Last week Sacha Gardener reported on this BU Research Blog on the publication of our most recent article ‘Why suicide rates among pregnant women in Nepal are rising’ in The Conversation. Since then we have been informed that this piece was reproduced in two Indian independent online newspapers, last week in The Wire and today in Scroll.in (India’s leading independent source of news, analysis and culture). Scroll.in used the heading ‘A project is training midwives in Nepal to stem rising suicides of pregnant women’, whist The Wire used the title ‘Why Suicide Rates Among Pregnant Women in Nepal Are on the Rise’. Suicide in pregnant women and soon after birth is an important issue in both Nepal and India. Just for completeness the original article, written by BU’s Visiting Faculty Dr. Bibha Simkhada and Prof. Edwin van Teijlingen based in BU’s Centre for Midwifery, Maternal and Perinatal health (CMMPH), can be found here!
Category / the conversation
Huge numbers of pregnant women and new mothers are taking their own lives in Nepal as they deal with extreme poverty, natural disasters, domestic violence and oppression. Research shows suicide represents 16% of all deaths in women of reproductive age. The rate is higher than previously recorded and there has been a considerable increase over the past few years. But a new project which trained midwives about mental health issues might hold the key to turning this around.
Suicide is primarily associated with unwanted pregnancy or the feeling of being trapped in poverty or situations of sexual and physical abuse. A study of 202 pregnant women (carried out between September and December 2014) found that 91% of them experienced some kind of physical, emotional or sexual abuse – mostly at the hands of their husbands and/or mother-in-laws.
The sad fact is that almost 40% of suicides in the world occur in South-East Asia. And one in three pregnant woman and new mothers are taking their own lives in low-income countries. In Nepal, 21% of the suicides among women aged 15-49 were in girls under 18 due to violence and being powerless in their families and communities.
Pregnancy is a known trigger for mental health problems. But gender discrimination and domestic violence are making matters worse. In addition to these issues, natural disasters are also a huge contributing factor to the spiralling mental health problems of young mothers.
Lack of control
In Nepal, making decisions about seeking maternity care is not in the hands of the pregnant woman but usually lies with her mother-in-law or husband. When young women marry they move in with their husbands’ family and their lives are ruled by their in-laws. These women often have little say in seeking health care during pregnancy, childbirth and the postnatal period.
In many poor families, husbands migrate for work leaving their young wives with family. Nepal has a real migrant workers economy with close to 50% of Nepalis relying on financial help from relatives abroad. Mental health problems can worsen for women who have been taken away from their own families. In other cases, young women face domestic violence due to their husbands’ drinking leading to mental health issues and suicide.
There is also a lack of understanding of pregnancy and childbirth-related mental health issues and husbands and mothers-in-law often fail to support these vulnerable young women. They in turn are reluctant to seek help due to the stigma associated with mental illness.
Cultural and social norms
Cultural practices and social norms, like gender inequalities and early marriage, hinder women who have a lack of choice when it comes to their role as mothers. There is also a preference for sons rather than daughters, who are seen as an “economic burden” in many families. If a woman is expecting a daughter, especially for the second or third time, this can also trigger mental health issues.
Depression and anxiety are common and affect ten to 15 out of every 100 pregnant women in the country. Postnatal depression is often reported, but less attention is given to more common and less obvious mental health issues.
Natural disasters and midwives
Recurrent earthquakes and floods exacerbate issues of depression and helplessness as women are forced to live in temporary shelters and have the burden of increased poverty.
For many rural Nepali women, the most qualified birth attendant they can expect to look after them is the Nepali Auxiliary Nurse Midwives (ANMs). But a study found that they received little or no formal training on perinatal mental health issues. Although there have been gradual improvements in health care for women during pregnancy, mental health support is leaving many women feeling that suicide is their only option.
The training helped raise awareness of mental health well-being and improved access to mental health care for pregnant women and new mothers. This is a vital first step towards improving community-based services for pregnant women in rural Nepal. But to offer hope to more young women there needs to be a significant increase in this type of training and awareness raising.
Bibha Simkhada, Postdoctoral Researcher in School of Nursing and Allied Health, Liverpool John Moores University and Edwin van Teijlingen, Professor of Reproductive Health Research, Bournemouth University
In the days before social media – and, presumably, media training – Gerald Ratner’s description of some of the products sold in his chain of jewellers as “total crap” became a byword for the corporate gaffe. Recently the chief executive of publisher Hachette Livre, Arnaud Nourry, seems to have suffered his own “Ratner moment” when he described ebooks in an interview with an Indian news site as a “stupid product”.
The interview, which was intended to address the future of digital publishing and specific issues facing the Indian publishing market, was widely misquoted and Nourry’s comments taken out of context. But there is no denying the fact that the publisher criticises his own industry (“We’re not doing very well”) and attacks ebooks for lacking creativity, not enhancing the reading experience in any way and not offering readers a “real” digital experience.
Some commenters on social media welcomed Nourry’s comments for their honesty. They highlight his seeming support for the idea that publishers should be championing writers and artists working to exploit the creative potential of digital formats to provide readers with experiences that may be challenging and disruptive, but also exhilarating and boundary pushing.
— Kate Pullinger (@katepullinger) February 19, 2018
But many of the 1,000-plus commenters reacting to coverage of the story on The Guardian’s website spoke out against “fiddling for the sake of it” – claiming they were not interested in enhanced features or “gamified dancing baloney” borrowed from other media. They also listed the many practical enhancements that ebooks and ereaders do offer. The obvious one is the ability to instantly download books in remote locations where there are no bricks and mortar bookstores. But there are other less obvious enhancements, including being able to instantly access dictionary and encyclopedia entries (at least if you have wifi access) and the option to have the book read to you if you have visual impairments.
Elsewhere, Australian researcher Tully Barnett has shown how users of Kindle ereaders adapt features such as Highlights and Public Notes for social networking, demonstrating that even if ebooks are not that intrinsically innovative or creative, that doesn’t necessarily mean that they can’t be made so by imaginative users.
Nourry clearly isn’t averse to the provocative soundbite – in the same interview he went on to say: “I’m not a good swallower” when asked about mergers and conglomeration in the publishing industry. On the other hand, he also seems very aware of the special place of books and reading in “culture, education, democracy” – so his use of the word “stupid” in this context is particularly inflammatory and insensitive.
My research on digital reading has taught me that debating books vs ereaders is always likely to arouse strong passions and emotions. Merely mentioning the word Kindle has led in some instances to my being shouted at – and readers of “dead tree” books are rightly protective and passionate about the sensory and aesthetic qualities of physical books that the digital version possibly can’t compete with.
But, equally, my research has shown that enhancements in terms of accessibility and mobility offer a lifeline to readers who might not be able to indulge their passion for reading without the digital.
In my latest project, academics from Bournemouth and Brighton universities, in collaboration with Digitales (a participatory media company), worked with readers to produce digital stories based on their reading lives and histories. A recurring theme, especially among older participants, was the scarcity of books in their homes and the fact that literacy and education couldn’t be taken for granted. Our stories also demonstrated how intimately reading is connected with self-worth and helps transform lives disrupted by physical and mental health issues – making comments about any reading as “stupid” particularly damaging and offensive.
