Journal articles on the topic 'Assessing marriage education'

This paper provides a first report of a study of the population of Somié, a Mambila village in Cameroun, which seeks to explore ways of linking microdemographic analysis and the results of anthropological research. We have sought ways in which we can analyze in a common frame genealogical data, residence patterns, and other data from anthropological fieldwork, together with census returns and archival materials.By combining the details of kinship and residence (gathered during anthropological fieldwork over a period of ten years) with the statistics of births and deaths from census results and archival materials from 1950 onwards, we can begin to assess the effects of genealogical and residence factors on fertility and mortality. Conversely, it becomes possible to examine the effects of demographic factors on the genealogical basis of village life.In an area where sister exchange marriage was practiced, repeated marriages give rise to complex genealogies whose connection to demographic factors has not been analyzed. Demographic changes influence the numbers of kin available for marriage, and the relationships between fertility, fecundity, mortality, morbidity, rates of sister exchange, and numbers of kin (in different categories) are significant and their change over time is hard to investigate without this type of research. In addition it provides ways in which demographic changes can be analyzed, and points to ways of assessing the impact of the introduction of health care provision and primary education on both demographic indicators and on beliefs and attitudes to health and fertility. Such research has clear relevance for policy-makers.

e19160 Background: Metastatic disease is generally treated with palliative intent, but a patient’s perception of this is highly variable and dependent upon multiple factors. Our study evaluated our patients’ understanding of their treatment goal and sought to identify factors affecting it. Methods: This was a prospective study of 111 consecutive patients with stage IV solid tumor malignancies at a single institution. Patients were given a survey during a routine follow up visit. Requested information included primary site of malignancy, stage, duration of treatment, whether they think the treatment is curative, and whether they think the treatment will help them live longer and/or relieve cancer-related symptoms. Patients also provided basic demographic information such as age, gender, marital status, race and education level. Their answers regarding cancer type, stage and length of treatment were compared with their medical records. Characteristics were compared to survey responses using Pearson’s chi-square test and Fisher’s exact test. Results: Median age was 62 years with 58.6% females. Sixty-five percent of patients were married and 55.9% had college education or higher. The primary malignancies consisted of breast, gastrointestinal, genitourinary, lung, sarcoma and skin. Sixty percent were metastatic at diagnosis, 27% of patients had received adjuvant therapy, and 49.5% of patients received two or more lines of therapy in the metastatic setting. Of all patients, 91.9% correctly identified their primary cancer but only 77.5% knew it was stage IV. Only 22.5% of patients knew their treatment was not curative while 32.4% believed it was and 45% did-not-know. Seventy-three percent thought treatment would help them feel better and 85.6% believed it would help them live longer. Lines of therapy received significantly affected whether a patient thought treatment would help alleviate symptoms. Cancer type was significantly associated with whether a patient believed treatment to be curative. Marriage, age, race and education did not significantly affect patients’ answers. Conclusions: Less than one-third of our patients receiving treatment with palliative intent reported that his/her treatment was not curative. Factors influencing a patient’s perception of treatment goals are many and include those specific to the patient, their cancer and their providers. Ongoing studies will focus on identifying more barriers affecting a patients’ perceived treatment intent and will explore possible solutions to overcoming them.

Alcohol dependence has a strong impact on quality of life (QoL) and OoL assessment is considered as a valid measure in evaluating the success of the treatment of patients with alcohol dependence. The goal of the study was to investigate QoL and some sociodemographic characteristics of patients with alcohol dependence in comparison with healthy individuals. Cross-sectional study (which is part of larger study) included 312 patients with alcohol dependence and 329 healthy individuals of both sexes. Structured interview for sociodemographic and alcohol related data, the Croatian version of the 5.00 Mini International Neuropsychiatric Interview (MINI), and the short version of the World Health Organization Quality of Life (WHOQoLBREF) were used. The results have shown that alcohol dependent patients were significantly more frequently uneducated (p=0.006) and primary education (p<0.001), while healthy individuals were significantly more likely to have secondary (p=0.003) and tertiary education (p=0.013). Patients with alcohol dependence were significantly more likely to be single (p=0.005), divorced (p<0.001), and living as married (p=0.008) compared to healthy people, while healthy populations were more often married (p<0.001) in comparison to alcohol addicts. Alcohol dependent persons were more often unemployed (p<0.001) and retired (p=0.005). Patients with alcohol dependence were more likely to have a perceived a sense of illness (p<0.001) than healthy subjects. There were significant differences in all domains of QoL: general, physical, psychological, social, and environment between patients with dependence and healthy individuals (p<0.001). To conclude, alcohol dependence has been shown to be negatively correlated with overall QoL and domains of QoL: physical, psychological, social, and environmental. Education of patients with alcohol dependence was lower than in healthy people, who were more likely to live in marriage and were employed.

Research suggests that trait resilience may be best understood within an ecological resilient systems theory, comprising engineering, ecological, and adaptive capacity resilience. However, there is no evidence as to how this theory translates to specific life domains. Data from two samples (the United States, n = 1,278; the United Kingdom, n = 211) facilitated five studies that introduce the Domain-Specific Resilient Systems Scales for assessing ecological resilient systems theory within work, health, marriage, friendships, and education. The Domain-Specific Resilient Systems Scales are found to predict unique variance in job satisfaction, lower job burnout, quality-of-life following illness, marriage commitment, and educational engagement, while controlling for factors including sex, age, personality, cognitive ability, and trait resilience. The findings also suggest a distinction between the three resilience dimensions in terms of the types of systems to which they contribute. Engineering resilience may contribute most to life domains where an established system needs to be maintained, for example, one’s health. Ecological resilience may contribute most to life domains where the system needs sustainability in terms of present and future goal orientation, for example, one’s work. Adaptive Capacity may contribute most to life domains where the system needs to be retained, preventing it from reaching a crisis state, for example, work burnout.

Background. 10-20% of pregnancies end due to spontaneous abortions. In recent years, nondocumentary evidence has been indicative of an increase in the prevalence of nonspontaneous abortions in Iran, especially in the Kurdish regions. The aim of this study is to assess the lifetime prevalence of spontaneous abortions and factors affecting spontaneous abortion in women 35-65 years old. Method. Data from the recruitment phase of Ravansar Non-Communicable Disease (RaNCD) cohort study was used. All of the 4831 married women 35-65 years old and with history of pregnancy were included in this study. In order to determine the abortion ratio, the number of abortions was divided by the number of live births, and multiple logistic regression analysis was applied to determine associated factors affecting abortion. Results. About 25.7% of women had a history of spontaneous abortion. The abortion ratio in women was 0.10. The abortion ratio in women with secondary education, first pregnancy and marriage age at ≥26, socioeconomic condition, and hyperthyroid and diabetes was high while the abortion ratio of women with high physical activity and BMI<18.9 or residents of rural area was low. After assessing the effective variables, it was found that women with high blood pressure have 63% less odds for nonspontaneous abortion, which is statistically significant (p value<0.05). Conclusion. Considering the effect of factors such as level of education, older age at the first marriage, and age at the first pregnancy on increased chance of spontaneous abortion, measures should be taken to take more care for these people.

