Now we’re into January I wanted to share some plans and developments for this blog. I’ve been blogging for six and a bit years, as a hobby in my spare time. It’s a space where I’ve been able to reflect on issues that bug me (like experiences in dealing with the media), highlight resources in sexual and reproductive health, or address more serious subjects (e.g. the medicalisation of sexual functioning). I’ve very much enjoyed doing this, particularly the freedom to talk about different issues as they’ve arisen, and tackling topics people have asked me to address.

However, I’ve recently felt a sense of disconnectedness between the blog and my working life. At work I lecture postgraduate students in International Primary Health Care – focusing on critically appraising evidence, putting that into practice, and reflecting on working effectively with communities and colleagues. Alongside this I supervise and carry out research on sex and relationships health, and apply this work by teaching continuing medical/professional education students core issues around understanding psychosexual and relationships topics and communicating with confidence with patients on sexual health issues.

That work has always informed what I write on the blog, and how I get to write it, but most of my writing hasn’t really been about my teaching or research.

I think the time has come to change that.

In recent years my research has moved from focusing on assessing psychosexual problems, through to evaluating how sexual and reproductive healthcare services are modernising (e.g. here, here and here). I’ve continued to be interested in how the media talks about sex and relationships (particularly around advice giving and public health messaging) (see here, here and here).

That work has led me to focus more on issues relating to sex and relationships when people are trying to conceive, during pregnancy, and when they have children. This interest has been sparked by feedback from participants and professionals during research; observations on what is available to parents to be and parents regarding advice on intimacy; and assessing how these topics are dealt with via the media and self help market. Completing systematic reviews on the academic literature has also informed my growing understanding of this area. Including topics such as psychosexual functioning following birth; relationship quality during pregnancy and parenthood; the impact on relationships following miscarriage, stillbirth or cot death; or how breast/bottle feeding impacts upon intimacy.

I’ve been amazed how in some areas there is a lot of really useful, critical and applied research on sex/relationships and pregnancy/parenting, but relatively little adoption of said evidence into practice in healthcare, education, therapy or media. For example there’s some fantastic writing unpacking some of the myths and stereotypes about breastfeeding and sex, and yet this seems to be largely ignored by midwives, health visitors and journalists.

There are also cases where there is nowhere near enough research completed, mirrored by relatively little discussion of the topic in healthcare or general advice for women and their partners. For example intimacy after miscarriage; or discussions on sex and relationships issues for people with disabilities, who are LGBT, single parents, or teen parents.

I’ll be focusing on these areas for the foreseeable future. Which brings me back to the blog – and where you can help.

I’ll be writing here about issues arising from my research, reading and teaching. For example covering topics like addressing relationships issues following miscarriage or stillbirth, intimacy and IVF, and breast/bottle feeding and the impact on libido. I’ll be focusing on reviewing evidence around core areas of sex/relationships and parenthood, and tackling problems identified in reproductive/maternal health care on these issues. Since many groups of people are excluded from research and writing around parenthood and intimate relationships, I’ll be seeking advice and input from people about their experiences of relationships and trying to conceive; pregnancy, surrogacy or adoption; or in parenthood.

Alongside this I’ve taken on board feedback I’ve had via email and from people I’ve met at public events discussing sex and science. In particular I’ve been asked to provide more practical guides around finding research papers, tools to aid critical appraisal of research, and information on how to apply sex research to our lives. Other requests include sharing ideas about how we can bring sex research to the public in innovative ways and will be reflecting on some opportunities for doing this over the coming months.

I’ve also been asked to clarify often used terms like ‘evidence based’, ‘sex positive’, or ‘behaviour change’. These phrases are often discussed in unproblematic ways – as if we all know and agree upon what they mean. I’ll be unpacking some of those core topics and thinking more widely about what they can mean (positively and negatively) within research and practice. If there are any poor or misleading media stories on sex and relationships I’ll do my best to debunk them.

I’ll continue to share information about interesting research papers, forthcoming conferences and events, and topical issues relating to sexual and reproductive health via twitter (@drpetra). I’ll also be sharing links to writing and projects by other inspiring and interesting people tackling diverse topics around sex, relationships, gender, sexuality and politics (sometimes all at once).

Your feedback via email (info@drpetra.co.uk) is always welcome. As I embark on this new role for the blog do keep me posted about what you like about it, where it needs to be improved and anything you think I need to be tackling. As much as time and work allows I’ll do my best to accommodate.

