Professor Lesley Hoggart

Sexual and Reproductive Health Co-funded (IPPF) PhD studentships.

Sexual and Reproductive Health Co-funded (IPPF ESRC) PhD studentship. The PhD will form part of the ACCESS Consortium project. The title is: The Search for Co-Creative Knowledge: Power and Transformation in Community Based Development: a case study of the Approaches in Complex and Challenging Environments for Sustainable SRHR (ACCESS) Programme in Uganda (tbc).

Working with RCOG as research adviser for the making abortion safe project.

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, rumour, 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.

In 2019 Relationships and Sex Education (RSE) will be mandatory in all UK secondary schools. The focus of the legislation was on safeguarding issues – partly because the RSE legislation was an amendment to a safeguarding bill. There is a danger that issues relating to sexual health and contraception are de-prioritised in the RSE guidance and in school’s RSE priorities. We know that sexual health and prevention of unwanted pregnancy remain high priorities in public health even at a time when funding is being reduced. The ‘gold standard’ for young people is good quality, evidence-based RSE which links young people into good quality, young people-friendly sexual health services. This was recently reiterated in the new Public Health England and Local Government Association Teenage Pregnancy Prevention Framework. Project aim To mobilise and support schools and local authorities to ensure that young people can act on the knowledge they have gained in RSE lessons about STI and pregnancy prevention, contraception and condom use by accessing appropriate sexual health services including C-Card schemes.

The ACCESS project will generate sustainable, scalable, rights-based approaches to deliver comprehensive SRHR to all, ensuring no one is left behind, even in the most complex and challenging settings. It will work in Ethiopia, Myanmar, Nepal, Sierra Leone, and Uganda. Three planned outcome changes: 1) Increased demand for and availability of quality, comprehensive SRH services and agency to claim and enjoy rights by the most marginalised populations in complex and challenging environments. (2) Strengthened SRHR capacity, preparedness and resilience of government, civil society and communities in complex and challenging environments, ensuring no one is left behind. (3) Improved national and global policy environment for an effective, coordinated, and evidence-based SRHR response in complex and challenging environments. There are six interlinked work streams, each led by one consortium partner: 1) Delivering comprehensive, quality sexual and reproductive health services: Led by the International Planned Parenthood Federation (IPPF) 2) Working with and for the most marginalised and underserved: Led by the International HIV/AIDS Alliance 3) Navigating complex and challenging environments: Led by the Women's Refugee Commission (WRC) 4) Generating high-quality research evidence: Led by the London School of Hygiene and Tropical Medicine (LSHTM) (5) Enhancing capacity-building and learning at scale: Led by the Open University (OU) 6) Influencing through advocacy, engagement and information: Led by Internews

Developing resources to support IUC consultations and address barriers to uptake in UK General Practice. Design and methods: The research draws on qualitative and quantitative data from practitioners and patients in General Practice in the UK to identify any barriers to uptake of IUC. We conducted semi-structured interviews (n=13) and a survey (n=209) with practitioners. We also interviewed women patients who had never used IUC (n=30), and conducted a survey (n=873 never users). Interviews were analysed utilising thematic analysis and surveys using descriptive statistics. Through our analysis we identified educational and informational needs for both practitioners and women, which are not presently addressed. Results: Lack of knowledge about IUC was cited by practitioners as a barrier to recommending IUC, by those practitioners, (mainly nurses) who were not trained to fit. Patient data indicated that there were concerns about IUC which were not addressed in standard informational leaflets, and some myths and misapprehensions about IUC were common, for example, concerns about the longevity of the device, what happens to the device within the body, and misperceptions about the risks and method of action of the device. In seeking answers to their queries, participants often looked to informal networks as a knowledge source in addition to seeking the opinions of family and friends. In comparing the concerns of our participants with standard patient information literature, we found evidence that information for patients is not sufficiently tailored to concerns expressed by never users. In addition, practitioners report being reluctant to discuss IUC as a method because of their own lack of confidence in their knowledge. Both information for patients, and increased support for practitioners providing this information, is needed to overcome this ‘double barrier’. Conclusions/Outputs To address this issue we have developed a 10 step ‘Aide Memoire’ to support IUC contraceptive consultations, and a short film for women to address the concerns reported by never-users in our study.

