1. P REGNANCY EXPERIENCES AND PERCEIVED SOCIAL SUPPORT AMONG PREGNANT WOMEN IN POOR RURAL ROMANIA A Photovoice Pilot Study VU University Amsterdam: Marijn Voorhaar Center for Health Policy and Public Health, Babeş-Bolyai University, Cluj-Napoca, Romania: Dumitrela Negură Alexandra Brînzaniuc Emanuela Marton-Vasarhelyi Ioana Cazan

2. I N THIS PRESENTATION : Introduction Methods: Photovoice Focus groups Results Discussion Conclusion Acknowledgements Questions

3. I NTRODUCTION Life changes and psychological adjustments 1 1 Da Costa et al., 1999 Transition to motherhood 2 2 Modh et al., 2011 Hormonal swings 3 3 Glazier et al., 2004 Stress and anxiety 4 4 Da Costa et al.., 1999 Worries and concerns about pregnancy 4 Relationship difficulties 4 Postpartum depression 2

4. I NTRODUCTION Possible consequences of anxiety and depression during pregnancy 4 : Complications during pregnancy and/or birth Low birth weight Poor neonatal status Prematurity 4 Da Costa et al.., 1999

5. I NTRODUCTION By taking the pregnant women’s experiences seriously, a postpartum depression might be prevented 5 Importance of sharing experiences of pregnancy with other pregnant women 6 Connectedness with other future mothers and sharing the feeling of both joy and suffering is considered meaningful 7 5 Lundgren, 2002 6 Bondas & Eriksson, 2001 7 Callister, 2004

6. I NTRODUCTION It is hypothesized that social support has a positive effect on psychological and emotional well-being of pregnant women by buffering the impact of life stress. Little research has been done to examine social support during pregnancy and the pregnancy experiences of women in poor rural communities.

7. I NTRODUCTION : R OMANIA 67% of the total poor population in Romania lives in rural settings. Need for qualitative research: explore and conceptualize pregnancy experiences and role of social support. This study is the first study that aims to provide insights into pregnancy experiences and perceived social support among pregnant women in poor rural communities in Romania. Photovoice method

8. I NTRODUCTION : R ESEARCH QUESTION How do pregnant women in poor rural Romania experience their pregnancy and how do they perceive social support?

9. M ETHODS : THE PARTICIPANTS N = 8 N = 9

10. M ETHODS : P HOTOVOICE Photovoice (Wang & Burris, 1994) High value on the power of visual images Everyday realities Own interpretation Participants are experts

11. M ETHODS : D ATA COLLECTION

12. METHODS: DATA COLLECTION MEETING I: PHOTOVOICE ASSIGNMENT Pregnancy experiences: Positive Negative Feelings about pregnancy Social support: Perceived social support Forms Sources  Written informed consent  Instructions disposable camera

13. Meeting I Aghireşu

14. Meeting I Aghireşu: portraits

15. M ETHODS : D ATA COLLECTION M EETING II Collection of cameras

16. M ETHODS : D ATA COLLECTION M EETING III: F OCUS GROUP “First round” Exchange photographs Pile sorting exercise SHOWED: What do you See here? What is really Happening here? How does this relate to Our lives? Why do these issues exist? How can we become Empowered by our new social understandings? What can we Do about it?

17. Meeting III: Pile sorting exercise

18. Meeting III: SHOWED

19. Meeting III: Evaluation

20. M ETHODS : D ATA ANALYSIS Content analysis: photographs Thematic analysis: group interviews Concept mapping: represent identified themes

21. R ESULTS ( PRELIMINARY ) Pregnancy positive experience Main sources social support: Children (group Cojocna) Husband (group Aghireşu) Need for support groups Evaluation Photovoice project “We were glad we could communicate with other pregnant women.” “Here we were able to share our troubles.”

22. D ISCUSSION Differences between Cojocna and Aghireşu groups: Ethnicity: Roma & Romanian Interaction during sessions Sharing experiences However: both groups would participate again

23. C ONCLUSION Photovoice encouraged the participants to share their pregnancy experiences and to describe their social support networks. Sharing experiences and worries with other pregnant women could be an important form of social support during pregnancy. Support groups for poor pregnant women living in rural areas could contribute to a better insight in the needs of these women.

24. A CKNOWLEDGEMENTS Participants, family physicians, mediator Research Team: Dumitrela Negură, MA Alexandra Brînzaniuc, MA Emanuela Marton-Vasarhelyi, MA Ioana Cazan, BA Supervisors: Răzvan Cherecheş, MD PhD, executive director CHPPH Anne Belonje, MD PhD, lecturer International Public Health, Athena Institute Advisor: Vincent O'Brien, Professor of International Health and Visual Ethnography, The University of Cumbria

25. Q UESTIONS