Wishing you all the best for the coming year and looking forward to sharing the next stage of my blogging journey with you. I hope you’ll find it useful and interesting.

Yesterday I was alerted to a worrying press release by @MrMMarsh (who has an amazing track record in critiquing commercial surveys). It was for Bounty.com – a parenting website, conducted by OnePoll. It claimed “one in 10 women have tricked a man into getting them pregnant with less than half actually wanting the person they ‘used’ to stick around once the baby was born” and went on to make further allegations about the women who deceive their partner into helping them conceive.

These women, according to this press release, are liars and tricksters, who use their seductive wiles to beguile men into parting with their seed.

Hmmm. Sounds similar to the way we used to accuse women of witchcraft – how apt for Halloween.

And apparently that was the reasoning behind this baffling campaign. According to Bounty (who had the story on their ‘entertainment page’) the poll was just a bit of ‘seasonal fun’. Doubtless they were only thinking of this in purely ‘fun’ terms, playing around the term ‘trick or treat’ with the suggestion women ‘tricked’ men into paternity. But due to a lack of forethought they inadvertently rehearsed other, far more sinister narratives about women’s sexuality that have been used to judge and harm women for centuries.

Perhaps unsurprisingly the campaign backfired. Massively. The outcry on Twitter and elsewhere online was uniformly negative about Bounty, OnePoll, and the ‘women as tricksters’ campaign.

However, that wasn’t before the story hit the headlines with coverage in both the Sun and the Daily Record.

What’s wrong with this poll?
The press release outlines 10 ‘most common ways women ‘trick’ someone’. Since we don’t have the original questions asked we can only assume they were based around these options, which include:
1. You just didn’t talk about it
2. You told them you were on the pill
3. You told them you’d had the injection
4. You weren’t very careful about taking the pill
5. You got them drunk
6. You told them you’d had the coil fitted
7. You put a needle through the condom / wrapper
8. You told them it was the wrong time of the month to conceive
9. You had a one night stand and didn’t make them use contraception
10. You told them you were infertile

These are a very odd mix indeed, and many of them describe common events that are not deliberate attempts at deceiving a partner into getting you pregnant. For example failed contraception (listed in 4) is a fairly common way for pregnancy to occur (although this survey presents it in a far more blaming way). Being confused over when you are fertile (which is one way of interpreting number eight) is also another reason women can find themselves pregnant. Simply not discussing pregnancy is not a definite sign of ‘tricking’ a partner. For many couples the topic of pregnancy is not always paramount unless they are particularly struggling with conception.

Not using contraception on a one night stand isn’t a great idea but it does happen and unless you’re specifically out to try and get pregnant from the encounter again is not a sign of someone deliberately tricking a partner into a pregnancy. It might, however, be a case of someone assuming they can’t get pregnant from a one night stand and discovering that’s a myth.

Knowing you’re fertile and telling someone otherwise (10) is not the same as thinking you may not be fertile and finding yourself pregnant – not unusual as some women will attest.

While options 2,3 and 6 involve lying about contraception use and 7 specifically describes scuppering a contraceptive, the remaining questions could easily happen without a person deciding to maliciously mislead another. Because there is no follow up to these questions there’s no way of knowing the context in which they happened.

From this the press release jumps to talk about how women continue to lie after they’ve got pregnant and talks about trapping ‘an unsuspecting male’.

While the press release does explain the majority of women don’t do this, the overwhelming tone of the story is that women are liars and out to trap men by getting pregnant. That they’re so deceitful they’ll continue to hide the secret that they tricked someone into getting them up the duff.

Why is this survey a problem?
Leaving aside the issues outlined above there are very real reasons why a survey like this is dangerous. Pregnancy and parenthood, while often positive, can also be stressful and difficult. Both can place considerable pressure on relationships. Adding to this any suggestion that women lie about getting pregnant could be devastating to many couples.

We already know that domestic violence is intertwined with paternity disputes (see here , here and here for example), although this is more often over concerns or accusations of whether a child is the biological offspring of a parent. Jealous and/or controlling partners can use accusations over paternity or the circumstances of a pregnancy to justify abuse.

At the very least this survey could put doubt into the minds of partners that they may have been conned into a pregnancy they weren’t ready for or perhaps didn’t want. Or make women feel their partners will distrust them. This might cause new parents to worry at one of the most vulnerable times in their lives. And if couples are already struggling because of distrust over conception this survey could provide unhelpful ammunition and widen the gulf between people.

