During the Covid-19 pandemic we have all spent less time in the company of others than perhaps ever before and for single women approaching the end of their fertility, the pandemic has come at a costly time when they would otherwise have hoped to be meeting a life partner and starting a family. Indeed, fertility clinics have seen a sharp rise in the number of women enquiring about egg freezing since the pandemic began. Egg freezing is a fertility extension technology and form of assisted reproduction which sees a woman undergoes hormonal stimulation to produce more eggs than she would in her normal monthly cycle, these eggs are then surgically retrieved and frozen at minus 196 degrees and stored at her clinic for potential future use. As mine, and others research has shown, women undergo egg freezing when faced with an illness or medical treatment that may render them infertile or may choose to freeze their eggs for so-called ‘social’ reasons such as due to their lack of a partner with whom to have a child.
When egg freezing was first legalised and regulated in the UK in 2000 there were many unknowns about who would use the technology, why, and about how long the eggs would remain viable. However, it is now widely accepted that once frozen, eggs remain in ‘suspended animation’ and do not age or decay. Since 2013 the number of egg freezing cycles performed by UK clinics has more than doubled as increasing numbers of women seek the opportunity to enable genetic motherhood later in life when their natural fertility may otherwise have declined. Currently women who freeze eggs for medical reasons, such as prior to chemotherapy for cancer, are able to store their eggs for up to 55 years. However, women who undergo the procedure for ‘social’ reasons, such as the lack of a suitable partner, have historically only able to freeze their eggs for 10 years at which point their eggs must be used or destroyed. Myself and others been campaigning for parity in storage times across both medical and social reasons and this week, following a public consultation, the Government announced that the 10 year storage limit will be replaced with a right for couples and individuals to access storage extensions for up to 55 years regardless of the reason for freezing. However, concerns have already been raised that this move may see greater numbers of women delaying motherhood until later on in life or see the emergence of much older mothers as women pursue motherhood for the first time in their 50s or even 60s.
Currently, the typical user of social egg freezing undergoes the procedure when she is on average 37 years of age, she is most often single, and in professional employment earning an above average income. The women I spoke to in my research recounted how their decision to undergo the procedure was most often shaped by the fear that they were running out of time to find a partner and form a conventional family as well as concerns of rushing in to a relationship with the wrong partner to avoid unwanted childlessness in the future. These women wanted to take the time to find the right partner, cultivate a secure relationship and environment in which to have a child prior to trying to conceive. At the time of freezing their eggs, many of the women I spoke to had wanted to have a child for many years, they didn’t really want to be freezing their eggs and in many cases would have preferred to actively be trying to conceive. Many women had been in relationships they had thought would lead to motherhood and had imagined that they would have already had a child by their current stage in life. As a result, these women often described how they felt they had not deliberately chosen to delay motherhood but had not become a mother for reasons outside of their control.
As such for these women, and those in research undertaken in America,Australia and Turkey, egg freezing wasn’t about putting off motherhood for as long as possible but about maintaining the possibility of shared genetic parenthood with a chosen partner as soon as was practically viable. Therefore, concerns that the lifting of the 10-year storage time limit on frozen eggs could lead to more women delaying childbearing is in my opinion unlikely. Egg freezing is expensive, invasive, painful and not without risk and not taken on lightly by its users. As a result, it is unlikely that large numbers of younger women in particular will pursue the procedure following a change in storage limits particularly as younger women are less likely to be able to bear the cost of the procedure but also because they have more time to find a partner and pursue motherhood naturally.
Instead, the rise in the storage time limit is most likely to help women who froze, or will freeze, their eggs in their mid to late 30s and who just need an extra few years to become ready to use their eggs to conceive. Indeed, my research and that of others indicate that women who freeze their eggs do not want to be pursuing motherhood for the first time in to their 50s and 60s but want the option to use their eggs in their early to mid-40s with a partner of their choosing. As such concerns that the extension in the time limit will lead to women using the technology to have children in their fifth and six decade of life is unfounded, particularly given the fact that UK clinics do not routinely treat women beyond the age of 50.
By Dr Kylie Baldwin
You can learn more about Dr Baldwin’s research on social egg freezing via her monograph on this topic which is free to download here.
Another year has passed and as is now tradition, we look back on what has continued to be a challenging but busy 12 months for the Centre and our members. It’s now well over a year since we were all together, and our planned socially distanced meet ups outside have continued to be thwarted by the ‘summer weather’ we are all enjoying, though we nonetheless hope to be reunited in the not-too-distant future.
We are all very familiar with the new world we now inhabit, and some of us have enjoyed the short ‘commutes’ to the kitchen table/spare room from which we work and the flexibility to take our dogs out in between the delightful summer downpours. And whilst we have not been together in a very, very long time, the collaborative and supportive culture of the centre has nonetheless continued. Amidst lockdowns we have developed new and further support for staff and students alike including early career development workshops, generalised skill and professional development sessions, writing and reading groups as well as our ‘PhD in Progress’ sessions delivered by postgraduate students.
Despite the suspension of face-to-face events, we have none the less shared details of our research virtually with several members giving invited talks at conferences and events this past year. Nicky Hudson gave two invited talks at ESHRE where she explored the management of chronic pain brought on by Endometriosis and the role of commercial interests and actors in the constantly evolving world of ARTs. She was also invited to share findings and insights from our ESRC project on egg donation with organisations like ‘Pathways to Parenthub’ and, in collaboration with Prof Lorraine Culley and Cathy Herbrand and the rest of the project team, published a new paper in the journal ‘Health Policy and Technology’ exploring the shifting landscape of egg donation in Europe.
CRR members have also been involved in Covid-19 related research. Recent PhD graduate Kriss Fearon took up a substantive post within the university on a UKRI funded project exploring the health impacts of Covid-19 on children in temporary accommodation and Tina Harris and colleagues published research based on a national cohort study examining maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth. Kylie Baldwin also spoke live on Sky News this May about the suggestion that women and couples may be pursuing more intensive fertility treatment protocols following a delay in accessing treatment during the pandemic, and contributed to a fascinating piece in The New Yorker on ‘The Promise and Perils of the New Fertility Entrepreneurs’.