<p class="abstract"><strong>Background:</strong> Hearing impairment is a common disability in children. This study is to evaluate the common high risk factors for hearing loss in our locality and to estimate hearing threshold by brain stem evoked response audiometry.</p><p class="abstract"><strong>Methods:</strong> 100 children under five years were subjected to brainstem evoked response audiometry. Wave V morphology was studied and hearing threshold estimated. The high risk factor(s) were analysed and degree of hearing impairment assessed. </p><p class="abstract"><strong>Results:</strong> 38 children were found to have hearing impairment. Most of the children had bilateral hearing impairment. Of them 30 children (79%) had profound hearing loss. Consanguineous marriage was the most common risk factor.</p><p class="abstract"><strong>Conclusions:</strong> Since consanguinity is the most common risk factor, health education and genetic counselling will help to decrease the incidence of autosomal recessive nonsyndromic deafness. Improvement in immunization for rubella can decrease the hearing impairment due to these infections. Due to availability of medical facilities hearing impairment due to perinatal factors have decreased.</p>

This study uses the cumulative fertility approach to examine a wide variety of factors affecting fertility among all ever-married women of childbearing ages in Bangladesh. Data are taken from the 2014 Bangladesh Demographic and Health Survey. The mean number of children ever born for all women is 2.45 and for women aged 40 to 49 years is 3.89. The one-way analysis of variance is performed to observe differences in the mean number of children ever born across the levels of covariates. The generalized linear model with Poisson link function is carried out to examine the effect of covariates on fertility. The incidence rate ratio is greater than one, that is, fertility is higher among women who are Muslims, illiterates, or primary school graduates; have no access to mass media; give the first birth at the age of 15 years or earlier; ever use any contraceptive; and desired three or more babies as the ideal number of children. Type of place of residence, administrative divisions, husband’s education, respondent’s working status, husband’s occupation, age at first marriage, and the spousal age difference are also significant to some extent, especially for assessing the fertility of all women.

Background: The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual’s breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. Aim: To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment. Subjects and Methods: In this cross-sectional study of 1488 women (aged 35 years and older), we used the Gail Risk Assessment Tool to assess the risk of developing breast cancer. Sociodemographic features such as age, lifestyle habits, body mass index, breast-feeding duration, consanguinity among parents, and family history of breast cancer were considered as possible risks. Results: The mean age of the study population was 47.8 ± 10.8 years. Qatari women and Arab women constituted 64.7% and 35.3% of the study population, respectively. The mean 5-year and lifetime breast cancer risks were 1.12 ± 0.52 and 10.57 ± 3.1, respectively. Consanguineous marriage among parents was seen in 30.6% of participants. We found a relationship between the 5-year and lifetime risks of breast cancer and variables such as age, age at menarche, gravidity, parity, body mass index, family history of cancer, menopause age, occupation, and level of education. The linear regression analysis identified the predictors for breast cancer in women such as age, age at menarche, age of first birth, family history and age of menopausal were considered the strong predictors and significant contributing risk factors for breast cancer after adjusting for ethnicity, parity and other variables. Conclusion: The current study is the first to evaluate the performance of the Gail model for Arab women population in the Gulf Cooperation Council. Gail model is an appropriate breast cancer risk assessment tool for female population in Qatar.

ObjectivePeer education is an intervention within the voluntary medical male circumcision (VMMC)–adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10–24 years) counselled.DesignA cohort study involving all young people counselled by 95 peer educators during October–December 2018, through secondary analysis of routinely collected data.SettingAll ASRH and VMMC sites in Mt Darwin and Bulawayo.ParticipantsAll young people counselled by 95 peer educators.Outcome measuresCensor date for assessing receipt of services was 31 January 2019. Factors (clients’ age, gender, marital and schooling status, counselling type, location, and peer educators’ age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated.ResultsOf the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%–13% referrals. Non-referral for HTS decreased with clients’ age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%–80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20).ConclusionWe found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators’ gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.

Background. Disclosure is a vital step in the process of finding a lasting solution and breaking the abuse chain in a victim woman by the intimate partner. Objectives. This study is aimed at assessing the disclosure of intimate partner violence and associated factors among victim women in Dilla town, Gedeo Zone, South Ethiopia, 2018. Methods. A community-based cross-sectional study design triangulated with the qualitative method was employed. Data were collected from 280 women victims of intimate partner violence using pretested, structured, and interviewer-administered questionnaires. SPSS version 20.0 software was used for analysis. Binary logistic regression and a multivariate logistic regression model were fitted to assess the association between the independent and dependent variables. Qualitative data were collected through in-depth interviews and categorized into themes and triangulated with the quantitative result. Results. Half of the respondents (51%) disclosed intimate partner violence. Partner alcohol use (AOR=1.99; 95% CI:1.18, 3.34), women experiencing a single type of intimate partner violence (AOR=0.38, 95% CI: 0.17, 0.79), women having strong social support (AOR=2.52; 95% CI:1.44, 4.41), and women whose partners’ having primary (AOR=2.04; 95% CI:1.07, 3.9) and secondary education (AOR=2.16; 95% CI: 1.07, 4.33) were significantly associated with the disclosure of intimate partner violence as the qualitative result shows most of the women prefer their family to disclose and those who kept silent were due to economic dependency, societal norms towards wife beating, arranged marriage, and not getting the chance especially those who went to the hospital. Conclusion. Nearly 50% of victims of intimate partner violence women disclose intimate partner violence to others. Thus, it is needed for stakeholders to use their efforts to further increase the disclosure of violence and respect women’s rights and equality.

PURPOSE: Comprehensive geriatric assessment (CGA) has aided the medical community greatly in understanding the quality-of-life issues and functional needs of older patients. With its professional team assessment approach, however, CGA may be time consuming and costly. The goal of the present study was to assess the ability of cancer patients to complete a self-administered CGA and then to characterize cancer patients across multiple domains and age groups. PATIENTS AND METHODS: Two hundred sixty-six male outpatient oncology patients at the Durham Veterans Affairs Medical Center were asked to fill out a survey assessing 10 domains (demographics, comorbid conditions, activities of daily living, functional status, pain, financial well being, social support, emotional state, spiritual well-being, and quality of life). RESULTS: Seventy-six percent of the patients who received their surveys and kept their appointments returned the assessment tool. Older oncology patients had significantly less education (P < .0001), income (P = .05), frequent exercise (P = .01), and chance of being disease free (P = .003) than younger patients. Other findings in older patients were a higher rate of marriage (P = .02), more difficulty in taking medications (P = .05), and less cigarette (P = .03) and alcohol (P = .03) use. Members of all age cohorts reported a sense of social support, with younger patients deriving this more from family and friends than older patients, and older patients deriving social support more from membership in religious communities than younger patients. No differences were found across age groups for number and impact of comorbid illnesses, number of medications, basic and instrumental activities of daily living, pain, overall health rating, financial adequacy, anxiety, depression, and quality of life. CONCLUSION: CGA can be conducted in an outpatient cancer community using a self-report format. Despite the fact that this population varied demographically across age groups and is limited to veterans, this study demonstrated remarkable similarities between younger and older cancer patients in terms of functional status, health states, and quality of life.