Obviously it would be remiss to say no woman has ever misled a partner over a pregnancy – either with good intentions or maliciously. But this study was not robust or compassionate enough to explore this issue sensitively. Instead it overemphasises the likelihood of cheating a partner – and implies this is always deliberately malevolent.

As this is such a sensitive issue it would be reassuring to know how participants were treated. Because neither OnePoll nor Bounty have made the process of this study transparent we have no idea how participants felt about being questioned over the circumstances of their conceptions. Could they have felt judged? Embarrassed? Humiliated? Were they left fearful a partner might discover they had not been clear about their motives in getting pregnant? Were some left feeling they were liars when previously they’d simply thought they’d misunderstood their cycle?

In social research you should always be careful not to cause harm or distress, to anticipate what harms you may cause in the questions you ask. On a potentially sensitive topic like this you would usually have many steps in place to ensure participants were supported and helped if the work raised any issues for them. We have no idea if women who took part in this survey were distressed by it (or the subsequent reporting).

It is important to stress that in all probability neither Bounty nor OnePoll considered the issues of domestic violence or relationship harm when putting this work together. I am not arguing here they deliberately aimed to distress women and their partners. However it does indicate the lack of consideration behind this work. Part of good survey work (and all social research) involves thoroughly considering and planning for all potential interpretations, outcomes and consequences of your work – good or bad. It is shocking that nobody at Bounty or OnePoll could apparently see what potential problems this work could create.

Given the poll is problematic on so many levels – and the public reaction to it so negative – you might have expected Bounty and OnePoll to take immediate and apologetic action.

Bounty’s response
Bounty initially shared the story on Twitter, however once they began to receive criticism for it they deleted this message later following it up with the statement “Apologies 2 any1 offended by our recent research story – this was meant as a bit of seasonal fun & is by no means a judgement of anyone”

While they were right to apologise, their reaction that this was ‘fun’ did not indicate a real understanding of WHY people were so offended by their publicity stunt. Nor did it seem sincere given they kept the poll information as a headline feature on their ‘entertainment’ page, despite requests to remove it.

OnePoll’s response
OnePoll’s reaction was as problematic as Bounty’s. If not more so. Rather than directly engaging with the issue or apologising (as Bounty attempted) they contacted me on Twitter saying Hi there – we are the agency who carried out this research, would love to have a chat with you, DM me your number? Thanks!

I suggested they email me a statement, which they duly did:
“As the agency which commissioned this research and distributed the resulting news story, I would like to respond. OnePoll polled 3,000 mothers on behalf of Bounty, looking into the subject of pregnancy. The stats emerged that a small percentage of women admitted to tricking their partner into getting pregnant. I’d like to say that the resulting story in no way glorifies or condones this, in fact Bounty support the very opposite in their quotes. As market research specialists and providers of national news, we would always present the stats, as they are, however controversial. I would like to apologise to anyone who was offended by this piece of research”.

Let’s look at this statement in more depth. The poll apparently was on the ‘subject of pregnancy’. Was this how it was presented to mothers? If so, how may they have felt if then asked to discuss if they had ‘tricked’ their partner into getting them pregnant? We don’t know the answer to this.

The press release and subsequent media coverage may not be seen as ‘glorifying’ misleading a partner, but it does make it seem like a major issue and the press release and subsequent coverage are highly judgemental to women as a result. The stats here (not presented by the company at this time) were arguably always going to be ‘controversial’ because the questions asked were framed in such a way as to create this outcome. As was the press release.

Rather than this being a case of a robust piece of carefully designed and sensitive research into fertility being accurately reported, what we see here is a deliberate strategy to create a shocking headline that will guarantee press coverage. Although it’s important to stress this is a standard approach in PR nowadays, so nothing particularly unique to or sinister about this particular poll.

I found the response from OnePoll odd. At a time when their work was being debated on Twitter they decided to email me a statement. I don’t know why. I responded:
“Thanks. I think you would be better of making these statements on Twitter and taking responsibility there. Ethically I think this was not a good approach and I hope given the criticism you’re noting from researchers, PR and other marketing companies – as well as from parents – that you will work to deliver more thoughtful work in the future.
Since you’re stating you think it’s important to put out the stats ‘however controversial’ you should also make these available via your site now so people can see the questions you asked, the way you recruited your participants and the data you collected.
Perhaps as Bounty have had the grace to apologise you may also want to make it clear it was not a serious piece of research rather than trying to make it look otherwise.
Many people were offended by the research and also your role in it. I think it best you try and repair that damage now on Twitter, on your website and through your future conduct”.

