Regarding the UN Sustainable Goals of Well-Being, Gender Equality, and Climate Action: Reconsidering Reproductive Expectations of Women Worldwide

Abstract

Climate action represents the most comprehensive of the 2015 United Nations 17 Sustainable Development Goals (SDGs) in that climate change impacts all other goals. Urban overpopulation is a primary cause, as energy consumption is a significant source of carbon dioxide emissions directing climate change. The population increase origin is attributable to the agricultural/urban developments that became geographically widespread approximately 6000 years ago. Simultaneously, religious belief stressed multiple children, with women obligated to produce them. This female duty created gender inequality and reduced the health and well-being of women, as pregnancy is a noted risk factor for decreased lifetime health. Regardless of the detrimental risk to their health and well-being, the gender inequality, and the adverse effects of birthing multiple children regarding climate action, women today continue to feel obliged to reproduce appropriately. This burden requires change to meet the three sustainable development goals of good health and well-being (SDG 3), gender equality (SDG 5), and climate action (SDG 13). An author-developed mindfulness-based psychoanalytic narrative research method presents a means for promoting such change based on a qualitative narrative analysis of the responses of several participants regarding its success in clarifying the values of these women in overcoming career-related burnout.

1. Introduction

Women significantly are beginning to envision their role in climate change through their adherence to entrenched reproductive norms to the point of these considerations becoming an ideological dilemma where women are contemplating producing fewer children to improve the quality of life for all [1]. Such thoughts regarding the role of reproduction in creating climate change are part of a more extensive concern related to the dominance of humans over the environment in their continuing development [2].

The world climate is changing regarding multiple-year weather comparisons [3,4]. The most detrimental change is the rise in carbon dioxide in the environment, with its concentration growing at a rate of more than two ppm/y [5]. The increase in CO₂ is primarily the result of burning carbon-based [6] fossil fuels [7] to meet the energy needs of humans [8]. Consequently, human activities from increased population result in higher energy demand, increasing CO₂ emissions [9,10]. A common concern is that continued human population growth, leading to intensifying development, requires increased energy consumption, nullifying any gains from renewable energy production, use, and expansion [11,12].

Development is sustainable when it meets present needs without compromising future generations to satisfy theirs [13]. Although they are not the first global standards, building on the earlier Millennium Development Goals (MDG) [14], the 2015 UN Sustainable Development Goals (SDG) are considered the most comprehensive and detailed by the United Nations to promote sustainable development [15]—they number seventeen. The relevant SDGs regarding women’s reproductive choices are SDG 3 (Good health and well-being) and SDG 5 (Gender equality). Although numbered far along the list at thirteen, climate action represents the goal on which all the other goals depend, as the current planetary climate change is considered unequivocal [16] and is recognized to undermine each of the other sixteen goals [17].

Regarding the goal of climate action, there is a direct relationship between historical changes in population and human development causing climate change resulting from the introduction of agriculture [18]. Figure 1 [19] demonstrates the growth of the human population since 10,000 BCE, representing a super-exponential curve—hockey stick behavior with a sharp jump at finite times [20]. As a mathematical formula, the seeds for this growth are found at its beginning in 10,000 BCE [21,22] with the start of agriculture [23,24], but particularly in the changes noticeable with the wide-spread development of agriculture and urbanization approximately 6000 years ago at 4000 BCE [25,26].

With the spread of agriculture and urbanization around 4000 BCE, the socially prescribed requirement to populate the world simultaneously became specified in what would become religious text [27,28]. As such, following the prescribed order convinced women to provide the means to large families [29]. It is with this necessity for women to use their bodies to create large families that gender inequality became institutionalized by society [30]—an inequality the intention of which SDG 5 is to alleviate [31].

Society’s continuing encouragement of women for 6000 years to produce children is contrasted ideologically with acknowledging that pregnancy is a nontrivial aspect of women’s health. Health-related quality of life has emerged as a key factor regarding pregnancy for women [32] and represents an aspect of SDG 3. Yet, the reproductive relationship between women and men is complicated and bound by social conventions such that, in certain societies, there is early and coerced motherhood following menarche that affects women’s social status and well-being [33]. In a situation of an unwarranted pregnancy, a woman must weigh more than the costs and risks of pregnancy termination itself and decide in response to pronatalist norms and punishment if departing from those expectations [34], especially considering the shift of the last ten years in global policy away from abortion rights [35].

Various problems arise from the increased stress on women’s bodies from pregnancy. Hypertension leading to preeclampsia is a leading cause of maternal morbidity and maternal mortality, affecting up to 5% of pregnant women [36], as maternal mortality is high in women who develop heart disease during pregnancy [37]. Valvular heart disease with severe mitral stenosis or aortic stenosis is associated with significant maternal morbidity and mortality [38]. Pregnancy can also see the development of gestational diabetes [39], which converts to either or both cardiovascular disease and diabetes mellitus as the woman ages [40,41]. The increased caloric intake associated with pregnancy can lead to obesity [42], and this is considered the perfect metabolic storm for future metabolic disorders later in life [43]. Childbirth-related perineal trauma from vagina birth is exceedingly common [44]. Both it and the pressure on the pelvic area can lead to persistent urinary and fecal incontinence as well as pelvic organ prolapse [45,46], including entire utero vaginal prolapse [47]. Beyond the physical body, pregnancy often results in postpartum depression [48], further exacerbated by weight gain [49]. In all, the desire created 6000 years ago for women to produce large families by the strain it places on women’s health ultimately has led to calls by the UN for good health and well-being (SDG 3) and gender equality (SDG 5), in conjunction with climate action (SDG 13).

