Category Archives: Personal Empowerment

Background

Childbirth and pregnancy are both a natural physiological phenomenon. During these stages, pregnant women face physical and psychological changes, which cause many health needs.1 Studies have shown that pregnant women have different health needs, such as nutritional management, drug and vaccine use, weight management, physiological changes, sexual behavior, delivery methods, neonatal care.15 Therefore, it is important that pregnant women get timely and accurate information about care and treatment options during pregnancy.6

Currently, the antenatal health care mode includes universal prenatal health management model, low-risk prenatal health management model, enhanced prenatal health management model, and high-risk prenatal health management model.7 The Chinese prenatal health management model predominantly adopts the universal prenatal health management model, which shows the care is provided based on a medical model (ie obstetric-led prenatal care).8 However, most women spend very little time with their obstetric providers during pregnancy. Thus, the social and psychological support for women during pregnancy was very poor, lacking a systematic management method.9 Due to the disconnection between health education during pregnancy and examinations, the concept of making pregnant women the center was ignored, which made it difficult to meet the diversified and personalized needs of pregnant women. This resulted in a low utilization rate of health care during pregnancy.1 Group prenatal care has emerged as a new way to provide prenatal care, which helps to meet multiple needs of pregnant women.10 The most widely known model of group prenatal care is the CenteringPregnancy model,9 which has been currently available at many countries throughout the world,11 such as the United States, United Kingdom, Australia, Canada, Iran and Nigeria.

In the 1990s, Sharon Schindler Rising developed a new antenatal examination mode which through evaluation, education, and providing support for pregnant woman, helps to improve pregnancy outcomes.12 In CenteringPregnancy, a group of 812 pregnant women of similar gestational weeks can participate in a seminar with their families every 24 weeks. They participate in self-assessment, which includes measurement of blood pressure and weight. An obstetrician, a certified nurse-midwife/certified midwife, or nurse practitioner, skilled in the group process, provide other professional prenatal examinations.12 Studies have shown that the CenteringPregnancy model uses group health education, peer discussion, and antenatal examination of pregnant women to effectively provide adequate knowledge of nutrition, fetal monitoring, needs during labor, and neonatal care,13,14 improve pregnant womens health awareness, satisfaction with medical treatment, and reduce the incidence of adverse pregnancy outcomes.9,15 It has gradually become the most concerned prenatal care model in the world due to its efficiency and effectiveness. It has attracted more attention due to the vital needs to improve prenatal care outcomes.9,10,16 The effectiveness of the CenteringPregnancy model in China was significant. It improved adverse pregnancy outcomes,17,18 reduced postpartum anxiety and depression, and increased the rate of natural delivery and satisfaction in pregnant women.19 The potential of digital technology to deliver healthcare services has been increasingly recognized worldwide.20 An increasing number of Internet-based medical services are being utilized as they can reduce the time and space limitations and better optimize medical resources. Studies have shown the Internet was a common pathway for accessing prenatal care-related sources among Chinese pregnant women,21,22 as well as in the western countries.23 It is still unclear whether the Internet can be used for CenteringPregnancy. We combined the Internet with the CenteringPregnancy model to construct a new model, the Internet-based CenteringPregnancy management model. The purpose of this study was to explore the participants experience of the Internet-based CenteringPregnancy management model, which would improve the prenatal care management model in China and in countries with similar healthcare systems and demographics as China.

We used an interpretative phenomenological research method to explore the participants experience of the Internet-based CenteringPregnancy management model. A semi-structured interview was used to collect qualitative data and Colaizzis 7-step method of phenomenological data analysis was used to analyze the data.24

Using purposive sampling, participants were recruited from a sample consisting of 12 pregnant women who had experienced Internet-based CenteringPregnancy during prenatal examination in a tertiary hospital in Wuhan, Hubei Province. The recruitment continued until data saturation was reached. We interpreted the data as saturated when no new themes emerged.25 Inclusion criteria included: (1) pregnancy at less than 16 weeks gestation, singleton pregnancy, and no gestational complications (such as gestational diabetes, etc.); (2) took part in online discussions and offline seminars of Internet-based CenteringPregnancy during the prenatal period. Exclusion criteria included: participating in offline seminars less than twice in total. Informed consent was obtained from all participants. The participants informed consent included publication of anonymized responses. Our study complied with the Declaration of Helsinki. The study was approved by the Ethics Committee of Medical School of Wuhan University, China (2018jk002).

Our team designed the Internet-based CenteringPregnancy based on the CenteringPregnancy model. The designer has been working in maternal care for 10 years and has extensive experience. Internet-based CenteringPregnancy includes three parts: online discussion in WeChat group, regular offline seminars, and WeChat public account. The topics of seminars and WeChat public accounts were outlined in Figure 1.

Figure 1 The topics of seminars and WeChat public account.

Pregnant women could freely converse in the WeChat group, including asking questions to other pregnant women or researchers, as well as sharing their experiences and feelings during pregnancy. Time and topic were not limited. When the discussion got stalled due to the limitations of thinking or knowledge, researchers in the WeChat group guided the discussion and solved the problems that the participants could not solve on their own. For example, when a pregnant woman did not understand a biochemical indicator in a prenatal check, the researcher would explain it.

The specific times and topics of the regular seminars were discussed prior to the study with participants and were determined according to their health needs and time schedules. The midwives or nurses made a brief introduction to the theme of the seminar before the formal start of the seminar so that the pregnant women could better understand and be prepared to have a successful discussion. The pregnant women discussed their problems around the theme of the seminar and together in a group resolved them.

Nine pregnant women who participated in the online discussion and offline seminars of Internet-based CenteringPregnancy were interviewed. Data was collected from October 2019 to November 2019. Before the interview, the interviewees were assured that the results of the interview would not affect the quality of their future perinatal care. After getting the participants written informed consent, we collected a general demographic questionnaire of pregnant women which included age, monthly family income, educational background, gravidity, and parity. All interviews were conducted by the same trained researcher. The semi-structured interviews were audio-recorded and techniques such as repetition, summarization, silence, were used appropriately. Interviewees non-verbal behaviors were also recorded. Each interview lasted an average of 3040 minutes. After the ninth interview, no new data was identified, terminating the data collection.

After consulting with experts and reading the literature, a preliminary interview outline was developed. Two participants were pre-interviewed, and the interview outline was modified according to the results. The interview guideline was attached in the Supplementary File. During the interview, we asked participants to describe their experiences and feelings after participating in Internet-based CenteringPregnancy. We used special known terms to represent each participant (eg Pregnant woman, 27 years) to protect the privacy of participants.

Within 24 hours after the interview, the audio recording was transcribed independently by two researchers using computer software (Luyinla),26 and the two transcripts were checked in combination with the interview notes to avoid errors. During the transcription process, the transcribers made notes on the interviewees modal words, pauses, and other details. Transcripts were uploaded to NVIVO (QSR International Pty Ltd. Version 10, 2014) software to manage the data. The raw data and transcripts produced during the interviews were in Chinese. The transcriptions were translated first into English by one researcher and then back into Chinese by another researcher, both with a PhD degree in the field of medicine. The two versions of the statement were compared until all researchers confirmed that the original meaning had been accurately retained and the results were unambiguous.

The Colaizzis 7-step phenomenological data analysis method was used to analyze the collected data.24 We followed a strict Colaizzis 7-step process, fully familiarizing the material, identifying significant statements, formulating units of meaning, clustering themes, developing an exhaustive description, producing the fundamental structure, and seeking verification of the fundamental structure. We read and compared the transcribed text repeatedly, focused on the interviewees experiences and the meaning behind them. We identified the relevant content, encoded, compared the codes, and summarized it into different categories. Using the crowd-sourcing method, we extracted the themes and summarized them. Finally, the original data and the extracted themes were passed to the experts of the research team for checking and sorting, and then sent to the participants to verify whether the data matched their expressed wishes, to enhance the credibility of the results.

After inclusion and exclusion criteria were considered, nine participants were finally included in the study. The average age of the 9 pregnant women was 28.71 (SD1.49, range 2630 years). Other characteristics of these participants were shown in Table 1. We extracted three themes from participants interviewed contents, see Figure 2.

Table 1 Characteristics of 9 Participants

Figure 2 Overarching themes.

The Participants believed that participating in online and offline discussions would allow them to learn and exchange pregnancy knowledge to help each other. When there were questions that no partner can answer, the participants said they will take the initiative to ask the researchers and receive prompt and patient answers.

(We) could discuss pregnancy knowledge together. If you did not understand relevant information, you could ask the teacher (researcher) and discuss with other pregnant women. We have learned a lot, and I believe that I would be a good mother. (Pregnant woman, 28 years)

Some participants expressed confidence to be a good mother because they mastered the practical skills such as nutritional management and baby care.

The model was pretty good. It had online discussion and, offline seminars, which meet individual needs . Eh, from the online discussion and offline seminars, I learned how to keep nutrition balanced, how to take care of my baby when she is coming. I am confident to be a mother. (Pregnant woman, 30 years)

Most participants had a high evaluation of the new management model, believing that they could gain knowledge, experience, and comfort from their partners during the discussion, which could not only learn and communicate pregnant health knowledge better, but also improve their mood.

In the prenatal exam, everyone would encounter a lot of problems, and then we could discuss and comfort each other in the group. (Pregnant woman, 26 years)

Everyone in the group had the same gestational week, so we could discuss similar problems together and this could help to improve your mood during pregnancy. (Pregnant woman, 28 years)

Most participants pointed out that offline seminar schedules tend to conflict with their own lives. For example, everyones spare time may not be the same, so the time the researchers set for the seminar did not match everyones free time. Some participants said that they had planned to attend the offline seminar, but something happened suddenly, so they had to change their plan and could not go to the offline seminar.

