionals such as academics and representatives of patient organisations. The views and ideas that emerged from these data were considered in light of the earlier philosophical analysis, and where relevant, initial conclusions were revised to account for these considerations. The results suggest that the prioritisation of patients based on age, violent history, and health and health behaviours is justified, that allowing conditional and known donations may benefit all patients by increasing the number of donors, and that a national system of allocation may confer similar benefits, as well as being fairer than current, local allocation.

Although the number of female leaders worldwide has yet to achieve par with that of male leaders, a growing number of female heads of state and female candidacies for that position signal that transformations are underway. Among them is Chile’s current president, Michelle Bachelet. Her first election generated significant debate since she possessed none of the qualities considered essential for eligibility. Attempts to lend logic to the contradictions imposed by that event are still largely inconclusive. This study investigates a deeper root system in Chilean history for causal factors with trajectories that lead into the twenty-first century. Under consideration are ways in which women attain political power, their management of power, and the role of the body politic in both of those. The latter part of the study establishes correlations between recent developments in the Chilean political landscape of female leadership and similar developments across the globe. During Bachelet’s first election, media coined the term—the “Bachelet Phenomenon”—to reference her unprecedented and improbable attainment of the presidency. This research consults a diverse body of resources to offer one interpretation of that. The findings contribute new perspectives to the existing body of literature that can be expanded by future research.

Aims: To compare binge-drinking between a university student and community sample of young females. Methods: A secondary-data analyses of two cross-sectional studies. A total of 409 participants were included (161 community and 248 students). The primary hypotheses explored the differences between the populations with regards to socio-demographic factors and clinical variables stratified by drinking status, the secondary hypotheses were to ascertain the relationship between resilience and mental health and their effect on hazardous drinking. Results: The total prevalence of binge drinking was 56.2%. Students had a higher prevalence (59.7%) than the community (50.9%) but this difference was not statistically significant. However, the community sample was at a higher risk for hazardous drinking and had poorer mental well-being in comparison to the students. No differences were found with regards to resilience. Mental well-being was the factor contributing the most to the variance on hazardous drinking with resilience not playing any part. Discussion: This is one of the few studies that focuses on elucidating binge drinking in young women and attempted to compare binge and hazardous drinking between a university student and community populations. Prevalence rates were similar to published rates for the UK. However, these high rates and the earlier age of onset of alcohol consumption pose a challenge to Public Health, in particular related to harmful effects on future reproductive health. In addition, this study suggests that mental well-being is a strong predictor of hazardous drinking, regardless of resilience. Efforts to improve the mental well-being of children and adolescents is fundamental to avoid problem-drinking later in life.

Volume 1: Research component There are three papers contained in this volume, all concerned with maternal mental health problems in the perinatal period. The first is a review that examines the existing literature on eating disorders in the perinatal period. It examines prevalence, symptomatology levels across the perinatal period and factors associated with development and remission from eating disorders in the perinatal period. The second paper is a report of research, carried out by the author, investigating obsessive compulsive disorder, bonding and meta-cognitions in new mothers. It specifically examines whether bonding is impaired in new mothers with OCD when compared with mothers who have no symptoms of OCD, a subject that has not been investigated in previous research. Both papers have been prepared for submission to Archives of Women‟s Mental Health. The final paper is a public domain paper describing the literature review and empirical papers and has been used to disseminate the findings of the research amongst participants, mother and baby organisations and mental health professionals. The appendices contain information regarding ethical approval, measures used and instructions to authors from the Archives of Women‟s Mental Health. Volume 2: Clinical component This volume contains five clinical practice reports (CPR) submitted during the doctorate course. These reports reflect the training of the course and the work completed over the three years of the course. CPR 1 and 2 were conducted during a child and adolescent placement. CPR 1 describes a doctor phobia in a five year old girl, formulated from a behavioural and a systemic perspective. CPR 2 reports a single case experimental design study on a narrative intervention for sleep difficulties in a nine year old boy. CPR 3 describes a qualitative service evaluation of a waiting list initiative and changes to the referral system to a Psychological Therapies Service within an adult mental health service. CPR 4 is a case study of a CBT intervention for a client with OCD in a specialist adult service. The abstract of CPR 5, a presentation on a CBT and narrative intervention for anger in a woman with a learning disability in an inpatient setting. The names and identifying details have been changed or removed from these reports to protect anonymity.