I would like to know if Nourry would still call ebooks stupid products after watching Mary Bish’s story: My Life in Books from our project. A lifelong reader who grew up in a home in industrial South Wales with few books, Mary calls her iPad her “best friend” and reflects how before the digital age her reading life would have been cut short by macular degeneration.
As well as demonstrating that fairly basic digital tools can be used to create powerful stories, our project showed that the digital also makes us appreciate anew those features of the physical book we may take for granted, the touch, smell and feel of paper and the special place that a book handed down from generation to generation has in the context of family life.
Athletes from Western nations have various protections, and many now share equal rights in most aspects of the law. But when they travel to compete in countries with regressive human rights records, these protections can be lost.
Australia competed at the 2014 Winter Olympics and the 2017 FIFA Confederations Cup, both of which were held in Russia. It will again send a team to Russia to play in this year’s FIFA World Cup and aims to compete in the 2022 edition in Qatar. Both countries have poor human rights records, particularly on LGBTI+ issues.
Sport is often lauded as a platform to advance human rights. But, for LGBTI+ individuals and athletes, this may not necessarily be true. The continued hosting of mega sporting events in countries with anti-LGBTI+ laws brings the role of sport in campaigns to advance human rights into focus.
LGBTI+ rights and the Winter Olympics
Sochi became a platform for LGBTI+ rights when Western activists called for a boycott based on several human rights concerns. Their resistance increased in direct response to the implementation of laws in Russia outlawing sexual minorities.
Principle 4 of the Fundamental Principles of Olympism was often referred to amid concerns for the safety of LGBTI+ athletes at Sochi:
The practice of sport is a human right. Every individual must have the possibility of practising sport, without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play.
Athlete activists have begun to challenge the hosting of mega sporting events in countries like Russia that ignore human rights and reinforce systems of oppression. But what has really changed since Sochi for Olympians?
This year a country with a questionable stance on LGBTI+ rights is again hosting the Winter Olympics. South Korea scores only 13% on the Rainbow Index, which measures the impacts of a country’s laws and policies on the lives of LGBTI+ people. This is only a marginally better score than Russia’s 8%.
Although homosexuality is legal in South Korea, LGBTI+ rights remain highly volatile. South Korean President Moon Jae-in has courted controversy with comments opposing homosexuality, and sexual minorities continue to face significant stigma in the region.
Australia is taking 51 athletes to compete in South Korea, with two openly gay women on the team. One, Belle Brockhoff, has criticised the anti-LGBTI+ laws in host countries. She joined 26 other athletes who signed a letter opposing Kazakhstan’s bid to host the 2022 Winter Olympics due to its anti-LGBTI+ policies.
However, it is not only host nations that can be called to account for their poor LGBTI+ records. Adam Rippon, an openly gay figure skater who has won bronze in Pyeongchang, recently said he did not want to meet Vice President Mike Pence as part of an official reception for the US team. Rippon argued the Trump administration does not “represent the values that [he] was taught growing up”.
A Fox News executive has criticised the inclusion of “African-Americans, Asians and openly gay athletes” in the US team. He claimed that “Darker, Gayer, Different” was now a more suitable Olympic motto than “Faster, Higher, Stronger”.
Current evidence suggests that anti-LGBTI+ discrimination is rising. Stonewall, the UK’s leading LGBTI+ charity, reports hate crimes toward the LGBTI+ community have increased: one in five LGBTI+ people have experienced a hate crime due to their sexual orientation or gender identity in the last year.
In the US, Donald Trump tried to ban transgender people from serving in the military. Several states have attempted to pass laws to restrict access to bathrooms for people who are trans or gender-diverse.
With increased visibility comes increased risk
An increasing number of athletes now openly demonstrate their sexual orientation, but many acknowledge it leaves them open to homophobic abuse – especially on social media platforms.
American Olympic skier Gus Kenworthy referred to social media as a space that serves to reinforce the presence of casual and aggressive homophobia. British Olympian Tom Bosworth said he believed fear of abuse on social media could be preventing athletes from coming out.
— Gus Kenworthy (@guskenworthy) February 9, 2018
Mega sporting events can be problematic for LGBTI+ athletes as many may not be “out” and there can be serious implications if they were to do so.
The safety and welfare of LGBTI+ athletes made headlines when a journalist went undercover in the athletes’ village at the 2016 Rio Olympics to identify out or closeted athletes. Several athletes who were identified were from countries where being gay is criminalised or even punishable by death.
Sport is responding at a notably slow pace to the advancement of LGBTI+ human rights.
Major sporting codes have shown they are not ready to tackle trans and gender diversity. For example, the Australian Football League recently banned transgender player Hannah Mouncey from joining its women’s competition.
There is still much work to be done around athletes with intersex variations, sex testing in elite-level competition, and transgender and transitioned athletes.
Hope for the future?
One particular social inclusion legacy to come from a mega sporting event is Pride House International. This initiative provides a safe space for the LGBTI+ community to engage with a sporting event.
In addition, the Principle 6 campaign, launched in response to Russia’s anti-LGBT laws, led to the expansion of that particular part of the Olympic Charter to include sexual orientation as something sport should be free from discrimination on.
It will be interesting to see whether the 2018 Winter Olympics can contribute to the advancement of LGBTI+ rights within South Korea and beyond. However, more scrutiny must be directed to the human rights records of potential host nations when awarding mega sporting events.
Keith Parry, Senior Lecturer in Sport Management, Western Sydney University; Emma Kavanagh, Senior Lecturer in Sports Psychology and Coaching Sciences, Bournemouth University, and Ryan Storr, Lecturer in Sport Development, Western Sydney University
Western society has a rather specific view of what a good childhood should be like; protecting, sheltering and legislating to ensure compliance with it. However, perceptions of childhood vary greatly with geography, culture and time. What was it like to be a child in prehistoric times, for example – in the absence of toys, tablets and television?
In our new paper, published in Scientific Reports, we outline the discovery of children’s footprints in Ethiopia which show how children spent their time 700,000 years ago.
We first came across the question of what footprints can tell us about past childhood experiences a few years back while studying some astonishingly beautiful children’s footprints in Namibia, just south of Walvis Bay. In archaeological terms the tracks were young, dating only from around 1,500 years ago. They were made by a small group of children walking across a drying mud surface after a flock of sheep or goats. Some of these tracks were made by children as young as three-years-old in the company of slightly older children and perhaps young adolescents.
The detail in these tracks, preserved beneath the shifting sands of the Namibian Sand Sea, is amazing, and the pattern of footfall – with the occasional skip, hop and jump – shows they were being playful. The site also showed that children were trusted with the family flock of animals from an early age and, one assumes, they learnt from that experience how to function as adults were expected to within that culture.
