Jennifer Inauen

Objectives Decisions about reproductive health are often influenced by women's female family members, particularly in low‐resource contexts. However, previous research has focused primarily on individual behavioural determinants. We investigated the interrelatedness of female family members' reproductive health behaviour with a dyadic version of an extended health action process approach. We investigated this for carrying heavy loads during pregnancy and postpartum, a risk factor for reproductive health in many low‐income countries such as Nepal. Design This cross‐sectional study included dyads of daughters‐in‐law and mothers‐in‐law in rural Nepal ( N = 476, nested in 238 dyads). Methods Dyads of daughters‐ and mothers‐in‐law were surveyed about avoiding carrying heavy loads during pregnancy and postpartum. The effects of a woman's cognitions and her female dyadic partner's cognitions on their intention and behaviour about avoiding carrying loads were estimated using linear mixed models. Results The results showed that a mother‐in‐law's cognitions were related to her daughter‐in‐law's intentions and vice versa. The mother‐in‐law's cognitions were also related to the daughter‐in‐law's behaviour. The mother‐in‐law's self‐efficacy and injunctive norms related to the daughter‐in‐law's intention and behaviour over and above the daughter‐in‐law's own self‐efficacy and injunctive norms. Conclusion Female Nepali family members' cognitions about carrying heavy loads during pregnancy and postpartum are interrelated. Including female family members in interventions to help women manage their reproductive health in low‐resource populations seems promising. These novel findings add to the growing body of research indicating the importance of including a dyadic perspective when understanding and changing health behaviour.

Background Pregnant women with obesity are more likely to experience cesarean birth compared to women without obesity. Yet, little is known about the underlying mechanisms. The objective of this study was therefore to evaluate how mediators contribute to the association between obesity and prelabor/intrapartum cesarean birth. Methods We retrospectively analyzed Swiss cohort data from 394,812 singleton, cephalic deliveries between 2005 and 2020. Obesity (BMI ≥ 30 kg/m 2 ) was defined as the exposure and prelabor or intrapartum cesarean birth as the outcomes. Hypothesized mediators included gestational comorbidities, large‐for‐gestational‐age infant, pregnancy duration >41 0/7 weeks, slower labor progress, labor induction, and history of cesarean birth. We performed path analyses using generalized structural equation modeling and assessed mediation by a counterfactual approach. Results Women with obesity had a cesarean birth rate of 39.36% vs. 24.12% in women without obesity. The path models mainly showed positive direct and indirect associations between obesity and cesarean birth. In the total sample, the mediation models explained up to 39.47% (95% CI 36.92–42.02) of the association between obesity and cesarean birth, and up to 57.13% (95% CI 54.10–60.16) when including history of cesarean birth as mediator in multiparous women. Slower labor progress and history of cesarean birth were found to be the most clinically significant mediators. Conclusions This study provides empirical insights into how obesity may increase cesarean birth rates through mediating processes. Particularly allowing for a slower labor progress in women with obesity might reduce cesarean birth rates and prevent subsequent repeat cesarean births in multiparous women.