P REGNANCY EXPERIENCES AND PERCEIVED SOCIAL SUPPORT AMONG PREGNANT WOMEN IN POOR RURAL ROMANIA

1. PREGNANCY EXPERIENCES AND PERCEIVED SOCIAL SUPPORT AMONG PREGNANT WOMEN IN POOR RURAL ROMANIA VU University Amsterdam: Marijn Voorhaar Center for Health Policy and Public Health, Babeş-Bolyai University, Cluj-Napoca, Romania: Dumitrela Negură Alexandra Brînzaniuc Emanuela Marton-Vasarhelyi Ioana Cazan A Photovoice Pilot Study

2. In this presentation: • Introduction • Methods: • Photovoice • Focus groups • Results • Discussion • Conclusion • Acknowledgements • Questions

3. Introduction Hormonal swings3 Life changes and psychological adjustments1 Postpartum depression2 Relationship difficulties4 Stress and anxiety4 Transition to motherhood2 Worries and concerns about pregnancy4 1Da Costa et al., 1999 2Modh et al., 2011 3Glazier et al., 2004 4Da Costa et al.., 1999

4. Introduction Possible consequences of anxiety and depression during pregnancy4: • Complications during pregnancy and/or birth • Low birth weight • Poor neonatal status • Prematurity 4Da Costa et al.., 1999

5. Introduction • By taking the pregnant women’s experiences seriously, a postpartum depression might be prevented5 • Importance of sharing experiences of pregnancy with other pregnant women6 • Connectedness with other future mothers and sharing the feeling of both joy and suffering is considered meaningful7 5Lundgren, 2002 6Bondas & Eriksson, 2001 7Callister, 2004

6. Introduction • It is hypothesized that social support has a positive effect on psychological and emotional well-being of pregnant women by buffering the impact of life stress. • Little research has been done to examine social support during pregnancy and the pregnancy experiences of women in poor rural communities.

7. Introduction: Romania • 67% of the total poor population in Romania lives in rural settings. • Need for qualitative research: explore and conceptualize pregnancy experiences and role of social support. • This study is the first study that aims to provide insights into pregnancy experiences and perceived social support among pregnant women in poor rural communities in Romania. • Photovoice method

8. Introduction: Research question How do pregnant women in poor rural Romania experience their pregnancy and how do they perceive social support?

9. Methods: the participants N = 8 N = 9

10. Methods: Photovoice • Photovoice(Wang & Burris, 1994) • High value on the power of visual images • Everyday realities • Own interpretation • Participants are experts

11. Methods: Data collection

12. METHODS: DATA COLLECTIONMEETING I: PHOTOVOICE ASSIGNMENT • Pregnancy experiences: • Positive • Negative • Feelings about pregnancy • Social support: • Perceived social support • Forms • Sources • Written informed consent • Instructions disposable camera

13. Meeting I Aghireşu

14. Meeting I Aghireşu: portraits

15. Methods: Data collectionMeeting II • Collection of cameras

16. Methods: Data collectionMeeting III: Focus group • “First round” • Exchange photographs • Pile sorting exercise • SHOWED: • What do you See here? • What is really Happening here? • How does this relate to Our lives? • Why do these issues exist? • How can we become Empowered by our new social understandings? • What can we Do about it?

17. Meeting III: Pile sorting exercise

18. Meeting III: SHOWED

19. Meeting III: Evaluation

20. Methods: Data analysis • Content analysis: photographs • Thematic analysis: group interviews • Concept mapping: represent identified themes

21. Results (preliminary) • Pregnancy positive experience • Main sources social support: • Children (group Cojocna) • Husband (group Aghireşu) • Need for support groups • Evaluation Photovoice project • “We were glad we could communicate with other pregnant women.” • “Here we were able to share our troubles.”

22. Discussion Differences between Cojocna and Aghireşu groups: • Ethnicity: Roma & Romanian • Interaction during sessions • Sharing experiences • However: both groups would participate again

23. Conclusion • Photovoice encouraged the participants to share their pregnancy experiences and to describe their social support networks. • Sharing experiences and worries with other pregnant women could be an important form of social support during pregnancy. • Support groups for poor pregnant women living in rural areas could contribute to a better insight in the needs of these women.

24. Acknowledgements Participants, family physicians, mediator Research Team: Dumitrela Negură, MA Alexandra Brînzaniuc, MA Emanuela Marton-Vasarhelyi, MA Ioana Cazan, BA Supervisors: Răzvan Cherecheş, MD PhD, executive director CHPPH Anne Belonje, MD PhD, lecturer International Public Health, Athena Institute Advisor: Vincent O'Brien, Professor of International Health and Visual Ethnography, The University of Cumbria

25. Questions