Danielle L. Herbert

Depression: an emotional obstacle to seeking medical advice for infertility.

OBJECTIVE To investigate the mental and general health of infertile women who had not sought medical advice for their recognized infertility and were therefore not represented in clinical populations. DESIGN Longitudinal cohort study. SETTING Population based. PATIENT(S) Participants in the Australian Longitudinal Study on Womens Health aged 28-33 years in 2006 who had ever tried to conceive or had been pregnant (n = 5,936). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Infertility, not seeking medical advice. RESULT(S) Compared with fertile women (n = 4,905), infertile women (n = 1,031) had higher odds of self-reported depression (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.43), endometriosis (5.43, 4.01-7.36), polycystic ovary syndrome (9.52, 7.30-12.41), irregular periods (1.99, 1.68-2.36), type II diabetes (4.70, 1.79-12.37), or gestational diabetes (1.66, 1.12-2.46). Compared with infertile women who sought medical advice (n = 728), those who had not sought medical advice (n = 303) had higher odds of self-reported depression (1.67, 1.18-2.37), other mental health problems (3.14, 1.14-8.64), urinary tract infections (1.67, 1.12-2.49), heavy periods (1.63, 1.16-2.29), or a cancer diagnosis (11.33, 2.57-49.89). Infertile women who had or had not sought medical advice had similar odds of reporting an anxiety disorder or anxiety-related symptoms. CONCLUSION(S) Women with self-reported depression were unlikely to have sought medical advice for infertility. Depression and depressive symptoms may be barriers to seeking medical advice for infertility.

Infertility, medical advice and treatment with fertility hormones and/or in vitro fertilisation: a population perspective from the Australian Longitudinal Study on Women's Health

Objective: To identify the factors associated with infertility, seeking advice and treatment with fertility hormones and/or in vitro fertilisation (IVF) among a general population of women.

Pregnancy Losses In Young Australian Women: Findings from the Australian Longitudinal Study on Women's Health

INTRODUCTION Little research has examined recognized pregnancy losses in a general population. Data from an Australian cohort study provide an opportunity to quantify this aspect of fecundity at a population level. METHOD Participants in the Australian Longitudinal Study on Womens Health who were aged 28-33 years in 2006 (n = 9,145) completed up to 4 mailed surveys over 10 years. Participants were categorized according to the recognized outcome of their pregnancies, including live birth, miscarriage/stillbirth, termination/ectopic, or no pregnancy. RESULTS At age 18-23, more women reported terminations (7%) than miscarriages (4%). By 28-33 years, the cumulative frequency of miscarriage (15%) was as common as termination (16%). For women aged 28-33 years who had ever been pregnant (n = 5,343), pregnancy outcomes were as follows: birth only (50%); loss only (18%); and birth and loss (32%), of which half (16%) were birth and miscarriage. A comparison between first miscarriage and first birth (no miscarriage) showed that most first miscarriages occurred in women aged 18-23 years who also reported a first birth at the same survey (15%). Half (51%) of all first births and first miscarriages in women aged 18-19 ended in miscarriage. Early childbearers (<28 years) often had miscarriages around the same time period as their first live birth, suggesting proactive family formation. Delayed childbearers (32-33 years) had more first births than first miscarriages. CONCLUSION Recognized pregnancy losses are an important measure of fecundity in the general population because they indicate successful conception and maintenance of pregnancy to varying reproductive endpoints.

Changing patterns of contraceptive use in Australian women

BACKGROUND This longitudinal analysis examines how patterns of contraceptive use changed over 11 years among Australian women born between 1973 and 1978. STUDY DESIGN The analysis included 6708 women sampled from the Australian universal health insurance database who completed four self-report postal surveys between 1996 and 2006. Change over time in use of any method of contraception and the common single methods of the oral contraceptive pill and condom was examined using a longitudinal logistic regression model. RESULTS The oral contraceptive pill was the most commonly used single method at each survey (27-44%) but decreased over time. Over time, contraceptive users were increasingly more likely to be single or in a de facto relationship or to have had two or more births. CONCLUSIONS Womens contraceptive use and the factors associated with contraceptive use change over time as women move into relationships, try to conceive, have babies and complete their families.

Birth outcomes after spontaneous or assisted conception among infertile Australian women aged 28 to 36 years: a prospective, population-based study.

OBJECTIVE To examine the extent to which the odds of birth, pregnancy, or adverse birth outcomes are higher among women aged 28 to 36 years who use fertility treatment compared with untreated women. DESIGN Prospective, population-based. SETTING Not applicable. PATIENT(S) Participants in the ALSWH born in 1973 to 1978 who reported on their infertility and use of in vitro fertilization (IVF) or ovulation induction (OI). INTERVENTION(S) Postal survey questionnaires administered as part of ALSWH. MAIN OUTCOME MEASURE(S) Among women treated with IVF or OI and untreated women, the odds of birth outcomes estimated by use of adjusted logistic regression modeling. RESULT(S) Among 7,280 women, 18.6% (n = 1,376) reported infertility. Half (53.0%) of the treated women gave birth compared with 43.8% of untreated women. Women with prior parity were less likely to use IVF compared with nulliparous women. Women using IVF or OI, respectively, were more likely to have given birth after treatment or be pregnant compared with untreated women. Women using IVF or OI were as likely to have ectopic pregnancies, stillbirths, or premature or low birthweight babies as untreated women. CONCLUSION(S) More than 40% of women aged 28-36 years reporting a history of infertility can achieve births without using treatment, indicating they are subfertile rather than infertile.