This spring, Cathy Herbrand and Kylie Baldwin convened and hosted British Sociological Association Human Reproduction Study Group summer conference ‘‘Reproductive challenges in a post-Covid19 world’ with a keynote from Prof Ayo Walberg exploring ‘Declining fertility forms in a stratified world’ and two excellent talks from Charlotte Faircloth and Mari Greenfield on the Covid-19 related research they have been undertaking. A recording of the full event is available here. Several CRR members also attended and presented virtually at the British Sociological Association Annual Conference; Caroline Law shared findings from her research examining men’s attitudes towards fatherhood in a time of economic precarity and Nicky Hudson, Christina Weis presented two papers on egg donation.
This past year we have also further developed our strand of work around men, fatherhood and in/fertility with key publications from Esmee Hanna and colleagues exploring male infertility and young fathers both published in the journal ‘Families, Relationships and Societies’, as well as in Sociology of Health and Illness from Caroline Law examining men’s views on male age‐related fertility decline and from the EndoPart project team exploring accounts of male partners of women with endometriosis. Christina Weis and Wendy Norton also have shared new findings on their research on heterosexually-partnered men’s experiences of becoming fathers through surrogacy in the ‘Journal of Diversity and Gender Studies’ and are working with Donor Conception Network to develop resources linked to the research.
In line with DMU’s commitment to United Nations Sustainable Development Goals as well as a as move to rethink the curriculum and generation of knowledge, we have begun new projects around decolonisation as well as sustainability. We hosted an important seminar delivered by Annabel Sowemimo on ‘Decolonising Contraception’ (you can find her excellent reading list here). CRR members Zaheera Essat, Diane Menage and Bernie Gregory have also been leading practice around Decolonising Midwifery education and recently had some of their work published in The Practicing Midwife.
The CRR also now hosts the Leicester Cloth Nappy Library which has received funding from Leicester City Council, DMU Local and DMU Sustainability and which is providing support to new parents across the city to reduce their waste by switching to reusable cloth nappies. This initiative has also provided work experience opportunities for undergraduate and postgraduate students within and outside of the centre and has supported a local nursery to use reusable nappies with their children, saving over 1,000 nappies from landfill every week!
As the academic year draws to a close, we look back not only on what we have achieved but forwards for what we have planned in the years and months ahead. Nicky Hudson will begin work on a collaborative project with Lucy Frith (University of Liverpool) and others on new ESRC funded research on direct-to-consumer genetic testing and donor-conception. This year we had Navi Kaur from the BSc Health and Wellbeing in Society course working with us as a project assistant as part of a student placement and we will be welcoming a new Frontrunner placement student this coming October. CRR staff are also involved in the launch of a brand-new MSc in Global Health this coming September, and we will be launching our very own undergraduate research project prize to reward excellent undergraduate research in the area of reproduction. Finally, we want to congratulate both Sasha Loyal and Kylie Baldwin on recent achievements and wish them the best of luck; Sasha submitted her PhD thesis this summer and will soon have her viva and Kylie Baldwin’s 2019 monograph was shortlisted for the Foundation for Sociology of Health and Illness Book Prize, the outcome of which will be announced in September. We wish both Sasha and Kylie the very best of luck. In the next academic year, we will continue our events programme in the form of our guest seminars and British Sociological Association Human Reproduction Study Group activities, and we very much look forward to meeting once again with our academic friends and colleagues who we have missed these past 15 months.
The outbreak of Covid-19, its global spread and global responses has significant impact on social and biological reproduction, and our reproductive choices, health and rights. In April 2020, the Centre of Reproduction Research has launched this ‘COVID-19 and Reproduction’ digest to capture the developments and build up a reference source over the time. The digest includes news articles, empirical research, commentary work, blog posts, advice and guidelines, petitions and calls for research contributions and participants. It is organised into the below categories which are updated and added to regularly.
We recognise that this digest cannot capture everything and invite you to contribute material by contacting firstname.lastname@example.org who coordinates collating material and maintaining the archive. Thank you to everyone who is contributing by sending in their publications, petitions and calls for research and special issues. Please share our resource widely!
Talking and thinking about the future can be tricky. The future is the next five minutes, it is also the next five months, and five decades. It is knotted together with the futures of other people, with places and politics, with pasts and presents. It includes needs, hopes and desires from the realistic to the fantastical. How do we find the right words, to get a sense of the scope and scale of the future, to talk about all of it in a meaningful way – especially when we really do not know what will happen? The future feels and is approached differently depending on a person’s past, on where they speak from in the present, and on the prospects they see ahead. Now consider the implications of long-term socio-economic inequalities and precarity, such as would result from ten years of austerity in the UK. What impact does this have on how people think, feel and talk about their futures?
These questions about how to think and talk about futures shaped the research I presented at the Centre for Reproduction Research in February, as part of a paper entitled ‘A pregnant pause? Oral histories and futures of reproduction and austerity’. Based on empirical work that I recently carried out as part of an ISRF Political Economy fellowship on Austerity and Social Reproduction, the phrase ‘pregnant pause’ refers to both the temporal elements of reproductive decision-making and to the particularities of talking methods. My aim with this project was to shed light on an oft-overlooked experience: that of people who have not had children (or not as many children as they wanted) due austerity and socio-economic conditions. The drop in birth rates in the context of austerity is a well-noted trend. However, most research to date tends to explore these dynamics at a macro scale, rather than personal-political scale.
To try and unpick the entanglements of reproduction, austerity and futures, I wanted to develop a methodology that would enable participants to communicate and share experiences in an empathetic space. This was significant, because they were revealing details about the most intimate aspects of their lives: their reproductive futures. I wanted to employ a method that would give participants space for reflection on their lives in the round, while also offering alternative ways of communicating. With this in mind, I developed a method that I call ‘Oral Histories and Futures’. Taking its inspiration from the strong traditions of oral history interviews, this technique relies on participants talking though their lived experience but gives the method a new twist. Oral history is a method for documenting people’s lives in retrospect. It is a form of interviewing to record and preserve often marginalised experiences, opinions and reflections on events. The Oral History Society has a fantastic set of resources for those interested in reading more.
My Oral Histories and Futures method builds upon oral history interviewing methods in five ways:
They include specific questions about the future, where oral histories are typically (though not exclusively) focused on past events and experiences.
