From finding work-life balance to nutrition during pregnancy.
From navigating sexual health and relationships in adolescence to following nutritional recommendations during pregnancy and juggling the demands of work and motherhood – all before menopause – women must adapt to shifting priorities for their physical and mental health and wellbeing.
To go behind the statistics reveals health choices are complicated by social influences and mixed messages – and there is always more to the story.
As of 2016, there were more than 600,000 one-parent families with dependent children in Australia and that number is rising. In those families, more than four out of five single parents are women.
Returning to work after having children can be rewarding for many mothers, but trying to establish a balance between work and family responsibilities is common. Sole working mothers may experience the challenges of combining work and motherhood more acutely.
“Work-family conflict is really common and linked to high psychological stress and burnout,” explains Dr Laura Robinson, Career Development Fellow in the School of Psychology, whose PhD focused specifically on stress and burnout in sole and partnered mothers.
Compared to partnered mothers, single working mothers with less social support who are solely responsible for childcare are vulnerable to persistent stresses that may lead to physical and psychological exhaustion, or burnout.
“Burnout is very detrimental because it impacts all parts of your life,” Dr Robinson says. “Maternal mental health obviously has a big impact on children and burnout affects the other social relationships in life as well as your work performance.”
Surveying mothers in the workplace, Dr Robinson found that sole working mothers had poorer physical and mental health than partnered working mothers, and that their poor health became more pronounced with less social support. Single working mothers were also more likely to have high work-family conflict coupled with low job satisfaction and work longer hours than partnered mothers.
Dr Robinson, a single mother of three, completed her PhD while working part-time. She found – in both her research and her own experience – that social and organisational support is key to managing burnout.
“The conflict is always there. It’s incredibly common. But women who had some control over their work, opportunities for development and social support experienced lower levels of burnout.”
Dr Robinson says it is important for organisations to support women by providing professional development opportunities to enable them to pursue meaningful work and advance their careers.
“Work can add so much to our lives. It’s important not to neglect the areas of your work that you want to develop. It’s not selfish to do so and it actually benefits your health and those around you.”
In 2015, the teenage fertility rate of Aboriginal and Torres Strait Islander women in the Northern Territory was five and half times the rate of all teenage women in Australia.
Associate Professor Kate Senior has worked with young Indigenous women in the community of Ngukurr in South East Arnhem Land, Northern Territory, for more than 20 years. There, the peak age of new mothers is 15 years old.
The community asked Professor Senior, a medical anthropologist, to explore the lives of young women in Ngukurr to understand the reasons behind the frightening statistics on women’s reproductive health. Professor Senior has returned every year since, her work capturing what adolescent women thought about their relationships and pregnancies.
“Those conversations revealed the lack of choices in their lives. [Becoming a mother] gave them level of esteem in the community but they weren’t particularly enamoured about having babies so young. They thought they had very few choices,” she explains.
Babies born to teenage mothers are more likely to be born pre-term and underweight, risks which are amplified for babies of Indigenous teenage mothers. Young mothers are also more likely to live in rural and remote areas with limited access to health services and they are at higher risk of sexually transmitted infections (STI).
Professor Senior continued to delve deeper, exploring how adolescents made decisions about potential sexual partners in an environment where early sexual activity is considered the norm and the risk of getting a STI is high. She found that young women felt unable to negotiate safe sex and that efforts to shock young people into safe sex only reinforced the stigma associated with STIs.
Most women of childbearing age do not meet the recommended iodine intake levels during pregnancy and while breastfeeding.
“Mild iodine deficiency during pregnancy is actually widespread across Australia,” says Associate Professor Karen Charlton. She is a dietitian who studies eating habits across the population and the implications for public health, building evidence to inform food policy.
In 2009, Australia introduced a mandatory iodine fortification program, adding iodised salt to bread to boost iodine in the food supply. National nutritional surveys and other studies had revealed that young children and pregnant women were not consuming enough dietary iodine.
Iodine is vital for healthy brain development in-utero and in early childhood. It is also important for normal thyroid function throughout life. Without iodine, the thyroid gland cannot produce hormones that regulate growth and metabolism. Major dietary sources of iodine include fish, seaweed, milk, cheese and fortified bread.
With the added iodine in bread, iodine intake has greatly improved across the board, but women are still falling short of their iodine requirements in pregnancy. Pregnancy places extra nutritional demands on women and it can be difficult to meet nutritional requirements based on food intake alone, so iodine supplementation is recommended.
“Women know that it’s good to take a folic acid supplement for the first trimester to prevent neural tube defects, but iodine supplements are required throughout the entire pregnancy and during lactation if breastfeeding,” Professor Charlton explains.
Along with fellow dietitian Catherine Lucas, Professor Charlton has been scrutinising what nutritional advice women receive during their pregnancy from general practitioners and public antenatal clinics to see whether women have been getting the message on iodine. Earlier studies led her to suspect that suboptimal iodine intake in pregnant women reflected a lack of knowledge or dietary advice from health professionals.
“Women need to get advice early in pregnancy but we found a gap in the knowledge of midwives and general practitioners who are their primary source of nutrition information.”
Professor Charlton and colleagues have developed an online educational resource to upskill health professionals.
“We want to make sure that health professionals caring for pregnant woman know the basic dietary advice so that women have the healthiest birth outcome possible and the next generation reach their full potential.”