Id love to go (to the offline seminar), but because I was busy on weekends, sometimes missed because the seminar schedules conflicted with my own time. (Pregnant woman, 29 years)

The participants expressed the offline seminar topics may be a little general and not detailed enough, the knowledge introduced is too professional and theoretical. They suggested that the topics should be more practical.

Too much professional knowledge I did not want to know. I want to know something more practical about my daily life I think some knowledge was too theoretical. I want to know how to solve a problem about pregnancy when I have it. (Pregnant woman, 28 years)

Although most participants could learn from the offline seminars and discuss freely in the WeChat from the Internet, some participants thought the discussion in the offline seminars and WeChat need to be managed better by the researcher. For example, researchers should correct the discussion direction if the content strays from the topic.

I know everyone could discuss, however, sometimes someone talked about other things, which I did not want to know. At that time, your research team should come to manage it by asking them not to discuss that topic. It influenced others in this group. (Pregnant woman, 26 years)

The Participants expressed that the information in the WeChat group was too much and confusing. Some participants felt fatigued to find useful information from beginning to end. They said the researchers should collate and summarize useful information and send it at fixed time points.

Sometimes When I opened my WeChat, there was so much information in our WeChat group. I did not have time to read all of them, but I was afraid that I would miss some useful information. So, if you could summarize some useful information at the end of each discussion and send it to us. I think it would be helpful. (Pregnant woman, 30 years)

The Internet-based CenteringPregnancy elicited a range of advantages among pregnant women. The results of the interview showed that pregnant women could obtain the knowledge needed for pregnancy through online discussions and offline seminars, thus empowering the women. It also could improve health literacy and meet their health needs, which was consistent with the other study.27 Respondents believed that the new prenatal management model enabled them to gain the knowledge and experience they needed, such as the meaning of pregnancy test results and nutrition management.28,29 When the participants had a problem, and their family, friends, and peers in the group could not answer, they could also ask nurses or midwives to get reliable and accurate information. In the traditional model of prenatal examination, obstetrician doctors and nurses and ultrasound doctors may have time constraints or other factors that could not always give them enough time to answer the questions and meet the needs of pregnant women. The doctors also may not be familiar with the pregnant women due to prenatal examination doctors being different every time. They also may not provide personalized solutions and support for each pregnant woman.29,30 The offline group discussions also provided participants with a platform for face-to-face consultation, discussion, and sharing.29

The participants believed that the new pregnancy management model provided them with opportunities to learn, communicate about their experiences, and discuss, from which they could obtain the required assistance to meet their own needs.27 CenteringPregnancy model could also help participants establish social networks and provide pregnant women with social support,31 which was like the results of our study. Most participants also reported that participating in online discussions and offline seminars helped them improve their mood as well as gain empathy and psychological support from their peers. In the new model, participants shared their questions and worries with peers. Listening to other peoples questions and communicating with each other in the discussion to solve the problems increased their sense of belonging, helped them to build a new social network and emotional support system,32 and reduced their isolation and anxiety during pregnancy.30,33

The Internet-based CenteringPregnancy was generally satisfactory to the participants but there were some challenges in developing the model. Currently, there are few studies focused on the factors influencing participants attendance at CenteringPregnancy seminars.34 In this Internet-based CenteringPregnancy, most interviewees believed that the schedule and timing of the offline seminar was the main factor behind whether they attended or not. This relates to one of the obstacles encountered in the current study as each participant had their own schedule so it was difficult to arrange a time where everyone could attend the seminar.28 In our study, the seminar was scheduled after the time of prenatal examination, which in theory saved time for pregnant women. Nevertheless, in practice, pregnant women still found that the offline seminar clashed with their personal schedules. Therefore, it was a big challenge to find a suitable time for everyone to participate. In the context of the times following COVID-19, we believe that increasing the number of online discussions and reducing the number of offline seminars could potentially be a good solution to the problem.

The participants also mentioned other factors that affected their participation. Some participants believed that the authority and experience of the experts invited to help host the offline seminar would influence their decision. Therefore, Internet-based CenteringPregnancy should frequently invite experts who had rich experience to assist the team in hosting seminars. Before the offline seminar start, the resume and experience of the invited experts and the number of participants who plan to go should be released to pregnant women in detail through a group of WeChat, which may improve the participation rate of offline seminars.

In Internet-based CenteringPregnancy, the topics of each seminar were proposed by the participants, but there were some challenges encountered while gathering consensus from the participants about offline seminar topics. Whatever, everything goes, and I dont know what I need were the most common responses when collecting opinions on the seminar. This indicates that the pregnant women were not clear about their own needs and that there are knowledge deficits as only a small number of pregnant women were able to come up with specific needs and ideas when the research team collected the offline seminar topics. To identify topics efficiently, we can retrospectively analyze some important topics by reviewing the literature and combining it with clinical experience in obstetrics. This could narrow down the range and help pregnant women to make choices. In addition, online discussion topics should be regularly posted in the WeChat group to guide the to ask questions, express their feelings and communicate their views around the topic. If the online discussion deviates significantly from the topic, promptly remind them to return to the topic. At the end of each online discussion, summarize useful information and send it to pregnant women in the group announcement to prevent them from missing important information.

At the beginning of the seminar, researchers gave a brief introduction of the discussion topic, so that the participants could understand the topic better and share their own experiences and feelings in the topic. However, some interviewees thought health education content was relatively broad and theoretical. From the research teams perspective, the health educations purpose was to introduce the seminar topic so that participants could have a general understanding of the topic and facilitate the subsequent discussion. Nonetheless, in the offline seminar, participants paid too much attention to the introduction of the topic and lacked enthusiasm in the discussion part.

Although there are some problems in the virtual CenteringPregnancy model, it also has some unintended benefits. Compared with traditional care models, relationships among patients that develop in the Internet group enhance pregnant womens social support levels, which may help women cope with their stress levels.9,28,35 For pregnant women with disabilities which is one of the most vulnerable pregnant individuals, the Internet-based CenteringPregnancy model can provide more comprehensive support especially when they are in trouble at home. The speed of information transmission on the Internet allows for timely resolution of pregnant womens problems, but there is also a risk that, due to untimely management by researchers, pregnant women may obtain the wrong information and take the wrong advice on the Internet group, which may affect the pregnancy outcome. Moreover, there are still problems with network coverage in some areas, so the network accessibility needs to be improved and the cost of Internet communication needs to be further reduced to promote the development of Internet-based medical services.

The strength of our study is that it was the first study to explore the pregnant womens experience in the Internet-based CenteringPregnancy model, contributing to the qualitative literature and showing the potential benefits of Internet technology in group maternal health care. Studies have shown that the CenteringPregnancy model could improve the accessibility and quality of pregnancy care services, and health outcomes in disadvantaged areas.36,37 Thus, the Internet-based CenteringPregnancy may provide a new solution to the problem of health care services during pregnancy in underprivileged and under-resourced areas. The policymakers are suggested to incorporate the Internet-based CenteringPregnancy model into routine prenatal care through the combination of offline group care and online medical services provided by the hospitals official WeChat.

There are several limitations in the current study. First, at the time of the interview, we did not know the outcome of the newborn after the birth or the maternal postpartum outcomes. A follow-up study to explore the long-term effects of the Internet-based CenteringPregnancy model on the outcomes of mother and child is needed. Second, we only explored pregnant womens experiences in one Wuhan hospital. Thus, the representativeness of the study was limited.

The Internet-based CenteringPregnancy retains the advantages of CenteringPregnancy: empowerment and psychological and social support for pregnant women. At the same time, it uses the Internet for more timely communication and improved flexibility. The process of implementation of the Internet-based CenteringPregnancy management model also encountered many difficulties, including time arrangement, topic selection, and discussion management, which showed the need for us to improve in the next step of the design. The Internet-based CenteringPregnancy provided a strategy for optimizing prenatal care models in China. Further research is needed on how to adapt the Internet-based CenteringPregnancy to different regional healthcare settings, increasing the coverage and quality of health care during pregnancy.

Research data can be made available to interested parties upon reasonable request to the corresponding author.

Informed consent was obtained from all participants. The study was approved by the Ethics Committee of Medical School of Wuhan University, China (2018jk002).

The authors would like to acknowledge the research participants who gave their time for this study.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

The research was supported by the National Natural Science Foundation of China (Grant No. 81903334), The MOE (Ministry of Education in China) Project of Humanities and Social Sciences [Grant No. 17YJCZH113] and Research Project of Health Commision of Hubei Province [Grant No. ZY2021M088]

The authors have no conflicts of interest to declare relevant to this studys content.

1. Kamali S, Ahmadian L, Bahaadinbeigy K, Khajouei R. Health information needs of pregnant women: information sources, motives and barriers. Health Info Libr J. 2018;35(1):2437. doi:10.1111/hir.12200

2. Hmeen-Anttila K, Jyrkk J, Enlund H, Kokki E, Nordeng H, Lupattelli A. Medicines information needs during pregnancy: a multinational comparison. BMJ Open. 2013;3(4):e002594. doi:10.1136/bmjopen-2013-002594

3. Miranda EF, Nunes da Silva AM, Teixeira Mand EN. Approaching health needs by nurse in prenatal consultation. Revista de Pesquisa. 2018;10(2):524533. doi:10.9789/2175-5361.2018.v10i2.524-533

4. Fuentes-Pelez N, Amors P, Garz MCM, Checa MJ, Bueno CM. The design of a maternal education program based on analysis of needs and collaborative work. Revista De Cercetare Si Intervenie Soc. 2013;42(4):5067.

