Electronic media use by first ladies dates to the 1930s when Lou Hoover delivered her first radio address. The development of radio and television—and later social media—placed a greater emphasis on image and personality, giving first ladies the opportunity to be heard as well as seen, and in some cases offering them more control over their messaging. This chapter looks at several notable examples of how first ladies strategically used—and in some cases misused—electronic media to shape their public image, support their husband’s programs, and advocate for their own causes.

Put simply–although nothing about it is simple–public diplomacy is diplomacy carried out in public, as opposed to most of diplomacy, which is done in private. It is a set of activities that inform, engage and influence international public opinion to support policy objectives or create goodwill for the home country. It is important to understand what public diplomacy is not. It is not an advertising campaign to get foreigners to like your country–even if they dislike it, they can still support, or at least accept, a particular policy or action. It is not a propaganda effort to mislead or lie to audiences for tactical or other advantage. It is a sustained endeavor that advances your country’s policies and reflects a solid understanding of the host-country’s language, culture, history and traditions. Both public diplomacy and propaganda are means to project power.

In 2012 the Enquiry moved to the National Perinatal Epidemiology Unit (NPEU) as part of MBRRACE-UK. CEMD Reports became annual and included near-misses. Life-threatening complications are 100 times commoner than death in pregnancy. In 2005 the NPEU had established a surveillance system through which all obstetric units notify uncommon complications. This facilitated a Confidential Enquiry into Maternal Morbidity, which identified an increase in severe haemorrhage due to abnormal placentation, and inadequate treatment of breast cancer due to withholding drugs in pregnancy. Positive trends included better long-term results of treating psychosis. The Enquiries’ work was hampered by NHS bureaucracy, the need for recommendations to be cost-neutral and a media embargo – even though the CEMD had shown that public information is vital for improving safety. Recently the CEMD revealed an increase in deaths from sudden death in epilepsy (SUDEP) due to withdrawal of medication in pregnancy, and continuing disparity in mortality rates between ethnic groups in the UK. Structural biases in the maternity care system persist, as shown by Black Lives Matter movement and the COVID emergency.