I followed this with a message on Twitter that I had been in discussion with OnePoll and advised them to apologise, justify the survey and make their data publicly accessible (as they claimed in the email is standard practice).

No response came to my email or to anyone’s messages on Twitter. At this time OnePoll have not apologised for nor justified this work on Twitter or their website. Nor have they made the data from this poll publicly available despite saying it was standard practice. They have, however, celebrated the news coverage of this story on their website.

If either Bounty or OnePoll genuinely were concerned over running this survey or the message it portrays their reaction would have been different. It suggests neither company are particularly concerned but simply want criticism to go away. Perhaps other people working in PR or communications could pick up on how this issue has been handled and what impact it could have on brand Bounty or the reputation of OnePoll.

What you can do?
Judging by responses on Twitter today, plenty of people have been upset by this survey and the actions of both OnePoll and Bounty. If you feel this has not been adequately dealt with you can take further action.

For Bounty you can write to their advertisers – all shown on their website asking them if they are comfortable placing their adverts with a parenting organisation who approve publicity stunts that present women as liars. And who then apparently ignore the distress caused to parents and the public. You may also want to do this more publicly engaging Bounty’s sponsors on Twitter, Facebook or other social networks where they may have a presence. If you belong to Bounty (or have purchased their products/services) you may consider whether you wish to continue this relationship.

OnePoll can be reported to the Market Research Society who oversee correct conduct and ethical practice in commercial social research. An outline of their professional standards can be found here, while details of how to make a complaint can be found here.

Everyone is accountable here, everyone signed this work off and approved it at all stages. From coming up with the idea, through to asking women about their experiences, through to writing the press release and subsequent submission to the media.

There were plenty of steps when SOMEONE could have noted there was a major problem and put a stop to this work. Nobody did. Everyone involved needs to take responsibility for this.

Commercial companies and market research ones need to learn they can’t misuse surveys to promote products, particularly if they could cause harm or mislead people. The same social networks they use to promote will be used to hold them accountable and expose poor practice. Creating commercial campaigns that could harm or distress cannot be explained away as ‘seasonal fun’. Here’s hoping both Bounty and OnePoll have the courage and decency to make amends for this sorry tale.

Today sees the launch of Contraception Awareness Week where we’re invited to think about contraception choices to suit our reproductive health needs.

This year the theme of the week is focusing on unplanned pregnancies in the over 35 age group, something that’s common but often underreported – and unexpected when it happens to women.

More information about the campaign and evidence underpinning it can be found via the Family Planning Association where you can also find out information about contraception options – whatever your age.

Over this weekend the story broke that pharmacies were going to give teenagers the pill – as a means of tackling teenage pregnancy.

News coverage included:
Teenage girls offered contraceptive pill over the counter in a drive to cut pregnancies – Daily Telegraph

Teenagers to get pill without prescription – Independent

Girls get the pill on demand: now teenagers can get the contraceptive without prescription

Teenage girls to get contraceptive pill in pilot scheme

You’ve got to love these ‘girls get the pill on demand’ style headlines – which kind of ignore the fact that contraception is free and available within the UK – and yes you can ‘demand’ it if you like!

From the press it sounds like girls across the UK are going to get the pill from the pharmacy – is that really the case? Well, before we get to that, let’s look at what we do know about providing contraception via pharmacies.

What’s the evidence?
The papers have not clearly indicated this is a pilot scheme, perhaps in their hurry to promote a shock/horror response they overlooked this. They also seemed to overlook the wider evidence base about oral contraceptive provision, and managing teenager pregnancy.

So what do we know about this issue? Well, we do know our teenage pregnancy rates in the UK are high. Most of those pregnancies are terminated, but the prevalence of termination (particularly repeat terminations) are of concern to healthcare providers. As a result there’s been a push within reproductive/sexual healthcare over the past decade to rethink how contraceptive services are delivered – and how teenage pregnancy rates can be reduced.

There is already an established evidence base that pharmacies can provide some forms of contraception and sexual health support – for example condom sales, testing for Chlamydia and providing emergency contraception (morning after pill).