5. Benediktsson I, McDonald SW, Vekved M, McNeil DA, Dolan SM, Tough SC. Comparing CenteringPregnancy to standard prenatal care plus prenatal education. BMC Pregnancy Childbirth. 2013;13:110. doi:10.1186/1471-2393-13-S1-S5

6. Peng Y, Lin H, Yi J. Relationship among Nesbitt score of high risk pregnancy, uncertainty in illness and anxiety level in pregnant patients. Chin J Mod Nursing. 2016;22(33):48374840. doi:10.3760/cma.j.issn.1674-2907.2016.33.027

7. Berhan Y. No hypertensive disorder of pregnancy; no preeclampsia-eclampsia; no gestational hypertension; no hellp syndrome. vascular disorder of pregnancy speaks for all. Ethiop J Health Sci. 2016;26(2):177186. doi:10.4314/ejhs.v26i2.12

8. Liu Y, Wang Y, Wu Y, Chen X, Bai J. Effectiveness of the CenteringPregnancy program on maternal and birth outcomes: a systematic review and meta-analysis. Int J Nurs Stud. 2021;120:103981. doi:10.1016/j.ijnurstu.2021.103981

9. Carter EB, Temming LA, Akin J, et al. Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis. Obstet Gynecol. 2016;128(3):551561. doi:10.1097/AOG.0000000000001560

10. Jolivet RR, Bella Vasant U, Meaghan OC, Kanchan L, Jigyasa S, Mary Nell W. Exploring perceptions of group antenatal care in Urban India: results of a feasibility study. Reprod Health. 2018;15(1):111. doi:10.1186/s12978-018-0498-3

11. Decesare JZ, Jackson JR. Centering pregnancy: practical tips for your practice. Arch Gynecol Obstet. 2014;291(3):499507. doi:10.1007/s00404-014-3467-2

12. Sharon S. Rising. CENTERING PREGNANCY: an interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43(1):4654.

13. Hartzler AL, Chaudhuri S, Fey BC, Flum DR, Lavallee D. Integrating patient-reported outcomes into spine surgical care through visual dashboards: lessons learned from human-centered design. eGEMS. 2015;3(2):117. doi:10.13063/2327-9214.1133

14. Salmon M, Salmon C, Bissinger A, et al. Alternative ultrasound gel for a sustainable ultrasound program: application of human centered design. PLoS One. 2015;10(8):111. doi:10.1371/journal.pone.0134332

15. Liwei C, Crockett AH, Covington-Kolb S, et al. Centering and Racial Disparities (CRADLE study): rationale and design of a randomized controlled trial of centeringpregnancy and birth outcomes. BMC Pregnancy Childbirth. 2017;17(13):113. doi:10.1186/s12884-017-1295-7

16. Ekhtiari YS, Majlessi F, Foroushani AR, Shakibazadeh E. Effect of a self-care educational program based on the health belief model on reducing low birth weight among pregnant Iranian women. Int J Prev Med. 2014;5(1):7682.

17. Xiao S, Fang Y, Huang Y, Yao Q, Liu F, Wang J. Application and effect evaluation of group prenatal care model in primiparas. Chin J Pract Nurs. 2021;37(11):820825. doi:10.3760/cma.j.cn211501-20200601-02574

18. Xiao S, Fang Y, Liu F, Wang J. Effects of Group Prenatal Care model on the fear of childbirth and pregnancy outcome of primipara. Chin J Mod Nursing. 2021;27(1):1116. doi:10.3760/cma.j.cn115682-20200422-02950

19. Guo S, Ma Y, Mao X. Effect of center group pregnancy care mode on outcome of delivery in elderly pregnant parturient for a second child. J Third Military Med Univ. 2020;42(1):99103. doi:10.16016/j.1000-5404.201907161

20. Zuccolo PF, Xavier MO, Matijasevich A, Polanczyk G, Fatori D. A smartphone-assisted brief online cognitive-behavioral intervention for pregnant women with depression: a study protocol of a randomized controlled trial. Trials. 2021;22(1):227. doi:10.1186/s13063-021-05179-8

21. Tang L, Lee AH, Binns CW, Duan L, Liu Y, Li C. WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial. BMC Med Inform Decis Mak. 2020;20(1):300. doi:10.1186/s12911-020-01322-8

22. Sun Y, Pan P, Zhang Q, Dai Z, Su Q. Research on the influence of Internet + midwife outpatient service model on pregnancy outcome and postpartum depression. J Modern Med Health. 2020;36(22):35373540. doi:10.3969/j.issn.1009-5519.2020.22.001

23. Gao L, Larsson M, Luo S. Internet use by Chinese women seeking pregnancy-related information. Midwifery. 2013;29(7):730735. doi:10.1016/j.midw.2012.07.003

24. Colaizzi PF. Psychological research as the phenomenologist views it. Existential Phenomenological Alternative for Psychology. 1978.

25. Morse JM. Data were saturated . J Article Qual Health Res. 2015;25(5):587588. doi:10.1177/1049732315576699

26. Encyclopedia B. Guangzhou Luyinla Network Technology limited liability company. Available from: http://www.luyinla.cn/. Accessed August 31, 2022.

27. Poshan T, Alex Harsha B, Isha N, et al. The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health. 2019;16(1):114. doi:10.1186/s12978-019-0820-8

28. Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in a public health clinic. Article. J Midwifery Womens Health. 2009;54(1):2734. doi:10.1016/j.jmwh.2008.05.008

29. Sultana M, Ali N, Akram R, et al. Group prenatal care experiences among pregnant women in a Bangladeshi community. PLoS One. 2019;14(6):115. doi:10.1371/journal.pone.0218169

30. McNeil D, Vekved M, Dolan S, Siever J, Horn S, Tough SC. Getting more than they realized they needed: a qualitative study of womens experience of group prenatal care. Article. BMC Pregnancy Childbirth. 2012;12(1):1726. doi:10.1186/1471-2393-12-17

31. Kania-Richmond A, Hetherington E, McNeil D, Bayrampour H, Tough S, Metcalfe A. The impact of introducing centering pregnancy in a community health setting: a qualitative study of experiences and perspectives of health center clinical and support staff. Matern Child Health J. 2017;21(6):13271335. doi:10.1007/s10995-016-2236-1

32. Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: promoting relationshipcentered care. J Obstetr Gynecol Neonatal Nurs. 2006;35(2):286294. doi:10.1111/j.1552-6909.2006.00040.x

33. McDonald SD, Sword W, Eryuzlu LE, Biringer AB. A qualitative descriptive study of the group prenatal care experience: perceptions of women with low-risk pregnancies and their midwives. BMC Pregnancy Childbirth. 2014;14(1):112. doi:10.1186/1471-2393-14-334

34. Shayna DC, Jessica BL, Jordan LT, Stephanie AG, Jeannette RI. Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes. Article. BMC Pregnancy Childbirth. 2017;17(1):113. doi:10.1186/s12884-017-1327-3

35. Picklesimer AH, Billings D, Hale N, Blackhurst D, Covington-Kolb S. The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. Am J Obstet Gynecol. 2012;206(5):415. doi:10.1016/j.ajog.2012.01.040

36. Harsha Bangura A, Nirola I, Thapa P, et al. Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health. 2020;17(1). doi:10.1186/s12978-019-0840-4

37. Adaji SE, Bawa U, Ibrahim HI, et al. Womens experience with group prenatal care in a rural community in northern Nigeria. Int J Gynecol Obstetr. 2019;145(2):164169. doi:10.1002/ijgo.12788

Read the original:

The Experience of Pregnant Women in the Health Management Model of Int | IJWH - Dove Medical Press

Express News Service

RAIPUR: The latest National Crime Records Bureau (NCRB) report that revealed data on the suicide victims by age and sex group states that the women & men suicide victims ratio is 1:1 till 18 years and it rises to 1:5 in 45-60 years.

It's clear that while mens suicide is consistent, women remain more or less stagnant.

From childhood to teenager (18 years) the ratio of suicide committed by male and female were almost the same at 1:1 with figures 5075 and 5655 respectively. However, the ratio began to widen for men as they grow older.

NCRB data cited (Between the age group 18-30 years) 37941 men and 18588 women with a ratio of 2:1 respectively have committed suicide.

As they reach the productive age of 30-45 years, the suicide victim ratio of men and women turned to be 3:1 with 40415 and 11629 respectively. At 45-60 years, the number rose to 24555 men and 5607 women with a ratio of 5:1.

That means steps taken for women's empowerment or welfare are somewhat fruitful for women but on contrary, it seems to have a negative impact on men who are often seen as culprits, asserted the activists fighting for the rights of men.

So, are men becoming the most depressing segment and thrown to the margins of endurance limit under family, personal and social pressure?

It's the government's duty to offer a protective advantage to men too and make policies for them. Why cant there be a Men Commission? Despite knowing the facts, people usually don't speak up for men, said Barkha Trehan, chairperson of voluntary organisation Purush Aayog advocating for gender-neutral laws and further added that over 50 laws exist to safeguard the interests of women but virtually nothing for the men.

Across the country, a man commits suicide every 4.45 minutes while a woman every 9 minutes apparently creates speculations on who is more vulnerable.

Again the data shows that the rate of committing suicide among married men is three times that of married women. In 2021 as many as 81063 married men committed suicide while the womens figure stood at 28660.

Family problems and illness were the major causes of suicides which account for 33.2 per cent and 18.6 per cent of total suicides respectively in 2021.

Read this article:

Men are more prone to suicide than women, reveals NCRB data - The New Indian Express

Music has the ability to empower the listener just as much as it does the artist. For members of less-represented communities especially, music offers a confidence boost for those moments when they feel powerless in the world.

