Health promotion is grounded in a commitment to structural change. The Ottawa Charter for Health Promotion (1) identifies five action areas, including healthy public policy, supportive environments, community action, personal skills development, and reoriented health services, which together position system-level action as central to improving population health. However, many areas of public health continue to prioritise individual behaviour change. This tension is particularly evident in perinatal public health systems, where responsibility for maternal and infant health is frequently concentrated on the pregnant or postpartum woman rather than distributed across policy, services, and broader social conditions (2-4).
In Australia, perinatal public health is strongly organised around maternal responsibility. Policy documents, clinical guidelines, service models, and health promotion programs commonly position mothers as the primary site of risk identification and management (2,3). Across domains including alcohol use, smoking, infant feeding, vaccination, antenatal screening, and digital self-monitoring, women are expected to manage complex responsibilities, often with limited institutional support. Evidence suggests this can contribute to stigma, interpersonal strain, inequitable burden, and reduced engagement with care, particularly among women experiencing disadvantage (5-8). Despite this, the system-level logic that produces these expectations has not been systematically examined.
This PhD project investigates how maternal responsibility is constructed and distributed across Australian perinatal public health systems, and how this shapes policy, practice, and lived experience. It asks how maternal responsibilisation has become a dominant organising framework, what assumptions sustain it, and what changes are needed to better align perinatal public health with the structural commitments of the Ottawa Charter (1). Bacchi’s policy analysis framework (9), supported by critical discourse analysis (12), will be used to examine how problems and responsibilities are framed within policy and practice. The Red Lotus Critical Health Promotion Model (RLCHPM) (4) and QATCHEPP (10) will provide criteria for assessing and informing structurally oriented responses.
Blackford et al. (11) illustrate this issue through “No Vax, No Visit” (NVNV), where mothers are left to manage vaccination-based visitation boundaries without formal system support. While consistent with public health advice, responsibility is enacted at the individual level, often generating emotional and relational strain. This example highlights the broader challenge addressed in this project: how responsibility can be more appropriately shared across systems rather than concentrated on individuals.
Aim
To examine how maternal responsibility is constructed and distributed across Australian perinatal public health systems, and to identify policy and practice reforms that better align with the structural action areas of the Ottawa Charter (1).
Objectives
- Analyse constructions of maternal responsibility across policy, programs, and practice materials: A purposive sample of Australian perinatal policy documents, clinical guidelines, and health promotion materials will be analysed across key domains. Using Bacchi’s framework, critical discourse analysis, and QATCHEPP, this phase will identify how responsibility is framed and the extent to which structural determinants are addressed.
- Examine how these constructions are enacted in practice: Interviews with perinatal practitioners will explore how responsibility expectations are interpreted and operationalised, and what system conditions are needed to support more structurally informed care.
- Assess population-level patterns of maternal responsibility burden: A national survey of mothers with young children will examine the extent and distribution of psychosocial burden associated with perinatal responsibility, including variation across social and geographic groups.
- Co-design recommendations for system reform: Participatory methods with mothers and practitioners will be used to develop actionable recommendations across the Ottawa Charter action areas, supported by RLCHPM and QATCHEPP. Outputs will include practice guidance, service design principles, and policy recommendations.
Significance
This project addresses a key gap in Australian perinatal public health. While evidence consistently shows that responsibility is heavily placed on mothers across multiple domains, including smoking (6), vaccination (11), alcohol use in pregnancy (13), infant feeding (14), digital monitoring (15), and antenatal screening (16), no study has examined how this pattern is produced and sustained across policy, practice, and health promotion systems. Maternal responsibilisation has important implications for health equity and service engagement. Evidence links current approaches to stigma, reduced self-worth, and barriers to care, particularly among women experiencing disadvantage (5-8,11). Yet responses often focus on improving communication rather than addressing underlying system structures.
This project will provide the first integrated analysis of maternal responsibilisation in Australian perinatal public health, combining policy analysis, practitioner perspectives, and population-level data. It will generate a reform agenda explicitly structured around the Ottawa Charter (1), with direct relevance to maternity care policy, service design, and preventive health practices. The project also advances health promotion scholarship by applying RLCHPM (4) and QATCHEPP (10) to system-level analysis. Each phase is designed to generate a publishable output, supporting a coherent thesis with strong academic and policy impact.
References
- WHO (1986)
- Lupton (2012)
- Lawless et al. (2014)
- Gregg and O’Hara (2007)
- Yelland et al. (2012)
- Fletcher et al. (2025)
- Penman et al. (2023)
- Fox et al. (2021)
- Bacchi (2009)
- O’Hara and Taylor (2023)
- Blackford et al. (2026)
- Fairclough (2010)
- Keane (2013)
- Donaghue et al. (2011)
- Johnson (2014)
- Rollans et al. (2013)
Ideal Candidate
We seek a candidate with a background in public health, health promotion, or a related field. Strong writing skills, interest in policy and equity, and willingness to engage with both qualitative and quantitative methods are essential. Experience in research methods or familiarity with perinatal or critical health research is desirable. The candidate should be capable of independent work and collaborative engagement. Additionally, the applicants should meet the eligibility criteria for entry into a PhD program at Curtin University.
This project is open to International and Domestic applicants.
Internship
The project includes opportunities for engagement with health departments, primary health networks, and perinatal services through Collaboration for Evidence, Research and Impact in Public Health (CERIPH) partnerships. The candidate will gain experience in policy analysis, stakeholder engagement, and applied research, supporting career pathways in public health research and practice.
Scholarship
If you are identified as the preferred candidate for this project, you may be considered for an RTP scholarship.
Enquires and How to Apply
For enquires about this opportunity contact Dr Krysten Blackford at K.Blackford@curtin.edu.au
To formally apply submit an Expression of Interest to Dr Krysten Blackford during the Central Scholarship round (July 1st – July 31st 2026)