Lava grey and antique cream: the diaspora of health research.

It may appear to the outsider that the world of health research consists of a homogenous collective of nerdy academics crunching numbers in an attempt to answer scientifically important questions. But for those of us living in that world there sometimes arises occasions that throw into stark relief the contrasting dynamics at play amongst our own peers.

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Source: thebillproject.org

This realisation came to the fore this week during the formalities of the annual Royal Australasian College of Physicians Victoria Trainee Research Awards. I was lucky enough to have my abstract, which recounts my research on child health in same-sex families, selected to present in the Paediatric division. I had made the somewhat bold decision to present the entirety of my PhD in the very strict 12 minute time restriction, but having twice competed in the 3 Minute Thesis competition 12 minutes seemed like a luxury!

On arrival I flicked through the program for the evening and straight away knew it would be an interesting night. My sole-author paper immediately contrasted with all the other abstracts which contained lists of authors as long as your arm. They were jam packed with p values and confidence intervals and had long complex words like sarco-osteoporosis or bamboozling molecular markers such as FLT-3. I was entering a room full of clinicians and lab-based researchers who knew that black is black and white is white. My mixed methods approach, drawing heavily on the social sciences, allowed black to be lava grey and white to be antique cream. It was going to blow some minds.

The presentation itself went well. I kept to time and handled the slightly predictable questions comfortably: “aren’t the parents better educated and earn more money”; “but don’t all children have to deal with bullying of some sort”. As the marks for each presentation were collated a panel discussion on ‘advanced training and research’ re-emphasised the focus on clinical work. One participant even suggested that being a clinician made you a better researcher and that good researchers do better clinical work. It’s over 5 years since I’ve seen a real patient!

In this clinical world it was a little surprising therefore that I discovered I had won the Paediatric prize. It may have been somewhat of a euphemistic win (if such a thing is possible) as the comments included: “weren’t your slides pretty” and “good on you for having the guts to use a different methodology.” Perhaps throwing words like post-positivism, social constructivism, queer theory and heteronormativity out at the audience did the job of impressing and confusing in equal measure. Putting all modesty aside it is more likely that the judges recognised the originality of my research and the efforts required to pull together the tricky mixed methods that I had had the ‘guts’ to use.

Mixed methods

While I am proud of the award, and proud that the college was able to recognise my work, I was reminded that there is a huge gulf between the more social perspectives of health, and public health in general, and the way in which many clinicians often think. As I continue my research, drawing on the social determinants of health, this illuminating night acts as an important reminder that we need to continually engage with our clinical partners to ensure that all the multidimensional aspects of health and wellbeing are brought to bear in our efforts to improve the health of the whole population.

I would like to thank Elizabeth Waters and Ruth McNair who have supervised my research, the Advisory Committee who allowed the development of a robust mixed methods framework and the whole of the Jack Brockhoff Child Health and Wellbeing Program for their advice and support.

Dr Simon Crouch, Honorary Research Fellow and Lead Investigator, The Australian Study of Child Health in Same-Sex Families

Hidden agendas – do researchers and participants bring bias to studies?

The recent publication of our research on child health in same-sex families has gained a little media attention this week following my piece in the Conversation. I have had some wonderful feedback from members of the community who feel that this research provides valuable insights into the many diverse ways in which same-sex attracted people are raising children. But in the background the usual group of critics have set about trying to undermine our work.

One issue that has been raised is that of bias. There are many types of bias that can have an impact on research and this is one key area that academics like myself make every effort to account for. In clinical sciences the randomised control trial is the gold standard for eliminating bias, but in many population studies this is not always an achievable methodology. You can’t take a group of children, for example, and randomly allocate them to being raised by same-sex attracted parents or heterosexual parents. When bias cannot be completely omitted it is important to acknowledge its potential influence and this is something authors will highlight when considering the limitations of their work.

When researching child health in same-sex families the first problem is identifying, and then recruiting, such families. In Australia there is only one way that this can be achieved: through convenience sampling. Overseas, attempts have been made to draw representative samples from population surveys. While perhaps removing the volunteer nature of the sample these studies do suffer from small sample sizes, as the same-sex parent population within any population sample will be very small. This strategy is not an option in Australia where there are no population datasets that capture parent sexual orientation. Thus the volunteer sample is the only option. This is where the first criticisms of our study have been leveled.

It is argued that only parents with a vested interest in promoting positive health outcomes will volunteer. While this cannot be discounted as a possibility there is no evidence to suggest that this is the case. The underlying aim of the study was to characterise health and wellbeing and to understand the influence of stigma on child health in this context. As any parent will tell you what is paramount is ensuring that your children have the best health opportunities available. To intentionally corrupt research so that it cannot identify where problems may lie is doing yourself, and your children, a disservice. Only by providing an accurate picture of your child’s health will you know what can be done if there are issues. And in a context where stigma might be having a negative impact this is important to identify.