Weve put together a list of 25 songs to help inspire people who want to live their lives as loudly and authentically as they choose, because regardless of who you are or where you come from, everyone is entitled to musical empowerment.

Express Yourself Madonna

Originally written as a feminist anthem about independence,Madonnas 1989 dance-floor standard has since become synonymous withself-love and holding oneself in high regard. The songs lyrics directly address women and urge them to not settle for men who dont treat them like the queens that they are. In the years following the songs release, it has been embraced by Madonnas gay fans around the world and has simultaneously become an anthem of personal expression and female empowerment.

Titanium DavidGuetta&Sia

Sias soaring voice on David Guettasdance-pophitTitanium can make even the most timid person feel invincible or, in this case, as impenetrable as titanium. Sias rallying cry of You shoot me down but I wont fall, I am titanium became a unifying theme at the memorial for the Pulse nightclub shooting last year, where Siateared up while performing the song.

?Q.U.E.E.N. JanelleMone&ErykahBadu

BeforeJanelleMonestarred intwoaward-winningfilmsin the same year, she sang and danced alongside legendary soul croonerErykahBaduin her Q.U.E.E.N. video.Monehasstatedin interviews that Q.U.E.E.N. (an acronym for Queer,Untouchables,Emigrants,Excommunicated andNegroid) was writtenfor those whoareostracized and marginalized by the worldwe live in. Its impossible to not feel galvanized byMonesimpassioned closing rapconsistingof quickjabsof wisdomlikeYou can take my wings but Im still gonna fly and Categorize me, I defy every label.

Born This Way Lady Gaga

In one of the loudest love letters to the LGBTQcommunity in music history, Lady Gagaassures all her fansthat no one is excluded from Mother Monsters love. The songs message of unapologetic self-love and self-expression has since become a cornerstone for the contemporary queer rights movement; the song itself has become a stapleof pride parades around the world.

Dont Stop Me Now Queen

When it comes to feeling empowered to live life as proudly as one chooses, no ones attitude can compare tolegendaryQueenfrontmanFreddie Mercury. Thetheme of Dont Stop Me Now is simple enough: Hes having a good time and doesnt want anyone to stop his fun. With rumors running rampant about Mercurys sexuality at the time of the songs release, the song held special significance. The song has come to stand in for Mercurys middle finger to all those who aimed to detract from his happiness.

Stronger Kelly Clarkson

Original American Idolwinner Kelly Clarkson has candidly discussed her mental health struggles as a result of pressure she felt to maintain a certain body image. Stronger, the titular track from her 2011 album, is a manifestation of how she felt after emerging from what she calls a very dark time. Its a simple idea, albeit a powerful one: What doesnt kill you makes you stronger.

No Tiene la Culpa Romeo Santos

Its no secret thatRomeo Santoslives up to his name: Most of the songs in his repertoire tell stories aboutdifferent girls he falls for.No Tienela Culpa differs from anything else Santos has donein that it tells the story of a gay youth struggling to accept himself (at one point even considering suicide) and hisjourney that eventually ends in happiness. In a spokeninterlude toward the end of the song, Santos delivers the statistic that more than 30 percent of young people who commit suicide every year are gay.Little Manuels happy ending serves as an inspiration for queer Latinx youth who may feel like theyll never see the light at the end of the tunnel.

BodakYellow Cardi B

Yes, whether you realize it or not, CardiBs breakout banger is as empowering as it is electrifying. The hook of the song sees Cardi brag about being able to afford multiple pairs of Christian Louboutin shoes a Bronx status symbol that can cost upward of $1,000 for a good pair. Whats more empowering than listening to an exotic dancer-turned-superstar rapper talk about being able to buy her own expensive things?

Just Like Fire P!nk

P!nks career has always been characterized by an underlying f you attitude that runs through lots of her music. Her song for theAlice Through the Looking Glasssoundtrack Just Like Fire carries that same sentiment of not letting anyone else tell you how you should act or live.

Roar Katy Perry

Katy Perrys 2013 hit is a quintessential pop anthem about being knocked down and getting back up even stronger than before: You held me down, but I got up / Get ready cause Ive had enough I got the eye of the tiger, a fighter / Dancing through the fire / Cause I am the champion, and youre gonna hear me roar. Consider it a more empoweringversion of Firework.

Go to Hell Empress Of

Brooklyn-based synthpopsinger Empress Of released Go to Hell earlier this year, and it delivers a message as clear as dayto all those who doubt her: go to hell. Everyone around me thinks Im going to fail, but they can go to hell.Empress Of has never been one to mince words with her music: her previous single Woman is a Word is a feminist slapper, telling belittling men Im only an image of what you see / You dont know me. If you ever feel like people are doubting you and your ability to succeed, give Go to Hell a listen.

Tell Le1f & DonChristian

Queer rapper Le1fsslinky 2015 trackTell is addressed to someone who he sees struggling to come out, and encourages them to find happiness by living their truth. Le1f himself struggled throughout his coming out process, telling Genius hecouldnt imagine living a lie. Le1f sympathizes with all those suffering in the closet, having been there himself: You should show who you want to be / Dont be too hard on yourself.

We R Who We R Kesha

Pop animalKeshasmusic has always been about embracing your inner freak and showing the world that you arent ashamed of that freak at all. We R Who We R is the epitome of that spirit. LikeKeshasbreakout hitTiKToKs idea that the party dont start till I walk in, We R Who We R confidently declares a similar sentiment: Tonight were going hard / Just like the world is our ours / Weretearin it apart / You know were superstars, we are who we are!

Feeling Myself Nicki Minaj & Beyonc

Beyonc is by no means a stranger to the empowering anthem: shes proudly declared that girls Run the World, and thateveryone should go about their livesknowing theyre ***Flawless.Feeling Myselfsees Beyonc delivering a similar message, albeit in a less serious and more entertaining medium: a Nicki Minaj song. Nickis lines about being able to buy whatever she wants and being the object of countless mens affection is enough to make anyone feel even a little bit more empowered.

Confident Demi Lovato

?The titular single to Demi Lovatos 2015 return to pop rock album oozes the confidence that Lovato sings so much about having. Whats wrong with being confident? Lovatoasks with a swagger that many pop stars today could use some of.

Wild Things Alessia Cara

If you dont like our 808s, then leave us alone AlessiaCara tells haters in her smash-hit single Wild Things. The songs themeof living unapologetically and taking pride in who you are can resonate with anyone, and serves as a mission statement of sorts for Caras career.

Sissy That Walk RuPaul

Sissy That Walk is by no meansRuPaulsfirst musical message of self-love and empowerment. Pick myself up, turn the world on its head, the song opens against a dance-ready beat. And for those who may belittle and tear down others, Mama Ru has one thing to say (besides you better work): Unless they paying your bills, pay them bitches no mind.

Brave SaraBareilles

Before she wrote the music behind the hit Broadway musicalWaitress,Sara Bareilleswas encouraging all her fans to be Brave. The message is simple, but it effectively communicates all that Bareilles wants for her fans: Say what you wanna say / And let the words fall out / Honestly, I wanna see you be brave.

Mean Taylor Swift

When we first metTaylor Swift, she was a little-known country singer with dreams of stardom and the big city. Mean, a country twanger from her sophomore album, addresses an unnamed hater for making her feel less than what she is, and for kicking her when shes down. She resolves toachieve her dreams despite how he treats her, and hell live to regret it. What better way to feel empowered than to prove your haters wrong?

Fighter By Christina Aguilera

One of Christina Aguileras earlier hits, Fighter deals with Aguileras rocky breakup with an unfaithful partner. Rather than harbor resentment towards him for his acts, Aguilera instead opts to take the high road, thanking him for what he did: It makes me that much stronger / Makes me work a little bit harder / It makes me that much wiser / So thanks for making me a fighter.

Cant Hold Us Macklemore & Ryan Lewis

Macklemoresrapid-fire flow through his verses of his 2011 hit Cant Hold Us is enough to make anyone feel a little bit more awake. The songs chorus, delivered by Seattle singer Roy Dalton, contains the crux of Macklemoresverbose raps: Tonight is the night, well fight till its over / So we put our hands up like the ceiling cant hold us.

Me, Myself, & I G-Eazy& Bebe Rexha

?G-Eazy and BebeRexhastrack about riding solo is enough to make anyone consider never making any friends ever again. Over a relaxed pop beat, Rexha croonsI dont need a hand to hold / Even when the night is cold / I got that fire in my soul. With words like that, how can onenotfeel inspired?

?Radioactive Imagine Dragons

Though Radioactive might not strike most listeners as the most empowering song, it does succeed in making listeners feel a little bit more invincible than they did before. One might say they might even feel radioactive.

Original post:

25 Empowerment Anthems: Songs for an Extra Boost of Confidence - Billboard

40 years later, business of healthcare changed in very personal ways

Technology has transformed the industry, significantly expanding pharma pipelines, facilitating more engagement, and empowering patients.

By Maria Fontanazza [emailprotected]

When Med Ad News was launched during September 1982, there was no Google, no smartphones, no apps that with a tap of the finger brought you access to nearly the entire world. The term blockbuster drug was non-existent, but billion-dollar drugs would soon enter the picture and remain a goal that pharmaceutical companies would pursue for the next 20-some years, until the rise of generics forced them to shift their strategy. Now 40 years later, life without touchscreens is unimaginable. Fast-tracked by the pandemic, technology has facilitated innovation with tremendous speed, forever changing the trajectory of healthcare. And in our conversations with industry stakeholders, they all pointed to technology whether from a communications perspective or drug development standpoint as being the key driver in addressing challenges and in the continued advancement of the industry.

