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Reproductive Bodylore: the role of vernacular knowledge in women's contraceptive decision-making

Lead Research Organisation: The Open University
Department Name: Faculty of Wellbg, Educ & Lang Sci(WELS)

Abstract

Unintended pregnancy remains a Public Health concern, yet we still do not know enough about the influences on women's contraceptive choices. Existing research calls for more insight about the influences of women's informal social networks on contraceptive choice. That is - stories, anecdotes, 'friend of a friend' tales, rumor, personal experience narratives and other informal communications. This project is highly significant in that it explores vernacular knowledge about the reproductive body and contraception through drawing together folklore studies and health research. An approach which is uniquely innovative and novel - there is at present no existing study on the topic in the UK and only very limited international focus.

The project addresses the question: How does vernacular knowledge influence women's contraceptive choices and mediate their experiences of reproductive control?
It has a number of aims: 1) To explore and document the greatest possible range of vernacular knowledge about the reproductive body and contraception 2) To offer an interpretation of this data, analysing and theorising how vernacular knowledge about contraception is transmitted between friendship and kinship groups, and how it may influence attitudes, behaviour, and experience 3) To engage with policy and practice and to enhance practitioner understandings about women's vernacular knowledge of the reproductive body, and to make appropriate suggestions for improving services.

In seeking to address these aims a multistrand approach comprising two Work Packages and a dissemination stage will be employed.

Work Package 1 will involve re-analysis of project data from a number of previous studies Victoria Newton (PI) and Lesley Hoggart (Co-I) have undertaken on women's contraceptive use and reproductive control (as listed in the case for support). This re-analysis will inform the development of the topic guides for the gathering of new qualitative data in WP2. In this way, the new research will be firmly grounded in research undertaken in the UK since 2010. It will provide a solid platform from which to develop robust and informed research tools (the 'prompt topics') for WP2.

Work Package 2 is a placement for the PI (VN) at Public Health England (PHE). This strand involves participatory research and will involve consulting with, including and working together with up to 20 lay researchers, who will be recruited via PHE's networks. Volunteer researchers will undertake interviews and focus groups among their own friendship/kinship and social networks. They will also search for media/social media stories stories. Data from this strand will be made available digitally via the Open University's Open Access Data Archive (ORDO).The placement will also involve sharing findings and implications for practice via 6-8 focus groups with clinicians at clinic sites across the UK. WP2 will culminate in a one-day symposium at The Folklore Society.

Dissemination: The project will culminate in a Public Engagement exhibition co-hosted in a public space in London - the geographic location of project partners (Public Health England and The Folklore Society). The exhibition will be designed and curated by The Liminal Space. The Reproductive Bodylore exhibition will be interactive and visitors will be invited to contribute their own thoughts and stories about contraception around the theme of 'I heard that....' The aim of the exhibition will be to demystify stories of contraception and invite engagement. The exhibition will also be showcased at sexual health practitioner conferences - eg, FIAPAC and RCOG to promote debate around informal communication, misinformation and individual contraceptive choice.

Planned Impact

The project has been designed collaboratively with key stake holders and project partners and will have impact on a number of communities beyond academia. Our advisory group will provide multiple routes for stakeholder engagement.
Women as users of contraception: On an individual level, the project will enhance the wellbeing of women through a number of different avenues. The main output of the project - the public engagement exhibition - will facilitate discussions about contraceptive use. The event will be a 'living exhibition', where visitors will be able to contribute their own stories and anecdotes to the project. The exhibition will also be an opportunity for common misperceptions to be addressed. Universal contraceptive choice will be at the heart of the exhibition, and all viewpoints will be valued. The aim of the event is not to encourage use of one type of contraceptive over another. Rather it is intended to value and highlight women's different contraceptive decision-making pathways without judgement. By making obvious the different stories about contraception (and women's concerns) the project will address and challenge stigma about the contraceptive choices women make, showcasing the different processes and values involved in an individual's choice. We hope that visitors to the exhibition will broaden their views and awareness about different methods of contraception. Evaluation: Following a model established with previous public engagement projects, the project team will undertake a formative evaluation process. We will collect visitor feedback (written and interview); interview volunteers; monitor social media and Press reception. We will then share our learning by: speaking at medical conferences; writing peer-reviewed publications and Press-releases; and running a social media campaign.
Participant and Public Involvement: The project contains a large component of participatory research, where lay researchers are involved in the collection and analysis of research data. The participatory methods benefit these communities by providing an opportunity to contribute towards and inform research that makes a difference to how other women's contraceptive choices and decision-making are supported. The participatory research will also upskill participants and give them experience in research methods and analysis techniques, which may be beneficial to CV development and future employability. The lay researchers' may also benefit from increased confidence as their contribution will directly inform the concept development of the Public Engagement exhibition.
Clinical partners who deliver contraception services: The project will provide an evidence base for the public health concern of unintended pregnancy and will facilitate the development of interventions and resources to support women in their contraceptive choices. During the placement at Public Health England, the PI will work with practitioners to develop new resources to support contraceptive consultations. These may include interventions such as an 'aide mémoire' for asking women about their preferences and concerns about a particular type of contraceptive.
Impacts will also extend beyond individual organisations to UK national bodies: The exhibition will be showcased at practitioner conferences such as the Faculty of Sexual and Reproductive Health and the Royal College of Obstetricians and Gynaecologists. Engaging with these national professional bodies is key to promoting growth in both awareness and activity around vernacular contraceptive knowledge. Collective efforts to explore vernacular knowledge has benefits for the wellbeing of women, and for contraceptive care providers. The project will highlight how arts and humanities research can be applied to a public health setting and break down barriers between academia and practice, leading to possible further interdisciplinary collaborations to tackle difficult and yet unaddressed research problems.
 
