Reproductive health

Reproduction is surrounded by an array of social norms, taboos and misconceptions. At Birmingham we are changing attitudes and approaches in these sensitive and sometimes contentious areas, making them part of our normal everyday reproductive life.

Repealing the 8th

The 2018 Irish Referendum on abortion in Ireland marked a significant historical moment, with Irish people voting by a landslide to repeal the 8th amendment to the country’s constitution, allowing the government to legislate for abortion for the first time.

Fiona de Londras, Professor of Global Legal Studies at Birmingham Law School and Máiréad Enright, senior lecturer at Birmingham Law School were pivotal in campaigning to ‘repeal the 8th’. They co-authored the book ‘Repealing the 8th’ which offered practical proposals for policymakers and advocates, including model legislation, and was used as a campaigning tool for the referendum.

Since the referendum, Professor Fiona de Londras has been advocating to ensure the laws maximise agency in reproductive life by making abortion available in a way that centres the rights of pregnant people.

Professor de Londras is also using her expertise to reform and design abortion law that complies with international human rights law, focussing on reform in Gibraltar and Northern Ireland.

The role of sperm in miscarriage

Miscarriage occurs in 1 in 4 pregnancies, often not long after a positive pregnancy test. Mothers traditionally have considered that it must mean something was ‘wrong’ with them and all diagnostic research has focused upon testing what might be wrong with their womb. Professor Jackson Kirkman-Brown, Professor of Reproductive Biology, and colleagues have identified that the quality of the DNA in the sperm is actually a leading cause of miscarriage. For some IVF patients, simply changing how the sperm which fertilises the egg is selected can avert up to 40% of pregnancy losses in assisted conception.

The team’s work is now focused not just on picking better sperm for IVF and improved diagnosis of sperm DNA quality, but on addressing the problem with the sperm so that the risk of miscarriage is reduced significantly. This work is changing a paradigm in miscarriage and reproduction by placing diagnosis and treatment at the centre of future care.

A pilot clinical trial to examine the role of nutritional supplements in sperm quality and miscarriage will commence in Summer 2019. If successful, we hope to prevent the 1 in every 12 pregnancies that currently miscarry due to this sperm DNA factor.

Professor Jackson-Kirkman Brown

“Until now, everybody has thought, after the man has got the woman pregnant, that's the end of his role. And if she loses the child, that's something that's wrong with her. Our research is really starting to turn that on its head. Now we think around half the time we can't find an answer about miscarriage, it may be down to sperm DNA.”

Pregnancy loss: finding the right words

In addition to miscarriage, 1 in every 200 births is a stillbirth, and 2,000 terminations for reasons of foetal anomaly are performed in the UK each year.

Pregnancy loss can be an isolating experience for families. The grief experienced may be intense, but the feelings of the bereaved may not be recognised – even by close friends and relatives – because pregnancy loss is not widely discussed.

In the Death Before Birth project, a 2-year ESRC-funded project, Professor Jeannette Littlemore, Professor of English Language and Applied Linguistics, explored the ways in which people who have experienced pregnancy loss and those who support use language to make sense of and communicate their feelings about their loss, examining the use of metaphor and figurative language.

We are identifying the best ways of using our findings to inform training for supporters, to provide an evidence base for formal guidance produced by the Royal Colleges (e.g. RCN, RCOG), and to contribute to public awareness about pregnancy loss.

Communication surrounding pregnancy loss

It is important for those who care for people who have experienced pregnancy loss to be sensitive to, and tolerant of, metaphorical responses to the situation which at first sight may seem ‘irrational’ but which are, in fact, powerful ways of dealing with and coming to terms with the situation.
People should listen to the language that is being used and respond to this language in non-judgemental ways, taking the lead from the bereaved.
People should avoid language that minimises the loss.
It is important to validate that a future life has been lost.
People need to be given time to make decisions following pregnancy loss.

Changing the treatment of heavy menstrual bleeding and hyperplasia

According to NICE, about 1 in 20 women¹ aged between 30 and 49 years consult their GP each year because of heavy periods or menstrual problems with menstrual disorders comprising 12% of all referrals to gynaecology services.

Janesh Gupta, Professor of Obstetrics and Gynaecology, has conducted the largest randomised clinical trial in the world assessing how people with heavy menstrual bleeding should be treated medically. The ECLIPSE trial found that the Mirena coil was more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life. This has influenced clinical guidelines (NICE guidelines) with the Mirena coil now considered as the first treatment for heavy menstrual bleeding in people with no other factors that exclude them for treatment.

In addition, Professor Gupta’s work has also shown the effectiveness of the Mirena coil to treat endometrial hyperplasia, a commonly diagnosed pre-cancerous condition that can become cancer of the womb, if left untreated. This research has been instrumental in the development of National (BSGE / RCOG) guidelines. A change in practice is expected to reduce the number of unnecessary hysterectomies carried out worldwide for this condition by at least 80%.