Not only has technology evolved dramatically, but the ability for pharma companies to better engage with healthcare providers and patients has changed dramatically, and the ability for agencies to deliver smart marketing cost effectively is a huge change, says Mike Myers, co-founder and managing director, CrowdPharm. With patients staking a greater claim in their own care, there is much more emphasis on empowerment and engagement, and pharma companies and marketing agencies have pushed to meet these needs by leveraging technology in new ways. This includes building community and deeper connections between patients, providers, and across the health continuum via technology platforms.

Theres an industrywide shift to help foster greater patient knowledge, self-advocacy and empowerment, yielding increased expectations of convenience and transparency in health-related experiences. This, along with increased measurement of outcomes at every level has mandated truly transformative technological approaches. In turn, this has led to significant changes in the business of life sciences and how we enable modern marketing and health education today with digitization leading the way, says Kim Johnson, global CEO, Ogilvy Health.

The principal client challenge and agency challenge remains the same to get good care into a patient. Its just the steps you go through are more complex, says Jay Carter, executive VP, director of business development, AbelsonTaylor. This is not about creating an oral tablet that is chemically related to another tablet that we know works for hypertension, and putting it out on the market, talking to doctors, leaving samples, and getting patients to take it, and then counting the money. Instead, its about finding the patient, communicating with them to create the need, facilitating the patient and the physician interaction, and ultimately driving use. Its highly personalized, and its highly specialized.

Data: its all about metrics and creating custom experiences

We have data being generated from devices and digital therapies, and on both the research and development side, and the commercialization and real-world side; we have a literal explosion of data types and data sources, says Dennis Urbaniak, executive VP digital therapeutics, Orexo US. Theres an entire industry built around gathering, storing, and maintaining health information that is being applied in multiple facets.

The shift from a one-size-fits-all approach to reach patients to a personalized strategy has pushed the industry to expand how, when, and why it uses data. Were seeing the role of data and technology now permeate everything that the healthcare industry does. The continued evolution of becoming more consumer focused, really thinking about patients as consumers is a key trend that were seeing, says Wendy Carhart, chief communications, culture and purpose officer at Real Chemistry. I think that personalization fits in here from an industry perspective as well, and we know that not all patients are the same, so how do we as an industry evolve to treat them differently, reach them differently, and reach them where they are?

As privacy laws become stricter, the ability to reach patients where they are will be a bigger hurdle and one that will push marketers to change their approach. I think youll see incentives for consumers and healthcare providers to opt in because I want your data, so if youre not going to give it to me, Ill pay you. As a result, consumers are going to receive pharmaceutical information that they want versus based on search [results], Myers says.

Despite the upcoming challenges, the omnipresence of data continues to help creatives, pharma marketers, and folks in the wider healthcare sphere gather meaningful insights and improve health outcomes and the use of data continues to advance and have a wider reach. I believe well see the experience economy meeting health care in a model that is increasingly consumer-driven, virtual, and personalized, with data being shared through a wide array of digital services, apps, and content, Johnson says. Virtual health is here to stay, as consumers are more and more in control of their health decisions, and hospitals and systems are reflecting that demand for a smarter and more personalized approach. These trends in health and customer experience open pathways for greater creativity to support positive health outcomes through diversified digital experiences. The onus is on us as marketers to use the smart technology, logic, and automation that are available to help solve the real health challenges were seeing from unmet patient needs across the health continuum, to easing the mental health burden of HCPs to increasing access to health education.

For pharma marketers, one of the keys to successful use of data is the ability to translate it into information that can be interpreted and deployed quickly, Urbaniak says. Its all about metrics and prospective metrics. I dont need them to bring in a mass of data scientists. I need someone who can talk to me and tell me, the goal for this idea is to accomplish this end result. In the beginning, thats the dialogue that I need to have even before we get into these big strategy sessions and deep dives.

Of course, questions remain regarding whether data overload could become an issue and potentially lead to wasted resources or poor decision making. How much do HCPs trust the data and how much do they trust it in making healthcare decisions? And how will doctors manage additional information that is not managed by a clinical source? pointed out Michael McNamara, managing director of McKinney Health. The generation and extrapolation of actionable data is a process of continuous improvement, experts agree.

The evolution of medicine

The era of blockbuster drugs is long gone, and pharma companies have shifted their sights to addressing much smaller markets. Its a huge shift, because if your target market is 100,000 people, pharmaceutical companies arent going to spend as much promotionally as if the target market is 2 million people, Myers says. Not only have we focused on smaller disease states and those in true need of care as an industry, but thats also changed the way that agencies and clients interact, because there were days when teams of 20-30 product managers were working on one product, and now one product manager might be overseeing two or three brands.

The evolution of technology has spurred significant progress in developing medications and more targeted treatment for diseases. Weve seen a massive increase in the understanding of the molecular and cellular basis of disease, and therefore a massive increase in the potential targets for drug therapy, which has driven a real need for scientific credibility and in some cases very complicated mechanisms of action of drugs and the interaction with some disease processes, says Neil Matheson, chairman, Atlantis Health. So theres been a shift from what I call pure marketing and promotion much more towards scientific and medical/clinical education as a backbone to promotion, with a lot more emphasis on the scientific side of the business and the clinical side of the business especially in areas that are complex like oncology, rare diseases, genetically based diseases, and of course the impact of mapping the human genome and the possibilities it provides in terms of gene therapy is massive.

Im here in the oncology group, and there are so many first-in-class technologies coming to the marketplace: drug device combinations; CAR-T therapies are amazing not just in terms of what they do but also how they go about re-engineering a patients T cells, says Chris Esposito, director, oncology specialty training, Janssen Pharmaceutical. Just the advancement in technology has been remarkable. At its current pace, it will be interesting to see from the customer standpoint, how they stay on top of this new and exciting information.

Johnson has been in awe of the magnitude of scientific progress and innovations across so many therapeutic categories. All of us have benefited from these advancements in one way or another from more comprehensive antibiotics to minimally invasive surgical procedures, Johnson says. Experiencing exciting breakthroughs in heart disease and stroke research and watching universal hepatitis C treatments evolve to the point where the word cure can now be used has been nothing short of extraordinary. The improvements in treating cystic fibrosis have also been remarkable to witness. And, of course, the significant advances in targeted cancer treatments that have improved the lives of so many. Getting closer and closer to the promise of personalized medicine year after year with advanced diagnostics in the genomics and proteomics space is truly inspiring.

Myers predicts the focus on personalized medicine will continue. Theyll tweak a drug down to the DNA based on who you are, or theyre going to adjust a cocktail of medicines; theyre going to be able to look at you and get data on you and improve that outcome, he told Med Ad News.

Carter agrees, stating that developing extraordinary treatments and even finding cures that were previously thought impossible for certain diseases are now becoming an attainable goal. Were getting better at understanding specifically what is going on in a disease state and therefore we can create medications that address them directly. Were working on a gene therapy for hemophilia B, and its not outside the realm of contemplation that we could cure hemophilia B. Those victories have happened over and over again, he says. In 1982, the industry supported many unmet needs in primary care: better products for hypertension, asthma, COPD, hyperlipidemia, and diabetes became available. That required a different kind of promotion mass marketing. Today, with the needs set for each of those disease states, except arguably for diabetes, pharma has evolved to meet more orphan or rare disease, whether that be uncommon disease states or rare cancers addressed by our evolving understanding of the precise reason for a specific cancer. Both open up the need state for virtually every disease: patients (and their caregivers, as many rare diseases are in children) dont know anything about their disease and are literally aching for connection that the industry can bring them.

Communication and making the connection

Industrys efforts to build community, authenticity, and create deeper connection with patients and healthcare providers is an ongoing process that is placing more emphasis on inclusion and a holistic health approach. Well be talking to people with a chronic disease not just about their disease, but also about how to get their stress level down and improve their mental health, McNamara says. And the data from wearables and electronic health records will marry it together to get the fuller picture. Physicians will have to evolve and realize that their relationship with patients cant be to treat them and then send them out. It must look at the individual holistically. This, McNamara points out, is where technology enters the picture in helping address the entire patient versus one aspect.

According to Matheson, the industry must also continue to understand the relationship between healthcare providers, patients, and caregivers, as well as the pressures they face.

Caregivers play a critical role in a lot of healthcare decision making and theyre part of the continuum. The industry has started to become patient focused but theres still limited understanding in how patients interact with physicians and how caregivers support those interactions, he says, adding that there needs to be an understanding of the constraints that physicians face as well. Physicians have a limited amount of time to learn and actually understand what is going on. The industry must understand the pressures on the audience theyre communicating with in terms of their time and adapt to that and maintain an empathetic approach. He states this tactic is critical to managing a healthy relationship, especially in the age of more virtual and digital interaction.

There are number of different ways you can communicate with people depending on what they need, how youd like them to feel, and what you are trying to address, Urbaniak says. And as a marketer, you have to pay attention to functional and emotional as a standard, know some of those triggers, and be able to map those together which is a lot of fun for a marketer because its quite different from the traditional model of drug launches. It also forces you to think very differently and learn a lot of different things. Most people in the industry would be motivated and excited by that.

The reality today is that you account for so much more than just the product and the disease state. This idea of understanding the healthcare ecosystem has really come to the fore. Understanding the business of health care in whatever space you happen to play, whether working in the academic, medical, or community setting, you need to understand that healthcare ecosystem and all the various stakeholders, Esposito says. Its about reacting to the complexity of the healthcare system with organized teams that can help patients get access to medicines. Were talking about potential cures and lifesaving therapies. Thats exciting. The innovation on the therapeutic front is probably what gets me out of bed the most every day. The first drug that I sold as a sales rep was for toenail fungus and now were selling therapies that extend life beyond lung cancer, solid tumors and blood tumors. Its a great time to be in medicine.