Further to this is the fact that significantly positive outcomes were only identified on a handful of scales. Overall 29 different measures of health and wellbeing were included in our study. Almost all showed no difference to the general population. Only 3 measures showed a significant difference, albeit a positive one for same-sex families. If same-sex attracted parents were systematically working to ensure an outcome that shows their children in the best light would there not be a more consistent skewing across all the scales? What is more likely is that there truly is something within same-sex families that shows a benefit on those three measures.

While the criticism has touched on the methodology, the limitations of which are clearly outlined in the published paper, there has also been an unfortunate focus on more personal aspects of the research. Some groups have highlighted the fact that I, the lead author on the paper, am a gay man raising children, suggesting that this is a conflict of interest and introduces inappropriate bias.

Family photo

The research team for this study is based within the Jack Brockhoff Child Health and Wellbeing Program at the University of Melbourne. This Program is led by Professor Elizabeth Waters, an internationally renowned child health researcher who leads work on many aspects of child health including obesity, oral health, disability and disaster recovery, to name a few. She is also a heterosexual parent and second author on the paper. The rest of the research team bring a range of research experiences and family backgrounds. But is there any relevance to their personal situations? All published papers go through a rigorous peer review process that is blind to such things, assessing work on its methodological merits alone. To suggest that my family situation is of relevance implies that no heterosexual researcher can produce unbiased work on heterosexual families. Or that any non-Caucasian researcher would be able to objectively conduct research on racial discrimination and child health.

Increasingly, across all areas of research, there is a move towards the publication of protocols. This establishes the theoretical underpinnings and methodological basis of studies and allows a continued process of transparency to be engaged from the outset. Our recently published findings on same-sex families took this approach and a protocol was published in the early phases of the project. By being up front and transparent at all times about the research we are allowing the work to be continually interrogated.

Research on same-sex families always draws critics. There is a small but vocal minority who do not accept family forms that fall outside the traditional mother-father construct. It is interesting to note that at the same time as criticising methodologies such as ours these same groups would baulk at including questions around sexual orientation on national surveys such as the Census. It is up to the scientific community to consider the merits of our work and place it in its appropriate context in terms of future health interventions and policy work.

It will never be possible to exclude bias completely from all research. But in the mean time it is up to us, the researchers, to maintain objectivity, be open about limitations, and be true to the evidence that our work provides.

Dr Simon R Crouch
Lead Investigator, the Australian Study of Child Health in Same-Sex Families (ACHESS)

Parent-reported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey

Kids from same-sex families fare as well as peers – or better

A non-specific sex

I have previously written about the unfortunate way in which boys and girls are pigeonholed based purely on their biology. But this gendered stereotyping and heteronormative worldview go far beyond the choices parents make when buying toys. It permeates all aspects of our society impacting on health programs, health policy and ultimately the ability of all individuals who do not fit within the binary construct of ‘male’ and ‘female’ to lead healthy and fulfilling lives. This week has seen a significant advancement when it comes to determining sex however. The NSW High Court has ruled that “non-specific” is now a legally allowed option on official records. The court found that there were no legal grounds that required a person to be identified as either a man or a woman, and perhaps this will now be recognised a little more in the wider society. Ironically, it was suggested by the court that the only place where a legal definition of ‘man’ or ‘woman’ may be required is in the Federal Marriage Act – perhaps it is time for this Act to be changed so that the gender binary is not used as an impediment when it comes to love and the legal security of all families. For Norrie, the person at the centre of the case, it was a matter of equality. And for the same-sex parent families with which we work equality is all they seek.

Norrie

Norrie Photo: Dalla Kilponen

Writing in The Conversation Prof Marian Pitts examines this legal decision further, highlighting the frustration and distress that results when people feel that their sex and gender identity are not being recognised. Over a number of years now there has been much progress made in the understanding that gender is not necessarily so black and white. Just earlier this year the popular social media site Facebook changed its settings to recognise over 50 different options for gender. Many people will not notice such a change, but for those people that it does affect such recognition sends a powerful message of acceptance.

It is an issue that a large proportion of the population would give little thought to. In fact something as simple as the difference between gender and biological sex passes most people by. It is quite possible to be biologically male yet identify as female when it comes to gender. Even when biology and primary gender identity match it might not be as straightforward as it seems; say a person of female biological sex who identifies as female in terms of their gender identity but also acknowledges typically male characteristics. In a heterosexual world this person might be considered as a tomboy, but if we complicate things further and add in sexual orientation then she might be described as a butch lesbian.