This thesis explores the interaction of gender and the construction of the Argentine state. It pays particular attention to the emergence of women’s movements as well as women’s writing and the way in which both reflect and express the history of the Argentine state after independence. Beginning with a brief account of Argentine independence and Domingo Faustino Sarmiento as founding-father of the Argentine nation, part one focuses on the historical periods of the Liberal State, Peronism, and the military dictatorships of the 1960s and early 1970s. It investigates how national discourse incorporated gender discourse without including women as citizens in their full right. It then explores how women’s movements articulated their ensuing discontent with the patriarchal system that attempted to ensure continuity of this exclusion. Part two identifies and analyzes selected texts by nineteenth and twentieth century Argentine female authors. Written from a specifically female standpoint, these novels and short stories articulate women’s grievances with the political developments addressed in part one.

Since the nineteenth century, social exclusion and inclusion have been prominent concepts in policy debates across Europe. This thesis discusses the fact that poverty and social exclusion are often seen as closely related, overlapping or even indistinguishable in the existing literature. Thus there are no uncontested definitions of poverty, social exclusion and inclusion, and these concepts remain the subject of definitional disagreements among intellectuals. This research has tried to bring out these concepts in a gender perspective on Bangladesh as a developing country, examining indigenous women’s status at the domestic and wider societal levels and recent developments in this. The data were collected using qualitative methods. Data analysis was done through the qualitative approaches that are presented by thematic analysis. The findings of this research indicate that the processes of social exclusion and inclusion of indigenous people, especially women, need to be addressed in a policy paper, since creating appropriate policy tools would be the best way of spreading – rather than imposing – the basic values and standards necessary to give a sense of inclusion to all the people of Bangladesh. At the same time, this research has highlighted the fact that, though Chakma and Garo indigenous women live in communities with different social structures – patriarchal for Chakma women and matrilineal for Garo women – in practice these two groups share common life experiences.

Little psychological research has examined the cultural context of Honour Based Violence (HBV) within South Asian and Middle Eastern communities and the cultural factors that are used as ‘justifications’ for this type of violence. This thesis examines these issues via three approaches; a systematic literature review, an empirical piece of research, and a critique of a psychometric measure. Chapter two explores the attitudes, experiences and beliefs of South Asian and Middle Eastern men, across the globe, regarding HBV to identify themes that are prevalent in the context of this crime. The papers collectively found that male dominance and patriarchy, female chastity, religion and culture, socialization, and the need for education are common themes in the context of HBV. Chapter three investigates the attitudes of British-born young South Asian males toward ‘honour’ and HBV are explored in a qualitative study. Focus groups are analysed using Interpretative Phenomenological Analysis (IPA). Four themes are identified that relate to the cultural context of HBV. These are 1) Gendered accountability in honour; 2) The ‘honour code’ – factors that drive HBV; 3) The role of the community and cultural rules; and 4) Fixing ‘honour’. Chapter four presents a critique of the Domestic Abuse, Stalking, Harassment and Honour Based Violence (DASH) risk checklist. It finds that the tool is acutely based on a narrative review of secondary and existing research and lacks evidenced evaluation. Collectively the thesis advances understanding about the cultural context of HBV and forms the basis of preventative work and interventions within British communities where HBV is most prevalent.

The first paper is a literature review which examines how women with a learning disability experience breast and cervical cancer screening, as well as how these procedures can be made more acceptable and accessible to them. Fifteen papers are reviewed and critically appraised. Learning disabled women tend to feel anxious at the prospect of these screening tests although for some, it is said to facilitate a feeling of connectedness to a ‘sisterhood’. The presentation of a DVD may be more worthwhile than lengthy classroom interventions in increasing preparedness for screening in this population. Simple adjustments, such as having accessible information, have been shown to make the process of screening more acceptable. Researchers are encouraged to use creative outcome measures which are not knowledge based when conducting research with individuals who have learning disabilities. The second paper is an empirical study which explores what women with a learning disability think makes a good mother. Eight women with a learning disability were recruited and interviewed on a one-to-one basis. Interpretative Phenomenological Analysis is used to analyse the resulting data into themes. The women spoke about the variety of skills needed to make a good mother, including an ability to show love and provide sensitive discipline. Many themes mirror principles of Attachment Theory, including an appreciation of reciprocity within a mother-child relationship. Some of the women interviewed feel mothers with a learning disability are stigmatised and are frustrated by this. An unexpected theme around bereavement frequently arose and is also included.