In this project, I was interested in the experiences of people aged 18-45 who would have recently been making reproductive decisions in a time of austerity in the UK. Oral history interviews are most commonly undertaken with older generations.
The discussions included participatory tasks, including writing postcards to futures selves, or they might involve storytelling or life mapping. I found this to be important, since talking about the future can often be difficult and feel abstract. These tasks enabled participants to focus their thoughts and express them in non-verbal ways.
The interviews were aimed at documenting lived experiences of reproduction in the context of austerity – in other words, while the event or crisis was occurring – rather than in retrospect.
Oral history interviews are most often carried out face-to-face, but due to the ongoing coronavirus pandemic, they were conducted online or on the telephone. This led to some interesting observations about how to communicate and encourage participants to speak, and made researching in a different part of the UK (in this case, the North East of England) logistically much simpler.
When combined, these adaptations meant that Oral Histories and Futures were a really useful technique in the project by which to detail and document reproductive lives. Reproduction is often a wide-ranging topic, connecting relational, financial, emotional, material, social and environmental issues, from personal decisions to national policy and changes across place and context. This method allowed participants to talk about their experiences in ways that were meaningful to them, embedded and emplaced in their past, present and prospective life-courses.
For example, one resounding finding that emerged was around the carrying of different possible reproductive futures in tandem. Experiences of participants often coalesced around dealing with the weight and effects of the future as a form of emotional labour. Participants spoke about a distinct labour in holding reproductive possibilities together, in conjunction, knowing full well that not all can be seen through. They were simultaneously regulating their own and others’ feelings about possible reproductive futures. These labours are often what drove them and their imaginative futures forwards. These possibilities were also tied to the security of housing, jobs, relationships and so on.
It is because of the rich findings the Oral Histories and Futures interviews elicited that I plan to extend their use into my current UKRI-funded research looking at the impacts of austerity on young people’s life-courses (especially in terms of employment, housing and reproduction) in three European contexts. The plan is also to train practitioners, policy-makers and project partners in using this creative tool. Likewise, I hope readers will consider using this technique in their research on reproductive lives.
March 2021 marks Endometriosis Awareness Month – a month where campaigners strive to raise awareness of this chronic gynaecological condition and to improve care, treatment and support. (Find out more about the condition here.) Endometriosis can have a devastating effect on so many aspects of women’s lives, but one particular issue which warrants more attention in research, policy and improving practice is the impact of endometriosis on women’s working lives. Endometriosis can mean more time off work, and reduced productivity while at work (see Culley et al, 2013 for an overview; also Soliman et al, 2017). A large-scale multicentre study revealed the average annual cost of productivity loss per woman with endometriosis to be around £5,500 in the UK. These figures make a powerful business case for addressing endometriosis in the workplace. But alongside this it is important not to lose sight of the moral case, to take notice of women’s experiences, and to recognise the costs not just to the economy but to women’s lives.
Our jobs, careers and experiences in the workplace can shape our confidence, identify and self-worth. Not being able to follow our desired career or perform to the best of our ability, and feeling misunderstood, unsupported and even discriminated against, can have profound effects, as some of the women we spoke to in the ENDOPART study told us. This study examined the impact of endometriosis on couples: 22 women and their male partners took part in separate, in-depth interviews and told us how endometriosis affects their relationships and everyday lives. Find out more about the study at www.dmu.ac.uk/endopartreport
Pain and fatigue, as well drowsiness from medication to treat the symptoms of endometriosis, can make work extremely difficult for some women. Jobs which involve a lot of moving and physical work may be especially challenging. While some women take time off sick, some we spoke to also described enduring work – ‘keeping going’ despite feeling terribly unwell. While this illustrates their tenacity and dedication, it also illustrates a concern that their symptoms may not be seen as a valid reason for time off, for which they won’t be penalised:
‘I’ve always made it in to work but I think that’s more because I’m just concerned about how it might impact my career if I was suddenly taking off two days every month … there are times when just a mixture of the pain and painkillers … I haven’t managed to achieve very much while I’ve been at work, I’ve been there physically at my desk and I’ve just been finding things to do that aren’t too mentally challenging.’
Being able to work flexibly was therefore very important. Some women achieved this by becoming self-employed, changing jobs and careers, or changing working hours. For some, this newfound flexibility was critical in enabling them to balance work demands alongside their physical and mental wellbeing.
‘I used to have Mondays off and now I have Wednesdays off. So I work two days, one day off, work two days, two days off, and I’m able to pace myself much better … It’s only been five weeks and I can’t get over how much better I feel.’
But women also spoke of a lack of support from employers and sometimes colleagues, often underpinned by a lack of awareness of the condition. Some women experienced poor treatment, unsupportive managers, a lack of reasonable adjustments, and feeling ‘forced out’.
‘I could like list the amount of jobs I’ve lost because of, it because people just don’t understand.’
It is well known that many women wait several years for a diagnosis of endometriosis – and not having a medical label for their condition adds a significant additional hurdle to accessing support and understanding.
‘Period pain is not taken seriously or considered a legitimate cause for sick leave by many. For that reason, I have always hidden how much pain I’m in at work and avoided taking time off even when I feel really unwell.’
Several felt that their career had not progressed as it may have done were it not for the endometriosis.
‘I don’t feel I am where I should be because of the endometriosis.’
‘I think it’s probably limited the amount of, my capacity to work extra hours … so my career progression hasn’t been the same as my peers.’
Amidst these negative experiences, women also spoke of supportive bosses, understanding colleagues, support from occupational health teams, and adjustments to sick leave allowances based on the protection within equalities legislation. Overall women found that navigating work was a delicate balancing act: women were acutely aware of their own ‘good’ and ‘bad’ time across a day, a week, a month – and scheduled their medication, work hours and tasks accordingly. Though the losses some women felt after having to leave jobs and careers were profound.
These experiences are echoed by other research which reports women with endometriosis to have lower salaries and lower salary growth than their peers (Estes et al, 2020), and to be more likely to be unemployed (Facchin et al, 2019). Endometriosis can affect women’s career ‘choices’ and career paths, leaving them often unable to work in their desired position (Sperschneider et al, 2019). A recent All Party Parliamentary Group (APPG) on Endometriosis Inquiry found that of over 9000 respondents, 38% were concerned about losing their job, and 35% had a reduced income due to endometriosis.