The reevaluation of women producing multiple children [50] is possible with the lessening of religiosity worldwide [51,52], yet the desire of women to give birth to several children persists [29], along with current opposition to active population reduction policies [53]. According to the most recent data available from 2022, high-income and upper-middle-income countries have procreation rates below two children per woman [54]—those from the middle range of incomes have fertility rates ranging from 2.2 to 2.7 per woman, while low-income countries represent 4.6 children per women. Based on these results, the women who need to consider their reproductive options regarding the three SDGs primarily live in densely populated developed areas of middle- and low-income countries [55].

Women rarely examine whether they want to become mothers and, if so, why [56]. However, women must be encouraged by society to reconsider their reproductive expectations regarding multiple children if there is to be support for good health and well-being, gender equality, and climate action simultaneously.

Reconsidering is a conscious act. As a conscious act, it is mindful, meaning fully engaged—differing from the lay understanding of the term that conflates mindful acceptance with disengagement [57]. Yet, mindfulness is well-cited as elusive to capture in studies [58]. In psychological research, mindfulness is a purposeful awareness of accepting stressful thoughts and feelings to facilitate engaged identification and exploration of adaptive responses [57]. However, studies often limit the definition to non-judgmental present awareness of physical, emotional, and mental states without identifying an adapted response as the purpose [59]. Mindfulness training then focuses on attentional control of internal conditions [60]. What is lacking from these mindfulness interventions is the added dimension of creating adaptive responses. In this regard, for an intervention to be mindful to help women reconsider their reproductive expectations, it must encourage their acceptance of themselves apart from a duty to reproduce. The need for creative solutions to support women regarding mindfulness in reconsidering their reproductive expectations is apparent [61].

This study examines one mindfulness-based intervention to help women consider their fertility by providing a structure to their thinking concerning their life goals. The design of this narrative research process is to reenergize researchers experiencing burnout. It permits the participant to understand what is of value to them in their life’s work. The hypothesis is that a mindfulness-based process effective in reducing burnout in researchers is similarly valuable to women in helping them become mindful of their fertility. The expectation is that demonstrating this would decrease the number of women who desire several children because of an urge to fulfill social expectations. The basis of this hypothesis is the observation that women participating in this process from 2015–2024 often considered their burnout related to their work as researchers as part of the issues regarding social expectations or evaluations of them as women.

This process is judged relevant to women in being mindful about their fertility because there are similarities between the expectations of women regarding pregnancy and those of researchers who become burned out. Both situations have standards, and the woman or researcher feels obliged to meet them. In the case of women and pregnancy, society has established the norm of considering pregnancy a woman’s greatest life fulfillment [62] so that the priming of women is to desire multiple pregnancies without introspection, as fertility has been characterized as essential to femininity [63]. For the burned-out researcher, there is no such suggestion that the standard the researcher feels unable to meet is what they most desire [64]. Instead, the standard to meet regards the goals of the research program. Consequently, this lack of social support for the importance of their research, in particular, is likely a reason women researchers burnout if they cannot meet the expected standard as researchers, creating the “mismatch” between the researcher and their job [65]. However, in common for both situations, there is a lack of mindfulness by the woman or researcher regarding the standards they expect they are to meet. In the case of women and pregnancy, their lack of mindfulness results in them doing the expected—having children. In contrast, by feeling they cannot meet the expectations of their work environment, the result is burnout for the researcher. Therefore, offering this process is a successful way of reducing burnout in researchers that may help women consider their reproductive goals by providing the opportunity to reflect on what their fertility means to them regarding their life expectations.

The presentation is of the responses of selected women researchers over ten years who have engaged in the mindfulness-based process. Those selected considered their research in a broader life context when reestablishing their research interest during the process. Revealed is the method and how it might be adapted to help women concerning their perspective on pregnancy. Women would become mindful of their reasons for reproducing by undertaking such a process. It is this type of mindfulness-based process that can support the good health and well-being of women, reduce gender inequality, and lead to climate action by questioning the current social preference of women to give birth to several children.

This study regards a new idea. The intention is to determine if it is reasonable and has the potential to help women mindfully consider their fertility. This work is significant because it is the first to examine the need [66] to reconsider women’s perceived social obligation to reproduce from the perspective of the three UN Social Development Goals of good health and well-being (SDG 3), gender equality (SDG 5), and climate action (SDG 13).

2. Materials and Methods

The method to gather the materials for this study is a unique author-developed narrative research process that examines varying perspectives of what a participant values in their life to make their experience understandable [67], comparable to recent narrative research directions [68,69]. The consideration is that when investigating a new idea such as this, narrative research is the most appropriate methodology [70]. In this way, data-inspection is stories regarding the relationship of the participant’s actions to their occurrence in a social context [71]. It represents a history taking in the psychoanalytic narratology tradition noted by Fludernik [72] as originating in the mid-1980s with works by Brooks [73] and Chambers and Godzich [74]. The aim is to investigate concealed aspects of the data to portray an individual’s history [75] by creating a structure for the thinking process. Narratology is a recognized humanities discipline that studies the practices, principles, and logic of narrative [76] as “chrononarratology” [77]. Although it has a history stretching back to the 1980s, significant contemporary work continues using the method of psychoanalytic narratology [78,79,80,81].