Miscarriage, preterm delivery, and stillbirth: large variations in rates within a cohort of Australian women

Objectives We aimed to use simple clinical questions to group women and provide their specific rates of miscarriage, preterm delivery, and stillbirth for reference. Further, our purpose was to describe who has experienced particularly low or high rates of each event. Methods Data were collected as part of the Australian Longitudinal Study on Womens Health, a national prospective cohort. Reproductive histories were obtained from 5806 women aged 31–36 years in 2009, who had self-reported an outcome for one or more pregnancy. Age at first birth, number of live births, smoking status, fertility problems, use of in vitro fertilisation (IVF), education and physical activity were the variables that best separated women into groups for calculating the rates of miscarriage, preterm delivery, and stillbirth. Results Women reported 10,247 live births, 2544 miscarriages, 1113 preterm deliveries, and 113 stillbirths. Miscarriage was correlated with stillbirth (r = 0.09, P<0.001). The calculable rate of miscarriage ranged from 11.3 to 86.5 miscarriages per 100 live births. Women who had high rates of miscarriage typically had fewer live births, were more likely to smoke and were more likely to have tried unsuccessfully to conceive for ≥12 months. The highest proportion of live preterm delivery (32.2%) occurred in women who had one live birth, had tried unsuccessfully to conceive for ≥12 months, had used IVF, and had 12 years education or equivalent. Women aged 14–19.99 years at their first birth and reported low physical activity had 38.9 stillbirths per 1000 live births, compared to the lowest rate at 5.5 per 1000 live births. Conclusion Different groups of women experience vastly different rates of each adverse pregnancy event. We have used simple questions and established reference data that will stratify women into low- and high-rate groups, which may be useful in counselling those who have experienced miscarriage, preterm delivery, or stillbirth, plus women with fertility intent.

The impact of funding deadlines on personal workloads, stress and family relationships: a qualitative study of Australian researchers.

Objective To examine the impact of applying for funding on personal workloads, stress and family relationships. Design Qualitative study of researchers preparing grant proposals. Setting Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. Participants Australian researchers (n=215). Results Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. Conclusions The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.

Recruiting young women for health surveys: traditional random sampling methods are not cost-effective.

Melissa L. Harris,1 Danielle Herbert,2 Deborah Loxton,1 Annette Dobson,3 Britta Wigginton,4 Jayne C. Lucke4,5 1. Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, New South Wales 2. School of Public Health & Institute of Health and Biomedical Innovation, Queensland University of Technology 3. School of Population Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland 4. UQ Centre for Clinical Research, The University of Queensland 5. Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, Victoria

‘As many options as there are, there are just not enough for me’: Contraceptive use and barriers to access among Australian women

Abstract Objective A comprehensive life course perspective of womens experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Womens Health (ALSWH). Methods The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18–23 years) to 2009 (31–36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. Results Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. Conclusion Side effects of hormonal contraception and concerns about contraceptive failure influence womens mental and physical health. Many barriers to effective contraception persist throughout womens reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women. Chinese Abstract 摘 要 目的 从一种全面的生命历程的角度来看，澳大利亚妇女缺乏获取和采用避孕方法方面的经验。本文探究了1973年至1978年间出生，参加澳大利亚妇女健康纵向研究（ALSWH）的女性所提供的关于避孕的自由评论。 方法 ALSWH是一项国家性的以人群为基础的群组研究项目，有来自各个年龄组的40,000多名女性参加，每三年对她们进行一次调查。最初搜索到的是在1996年（当时她们18-23岁）至2009年（当时她们31-36岁）参与五项研究的690名女性所做的1600条评论。本项分析包括289名参与者的305条评论。采用主题分析方法确定并探究了与所面临的障碍和采用理想避孕方法等方面的经验相关的因素。 结果 随着这些女性年龄的增长，五项研究的五个主题再次出现：（i）影响生理和心理健康的副作用；（ii）缺乏避孕相关的信息；（iii）卫生服务的负面经历；（iv）避孕失败；（V）成功避孕的困难。 结论 激素避孕和对担心避孕失败的副作用影响女性的生理和心理健康。许多有效避孕的障碍会始终贯穿女性的育龄期。下一步的研究应减少障碍并使负面的经历最小化，为澳大利亚妇女确保最佳的避孕方法。

The feminisation of contraceptive use: Australian women’s accounts of accessing contraception

The oral contraceptive pill remains the most widely used contraceptive method. We consider The Pill’s depiction as variously revolutionary and liberating, oppressive for women, and more recently, a ‘lifestyle drug’. Drawing on discourses of (hetero)sex, heterosexuality and gender performance, we discuss how contraceptive use has been feminised and consider the current gap in understanding how women negotiate their positioning as responsible for contraception. To begin to fill this gap, we conducted a thematic discourse analysis using 75 free-text responses (to a general question in a wider contraceptive survey) to explore how women account for their agency and responsibility in discussions of accessing contraception. We identified two themes: responsibility for education and information and ‘finding contraceptive fit’. Women’s discussions of responsibility for education and information highlight the need for transparency from educational bodies, which are positioned as lacking in their delivery of contraceptive information. Women describe “finding contraceptive fit” as an embodied process of experimentation with contraception to ultimately find one with minimal negative side effects. We situate our findings within critiques of the gendered nature and production of health, conceptualising contraceptive use as a distinctly feminine practice, which promotes self-surveillance and embodied awareness.