So, what can be done? The stories we heard from women shows evidence of some good practice by employers – and there are opportunities for this good practice to grow. Endometriosis UK has set up the Endometriosis Friendly Employer scheme to enable employers to improve support by working towards the principles of the scheme, which include the provision of flexible working, tackling stigma, raising awareness and appointing endometriosis champions. Employers receive information, support and resources to help them on their journey. You can find out more about this here. Women experiencing difficulties may find the Endometriosis UK publication ‘Endometriosis in the Workplace’ useful to share with their employers. In addition, Endometriosis UK are hosting a panel discussion on this topic on Thursday 11 March at 12 noon – registration details can be found here.
As awareness and understanding of endometriosis continues to grow, it is vital this finds its way into a greater number of workplaces, policies and positively shapes the attitudes of employers and co-workers. As the APPG on Endometriosis argues:
‘those whose lives are significantly affected should be afforded the support they need to thrive in the workplace – as with any other medical condition.’
The year 2020 provided plenty of opportunity for reflection on many aspects of our lives, and for some this included greater consideration and thought about our shopping and consumption habits. ‘Lockdown’ (part one at least) saw lots of people turn their hand at baking their own bread or amateur gardeners with access to their own green space growing their own fruit and vegetables. Other people began to shop more locally and independently to help support small businesses who were struggling amiss a collapse in the footfall that they had previously relied upon to bring in trade particularly around the summer and Christmas period. During this time, as a new parent what I personally noticed was the explosion of WAHM (work at home mum, or parent) ‘kitchen table’ businesses selling sustainable and eco-friendly ‘green’ products for use with baby but also in the home. In particular it seems that the panic-buying of items such as toilet rolls and disposable nappies prompted some people to consider alternatives to these throw away items such as cloth/reusable nappies and other cloth-based items that could help them decrease their waste but also (and perhaps crucially in those early months) reduce the need for additional trips to the shops.
For the un-inducted, cloth nappies are simply reusable and washable nappies which are often made from sustainable and natural fibres which, with a little bit of care, can be used dozens of times and across multiple children. It is estimated that one child can easily use in excess of 5,000 nappies between birth and potty training whereas by contrast only 20-25 cloth nappies can be needed for the same child. For many, the notion of reusable nappies can summon up images of stewing nappies in a pail or the heavy smell of Milton and disinfectant, whereas modern cloth nappies are often eye catching, bright and simple to use.
This year, particularly since the early spring I have witnessed an explosion of ‘eco shops’ opening online often based out of people’s homes selling reusable nappies, reusable wipes as well as cloth sanitary pads, ‘family cloth’ (reusable toilet roll), beeswax wraps and other sustainable/multi use items as alternatives to the disposable single use plastics that we have become accustomed. These businesses, in some cases, have emerged out of parents being furloughed from work or the loss of already precarious employment due to the pandemic and allow parents (though, usually mothers) time to work flexibly alongside the demands of their children and family. These small business, either as stockists of reusable ‘green’ items or as the makers or designers of them, encourage parents as consumers to ask questions about their sustainability credentials, including issues of traceability such as where the raw materials are sourced, how and where their items are manufactured, by whom, the working conditions, rates of pay and job security of employees, how the items are transported (rail/plane/boat) and to be aware of so called ‘green washing’.
These new businesses in the ‘green economy’ are perhaps well needed; it is estimated that over 700,000 tons of nappies go to landfill every year, with over three billion nappies thrown away yearly in the UK alone, accounting for 2-3% of all household waste. It is commonly accepted that that it would take 200-500 years for a disposable nappy to biodegrade and the decomposition of nappies can cause groundwater and soil contamination due to the leaching of organic components. Disposable nappies also contribute to landfill gases such as methane and CO2, both of which are potent greenhouse gases which exacerbate climate change. These single use nappies along with other mixed plastics are commonly exported to countries in the global south, particularly South-East Asia where what can be, is recycled often unsafely and to low standards, and the rest incinerated or left in landfill to leach into the environment. By contrast, reusable cloth nappies use 20 times less land for production of raw material and require three times less energy to make, can be used across multiple children and then sold on or donated once the user has no need for them. Furthermore, the recent boom in cloth usage has seen a growth in the number of small, independent and homemade manufacturers providing creative outlets and forms of income for their family.
The evidence is clear, disposable nappies and wipes whilst convenient for parents have been an environmental disaster, however data show that if only 20% of parents using such disposable items switched to reusables, the amount of waste that could be prevented in the EU-28 would be more than 1 million tonnes each year. Unfortunately, awareness of cloth nappies is relatively low amongst both parents and professionals (doctors, health visitors, midwives etc), and unlike the disposable nappy manufacturers, the producers of real nappies do not have deep pockets to be able to promote them heavily. Cloth nappies can be very difficult to find in the shops, meaning parents often have to buy nappies online and spend money on products they’ve not physically seen or had someone show them how to use. This is where ‘cloth nappy libraries’ are invaluable as they allow people to hire kits for a discretionary fee to find out what works for them and receive support during and beyond the hire period. Late last year Leicester Council and DMU, via the DMULocal programme, provided funding to the newly re-invigorated Leicester Cloth Nappy Library; a not for profit volunteer run organisation which provides information and support about using cloth to residents across the city and county. With the support provided by DMU and the Council, CRR members Kylie Baldwin and Sasha Loyal have rebranded the library, expanded the kits available to hire and created a suite of ‘Covid-secure’ resources for use by clients wishing to hire a kit. They have also run online tutorials about how to use cloth and recruited further volunteers both within but also outside of DMU to carry on delivering the library in the community in to 2021.
The support DMU has provided to the library is reflective not only of its commitment to sustainability at a local level but also inter/nationally. Indeed, DMU is the only higher education institute in the UK to be a global hub for one of the United Nations Sustainable Development Goals (UNSDGs). The UNSDGs were introduced by the United Nations in 2010 with the aim of improving the lives of millions of people by 2030 and include a commitment to 17 different goals including on: sustainable cities and communities, climate action, life below water and responsible consumption and production. As such the activities of the nappy library, led by Kylie Baldwin but with the support of staff and students across several different faculties, intersects and contributes to many of these goals. Alongside DMULocal, the Leicester Cloth Nappy Library (LCNL) will be working in the community to raise awareness of reusable alternatives to disposable items and bringing to people’s attention ways in which it is possible to make more sustainable and environmentally friendly decisions as consumers. The LCNL is currently delivering online demonstrations via Zoom and are continuing to offer kits for hire available via contactless collection. To learn more about the nappy library including how to hire a kit or to volunteer visit the library website www.leicesternappylibrary.org.ukor email email@example.com. If you are outside Leicester(shire) you can find your closest nappy library here.