The article assesses the demographic potential of the Arctic regions of the Russian Federation, taking into account the stages of its innovative development. The relevance of the study is due to the need for the formation of an innovative economy, which will help reduce its resource dependence and increase diversification, as well as improve the quality of life of the population. Recently, there has been a “devastation” of the country’s Arctic territories, which jeopardizes their integrated development, including the introduction of an innovative vector into it. In this regard, a comprehensive assessment of the existing demographic potential on the territory of the Arctic zone of the Russian Federation in conjunction with the assessment of the innovative development of the economy in the area is required. The suggested assessment methodology includes a system of indicators characterizing the natural and mechanical movement of the population, gender and age structure and health of the population, marriage rate, divorce rate and the level of its education, as well as reflecting the creation, implementation and use of innovations. The authors propose to carry out the assessment using scoring methods, natural groups, statistical analysis, interregional comparison, and expert assessments. The final stage of the assessment is the calculation of integral indices for assessing the demographic potential and innovative development of the country’s Arctic territories, presented graphically. Based on the assessment results, the authors divide all subjects into nine clusters. The old-developed regions of the European part of the Russian Arctic during the second stage of the country’s innovative development “lost ground” in most indicators of demographic potential assessment, despite the relatively high estimates of the innovation sphere. The leading positions according to the results of the demographic potential assessment in the context of innovative development belong to the Arctic regions of new development. However, in terms of the development of innovations they are among the outsiders. Thus, the authors outline a weak connection between the demographic and innovative development of the territories of the country’s Arctic zone, or predict a “delayed” effect from the introduction of innovations over time. The authors suggest applying the assessment results in the adjustment and designing of program and strategic documents of state policy in the field of demographic and innovative development of the Arctic territories of Russia.

The primary aim of this investigation was to examine the extent to which the meanings women attach to their provider-role responsibilities are differentially related to their psychological well-being and family relationships and to the division of labor in the home. The sample included 43 dual-earner and 50 single-earner families. In home interviews, wives reported on role overload, depression, satisfaction with the marriage, and attitudes regarding women's and men's roles. Their children completed two measures assessing daily hassles and their relationship with their mother. Reports of daily involvement in household work were obtained from wives and husbands during four telephone interviews. Discriminant function analyses indicated that aspects of women's psychological well-being and marital and parent-child relationships and of the division of labor discriminated women in four different provider groups: main/secondary providers, ambivalent coproviders, coproviders, and homemakers. Wives who were ambivalent about their provider responsibilities tended to report higher levels of depression and overload and significantly lower marital satisfaction. Wives who saw their employment as secondary to that of their husbands reported relatively higher levels of depression and overload but also the highest levels of marital satisfaction.

Introduction Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women. Methods We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. Results The participants’ mean age was 38.6 (range: 18–69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72–80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34–0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31–0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34–0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. Conclusion IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.

Aims and objectives: The paper studies Kpelle–Mano bilingualism in the broader context of local multilingual repertoires and assesses symmetry in the patterns of language use. Methodology: We combine natural speech sampling with ethnographic observations, interviews, sociolinguistic surveys and elicitation tasks. Data and analysis: The data analyzed includes 88 questionnaire responses, targeted elicitation with 21 individuals, as well as corpus collection and ethnographic observations over the course of fieldwork from 2008 onwards. Findings: Neither Mano nor Kpelle has an overt prestige value. Marriage patterns and economic activity are symmetrical, and both languages can be in certain cases chosen as a means of interethnic communication. However, bilingualism is typically unreciprocated, and the Mano speak Kpelle more often than the other way round. Contact-induced change is almost exclusively unidirectional, with Kpelle influencing Mano. We suggest relative population size as the main explanatory factor. In contrast, both Mano and Kpelle are in an asymmetric relationship with Maninka, which is frequently used by urban Mano and Kpelle speakers. Even if some Maninka claim to speak Kpelle to a certain extent, they rarely use it in real life. Originality: This paper is a report on a previously unstudied multilingual setting. We stress the theoretical and the empirical importance of the patrilect. In addition to its being the defining identity feature, the patrilect is also the main predictor defining the language choice in communication and the volume of the repertoire. Significance: We applied long-term participant observation in various social settings to obtain a fine-grained account of the rules governing language choice, which a typical background questionnaire would overlook. We also sampled natural and elicited speech of L1 and L2 speakers of Mano and Kpelle, a method that yields better results than proficiency tests because it captures interference in grammar, which has far-reaching consequences for contacting languages.

Background & Aim: Intrauterine device and depo-medroxyprogesterone acetate are among the most effective reversible contraception in the world, still few consensuses exist about sexual and mood changes of these two conventional methods. The present study has compared the sexual satisfaction and depression level in these two methods. Methods & Materials: A cross-sectional study was conducted between August 2017 and January 2018, in 300 married women aged 19-50 year, in Tehran, Iran. One hundred and fifty IUD users and 150 DMPA consumers, 12-18 months after starting the current method, recruited to the study from 34 health centers of Tehran University of Medical Sciences by convenience sampling. Two standard questionnaires of Index of sexual satisfaction (ISS) and Patient Health Questionnaire (PHQ) were used for assessing sexual satisfaction and depression, respectively. Chi-square and independent t-test were used for the homogeneity of the two groups. The linear logistic regression analysis was conducted to estimate the strength of associations. Results: There was not any significant difference between two groups in demographic characteristics such as age, marriage duration, education level, number of children and breastfeeding condition (P>0.05). Significantly higher sexual satisfaction (P<0.001) and lower depression level (P<0.001) reported in IUD users than DMPA consumers in the t-test. A multivariate regression confirmed that sexual satisfaction increased 6.4 scores in the IUD group in comparison to DMPA users (P= 0.003, B= -6.4), and with increase 1 year to duration of the marriage, sexual satisfaction increase 0.33 score. For depression, the only significant variable was the contraceptive methods, and depression level increase 1.24 scores in DMPA users than IUD consumers. (P=0.006, B= - 1.24). Although in univariate analysis, some variables showed effects on sexual satisfaction and depression, multivariate regression results did not confirm any significant relationships. Conclusion: Both sexual satisfaction and mood level was higher among IUD users. This paper reconfirmed that IUD is a preferable method in women who are eligible to use both methods.