Title Bodylore: The role of shared stories in making contraceptive choices. 
Description As a piece of publicly-funded research, and also as a piece of participatory research, it was important for us to take the stories that emerged during the research back to the public, and to share the role these narratives play in decision-making. We also wanted to bring these usually private stories that women told each other into a public space, to see how people responded to them. The project culminated in a public engagement exhibition at the Truman Brewery, London in October 2023. Working in collaboration with design consultants The Liminal Space, and with input from our volunteer researchers, we framed the exhibition around five different stations, representing different points in life where contraception might have different meanings. 
Type Of Art Artistic/Creative Exhibition 
Year Produced 2023 
Impact In the space of 6 days, approximately 1,360 people entered and explored the exhibition and feedback from visitors was overwhelmingly positive and indicated an appreciation for the space to read, listen and contribute their own individual stories. Bringing these stories to the fore is one way of tackling reproductive stigma and opening up conversations around sensitive topics. Visitors commented: "Thank you for this exhibit it should be talked about more"; "We are really talking about it. Can relate to many of these stories. Thank you"; "It's sad there are no other spaces like this - women should be able to share their stories and not feel alone in this". Visitors also shared their own stories with contraception, some of which echoed narratives from the wider project demonstrating them to be in circulation in real time, as well as people gaining new knowledge from attending the exhibition: "I had taken the next mornings pill [EHC] twice in my life, and until today I thought that I have one more chance to take it. I am glad I learned today here in this exhibition, that these 3x times only number is a myth. But still, only women taking pills is not right." 
URL https://wels.open.ac.uk/research/projects/bodylore
 
Title Illustrated definition - 'vernacular knowledge of contraception' 
Description We commissioned Lucy Wright (a folklorist and artist) to design a visual representation of our definition of vernacular knowledge. The artwork is grounded in the qualitative analysis of Work Package 1. 
Type Of Art Artwork 
Year Produced 2020 
Impact We used this artwork during our training sessions with lay researchers in Work Package 2. It helped our co-researchers to develop their understanding of vernacular knowledge. 
 
Description A negative (or less often) positive experience of a friend or family member was a valuable consideration in personal decision-making. During WP2 (the participatory research) the interviewees spoke about contraceptive use as a trade-off between reproductive control and perceived effects on the emotional and physical body. Hormonal contraception was perceived as toxifying or polluting in some way to the natural body. A key theme cutting across both the secondary analysis and participatory interview data was 'fertility fears'. Within this theme, a detrimental effect on future fertility was seen as a possible consequence of using hormonal or long-acting contraceptive methods. Contraception was often conceptualised as 'burden' and informal information sharing was one way of exploring the perceived risks and benefits of different methods and seeking the opinions and experiences of others.
When considering a new method of contraception, participants described sifting through information from a range of different sources e.g. NHS website, personal experience accounts, media and online. Vernacular knowledge was one component of information seeking. However, listening to the stories of others, together with personal experience, provided reassurance or discouragement in trying new contraceptive methods.
Vernacular or informal knowledge is one component of women's contraceptive literacy that is overlooked for study and not adequately addressed in contraceptive consultations. It can provide important insights into everyday understandings of reproductive health and wellness, including perceived risk and risk behaviours. Clinicians should listen and seek to understand contraceptive information derived from informal sources. The circulation of such narratives demonstrates that patients are interested and involved in their healthcare decisions. Participant concerns about future fertility highlight the importance of greater education around fertility awareness in relation to pregnancy planning and avoidance.