More:

40 years later, business of healthcare changed in very personal ways PharmaLive - PharmaLive

"It's okay if you text me, but I can't respond until after work."

"I just need 30 minutes to complete this task, and then we can talk."

"I know I said I was available tonight, but I think I do need a quiet night at home."

If saying any of this scares you, you're not alone.

For many, the idea of setting boundaries with people you love and work with can feel mean, says Nedra Glover Tawwab, a licensed therapist and author ofSet Boundaries, Find Peace. However, there are tons of psychological benefits to drawing lines in your personal and professional life.

"Anxiety and depression are just some of the mental issues or concerns that arise when boundaries are not present in relationships," she says. "The lack of boundaries can make people feel powerless and hopeless."

And setting boundaries with friends, family, and partners can actually help strengthen those relationships.

"People want to feel seen and being unable to have your needs met equates to you not being seen in relationships," Tawwab says.

Setting boundaries can also shield you from damaging experiences at work, says Lisa Bobby, psychologist and clinical director ofGrowing Self Counseling & Coachingin Denver, Colorado.

"Setting boundaries means knowing your own limits about what you will and won't tolerate," she says. "This is important because it is the first step in protecting yourself from experiences that would be harmful to you if you allowed them."

Telling people what you need can also lead to "increased feelings of empowerment and control over your own life experience," she says.

If you have trouble setting boundaries in your life, there are ways to talk to yourself and others that might ease the process.

Taking care of your own needs before or in tandem with those of your loved ones can often be painted as "selfish," but it's not. "Unlearn that you shouldn't have boundaries," Tawwab says.

"Self-neglect is not a way to show how much you care for others. In relationships, both parties can choose what they want and need."

Start to tell yourself that you deserve to have preferences, she says: "This can be a helpful step toward speaking your needs and desires."

Self-neglect is not a way to show how much you care for others.

Nedra Glover Tawwab

Therapist

Saying "yes" to everything a boss, friend, family member, or even partner asks you to do leaves very little energy for you to pursue what makes you happy.

"Boundaries around how you spend your time and allow others to use it are essential," Tawwab says. "Thinking about time as finite, not infinite, can make people more aware of how important and impactful their time is."

Remind yourself that you only have a limited amount of hours in the day. Then, you'll be more likely to say "no" to experiences that don't serve you.

When it's finally time to draw the line, make the conversation about your actions, not the other person's. "Keep it clear and concise without overexplaining yourself," Tawwab says. "Your boundaries are about you. Communicate in 'I' statements instead of 'you' statements. Instead of explaining the problem, focus on what you need. That's the boundary."

For example, instead of telling a friend not to talk about a specific topic in front of you, communicate that it's unhealthy for you to participate in conversations about that topic.

A boundary could also be about a specific tone or attitude, Bobby says.

"Healthy boundaries are not saying, 'you can't talk to me that way," it is saying, 'if you talk to me that way I will remove myself from this conversation.'"

Stress that this is meant to improve your relationship, not stifle it, Bobby says.

"Find a special time to have a serious conversation that is not on the fly or during an argument," she says. "Use 'soft startup' skills that emphasize your good intentions, and desire to have a better relationship."

Go here to read the rest:

Setting boundaries in your daily life can protect you from 'harmful experiences': Here are 3 tips to get you started - CNBC

The recent victory in Kansas signals good news for the rest of the country. Last week, voters in Kansas became the first in the country to decide the fate of abortion rights. Overwhelmingly, Kansans chose to protect abortion in the state. After weeks of mobilizing on the ground, reproductive justice organizations can now rest easy knowing that their hard work paid off.

Voters were deciding whether the states constitution protected or denied the right to abortion in the state. Rightwing state lawmakers passed an amendment in early 2021 that would have outlawed abortion. But changing the constitution in Kansas requires a statewide referendum. Legislators purposefully added the measure to the ballot in August, when few historically turn out to vote. One July poll even indicated that the majority of voters were in favor of the amendment.

What lawmakers could not prepare for was the reversal of federal abortion rights in June. In the wake of the Supreme Courts Dobbs decision, dozens of states immediately outlawed abortion with minimal exceptions. Others yet imposed severe bans, and more states are poised to follow suit.

This comes at a time when 85 percent of voters think abortion should be legal in some and all cases and 56 percent of Americans are opposed to the Dobbs decision. As the first post-Roe battleground, Kansans had a lot riding on them. Upending expectations, 59 percent of voters rejected the amendment in what CNN called a thunderclap ballot box victory.

Abortion is more than a pet cause of activists in so-called blue states.

Tonight, Kansans from a broad coalition of political beliefs voted resoundingly to maintain the status quo and keep access to abortions legal, Trust Women, an abortion clinic in Witchita, Kansas, said in a statment via email. This was the correct decision, and also the only compassionate and humane option on the ballot. Kansans have rejected the notion that pregnant people are hostages to their pregnancy. They have rejected the notion that the most personal and important life decisions must be managed by distant lawmakers. They have chosen liberty and self-empowerment over extremist ideology.

In the days following the Kansas referendum, The New York Times released new data showing that voters in more than forty states would reject a similar initiative to roll back legal abortion. While this is just a rough estimate, it clearly signals that abortion is a winning issue.

Kansas surprised the nation. Just two years ago, Trump won Kansas by fifteen points.

But this referendum saw 140,000 more votes than the states gubernatorial primary races combined and more Kansans voted in this primary election than in any other in the states history. There was also a massive spike in voter registrations by women after the Dobbs draft opinion leaked in May, and an even larger jump after the decision officially came down, according to data compiled from state voter registration files by Tom Bonier, a lecturer in political science at Howard University.

Anti-abortion actors should take note. The Roman Catholic Archdiocese of Kansas City spent $2.45 million to fund the anti-abortion movement in the state. Its clear that opponents of abortion are deeply out of touch with their constituents and have drastically underestimated the lengths to which people will go to protect access. Abortion is more than a pet cause of activists in so-called blue states. It is a tool of hope, empowerment, and liberationno matter where we live.

Steph Black is an abortion activist and writer based in Washington, D.C. She also writes a column, "The Activist Offering," for The Progressive. Read her work at stephblackstrategies.com.

August 10, 2022

11:21 AM

More here:

The Activist Offering: Lessons from Kansas - Progressive.org - Progressive.org

If youre looking for a way to support female empowerment while you get your sweat on, youre in luck. Global athletic retailer PUMA has partnered with the Frida Kahlo Corporation and OEG Latino to launch the PUMA x FRIDA KAHLO collection to honor the iconic Mexican artist.

The FRIDA KAHLO Collection is part of PUMAs new Female Artist Series, an initiative that celebrates equality and empowers the voices of female artists. Who better to represent such a mission than Kahlo, one of the most inspirational change-makers in history, known for challenging norms and channeling personal struggles into art and self-confidence?

PUMAs collection features workout gear like leggings, crop tops, jackets, tank tops, running shoes and even accessories like hats and gym bags. The pieces all combine style and purpose through beautiful, detailed design and technical fabrics. The designs are inspired by the portraits and artwork of Kahlo.

And best of all, most pieces highlight a powerful Kahlo mantra: No es pecado ser original, serving as an awesome reminder to push yourself.

The pieces in the collection look like works of art in their own right, from vibrant colors to fine stitching. But theyre just as functional as they are beautiful. I love to work out from running to weight lifting to yoga so I was excited to give the pieces a try. I tested out the crop bra, 7/8 tight and reversible jacket. Heres what I thought:

Crop Bra

This crop sports bra has an open back design with delicately woven criss-cross elastics. It allows for excellent breathability while your workout intensifies. The front of the top is equally visually impressive, with floral graphics that run up the sides and colorful contrast stitching accents. I found the fabric to be quite comfortable; its supportive and quick-drying. The moisture-wicking technology helped me to stay dry and comfortable during even intense workouts. This crop bra works well for a workout like spinning, for example, because it provides great coverage that moves with you.

7/8 Tight

This tight is a fashion-forward legging with floral prints, inspired by Kahlos lovely blooms, a lace-up elastic waistband detail and contrast stitching. The effect of this detailing is an enchanting homage to the eclectic personal style Kahlo is known for. The tight features supreme support, quick-drying fabric and opaque coverage so you dont have to worry about any wardrobe malfunctions while youre getting a workout in. These are a nice fit for a run or HIIT workout because they have just the right amount of compression to keep your muscles engaged.

Reversible Jacket

Finally, the reversible jacket tells a powerful story. Inspired by The Two Fridas, an emotionally charged portrait that illustrates the artists two differing personalities, the jacket provides an illustration of duality. One side features a solid color design with a subtle flower crown along the hood. The other side boasts a vivid allover floral graphic, ideal for when you feel like making a statement. Whether you are going for subtlety or prefer to be bold, the jacket is a perfect fit. This jacket is awesome to toss on after a sweat session because it transitions nicely from the gym to running errands. Or if youre gearing up for a cold-weather workout, its a great lightweight layer that wont slow you down.

The FRIDA KAHLO collection is a unique outlet for Kahlos artwork and legacy, gorgeously illustrating female empowerment and independence. Her passion continues to serve as a legacy that moves us forward, through her art and pieces like this collection. Not only does the collection offer a wide variety of styles, but theres also variety in their sizing, inclusive for all body types.

The FRIDA KAHLO Collection is available on PUMA.com and in PUMA stores with a price range of $35-$150.

Notice any corrections needed? Please email us at corrections@wearemitu.com

Follow this link:

I Tested PUMA's New Frida Kahlo Collection Honoring the Iconic's Legacy - mit

The digital route taken by photography today has led to people forgetting the existence of film, a medium that called for much patience from photographers due to the length of time between taking the image and producing it as a viewable photograph.