Last week on Tuesday the 24th November we hosted a joint webinar with the University of Manchester and Emerald Publishing. The focus of the webinar was twofold, firstly to launch centre member Kylie Baldwin’s book, ‘Egg Freezing, Fertility and Reproductive Choice: Negotiating Responsibility, Hope and Modern Motherhood’ (Baldwin, 2019), which was published as part of the Emerald Studies in Reproduction, Culture and Society Series and secondly, to discuss the field of reproduction research, the special series and how to go about publishing with Emerald. The panel was made up of the series editors Dr Petra Nordqvist (Morgan Centre for Research into Everyday Lives, University of Manchester), and Professor Nicky Hudson (Centre for Reproduction Research, De Montfort University) and included Dr Kylie Baldwin (Centre for Reproduction Research, De Montfort University) as well as Jen McCall (Senior Editor at Emerald).
The special series ‘Emerald Studies in Reproduction, Culture and Society’ was born out of discussions between the editors and from the desire to create a publishing platform dedicated to reproduction research distinct from the broader topics that often surround it. By bringing together scholars from a variety of disciplines, including, but not limited to the social sciences, humanities, law and health the editors described how they hope to foster interdisciplinarity and contribute to knowledge and thinking around reproduction in a critical academic context.
The series welcomes proposals for monographs, edited collections and short form books. To date, in addition to Kylie’s book, the series has published two other outputs Sappleton (2018) and Kroløkke et al (2019) and over the next 18 months has further exciting titles forthcoming on topics including:reproductive ageing, commercial surrogacy and migration in Russia, anti-abortion activism in the UK, solo motherhood and donor conception, donor sperm and subversive practices, and reproductive governance.
In addition to discussing the special series, the webinar also gave Kylie Baldwin the chance to talk a little about her book and the practicalities of research and writing for publication. Kylie’s book situates egg freezing as a tool of fertility extension and genetic conservation, which helps women maintain the ability to engage with genetic kinship making. Baldwin positions the technology as inherently socially situated and seeks to challenge the common view presented in the media that women use egg freezing in order to delay motherhood to focus on their career. Drawing on themes of responsibility, neoliberalism, risk management and the sexual politics of reproductive aging her book provides some of the first insights into social egg freezing in a UK and American context. In a recent review of Kylie’s book, Heather Griffiths notes:
“The book aims to better understand how women who freeze their eggs ‘determine and negotiate their mothering desires’ (p.21) and, more significantly, how this is ‘mediated and constrained not only by wider socio-political and market contexts but also their intimate encounters with (non)reproductive partners’ (p.21). As Baldwin argues, the narrative around women ‘delaying’ or ‘putting off’ motherhood is not only ‘inaccurate’ but ‘hurtful and deeply neglectful’ of the socially constructed ‘constellation of factors which exist beyond the control of women as individuals’.
To try and understand what motivates women to freeze their eggs, Baldwin interviewed 31 women who she described as ‘pioneering users’ – those who already had or were considering freezing their eggs. She asked them how they arrived at their decision, how they perceived the risks and benefits of the procedure, and how they experienced the medical side of the process.
The book provides a chronological story of these women’s experiences, beginning with a discussion around their motivations for choosing egg freezing, charting the often long and emotional decision-making process. This is followed by their experience of the physical and psychological impacts of the procedure itself, documenting the often messy and uncomfortable medical procedures women endure as they embark on what is essentially the first half of an IVF cycle. The findings section concludes with a shorter reflection as participants explain how social egg freezing impacted their lives and future relationships.
The emphasis throughout the book is that, rather than being irresponsible by delaying motherhood, these women are experiencing a ‘social infertility’ as they struggle to build the life they envisaged for themselves and their future children. Paradoxically, Baldwin finds that these women engage in social egg freezing precisely in order to adhere to normative constructions of responsible motherhood, as it gives them more time to create the stability and security they feel they need in order to start a family.”
(Reproduced with permission from Heather Griffiths and The Sociological Review, for the full review, please see here).
During the webinar Kylie recounted her experience of navigating the (sometimes) uncertain terrain of writing her monograph, and the tools she used to tread her path, drawing on the works of respected scholars as a point of reference, including Lowe (2016), Nordqvist and Smart (2014) and Brooks (2017).
A salient consideration for Kylie during the planning and writing of her book was how to situate it in context with other emerging works on egg freezing, she also described how she wrote her book with a particular audience in mind ensuring accessibility in both content and access, not only for academics but also for informed publics. The open research and open access movement, and the impetus for knowledge to be made available for all, is even more pertinent than ever before and to this end, she credits working with both the series editors, and the editing team at Emerald Publishers, whose central focus on author care supported not only the inclusivity and accessibility of the tone and the content of the book, but also an individual publication strategy. In publishing her book in paperback, and open access available here, Kylie’s book contributes to more equitable knowledge production and more meaningful impact by being accessible to not only an academic audience but potential users of egg freezing, as well as those who support, deliver, provide, manage and govern reproductive technologies.
I think Kylie has not only achieved what she set out to do, publishing a book that speaks to and is available to a variety of audiences, but in sharing her thoughts on the processes around planning and writing her book, she has also made writing and publishing more accessible to those interested in doing so. The full recording of the webinar and Q&A which includes information on navigating the route to publication including preparing and submitting a proposal, the publication process and marketing can be found here.
By Jessica Turner
Baldwin, K. (2019). Egg Freezing, Fertility and Reproductive Choice: Negotiating Responsibility, Hope and Modern Motherhood. Bingley: Emerald Group Publishing.
Brooks, A. T. (2017). The Ways Women Age: Using and Refusing Cosmetic Intervention. New York: NYU Press.
Kroløkke, C., Petersen, T. S., Herrmann, J. R., Bach, A. S., Adrian, S. W., Klingenberg, R. and Petersen, m. N. (2020). The Cryopolitics of Reproduction on Ice: A New Scandinavian Ice Age, Bingley: Emerald Group Publishing.