The connection between poverty and women's lack of power over resources and decision-making has now caught the attention of policymakers in government and mainstream development all over the world. Women empowerment issues perceived nationally or locally are being addressed by both state and non-state agencies. Beside the government intervention, NGOs are implementing various types of Women Empowerment Programmes including IG Programmes. Women Empowerment Programmes in India include livelihood support Programme, rehabilitation and job placement for rescued women, safe motherhood Programme and so forth. In spite of involvement of various NGOs in women empowerment through Income Generation and Skill Development Programmes, the status of women is still not satisfactory in India as various official as well as unofficial reports claim and the outcomes against the stated objectives of the NGOs' Women Empowerment Programmes are often questioned. Therefore, the present study is focused in assessing the impact of IG Programmes run by non-government organizations in empowering women. The researcher hypothesizes that IG Programme with its components viz., skill training, resource inputs of loan and equipment help to increase income to the women through independent business or work in the related field; the increased income lessens their dependence on family heads and enables to spend for personal expenses; gives them certain freedoms as individuals; enables them to contribute to family affairs financially, which creates an environment in the family in favor or the women to accept her views and participation in family matters like education, marriage, purchase etc.

Abstract Study question How do Indian healthcare professionals describe their clinical experience with and perspectives on AMH testing in Indian women seeking fertility treatments including fertility preservation? Summary answer The HCPs cautioned against AMH testing as a screening tool in presumed fertile Indian women due to its anticipated impact on women’s arranged-marriage prospects. What is known already AMH test is being increasingly used to assess women’s ovarian reserve (OR) while planning fertility treatments or to guide decisions about fertility preservation (FP). There is weak evidence suggesting that serum AMH level and fertility treatment outcomes vary in different population groups. Surveys with women in reproductive age (e.g. the US, Ireland, the Netherlands) indicate that a majority wants to know their OR to aid reproductive decision making. As yet, both globally and in an Indian context, there are only few qualitative studies exploring the views of HCPs on the OR assessment in clinical practice and its socio-cultural implications. Study design, size, duration This paper reports the findings of an exploratory qualitative research aimed at understanding whether and how elective fertility preservation could influence reproductive autonomy of Indian women. Between June 2018 and April 2019, IVF specialists and obstetricians practicing in ten cities across five Indian states were interviewed in English (language commonly spoken) using a semi-structured interview guide. The discussion about OR assessment with AMH-testing was initiated by the participants indicating its significance in their clinical practice. Participants/materials, setting, methods The study sample included 17 male and 15 female HCPs, the majority (18/32) was practicing in Mumbai. Twenty-six of them were in private practice while six worked as OBGYNs in publicly funded teaching hospitals. Twenty-six participants were interviewed in their clinics and the remaining six using Skype or telephone. After several rounds of immersive reading, the interview sections on OR and AMH-test were analyzed inductively using Braun and Clarke’s thematic analysis. Main results and the role of chance Several participants reported that many of their patients present with decreased OR (DOR) at a younger age and need higher dosages of hormones for ovulation induction compared to the dosages mentioned in international guidelines. They corroborated this experience with a few peer-reviewed articles indicating a six-years age difference in OR of Indian women undergoing IVF compared to Spanish women. A majority of participants advocated for the rational use of OR assessment in IVF patients but warned against its indiscriminate use or interpretation out of context due to concerns about overdiagnosis of ovarian factor infertility and overtreatment with IVF with donor eggs. Although the physicians who had performed elective FP perceived AMH test as a simple, affordable and empowering tool to guide FP decisions, most participants were critical of using AMH-test as a screening tool in young, presumed fertile women completing university education. They were concerned that a diagnosis of DOR as a result of such screening in this population in the Indian context will adversely impact women’s chances of marriage and might further increase pressure on women to get married and complete their childbearing early even if they are not ready for it. Limitations, reasons for caution This is the first qualitative study assessing views of Indian HCPs on AMH testing. These results are indicative rather than a representation of views of Indian HCPs. Almost half of the contacted HCPs did not respond to interview requests; we do not know whether they had different views. Wider implications of the findings The insights on clinical implications of AMH testing in India are relevant to other societies beyond the Euro-American and Australian context where AMH testing will increase in the future. The socio-cultural implications of ‘routine’ AMH testing in India urges us to be aware of similar implications in other cultural contexts. Trial registration number Not applicable

Abstract Study question How do Indian healthcare professionals describe their clinical experience with and perspectives on AMH testing in Indian women seeking fertility treatments including fertility preservation? Summary answer The HCPs cautioned against AMH testing as a screening tool in presumed fertile Indian women due to its anticipated impact on women’s arranged-marriage prospects. What is known already AMH test is being increasingly used to assess women’s ovarian reserve (OR) while planning fertility treatments or to guide decisions about fertility preservation (FP). There is weak evidence suggesting that serum AMH level and fertility treatment outcomes vary in different population groups. Surveys with women in reproductive age (e.g. the US, Ireland, the Netherlands) indicate that a majority wants to know their OR to aid reproductive decision making. As yet, both globally and in an Indian context, there are only few qualitative studies exploring the views of HCPs on the OR assessment in clinical practice and its socio-cultural implications. Study design, size, duration This paper reports the findings of an exploratory qualitative research aimed at understanding whether and how elective fertility preservation could influence reproductive autonomy of Indian women. Between June 2018 and April 2019, IVF specialists and obstetricians practicing in ten cities across five Indian states were interviewed in English (language commonly spoken) using a semi-structured interview guide. The discussion about OR assessment with AMH-testing was initiated by the participants indicating its significance in their clinical practice. Participants/materials, setting, methods The study sample included 17 male and 15 female HCPs, the majority (18/32) was practicing in Mumbai. Twenty-six of them were in private practice while six worked as OBGYNs in publicly funded teaching hospitals. Twenty-six participants were interviewed in their clinics and the remaining six using Skype or telephone. After several rounds of immersive reading, the interview sections on OR and AMH-test were analyzed inductively using Braun and Clarke’s thematic analysis. Main results and the role of chance Several participants reported that many of their patients present with decreased OR (DOR) at a younger age and need higher dosages of hormones for ovulation induction compared to the dosages mentioned in international guidelines. They corroborated this experience with a few peer-reviewed articles indicating a six-years age difference in OR of Indian women undergoing IVF compared to Spanish women. A majority of participants advocated for the rational use of OR assessment in IVF patients but warned against its indiscriminate use or interpretation out of context due to concerns about overdiagnosis of ovarian factor infertility and overtreatment with IVF with donor eggs. Although the physicians who had performed elective FP perceived AMH test as a simple, affordable and empowering tool to guide FP decisions, most participants were critical of using AMH-test as a screening tool in young, presumed fertile women completing university education. They were concerned that a diagnosis of DOR as a result of such screening in this population in the Indian context will adversely impact women’s chances of marriage and might further increase pressure on women to get married and complete their childbearing early even if they are not ready for it. Limitations, reasons for caution This is the first qualitative study assessing views of Indian HCPs on AMH testing. These results are indicative rather than a representation of views of Indian HCPs. Almost half of the contacted HCPs did not respond to interview requests; we do not know whether they had different views. Wider implications of the findings: The insights on clinical implications of AMH testing in India are relevant to other societies beyond the Euro-American and Australian context where AMH testing will increase in the future. The socio-cultural implications of ‘routine’ AMH testing in India urges us to be aware of similar implications in other cultural contexts. Trial registration number Not applicable

