By Ranjana Das
The context: Gaps in provision and a turn to the digital
Put simply, mothers struggling with post-natal mental health difficulties in the UK, find uneven amounts of support. In the UK, a series of gaps in maternal wellbeing support have emerged, owing to the fact that face-to-face support for mothers from the NHS, is under pressure owing to budget cuts. Health Visiting services are struggling in England, owing to public funding cuts.
Increasingly, to find support and information and advice before and after having babies, in that critical perinatal period, mothers are going online, to find information, camaraderie, support, and social connections, using a range of sites, including general parenting forums, specialist online groups, people nearby apps, and perinatal support-focused Twitter hashtags, in the process. In the healthcare sector, policy is placing digital technologies at the heart of an ambitious agenda. Technology is often expected in many ways to revolutionise healthcare, and to fill gaps in offline care, cut costs, and bring benefits. But as yet, poor understanding remains, on the brighter and darker sides of how mothers are using existing new technologies for perinatal well-being, and how diverse this is for mothers – far from a homogenous group. Also, as yet, there is not a defined and distinct space for maternal digital well-being in overall digital well-being ambitions it seems.
Fieldwork with struggling mothers
Is there merit in high degrees of optimism around digital solutions in this context? I have been exploring some of this, through qualitative, face-to-face fieldwork with pregnant women, new mothers, mothers of toddlers, charities and healthcare professionals, combining this with analysis of online data from a range of digital sites, using funding from, first, the British Academy (2016-2018), and then, the Wellcome Trust (2017-2018). I have previously suggested that the picture is mixed – and there is reason to be cautiously optimistic, balancing positive and less than positive pictures in this context.
- Online emotional support and information seeking is of critical value. Women value information and emotional support on well-being related issues in the perinatal period, from accessible, even lay experts online. Some key Twitter hashtags with a significant role to play here include things like #PNDHour where a huge amount of peer support and camaraderie is evident. Women are sometimes bypassing difficult-to-access formal channels of support by making use of peer support online, and also being able to avoid well-meaning but dated advice from informal sources in the family by finding up-to-date peer support on various forums.
- Online camaraderie contributes significantly to offline solutions and support. This was particularly significant for mental health issues around childbirth, birth trauma and fear of birth. Online support, including People Nearby Applications seems to enable women to seek offline support better, and articulate and assert clearer offline expectations. Online bonds seem to become particularly reinforced when they move offline into women’s everyday lives. This aligns with recent research on PNAs which show how feelings of safety and trust are fostered prior to offline meetings, and their potentials in supporting cultural and social capital.
- Digital technologies offers ‘bridging’ roles between need and offline care. Findings showed that the anonymity of online platforms coupled with 24/7 immediacy of postnatal difficulties bridges gaps between need and formal support. Night-time difficulties, need for support in unsocial hours, long waiting periods for offline help meant that these gaps were overcome and bridged online. Online support and camaraderie was found to be more “accessible” than struggling to go to a group, bridging gap between acute anxiety and finding help offline. Many spoke of the convenience and the ‘low key’-ness of posting online or even reading up about other’s experiences of postnatal emotional difficulties, when they personally found themselves unable to face a large group, or social interactions in offline spaces.
- Commercial intrusions on women’s biological data complicate the digital. Commercial adverts for apps encouraging women to constantly monitor and track their fertility data all month long, are being pushed to women on sites like Facebook. I found in my conversations with women, that they presented conflicting discourses around these invitations to self-monitor and self-regulate in the context of fertility and conception.
- The health digital divide continues to function. Evidence from race studies and healthcare shows that ethnic minority migrant mothers face increased postnatal mental health risks and migrant mothers struggle particularly with cultural taboos around mental ill-health. My findings showed that migrant mothers, especially those from lower socio-economic backgrounds, often offline, showed many accounts of isolation throughout the perinatal period. Many felt surveilled by large extended families yet unable to connect to non-family others online. Many were entirely offline, and often, dependent on their husbands to top-up phones.
- Online rhetoric can silence, exclude and marginalize as much as offline ones. Findings showed that silencing and competitive mothering online references ‘intensive’/’good’ motherhood cultures leading to feelings of blame, shame and guilt. Many mothers felt silenced online about traumatic and difficult experiences at birth or with infant feeding. Many spoke of having been made to feel like a failure online.
A balanced, context-sensitive and cautiously optimistic approach to researching existing, informal digital avenues of support, and developing a space for maternal digital well-being in a digital strategic plan in the national health services in the UK, would be a welcome and constructive step. Such a step must frame mothers as active agents, and widely diverse in needs and practices, and any anticipated digital filling of gaps in provision must take into account not simply questions of access, but also digital health literacies, online-offline linkages, interinstitutional cooperation (between the NHS, organisations such as the NCT, third sector organisations such as PANDAS, and the myriad peer-support communities across the country), transparency, freedom from commercial encroachment, and suitable mechanisms of evaluation.
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