Prof Pitts begins her discussion questioning whether it is necessary for institutions to ask people to identify their sex as male or female. Working with children in many family contexts the Jack Brockhoff Child Health and Wellbeing Program often collects data on both gender and biological sex. An understanding of the social determinants of health tells us that there are many factors that contribute to overall wellbeing, and gender identity and biological sex, as well as sexual orientation and a myriad of other characteristics, are all important factors. If we do not collect these data in our ongoing epidemiological work then we are not in a position to identify areas of need as we seek to enable a healthy and fulfilling life for all. The challenge is to collect information in an inclusive manner, ensuring that everyone has the opportunity to identify in a way that most fits their innate being. As such the Jack Brockhoff Child Health and Wellbeing Program continues to examine the research it conducts in a way that is both inclusive and empowering.

As we recognise the significance of the NSW ruling we should all reflect on our own roles and ask if we are constraining ourselves to an outdated binary construct. Let’s celebrate difference. Let’s celebrate that non-specific sex.

By Dr Simon R Crouch

Lead Investigator, The Australian Study of Child Health in Same-Sex Families

Proud to be Australian?

It’s been nearly five years since I stood in the echoic expanse that is St Kilda Town Hall and collected the small pot of native flora that marked my acceptance as an Australian citizen. A privilege that was afforded to me by way of my partner.

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(Image courtesy of: http://tizona.wordpress.com/2009/02/11/australian-flag-collection/)

In the time that followed I have worked for the Australian Government, celebrated the birth of my twin boys, integrated my family into a tightly knit community and travelled extensively, with my family, throughout Australia and the world. This Australia Day will mark the fourth occasion where my neighbours will join me and my family as we spill out from our houses and enjoy a street party while strengthening the community ties that we all enjoy.

And all this as an out and proud gay man.

You may think this is all rather unremarkable, after all same-sex attracted men and women are an increasingly visible part of Australian society. But it has not always been so. It was not until 2008 that the then Labor government, through a rare act of bipartisan support, introduced legislation to bring greater equality for same-sex attracted people and their families. This had a significant impact from cradle to grave, including opening up access to assisted reproductive technologies and allowing for appropriate inheritance rights. Today in Australia I can be secure in the knowledge that if anything were to happen to my partner, my children and I will be both financially secure and legally protected.

As I look around the world I am grateful that I live in Australia. In India homosexuality has recently been re-criminalised. In Russia it is an offense to talk positively about being homosexual, and Vladimir Putin has assured gay and lesbian competitors that they will not be hassled at the upcoming Winter Olympics as long as they don’t talk to children! In Gulf Cooperation Countries officials are exploring the slightly ludicrous possibility of developing medical tests to detect homosexuality in order to prevent same-sex attracted expats from entering these states. Both Uganda and Nigeria have just passed strict anti-homosexuality laws, and five countries (Mauritania, Sudan, Iran, Yemen and Saudi Arabia) have legislation in place that allows the punishment of homosexuality with death. When reflecting on what my life might be like in some of these countries it is hard not to feel proud to be Australian.

But Australia is not perfect. Our first attempts at marriage equality in the ACT were overturned when the Federal Government challenged the legislation in the High Court just before Christmas. While countries such as the United Kingdom (where I am also incidentally a citizen) move towards full marriage equality this year, Australia continues to drag its feet. Despite our research here at the Jack Brockhoff Child Health and Wellbeing Program suggesting that children with same-sex attracted parents are doing really well overall, politicians such as Cory Bernardi continue to promulgate negative views about non-traditional families. This negativity has a significant impact on families like mine.

This Australia Day we should all be proud of our country for the leaps and bounds it has taken in providing equality for same-sex attracted people and their families. But we should not forget that the long journey to equality is not over here at home, and certainly not over for many homosexual people abroad.

Advance Australia, nay the world, fair!

 

By Dr Simon R Crouch

Lead Investigator, The Australian Study of Child Health in Same-Sex Families

“Is it a boy or a girl?”

With Christmas just around the corner the challenge of identifying that handful of special toys that the children in your life will delight in grows ever pressing. Perhaps it is with a modicum of dread that you will tentatively sidle into the department store and hunt out the aisles that are overflowing with yuletide stock designed to entice children and adults alike. Many will breathe a sigh of relief when they realise that the overwhelming choice has been handily whittled down by half into neat categories of ‘boys’ and ‘girls’. The pink dolls and ponies, cuddly pets and fairies for the little ladies; monster trucks, action figures and footies for the little men. 