Abstract Background Dropout of infertility treatments is a global issue and many factors play role in this phenomenon. It is one of the most challenges in life of infertile couples. The purpose of this study was to determine dropout rate and related factors/reasons in the world and in Iran. Methods We will conduct a mixed method study with sequential exploratory design (systematic review, qualitative and quantitative phase). In the first stage a systematic review on dropout rate of infertility treatments and related factors will be done. In second stage (quantitative–qualitative study), a retrospective cohort study will be conducted on infertile couples to determine dropout rate of infertility treatments. The follow-up period to assess the discontinuation of treatment in patients, who have discontinued the treatment, will be considered 6 months after the treatment cessation. Data would be analyzed by descriptive statistics. We want to determine proportion and percentage of discontinuation rate among different groups with different causes of infertility. Then, we also will use Chi-square test to compare discontinuation rates among these groups. In qualitative section of second stage, semi-structured interviews would be performed with infertile female who had the history of infertility treatments failure. In this stage, participants will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation, type of infertility, type of treatments, number of unsuccessful treatment and infertility duration. Data would be analyzed using conventional content analysis. Discussion Determining dropout rate and its related factors/reasons would be helpful for future studies to plan suitable interventions for supporting infertile couples. It also helps politicians to have a better understanding of infertility and its consequences on infertile couple’s life. Plain English Summary In today’s world, infertility is a common phenomenon due to postponement of childbearing following the older age of marriage, tendency to reach higher educational level, economical problems and etc. Infertility brings many challenges and stresses to the individuals by itself and it is very hard to cope with. The problem gets worse, when it is associated with failure in treatments. Many of infertile couples cannot tolerate this failure and may decide to discontinue treatments before achieving pregnancy for ending many stressors which are associated with treatments. As we know, childbearing and having at least one child has important position in some societies such as Iranian culture; so ending the treatment before achieving optimal result may have some adverse consequences in the families such as divorce, remarriage, family conflicts, et. Absolutely many factors play role in dropout of infertility treatments, and many studies around the world have suggested many factors/reasons in dropout of infertility treatments, but there are still many gaps about this subject, especially among Iranian society. This study would be conducted in three consecutive stages, in the first stage; we will do a complete review of existing studies of the world to find out related factors/reasons of dropout in detail. In second stage, dropout rate of infertile couples (380 couples) after at least one unsuccessful cycle of treatment would be achieved by assessing medical records and telephone interview. Data of the first and second stage will help us to have better vision about the issue of dropout and would be used to construct a semi structured interview for the last stage. And finally in the third stage, reasons of dropout would be asked by an in depth interview from infertile couples. We hope the information from this study will help politicians better understand and plan for dropout of treatment.