No helicopter parents
But what about the childhood of our earlier ancestors – those that came before anatomically modern humans (Homo sapiens)? Children’s tracks by Homo antecessor (1.2m to 800,000 years ago) were found at Happisburgh in East Anglia, a site dating to a million years ago. Sadly though, these tracks leave no insight into what these children were doing.
This assemblage of tracks is capped by an ash flow from a nearby volcano which has been dated to 700,000 years ago. The ash flow was deposited shortly after the tracks were left, although we don’t know precisely how soon after. The tracks are not as anatomically distinct as those from Namibia but they are smaller and may have been made by children as young as one or two, standing in the mud while their parents and older siblings got on with their activities. This included knapping the stone tools with which they butchered the carcass of the hippo.
The findings create a unique and momentary insight into the world of a child long ago. They clearly were not left at home with a babysitter when the parents were hunting. In the harsh savannah plains of the East African Rift Valley, it was natural to bring your children to such daily tasks, perhaps so they could observe and learn.
This is not surprising, when one considers the wealth of ethnographic evidence from modern, culturally distinct human societies. Babies and children are most often seen as the lowliest members of their social and family groups. They are often expected to contribute to activities that support the mother, and the wider family group, according to their abilities. In many societies, small boys tend to help with herding, while young girls are preferred as babysitters. Interestingly, adult tools – like axes, knives, machetes, even guns – are often freely available to children as a way of learning.
So, if we picture the scene at Melka Kunture, the children observing the butchery were probably allowed to handle stone tools and practice their skills on discarded pieces of carcass while staying out of the way of the fully-occupied adults. This was their school room, and the curriculum was the acquisition of survival skills. There was little time or space to simply be a child, in the sense that we would recognise today.
This was likely the case for a very long time. The Monte Hermoso Human Footprint Site in Argentina (roughly 7,000-years-old) contains predominantly small tracks (of children and women) preserved in coastal sediments and it has been suggested that the children may have played an important role in gathering seafood or coastal resources. Similarly, most of the tracks in the Tuc d’Audoubert Cave in France (15,000-years-old) are those of children and the art there is striking. Perhaps they were present when it was carved and painted?
However, these observations contrasts to the story that emerged last year based on tracks from the older Homo Homo erectus (1.5m-year-old) at Ileret, located further south in the Rift Valley, just within the northern border of Kenya. Here the tracks have been interpreted as the product of adult hunting groups moving along a lake shore, rather than a domestic scene such as that at Melka Kunture. However, these scenes aren’t mutually exclusive and both show the power of footprints to provide a snapshot into past hominin behaviour.
But it does seem like the overwhelming parenting lesson from the distant past is that children had more responsibilities, less adult supervision and certainly no indulgence from their parents. It is a picture of a childhood very different from our own, at least from the privileged perspective of life in Western society.
Sex work is a controversial form of income. It is a subject much discussed by experts in feminism, religion, law and politics. And its popular portrayal is often left to people far removed from the realities of sexual commerce. Those who (wrongly) conflate sex work with human trafficking and exploitation would like to see it abolished.
In Brazil, sex work remains politically and socially contentious. But thanks to a staunch sex worker movement in the country, the people who actually do the work have made themselves key contributors to the debate. It is a movement which has informed political policy, affected legislation in urban reform and sexual healthcare and fought tirelessly for the full recognition of sex work as a profession.
This year marks the 30th anniversary of that movement. As part of the celebrations, an international exhibition is being held which features photographs taken by sex workers. Entitled “O Que Você Não Vê” (What You Don’t See), it centres on sexual commerce during the 2016 Olympic Games in Rio de Janeiro. But it also provides an opportunity to reflect on the lessons that can be learned from three decades of an organisation representing the best interests of sex workers.
As in many countries around the world, the legal status of prostitution in Brazil is vague. The criminal code issued in 1940 criminalised prostitution-related activities such as recruitment and facilitation, but not the direct sale of sex.
In the late 1970s, police raids on sex-related businesses in places such as São Paulo forced many sex workers to find work on the streets. A more precarious and isolated environment, it increased the need and appetite for some kind of organisation among the people working there.
In July 1987, Gabriela Leite and Lourdes Barreto, two São Paulo-based sex workers held the first national meeting for Brazil’s prostitutes. It resulted in the Brazilian Network of Prostitutes (BNP) as well as the publication of a newsletter “Beijo da Rua” (Kiss from the Street). The BNP’s mission was to build a new discourse of prostitution, not tied to crime or victimisation.
Conversation focused on state repression, health, collective identity and female sexual desire. Working with the Brazilian Ministry of Health, the BNP became instrumental in the creation of internationally applauded strategies to prevent the spread of HIV and AIDS.
Then in 2002, a group led by Leite influenced the Brazilian government to issue “Ordinance 397” – which recognised sex work as an “official” occupation. Those registered as “sex professionals” would be taxed as autonomous workers and entitled to regular employment benefits including maternity pay, a state pension fund and medical care. It was a crucial moment of increased social tolerance.
Some years later, in the lead up to two huge sporting events due to be held in the country – the 2014 FIFA World Cup and the 2016 Olympic Games – Brazilian public discourse once again focused on anti-trafficking strategies, which further conflated forced migration and sexual exploitation with adult, consensual sex work – and served to reignite the abolitionist agenda.
A window into a sex worker’s world
After the closure of several sex-related businesses, a report entitled “Human Rights Violations of Sex Workers in Brazil” was compiled by sex worker support groups and submitted to the United Nations. The photographic project, “O Que Você Não Vê” was also launched as a platform to present a counter-narrative to the sensationalist stories of sex work during the Olympics.
The exhibition (which is funded by the Economic and Social Research Council) provides an insight into the mundane, everyday experiences of those working far away from the slick and glamorous portrayal of an international sporting spectacle. The exhibits reveal sarcasm and humour, and play on the mythologies that surround the sex worker’s profession. There is a dominatrix in her “pain” room, a woman posing with her “puta” family.
Each photographic perspective is unique. But collectively, there is a clear appreciation of the chance for their voices to be heard (albeit in visual form). The exhibition represents yet another step forward for this historic workers’ movement. It is a reflection of resilience, a commitment to civic involvement. It is another attempt to reframe stigmatised bodies as human – worthy of non-exploitative labour, self-expression and care.
Ratko Mladić has been convicted of genocide and persecution, extermination, murder and the inhumane act of forcible transfer in the area of Srebrenica in 1995. He was also found guilty of persecution, extermination, murder, deportation and inhumane act of forcible transfer in municipalities throughout Bosnia and Herzegovina and of murder, terror and unlawful attacks on civilians in Sarajevo.
In addition, the former Bosnian Serb army general was convicted for the hostage-taking of UN personnel. But he was acquitted of the charge of genocide in several municipalities in Bosnia and Herzegovina in 1992.
The events that occurred in and around the Srebrenica enclave between July 10-19 1995, where an estimated 8,000 Bosnian Muslims, mostly men and boys, lost their lives, are well documented. These atrocities, culminating in the “biggest single mass murder in Europe” since World War II, not only resulted in a tremendous loss of life and emotionally scarred survivors, it also left behind a landscape filled with human remains and mass graves.
