Monday, 12 May 2014

Shame, stigma and mother-blaming following miscarriage

Imagine having a miscarriage and keeping it secret because you’d get the blame for your pregnancy loss? We might believe that only happened in the past, but it is a situation faced by countless women every day. And, like miscarriage itself, it remains taboo to talk about.

Miscarriage is a common event. Around 1:4 pregnancies end in this way. Yet worldwide we remain poor at supporting women and their partners during and after miscarriage. This can be particularly acute in communities where access to health services are limited, which in turn can exacerbate physical and psychological recovery after pregnancy loss.

These issues are sensitively explored by Dellicour and colleagues who invited 90 women from Rarieda District, Nyanza Province, in western Kenya to talk about conception, pregnancy, birth, disability and loss. These focus group discussions included teens, women of childbearing age, pregnant women, Nyamrerwas (traditional birth attendants) and mothers of children born with a congenital abnormality.

Despite awareness of different reasons a woman might miscarry (both accurate and inaccurate) a strong sense of women blaming ran throughout the participants narratives, which has implications for both disclosing and seeking help during or after pregnancy loss.

Infidelity in particular was negatively associated with miscarriage – participants suggested either that conceiving a child with someone who wasn’t your husband could cause congenital abnormalities or a miscarriage, or sleeping with someone else while pregnant with your husband’s child could do the same. Other blame-related factors linked to miscarriage included women or their partners not respecting ‘tradition’ (for example failing to pay a bride price or building a new home), or being cursed or possessed.
Women and their partners remain uncertain
how to communicate together or move on following loss
Miscarriage is well noted for affecting relationships. Women and their partners remain uncertain how to communicate together or move on following loss. In cultures where blame and shame is strongly associated with miscarriage this can be compounded, as it is difficult to support your partner if you believe she has lost a baby due to infidelity or being cursed. Links to increased familial violence go with miscarriage in such cases, and may extend to those who’ve had children born with congenital abnormalities which may be viewed as a sign of the mother’s wrongdoing, coupled with the child being viewed as a burden on the family.

Participants in this study talked of women who’ve miscarried being distanced from their families and existing children until they’ve either been ‘cleansed’ by a spiritual healer or the church. Another view was that those who have miscarried should stay away from pregnant women in case they cause them to do the same. All of this results in situations where women who’ve miscarried (and may be in distress) are isolated, stigmatised and prevented from seeking help, if any is available – in many cases it is not.

The paper clearly unpacks the barriers faced by women in rural Kenya and recommends an informational approach to addressing their problems, but it would have been good to also hear more about how these issues might be addressed in practice. I hope the researchers are able to follow this paper up with more practical guidance around how communities, media charities, NGOs, healthcare and therapy providers might find ways to unpack and address the blaming, shaming and silencing of women during and after miscarriage.

Dellicour S, Desai M, Mason L, Odidi B, Aol G, Phillips-Howard PA, Laserson KF, & Ter Kuile FO (2013). Exploring risk perception and attitudes to miscarriage and congenital anomaly in rural Western Kenya. PloS one, 8 (11) PMID: 24236185

Post written for the BPS Research Digest by guest host Petra Boynton, Senior Lecturer in International Primary Care Research, University College London and the Telegraph's Agony Aunt.

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