But Serena Chopra has used film to capture the simple subject of the Tibetan refugees living in Majnu Ka Tilla, North Delhi, and released the photographs thus produced in the form of a book. The colony is on the periphery of the Yamuna river, encircled by stinking drain waters and the Ring Road and close to the Inter-State Bus Terminus (popularlyknown asKashmiri Gate ISBT).

Most of the people in Majnu Ka Tilla are Tibetans. Many of them escaped the arrival of Chinas Red Army in their country with their lives and not much else. Living in India as refugees since the time of Jawaharlal Nehru, the older generations of this colony have not applied for Indian citizenship because, while this may be their sanctuary, it is not their home. Indeed, from the moment they arrived in India, they have been involved in the Free Tibet campaign that demands the return to Tibetans of their land from China.

The Majnu Ka Tilla Diaries is not an expensive coffee table tome. Rather it is small, square-ish and looks like a journal. With 123 matt finished pages and photo plates, the images of the people Serena captured connect directly with readers.

From Serena Chopras book.

The intimacy of the written word in a personal diary format has always appealed to me as a mode of personal expression, says Chopra, explaining why she chose this format for her book. The Majnu Ka Tilla Diaries emerged like imagined excerpts from the diaries of this displaced community of refugees who struggle to survive here.

Chopras book includes a few pages from the diaries of some of the individuals she photographed. These handwritten pages tell of the writers struggles against the mammoth Chinese occupation of their country.

Vision of understanding

Photography is a tool that gives the unheard a voice, especially with regard to struggle, conflict and identity. Serena has used her art skilfully to depict the lives of the ordinary Tibetans who live in a small area of Delhi mostly known only to university students who treat it as a place to hang out and eat.

The more than half a century that the Tibetan diaspora have lived and thrived here, creating cultural coherence in a foreign land, has been noteworthy, says Chopra. I was struck by the human complexities of those who live in exile. The dream of going home to Tibet is a faraway one. Yet thats what seems to hold them back from actively seeking citizenship after more than 60 years of exile. The reality and dreams of the second and third generations after the exodus, however, shift the status quo. Their needs for identity and security cannot remain the same as they establish a new dual identity.

From Serena Chopras book.

With the growing hegemony of China in the world, Chopra displays Tibetan empowerment through her photographs.

Art and words dont know borders. Images and text are subliminal and powerful sensitisers, sometimes making meaningful inroads into our understanding, she says.

Inside the colony

Serena first came across Majnu ka Tilla as a University of Delhi student in the 1970s. But she worked on this book between 2007-2015. Though there are several Tibetan settlements around the country, Chopra focused on Majnu Ka Tilla because, It seemed to me to be truly representative of the Tibetan refugee situation in and around India.

The book uses images of the surroundings and the people to define the small colony and the struggle of those who inhabit it. Chopra used a Hassalblad 120mm format camera and black and white film to portray the ideas of the lives within the colony. While the images display an intimacy with and empathy for the struggling and growing community that stands firm against Chinas global power, the book is also about the everyday lives of the people in this colony.

Refugees from Tibet have been welcomed in India since Jawaharlal Nehrus years as Indias first prime minister. The young Dalai Lama was permitted to grow up in exile in India and many Tibetan refugees settled in McLeodganj in Himachal Pradesh, Bylakuppe in Karnataka and the colony of Majnu Ka Tilla in New Delhi.

China has never been happy with Indias policy towards Tibetan refugees, which allows the Tibetans to fight for their rights from India. So far, however, India has stood by the refugees from Tibet.

See the article here:

'The Majnu Ka Tilla Diaries' Reveals Tibetan Empowerment in India - The Wire

Kentwood Players will hold open auditions for 9 to 5 the Musical, with Music and Lyrics by Dolly Parton, Book by Patricia Resnick, on Saturday, August 27, 2022 from 1:00 pm to 4:00 pm and Sunday, August 28 from 6:00 pm to 9:00 pm. Callbacks will be held on Monday, August 29 by invitation only. This is a non-equity, non-paid production directed by Kirk Larson, musical direction by Catherine Rahm, choreography by Marie Gleerup, and produced by Jeremy Palmer and Bouket Fingerhut for Kentwood Players with rights secured from Music Theatre International.

Performance dates are November 11th through December 10th, 2022 on Fridays and Saturdays at 8:00pm, Saturdays and Sundays at 2:00pm. There are no performances Thanksgiving weekend, November 25 27. Auditions and performances take place at the Westchester Playhouse, located at 8301 Hindry Avenue in Westchester, CA 90045.

Based on the hit 1980 movie starring Dolly Parton, Jane Fonda, and Lily Tomlin, 9 to 5 the Musical tells the story about three workmates pushed to a boiling point by their sexist and egotistical boss. Outrageously funny, thought-provoking, and even a little romantic, this musical is about friendship and revenge in the Rolodex era.

Those auditioning must be fully vaccinated, with mask wearing required indoors unless performing onstage. Please read the play before auditioning to become familiar with the characters. No appointments are necessary to audition; just arrive to allow time to sign-in and complete paperwork during scheduled audition times. Please bring a current headshot and resume as well as your calendar as a rehearsal schedule will be posted at auditions and you will be asked to note any conflicts. Actors are asked to bring music in the style of the show and will be required to learn and perform a short dance number. Please be prepared to cold-read from the script at auditions. If you have any questions for the production team, please email 9to5@kentwoodplayers.org

Free street parking is available on 83rd Street and in the adjoining neighborhood, but not on Hindry Avenue, with left turns restricted on the corner of Hindry and Florence. So please read all traffic and parking signs carefully when you arrive to audition.

Character Breakdown:

Auditions for all characters are open to all ages, genders, ethnicities and physical abilities. Please see playable ranges below.

Violet 40-50, F3 D5. The company's Head Secretary and Mr. Hart's Administrative Assistant, she is a single mother and typically stands up for what she believes in. Attractive, strong, ambitious.

Doralee 20-30, G3 E5. A young, sexy spitfire who works at Mr. Hart's office. She is proof that there is more to a woman than just her looks.

Judy 30-40, A3 F5. The "new" girl at the firm, she has been burned by her husband's affair and is searching for personal empowerment. Insecure, determined, and hopeful.

Franklin Hart 45-55, C3 G4. One of the firm's executives and a notorious chauvinist. He is capable of faking charm but usually shows his true colors as an arrogant, self-absorbed boss.

Roz Keith 35-45, G3 C5. The attentive office gossip queen and snitch. She has an unrequited love for Mr. Hart and will do anything she can to win his approval.

Joe 25-35, B2 G4. A handsome, young office accountant. Genuine and nice, and smitten with Violet.

Dwayne 25-35, A2 G4. Doralee's attractive husband. He is very supportive of her professional pursuits.

Josh 15-18. Violet's awkward teenage son.

Missy 20-35. Franklin Hart's wife, clueless to her husband's true nature.

Maria 20-30. A young and vibrant secretary in Hart's office.

Dick 35-45. Judy's soon-to-be ex-husband. An average guy, he is sporting a little less hair and a little more paunch than he did ten years ago.

Kathy 30-40. A secretary in Hart's office with a tendency to gossip.

Margaret 30-40. A secretary in Hart's office with a tendency to drink.

Tinsworthy 50-65. Franklin Hart's boss and Chairman of the Board. A good man, who may be wiser to Hart's ways than he lets on.

Ensemble Office employees, police officers, hospital employees, etc.

To meet the 9 to 5 the Musical production team and learn more about Kentwood Players, the public is invited to attend our general membership meetings, which are free and held on the third Wednesday of each month at 7:30 pm at the Westchester Playhouse located two blocks west of the San Diego Freeway and two blocks north of Manchester at 8301 Hindry Avenue in Westchester, CA 90045. The production team can provide a Zoom link to participate in the meeting virtually.

COVID-19 Policy: Everyone ages 12 and over must show proof of vaccination and photo ID for admittance to the Westchester Playhouse. Face masks are required while inside the building unless performing onstage. This policy will be updated following Covid safety protocols as set by the city and county of Los Angeles.

Kentwood Players is a nonprofit theatre group dedicated to enriching, educating and entertaining our community through the transformative power of live theatre while creating an environment for inspiring human potential. As a 501C3 organization, donations to Kentwood Players are tax-deductible to the extent allowed by law. For more information about Kentwood Players including our current production and upcoming auditions, please visit the Kentwood Players website at http://www.kentwoodplayers.org. You can also find Kentwood Players information on Facebook, Twitter, Instagram and YouTube.

Follow this link:

Kentwood Players announces open auditions for 9 TO 5 the Musical - Culver City Observer

This story contains spoilers.

I never expected a slasher flick on gay and transgender oppression to have an uplifting Hallmark message.

They/Them, which hit Peacock on Aug. 5, has many ingredients of a legit horror film: an opening scene with a masked assassin, a sleep-away camp in the woods stocked with torture devices, a group of teens poised to engage in forbidden (read: queer) sex.

But despite centering on the terror of LGBTQ "conversion therapy" -- a topic deserving of cinematic complexity -- They/Them (pronounced they-slash-them) isn't the stuff of nightmares. Instead, it delivers a feel-good folktale wrapped in a tidy happily-ever-after bow. The aim of the film's writer and director, John Logan, wasn't to focus on psychological abuse or gay victimhood, but "to celebrate queerness."

For well over a century, LGBTQ people have been told they're sinful, diseased or suffering from a mental condition, and that they can change their sexual orientation, gender identity or gender expression through psychological, behavioral or spiritual "conversion" efforts. According to Casey Pick of The Trevor Project, 17% of LGBTQ youth report being threatened with or subjected to conversion therapy.