Forensic investigations into the Srebrenica massacre assisted in convicting Mladić, who stood accused for his involvement in implementing and orchestrating the forcible transfer and eventual elimination of the Bosnian Muslim population from Srebrenica. For the Srebrenica investigations, between 1996 and 2001, the International Criminal Tribunal for the Former Yugoslavia (ICTY) conducted exhumations at 23 sites, while a further 20 mass graves were probed to confirm that they contained human remains.
The investigative objectives for these investigations were to:
* Corroborate victim and witness accounts of the massacres;
* Determine an accurate count of victims;
* Determine cause and time of death;
* Determine the sex of victims;
* Determine the identity of victims (a process that is ongoing with the help of DNA analysis); and
* Identify links to the perpetrators.
The task of locating and exhuming mass graves in Bosnia continues, as does the general quest of locating the missing in the territory of the former Yugoslavia. And this evidence still matters for the ICTY. Evidence on hundreds of bodies exhumed from the Tomašica mass grave near Prijedor in the north-west of Bosnia and Herzegovina, was presented in the Mladić trial.
The summary judgment read out in the court room in The Hague made this very clear:
During several weeks in September and early October 1995, senior members of the VRS [Army of the Bosnian-Serb Republic] and the MUP [Ministry of the Interior] attempted to conceal their crimes by exhuming their victims’ remains from several mass graves, and then reburying those remains in more remote areas in Zvornik and Bratunac municipalities. Their attempt to cover up the Srebrenica massacres ultimately failed.
Such attempts at hiding crimes by digging up mass graves only to dispose of the bodies in so called “secondary mass graves” results in commingled and mutilated body parts rendering identification and repatriation of human remains all the more difficult. This causes further and prolonged distress to the survivor population and can be seen as intent to cause suffering.
Properly investigated forensic evidence from mass graves, the presentation of such physical evidence, the testing of expertise, independence and impartiality of the accounts in court, is likely to result in more reliable findings. In the case of Bosnian Serb leader Radovan Karadžić forensic evidence helped confirm the crimes committed – it can be assumed that the same is the case for Mladić; at the time of writing the judgment in its entirety is not available yet.
It is well worth remembering that the information from forensic mass grave investigations has another purpose and does not only speak to a court of law. The work on the ground through organisations such as the International Commission on Missing Persons will continue as there are “too many people who are still searching for their children’s bones to bury”. Those forensic findings will have a value and meaning for family members and survivors that judgments such as the Mladić one cannot have. It offers them information on their lost loved ones and, hopefully, the return of their human remains.
Over the past few years, there has been an increase in media reports about postnatal depression and other maternal mental illnesses, and campaigns have led to greater understanding about the need for more specialist services. Although this is encouraging, very little is said about fathers. But men can get postnatal depression, too.
Currently, only mothers can be diagnosed with postnatal depression. The psychiatrists’ “bible”, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), includes a diagnosis of “peripartum depression”. Peripartum depression is a form of clinical depression that is present at any time during pregnancy, or within the four weeks after giving birth, although experts working in perinatal mental health tend to be more flexible, extending that period to the first year after giving birth.
In many ways, postnatal depression varies little from traditional depression. It, too, includes a period of at least two weeks where the person experiences low mood or a lack of motivation, or both. Other symptoms include poor sleep, agitation, weight changes, guilt, feelings of worthlessness, and thoughts of death and dying. But the biggest difference is that a depression at this time involves a significant additional person: the child.
Evidence suggests that the long-term consequences of postnatal depression on the child can be damaging, including developmental problems, poor social interaction, partner-relationship problems and greater use of health services (including mental health services).
Around 7-20% of new mothers experience postnatal depression. A common view is that it is caused by hormonal changes. Although this is partly true, it is far more likely that life factors are responsible, such as poverty, being younger, lack of support and birth trauma. Another potential cause is the sudden overwhelming responsibility of having a baby to care for, and the life changes that it entails.
Depressed mothers also feel intensely guilty about the way they feel about their baby, and fear shame and stigma from society. As a result, at least 50% of mothers will not report a mental health problem. Other mothers will not tell their health provider out of fear of having their child taken away by social services.
All of the above factors can equally apply to fathers. But there is no formal diagnosis of postnatal depression for fathers. Yet evidence from several countries, including Brazil, the US and the UK, suggests that around 4-5% of fathers experience significant depressive symptoms after their child is born. Some other studies claim that prevalence may be as high as 10%.
The cause of these feelings in fathers is similar to what we see with mothers, but there are extra complications. Men are much less likely to seek help for mental health problems, generally.
Societal norms in many nations suggest men should suppress emotion. This is probably even more a factor for fathers, who may perceive their role as being practical and providing for the family. Fathers – especially first-time fathers – might experience many sudden changes, including significant reduction in family income and altered relationships with their wife or partner. These are major risk factors for depression in fathers.
The importance for supporting fathers at this time is as vital as it is for mother. Evidence suggests that a father’s depression can have a damaging effect on their child’s development. Despite this, it has been shown that fathers are also less likely than mothers to seek help, and that health professionals are less likely to consider that fathers need support, compared with mothers. More evidence is needed to build a case that fathers need support as much as mothers.
It has been argued that, until recently, health professionals have been poorly equipped to recognise and treat mental illnesses associated with the birth of a child. Recent campaigns in the UK have led to changes in policy, funding and health guidelines. However, the recent revision of the National Institute for Health and Care Excellence (NICE) guideline on perinatal mental health does not address fathers’ needs. Despite a campaign to address this having support from several professionals and academics, a NICE spokesperson told the BBC that guidelines are unlikely to be changed as there is no evidence that men experience postnatal depression. However, if we discount hormonal factors in new mothers, the remaining risk factors for postnatal depression also apply to fathers. And we need support that recognises that.
Ms. Sheetal Sharma who will be graduating from Bournemouth University with a Ph.D. on November 10th has been awarded Bournemouth University’s The Postgraduate Research Prize. This prize is for the postgraduate student whose achievement is deemed by the Vice-Chancellor to have been most outstanding in their time at BU.
Sheetal stood out as a Ph.D. student as her maternal health research project in Nepal resulted in several many publications [1-6], some in very prestigious journals such as BMC Pregnancy & Childbirth  and PLOSOne  . She won the best poster prize at the international GLOW conference in Birmingham in 2013 with the poster presentation ‘Getting women to care in Nepal: A Difference in Difference analysis of a health promotion intervention’. She won a SBSP travel scholarship to present a poster at the 8th European Congress on Tropical Medicine & International Health in 2013 in Denmark. Sheetal’s abstract of the poster was also officially published .
Sheetal presented at the Science in Society conference (SiS) at Berkeley University in November 2012 where she received a Graduate Scholar Award. In addition, she won a Santander travel scholarships for £5,000 to learn about research at the University of Buenos Aires, Institute for Clinical Effectiveness & Health Policy (Argentina) and at the University of Barcelona in Spain. This scholarship resulted in a great publication with the world-famous researcher in reproductive health care prof. Jose Belizan as co-author. Sheetal also presented her work at the first ever national health promotion conference in Nepal.