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For a growing number of families however, this really rather arbitrary divide is not only unhelpful but one component in a daily challenge to live lives that are unencumbered by gender stereotypes and heteronormative assumptions. In constructing their families many same-sex attracted parents have to run counter to the socially constructed tides of gender and heteronormativity. In a world where many assume that heterosexual relationships form the basic building blocks of family, made whole by a caring mother and provider father, same-sex attracted parents have to navigate a path that deconstructs this assumption and allows for their children to live free of stigma and discrimination. Fundamental to this is the ability to eschew numerous aspects of the gendered world in which we live. Many modern parents subscribe to a similar ethos – increasingly it is understood that young girls can enjoy sports and grow up to be doctors or that boys can choose to be nurses or stay at home dads – but rarely are their lived experiences negatively affected by the subversive gender divide that is ubiquitous throughout society. Most would not give a second thought to the separation of toys in the department store.

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The heteronormative world begins its gender distinctions before birth. “Is it a boy or a girl?” is the first question most women are asked when they announce that they are pregnant. And from there it is perpetuated in books, on television, at childcare, in schools. Wothout meaning to discriminate even the most enlightened adults are unlikely to buy pink clothes for their son or a toy tool-kit for their daughter. For same-sex parents and their families it becomes a battle to counter-act this. Having lived outside the heteronomative in their own relationships their children have to wrestle with the abandonment of gendered parenting on the one hand and the ever-present gendering that society throws at them on the other. At once this can be both detrimental to their health, if the rejection of gender leads to increased stigma, and positive for their wellbeing, as parents freed from the constraints of gender-based parenting can find roles that suit the whole family, building family harmony.

 

This is not all theoretical. As the Australian Study of Child Health in Same-Sex Families nears the end of its first chapter we have already seen how same-sex parent families excel in terms of family cohesion and how their children display excellent general health. We know that the stigma that these families encounter can be detrimental, and talking to both parents and children reveals their continual battles against heteronormativity and gender stereotyping. To what extent society can learn from this is as yet uncertain, but there are definitely lessons here that are worthy of hearing.

 

I have twin boys. They are four years old. When I go shopping this Christmas I will be seeking out toys that reflect their interests alone and won’t be swayed by the imposed gendering of department stores.

 

So that will be one red fire engine and a pink My Little Pony please!

 

By Dr Simon R Crouch

Lead Investigator, The Australian Study of Child Health in Same-Sex Families

http://www.achess.org.au

It’s time we all listen to Indi

With the seat of Indi still too close to call it may well be that the role of children in same-sex relationships may have had some small bearing on the outcome. Sophie Mirabella, a Liberal Party frontbencher who headed into the election with a comfortable 9 point lead, has found herself in the fight of her life. Her competition, Cathy McGowan, is a popular local independent enjoying significant support in an election that generally saw a considerable swing to the Liberal Party. Now I am not a political pundit, and I am sure there are many factors at play that have led to this surprising result, but I can not look past the role that same-sex families may have played in the final days of the campaign.

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Photo from: http://www.cathymcgowan.com.au/

On the Wednesday before the election The Age reported on the distribution of offensive pamphlets in the seat of Indi. Let me make it clear at the outset, there is no evidence that these pamphlets were either the responsibility of, or supported by, the Liberal Party. The pamphlets portrayed young children with quotes such as, “I need my mum and dad.” They went on to urge voters to distribute their vote such that Cathy McGowan, among others, be preferenced last. The reason given in the pamphlet was that Ms McGowan is in favour of marriage equality. Sophie Mirabella has consistently and repeatedly emphasised her position that marriage should only be between a man and a woman and, as reported in The Age, she believes that marriage was “developed for the creation and raising of children.”

It is reassuring to think that perhaps our research is starting to gain significant traction in the community. Where previously these scare tactics might have boosted the conservative vote it seems that we might be moving into an era where the population as a whole understand that there are many valid and healthy ways to raise children. This evolution in public opinion is so important. As our research evolves we are seeing the negative impact that opinions such as those expressed in the unwelcome pamphlets can have on children with same-sex attracted parents. And while these children are in general developing well, a message that may finally be cutting through, the final remnants of negative outcomes could be taking their last gasps as local Australians embrace same-sex parent families, even if some politicians are slow to reflect this.

The coming days will bring a final result in Indi, but whoever triumphs one thing is certain. At least in this small corner of our country attempts to discriminate against, and vilify, same-sex attracted parents seem to have failed. It gives me hope that with the aid of our ongoing work same-sex parent families have a bright future. Perhaps Mr Abbott will realise this and allow a conscience vote the next time marriage equality comes up in parliament.

Come on Prime Minister, listen to Indi.

By Dr Simon R Crouch
Lead Investigator, The Australian Study of Child Health in Same-Sex Families
http://www.achess.org.au