This issue of M/C Journal explores the notion of "impact" and the capacity of contemporary research work to influence not only academia but the direction of current debates in the public sphere surrounding social, political and cultural agendas. The nine papers selected cover a broad range of topics: experimental research methodologies which confront the problem of 'measuring' research impact in the world of work; the creative industries and documentary films; identity politics debates address queer, migrant, racial issues; as well as investigations into the use of storytelling and autoethnography to promote cultural understanding and social inclusion. "Impact" for the vast majority of these contemporary cultural and social researchers is a moot term, especially the idea that the impact of research outcomes is a measurable quantity. However measuring and assessing the affect and applicability of research outcomes is an all too familiar reality, particularly since the majority of funding applications expect such a consideration. Even at the very early stages in a researcher's career, the doctoral Confirmation of Candidature demands a discussion of the proposed study's significance and potential wider cultural and social purpose. The comments of UK-based academic Ananya Kabir support this concern for the "state of research" that resonates far beyond the UK context: Academics cannot afford not to want to be impactful, or their work to be 'applicable'. On every application for funding we make to any Research Council, a 'statement of impact' is not merely desirable; it is very much a demand. This is certainly true of the situation in Australia with the previous government's 2005 planned Research Quality Framework (RQF) which advocated a strong focus on impact and the measuring of it, and the subsequent establishment in 2007 of the Excellence in Research for Australia (ERA) initiative (McDonald). While ERA's main aim is the assessment of research quality with no specific reference to "impact" as such, one of ERA's evaluation indicator categories—research application—requires such a consideration (ERA 2). Moreover, the very recent publication Measuring the Impact of Research by the Group of Eight illustrates the Australian academia's concern with the term, stressing that impact measures would greatly complement ERA's assessment (Rymer 3). However, there is substantial debate and questions raised concerning these government policy developments. Notwithstanding the difficulties of finding reliable measurement methods and differing perspectives on the evaluation of findings (cf. Group of Eight); will a single regime of measurement suit all disciplines equally? As Stefano Harney stresses impact will "subject the humanities to the same pressure as knowledge transfer did engineering and science. And meanwhile the professional schools, business, law, medicine, use their regulative status to prove impact easily, putting yet more pressure on the humanities." Stephen Shapiro paints an even darker picture: "The lesson is clear: 'impact' is the Trojan horse designed to institutionalize entrepreneurial interests that will be the 'invisible hand' policing the British academy." However, does measuring impact really restrict us to a particular definition of the term? It is impact that should be at the heart of these types of discussions not the obsession with measurement. Perhaps the challenge is to encourage high impact research without the constraint of a specific metrics. As Rick Rylance puts it: For me, thinking about impact as a challenge and not as a threat is part of this recognition. This is because impact encourages us to conceive of the disparate kinds of benefit research produces which are of many kinds. Sometimes the outcomes are of direct practical advantage. What is needed then is a greater flexibility with the term and a clearer distinction between impact and impact evaluation or measurement. Although, to some extent, we have to acknowledge the significance of impact evaluation as a necessity in demonstrating that research funding is fairly distributed and spent. Like government funding for the arts for example, it is difficult to demonstrate the value of research aside from the ability to attract financial support. Paula Gilligan observes: "The defence of the Humanities is invariably linked to the defence of the 'Arts'. We are seen to have common cause, united against the scientists, who are 'winning'. We need to start questioning this assumption." In particular, Hadley and Gattenhof's paper in this issue of M/C Journal engages a number of discourses surrounding these concerns, with their response to the Australian Government's "National Cultural Policy Discussion Paper", suggesting an approach for measuring and assessing the impact of the work of artsworkers. Central to their model is the demands of policy requirements for progress to be 'measurable' and therefore the necessity to train arts, cultural and creative workers to conduct such an assessment and to make the impact of this work evident to stakeholders. This investigation also raises questions for scholars, educators and employers about what artsworkers actually do, the worth of their work and how it could be improved upon. Two other papers propose diverse methodologies for addressing the problematic area of measurement and assessment. Humphrey's unique approach to the often neglected area of contemporary work and media, introduces the term "officing" (the daily use of information and communication technology) to explore new ways to approach the identification and measurement of the space, time and technology in everyday work practices. Drawing on the ideas of Anselm Strauss to analyse the office workplace as a "contingent and provisional arrangement or process", the author highlights the benefits of this investigation and its impact on productivity and work-life balance, with the ultimate aim to "contribute to the design of more sustainable work environments". Karlin and Johnson, on the other hand, explore another under-researched area where assessment is required: measuring the impact of films on individual attitudes and cultural narratives and evaluating its importance for documentary film campaigns. The authors argue that though it is increasingly necessary for "issue-based" films to provide information on their social investment returns to justify production costs, of equal importance is that the questions asked and the methods used to answer such queries are "valid and respectful." The paper proposes an "emerging research agenda" for the examination of documentary film which allows investigation of the importance of such evaluations and the key issues relevant to assessing their impact. The power of personal narratives is explored when Hummel investigates the tension between culture and autoethnographic performance. The author questions the "capacity of gender identification to justify the crisis of representation" and the impact of autoethnography with its "resistance to traditional culture and power divisions through its emphasis on shared experience, emotion and subjectivity." This researcher presents a highly personal narrative of her experience as a woman in Bangladesh to highlight the potential of autoethnography to promote alternate ways of understanding and transcend cultural boundaries. Hancox also examines the potential and capacity of storytelling and personal narratives to contribute to cultural research and social inclusion. Through a 2009 digital storytelling project conducted with a group of Forgotten Australians prior to the public apology in the Australian Parliament, the paper explores how the "endemic, institutionalised abuse of a group of people was translated to the broader community and galvanised support through the impact of their personal stories." This approach is advocated as a way of enhancing broader issues, such as public understanding of the needs of marginalized groups, which can result in changes to social inclusion through policy and community based solutions as "personal narratives energise public narratives and shape our ways of thinking and collective understandings" (Harter et al. 4). The effect of Government policy on citizenship and its impact on individuals and communities is examined by two writers: Chisari and Raj. Through a Foucaultian genealogical analysis of Becoming an Australian Citizen, (the resource booklet that prepares a potential new Australian for the citizenship test), Chisari explores Australian identity and how subjects are shaped by the operations of governance and the interrelationship of truth, power and knowledge. In an attempt to move beyond the History Wars, the author problematises the notion of historical "objective truths," endeavouring to influence policy-making surrounding issues of civil education for the Australian migrant. Chisari argues that such an approach has the potential to impact upon historical narratives and promote the inclusion of multiple, alternate stories of Australia and Australian identity. Raj's paper tackles the hot topic of gay marriage in policy and activist debates. With reference to the writings of Judith Butler and Michael Warner, Raj explores neo-liberal political arguments, queer theory and community politics to critique issues such as intimacy, citizenship and equality. Advocating the belief that by "understanding cultural difference(s) rather than conforming to a norm," this paper proposes a critical framework for "intimate citizenship" that provides a platform for further policy and activist dialogues. Another arena of contemporary debate is explored by Malatzky's article which examines representations surrounding what Western women should "look like as mothers," and the importance of cultural research projects for the broader community in terms of their potential to inform and direct discussions. Utilising qualitative feminist methodologies', this researcher investigates the media's role in shaping contemporary expectations surrounding the postnatal body, arguing that such investigations can influence the "creation of alternate mothering discourses, and can direct current debates that have a direct impact on, and relevance for, everyday Australian women and men." Identity is also an issue for our last early career researcher's paper. Al-Natour uses his personal experiences as a researcher investigating the controversy over a proposed Islamic school in Sydney to examine the ways a researcher's identity can affect their participants, and whether this relationship impacts data collection processes. As an outcome of these field work experiences, Al-Natour proposes a series of suggestions for fellow cultural studies researchers in dealing with such dilemmas. An exploration of the impact of cultural and social researchers in this issue of M/C Journal has ranged from the problems of measuring research outcomes to debates surrounding citizenship and identity and the power of narratives to transcend cultural boundaries. A shared belief that emerges from these explorations and proposals is that though the measurement of impact is problematic, by introducing new discourses, perspectives and paradigms which have the capacity to sway policy making, cultural researchers can position themselves as intermediaries to inform societal groups and various communities. The outcomes of these research projects can then address this concern about the affect and applicability of their findings which have the potential to present accessible, transparent and practicable forms of cultural understanding and genuine solutions to social and cultural problems. ReferencesERA. Excellence in Research for Australia – National Report. Canberra: Australian Research Council, 2010.Gilligan, Paula. "'Creative' Functionalism and Continental Philosophy at Middlesex." SocialText - Periscope (Aug. 2010). 12 Dec. 2011 ‹http://www.socialtextjournal.org/periscope/2010/08/impact-innovation-and-creative-functionalism-in-the-uk-the-case-of-the-department-of-philosophy-at-m.php›.Harney, Stefano. "The Real Knowledge Transfer." SocialText - Periscope (Aug. 2010). 12 Dec. 2011 ‹http://www.socialtextjournal.org/periscope/2010/08/the-real-knowledge-transfer.php›.Kabir, Ananya. "The Impact of 'Impact'." SocialText - Periscope (Aug. 2010). 12 Dec. 2011 ‹http://www.socialtextjournal.org/periscope/2010/08/the-impact-of-impact.php›.McDonald, Kate. "New ERA for Research Quality - Science Minister Kim Carr Announces Replacement for Dumped RQF." LifeScientist 27 Feb. 2008. 12 Dec. 2011 ‹http://www.lifescientist.com.au/article/207244/new_era_research_quality/›.Rymer, Les. "Measuring the Impact of Research – The Context for Metric Development." Go8 Backgrounder 23 (2011).RQF. Assessing the Quality and Impact of Research in Australia - Issues Paper. Canberra: Commonwealth of Australia, 2005.Rylance, Rick. "The Impact Effect." SocialText - Periscope (Aug. 2010). 12 Dec. 2011 ‹http://www.socialtextjournal.org/periscope/2010/08/the-impact-effect.php›.Shapiro, Stephen. "Deepwater Impact." SocialText - Periscope (Aug. 2010). 12 Dec. 2011 ‹http://www.socialtextjournal.org/periscope/2010/08/deepwater-impact.php›.