Here the pharmacy becomes an additional service for providing contraception/sexual health support, alongside existing reproductive health/family planning clinics or GPs.

Young people are frequently blocked from accessing services due to unclear signposting of services (so young people don’t know where they are); restricted opening times which often don’t fit with young people’s timetables; problems with location; uncertainty over what happens in a clinic; worries about confidentiality; or just basic information (many young people still wrongly think you have to pay to get contraceptives).

Add to this problems with sex education and general problems around poverty and social exclusion, there are understandable reasons why young people get pregnant. Culturally we’re often quick to blame them without appreciating the lack of access to information and contraception that affect some teenagers. You can read more about how poverty, lack of education and healthcare barriers contribute to sexual and reproductive health problems here (with an ongoing investigation into the issue reported here)

Part of a response to our current sexual health crisis been a shift to making sexual health less clinical and more about self management. This has been suggested to reduce strain on services and make aspects of care that can be managed in other settings more effective. So pharmacies can be one additional place to deliver care, as might school nurses, or even cafes and nightclubs. More choices and more places to get advice and services are a step to reduce teenage pregnancy and termination rates.

There is no evidence that making sexual health services more accessible increases teenage pregnancy (as some media reports have claimed). Although it’s worth noting that many of the schemes trying to reduce teen pregnancy are being rolled out in areas where teen conception is already very high.

What’s actually happening?
This is a pilot scheme being run in a deprived area of London with a high prevalence
of teen pregnancy. You can read about the area’s history on this issue here. This borough has received charitable trust funding to modernise a variety of services, including sexual health. You can read an independent evaluation of that work here.

Within this modernisation work, practitioners have already investigated delivering sexual health services within community settings, including assessing whether community pharmacies were suitable locations for Chlamydia testing.

This latest pilot is part of an ongoing project looking to modernise, improve and make more accessible sexual and reproductive health services for a resource poor community. All activities have been based upon evidence and completed in consultation with the community.

So rather than the pill being given to all teenagers across the UK, this is simply a pilot scheme to see whether providing the pill to younger people within community pharmacy settings is feasible – and works to reduce teen conceptions. If it does, then the scheme will be rolled out to other pharmacies. If it doesn’t work then alternative approaches will be considered.

Why do we need to be cautious?
My first question about this story is ‘is this really news?’. It created a widespread splash in the papers, but it was actually launched to the press last year, and there was some coverage of the proposed scheme in August 2009 too.

We need to discuss why this story got back into the papers. It isn’t clear. But what is clear is the majority of coverage was judgemental or negative, and has discussed a pilot scheme within the press before it has even really got started. That’s a problem as it can scupper a pilot and mean we never get to see if it can work or not. It can lead to people interfering with the delivery of a service – particularly those who’ve been led by the media to see such a pilot in negative ways.

We don’t know if this will work – that’s the point of a pilot. To investigate and explore. So media coverage should really only happen when a study has been completed – not speculation before it starts, or during any study.

We’ve seen similar problems with the media outing interventions to reduce teen pregnancy in the past. You could be forgiven for believing some media outlets simply don’t want us to tackle the problems we’re experiencing with teenage pregnancy and sexual health.

Generally health evaluations work better if left undisturbed and can be reported faithfully whether they work or not. We really do need to challenge this practice of reporting on pilots until they are finished. Particularly in the restrictive way the media approaches this which is to find a practitioner (usually from a faith based group) to say how such a scheme will inevitably make things worse. What may help more would be to put such schemes within the context of wider evidence, and if you want a debate to talk about whether other approaches – like better sex education, tackling poverty or increasing aspirations for young people – might be equally or more effective.

For the record this pilot scheme does not mean all teenagers are going to be offered the pill. It’s a pilot taking place in a specific part of South London. Even within the pharmacies in the pilot it doesn’t mean that pharmacists will be pouncing on all young women entering their stores and giving them oral contraceptives. Any young woman requesting oral contraception will have consultation and be assessed for competence and the pharmacist can refer to other services if needs be.

Parents don’t need to worry that pharmacists will be slipping the pill to their daughters behind their backs. Even if some journalists have misled them that this will be the case.

For now, all we can do is wait and see if this pilot works. And in the meantime additional focus will continue to address ways for reducing teen pregnancy in
poor/deprived boroughs.