Sheetal also had less academic achievements as she won the BU photo competition at the 2014 PGR conference with the photo in this blog.
Sheetal was also actively involved as a student representative in the Faculty of Health & Social Sciences as well as in the Graduate School. She even found time to join the editorial board of the newly formed Journal of Asian Midwives.
Over the past five years Sheetal has had many mentions on this BU research blog as one of BU’s most prolific publishing PhD students.
As supervisors and co-authors we are proud of her!
Dr. Catherine Angell, Prof. Vanora Hundley & Prof. Edwin van Teijlingen (CMMPH)
BU Visiting Professor Padam Simkhada, Liverpool John Moores University
Dr. Elisa Sicuri, Assistant Research Professor at ISGlobal, Spain
Prof. Jose Belizan, University of Buenos Aires, Argentina
References to published work by Sheetal Sharma:
- Joshi, R., Sharma, S., van Teijlingen, E. (2013) Improving neonatal health in Nepal: Major challenges to achieving Millennium Development Goal 4, Health Science Journal 7(3): 247-257. http://www.hsj.gr/index.files/Page1421.htm
- Sharma, S., Joshi, P., van Teijlingen, E. (2015) ‘Nepenglish’ or ‘Nepali English’: A new version of English? Asian Journal of Humanities & Social Sciences 4(2): 188-193. www.ajssh.leena-luna.co.jp/AJSSHPDFs/Vol.4%282%29/AJSSH2015%284.2-21%29.pdf
- Simkhada, B., Sharma, S., van Teijlingen, E., Silwal, RC, Simkhada, P. (2015) Exploring Maternal Mortality Reduction. In: Wasti, SP, Simkhada, PP, van Teijlingen, E. (Eds.) The Dynamics of Health in Nepal, Kathmandu: Social Science Baha & Himal Books: 95-121.
- Sharma, S., van Teijlingen, E., Belizán, J.M., Hundley, V., Simkhada, P., Sicuri, E. (2016) Measuring What Works: An impact evaluation of women’s groups on maternal health uptake in rural Nepal, PLOS One 11(5): e0155144 http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0155144
- Sharma, S., van Teijlingen, E., Hundley, V., Angell, C., Simkhada, P. (2016) Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal BMC Pregnancy & Childbirth 16: 147 https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0938-4
- Sharma, S, Simkhada, P, Hundley, V, van Teijlingen E., Stephens, J, Silwal, RC, Angell, C (2017) Evaluating a Community Maternal Health Programme: Lessons Learnt. Journal Asian Midwives 4(1):3–20.
- Sharma, S., van Teijlingen, E., Hundley, V., Stephens J., Simkhada, P., Angell, C., Sicuri, E., Belizan, J.M. (2013) Mixed-methods evaluation of a maternity care intervention in rural Nepal: measuring what works, Poster P.2.3.004 (A), Tropical Medicine & International Health 18 (Suppl. 1): 108–231.
Julie Robson from the Department of Marketing (FoM) has co-authored an article published today in The Conversation about unpaid student placements and debt.
The piece is loosely based on earlier research that examined students as vulnerable consumers where debt is concerned. This project was made possible following a successful application to the BU Undergraduate Research Assistant Programme (URAP) in 2015. Results from the research will be published in November 2017 in the Journal of Marketing for Higher Education. The article is entitled Working up a debt: Students as vulnerable consumers. The authors are Julie Robson (BU), Jillian Dawes Farquhar (Southampton Solent) and Christopher Hindle (BU URAP).
The article in The Conversation is entitled – Student interns are not entitled to the minimum wage and its costing them big time and can be accessed here.
Congratulations to Dr. Hyun-Joo Lim Senior Lecturer in Sociology at BU who has just written an interesting piece on human rights issues faced by North Korean female defectors in China in The Conversation. You can access this article by clicking here!
Prof. Edwin van Teijlingen
After recent media exposure about overcrowding at tourist destinations and local-tourist conflict, destination authorities have sought to introduce codes of conduct across European tourist destinations. From Hvar in Croatia, towns near Amsterdam, and Venice, there is a belief that the tourism system, like the financial system, is not working for everyone. Local residents are starting to feel like they’re receiving less than they’re giving. Therefore, authorities have stepped in with codes, with the aim to assign rules to make tourists more sensitive to local residents and protect natural, cultural, historical and other resources.
Michael O’Regan, PhD from the Department of Events & Leisure, is exploring whether these codes work, and whether the introduction of these measures really protect tourism resources. Taking a critical approach, Michael argues that such codes work at different levels, from marketing strategies, as local politicians and businesses gain reputational capital by scapegoating tourists to their role in smarter governance models. Read more on the Conversation UK.
Last week saw the publication of a piece by BU Professors Vanora Hundley and Edwin van Teijlingen in The Conversation under the title: “Why UK midwives stopped the campaign for ‘normal birth’”. The editor of The Conversation invited the authors to write in reply to the statement: “According to media reports, women will no longer be told they should have an intervention-free birth and midwives will be encouraged to use terms a “physiological birth” rather than “normal birth”. We are looking for an expert to comment on this.”
The resulting article is the result of a quite long process of writing a draft, which was initially edited by The Conversation in a way the authors did not feel represented what they wanted to say. In our original submission we raised the role of the media with regard to responsible reporting, but it seems this was a step too far. In submitting a re-written version, which was edited again before it came back to the authors, we were advised that academics should not ‘blame the media’ since that avoids addressing the issue, but what if the media really does have a role? After seven or eight major alterations we reached and an agreed version that we think is a balance and fairly easy to read newspaper article. Our new book Midwifery, Childbirth and the Media due to be published by Palgrave Macmillan will cover these media issue in greater detail.
Professors Vanora Hundley & Edwin van Teijlingen
Office for Students
- Justine Greening, Secretary of State for Education, said: “Nicola Dandridge’s knowledge and experience will be key for this important role…The OfS will replace an outdated regulatory system with a framework that can truly respond to the challenges of our 21st Century and ensure the university system meets the needs of the students.”
- Jo Johnson, Universities Minister, stated: “I am delighted that Nicola Dandridge is taking up this crucial role. Her knowledge and experience of the higher education system makes Nicola an excellent choice to work alongside Sir Michael Barber at the helm of the OfS…The new regulator will rightfully put the interests of students at the heart of regulation and play a pivotal role in reforming one of our nation’s greatest assets – the higher education sector.”
- Les Ebdon, Director of Fair Access, has also welcomed and commended Nicola and emphasised her connection to social mobility: “…she is ideally placed to take up this important post. I know from the leadership Nicola showed when she chaired the Social Mobility Advisory Group that she has a strong personal commitment to fair access.”
UUK anticipate announcing their new chief executive in September.
Michael Barber is the Chair of OfS, Martin Coleman is the deputy chair, and five other OfS Board members have been confirmed – two Board spots remain open, including the seat for student experience, which was advertised this week.
