Pride Month 2023

23rd June 2023

In support of Pride Month 2023, we are delighted to share this Voices blog by Emily Rounds, iHV Professional Development Officer – Perinatal & Infant Mental Health.

Health visitors have a vital role in supporting parental, child and family mental health, parent-child relationships, and a child’s social and emotional development. On 19 June we hosted our annual Perinatal and Infant Mental Health (PIMH) Conference, a real celebration of our commitment to improving the wellbeing of all babies, children, and their families. Taking place during PRIDE Month 2023 and on International Fathers’ Mental Health Day, a key focus was tackling inequalities in PIMH and developing inclusive practice. It was a joy and privilege to spend the day with so many inspirational practitioners including health visitors, midwives, PIMH Champions, and Specialist PIMH HVs – all of whom are doing an incredible job to improve outcomes for children and families, despite significant challenges. Together we harnessed our curiosity and wondered about what some of the latest research and innovation in PIMH means, in relation to providing safe, personalised, inclusive, high-quality PIMH care.

As a passionate ally to the LGBTQI+ community, it was a real thrill to meet and hear from Dr Zoe Darwin (Reader in Health Research, University of Huddersfield), Jacob Stokoe (birthing father to his two children and founder and director of Transparent Change CIC), and connect with DadPad, who have been busy developing their Co-ParentPad.

According to the 2021 Census, at least 1.5 million people in England and Wales are Lesbian, Gay or Bisexual and one in 200 people are transgender¹. In 2019 there were 212,000 same-sex families in the UK; an increase of 40% since 2015². Lesbian couples are one of the fastest growing groups within maternity services, with fertility treatment and live births increasing by 15-20% per year^1,3. The numbers of trans^[i] parents are also increasing, but we currently lack the data to demonstrate this⁴.

We know that around 1 in 4 mothers⁵ and 1 in 10 fathers⁶ experience a perinatal mental health (PMH) problem in the UK, and that without treatment, this can have a devastating impact on the whole family, with long lasting consequences⁷. However, these figures are not representative of all parents and do not capture the diversity of family forms. Indeed, not all birthing parents are women, and not all non-birthing parents are men.

There is limited research into the perinatal experiences and needs of LGBTQI+ parents and their families. However, we do know that LGBTQI+ people are more likely to experience or have a history of discrimination, trauma, anxiety, depression, self-harm and suicide attempts^4,8,9,10. They are also at greater risk of social isolation or reduced social support, and many will have experienced significant stress associated with planning for and starting their family^11,12. As health visitors, we are bound to work within the NMC Code and ‘prioritise people’ – this includes all people. It is therefore imperative that we seek to understand the needs of the diverse community of parents across the UK and develop inclusive services for all people.

At the conference, Dr Zoe Darwin expanded on her recently published Non-birthing mothers’ experiences of perinatal anxiety and depression¹³. In the article, she explored the experiences of perinatal depression and anxiety of non-birthing mothers in female same-sex parented families. Some experiences are akin to the PMH experiences of fathers, such as feeling excluded by services and placing emphasis on protecting family. However, others are distinct and/or amplified for non-birthing mothers:

• lack of socially recognised and defined role,
• stigma concerning mental health and homophobia,
• exclusion from heteronormative^[ii] healthcare systems,
• importance placed on biological connectedness.

One of six key themes from the research, “Perceived Legitimacy of (Di)stress as a Non-birthing Parent,” left some questioning whether it was possible for them, as non-birthing mothers, to even get postnatal depression, and was found to significantly impact help seeking behaviour and access to support.