This project comprises two strands of an integrated programme of knowledge exchange activities designed to challenge abortion stigma in the UK. ‘Abortion Stories: showing and telling’ is a public engagement project based on research on women’s experiences of abortion in England. The project will comprise a multimedia installation that would enable participants to watch/listen to women's stories, and potentially contribute their own story; and the development of an associated on-line website. The installation will be co-designed by the academic and non-academic partners, and the website will be publicised (and linked) by all the partners.

We will facilitate a workshop that will enable Oxford University, The Open University, and other academic and non-academic partners to develop a knowledge exchange project for challenging abortion stigma alongside an ongoing exploration of the moral dimensions of abortion decision-making. This project will be a knowledge exchange and development activity based: firstly, findings from a completed research project on young women’s abortion experiences (The Open University, Hoggart); secondly, YouTube films based on the young women’s abortion narratives that have already been produced. Academics and practitioners will work together to disseminate the films, and develop a proposal for evaluation, and further development.

The overall aim of the study is to understand the barriers to uptake of intrauterine contraception (the IUS and the IUD) in General Practice in the UK. The project investigates the acceptability, or otherwise, of these methods to women aged 18-49; and also any barriers that can be identified by two groups of professionals: general practitioners, and practice nurses.

The aim of this research project is to quantitatively and qualitatively examine and compare the prevalence and cultural construction of intimate partner violence (IPV) perpetration by males in substance abuse treatment in London and São Paulo. For the purpose of this study, IPV refers to physical, sexual or psychological abuse or controlling behaviour perpetrated by male substance abusers against their current or ex female partner/wife. The findings will inform the development of a cultural theory of IPV perpetration and substance abuse, and a theory based IPV assessment instrument for people engaged in substance abuse treatment. In addition, current strategies, protocols and care pathways for male substance abusing IPV perpetrators in both London and São Paulo will be reviewed, and key stakeholders will be interviewed to identify the barriers and facilitators to working with this client group. The research will inform the development of an evidence and theory based cross-cultural Capacity Framework and training resource for working effectively with male IPV perpetrators in substance abuse treatment. International and local Learning Alliances of expert academics, practitioners, voluntary organisations, charities, policy makers and service users will be established at the initiation of the project; to strengthen and support the exchange and dissemination of information, determine how alcohol and drug services can best respond to IPV perpetration by male clients and enhance translation of findings to policy and practice in England, Brazil, Spain and the US.

This research is an exploratory study that seeks to identify the behavioural, social and service related factors associated with why young women under 25 years continue to practice sexual behaviour that puts them at risk of repeat unintended and unwanted pregnancy and abortion . This study also aims to identify more effective ways of providing young women with information and services that encourage safer sexual health behaviours, such as more effective use of contraception post abortion to reduce the incidence of repeat abortion; and to provide recommendations to policy makers, commissioners and service providers accordingly. The policy objective of reducing abortions and repeat abortions will be informed by the critical examination of different influences on individual behaviour.

Helping young women to exercise effective reproductive control and avoid unintended pregnancy remains a public health priority. However, hormonal contraceptives (the Pill, contraceptive implant, Depo-Provera injection, Mirena coil) can cause side-effects, the most common being changes to uterine bleeding patterns (French 2009). Altered bleeding patterns have been identified by some studies as the main reason for the discontinuation of hormonal methods. Literature also suggests, however, that reasons behind contraceptive choice are complex and there are many influencing factors in addition to pregnancy avoidance. This study aimed to provide insight into these factors by examining young women’s informal learning and vernacular knowledge about menstruation and contraception, and analysing the impact this had on their contraceptive decision making. Qualitative data was collected by means of 6 focus groups and 12 one-to-one interviews with young women. Emerging themes were shared during 2-3 practitioner interviews, allowing for a service-provider insight into the research findings.