2.1. The Narrative Process

The Health Narratives Research Process (HeNReP) represents a longitudinal author-developed University of Toronto-affiliated one-on-one intervention for those self-identifying as experiencing research burnout [82]. The researcher experiencing burnout seeks out the intervention after becoming aware of it—previously through Department of Psychiatry advertising, currently through personal contact with the author, the facilitator of the intervention. One-on-one since the 2022/2023 academic year, the HeNReP evolved from the author-developed Health Narratives Research Group (HeNReG), a free-of-charge in-person group offering at the Toronto Mount Sinai Hospital from 2015–2020. COVID-19 restrictions were the cause of the group moving online to a yearly private Facebook group—the platform for the weekly group process from March 2020 until the end of the 2021/2022 academic year. Previous publications by the author regard the positive effect of the group process on reducing burnout [83,84,85,86,87]. The results of the one-on-one HeNReP over the last two years are available in a recent publication [88]. Historical analysis of the relevant documents associated with the two years of the one-on-one online process determines these results.

The HeNReP provides a structured questioning method to help those researchers who self-identify as experiencing burnout reconsider their relationship to their perception of themselves as a researcher. Commencing with asking a participant to describe themselves as researchers, the prompts that follow in the one-on-one online sessions as they proceed begin with the most objective and specific to those becoming increasingly subjective and general by following a set order of question-asking—when, where, who, what, how, and why. This technique has value because the perspective developed by the participant answering the questions represents their beliefs [82]. Answers given by the participant regarding the “when” questions relate to time. Answers to the ”where” questions come from identifying locations. “Who” questions elicit answers concerning people who affect the research endeavor of the participant. The answers to “what” questions offer the narrative story related to the organized knowledge of the participant [61]. “How” questions provide the techniques involved. Finally, “why” questions reveal the values guiding the participant research program.

Participants can complete this mindful activity without facilitated help once they understand the process and structure of questioning. Those most likely to be able to self-direct through this narrative research process are optimistic, possess emotional intelligence, and are resilient [89]. However, participants who seek out this intervention self-identify as burned out and are less likely to have these traits as a result [90,91]. For those unable to approach this process alone, the role of an empathetic and supportive facilitator in a private group is imperative [92]. Such facilitators demonstrate six facets in their relationship with participants. They (1) build trust, (2) enable, (3) inquire, (4) set the direction of the discussion, (5) identify the value focus, and (6) act as advocates for participants [93].

Table 1. The asking order of questions and the first word of each type of question asked regarding examples of the body of twenty-eight questions posed to participants of the narrative research process of both the HeNReG and HeNReP.

Order	First Word	Body of Question
1	Describe	yourself regarding your research related to health
2	When	were you first interested in your research topic
3	When	did you start to feel distanced from your research
4	When	did you think you might need help with your research
5	When	did you wonder if you were pursuing the right research topic
6	Where	do you go to devote time to your research
7	Where	are you most comfortable discussing your research
8	Where	do you feel supported for working on your research
9	Where	are you most frustrated in accomplishing your research
10	Who	has devoted time to helping you pursue your research
11	Who	has kept you away from your research
12	Who	do you want to impress with your work on your research
13	Who	has provided you with the most inspiration in your research
14	What	holds you back from finding time for your research
15	What	place gives you the most joy in conducting your research
16	What	could you do to inform others of your research
17	What	significant thing do you want to accomplish with your research
18	How	has time gotten away from you as a researcher
19	How	have you found a productive place to research
20	How	would you improve to reach others as a researcher
21	How	do you organize yourself to be most effective as a researcher
22	How	would you do things differently restarting as a researcher
23	Why	have you not spent enough time as a researcher
24	Why	do you think you need a new location to research
25	Why	are people not understanding you as a researcher
26	Why	is your research valuable
27	Why	do you need to find a new approach to your research
28	Why	are you reconsidering the reason you research

provides an example of the types of questions asked of participants throughout the intervention. The questions asked changed each year for the HeNReG and with each individual for the HeNReP. In the group form that was the HeNReG, there was a new question each week in a twenty-eight-session, in-person meeting. Questions were asked verbally by the facilitator, and participants responded in writing. Once the group process moved online, resulting from COVID-19 limitations, the weekly process of one question per week persisted; however, all aspects of the process were written and online. After the group process became the one-on-one online intervention of the HeNReP, the process timing depended on participant preference. This preference might mean completing several questions and answers in a day, or a question asked might not be answered for several weeks—all questions and answers remained written and online. Some participants opted to use Messenger as the app for the process rather than a facilitator-created private Facebook group.

There are several points regarding the questions asked in Table 1. The first is that the answer to the initial prompt by the participant—asking them to describe themselves as a health researcher—provides the context for answers that will follow. As such, one role of the facilitator is to remind the participants to answer the questions in the context of their description of themselves. The next point is that the questions develop from those that ask for objective answers to those that require increasingly subjective answers. Thirdly, the themes of the questions return to a reconsideration of the more objective answers from a more subjective point of view as the participant moves along in the process. For example, there is a relationship among questions 2, 6, 14, 18, and 23, as all of these questions concern time-related issues. Questions 3, 7, 15, 19, and 24 concern space-related matters. Questions 4, 8, 16, 20, and 25 regard the effect that others have on the participant research. What the participant is researching is the topic of questions 5, 9, 17, 21, and 26. There are four questions of those posed that number four—only “how” questions, and “why” questions number more. There are additional questions for “how” and “why” because they require increasingly subjective answers. It is these answers that are the most relevant to potentially decreasing the burnout of the participant; yet, they are the most challenging to answer for the participant in being burned out, requiring that they come later in the process and build up in their number slowly—providing the reason “how” questions are five and “why” questions six. Subjective questions are the most difficult for these participants because of emotional mismanagement in those identifying as burned out [94]. Thus, the process provides various opportunities for women to reconsider whether they want to continue their research careers.