Lowe, P. (2016). Reproductive Health and Maternal Sacrifice. London: Springer.
Nordqvist, P., and Smart, C. (2014). Relative strangers: Family life, genes and donor conception. Hampshire: Palgrave Macmillan.
Sappleton, N. (2018). Voluntary and Involuntary Childlessness: The Joys of Otherhood? Bingley: Emerald Group Publishing.
Dr Christina Weis and Dr Wendy Norton share insights from their study of heterosexually-partnered men’s experiences of becoming dads through surrogacy.
We know from previous research, that men in heterosexual relationships tend to be side-lined in surrogacy arrangements as the intending mothers and the surrogates find it easier to bond. These findings are based on research with mainly surrogates and intending mothers, as researchers report women ‘do the talking’ and it’s often difficult to recruit men.
We interviewed 10 men to learn more about their experiences, and found that men were cast into several roles that they found challenging: as expectant fathers, partners to infertile women, and mediators, helping to nurture a relationship with the surrogate who is gestating a child for them as a couple. Edward (not his real name) wanted to highlight to other men seeking surrogacy that with the “best will in the world, having two women in the relationship, one of which is pregnant who is not your wife…that is not easy”.
While the men in our study did confirm being side-lined in their arrangements, men were also intentionally and unintentionally side-lining themselves in their endeavour to support their partners, to enable them to bond more closely and experience the pregnancy they weren’t carrying. Several men expected and would have preferred to be more involved in the relationship with their surrogate, but felt unsure and insecure in “how to be well involved and how to be properly involved”. Furthermore, in several cases men felt similar to Edward who reported that “[our surrogate] wanted a strong relationship with my wife (…). It was very much her helping [my wife] than her helping us”.
Consequently, men resorted to taking charge of more practical or managerial tasks and as a direct result of prioritising support for their partners and surrogates, their own needs for involvement were relegated, as Jeremy expressed: “if I am honest, I would say my emotions took a back seat, always, to [my wife’s] and [surrogate’s], that’s the hierarchy shall we say.” Fred explained that it was important to him that his wife was “front and centre” in the arrangement as she was “not contributing biologically, and that’s a big deal and so I just felt that is was ever so important that she is…in control of it and running it.” Looking back, Fred reflected that he would like to be more involved, “because where I have been involved, it has been really good”.
Men described their surrogacy experience as “female-centred”, expressing frustration with the absence of tailored counselling addressing their experiences. Several men found partaking in the interview cathartic, and welcomed further opportunities for professional and peer support and exchange. We therefore recommend that surrogacy organisations and counsellors offer more tailored counselling for men and we are currently working with the Donor Conception Network (DCN) to provide resources for counsellors.
This post has originally been published in the Donor Conception Network Newsletter (Summer 2020, Issue 22).
August is now upon us and, as is now tradition, we wanted to pause for a moment and look back on our third year as a research centre. This year has been turbulent for everyone; COVID-19 and the need for social distancing has meant that we have not seen each other in-person for five months or more and we have all had to adapt to a way of living that has felt strange, saddening, as well as outright scary at times. Those of us who live alone have experienced the loneliness of ‘lockdown’ and others have had to balance the needs of working alongside home educating children and reassuring and meeting the emotional needs of those who depend on us. We don’t yet know when we will be seeing each other again face-to-face, however we have fallen into patterns of communication, which, as academics who often work from home, have felt some-what familiar. The low rumbling ring of ‘Zoom’ and ping of ‘Teams’ have become the tunes of our afternoon meetings. Early on in to lockdown we introduced weekly ‘CRR hangouts’ as an opportunity to talk and see (other) familiar faces, we continued our regular reading and our writing groups, chaired by Christina Weis and Helene Mitchell, and even have managed some productive work during our ‘shut-up and write’ sessions.
Whilst we have not yet met face-to-face, this academic year we welcomed Victoria Lang, Caroline Law and Kylie Baldwin back from maternity leave and have sent Sumaira off with our best wishes as she has her first baby. We have also welcomed some new members to the centre, Dr Diane Menage, Senior Lecturer in Midwifery, Dr Ying Liu who is a new lecturer in Psychology and Dr Kim Watts (Associate Professor) who has joined the DMU as our Faculty Lead for Research Students. Ying is currently researching the experience of sibling abortion under China’s one child policy and thus her expertise adds to the growing body of work undertaken by centre members examining (non)reproduction in China. In particular, Ying’s work compliments that of Amanda Wilson who has recently published some of her research on the mental health outcomes of prenatal and postpartum women in China after the implementation of the two-child policy. Amanda has also been undertaking work exploring men’s engagement in family planning and published her findings in ‘The Journal of Men’s Studies’ earlier this year.
‘Men and reproduction’ is one of the key themes in the work of CRR and is an area we have seen further development over the last year. Esmee Hanna and colleagues have shared the findings of their research on male infertility in several publications and, with the support of DMU Frontrunner Martha Dean-Tozer, they created a series of infographics which were shared widely during infertility awareness week. Caroline Law, whose PhD explores reproductive timing among single and partnered men, has also published some findings from her research which examines men’s views on age-related fertility decline and sperm freezing.
The work on our ESRC-funded EDNA project continues, and in February we held a stakeholder workshop with a focus on international knowledge exchange. This workshop, organised with the help of Sasha Loyal and Jess Turner, was attended by egg providers, fertility service providers and professional and academic experts from the UK, Belgium and Spain. At this workshop we presented key findings from the research and discussed some new and emerging policy recommendations. We have been continuing to disseminate the findings of this project in blog posts, at key conferences such as ESHRE and the ESA, as well as in a recent paper in Health Policy and Technology.
In other funding news we are pleased and very proud to say that Esmee has secured a prestigious and highly competitive NIHR Fellowship and was promoted to Reader/Associate Professor last August. Her NIHR project will explore psychological preparedness for amputation surgery, more information about Esmee’s work on this topic can be found here. Kylie was also awarded a DMU Global Fellowship. This fellowship is providing her the opportunity to complete analysis of, and publish from, her current research examining the medium to long-term reproductive experiences of users of egg freezing as well as put together new bids for research funding.
