In an era where popular culture is increasingly recognized for its impact on lay understanding of health and medicine, few scholars have looked at television's powerful role in the creation of patient expectations, especially regarding pregnancy and birth.
As part of a larger research project funded by a National Science Foundation Dissertation Improvement Grant, Danielle Bessett, an assistant professor of sociology in the McMicken College of Arts and Sciences at the University of Cincinnati, examined how women understand their television viewing practices regarding pregnancy and birth.
Her research, which she will present at the 110th Annual Meeting of the American Sociological Association (ASA), reveals the profound influence that reality TV and fictional programs have on pregnant women's perceptions of pregnancy and the birthing process, even when they do not necessarily believe they are affected.
In her study, which focuses on a very socioeconomically and racially-diverse group of 64 pregnant women in the greater New York and Connecticut metropolitan area over a two-year period, Bessett describes their pregnancy-related use of popular media -- especially television -- and their perspectives about how popular media affects their expectations for pregnancy.
Twenty-eight women (44 percent of the sample) indicated that they had watched at least some reality television that related to pregnancy. Women volunteered television reality shows such as TLC's "Baby Story" and "Maternity Ward" and Discovery Health's "Birth Day," when asked what television shows affected their expectations for pregnancy. Women who worked outside the home were least likely to describe watching these programs, while women who were unemployed or cared for children at home were more likely to report pregnancy-related viewing.
Women's social class, as measured through their education levels, played a role in how they described their use of television. Bessett says the more educated group downplayed the significance of television in their expectations for pregnancy.
"We found clear class differences in how women saw television influencing their pregnancy knowledge," says Bessett. "When asked what part reality shows or fictional TV played on their learning or education about pregnancy and the birthing process, the groups professed two entirely different perspectives."
On the one end of the spectrum, Bessett says highly educated women who watched tended to disavow reality and fictional television as information sources for themselves and initially framed those programs as merely a tool for entertainment and for educating young children about reproduction.
On the other end, women with lower educational attainment were more likely to perceive television as an alternative to traditional childbirth education. Women who were more disadvantaged tended to discuss reality programs as part of a comprehensive approach to information gathering. They saw reality TV as one of many sources that they could take advantage of and basically did not rule any potential source of information out. In many instances, these women evaluated the reality shows critically, assessing their credibility.
According to Bessett, existing research reveals that, on average, reality shows portray births with many more medical interventions than typically happen in real life at the population level.
"So there is a strong sense that what women are getting from those reality shows is a more skewed and medicalized view," says Bessett. Although there is less research on fictional television and Bessett's study did not assess the content of fictional programs, Bessett hypothesizes that these programs are even more distorted: "My best guess is that they are even more dramatically scripted to keep people's attention and kind of ramp up the emotions of the viewer."
Bessett's study results showed that many women cited overly dramatized medical scenes as they expressed fears about how their own births would take place. Other examples of media's influence included disillusionments in their own birth processes in relation to what they saw though television.
As it turns out, after looking closely at the data, Bessett found that a majority of the women she interviewed -- even those who said they did not get pregnancy information from television or watch reality programs and the highly-educated women who denied the influence of television -- made references to multiple instances in which they formed impressions about pregnancy and birth after years of exposure to representations of pregnancy and birth on television. Bessett developed the concept of the "cultural mythologies of pregnancy" to capture the ways television, film, and word of mouth become part of the cultural milieu in which all of them operate and then become "just the way things are."
While television was just one component of these mythologies, Bessett says it is important.
"Hearing women -- even women who said TV had no influence on them -- trace their expectations back to specific television episodes was one of the few ways that we can see the power of these mythologies," she explains.
Bessett adds that many women mentioned pregnancy representations they had seen long before they got pregnant, and those powerful impressions ultimately stayed with them.
"If we believe that television works most insidiously or effectively on people when they don't realize that it has power, then we can actually argue that the more highly-educated women who were the most likely to say that television really didn't have any effect on them, may in the end, actually be more subject to the power of television than were women who saw television as an opportunity to learn about birth and who recognized TV's influence," says Bessett.
In addition to broader class differences in how Americans value television, Bessett believes one of the reasons that more educated women denied television's influence may be their desire to be seen as following doctor's orders and valuing science.
"This research implies that many women underestimate or underreport the extent to which their expectations of pregnancy and birth are shaped by popular media," says Bessett. "This important new awareness suggests that scholars must not only focus on patients' professed methods for seeking information, but also explore the unrecognized role that television plays in their lives."
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