The Walt Disney Company has been creating magical fairy tales since the early 1900s and is a trusted brand synonymous with wholesome, family entertainment (Wasko). Over time, this reputation has resulted in the Disney brand’s huge financial growth and influence on audiences worldwide. (Wohlwend). As the largest global media powerhouse in the Western world (Beattie), Disney uses its power and influence to shape the perceptions and ideologies of its audience. In the twenty-first century there has been a proliferation of retellings of Disney fairy tales, and Kilmer suggests that although the mainstream perception is that these new iterations promote gender equity, new cultural awareness around gender stereotypes, and cultural insensitivity, this is illusory. Tangled, for example, was a popular film selling over 10 million DVD copies and positioned as a bold new female fairy tale character; however, academics took issue with this position, writing articles entitled “Race, Gender and the Politics of Hair: Disney’s Tangled Feminist Messages”, “Tangled: A Celebration of White Femininity”, and “Disney’s Tangled: Fun, But Not Feminist”, berating the film for its lack of any true feminist examples or progressiveness (Kilmer). One way to assess the impact of Disney is to look at the use of shape shifting and transformation in the narratives – particularly those that include women and young girls. Research shows that girls and women are often stereotyped and sexualised in the mass media (Smith et al.; Collins), and Disney regularly utilises body modification and metamorphosis within its narratives to emphasise what good and evil ‘look’ like. These magical transformations evoke what Marina Warner refers to as part of the necessary surprise element of the fairy tale, while creating suspense and identity with storylines and characters. In early Disney films such as the 1937 version of Snow White, the queen becomes the witch who brings a poison apple to the princess; and in the 1959 film Sleeping Beauty the ‘bad’ fairy Maleficent shapeshifts into a malevolent dragon. Whilst these ‘good to evil’ (and vice versa) tropes are easily recognised, there are additional transformations that are arguably more problematic than those of the increasingly terrifying monsters or villains. Disney has created what we have coined the ‘princess bubble’, where the physique and behaviour of the leading women in the tales has become a predictor of success and good fortune, and the impression is created of a link between their possession of beauty and the ‘happily-ever-after’ outcome received by the female character. The value, or worth, of a princess is shown within these stories to often increase according to her ability to attract men. For example, in Brave, Queen Elinor showcases the extreme measures taken to ‘present’ her daughter Merida to male suitors. Merida is preened, dressed, and shown how to behave to increase her value to her family, and whilst she manages to persuade them to set aside their patriarchal ideologies in the end, it is clear what is expected from Merida in order to gain male attention. Similarly, Cinderella, Aurora, and Snow White are found to be of high ‘worth’ by the princes on account of their beauty and form. We contend, therefore, that the impression often cast on audiences by Disney princesses emphasises that beauty = worth, no matter how transgressive Disney appears to be on the surface. These princesses are flawlessly beautiful, capable of winning the heart of the prince by triumphing over their less attractive rivals – who are often sisters or other family members. This creates the illusion among young audiences that physical attractiveness is enough to achieve success, and emphasises beauty as the priority above all else. Therefore, the Disney ‘princess bubble’ is highly problematic. It presents a narrow range of acceptability for female characters, offers a distorted view of gender, and serves to further engrain into popular culture a flawed stereotype on how to look and behave that negates a fuller representation of female characters. In addition, Armando Maggi argues that since fairy tales have been passed down through generations, they have become an intrinsic part of many people’s upbringing and are part of a kind of universal imaginary and repository of cultural values. This means that these iconic cultural stories are “unlikely to ever be discarded because they possess both a sentimental value and a moral ‘soundness’” (Rutherford 33), albeit that the lessons to be learnt are at times antiquated and exclusionary in contemporary society. The marketing and promotion of the Disney princess line has resulted in these characters becoming an extremely popular form of media and merchandise for young girls (Coyne et al. 2), and Disney has received great financial benefit from the success of its long history of popular films and merchandise. As a global corporation with influence across multiple entertainment platforms, from its streaming channel to merchandise and theme parks, the gender portrayals therefore impact on culture and, in particular, on how young audiences view gender representation. Therefore, it could be argued that Disney has a social responsibility to ensure that its messages and characters do not skew or become damaging to the psyche of its young audiences who are highly impressionable. When the representation of gender is examined, however, Disney tends to create highly gendered performances in both the early and modern iterations of fairy tales, and the princess characters remain within a narrow range of physical portrayals and agency. The Princess Bubble Although there are twelve official characters within the Disney princess umbrella, plus Elsa and Anna from the Disney Frozen franchise, this article examines the eleven characters who are either born or become royalty through marriage, and exhibit characteristics that could be argued to be the epitome of feminine representation in fairy tales. The characters within this ‘princess bubble’ are Snow White, Cinderella, Aurora, Ariel, Belle, Jasmine, Tiana, Rapunzel, Merida, Elsa, and Anna. The physical appearance of those in the princess bubble also connects to displays around the physical aspects of ethnicity. Nine out of eleven are white skinned, with Jasmine having lightened in skin tone over time, and Tiana now having a tanned look rather than the original dark African American complexion seen in 2009 (Brucculieri). This reinforces an ideology that being white is superior. Every princess in our sample has thick and healthy long hair, the predominant colour being blonde. Their eyes are mostly blue, with only three possessing a dark colour, a factor which reinforces the characteristics and representation of white ethnic groups. Their eyes are also big and bulbous in shape, with large irises and pupils, and extraordinarily long eyelashes that create an almost child-like look of innocence that matches their young age. These princesses have an average age of sixteen years and are always naïve, most without formal education or worldly experience, and they have additional distinctive traits which include poise, elegance and other desired feminine characteristics – like kindness and purity. Ehrenreich and Orenstein note that the physical attributes of the Disney princesses are so evident that the creators have drawn criticism for over-glamorising them, and for their general passiveness and reliance on men for their happiness. Essentially, these women are created in the image of the ultimate male fantasy, where an increased value is placed on the virginal look, followed by a perfect tiny body and an ability to follow basic instructions. The slim bodies of these princesses are disproportionate, and include long necks, demure shoulders, medium- to large-sized perky breasts, with tiny waists, wrists, ankles and feet. Thus, it can be argued that the main theme for those within the princess bubble is their physical body and beauty, and the importance of being attractive to achieve success. The importance of the physical form is so valued that the first blessing given by the fairies to Aurora from Sleeping Beauty is the gift of physical beauty (Rutherford). Furthermore, Tanner et al. argue that the "images of love at first sight in the films encourage the belief that physical appearance is the most important thing", and these fairy tales often reflect a pattern that the prince cannot help but to instantly fall in love with these women because they are so striking. In some instances, like the stories of Cinderella and Snow White, these princesses have not uttered a single word to their prince before these men fall unconditionally and hopelessly in love. Cinderella need only to turn up at the ball as the best dressed (Parks), while Snow White must merely “wait prettily, because someday her prince will come" (Inge) to reestablish her as royalty. Disney emphasises that these princesses win their man solely on the basis that they are the most beautiful girls in the land. In Sleeping Beauty, the prince overhears Aurora’s singing and that sets his heart aflame to the point of refusing to wed the woman chosen for