Tina Harris continues to work as Senior Clinical Lead for the National Maternity and Perinatal Audit; a collaborative project led by the Royal College of Obstetrics and Gynaecology in collaboration with the Royal College if Midwives, the Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine. This Healthcare Quality Improvement Partnership (HQIP) commissioned project is funded by NHS England and the Scottish and Welsh governments. Originally funded for three years until July 2019, last year the audit team secured an extension to contract with HQIP for a further 18 months. Congratulations to all!
Prior to lockdown measures, several Centre members gave invited talks on their research. Cathy Herbrand and Nicky Hudson were invited speakers at an event in Lausanne, Switzerland where they shared findings from the EDNA project as well as Cathy’s research examining reproductive and parenting rights of lesbian and gay couples in Belgium. Christina asked ‘Who is a patient in commercial surrogacy arrangements?’ at a talk in Cambridge in October and Nicky gave a keynote address exploring the creation of ‘world families’ via cross-border reproductive treatment at a conference in Germany.
Throughout the pandemic Christina has updated our blog with a ‘COVID-19 and Reproduction Digest’ which has brought together news stories and research on COVID-19 as it relates to our area of work. Sasha Loyal, Research Fellow, also questioned whether we would be likely to see a boom of ‘Corona-babies’ nine months after lockdown.
This year, three further members of the Centre completed their PhDs, Kriss Fearon who used photovoice to explore the reproductive choices of women and girls with Turner Syndrome, Zara Hooley who explored LBTQ friendships and parenting and Rowena Doughty whose work explores questions of obesity in pregnancy. Congratulations all!
Wendy Norton and Christina Weis worked together on a project exploring heterosexual partnered men’s experiences of becoming fathers through surrogacy and Wendy has collaborated with several other colleagues on projects exploring fertility discussions with young adults with cancer and has also written guidance on the role of practice nurses in the management of endometriosis. It has been this latter work that led her to be awarded a Fellowship from the Royal College of Nursing this July. Wendy was one of only eight recipients of the award which is an honour that recognises outstanding contributions to advancing the art and science of nursing and improving health care. Well done Wendy, we are so very proud!
As summer advances many of us are taking time away and reconnecting with family and friends after a long time apart and recharging our severely depleted batteries. It seems unlikely that our lives are going to revert to normal any time soon, but we appreciate the connections we have within the Centre, across the university and beyond and send our very best to all of our colleagues and friends for the summer vacation.
Last night the BBC Panorama with Stacey Dooley explored the experience of mothers giving birth during the height of the pandemic. I gave birth to my third child on 6th April 2020, two weeks after the UK was put into ‘lockdown’ in response to the unfolding global covid-19 pandemic. At this time the government had instructed all UK residents to ‘stay at home’ in order to limit the spread of the virus, to ‘protect the NHS’ and ‘save lives’. Although studies have not shown any greater risk to pregnant women from Covid-19, it is known that pregnancy can affect the way some women’s bodies respond to viral infections. Taking a cautious approach, pregnant women had already been categorised as in the ‘vulnerable group’by the Government’s Chief Medical Officer on March 16th and advised to reduce their social contact with others through social distancing measures.
One of the most visible impacts of the coronavirus pandemic has been the sudden disruptions to established practices and routines in pregnancy and maternity care. Although the Royal College Obstetricians and Gynaecologists have worked hard in their attempts to provide as much continuity as possible, some marked changes were deemed necessary in order to manage the threat to safety of both staff and patients.
For example, some maternity units cancelled home births due to staffing and safety concerns, such as the lack of a guarantee that there would be an ambulance for transfer to hospital should complications arise.
Many medical consultations, antenatal classes and breastfeeding support groups were transferred from face to face to virtual appointments, to save NHS capacity, reduce unnecessary travel and minimise human contact. Those still requiring face-to-face appointments would be met by practitioners wearing enhanced personal protective equipment (PPE) – such as face masks, plastic visors, aprons and gloves – to prevent the spread of infection.
New rules were put in place to restrict the presence of birth partners and other family members at antenatal and postnatal appointments, and during childbirth. While typically most hospitals are currently allowing one birth partner to be present at the birth itself, restrictions have been put in place across the board preventing visitors to hospital wards.
Welcoming a new baby into the family should be an exciting, joyous and happy occasion, but even under more normal circumstances pregnancy, birth and early parenthood are highly emotive times, which can be accompanied by heightened stress and anxiety for some. For me, late pregnancy and preparing for childbirth under lockdown was stressful, the uncertainty giving rise so many new questions adding to my anxieties. With official guidance changing all the time, would my partner be able to be there at the birth of his daughter? Would I still be able to have a planned c-section? If not, would I have to labour alone? What would happen if I went in labour early? Who would look after my other children while we were in hospital without breaking lockdown rules at the time preventing different households from mixing? Would the police stop us on the way to the hospital to check if our journey was essential? How long would I have to stay in hospital for? Would the care I received be any different? And most anxiety inducing of all, would I be exposed to the virus?
In the days – and many sleepless nights – leading up to my planned admission into hospital I spent hours scouring the Internet for answers to my questions, finding many other women on message boards asking the same things.
Reading other women’s stories can be comforting and disconcerting in almost equal measure. While there have been plenty of positive stories circulating of happy mums and healthy babies, equally there have been as many distressing stories. There have been reports of women having to attend antenatal appointments alone, only to be given devastating news of complications or pregnancy loss. Women have shared their heart – breaking accounts of still births and anguish of delayed fertility treatments, while others going through surrogacy tell distressing stories of separation from their newborn children.
The night before my planned C-section all I felt was dread. I was terrified of going into hospital, having close contact with others, getting infected and bringing the virus home to my family. These same fears and reluctance for pregnant women to go into hospital have reportedly led to a rise in missed antenatal appointments and births taking place in the car hospital park.
During the final weeks of my pregnancy, all of remaining antenatal appointments were changed to virtual appointments. At the forefront of each conversation was Covid -19, and most of the time was taken up with staff checking that I didn’t have any symptoms of the virus.
Moves towards so called digital health or ‘e-health’ have been gaining traction for many years in different areas of medicine in order to improve access for hard to reach populations, to make efficiency savings and reduce demand for face to face appointments.
In addition, telephone triage services are already an established part of maternity care in the UK, where midwifes provide support and advice to pregnant women and manage access to maternity services over the phone, although there has been little research into this aspect of health service delivery.