2.2. Participants

Women who have felt burned out regarding their research have been participants in both the HeNReG and the HeNReP over the years. Partially, this burnout results from a lack of belief that they should be researching if they are mothers already or considering becoming mothers. Although the development of this psychoanalytic narratology process was not to help women reconsider their reproductive aims, regarding several participants over the years, it has done just that.

The women participants who commented on matters related to questioning themselves as researchers related to health while engaging in the mindfulness-based process equaled twenty-one in the academic years between 2015–2024. Some mentioned their concerns with motherhood directly. In others, the inference is indirect because the social expectation is for them to be mothers rather than researchers. The participants included undergraduate students, graduate students, administrators, researcher associates, and faculty of the University of Toronto. Seven were married—three of these had children. Sixteen participants were members of a HeNReG, and four participated in an individual HeNReP.

All participants in both the HeNReG and the HeNReP were provided with information regarding the process operation when they first contacted the facilitator to participate. Part of the information provided was that the process could stop whenever the participant desired and that there would be protection of the identities of each participant. The email sent by the woman to the facilitator to start the process represented the informed consent to participate. They agreed in writing that by participating, the facilitator could use the answers and yearly feedback they provided anonymously in academic presentations and publications.

The comments are from the records the author has kept as the facilitator of these processes. They are from two sources—the online Google feedback forms the participants completed after finishing the process and the private Facebook group comments made during the process by these women.

3. Results

The results concern the comments made by the various female researchers in chronological order over the years that, rather than focusing on being a researcher, have led the participant to think of why they are not a researcher (if already a mother), how being a mother has affected their research career or questions that might be related to avoiding motherhood. Reconsidering their role as researchers became prominent in the answers provided for these women. What these results demonstrate is that a method developed to reenergize researchers who feel burned out is one that indirectly permits women to reconsider their expectations regarding reproduction.

Table 2. Participant number, type of researcher, research area, year of participation, married (Y/N), children (n), program participation (HeNReG = 1, HeNReP = 2).

#	Type of Researcher	Research Area	Year	Married	Children	Program
1	Administrator	Community Health	2015	Y	3	1
2	Administrator	Health Arts	2016	Y	0	1
3	Administrator	Narrative Medicine	2017	N	0	1
4	Faculty	Palliative Care	2018	Y	0	1
5	Undergraduate Student	Socially Engaged Art	2019	N	0	1
6	Graduate Student	Health Leadership	2019	N	0	1
7	Research Associate	Pharmacy	2019	Y	0	1
8	Research Associate	Disability Studies	2019	N	0	1
9	Graduate Student	Psychology	2019	N	0	1
10	Undergraduate Student	Health & Immunology	2020	N	0	1
11	Undergraduate Student	Diaspora Studies	2021	N	0	1
12	Graduate Student	Psychiatry	2021	N	0	1
13	Graduate Student	Psychiatry	2021	N	0	1
14	Research Associate	Bioinformatics	2021	N	0	1
15	Undergraduate Student	African History	2021	N	0	1
16	Graduate Student	Narratology	2022	Y	0	1
17	Graduate Student	Mental Health	2022	Y	2	1
18	Undergraduate Student	Health and Disease	2023	N	0	2
19	Faculty	Psychiatry	2023	Y	2	2
20	Undergraduate Student	Anthropology	2023	N	0	2
21	Graduate Student	Social Work	2023	N	0	2

indicates the selected women who have participated in either the HeNReG or the HeNReP between 2015–2024.

The narrative results to follow from this select group of women regard comments that, over the years, women participants in either the HeNReG or the HeNReP have made relevant to a broader consideration of their role as researchers.

3.1. Reconsidering Being a Researcher

One result that can come from a mother participating in this process is that she can decide that the way to reduce her burnout related to research is to stop identifying as a researcher. In the first year of the operation of the HeNReG, 2015, this was feedback provided on the feedback form by one such mother representing participant 1.

The group was a good introduction to get me thinking on many topics and how to approach any given topic without it bogging me down. I have learned it requires patience and in research, one can never come up with 100% hard and fast conclusions on anything. I have also learned I am not really a “researcher” but the group has helped me to grasp that with any topic, research is very important. Learning to approach topics that have personally impacted me, objectively, has been of great value. If a person can overcome how one particular topic/issue has emotionally impacted them and become clear thinking and grounded on their experience, they can communicate better on how to help themselves and others who go through a like experience. Or simply use it as a teaching method. Writing narratives are also useful to sort out information and experiences. They are a great tool to use when approaching many subjects/situations. They help to solve puzzles and they surprisingly offer solutions and/or inspirations for the next chapter.

Non-mothers, divided between social expectations and their urge to be researchers, also reconsidered in what ways they might be researchers. The following academic year, in 2016, participant 2 reconsidered becoming a researcher. With group help, she was able to visualize herself as a researcher in a way she could not previously. “This group helped me learn about myself, my tendencies as a researcher and creator. It widened my perspectives through considering others’ approaches, and receiving group feedback on mine”. In 2017, participate 3 saw the HeNReG as a needed segway to more meaning in her career choice—and keeping her from motherhood—“I have been gathering research on narrative medicine, medical humanities, arts in medicine and creative/expressive writing for more than a year now. My goal, as shared in our first group session, is to find a meaningful way or ways to incorporate this into my career”. Another way that a participant reconsidered being a researcher was in recognizing, as did participant 4, in 2018, that self-reflection encouraged her evolution as a researcher “I think this group will help me engage in more self-reflection, which will strengthen the quality of my research”.

