Saturday, 27 August 2016

Surprise! Dolls Don't Stop Teenage Pregnancy

A young woman is woken in the middle of the night by the sound of crying. This is the third time so far and she is exhausted. She pushes back the duvet and swings her cold feet to the floor, wondering what awaits her, another feed, another wet nappy? What has the programming decided to wake her for this time?

Fake baby dolls have been used all over the world for years to scare teenagers, usually girls, off the idea of getting pregnant. If you've experienced the utter soul sapping exhaustion of caring for a new born it seems like common sense, give a teen a taste of that and they will be put off the idea of taking it on for real. Right?

Except assumptions, even when they seem so obvious, can be wrong. This is why sometimes we need people who ask seemingly silly questions and scientists who will answer them.

Scientists like the group in Australia who looked to see if the baby dolls really did lower the teenage pregnancy rate and found that not only did the dolls not reduce the number of girls getting pregnant, they actually seemed to increase it.

Given how widely the dolls have been used it is perhaps surprising that no one has ever done a proper scientific check before to see if they actually work. But there is no published data. So the Australian team set up a controlled trial. They recruited 57 schools and randomly assigned them to be either test sites, where the doll program was run, or controls who just got standard health education classes. In all, almost 3000 teenage girls were involved and the researchers used medical records to follow them up until they reached twenty.

When they put all the numbers together it was clear that those who took the dolls home were more likely to have a baby or an abortion in the subsequent years.

But perhaps that shouldn't be such a surprise. It strikes me that the doll program grossly oversimplifies both being a mother and being a teenage girl.

Firstly, girls often only get the dolls for a weekend, and while two or three nights of disturbed sleep is tough, it's nothing compared to the accumulated exhaustion of being in demand 24/7 for months or even years. I also doubt the cry of a plastic toy could truly grab you by the heart and guts in quite the way that the scream of your own flesh and blood baby does.

Besides, real life new mums are taking on far more than just sleep deprivation and night feeds. There's the physical after effects of pregnancy and birth, the constant worry over keeping the baby safe and over every one of a million choices in how to raise it. Then there is the probably permanent loss of your previous, child free life. Nothing in the world can truly prepare you for the realities of becoming a mother. So it's perhaps not so surprising that a weekend with a demanding doll doesn't do it either.

But the dolls failure says less about the girl's inability to grasp the reality of motherhood than it does about everyone else's poor understanding of the lives of teenage girls.

Most of them are smart enough to realise that there must be some positives to motherhood. After all, most women who go through the months of new born chaos are eventually quite keen to do it all again.

More sadly, some teenage girls see few other options in their future. The dolls may give them a breif glimpse of a purpose or even of some kind of status. "Mother" is the only roll that seems both significant and achievable. Even though girls now often outperform boys at school our society still focuses on what women and girls do with our bodies and present motherhood as an essential, an ultimate purpose and duty. Often little else is on offer.

Trying to scare girls off teen pregnancy with a weekend of simulated semi motherhood isn't going to work unless we can ensure girls have desirable and attainable alternatives and that they believe their worth doesn't rest solely in their reproductive organs. That of course is far harder. It also involves the boys. The study didn't look at the effect of boys taking the dolls home or how this may have changed their behavior with girlfriends, their opinion of motherhood or the role of women.

As ever, the responsibility for pregnancy and preventing it is placed entirely on the potential mothers, even when they are still children themselves. Even when the baby is a doll.


Sunday, 21 August 2016

A Mum's Guide To Dodgy Science: Cause v Correlation

Time for another in my (very) occasional series of posts giving you tips on how to spot a dubious science story. The previous posts covered Publication By Press Release and the problem of Comparing People To Petri Dishes. This one has a few less P's in it but it's a biggy, something that crops up time and again in the media: causation v's correlation.

I've touched on it before (in this post), but the problem is essentially this: if a study finds that, say, people who eat lots of broccoli are better at maths than those who don't, then it could be claimed that eating broccoli causes super maths skills. 