However, the rapid reconfiguration of NHS services from face-to-face to online video consultations and telephone appointments in response to the pandemic has been quite remarkable, especially in primary care. Some GP practices for instance report that 99% of their work was transferred online allowing them to comply with the rules on social distancing.
Although I was grateful that the changes made meant I didn’t have to leave my home, the conversations I had with health care professionals during this period felt more rushed and impersonal than before. I felt as though I wasn’t able to properly talk through the procedure I was about to face or to formulate a birth plan with a professional. Concern seemed to centre on whether I was infectious or not, with other aspects of my maternal health falling aside. Downsides of virtual appointments have been discussed in depth, including possible interference in the relationships between patients and practitioners. That personal connection between practitioner and patient can become disrupted when meetings are no longer in person. Midwifery especially is such a tactile profession with the materiality of the pregnant body and its fleshy reality at the centre of interactions. After the telephone appointments I worried if my blood pressure was too high, whether I had proteins or ketones in my urine, whether my iron levels were normal, what my ‘bump’ was measuring – all of these things had seemed so important just a few weeks earlier.
It will be interesting to see if any of these changes to health service delivery remain in place in the longer term.
I arrived at the hospital on the morning of my daughter’s birth, feeling very nervous and still unsure of quite what to expect. My partner was allowed to walk me to the door of the ward where we said a quick goodbye and teary eyed, I was shown to a bed while my partner had to go and sit in the car and wait – for five hours – until it was my turn in theatre.
Staff on the wards and in theatre were all in plastic aprons, face masks and gloves, doctors had added plastic visors. There was a visible display of handwashing by every professional before and after visiting each patient. I was issued a face mask of my own to wear if leaving the bed space. Although I had been worried about being in hospital beforehand, I did feel safe there. The visibility of the measures that were being taken to prevent the inadvertent spread of this pathogen made the severity of the threat hit home, but also was reassuring in the sense that it seemed like everything possible was being done to protect staff and patients alike.
I walked down to theatre with a nurse in a facemask and plastic apron, arriving in surgery to be greeted by the medical team all in full PPE. My partner appeared amongst the mass of people, and I almost didn’t recognise him at first, dressed in scrubs and hidden behind a face mask. It all felt a bit surreal.
Concerns have been raised about disruptions to communication because of PPE, particularly for those with hearing loss who rely on lip reading to communicate. Even without hearing loss, I found it difficult to hear exactly what anyone was saying to me through the face masks and plastic visas or to tell who was who. I wasn’t able to see their faces or read their facial expressions, voices were muffled. It is amazing how something as simple as a smile can put a patient’s anxieties at ease. I wasn’t asked what I wanted to happen nor given the opportunity to follow my birth plan for a natural c-section and immediate skin to skin with my baby. It seemed as though everyone wanted the procedure to be over as quickly as possible, and in that moment the safe delivery of my baby was all that seemed to matter to me too.
My partner got to see our daughter’s birth and stay with me in the recovery for around 15 minutes before being asked to leave and my newborn daughter and I were wheeled back to the maternity ward to recover.
The mood on the maternity ward was friendly and calm, I spent a lot of time talking to the three other new mothers on the same bay as me and to the nurses and health care assistants. It felt as though there was an immediate, albeit temporary, bond between the four of us women on the bay that day, living through a shared experience. The sounds of video calls introducing new babies to their siblings and extended families replaced the chitter chatter of visitors. One of the unexpected positives of the visitor ban for me was how peaceful and private the maternity ward felt in the absence of visiting family members and the hustle and bustle of their comings and goings.
Angela Barry, a midwife in a London hospital, writing about her experiences of the postnatal ward during the pandemic in The Guardian, reached a similar conclusion. She writes how she has observed women sharing birth stories with one another and helping each other with breastfeeding, building, as she puts it “a spirt of female empowerment and togetherness” in a way she “thought was a thing of the past”. She comments that, at her hospital at least, they may consider making changes to visiting arrangements post-pandemic.
The rest of my time in hospital passed in a bit of a blur, aided by the diamorphine and sleep deprivation no doubt. Discharge felt very hurried, just 30 hours after giving birth I was in the car on the way home.
One of the most enjoyable parts of early parenthood is bringing the new baby home from hospital and to meet siblings, grandparents, family and friends. For those of us giving birth during the lockdown and those with young babies, this was another major disruption to how we had imagined things. Earlier on in the pregnancy I had envisioned a steady stream of visitors coming for cups of tea and cuddles with the new baby. I had expected to be spending lots of time outdoors with friends who are also parents, sharing cake and stories of sleepless nights, going to baby groups and meeting other new parents, building our social networks. This has been replaced by video calls and socially distanced greetings in gardens and doorways, grandparents getting their first glimpses of their new grandchildren through screens and windows. As the old saying goes, it takes a village to raise a child, a consequence of lockdown rules on social distancing is the physical separation from our ‘villages’, leaving new parents without vital support networks.
Concerns have been raised about the impacts of social isolation due to the lockdown on parents and children, in particular in relation to mental health. The Parent – Infant Foundation for example, surveyed 5000 new parents as a part of Infant Mental Health Awareness week, reporting that they perceived their babies to be more clingy than usual and crying more.
In addition, there are lots of reports of grandparents in particular finding this physical separation difficult. Grandparents have expressed a real sense of ‘missing out’ not being able to cuddle their grandchildren, get to know them, bond with them and be there to witness them growing from tiny babies into independent little people. Indeed, when the daily government coronavirus briefing changed format at the end of April to allow members of the public to question ministers, the first question was from a grandmother asking ‘when can I hug my grandchildren again?’ The intensification of the grandparenting role over recent years has begun to attract sociological attention, with these intergenerational relationships shown to have positive benefits on wellbeing and longevity. As the lockdown eases in England, some families have been reunited. However, many families are still waiting. The social distancing measures imposed on us due to Covid -19 thus, may have far reaching implications for all members of the family.
These are just some of the things that have struck me related to my own experiences of pregnancy, childbirth and early parenting during this extraordinary time. I wonder which, if any, of these changes should become a part of ‘the new normal’ as society continues to respond to the threat of the virus – and will any of these changes be here to stay as the pandemic abates?