Reproductive bodylore had four specific objectives:
1) To make a significant theoretical and methodological contribution to folklore research in the UK. We achieved this objective through presentations at international folklore conferences e.g. The Folklore Society annual conference and the International Society of Contemporary Legend Research conference, as well as organising a project specific conference on Fertility, Folklore and the Reproductive Body. Victoria is drafting publications to the journals 'Folklore' and 'Contemporary Legend' and has been invited to give a public talk at the Folklore Society which will be recorded in the Folklore Society Archive. Victoria also applied for AHRC OOC doctoral funding in partnership with The Folklore Society to build capacity in applied folklore and health as an area of research.
2) To engage and inform thousands of people about contraceptive lore through the development of a public engagement exhibition. We worked with The Liminal Space to produce a public engagement exhibition which was held at the Truman Brewery in London 3-8 October 2023. Over 6 days, approximately 1,360 people came inside to explore the exhibition, and 4,650 people engaged with window displays outside.
3) To engage with 100s of clinicians about the role of vernacular knowledge in contraceptive decision making. We have presented the research at the Royal College of Obstetricians and Gynaecologists global meet and are awaiting the outcome of an abstract at the European Society of Contraception. Victoria presented the findings of the research during a stakeholder event with the Royal College of Nursing, General Practice Nurses Forum in July 2023.
4) To document the broadest possible range of vernacular knowledge about contraception. This work was undertaken during the WP1 - qualitative secondary analysis, and the collectanea exercise with co-researchers.
Exploitation Route The project demonstrates a greater opportunity for folklore scholars to think about the application of their work in all areas of health. Bringing together folklore and health in an applied context can be a rich and rewarding process for both areas, and an opportunity to generate new approaches to, and theories about, long-standing real-world issues
Sectors Healthcare

URL https://ordo.open.ac.uk/articles/presentation/Reproductive_Bodylore_the_role_of_vernacular_knowledge_in_contraceptive_decision_making_/25164191
 
Description Feedback from visitors at the Bodylore Public Engagement event was overwhelmingly positive and indicated an appreciation for the space to read, listen and contribute their own individual stories. Bringing these stories to the fore is one way of tackling reproductive stigma and opening up conversations around sensitive topics. We received 206 feedback forms from the Bodylore exhibition. Around 80% of those who returned forms said they had learnt something new, and were more likely to talk to family or friends about contraception as a result of having visited the exhibition. 95% of people who returned forms said they had found hearing other people's stories helpful. After the exhibition the project team were contacted by other researchers working in contraceptive research. New connections for future research were made and we are in the process of applying for follow-on funding from the AHRC with a new charity collaborator, who reached out to the team after staff visited the Bodylore exhibition.
First Year Of Impact 2023
Sector Other
Impact Types Cultural

Societal

 
Description Free Open Access Course on OpenLearn
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
URL https://www.open.edu/openlearn/education-development/conducting-qualitative-interviews-introduction/...
 
Description Internal OU Funding - Research Development (Competitive Round) - Literature Review: Male partner's involvement in contraceptive and reproductive decision-making. Funding applied for after discussion at Bodylore Advisory Group.
Amount £1,783 (GBP)
Organisation Open University 
Sector Academic/University
Country United Kingdom
Start 03/2021 
End 07/2021
 
Description Open-Oxford-Cambridge AHRC DTP-funded Collaborative Doctoral Award at The Open University, in partnership with The Folklore Society. Title: Healthy Folk - The role of vernacular knowledge in health-related decision-making.
Amount £55,000 (GBP)
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 09/2024 
End 09/2027
 
