Bereavement

Illustration by WHO, 2019

The unacceptable stigma and shame women face after baby loss must end

By Dr Nono Simelela

Too many babies still die in pregnancy or childbirth. The numbers are heartbreaking: approximately one in four pregnancies end in miscarriage, generally before 28 weeks, and 2.6million babies are stillborn, half of whom die in childbirth. Many of these deaths, especially the stillbirths, are preventable with effective care during pregnancy and childbirth.

Whatever the circumstances surrounding the loss of a baby, every single woman deserves respectful and dignified healthcare that acknowledges her loss, provides support for any psychological issues she may face, and empowers her to make future decisions about having a child. Any doctor who has had to communicate the loss of a baby to an expectant mother witnesses the pain in that mothers’ eyes. It is not a sight for the fainthearted.

Women still face enormous stigma and shame when they lose a baby and they are often not encouraged to talk about their experience and loss. This can lead to isolation and disconnection, even from their partners and close family, and means that women end up trapped in their own personal grief.

Such compounded pain is unacceptable.

This is why we have worked on guidelines for healthcare professionals on how to provide respectful care during pregnancy and childbirth, including guidance on how to deal with miscarriage or stillbirth. The Network for Improving Quality of Care for Maternal, Newborn and Child Health, which currently has ten participating countries was established to ensure that women receive the highest quality of care during pregnancy and childbirth.  We know how to tackle mental health conditions that are connected with pregnancy, including anxiety, depression and post-traumatic stress disorder.

Respect and autonomy are central to women-centred care. Young girls must be protected from harmful practices such as child marriage and female genital mutilation, and women need to be in control of their sexual and reproductive choices from adolescence, through pregnancy, and beyond. Culture, socio-economic circumstances and social norms should not deny women the right to control of their reproductive lives.

Not all pregnancy loss is inevitable. We have a wide range of tools and protocols which if appropriately deployed could prevent at least 1.3million stillbirths. Some of these include, ensuring early diagnosis of pregnancy, proper screening for any medical conditions which may have a negative impact on pregnancy outcomes, monitoring the baby’s heart rate during appropriate times during pregnancy and throughout labour,  treating infections such as malaria and syphilis, and good surveillance during labour.

Ensuring a healthy pregnancy requires that women have access to effective antenatal care right from the start of her pregnancy, be able to access care in the community, and have midwife-led continuity of care where possible.

Nurses and midwives can be critical allies for women, and this is one reason why WHO has designated 2020 the Year of the Nurse and Midwife, which will coincide with the first-ever State of the World’s Nursing report. In low-income countries, increasing the care provided by midwives by just 10% could reduce the number of stillbirths by a quarter.

It is fundamental that human rights are the foundation of healthcare provision. Women must be in charge of their own bodies. Women and their babies must not just survive pregnancy, they must be supported to ensure their babies thrive and grow to their full potential. Pregnancy must be a positive experience for mothers and babies – when that isn’t possible, then women deserve our empathy, respect and support.

 

This blog was originally posted by the World Health Organization here.

About the Author

Dr Nono Simelela is Assistant director-general for family, women, children and adolescents at the World Health Organization.


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