Paid maternity leave: How the top 25 countries in the United Nations Human Development Index compare

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According to the International Labour Organization:

…pregnancy and maternity are an especially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent harm to their or their infants’ health, and they need adequate time to give birth, to recover, and to nurse their children. At the same time, they also require protection to ensure that they will not lose their job simply because of pregnancy or maternity leave. Such protection not only ensures a woman’s equal access to employment, it also ensures the continuation of often vital income which is necessary for the well-being of her entire family. Safeguarding the health of expectant and nursing mothers and protecting them from job discrimination is a precondition for achieving genuine equality of opportunity and treatment for men and women at work and enabling workers to raise families in conditions of security.

Using information collected by UN Data on 2013 Maternity Leave Benefits, I plotted the number of days of paid maternity leave by the % of wages paid during leave for the top 25 countries listed in the 2013 UN Human Development Index. The provider of benefits varied by country and included social insurance, social assistance systems financed by the State, social security, and employers.

Maternity leave standards determined by the International Labour Organization (ILO) were used as a ‘gold standard’ for benefits. The Maternity Protection Convention, 2000 (No. 183) is the most up-to-date international labour standard on maternity protection, and according to the ILO (emphasis my own):

Convention No. 183 provides for 14 weeks of maternity benefit to women to whom the instrument applies. Women who are absent from work on maternity leave shall be entitled to a cash benefit which ensures that they can maintain themselves and their child in proper conditions of health and with a suitable standard of living and which shall be no less than two-thirds of her previous earnings or a comparable amount.

There has been a great deal of progress when it comes to maternity (and paternity) leave benefits, yet there is no consistent and lawful standard for paid leave in the United States. So while we may applaud a company like Netflix for their progressive policy on ‘unlimited parental leave’ in the first year after birth or adoption, most Americans are not afforded such a privilege…or what some might argue is a right. The average length of maternity leave in the United States is 84 days and the percentage of wages paid during this period is 0%. The US is the only country that does not meet at least one of the requirements of the ILO standard.

NuvaRing, A Case Study: Making medical instructions feel less medical

ringbody1

In brief: I discuss some of the major issues and decisions I faced in redesigning instructions for the birth control device, NuvaRing. My goal was to design the instructions to be more human centered and supportive of sex positive attitudes towards women’s sexual health. Images in this post are NSFW.

NuvaRing was launched in the early 2000s around the same time I started working as a sexual health educator. It is a flexible ring that is inserted into the vagina where it releases hormones into the body to prevent pregnancy. NuvaRing is worn consistently for 3 weeks and then removed for one week during which a woman menstruates.

I decided to redesign the instructional material for NuvaRing as a part of an information design study for a spring course I took at the School of Visual Arts. I chose the ring largely because of my familiarity and fondness for the product. As medical device instructions don’t have a great reputation for compelling information design, I also saw this as a good design challenge and an opportunity to use materials to improve the overall birth control experience.

Better instructions, better experiences

It is important for manufacturers to design clear, accurate and comprehensive instructional materials so that people can effectively use their birth control. Even better, when designed with the intended user in mind, materials can feel more engaging and supportive to people’s needs. With the potential to reach millions of consumers worldwide, the language and tone of these materials matter because, intentionally or not, they convey beliefs and attitudes about women’s bodies and sexual health. That is, their impact is felt well beyond the individual user.

Instructional materials surface at critical touchpoints in the birth control experience: They help foster a relationship with users, and become a familiar face in the birth control journey. Every time a woman receives her birth control, she receives materials.

And yet, the design of materials often feels like an afterthought. Despite the sensitive topics they cover, birth control instructions can look and feel no different than materials you receive with an everyday household appliance. They tend to be dense and crammed with fine print, spouting legal disclaimers and warnings about health risks. And while this is all essential information, the way it is communicated can be daunting and (slightly) terrifying, at least from my perspective. Typically I find device instructions to feel highly technical, losing sight of the person at the center of the experience. With female oriented products, it’s particularly important to consider how instructional material can promote sex positivity and challenge stereotypes and stigma around female sexuality.

How might we design better instructions?

The following questions guided me through the redesign:

  • How might we design clear, credible and effective instructions?
  • How might we design instructions that women from diverse cultural contexts can identify with?
  • How might we normalize the relationship between women and their sexual body parts?
  • How might we promote sex-positive attitudes about sexual health and behaviours?