To improve the PIMH of all LGBTQI+ parents and their families, we must recognise the diversity of family forms and the unique experiences and needs of each individual. In our ambition to ensure that all mothers, birthing people, fathers, co-mothers, co-parents and intended parents receive high quality care and support, we recently launched our iHV LGBTQI+ People & Perinatal Mental Health Champions training programme. The training incorporates voices of people with lived experience and covers a broad range of key topics including language, routes to parenthood, infant feeding, and risk factors of PMH for LGBTQI+ people. Health professionals are given the opportunity to reflect on how inclusive their own practice/service is, what they can do to improve it, and practice skills required to successfully work in partnership with all LGBTQI+ people and their families. I am so very proud to be leading on this training programme, and love to see participants leaving the course feeling empowered in their role as iHV PMH Champions for LGBTQI+ people and their families:

“Thank you for such excellent, thought-provoking and inspiring training, which I hope will really influence my practice and influence others too. Really enjoyed it too!”

Our next training event is taking place on 26 September 2023 – email [email protected] for more information or to book your place!

iHV position on gender-inclusive language: The iHV has adopted a gender-additive approach to the language we use in policies, resources, projects, and events. A gender-additive approach means using gender neutral language alongside the language of womanhood and manhood, to ensure that everyone is represented and included.

References:

1. Sexual orientation: age and sex, England and Wales: Census 2021, Office for National Statistics. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/sexuality/articles/sexualorientationageandsexenglandandwales/census2021 [accessed 22.06.23]
2. Families and households in the UK: 2022. Office for National Statistics. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/bulletins/familiesandhouseholds/2022 [accessed 22.06.23]
3. Family formations in fertility treatment 2018, Human Fertilisation & Embryology Authority 2020. Available at: https://www.hfea.gov.uk/media/3234/family-formations-in-fertility-treatment-2018.pdf [accessed 22.06.23]
4. Trans and Non-Binary Experiences of Maternity Services (ITEMS) report, LGBT Foundation 2022. Available at: https://dxfy8lrzbpywr.cloudfront.net/Files/97ecdaea-833d-4ea5-a891-c59f0ea429fb/ITEMS%2520report%2520final.pdf [accessed 22.06.23]
5. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19(3): 13-27. Available from: doi:10.1002/wps.20769
6. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010; 303:1961–1969. Available from: doi: 10.1001/jama.2010.605
7. Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B. The costs of perinatal mental health problems. Centre for Mental Health and London School of Economics. 2014. Available from: https://bit.ly/413ZAN1 [Accessed 22.06.23]
8. LGBT In Britain – Health, Stonewall 2018. Available at: https://www.stonewall.org.uk/lgbt-britain-health [accessed 22.06.23]
9. Barr, S. M., Snyder, K. E., Adelson, J. L., & Budge, S. L. Posttraumatic stress in the trans community: The roles of anti-transgender bias, non-affirmation, and internalized transphobia. Psychology of Sexual Orientation and Gender Diversity 2022: 9(4), 410–421. https://doi.org/10.1037/sgd0000500
10. Wiepjes et al (2020) Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017) Acta Psychiatr Scand. 2020 Jun; 141(6): 486–491. https://doi.org/10.1111/acps.13164
11. Ross, L. E., Steele, L., Sapiro, B. Perceptions of predisposing and protective factors for perinatal depression in same-sex parents J Midwifery Womens Health. 2005 Nov-Dec;50(6):e65-70. doi:10.1016/j.jmwh.2005.08.002.
12. Kirubarajan, A., Barker, L. C., Leung, S., Ross, L. E., Zaheer, J., Park, B., et al. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG 2022;129(10):1630-1643 https://doi.org/10.1111/1471-0528.17103
13. Howat, Masterton & Darwin, Non-birthing mothers’ experiences of perinatal anxiety and depression: Understanding the perspectives of the non-birthing mothers in female same-sex parented families. Midwifery: 120, May 2023, 103650 https://doi.org/10.1016/j.midw.2023.103650

Definition of terms

[i] Trans or transgender: An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, genderqueer (GQ), gender-fluid, non-binary, gender-variant, agender, nongender, third gender, bi-gender, trans man, trans woman, trans masculine, trans feminine and neutrois.

[ii] Heteronormative: suggesting or believing that only heterosexual relationships are normal or right and that men and women have naturally different roles.