In other people news, Chris Husbands (VC of Sheffield Hallam and Chair of the TEF panel) has been appointed as the new chair of HESA. Chris stated: “HESA is a jewel in the crown of UK higher education: a trusted source of insightful data and analysis across the higher education landscape in the UK, which helps to shape policy and promote wider understanding and confidence in the sector. High quality data and data analysis is increasingly critical to successful organisations.”
On Tuesday, Sir Mark Walport, the Chief Executive Designate of UK Research and Innovation (UKRI) made a speech outlining his vision for the future of UKRI, which you can watch here.
Focus on tuition fees
Labour’s promises to abolish tuition fees (and forgive loans for graduates) have been credited in some quarters as leading to an increase in turn-out amongst young people at the election, and a consequent increase in the Labour vote. Speculation is building about a government response to this. As a result, tuition fees and the loan system have been all over the press this week, with Jo Johnson on Newsnight and the Today programme, and active on twitter.
The voting problem
Did young people turn out in massively increased numbers as claimed immediately after the election? Some suggested more turn out figure above 70%.
- The BBC reality check uses two polls – a YouGov poll released on 13th June and an Ipsos Mori poll released on 20th “YouGov found that about 58% of people between the age of 18 and 24 voted, while Ipsos Mori estimated that it was 54%. Both of those figures are a proportion of all 18- to 24-year-olds, not just those who are registered to vote.”
- That is compared to an Ipsos Mori poll for the 2015 election showing 28% turnout amongst that group, 43% of those registered to vote. The piece adds “The overall turnout (and these are actual figures – not based on polling) was 69%, compared with 66% in 2015, so it appears that the youth vote increased by considerably more than the overall turnout.”
- See also the Full Fact article
Of course, we don’t trust polls as much as we used to. There’s an interesting pre-election piece on the Higher Education Policy Institute (HEPI) blog and BU’s Darren Lilleker asked about the impact of polls on voting. After the 2015 general election, an inquiry was commissioned into election polls, which concluded that the main issue in 2015 was unrepresentative samples. Accuracy was an issue again during and after the EU referendum. And the same issues arose in the General Election, although the final BBC poll was remarkably close. The House of Lords have appointed a new committee to look at Political Polling and Digital Media, which will report by March 2018 – so maybe that will give us more confidence.
Did the increased number of young voters vote Labour? The BBC reality check says all the polls show a substantial swing to Labour amongst younger voters (18-24).
So was the swing to Labour amongst the young a result of tuition fee promises? That’s a very reductive perspective – surely, students are interested in the same issues as everyone else? And, of course, many among that group do not attend university. HEPI had a piece on student voting intentions in May based on a YouthSight poll. At BU, the Students’ Union (SUBU) organised the only local hustings for parliamentary candidates with all five candidates present. The audience was mostly students and the debate was wide ranging. It covered public sector pay, Brexit, immigration, the economy, housing, security and local matters amongst other things. Tuition fees barely got a mention.
The tuition fees problem
The debate about tuition fees is complex, and highly political. So some key points:
- The headlines are all about debt – but it isn’t normal debt. So the headlines are unhelpful.
- Martin Lewis tweeted – you can read more here.
- Despite the fees and loans structure, there are more university students from unrepresented backgrounds than there were (maybe there could be even more, of course)
- The long term impact is greatest on students from low-income families, not because of tuition fees but because they borrow more for maintenance (helpful Wonkhe article looking at the recent report from the Institute for Fiscal Studies)
- There has been criticism of the interest rate: the Wonkhe article notes that rates are due to go up in September linked to inflation: “The 6.1% interest rate that some graduates will face come September is equally difficult to justify. For high earners, the use of RPI + 0–3% (rather than CPI + 0%) increases lifetime repayments by almost £40,000 in today’s money. A blog from Million Plus’s CEO uses adjectives like “staggering” and “usurious”.”
- There has been particular criticism of the freeze on the repayment threshold. The threshold was supposed to increase in line with earnings but in 2015 it was frozen despite a consultation in which 84% of respondents opposed a freeze.
- Government student loan statistics can be found here.
What had happened before the election?
During the passage of the Higher Education and Research Act 2017, issues with fees and loans, and the repayment threshold in particular were regularly discussed, in both houses. There was a debate on a “motion to regret” on 5th April in the House of Lords.
The government amended the bill so that inflation based tuition fee increases (already permitted under legislation, but requiring a statutory instrument to implement each change), now require positive approval by both houses. The inflation-based increase in the cap for students starting in 2018/19 should be announced relatively soon – and is likely to be more than the £250 that takes effect this September.
The government also delayed the differentiated fee cap linked to TEF – see more in our HE policy update from a couple of weeks ago. As I wrote on Wonkhe recently, the link between fee increases and TEF has caused all sorts of problems with the TEF – it isn’t the only reason that the NUS are opposed to TEF and called for a boycott of the National Student Survey (NSS) but it is one of the reasons – apparently 25 student unions supported the boycott, and at least some will not have valid NSS data for the TEF next year.
In the election campaign there was a great deal of debate about the affordability of the Labour commitment to abolish tuition fees – one analysis on Wonkhe here.
- BBC: Student debt rising to more than £50,000 says IFS
- Guardian: Why would we scrap £9,000-a-year tuition fees when we know they work?
- Evening Standard: Three quarters of graduates will never pay off their student debt
- International Business Times: 8 in 10 graduates will never repay their student loans
- Express: Martin Lewis reveals why student loan debt should NOT stop students going to university. In this article Martin concurs with Jo Johnson’s party line, that student debt isn’t a real loan but a ‘graduate contribution’ and tries to encourage the debt-adverse to attend university. Commenters on the article raise the physiological effect of ever-increasing debt and the impact of the loan counting against mortgage decisions.
- Andrew McGettigan comments on the IFS report.
- Guardian: The end of tuition fees is on the horizon – universities must get ready
- THE: Tax all graduate to pay for universities (even if they graduated years ago)
- And an old report from Million Plus: A Graduate Tax: Would it work? “Replacing maintenance grants with loans based on household income has meant that students from the poorest families could graduate with student debts in excess of £57,000 from a three-year degree, the Institute for Fiscal Studies (IFS) says. Meanwhile, the average student accrues £5,800 of interest while studying”
And what is happening now?
Jo Johnson argues that the fees improve access to HE for deprived students because of the removal of the student numbers cap, that it provides sufficient funding for universities to offer world-class teaching and research, and is fairer to the tax-paying public. And on Radio 4 today’s programme said that the unpaid written-off debts are the government’s contribution to higher education funding.
There has been speculation that a Conservative manifesto commitment to review Further Education funding will lead to a massive shakeup of university funding – if that is added to a review of tuition fees then change is really on the horizon.
