Understanding and improving the communication of risk relating to pregnancy
About the project
The WRISK project is a collaboration between the British Pregnancy Advisory Service (bpas) and Heather Trickey at the School of Social Sciences at Cardiff University. Working with stakeholders from a wide range of disciplines, the project draws on women’s experiences to understand and improve the development and communication of risk messages in pregnancy. The project is funded by the Wellcome Trust.
Women who are planning a pregnancy or who are pregnant receive many public health messages that are intended to guide their decision making. For example, they receive advice about what to eat, drink, how much they should weigh, and what medications they should or shouldn’t take. These messages are intended to improve outcomes for babies and mothers. However, there is growing concern that messages do not always fully reflect or explain the evidence base underpinning them, and that negotiating the risk landscape can sometimes feel confusing, overwhelming, and disempowering. This may negatively affect women’s experiences of pregnancy and motherhood, and be exacerbated by a wider culture of parenting that tends to blame mothers for all less-than-ideal outcomes in their children.
The WRISK project will be conducted over two years from November 2018 to November 2020. The project takes a woman-centred approach – starting with an exploration of women’s experiences of risk messaging. Women’s voices will be gathered and collated through public involvement and qualitative methodologies. Lessons drawn from women’s experiences will be considered by a group of stakeholders using a consensus methodology. Stakeholders include scientists, public health and risk communication specialists, women’s advocacy groups, and specialists in women’s sexual and reproductive health. This work will lead to the development of recommendations for respectful risk communication in pregnancy.
“The WRISK project is taking an important step forward in seeking to develop recommendations that re-align public health messages for pregnancy with women’s needs and lived experiences. This can only result in more effective information that supports both principles of maternal autonomy and public health objectives.”
Dame Cathy Warwick, former Chief Executive of the Royal College of Midwives
Project aims & objectives
News and updates
The WRISK project regularly asks contributors to share their perspectives on a range of issues related to risk communication in pregnancy to further understanding of the challenges faced by scientists, clinicians, policy makers and of course women themselves when...
In our latest guest blog, Norah MacKendrick and Kate Cairns share findings from their research looking at the individualisation of environmental risks during pregnancy. While their work focuses on the US, there are parallels with how risk and risk mitigation is approached in the UK when it comes to environmental hazards. Recent UK media reports on studies looking at the impact of factors such as air pollution and plastics on pregnancies have included suggestions that pregnant women avoid main roads, time their pregnancies to avoid the most polluted times of year and try to limit their exposure to chemicals found in everyday personal care products like shampoo.
Mental health vs. pregnancy: coping with simplistic and conflicting medical advice on antidepressants
The WRISK project regularly asks contributors to share their perspectives on a range of issues related to risk communication in pregnancy to further understanding of the challenges faced by scientists, clinicians, policy makers and of course women themselves when trying to navigate risk messaging. These represent individual and personal viewpoints and are aimed at encouraging reflection and discussion, rather than reaching conclusions.
Here, Clare Foster writes about her experiences of coping with conflicting medical advice on antidepressants and pregnancy.
It’s the mother! Is there a strong scientific rationale for studying pregnant mothers so intensively?
Dr Gemma Sharp, University of Bristol, writes the inaugural WRISK guest blog.
“For many years, researchers have been studying how our early life experiences, including those that happen before we are born, can affect our lifelong health. In an article we wrote last year, Debbie Lawlor (University of Bristol), Sarah Richardson (Harvard University) and I show that most of these studies have focused on the characteristics and behaviours of mothers around the time of pregnancy.
We argue this is because people assume that mothers, through their connection to the developing fetus in the womb, are the single most important factor in shaping a child’s health. In our article, we question the truth behind this assumption.”
Alexandra Freeman and David Spiegelhalter have recently published an article on the responsibilities that researchers, journalists, and press officers have to accurately communicate health risks. They claim that “research that is poorly communicated or presented is as potentially damaging as research that is poorly conducted or fraudulent”. This blog looks at the main points raised in the paper, and how they relate to the WRISK project.