Critiquing the manufacturer’s instructions

00A booklet is provided in the NuvaRing package (purchased in Canada)

01Insertion instructions begin on p16 (click to enlarge)

02Figure 2 shows proper handling of ring, Figure 3 shows insertion, Figure 4 shows removal (click to enlarge)

03Continuation of ring removal instruction and Q&A about use (click to enlarge)

Images from the manufacturer’s instructional material are above. My main observations:

  • The instructions on using the ring are explained over several pages of the booklet
  • Visual and text instruction are interspersed and the formatting of the text is inconsistent
  • Illustrations show detailed anatomical cross-sections of the female body, and depict internal organs; the vulva and vaginal opening are not explicitly shown
  • There is not a clear distinction between internal and external body parts; parts are not labeled
  • Internal and external body parts appear in varying flesh tones
  • The woman in the instructions appears to be completely nude; she is shown from her side profile and appears to be looking at her pelvic area

Strengths: The small booklet fits nicely into your hands and the NuvaRing package. Though not directly related to the instructions, the booklet includes reminder stickers for your calendar to insert/remove the ring, which seems thoughtful.

Opportunities for change: The dense text throughout the booklet made the content feel onerous. The instructions were also difficult to follow without clear sequential steps. Illustration-wise, the relationship between the ring, the woman, and her sexual organs (vulva, vagina) felt disjointed and lacked a clear flow, perhaps in part because the information was spread out over several pages. The illustrations themselves were also somewhat confusing and off putting: A completely nude woman (you don’t need to be naked to insert the ring!) and a cross section of a woman’s internal organs. The latter actually reminded me of viewing cadavers in my undergraduate biology courses. To me, these visuals depict a medicalized view of the female body from the perspective of a healthcare provider (HCP) interacting with a patient. You might call this the HCP’s “gaze” or point of view, a lens that comes from a place of great (and often undisputed) power and privilege. Ultimately, what is missing here is the woman’s perspective.

The redesign

I decided to create a quick reference guide — an at-a-glance guide to using the ring on a routine basis that accompanies a more comprehensive material with all the mandatory “fine print” (this pairing is quite common in the world of medical device materials). I identified and arranged key steps of the instruction and created a range of options for illustrations. Because the average user is not likely to read the instructions in their entirety, I was especially judicious about content design. I had to strike the right balance between the type and amount of information to provide to the user, and when to provide it.

1\3(Re)arranging content for the instructions and exploring illustration options: pink stickies are “stages” of use, dark yellow stickies are key instructions, and light yellow stickies are illustrations

As I was prototyping, I found myself grappling with several key issues related to content:

Point of view (POV): I experimented with several POVs for the illustrations. I found that a first person POV (that did not show the vulva) was true to the user experience yet unhelpful in conveying specific instructions, and that a ‘spectator’ POV (a person watching someone else use the ring) came across as somewhat intrusive. For the most part, I decided to use a modified first person POV from the perspective of a woman viewing her vulva in a mirror. I appreciate this POV because it comes from a sex positive place: Mirrors are a source of empowerment for women who want to learn more about their bodies. This vantage point implies that the user has greater control over her experience and that her body is ‘on display’ for her only, which may promote a sense of privacy/intimacy with use of the ring.

Positioning of hands: I felt it was important to show the user’s hands directly touching her genitals to normalize this interaction; this is otherwise often considered shameful or overtly sexual behavior for a woman. In doing research for this project, I sought out visual references of hands interacting with the vulva. I found most of these references from medical textbooks (view of vulva with a gloved hand touching it) or pornography (view of vulva with a woman touching herself). The intention behind displaying the genitals are quite different: The former is meant to display the female anatomy, often in a diseased state, in a sterile environment for educational purposes, while the latter is intended to showcase the genitals with the aim of stimulating sexual arousal. There is a complex history and interesting crossover between these representations of the female genitalia that Kapsalis thoughtfully discusses in her book, Public Privates. This was helpful food for thought when considering how to represent the vulva.

For the instructions, I envisioned showing one hand inserting the ring and the other spreading the labia to facilitate easier access to the vagina. However, in sifting through my visual references for the latter, the only consistent “methods” came from porn (e.g., using the index and middle fingers to create a “V” shape). I chose not to explicitly draw from any specific references and, rather, settled on a hand position that I felt was realistic and practical.

hand positions

Possible positioning of hand to spread the labia: hand position used for redesign (left) and “v” shaped finger spread (right)

Representations of the body: I took a multi-pronged approach to developing simple and inclusive illustrations and language that would resonate with a diverse user audience. (1) Avoiding the use of gender pronouns: I debated this because being a woman is likely a very powerful and important part of most users’ identity, however, I did not want to exclude users who may not identify as female. (2) Simplifying illustrations: I removed parts of the body that were not critical to the instruction to minimize distraction and confusion. This forced me to prioritize and determine to what extent to include body parts (e.g., do I show the anus? urethra?) and why (e.g., for reference? educational purposes?). For instance, when showing the vulva and vaginal opening, I decided to include the urethra and labia minora and majora as key visual references. (3) Strategic use of color: I selectively used color throughout the illustrations to emphasize certain instructions and neutralized skin tones to make them more inclusive. I also shaded the labia to suggest pubic hair. As a natural and normal feature of the body, I felt it was important to include so long as it did not interfere with the illustrations. The absence of pubic hair may otherwise suggest that a person is pre-pubescent or has intentionally removed their hair.