Amongst many blogs and articles on the subject, David Phoenix has written for Wonkhe about why it is time for a review. He argues that while Labour’s abolition of tuition fees isn’t progressive the Conservative alternative doesn’t work either and calls on the sector to find a balanced solution. He writes: “The majority of students do not object to making a contribution to the cost of their education, but it’s the scale of the contribution that matters. A better balance between the student (or graduate) and state acknowledges that students will benefit financially from their degree, whilst also acknowledging the wider public good of higher education: social mobility, civic engagement, productivity, and innovation.” Speaking of the recent election result, he states: “It’s clear to me is that young people have, in large numbers, rejected continuity of the current system. We also know that the current funding structure is being quietly rejected by potential mature applicants. The job is now for the universities sector and policy makers to work together to rebalance the system to meet the needs of learners, our economy, and our public services.”
And the Wonkhe article noted above quotes the Dearing Review of 20 years ago, which started the move to debate on tuition fees: “One backbencher in the debate on Dearing nearly 20 years ago presciently remarked: “There is real concern that the Government’s decision not to follow Dearing’s proposal to introduce tuition fees while maintaining the maintenance grant, but rather to abolish the maintenance grant and replace it with loans will, far from widening access, narrow it.” Theresa May – for yes, it was she – hit the nail on the head. Discussions about affordability and access have to take place while looking at the entire student support and HE funding package. Taking a report (as happened with both Dearing and Browne) and cherry-picking politically or economically attractive aspects is not a recipe for a fair or sustainable system.”
Realistically – what might happen now?
Labour are sticking to their policy, despite affordability questions and the regressive nature of the change, and criticism of the repeated – an inaccurate- claim that fewer people from poor backgrounds are going to university.
Looking at the statistics above, it seems unlikely that this policy had as big an impact on the outcome of the election as was initially claimed. Apart from students, the policy may also have been popular with parents – but unlikely to have been a game changer in its own right.
So what will the government do?
- There might be some sort of review/consultation – it is hard to see that this will result in major changes to the structure but it would look like doing something
- There might be a change to the interest rate – to delay or reduce the rise that will otherwise happen in September
- There might be a relenting on the repayment threshold freeze – passed in 2015 for 5 years, so perhaps it won’t be extended
- They could choose not to increase fees by inflation at all in 2018/19. There is no rule that says they have to; even though they announced that they plan to as part of the White Paper/TEF implementation.
- There might be more consideration given to maintenance funding arrangements. As noted above, these add hugely to student loans, and disproportionately so for students from lower income families.
It is hard to see more drastic changes than that at a time when there are so many calls on the “magic money tree”. Although I’m still not making predictions in this uncertain world…
International staff and students
Hotcourses insights Brexit report compares global demand for HE over the last 12 months. It finds that international student interest has decreased from 28% to 25.6%, although EU student interest has dropped more substantially from 36.9% to 30.7%. The USA share of the student interest has also dropped, whilst Canada and Ireland have both gained.
Jo Johnson announced the Ernest Rutherford Global Talent Research Fund (£100 million) which aims to attract highly skilled researchers to the UK. Johnson stated: “Rutherford and his immense contributions to science exemplify our vision of a Britain that is open to the best minds and ideas in the world, and stands at the forefront of global collective endeavours to understand, and to improve, the world in which we live…We look forward to welcoming these talented Rutherford research fellows to the UK. The Rutherford Fund will send a strong signal that, even as we leave the European Union, we are open to the world and will reinforce our ambition of making the UK the go-to country for innovation and discovery.”
As parliament begins to bed down the select committees will re-form and appoint their new chairs.
This week relevant Parliamentary Questions have dovetailed the media interest in tuition fees. Angela Rayner has tabled two PQs (due for answer next week). The first asks the government for a statement on whether they intend to privatise the student loan book. The second asks what estimate has been made of potential revenue in privatising the student loan book.
When the prime minister, Theresa May, called a general election back in mid-April it was widely assumed she would easily win a large majority. The Conservative leader was far more popular than her Labour rival Jeremy Corbyn, and had a clear path back into No 10. We know this because the voters themselves told us – through opinion polls.
Six weeks later, the narrative is rather different. Labour’s manifesto has been praised while the Tory campaign has stuttered. Though a Conservative majority is still the most likely outcome, Corbyn appears increasingly confident while May seems more worried. But again this is largely down to the polls.
Like it or not, opinion polls are a staple part of an election campaign narrative. The media often obsesses over the slightest swings, enquiring of their readers and of party leaders: why, what have you done to increase or lose support?
But what if the media was not allowed to report on such polls during an election campaign? It might lead to a renewed focus on policy issues instead of “who is winning”. But banning polls may also hand even more power to political parties and media gatekeepers.
The influence of polls
Polls can drive campaigning style and substance. A leader buoyant in the polls will appear more confident and relaxed, so fulfilling the prophecies of the polls by delivering more assured performances. A leader lagging may seem edgy and nervous about answering questions, constantly second guessing how the media will replay their words and how the public will respond. This can lead to the sort of less assured performance that voters can find a turn off.
But an impact on substance matters. A struggling campaign will seek magic bullets to secure victory, which may simply mean candidates repeat slogans they think have traction, or focus on negative messages and image building exercises. As polls narrow, so does the debate, and candidates will completely avoid getting drawn into debates on policy detail that might obscure their message. Without the distraction of headlines based on polling, however, campaigns may feel more able to engage in serious and detailed policy debate.
Polls also influence voters. There has long been talk of polls creating a bandwagon effect, with voters flocking to support the party or candidate who is the most likely winner. This might explain the recent surge in Labour support, or the landslide victory in Scotland for the SNP in 2015. In both cases polls suggested the tide was moving one particular way, which can drive the decision making of undecided voters.
Alternatively poll predictions can mobilise or depress activism and voter turnout. If activists believe their party is doing well they may not feel the need to do as much door-knocking, while if a party is doing poorly they may feel disillusioned (though the reverse can be the case for both scenarios).
Similarly on election day voters can look at the polls and form the belief their vote does not matter or that they will get the outcome they want without making the effort to vote. Hence polls affect the nature and levels of engagement of an election campaign.
Polls provide transparency
But polls will be commissioned regardless of coverage, and many parties rely on pollsters to give an indication of how their campaign is going. If polls go unreported citizens will not be aware of why the focus of a campaign is shifting.
Voters may attribute a less than assured performance to poor poll performance and be sympathetic. Similarly they may see an act as desperate and driven simply by the polls and so grow cynical. Without the polls a vital sense of transparency of process is lost, and voters would only be able to speculate at what is driving campaign strategies.
So a campaign without polls could allow leaders to be themselves, unaware of the public reaction beyond that from the audience immediately in front of them. Leaders may also feel they must get more into the detail, persuading through the use of facts and costed promises that can be interrogated, rather than resorting to headlines or negative attacks in order to draw in the least engaged voters. Parties may also court activists more, in the hope that every leaflet or phone call can make a difference.
While many of these things happen in the course of a campaign anyway, the focus can be skewed by the erroneous notion that polls are shifting for or against a party. Comparing the performances of May and Corbyn one might attribute some of their performance style and communication strategy to perceptions of their relative standing in the polls.
All this relies on party leaders and strategists also being unaware of their standing with the public, however. And with pollsters in the business of making news and attracting corporate clients, it is hard to imagine an election truly without polls.