Description Placement at Public Health England (part of Work Package 2) 
Organisation Public Health England
Country United Kingdom 
Sector Public 
PI Contribution The PI (Victoria Newton) undertook a virtual placement at PHE. As part of this placement, Victoria: 1) Attended PHE team meetings 2) Presented at a webinar with PHE and Bloody Good Period on menstruation, language and stigma (circa 550 participants signed up) 3) Has joined a steering group for a project on women's reproductive health experiences (between PHE and LSHTM) 4) Assisted in initiating a seminar series aimed at knowledge exchange with policy makers. The first seminar took place on 26th February 2021.
Collaborator Contribution The placement at PHE has afforded a number of opportunities in networking and knowledge exchange. 1) Victoria presented an overview of the project at a PHE team meeting in November 2020. 2) PHE is supporting a seminar series (detailed above) which is aimed at sharing research findings with policy makers. Victoria shared the findings from Work Package 1 at the first seminar in February 2021. 3) PHE is supporting project recruitment and has brokered introductions to a number of networks who can support recruitment to the project (E.g. PHE's people's panel) 4) PHE has brokered introductions to other researchers working in similar fields, some of whom have agreed to join the project Advisory Group.
Impact 1) Webinar with PHE and Bloody Good Period on menstruation, language and stigma (circa 550 participants signed up) - interdisciplinary (health and folklore studies) 2) Seminar with PHE's Reproductive and Public Health Research Group - "Choosing Contraception: the impact of knowledge, experience and social influence on women's decision-making" - Victoria presented the themes from Work Package 1 of the Reproductive Bodylore project on 26th February 2021.
Start Year 2020
 
Description Analysis workshop with volunteer researchers 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact 10 volunteer researchers attended an analysis workshop over Zoom. During this 2-hour workshop we discussed qualitative analysis and undertook some basic coding exercises. We then asked participants to reflect on the tentative findings and discuss whether they resonated with the experiences and knowledge of their interviewees.
Our findings related to the following themes: natural vs. medical; family and friends; diverse information sources; reproductive control as a balancing act; experiential knowledge valuing different knowledges. After presenting these largely descriptive themes we asked two key questions: 1) Do these findings resonate with what your participants were saying? 2)Are there any additional points we have missed/should look at?
At the workshop, attendees actively discussed their experiences with conducting the interviews and noted some emerging themes from their experiences. On reflecting on their involvement volunteer researchers noted that they gained skills in data collection and conducting interviews, commenting that they found the interviewing process creative and insightful. It led them to have increased knowledge and openness and they noted that the interview process increased their knowledge around contraception and allowed them to have these conversations with friends. This helped to address some of the stigma of the subject as a more open discourse is a powerful tool in addressing reproductive stigma.
Year(s) Of Engagement Activity 2021
 
Description Fertility, Folklore, and the Reproductive Body - joint conference with The Folklore Society 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Fertility, Folklore and the Reproductive Body was a collaborative conference between the OU Reproductive Bodylore project and The Folklore Society. It took place on Tuesday 14 November 2023, 09:30-17:00 at the Royal Anthropological Institute, 50 Fitzroy Street, London W1T 5BT, and online. The conference was free and dedicated to folklore of the reproductive body-fertility, childbirth, contraception, menstruation, and reproduction, including, but not limited to, popular knowledge and belief, folk narratives and contemporary legend, vernacular religion, superstitions, rites and rituals, interdisciplinary perspectives, material culture, and wellbeing.
There were 126 Eventbrite registrations with 55 participants joining online and 11 in-person. The conference reached an international audience with speakers presenting from England, Scotland, India, Ukraine, Portugal, and USA. We received a number of follow up emails including requests for more information about the Bodylore Public Engagement exhibition, and the possibilities for future collaborations. The day was described by participants as inspiring and enjoyable.
Year(s) Of Engagement Activity 2023
URL https://folklore-society.com/event/fertility-folklore-and-the-reproductive-body/#:~:text=A%20one%2Dw...
 
Description International Society of Contemporary Legend Research (ISCLR) 40th Anniversary Conference - Perspectives on Contemporary Legend 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact In-person presentation: 'It can actually make you infertile': Contemporary Legend and Vernacular Knowledge about Contraception. Generated discussion about the new insights folklore research can provide on health-related topics. Links made with other researchers for possible future collaborations.
Year(s) Of Engagement Activity 2023
URL https://contemporarylegend.org/2023/05/24/isclr-40th-anniversary-perspectives-on-contemporary-legend...
 
Description Invited to join a research project Steering Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Was able to contribute to the design of a new study on women's reproductive health led by PHE and LSHTM.
Year(s) Of Engagement Activity 2021
 
Description Menstrual Wellbeing Seminar with Public Health England and Bloody Good Period 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Victoria gave a short presentation about menstruation, language and stigma, which sparked chat questions and discussion about the significance of language in perpetuating menstruation-relate stigma.
Year(s) Of Engagement Activity 2021
URL https://eur01.safelinks.protection.outlook.com/?url=https:%2F%2Fclicks.eventbrite.com%2Ff%2Fa%2F7nwg...
 