3.2. Self-Value

In spring 2019, regarding how the process was able to help women reflect on why they have a right to be researchers when responding to how the HeNReG was valuable to them as a researcher, participant 5 shared, “It provided me with a platform to be critical about my research and get feedback from the outside”. Participant 6 stated, “It helped me reflect on what I want to do”. Participant 7 stressed, “The group may help me to understand and respect other points of view and understand that we can ‘agree to disagree’”. Finally, participant 8 shared that it helped her in “being able to verbalize my ideas and experiences”.

Participant 9 began the new academic year, in October 2019, considering her self-value in response to the question “When do you feel unsure regarding your research related to health?”. “I feel the most unsure regarding my research related to health when I embody feelings of shame regarding my presence and worth. This is to the point where I subconsciously resort to internalizing other people’s perspectives as a coping mechanism. The work gets lost because the premise is that everyone else’s ideas are equally valid, but mine are inferior”.

That same academic year, spring 2020, participant 10 commented, “HeNReG has helped me reflect on the motivations behind my research and determine the directions that I want to take it in the future”.

During the pandemic, in the fall of 2021, women shared their experiences on their feedback forms regarding participating in the HeNReG and why it was valuable to them regarding their self-value. Participant 11 reflected “It helps me get out of my head and see new perspectives”. Participant 12 realized the HeNReG would be helpful to her in the future by “Challenging me to reflect on my experiences throughout the process of researching”. Participant 13 offered it “Allowed me to realize why I care about this work and what I have to bring to it”. Especially during the pandemic, without the process provided, participant 14 commented, “I would probably forget to do my research otherwise”. Participant 15 realized it “Forced me to make time to think about what direction I want to take in future research”. A final comment made in the fall of 2021 by the same participant 15, provides an overall summary of the value of the process, particularly in helping this woman respondent during COVID-19.

COVID-19 and the isolation and anxiety it brought highlighted a lot of very negative attitudes I had towards my education and my future. Even prior to the pandemic I found it difficult to look forward, ask myself questions, and prioritize my health and wellbeing. With isolation, I realized I had been so intensely geared towards producing that I had neglected every aspect of myself that I had not deemed useful in whatever I was doing at the time. It got rough. Although I still do struggle with that, finding time and understanding the importance of asking myself why and how and where do I as a person with history and heart fit, I do think that HeNReG has helped illustrate the importance of that. Putting the person back into the researcher. I think it is really cool and I believe it has really helped me understand that it takes conscious effort to unlearn all of the harmful ideas that have been injected into a lot of us.

3.3. The Influence of Why Questions

As the prompts that are the most subjective, the “why” questions are those that are inclined to lead to reconsideration by researchers. Participant 16, who left her husband at the end of the HeNReG process, had this to say, April 2022, in response to “Why have you been searching for an additional reason to continue with your research related to health?”. “Because I thought there must be a deeper reason than just being interested in what I research. I wanted to understand in a more profound way why I am doing what I am doing. Where this interest stems from and how it informs and is being informed by my values”.

3.4. Juggling Family and Research

October 20220, participant 17 recounted having to juggle home life with research, “there have been instances where I have had to leave everything aside and tend to a sick child but in the middle of it as well I have been able to attend to research work. So I have not really taken time off from research because of family”. This response was provided regarding the third “when” question, “When did you put your family before your research related to health?”.

3.5. Negative Advice from a Counselor

In one instance, in February 2023, a “who” prompt revealed that participant 18 had been advised not to concentrate on research—presumably because having a family was likely her ultimate choice. The question asked was, “Who do you wish you had not met regarding your research related to health?”.

A person I wish I had not met is a counselor I met with in my first year at U of T. In my first year, I was not doing well at all mentally and academically; which is something I think a lot of students go through, but I did not know that. I decided to try and pick myself up the best way I could, and started reaching out to faculty members, counselors, and taking appointments with them. I met with a counselor who I asked for advice about my first year, when I was still in the beginning of my second semester. She was very nice and considerate; however, it felt like the chat was not personal, and that she was just reciting the same conversation she says to every student she meets with. At this time, I needed encouragement and comfort, as it was just the beginning of my health-related journey; yet she did not provide that, but instead told me in a way that I could not get where I wanted to be, and that it is too late for me, which was not true. After the conversation, I thought what I liked doing was not for me. I wish she had let me know that it was just the beginning of my journey, and that if I put the effort in, I could have picked myself up and done better academically.

3.6. Recognizing a Deeper Problem

Another type of reconsideration that happened for a mother, this time while participating in the HeNReP in October 2023, was participant 19 realizing that her research suffered after the birth of her first child because of the sadness she was experiencing. This answer came in response to the second “when” prompt designed specifically for her by the facilitator—"When did you start to witness a connection between your mind and your body regarding your research related to health?”.

Sometime after having my first child, my husband tried to gently broach the topic of my “fatigue” and irritability being more a result of unexpressed sadness rather than simply an issue of lack of sleep. I would often blame my moodiness and lack of energy on late bedtimes. In truth, he was right but it took many years to be able to acknowledge and understand the unresolved trauma and its impact on my physical state. This was not the first time he had tried to point this out, but by this time I had done several years of intensive therapy and trained as trauma therapist, so had gained tools to be able to receive his words and perspective and process them in a forward moving way.