But is the broccoli really the cause? It could just be a coincidence or there could be another factor that causes an increase in both maths geekiness and tiny green tree consumption. 

If you fancy making up some correlations of your own have a play on this website, apparently, increasing sour cream consumption results in more Lawyers in New York.

This might sound quite obvious (not the sour cream bit) but it's all too easy to fall for it. Especaially if the cause and effect seems to back up our own beliefs. This is a whole other problem (known as confirmation bias) and it's really really hard to avoid. Show me a headline that says getting a science degree causes you to be a totally awesome person and a little bit of me would be very happy to believe it (ok a pretty big bit). The moral of the story is, if you disagree with the findings of some research, be skeptical about it. If you agree with the findings be really, really skeptical about it.

So if we accept we are all just human, how can we spot when there is a causation v correlation issue in an article? 

There are some key phrases you can look out for, things like "linked to" "associated with" "relationship between" . Basically anything that suggests a connection between two things but doesn't explicitly say "causes" is a bit of a red flag.

*It's usually the mothers right?

As ever I tend to get around to writing these posts because I saw something that annoyed me, so here's that something:

There is a strong positive relationship between planned birth at home and breastfeeding rates, according to researchers.
Their study review found breastfeeding was twice as likely among mothers in UK and Ireland who had a planned home birth, compared to hospital births.
The article goes on to list a number of reasons why this may be: Home birth mums are looked after by midwives not doctors, they aren't confused by lots of different medical professionals and are less likely to have medical interventions or pain relieving drugs. They might also be more likely to have skin to skin contact immediately after birth and less likely to have formula on hand. 
All of these things are mentioned in the paper the article is based on and they may well all have contributed to the results. BUT there is also a glaring correlation issue:
In the UK and Ireland very few births happen at home. In the two populations studied it was just 1% and 2%. So no one was going along with a home birth because it's just what everyone does. It's a carefully considered and sometimes fought for decision. Hospitals deal with everyone from super healthy twenty somethings to those with multiple health and social issues but home birth mums tend to be similar. They are usually educated, healthy and relatively well off. Exactly the same demographic that is most likely to breast feed, wherever they give birth. 
This issue is discussed at length in the paper, it's such a biggy that the authors spent time on complex stats to try to adjust for things like socio economic status and if the mother had a live in partner. Yet the article doesn't mention this problem at all. 
The paper is also quite clear that, even with those statistical adjustments (and they are never perfect) there is still the issue of belief. 

Those mothers making an active choice to give birth at home do so because they believe it is best for them and their baby. They are fairly confident that birth is a normal, natural event which they are perfectly capable of going through with no need for artificial intervention from doctors and modern medicine. It would be very odd then, for women with that belief not to extend it to the normal and natural act of breastfeeding. 

Sadly belief and determination are not enough to make breastfeeding successful, I write this as someone who had both and had a hell of a time with my fist baby. But they do help, sometimes a lot. Yet the article makes no mention of the importance and power of women's beliefs.

Instead, the story painted is one that fits neatly into the current ideal of childbirth: Doctors, hospitals and pain relief are bad. Midwives, breastfeeding and all things natural are good. 

But to get back to the causation issue - why does this matter?

This article didn't appear in a tabloid paper. It was in a nursing magazine. Most people reading it would expect it to be an accurate source of information and they probably don't have the time to dig through the original research to check on that. Yet the article follows the same formula we see in the general media. It cherry picks the bits of the paper which will most appeal to it's audience but leaves out some very important problems.

We all love a quick fix. Take this pill to get slim, eat today's favourite "super food" and stop feeling tired all the time. But it is rarely that easy. Discouraging doctors, epidurals and formula in the hospital would all be doable and pleasing graphs could be produced of their decline. But it could mean coercing women into births that are more painful or risky than they would otherwise choose. If these things aren't even the main cause of the reduced breast feeding rate, if hospital birth over all is more a correlation than a cause then just jumping into the quick fix could do far more harm than good.