Description Participatory Research in Folklore workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Folklorists working in participatory research attended a co-hosted workshop at the Contemporary Folklore Research Centre, University of Sheffield. Participants included academics and community partners.
Year(s) Of Engagement Activity 2023
URL https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FCFRC_Folklore%2Fstat...
 
Description Presentation at the Folklore Society Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Supporters
Results and Impact We presented at a panel on Applied Folkloristics, which sparked debate around belief and knowledge, which continued throughout the conference,
73 registered participants at the conference, mix of academics, general public and hobbyists. International reach.
Year(s) Of Engagement Activity 2021
 
Description Project website - public engagement exhibition 'Bodylore' 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact To promote the project public engagement exhibition and host any project outputs.
Year(s) Of Engagement Activity 2023
URL https://wels.open.ac.uk/research/projects/bodylore
 
Description Public engagement workshop with volunteer 'lay' researchers 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact Development workshop for Public Engagement exhibition. Led by public engagement consultants The Liminal Space. Attended by project advisory group members and four volunteer 'lay' researchers.
Year(s) Of Engagement Activity 2023
 
Description Reproductive and public health research group - evidence informing policy. Seminar 1: Choosing Contraception: the impact of knowledge, experience and social influence on women's decision-making 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact As part of her placement at PHE, Victoria has helped to set up a bi-monthly seminar group: reproductive and public health research group - evidence informing policy. The seminars are aimed at maximising the policy-research impact of reproductive health research.

The seminars consider the following broad questions as well as specific issues that are brought up by the research being presented.

Who are the key target audiences for this research?
What are the relevant policy questions of the research?
What are the key outcomes that are likely to influence change?
What needs to happen, by who, how and when to respond to the research?
What are the key levers to help influence change?
What are the recommended next steps?

Participants were engaged and thought about how the research/presentations could be applied in their own context.

Plans have been made to continue discussions around 'contraceptive choices' using an online whiteboard, in addition to holding future seminars on new topics. The next seminar will be on 'supported self-care'.
Year(s) Of Engagement Activity 2021
 
Description Research presentation at Reproduction, Sexualities and Sexual Health Research Group (internal OU) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Victoria gave a 'work in progress' presentation to the Reproduction, Sexualities and Sexual Health Research Group at the OU. The presentation reflected on the participatory research aspect of the Bodylore project. Two postgraduate students asked for follow up meetings/mentoring to discuss further the learning from the Bodylore project and possible applications for their own postdoctoral studies.
Year(s) Of Engagement Activity 2021
 
Description Research workshop with volunteer 'lay' researchers 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact 24 participants attended a workshop to brief them about the project and train them in a basic research interview. Workshops lasted 2 hours and took place on 27/03/21, 31/03/21, 01/04/21. Participants reported enjoying the training and being enthusiastic about their involvement in the project.
Year(s) Of Engagement Activity 2021
 
Description Royal College of Nursing - General Practice Nursing National and Regional Update - Webinar 18 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Was invited to present research at Royal College of Nursing General Practice Nursing Webinar (Webinar 18, 14th July 2023). Stimulated discussion amongst participants attending live session about possible future avenues for research, dissemination and impact. Webinar recording hosted on RCN website.
Year(s) Of Engagement Activity 2023
URL https://www.rcn.org.uk/Get-Involved/Forums/General-Practice-Nursing-Forum/GPN-forum-Webinars-2022202...
 
Description Royal College of Obstetricians and Gynaecologists (RCOG) World Congress 2023 - Digital Poster 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Digital Poster Presentation: The Role of Vernacular Knowledge in Women's Contraceptive Decision-Making (Ref. EP.0988).
Conference was attended by over 2,400 delegates from 85 countries (in-person and virtually).
Year(s) Of Engagement Activity 2023
URL https://www.rcog.org.uk/careers-and-training/training/courses-and-events/rcog-world-congress/rcog-co...
 
Description Three focus groups to share emerging findings with Clinicians. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Three online focus groups with clinicians. Victoria gave a research presentation which sparked 20-30 minutes of discussion regarding implications for practice and avenues for future research. Focus groups were also attended by volunteer researchers to ensure their voices, and the voices of their participants were represented.
Year(s) Of Engagement Activity 2023