3.7. Confronting Self-Doubt

More than one woman researcher who had not birthed children commented on their self-doubt regarding their ability to be a researcher when providing feedback during the 2023–2024 academic year as part of a HeNReP. Responding to how the HeNReP might be of help to them in the future, participant 20 answered, “It helped me remind myself that I am much more capable than I think, and know that I have written down what I am interested in health research, it will be nice to be able to go back to that response when I am doubting myself”. Participant 21, when offering her comments on the experience of participating in the HeNReP, stated, “This has been really helpful, some grief popped up before as learning this way feels natural and would have been wonderful in high school to do things a bit different. Thank you ”. Both these women were burned out as researchers because they did not know if they had a right to continue as researchers given social expectations of them.

3.8. Summary

The HeNReG and the HeNReP were developed as ways to lessen research burnout. They were not designed to differentiate responses by sex. However, women participating in the process over the years took the opportunity to respond to prompts in a way particular to their social expectations as women. Their responses are grouped chronologically. They can also be grouped by the similarities in the content of the themes. This content ranges from those women who: have given up on research, are in a quandary about their research, focus on others as thwarting their research, and are doing their best to meet social obligations regarding motherhood while remaining a researcher,

Participant 1 is a mother of three who has given up on thinking she is a researcher. She represents women who give up on research because of their social obligations as mothers. Those women who are unsure of their abilities as researchers include three types: those who are reconsidering being a researcher—participants 2–4, those questioning their self-value, representing the majority of these women—participants 5–15, and those confronting their self-doubt—participants 20 and 21. Two participants saw others as the catalyst for their being unable to continue with their research by making them question their social responsibilities—participant 18, who received the negative advice from a counselor, and participant 16, who felt that the entrapment of her marriage and the social expectations that it demanded were sufficient to keep her from her research. Finally, participants 17 and 19 represent women who are doing their best to simultaneously continue their careers as researchers while meeting the social obligations of women as mothers.

What these comments together indicate is that there is no easy solution for women who choose a life path that differs from motherhood. Although each left either the HeNReG or HeNReP process with a greater understanding of their relationship to their research, for some, the realization of their dilemma meant they were unable to complete the process, expressing guilt and shame as a result [88].

4. Discussion

Neither the original HeNReG developed for in-person group meetings nor the one-on-one online HeNReP were created for women to reconsider their reproductive expectations. However, the finding is, over a decade of this question-asking process representing psychoanalytic narratology, that women who self-identify as experiencing research burnout are reconsidering what they value in life more generally. In doing so, these women may come to decisions regarding their reproductive choices.

The suggestion is that this process, in either form, is the type of mindful activity meeting the conditions for encouraging a reconsideration of reproductive expectations.

The importance of mindfulness in women making decisions regarding their fertility to reduce gender inequality has been noted [94]. This mindfulness must extend to considerations regarding the health and well-being of women—particularly concerning cardiovascular health—across the lifespan related to “female reproductive milestones” [95]. Perhaps even more importantly, mindfulness is necessary for reconsidering the reproduction expectations of women concerning climate action. As one researcher has noted, “There are plausibly too many sexist, racist, classist, and eugenic outcomes in demanding people limit their procreation to one child” [96]. The suggestion by the author of this statement is that people require help to develop their ability to think through procreation rather than putting limits on fertility. Developing a mindfulness-based process following the example of the HeNReG and HeNReP is one way this thinking-through can be accomplished.

4.1. A Health Narratives Pregnancy Process

A mindful approach to fertility considerations has been presented as the preferred way to meet each of the three SDGs of good health and well-being (SDG 3), gender equality (SDG 5), and climate action (SDG 13). The author-developed psychoanalytic narratology process of the HeNReG for groups and the HeNReP for one-on-one interventions is specific to researchers experiencing burnout. However, from the results, this questions-asking method can create the conditions for women to consider their overall goals in life. As such, it is reasonable to suppose a similar process specifically for women to be mindful regarding their fertility would be relevant for responding to the three SDGs. This process might be named the Health Narratives Pregnancy Process (HeNPreP).

Table 3. The asking order of questions and the first word of each type of question asked regarding examples of the body of twenty-eight questions posed to women participants of a HeNPreP devoted to reconsidering their reproductive expectations.

Order	First Word	Body of Question
1	Describe	yourself regarding your potential to become pregnant
2	When	have you thought about how long pregnancy lasts
3	When	did you consider where you would live if pregnant
4	When	did you visualize the ideal man to impregnate you
5	When	have you worried about the possibility of pregnancy
6	Where	could you get help most quickly if you were pregnant
7	Where	would you go to determine if you were pregnant
8	Where	is the healthcare provider you would go to if pregnant
9	Where	do you go online to get information about pregnancy
10	Who	has spent time with you talking about pregnancy
11	Who	would give you a place to live if you were pregnant
12	Who	would tell others about your pregnancy
13	Who	has offered you valuable information about pregnancy
14	What	would you do during the nine months of pregnancy
15	What	would be comfortable in your home if you were pregnant
16	What	support would the father provide if you were pregnant
17	What	would you do if you were pregnant
18	How	would you organize your time commitments if pregnant
19	How	would you meet with your healthcare provider if pregnant
20	How	much would you tell the father about your pregnancy
21	How	would you know if you wanted to be pregnant
22	How	do you decide what information is relevant about pregnancy
23	Why	is this not the right time to be pregnant
24	Why	do concerns about the earth matter regarding pregnancy
25	Why	is there tension between men and women about pregnancy
26	Why	does it matter what you would do if you were pregnant
27	Why	should you know the health-related issues of pregnancy
28	Why	are you reconsidering your responsibility to be pregnant

