The Poverty of Research

This chapter presents an argument about both the narrow and the wider meanings of the Social Support and Pregnancy Outcome study. It addresses the question of findings within three contexts. The first context is that of previous work on social support and health, and of the relations between social and material support; in other words, does befriending pregnant women make sense when their greatest enemy is not lack of social support but inadequate material resourcing of motherhood? The second context is the cultural treatment of women and reproduction; here the question is about the implications of the study for the routine provision of maternity care. The third context relates to the question of who listens, and attends, to the results of research; because of the problematic nature of this part of the process, the question is: does research make any difference to the ‘real’ world anyway?

Models of Knowing and Understanding

Whereas Chapter 11 examined what the Social Support and Pregnancy Outcome (SSPO) project can be said to have achieved in the way of research ‘findings’, this chapter broadens the framework of discussion to questions about the status of knowledge and methodologies of inquiry. It attempts to locate the SSPO study within the paradigm of the cultural turning-point referred to earlier — as an instance in the reworking of approaches to knowledge which characterizes intellectual debate in the latter part of the twentieth century. One way to approach this broader task from the specifics of the SSPO study is to ask what kind of methodology it is that combines the approach of a randomized controlled trial with that of ‘qualitative’ interviews.

Women at Risk

This chapter moves on from the case study material for the four women presented in Chapter 8 and the quantitative findings relating to pregnancy ‘outcome’ discussed in Chapter 9 to attempt a synthesis of how all the women in the study regarded their participation in it. A critical focus of this part of the analysis is the notion of risk. The women who took part in the Social Support and Pregnancy Outcome study were not only exposed to the ‘risk’ of taking part in research, they had been identified as ‘at risk’ in the narrowly biological sense of having already given birth to at least one baby weighing less than 2500 g. In using a quantifiable measure of risk derived from the medical domain, the study thus participated in a particular conceptualization of women and motherhood — one which prioritizes a set of meanings attached to motherhood by people other than mothers themselves.

Four Women

The chapter presents four case studies, selected from a possible total of 509, according to the following criteria: (1) there should be one from each of the four geographical areas included in the Social Support and Pregnancy Outcome study; (2) they should be selected from the intervention group, in order to give a fuller picture of just what ‘giving social support’ means; and (3) they should exemplify and expand on a number of critical themes both within the study and outside it. These themes concern the social and medical construction of women's reproductive bodies and social selves. Particular issues relate to the appropriation of women's domestic labour by the privatized family; the material (under)resourcing of women as mothers; the commodification of the female body and of reproduction by the medical system; and the ownership of expert knowledge about reproduction and motherhood.

‘A Friend a Day Keeps the Doctor Away’: Social Support and Health

Among the social origins of the Social Support and Pregnancy Outcome study, as described in Chapter 1, was the idea that social support is good for health. This chapter attempts to draw together ideas, insights, and problems from disparate areas of sociology, psychology, psychiatry, history, epidemiology, and medicine to address the question: why, in the first place, should anyone suppose that social support can be helpful to childbearing women and their families? The discussions cover the health outcomes influenced by social support; the link between social support and reproduction; how social support works; and the research challenge posed by the certain hostility of modern medicine towards the role of social factors in influencing patterns of health and illness.

‘Real’ Results

The Social Support and Pregnancy Outcome study used both quantitative and qualitative methods. The previous chapters concentrated on qualitative, case oriented descriptions of the processes of carrying out the study. This chapter is occupied with the quantitative angle, describing the way in which quantitative research ‘findings’ were generated in the analysis phase of the study, and at the same time taking a self-critical look at some of the epistemological assumptions built into the notion of quantitative methods. The chapter focuses on the example of birthweight because of the ideological and moral importance attached to birthweight within the medical frame of reference and thus, via the medicalization of culture, within the moral frame of reference used to define women's position as mothers.

‘One of Mummy’s Ladies’

This chapter explores the role of the research midwives in the Social Support and Pregnancy Outcome (SSPO) study — what they did, said and felt; how they were perceived by the study women; the impact of the study on their lives. The midwives' role in the study was made up of conflicting elements. First, the injunction to provide social support seemed to them at times at odds with adhering to the methodology of a randomized controlled trial. Second, the midwives found that providing social support in practice had to contend with a burden of social disadvantage and difficulty in the lives of the study women, which was likely to overwhelm any chance of the social support intervention having any beneficial impact. Thirdly, in attempting to provide support in such circumstances, the midwives sometimes found themselves up against gaps and deficiencies in the health and welfare services which they were powerless to change. Fourthly, there was the problem of their own task in all of this, a problem which could be reduced to the question: who supports the supporters?

Who’s Afraid of the Randomized Controlled Trial?

This chapter details the design of the Social Support and Pregnancy Outcome (SSPO) study. It describes the ‘hybrid’ nature of the study, which made it difficult for the author to secure funding for it. The Department of Health eventually agreed to fund the SSPO study for three years from September 1985. By then, the author had left the National Perinatal Epidemiology Unit, with its resource of medical and epidemiological expertise, and the final protocol named a collaborator there, Dr Adrian Grant, who had extensive experience in the randomized controlled trial field, and was willing to help at all stages of the study.

Sickness in Salonica and Other Stories

This chapter attempts to provide context for the Social Support and Pregnancy Outcome (SSPO) study covered in the subsequent chapters by considering the causal relationships between the social aspects of people's lives and their health. It reviews various groups of intervention studies to justify the argument that giving people social support is likely to be good for their health. The SSPO study was planned against this background. It is obvious that social interventions in health, although adding up to impressive evidence that social support is health-promoting, have varied ethically, methodologically, conceptually and in terms of the policy concerns they address. A major problem in understanding social interventions lies with the challenge these may pose to commonsense understandings of how health is best promoted.

A Bite of the Apple

During the pilot study for the Social Support and Pregnancy Outcome project, several shared themes emerged from the stories told by participants. These themes later took shape as systematic patterns during the main project itself. Among these themes are: the unresolved anguish of having a small, sick baby in the past, and the consequent increased anxiety in the next pregnancy; inability to get enough of the right kind of information from medical and midwifery staff; problems of insensitive care; physical and/or emotional and/or financial difficulties with partners; trouble with other relatives; and the task of becoming and being a mother in conditions of poverty. This chapter looks at the way in which these themes emerged in the pilot study, and at other ‘results’ of this stage of the research.