PS. There are a bunch of other issues with article, (including an error in the first paragraph), there are also some weaknesses in the paper but for brevity I've resisted a full rant!

Wednesday, 10 August 2016

How To Cope With Living In London

I have to admit to a little guilty pleasure, the Mumsnet AIBU thread. If you’re not familiar with it, AIBU stands for "Am I Being Unreasonable?" and the answer is quite often yes, yes you really are.

This week someone asked “AIBU to wonder how people cope living in London” which reminded me that I haven’t written for quite some time about just what a great place to live this is. The “Southwark” part of this blogs title comes from my London borough afterall.

The mistake the OP (original poster) had made, was coming to London as a tourist. Yes there are a lot of people here and yes the tube is packed and horrible in rush hour in the summer. The big tourist attractions are little better. But London has high standards. If you only give her a day or two, she’ll let you see the sights and not care if you have to be crammed in with a thousand other people to do it. But if you put in the time, the effort she deserves, then she lets you have the good bits.

I’ve been here for thirteen years now and I still only really know patches of this huge city but here are just some of the things I love about living here:

The Transport:

No, really.
The tube isn’t awful all the time and when it’s not it’s a great way to get about. My visiting parents once declared; “oh good only 10 mintues till the next one” after we just missed a tube. Everyone else on the platform was incensed it was that long, a two minute wait is far more normal. But the thing is, it’s not just about the tube. Where I live there isn’t even a tube line. In fact you don’t need transport a lot of the time. From my house I can walk to several different shopping streets, two sports centers, the doctors, dentists, three children's centers, school and more than half a dozen parks and playgrounds. The shiny new network of segregated cycle ways means I can now ride my bike to work almost entirely off road. The buses, trains and London overground service get me anywhere else in the city. Our car is mainly for trips to other places which just aren’t so, well, good.

It’s a great place to raise kids:

Firstly London has really good schools. Years ago they were awful, but for a quite a while now they have been the best in the country. Then there is all the free stuff to do with kids. The national history museum, science museum, British museum, V&A, National Gallery, Tate Modern etc. etc. etc. are all free. So there is no need to drag around for hours after it stopped being fun so that you see it all in your one day window. We can hop on a bus or train, look around for an hour and then go to the park for a bit. Safe in the knowledge that we can come back any time we like. Oh and the bus and train are free for the kids too. For older teens this means the whole great city is there to entertain them, for nothing. For MissE it's meant a long list of cheap or free school trips. No need to pay for a coach when the class can all just pop on the bus at the end of the road.

You can be whoever you want to be:

In London you are never the weirdest person on the bus, and (for the most part) that’s a good thing. You can dress however the heck you like (just do it like you meant it). There is no single "normal" to blend into anyway. Want to go sailing and horse riding? Ok, knitting group? Coding class? Art house cinema? Whatever your passion (with the possible exception of Bobsleigh I suppose) you can do it in London. You’ll probably also find others who share it, who come from your home country and are seeking out the same food, or maybe even like the same odd kind of music as you.

There is always something new to discover:

You could spend a lifetime visiting different London restaurants, trying new international cuisines and never get to all the good ones. You can never tire of sightseeing either. Once you move beyond the obvious tourist sites there is still so much to see. I recently altered my route to work a little and discovered some of the Inns of court. There are beautiful churches, cobbled streets and grand Georgian squares. It’s all a short walk from St Paul’s Cathedral but you have to find and step through the unassuming archway on Fleet street to get in. Few tourists notice it, so it feels like a secret, hidden world.

So yes it is busy and hectic. The tube is horrible in the summer (and worse in the winter when it’s almost as hot but you’re wearing a coat). The house prices are horrific and the rents not much better and maybe one day I will move on somewhere else, who knows. But for now I for one am not just coping with living in London, I’m loving it.