Recent movies have put a spotlight on the damaging effects of "reparative therapy," includingThe Miseducation of Cameron Post, the 2018 drama about a young woman attending a Christian "ex-gay" camp; andBoy Erased, based on the memoir of Garrard Conley, the son of a Baptist pastor who went through the infamous Love in Action program. The 2021 Netflix documentaryPray Away profiled former leaders of Exodus International, once the biggest conversion therapy organization worldwide, who now regret the suffering they caused.

They/Them is the first to tackle the theme of gay and trans conversion therapy as a slasher film. With a cast of LGBTQ actors, Logan (who's openly gay) consulted with executive producerScott Turner Schofield to make sure the characters were represented in an inclusive way.

The film Get Out masters the social thriller genre, in which horror is used to reveal provocative and unnerving truths about inequality.

But the movie is still a shallow dive into LGBTQ oppression. Few filmmakers have effectively pulled off the social thriller genre, one that exposes how the real evil is society itself. It requires a willingness to be divisive -- to reveal biases and unlock audience fears through deep political underpinnings and subtext. My expectations were high for They/Them to be a trailblazer, much the way Jordan Peele's Get Out masterfully used horror tropes to unpack the daily perils for Black people in America.

Logan's film doesn't follow the fright playbook: There's no edge-of-your-seat tension or dread. (The oppressed aren't even the ones being hunted by a killer, contrary to the movie's trailer.) Nor does it deconstruct the trauma that comes with anti-gay and anti-trans bigotry the way Peele does with racism. Instead, it relies on inoffensive and overly simplified themes of personal empowerment.

In the film, Owen Whistler (Kevin Bacon) runs a weeklong conversion program for LGBTQ youth, most of whom have been sent by their families to be "cured." Whistler deceptively tells the campers, "If you're happy with the way you are, then more power to you," adding that God doesn't hate them. Jordan (Theo Germaine), the film's central protagonist, who's trans and nonbinary, is suspicious of the lack of overt Bible-thumping bigotry. So was I.

But the brutal tactics of Whistler camp are soon revealed -- which do, in fact, reflect real life. The campers are separated by gender, with Jordan pushed into the boys' cabin and Alexandra (Quei Tann) forced to move out of the girls' cabin when it's discovered she hasn't fully transitioned. The two trans storylines in the film echo the heated controversy over gender identity in public bathrooms, sports teams and schools. In fact, many of the figures leading conversion programs in the US today are also behind anti-transgender policies and legislation, pushing kids to only be labeled by the gender they were assigned at birth.

Theo Germaine, who plays Jordan in They/Them, appears in a particularly impactful scene demonstrating the psychological anguish of conversion therapy.

In their separate groups, the campers participate in traditionally gendered activities, from knitting and baking cakes to shooting guns -- and Whistler roars at one of the campers to "be a fucking man" and kill Duke, the camp's infirm dog. Such behavioral "training" is premised on the notion that gender or sexual nonconformity is a pathological disorder.

Before seeing the movie, I spoke to Mathew Shurka, co-founder of Born Perfect(a global campaign to end conversion therapy), who experienced his own kind of bullying into "manhood" when undergoing the practice as a teenager. A licensed psychologist claimed that Shurka could become straight under the guidance of men. To avoid adopting "effeminate behaviors," Shurka was prevented from having any meaningful interaction with women. He couldn't engage with his mother and sisters for a full three years.

Today, conversion practices lurk in the corners of religious youth camps, addiction treatment facilities and online groups, but Shurka told me that they mostly occur during one-on-one talk therapy. That means that instead of providing tools for overcoming anxiety and depression, a psychotherapist manipulates an LGBTQ patient's trust by poking at their shame and intensifying their self-hatred.

The one truly chilling scene of They/Them is a therapy session with Jordan. Cora Whistler (Carrie Preston) exploits Jordan's innermost doubts about their parents' rejection, saying, "You're nothing to them, you're not even a freak." In the robotic creep of a Stepford wife, she crushes her prey: "They're never going to love you... unless you drop this nonsense and admit what you are. A scared, lonely, ugly little dyke." Jordan returns to their cabin disarmed, believing they're a fake.

But in a bizarre about-face a few minutes later, Jordan and the other campers appear to be in a Lin-Manuel Miranda musical, proudly singing and dancing to Pink's 2010 song Fuckin' Perfect. The filmmaker's message in this impromptu performance is supposed to be that the campers are united as a tribe, but the gleeful celebration is a tonal misfiring that underplays the burden of psychological abuse.

In another scene, star athlete Stu (Cooper Koch) is subjected to electric shock therapy as punishment for sex with another camper, Gabriel (Darwin del Fabro)... who turns out to be an undercover agent for the sadistic counselors. With electrodes attached to his chest, Stu is shocked with each image flash of a burly man, in an attempt to associate gay desire with pain and torture. Whistler tells Stu to look on the bright side: "In my grandfather's day, you'd be on the lobotomy table."

In the first edition of the DSM in 1952, homosexuality was referred to as a "sociopathic personality disturbance." Its classification as a mental disorder was officially dropped in 1973, but "sexual and gender identity disorders" were replaced with other coded diagnostic names until 2013.

Not long ago, the US government deemed LGBTQ people abnormal and criminal, barred them from employment or committed them to psychiatric institutions. In the 1950s, homosexuality was officially characterized by the American Psychiatric Association as a mental illness. For decades prior, doctors and medical professionals had already been "treating" gay and gender-nonconforming people through "corrective" violence and surgery, medication and electroconvulsive shock treatment, among other types of aversion therapy and pseudoscientific techniques.

The characterization of homosexuality as a mental illness wasn't officially removed from the Diagnostic and Statistical Manual of Mental Disorders until the early 1970s, as depicted in the 2020 documentary Cured. And that's when new forms of conversion therapy came onto the scene, particularly among religious leaders dedicated to "praying the gay away."

Conversion therapy today has been rejected by virtually every major medical and mental health organization in the US and outlawed in multiple states, counties and cities. But according to Pick, it's still legal for licensed professionals to practice conversion therapy on minors in 30 states. Shurka told me that Born Perfect has tracked at least 5,500 conversion therapists nationwide in the last two years.

One survivor of conversion therapy I spoke with, Matt Davis, contacted a "prayer hotline" in a Christian magazine when he realized he was gay as a young teen. Growing up with a fundamentalist family in conservative Kansas in the early 2000s, Davis was terrified of going to hell and struggled with obsessive thoughts of being a failure. A pastor encouraged him to take a 60-day online class called the Door of Hope on the website Setting Captives Free.

Through the program, Davis was assigned a mentor to whom he confessed his sexual thoughts about men. He was forced to read testimonials of men who had committed sex crimes, which evoked tremendous shame by putting Davis in the same category. Davis told me that the program taught him that being gay "would lead to a sad, lonely and unhealthy life." He became so angry that he resorted to self-injury and considered suicide. "I still have lingering depression and anxiety that continues to this day," he said.

Like Davis, LGBTQ youth who are under pressure to change their sexual orientation or gender identity suffer from extreme despair and alienation, not to mention homelessness and drug use. Gay and trans youth who experience high levels of family rejection -- including by having to undergo conversion therapy -- are eight times more likely to report having attempted suicide.

Map of 20 US states and territories with laws that fully ban licensed mental health practitioners from subjecting LGBTQ minors to conversion therapy practices. The other 30 states have either no laws, partial bans or injunctions preventing enforcement of bans on conversion therapy.

While the Door of Hope no longer exists (it's been replaced with a program called Purity Bootcamp), multiple outfits like these continue to operate, some openly so. Others fly under the radar, rebranded through "rainbow-washing" -- that is, falsely positioning themselves as friends of gay and trans people by co-opting new language to emphasize healing and freedom.

Though moviegoers are led to believe that the LGBTQ youth are being hunted by a bloodthirsty maniac, the actual targets of They/Them are the bigoted Whistler Camp staff. In the last scenes, the masked assassin is revealed -- a former camper named Angie (Anna Chlumsky) driven mad by her abuse. Disguised as Molly, the camp nurse, Angie was able to carry out her kills from the inside.

In Angie's final confrontation with Whistler, she says what motivates her revenge: the long-lasting damage and trauma that plagued her into adulthood. Her plot is to expose and shut down all gay conversion therapy camps that "hollow out" their child victims.

For a brief moment, I thought this tame storyline would suddenly be packaged as a revenge fantasy, and I was ready to embrace an antihero. Though a brave avenger's actions are often futile and nihilistic, at least they're based on a desire to take down the criminals and institutions that destroy innocent lives. That sense of righteous rage and resistance is what makes other narratives -- like Django Unchained or Promising Young Woman -- so satisfying.

But the filmmaker chose to depict Angie as a lonely, weak and unhinged villain. Before impaling Whistler with a mounted rhino head, Angie encourages Jordan to shoot him, but they refuse. "I'm strong enough to not do this," Jordan says. For a film that avoids much mention of religion, the final message seems to be that neither God nor the devil can save us. It also goes out of its way to coddle all the LGBTQ characters, making sure they come off as unsullied angels.

Logan's movie intended to emphasize a collective solidarity in queer culture, yet it sells the idea that emancipation is an entirely personal, not societal, act. And this, perhaps, is the most unsettling. Conversion therapy tells us that if we're not "cured" of being gay, it's our fault -- but is it also our fault if we don't overcome the trauma of conversion therapy via our own internal strength?

They/Them might bring a sense of catharsis to certain viewers, but it suffers from romantic simplicity. And that means it won't educate its audience on a cruel practice that continues to terrorize LGBTQ youth to this day.

See the article here:

'They/Them' Review: A Slasher That Isn't as Scary or Subversive as Real Life - CNET