presents an example of possible questions during the 28 sessions of such a HeNPreP. Regarding these pregnancy-related questions, the woman would begin by describing herself as someone with the potential to be pregnant. The answers that follow would concern her view of herself in this regard. The initial questions regarding time, space, people, and content are the type of concerns the woman would need to face if she were pregnant or desired to be so. The “how” questions direct the woman to take a more comprehensive look at her potential pregnancy regarding problem-solving techniques. Finally, the “why” questions bring to the woman’s notice the concerns of the three SDGs, providing the opportunity to consider pregnancy from a broader perspective of health and psychosocial matters. Similar to the questions provided in Table 1, the first four questions of all six types of questions follow the order of (1) a time-related question, (2) one concerning space, (3) one involving people, and (4) a question on what represents the potential pregnancy. For both the “how” and the “why” prompts, an additional question concerns how to approach the pregnancy. Finally, for the “why” questions alone, there is a meta question regarding the purpose of this mindfulness endeavor for the woman about her reconsidering her reproductive expectations.

This structured method is offered here to all women during their reproductive years to help them understand what they value concerning their ability to reproduce without expecting that they must procreate to the extent they believe socially acceptable. Unlike either the HeNReG or HeNReP, intended for researchers experiencing burnout, this HeNPreP is valuable to any woman of reproductive age. As such, women without burnout have a greater likelihood of completing the process on their own, without the aid of a facilitator [89] than women who self-identify as burned out [83,84]. For women who recognize themselves as burned out and unable to complete the process alone, an empathetic facilitator [86] who would supportively pose the questions is the suggestion [92].

4.2. Comparison of the Proposed HeNPreP with Other Health-Related Theories

The proposed HeNPreP, although mindfulness-based, would not be equivalent to using mindfulness practices regarding fertility-related decisions. Mindfulness practices specific to fertility decisions have a recent summation including the following aspects, as quoted from [97].

• Awareness; attention; choosing to focus on something without judgment
• Noticing a thought or feeling (then maybe choosing to focus on something else)
• A part of living an effective life; often a first step in using other skills
• A skill that requires much practice
• A capacity everyone has (whether you know it yet or not)
• Choosing to try to keep your focus even though distractions will probably arise again and again.
• Mindfulness involves noticing the wandering and gently guiding your attention back to your chosen focus
• An exercise that involves full participation and acceptance of “what is,” which at any given time could be a state of tension
• A non-judgmental acceptance of reality (even though it may lead you to make changes)
• Enables us to relate in a new way to the things that trouble us, rather than trying to make them go away

In contrast, the HeNPreP would be more structured—yet less demanding in time and focus than mindfulness practices regarding fertility. The two types of mindfulness-based practices are similar in that both promote choosing to attend to something without judgment—defined as noticing the thought without distraction—to accept reality. However, devoted mindfulness practices view such attention as requiring significant and persistent practice to produce the desired change [98]. With the mindfulness-based HeNPreP, creating change requires responding to a set number of ordered prompts in stream-of-consciousness writing, where the prompts ask the most objective questions first, then those that ask increasingly subjective ones. Unlike devoted mindfulness practices used in fertility research [97], which require a life-changing commitment that may be impossible to achieve [99], the HeNPreP would take 28 sessions and could be engaged in however often the participant chooses by proceeding in an orderly progression through a new set of prompts. The accomplishment can be self-directed of the initiation of the HeNPreP and the design of the prompts after learning the method. However, burned-out participants in the HeNReP have noted that the facilitator is essential to them in considering they can continue with the process [100].

A comparison of the proposed HeNPreP method is relevant with other non-mindfulness-based methods employable to help women reconsider their role in reproduction. In particular, fertility educators rely on these three theories—the Theory of Planned Behavior, the Social Cognitive Theory, and the Health Belief Model [101].

Ajzen’s Theory of Planned Behavior is widely used in health education [102]. In this theory, behavioral intention determines behavior, dependent on attitude, the subjectively perceived norm, and behavioral control. Attitude relates to feelings towards the behavior, determined by beliefs and evaluations of the outcome. Normative beliefs, like perceived social pressure to adopt the behavior of significant others, define the subjective norm. Beliefs affecting the behavior performance difficulty determine the feeling of behavioral control. This theory has been well-employed in recent fertility research—particularly regarding contraceptive use [103] and elective egg freezing [104]. However, although this theory has predictive power regarding women’s reproductive decisions, what it does not do is promote a means to increase the self-direction of women in mindful consideration of their reproductive options. Instead, health programs adopting this theory accept women as other-directed in their behaviors, providing advice and solutions based on this other-directedness in a way that the HeNPreP would not by supporting self-direction in women.

In contrast, the Social Cognitive Theory by Bandura [105] views women as agents in their behaviors. This theory stressing self-efficacy—the individual’s belief in their ability to perform a behavior—is the most widely used health-related theory in the United States [106], and the concept of self-efficacy is the focus of studies on the experience of infertility [107]. However, this agency depends on women learning from each other through deliberative and mentally costly processing by consciously weighing images and information to decide a course of action. As such, this self-efficiency is only created in necessary situations [101], explaining why Social Cognitive Theory is the most widely used theory regarding contraceptive use [108]. The HeNPreP would, in comparison, be a less taxing and more inviting method for women who are considering the multi-faceted, personally and socially meaningful outcome of their fertility choices.

The Health Belief Model is a psychological theory of change in health behavior. It considers that change in health behavior arises when people feel personally susceptible to severe health risks, and the benefits outweigh the barriers in the preventative change [109]. This model views the fertility decisions of women as made only when they feel forced, and there is a perceived benefit in making a change. As such, women are considered unable to focus their attention on significant fertility matters unless under pressure to do so. This theory abandons the acknowledgment that women can self-direct their thinking regarding fertility, considering that only self-efficacy will create the degree of energy needed to make a change [110]. It is at the point of considering that women can mindfully self-direct their decisions regarding reproduction that the HeNPreP would begin, contrasting with this theory.