It has been just a week since the launch of the WRISK website and social media channels, and we are already overwhelmed by the number and range of people who have got in touch with us. We have received messages from senior research midwives, civil society organisations, public health professionals, and clinicians. Most importantly, we have been contacted by many people who have lived experience of pregnancy and have been on the receiving end of a multitude of messages regarding risk.
Introducing WRISK: drawing on women’s experiences to develop recommendations for public health messaging in pregnancy
The WRISK project is a Wellcome-funded collaboration between the British Pregnancy Advisory Service (bpas) and Heather Trickey at the School of Social Sciences at Cardiff University. WRISK engages expert stakeholders and draws directly on women’s experiences to develop recommendations to ensure effective and respectful public health messages for women in pregnancy.
Workshop on pregnancy and riskIn 2017, bpas hosted a workshop which brought together stakeholders interested in women’s sexual and reproductive health to discuss the impact of public health messages on women’s experiences of pregnancy. The group recognised that information and conversations about decisions in pregnancy can provide an invaluable guide to aid women’s decision-making. Many felt that current approaches are not doing enough to protect women’s autonomy in decision-making, and that women are not getting all the information they need to allow them to weigh up and evaluate different sorts of risks.
Stakeholders also tended to feel that not enough attention is being paid to the possible negative impact of risk messages. Public health messages directed towards women, whilst important and vital, may be inadvertently under-emphasising the impact of a woman’s surroundings, social networks, and the availability of health services on her pregnancy.
In summary, these problems may be undermining the effectiveness and credibility of public health messaging, and stakeholders recommended research be undertaken which draws on women’s experiences of risk messages relating to pregnancy.
Issues in the media
Women receive many messages about risk and pregnancy in the media, which may impact how they experience pregnancy and parenthood. Here are some recent examples.
The Evening Standard, December 2018
The Daily Mail, November 2018
The Daily Star, November 2018
The Economic Times, October 2018
The Guardian, October 2018
The Guardian, September 2018
Director of External Affairs, British Pregnancy Advisory ServiceClare Murphy is Director of External Affairs at the British Pregnancy Advisory Service. Clare runs the communications department at bpas, which is responsible for the charity’s advocacy, campaigns, media work, and education programmes. She is also a board member of the European Consortium for Emergency Contraception (ECEC), which works to expand knowledge about and access to EC within the European region. Before joining bpas in 2010 Clare worked for the BBC as a health and science journalist, with a particular interest in women’s health.
Research Fellow, School of Social Sciences, Cardiff UniversityHeather’s research focuses on public health policy in relation to parenthood. Her methodological interests include participatory methods, realist synthesis, intervention development and process evaluation. Her substantive focus is infant feeding policy, public health message communication, and peer support intervention.
Professor of Clinical Nursing and Midwifery, Cardiff UniversityPrior to her current appointment Julia was a Consultant Midwife in Cardiff and for 10 years ran the ‘Birth Choices’ clinics for women to discuss and plan their antenatal and labour care. She has plenty of experience of caring for women who have declined recommended care and is aware of challenges in balancing the views of individual women toward risk with professional responsibilities to provide information on risks in pregnancy. Julia has a Masters degree in Public Health, a Masters degree in Medical Law, and extensive experience in the management of large and complex pregnancy related research studies.
Research and Engagement Officer, British Pregnancy Advisory ServiceRebecca Blaylock is Research and Engagement Officer at bpas. She has a Master’s in Public Health from Imperial College London, and an undergraduate degree in Social Anthropology from the University of Cambridge. Rebecca has held several roles across community engagement and widening participation. She is passionate about a rights-based approach to all aspects of sexual and reproductive health.
The following partners supported the WRISK team on the funding proposal: Dame Cathy Warwick; Rebecca Schiller, Birthrights; Jane Fisher, Antenatal Results and Choices; Caitlin Dean, Pregnancy Sickness Support; Elizabeth Duff, NCT; Irene Peterson, UCL; Amber Marshall, Big Birthas; Elselijn Kigma, Southampton University; and Julie Bishop, Public Health Wales.