him at birth by the king. Fortunately, she is one and the same person, so the patriarchy survives, but this idea of beauty, and of 'love at first sight', continues to be a central part of Disney movies today, and shows that “Disney Films are vehicles of powerful gender ideologies” (Hairianto). These princesses within the bubble of perfection have priority placed on their physical and sexual beauty (Dietz), formulating a kind of ‘beauty contest motif’. Examples include Gaston, who does not love Belle in Beauty and the Beast, but simply wants her as his trophy wife because he deems her to be the most beautiful girl in the town. Ariel, from The Little Mermaid, looks as if she "was modeled after a slightly anorexic Barbie doll with thin waist and prominent bust. This representation portrays a dangerous model for young women" (Zarranz). The sexualisation of the characters continues as Jasmine has “a delicate nose and small mouth" (Lacroix), with a dress that can be considered as highly sexualised and unsuitable for a girl of sixteen (Lacroix). In Tangled, Rapunzel is held hostage in the tower by Mother Gothel because she is ‘as fragile as a flower’ and needs to be ‘kept safe’ from the harms in the world. But it is her beauty that scares the witch the most, because losing Rapunzel would leave the old woman without her magical anti-aging hair. She uses scare tactics to ensure that Rapunzel remains unseen to the world. These examples are all variations of the beauty theme, as the princesses all fall within narrow and predictable tropes of love at first sight where the woman is rescued and initiated into womanhood by being chosen by a man. Disney’s Progressive Representation? At times Disney’s portrayal of princesses appears illusively progressive, by introducing new and different variations of princesses into the fold – such as Merida in the 2012 film Brave. Unfortunately, this is merely an illusion as the ‘body-perfect’ image remains an all-important ideal to snare a prince. Merida, the young and spirited teenage princess, begins her tale determined not to conform to the desired standards set for a woman of her standing; however, when the time comes for her to be married, there is no negotiating with her mother, the queen, on dress compliance. Merida is clothed against her will to re-identify her in the manner which her parents deem appropriate. Her ability to express her identity and individuality removed, now replaced by a masked version, and thus with the true Merida lost in this transformation, her parents consider Merida to be of renewed merit and benefit to the family. This shows that Disney remains unchanged in its depiction of who may ‘fit’ within the princess bubble, because the rubric is unchanged on how to win the heart of the man. In fact, this film is possibly more troublesome than the rest because it clearly depicts her parents to deem her to be of more value only after her mother has altered her physical appearance. It is only after the total collapse of the royal family that King Fergus has a change of patriarchal heart, and in fact Disney does not portray this rumpled, ripped-sleeved version of the princess in its merchandising campaign. While the fantasy of fairy tales provides enthralling adventures that always end in happiness for the pretty princesses that encounter them, consideration must be given to all those women who have not met the standard and are left in their wake. If women do not conform to the standards of representation, they are presented as outcasts, and happiness eludes them. Cinderella, for example, has two ugly stepsisters, who, no matter how hard they might try, are unable to match her in attractiveness, kindness, or grace. Disney has embraced and not shunned Perrault’s original retelling of the tale, by ensuring that these stepsisters are ugly. They have not been blessed with any attributes whatsoever, and cannot sing, dance, or play music; nor can they sew, cook, clean, or behave respectably. These girls will never find a suitor, let alone a prince, no matter how eager they are to do so. On the physical comparison, Anastasia and Drizella have bodies that are far more rounded and voluptuous, with feet, for example, that are more than double the size of Cinderella’s magical slipper. These women clearly miss the parameters of our princess bubble, emphasising that Disney is continuing to promote dangerous narratives that could potentially harm young audience conceptions of femininity at an important period in their development. Therefore, despite the ‘progressive’ strides made by Disney in response to the vast criticism of their earlier films, the agency afforded to their new generation of princesses does not alter the fact that success comes to those who are beautiful. These beautiful people continue to win every time. Furthermore, Hairianto has found that it is not uncommon for the media to directly or indirectly promote “mental models of how a woman should look, speak and interact with others”, and that Disney uses its pervasive princess influence “to shape perceptions of female identity and desirability. Females are made to measure themselves against the set of values that are meted out by the films” (Hairianto). In the 2017 film Beauty and the Beast, those outside of the princess bubble are seen in the characters of the three maidens from the village who are always trying to look their very best in the hope of attracting Gaston (Rutherford). Gaston is not only disinterested but shows borderline contempt at their glances by permitting his horse to spray mud and dirt all over their fine clothing. They do not meet the beauty standard set, and instead of questioning his cruelty, the audience is left laughing at the horse’s antics. Interestingly, the earlier version of Disney’s Beauty and the Beast portrays these maidens as blonde, slim, and sexy, closely fitting the model of beauty displayed in our princess bubble; however, none match the beauty of Belle, and are therefore deemed inferior. In this manner, Disney is being irresponsible, placing little interest in the psychological ‘safety’ or affect the messages have upon young girls who will never meet these expectations (Ehrenreich; Best and Lowney; Orenstein). Furthermore, bodies are shaped and created by culture. They are central to self-identity, becoming a projection of how we see ourselves. Grosz (xii) argues that our notions of our bodies begin in physicality but are forever shaped by our interactions with social realities and cultural norms. The media are constantly filled with images that “glorify and highlight some kinds of bodies (for example, the young, able-bodied and beautiful) while ignoring or condemning others” (Jones 193), and these influences on gender, ethnicity, sexuality, race, and religion within popular culture therefore play a huge part in identity creation. In Disney films, the princess bubble constantly sings the same song, and “children view these stereotypical roles as the right and only way to behave” (Ewert). In The Princess and the Frog, Tiana’s friend Charlotte is so desperate to ‘catch’ a prince that "she humorously over-applies her makeup and adjusts her ball gown to emphasize her cleavage" (Breaux), but the point is not lost. Additionally, “making sure that girls become worthy of love seems central to Disney’s fairy tale films” (Rutherford 76), and because their fairy tales are so pervasive and popular, young viewers receive a consistent message that being beautiful and having a tiny doll-like body type is paramount. “This can be destructive for developing girls’ views and images of their own bodies, which are not proportioned the way that they see on screen” (Cordwell 21). “The strongly gendered messages present in the resolutions of the movies help to reinforce the desirability of traditional gender conformity” (England et al. 565). Conclusion The princess bubble is a phenomenon that has been seen in Disney’s representation of female characters for decades. Within this bubble there is a narrow range of representation permitted, and attempts to make the characters more progressive have instead resulted in narrow and restrictive constraints, reinforcing dangerous female stereotypes. Kilmer suggests that ultimately these representations fail to break away from “hegemonic assumptions about gender norms, class boundaries, and Caucasian privileging”. Ultimately this presents audiences with strong and persuasive messages about gender performance. Audiences conform their bodies to societal ‘rules’: “as to how we ‘wear’ and ‘use’ our bodies” (Richardson and Locks x), including for example how we should dress, what we should weigh, and how to become popular. In our global hypermediated society, viewers are constantly exposed to princesses and other appropriate bodies. These become internalised ideals and aid in positive and negative thoughts and self-identity, which in turn creates additional pressure on the female body in particular. The seemingly innocent stories with happy outcomes are therefore unrealistic and ultimately excluding of those who cannot or will not ‘fit into the princess bubble’. 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