4.3. Mindfully Considering Their Options Helps Women Plan Families

The HeNPreP is offered as a method to help women reconsider their socially imposed role to reproduce given the effects of pregnancy on their health, the sexual inequality that accepting these norms without question produces, and the role of over-population in creating climate change through persistent development requiring increased levels of CO₂ production. The question is, would such a method be successful in helping women as anticipated?

There are no studies regarding the HeNPreP in this regard, as this is a new idea that originates from this article. However, there are comparable methods designed to help women in countries that are seeing a decrease in their population to reconsider their reproductive choices mindfully. Italy, for example, is a country where the selection of women is to have fewer children to the extent that there has been a persistent decrease in the population [94]. According to this study, SDG 5 (gender equality) is from the perspective of women wanting to have at least two children, but for economic reasons related to gender inequality, they are unable to afford to do so. From the perspective of helping women make mindful decisions regarding family planning, the finding is that when provided with a mindfulness-based approach, women can see how they can accomplish having their desired number of children. Mindfulness-based processes have helped in family planning in China [111], where the previous one-child policy has resulted in a consequential population decrease, and in Iran, where one child is now the norm [112]. This latter publication includes a study in Iran that has shown mindfulness-based programs can significantly reduce pregnancy-related anxiety. The expectation is that the desire of women to have more children will increase.

These recent examples of research demonstrate that mindfulness-based processes can help women reconsider their expectations regarding their fertility. However, in that this research regards the aim of having women increase the number of children they birth, it is clear that the arrangement of mindful-based practices can be those fitting the social intention. This, although the aim is to meet all three SDGs—3, 5, and 13. The results of these studies demonstrate that the mindfulness-based program must not intend to influence the thinking of women in a socially advantageous manner. Instead, the appropriate mindfulness-based practices help the woman thoughtfully consider her relationship to pregnancy from all perspectives in a self-directed manner. The offering of the HeNPreP is regarding a mindfulness-based process of this order.

4.4. Limitations

The proposed mindfulness intervention is psychoanalytic narratology—a method depending on the empathy of the facilitator (if used) and the woman in reconsidering her reproductive expectations for its success [113]. Without the required level of empathy, this form of intervention is not likely to succeed. As such, the necessary mindfulness regards answering the questions posed and concerns an empathetic acceptance by the woman of the answers she provides. This double layer of mindfulness is why process facilitation is advisable if the woman self-identifies as burned out. With the necessary empathy, a psychoanalytic method productively broadens horizons in confronting challenges concerning future-related problems and processes [114].

The result of following psychoanalytic narrative research by one researcher at one academic institution where participants were assured anonymity is that the data lack transparency and are susceptible to subjective interpretation [115]. Validation of this method will require replication by researchers at other institutions. The absence of such independent validation diminishes confidence in the methodology’s applicability to this subject and risks a generalization error [116].

In presenting this mindfulness intervention as a reasonable approach to helping women become mindful about their fertility based on the effectiveness of a process for reducing burnout in women by their reassessing their role as researchers in a society that does not encourage them to research, this work lacks practical advice on accomplishing this. It does not attempt to guide program decision-making, process delivery, or policy development related to it. The reason is that the aim was limited to initially demonstrating the idea of a HeNPreP to be meaningful in helping women mindfully consider their reproductive options. The consideration is that the narrative research represents the appropriate methodology when presenting this as a new idea [70]. The next step is devising the means to encourage women to participate in HeNPrePs. It is a limitation of this work that it does not take that next step. Future research in this regard would examine the global introduction of this process, considering but not limited to matters involving funding, training, infrastructure, communications, management, support, and accessibility. In meeting SDG 3 and SDG 5 to work towards SDG 13, it is most relevant to determine who this intervention would best serve in respecting the sociocultural differences among women of reproductive age.

5. Conclusions

Meeting the challenges of good health and well-being (SDG 3), gender equality (SDG 5), and climate action (SDG 13) fundamentally requires that women reconsider their reproductive expectations as the overpopulation of urban areas is a primary reason for the climate changes that affect each of these goals. However, rather than placing limits on procreation, especially as high- and upper-middle-income countries have seen a significant decrease in their population already, this study has presented a mindfulness-based, psychoanalytic narratology method for helping women make an informed choice regarding their reasons for reproducing. The hypothesis was that the author-created mindfulness-based process for reducing burnout in researchers might be similarly valuable to women in helping them to become mindful of their fertility and that doing so would decrease the number of women who desire several children merely because of an unexamined urge to fulfill social expectations. The hypothesis was tested with psychoanalytic narratology examining the relevant responses of twenty-one women who participated in this process from 2015–2024, in which it was observed that these women often considered their burnout related to their work as researchers as part of larger issues regarding social expectations or evaluations of them as women. As such, there is good reason to suppose that a similar process directly relevant to considering pregnancy would be useful for women in mindfully considering their reproductive options. The recommendation is that by considering the broad implications of pregnancy on their lives, their bodies, their relationships, and on the earth, women can make the type of decisions regarding their fertility that improve on all three of these SDGs and the Health Narratives Research Process (HeNPreP) method proposed is an effective way that this can be accomplished. Suggested future research directions are for researchers to examine the outcome of women who use the structured narrative process offered, including a comparison of those women who undertake this process alone with the outcomes of those collaborating with a facilitator.