But what if polls were treated with greater caution and scepticism? If reporters were more clear about margins of error, or the difficulty of factoring in underrepresented groups, then both parties and citizens may not be so ready to be influenced by each percentage point change. In turn elections may be less negative, more substance focused and leaders could perform with fewer worries about the next day’s headlines.
Perhaps reporting of polls simply needs to be better – not banned.
From August, nursing, midwifery and most allied health students will no longer have their tuition fees paid by the NHS, nor will they receive maintenance bursaries. This will undoubtedly affect the number of students opting to study these subjects. And it will negatively impact NHS England staffing levels in three years’ time.
Many nursing students are mature students and having their fees paid has been an incentive to study. At Bournemouth University, we have a large number of mature students who have a mortgage and dependent children, so they may be reluctant to take on more debt. Taking away the bursary could prevent many talented people from becoming tomorrow’s nurses, midwives, physiotherapists, occupational therapists and speech-and-language therapists, to name just some of the healthcare degrees that will no longer be funded by the government.
The Royal College of Nursing (RCN) confirms that nursing and midwifery student applications across England are down by 23% this year. This doesn’t necessarily mean that the places on these courses won’t be filled, as they are often oversubscribed, but it’s a worrying dip, nonetheless.
If the government – whoever they may be after June 8 – is serious about securing an NHS workforce for the future, they need to be serious about investing in it now.
Inventing new roles
There are over 55,000 EU nationals working as nurses and doctors in the NHS. As a result of Brexit, fewer nurses from the EU are applying for jobs in the NHS. And the RCN confirms that student nurse applications from EU citizens are down 7% this year.
New healthcare roles have been created in an attempt to counteract the changes to student funding and to Brexit, such as the new nursing associate role. A nursing associate is more junior than a registered nurse, but they can go on to become a registered nurse either by completing a degree-level nursing apprenticeship or by taking a shortened nursing degree at university.
The government has also expanded the range of apprenticeship schemes, such as nursing-degree apprenticeships and apprenticeships which support the development of advanced-practice nurses. But none of these initiatives is a quick fix.
In fact, with the introduction of the apprenticeship levy, introduced for all large organisations since April 2017, the government hopes to train 100,000 apprentices in the NHS by 2020. These apprenticeships will include nursing associates and healthcare assistants (a position below nursing associates). This means that all organisations, not just the NHS, who have an annual wage bill of £3m or more will have an apprenticeship levy of 0.5% of their total wage bill deducted to pay towards the government’s apprenticeships scheme. However, paying for a three-year degree apprenticeship by the NHS Trusts will far exceed what the levy will pay for.
Nursing shortages will not just be bad for patients, they will be bad for nurses too. A study, published in JAMA, showed that a poor nurse-to-patient ratio can result in an increase in patient mortality and have a detrimental effect on the health and well-being of the nurse, leading to job dissatisfaction and more nurses quitting.
The NHS cannot survive the continued and worsening workforce shortage and retain its reputation for high-quality patient care. So, unless incentives are introduced, such as fees paid for those with a first degree to enter these programmes at the postgraduate level, or assistance with childcare, or similar incentives that would encourage candidates to enter healthcare professions, the workforce crisis in the NHS can only continue to spiral out of control.
Our ancient ancestors seem to have survived some pretty harsh arid spells in East Africa’s Rift Valley over five million years. Quite how they kept going has long been a mystery, given the lack of water to drink. Now, new research shows that they may have been able to survive on a small networks of springs.
The study from our inter-disciplinary research team, published in Nature Communications, illustrates that groundwater springs may have been far more important as a driver of human evolution in Africa than previously thought.
The study focuses on water in the Rift Valley. This area – a continuous geographic trench that runs from Ethiopia to Mozambique – is also known as the “cradle of humanity”.
Here, our ancestors evolved over a period of about five million years. Throughout this time, rainfall was affected by the African monsoon, which strengthened and weakened on a 23,000-year cycle. During intense periods of aridity, monsoon rains would have been light and drinking water in short supply. So how did our ancestors survive such extremes?
Previously, scientists had assumed that the evolution and dispersal of our ancestors in the region was solely dependent on climate shifts changing patterns of vegetation (food) and water (rivers and lakes). However, the details are blurry – especially when it comes to the role of groundwater (springs).
We decided to find out just how important springs were. Our starting point was to identify springs in the region to map how groundwater distribution varies with climate. We are not talking about small, babbling springs here, but large outflows of groundwater. These are buffered against climate change as their distribution is controlled by geology – the underlying rocks can store rainwater and transfer it slowly to the springs.
We figured that our ancestors could have stayed close to such groundwater in dry times – playing a greater part in their survival than previously thought. When the climate got increasingly wet, groundwater levels would have risen and made springs more plentiful – feeding smaller rivers and leading to lakes becoming less saline. At this point, our ancestors would have roamed across the landscape free of concerns about water.
Life and death decisions
To test this idea, we embarked on a computer experiment. If the springs and water bodies are thought of as the rest stops, or service stations, then the linkages between can be modelled by computers. Our model was based on what decisions individuals would have taken to survive – and what collective behaviours could have emerged from thousands of such decisions.
Individuals were give a simple task: to find a new source of water within three days of travel. Three days is the time that a modern human and, by inference, our ancestors could go without drinking water. The harder and rougher the terrain, the shorter the distance one can travel in those vital three days.
We used the present landscape and existing water springs to map potential routes. The detailed location of springs may have changed over time but the principles hold. If our agent failed to find water within three days, he or she would die. In this way we could map out the migration pathways between different water sources as they varied through 23,000-year climate cycles. The map shows that there were indeed small networks of springs available even during the driest of intervals. These would have been vital for the survival or our ancestors.
The model also reveals movement patterns that are somewhat counter-intuitive. One would assume that the easiest route would be along the north to south axis of the rift valley. In this way, hominins could stay at the bottom of the valley rather than crossing the high rift walls. But the model suggests that in intermediate states between wet and dry, groups of people may have preferred to go from east to west across the rift valley. This is because springs on the rift floor and sides link to large rivers on the rift flanks. This is important as it helps explain how our ancestors spread away from the rift valley. Indeed, what we are beginning to see is a network of walking highways that develop as our ancestors moved across Africa.
Human movement allows the flow of gossip, know-how and genes. Even in modern times, the water-cooler is often the fount of all knowledge and the start of many budding friendships. The same may have been true in ancient Africa and the patterns of mobility and their variability through a climate cycle will have had a profound impact on breeding and technology.
This suggests that population growth, genetics, implications for survival and dispersal of human life across Africa can all potentially be predicted and modelled using water as the key – helping us to uncover human history. The next step will be to compare our model of human movement with real archaeological evidence of how humans actually moved when the climate changed.
So next time you complain about not finding your favourite brand of bottled spring water in the shop, spare a thought for our ancestors who may died in their quest to find a rare, secluded spring in the arid African landscape.
This research was carried out in partnership with our colleagues Tom Gleeson, Sally Reynolds, Adrian Newton, Cormac McCormack and Gail Ashley.