Here’s a summary of the major changes I made in the redesign:

  • Created a square QRG that would fit into the package alongside the ‘fine print’
  • Illustrations have minimal detail and most are drawn from the perspective of a woman viewing her body in a mirror
  • Instructional steps are numbered and organized into four major stages of use (prepare, insert, wear, remove)
  • Visuals and plain-language text are paired in a linear sequence
  • Body parts relevant to the instruction are labeled for educational purposes
  • Gender neutral figures shown explicitly touching their genitals demonstrate different positions for ring insertion
  • Skin tones are neutralized so they are more inclusive; shading applied to the vulva area is a reference to pubic hair
  • Color is used to highlight key actions (arrows)
  • Introduced a friendly logo and color palette, aligned with brand colors

Photos of the NuvaRing Quick Reference Guide

cover1Cover with a basic overview of use

inside1Opens into tips for insertion (click to enlarge)

spread1Continuous spread of instructions (click to enlarge)

back1Back cover with manufacturer contact information

There are already changes I could imagine making to this iteration of the guide (e.g., including info like Q&As and health warnings, etc.), but it is a starting point. The true test of this material would be in usability testing (if that were to ever happen). I welcome your critiques and comments!

We’re up all night to get lucky

knockin'

 

I made the images above and below for the Bedsider.org blog a few months ago. The posts can be viewed here and here.

Bedsider is an initiative of the National Campaign to Prevent Teen & Unplanned Pregnancy, a private non-profit organization whose goal is to help women find “birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.

I support Bedsider.org for a number of reasons: It’s an informative, light-hearted and non-judgmental resource, it is beautifully designed (courtesy of IDEO), and it also happens to offer fun birth control/appointment reminders that you can sign up for here.  I admire their work and had a great time brewing up ideas for their tumblr.

getlucky

If Wes Anderson Created a Period Starter Kit

Hello Flo’s latest viral video, First Moon Party, made me appreciate the company’s refreshingly positive (and hilarious) take on menstruation. The ad shows a young girl so eager to get her first period that she fakes it, prompting mom to throw her an awkward and over the top ‘First Moon’ party as punishment for lying. What I love is that the messaging counters our common perceptions of first menstruation as dreadful, embarrassing, and what many have affectionately nicknamed “the curse” — the time of month when a woman is bloated, bleeding, and b**chy.  Periods are a natural part of being human and quite phenomenal when you consider how and why people menstruate in the first place. Just think: the body cyclically prepares itself for pregnancy so it may nurture, grow and birth new life…and we can actively manipulate these complex processes using contraception. In fact, it’s a good reminder of just how sophisticated our bodies are.

As a former sexual health educator, I think it’s important to embrace and normalize menstruation, even before that very first period. This means it is crucial to encourage girls and young women to learn about their bodies in a manner that is honest, open and accurate, and enables them to make informed decisions about their sexual and reproductive health. This also means calling things out as they are (that “va-jay-jay” is actually a vagina) and creating awareness around the full gamut of care options women have during menses so they can find a best fit for themselves.

I’ve seen a lot of “starter kits” for a first period — googling around gives you a sense of what these look like. Most contain what you might expect: jewellery, candy, painkillers, carrying bag, etc. I decided to quickly jot down some of my own ideas, with an intent to expand a woman’s options beyond those typical pads and tampons:

  1. Mirror: A mirror can serve as a very simple yet powerful educational tool for understanding parts of the body that cannot be easily seen on a day to day basis. It can also clarify where exactly to insert a tampon, sponge or cup.
  2. Extra underwear: Important backup for any spillage.
  3. Sweets: Sometimes a little sugar can help distract from those cramps.
  4. Diary: A personal health record for keeping track of the flow and the experience.
  5. Painkillers: To wrangle those potential aches and pains.
  6. Tampons: A good option for those comfortable with insertion.
  7. Pads: Can be reusable or non-reusable and serve as panty liners.
  8. Menstrual cup: An insertable, reusable yet less popular option.
  9. Sponge: Not to be confused with the contraceptive sponge (which always reminds me of Seinfeld), this is an option made of naturally occurring materials.

I personally think it’d be great to see all of these items in one kit as it offers more than what you would typically find in the “feminine hygiene” aisle of your local pharmacy. I think it’s also worth noting that we can talk about tools for menstruation as well as a mindset for menstruation…this list focuses on the former but directly informs the latter.

Because my mind just works this way, I decided to illustrate this list using a visual style inspired by Wes Anderson. See below. If you’re not familiar with the reference, SNL made a brilliant spoof of Wes Anderson films you can watch here. And in case you’re wondering, the spoon is how I visually think about the amount of menstrual fluid generated per period (2-4 tablespoons on average).

I’d be interested to hear what else would be helpful in such a “starter kit”? Maybe books, a carrying case…?

 

menarche

mirror

underwear

sweets

diary

painkiller

tampons

pads

cup

sponge