Miscarriage occurs in 10–25% (or more in older women) of all diagnosed pregnancies – Science Direct
When the joy of pregnancy gives way to a spontaneous abortion (miscarriage), the suddenness of the traumatic experience can cause a spiral of grief, guilt, and depression. While the psychological ramifications the mother goes through is frequently palpable, the grief often extends to their partners and respective families. According to clinical psychologist, Daanesh Umrigar, “There’s a lot of stigma attached to it… Motherhood and death… Two basic things that cause a lot of conflict for the individual. Couples also tend to keep it hush-hush.” Media professional, Rizoota Kashyap Chaubey, was heartbroken after her miscarriage, but she says, “It got me and my hubby closer, to understand life and the importance of it.” For some, the trauma of pregnancy loss can extend for months according to the International Federation of Gynecology and Obstetrics, with miscarriages leaving in their wake “30 – 50% of women with anxiety and 10 –15% experiencing depression.”
With 5 miscarriages in 4 years, it has been difficult for Marketing Merchandiser, Anupama Maurya Chugh: “I have done all required investigations. Every time, I followed all advised instructions; but every time we failed. Now I’m left with lots of sorrow and pain.” Umrigar has found that, “Often, they try immediately afterward… Two things: ‘are they biologically ready and are they psychologically ready?’ and ‘even if the child is unborn, it does not mean that the mother has not internalized the grief.'” Despite the possibility that 1 in 4 pregnancies could result in a miscarriage, policy interventions facilitating psychological support are inadequate, and Sanghamitra Acharya suggests that “the support of bereavement arising out of early deaths does not form a part of any (Indian) policy including the Health Policy of 2017.”
With a woman’s identity largely structured around motherhood in India, the psychological impact of social response to a miscarriage influences the woman’s experience of grief and is often a barrier to emotional recovery. Stepping out after almost 2 months since her pregnancy loss, Composting & Gardening coach Priyanka Kumari encountered “rumours… that she is careless, she is into all forest, soil trees, insect, and weird stuff, so she didn’t take care.” Priyanka says, “Neighbours were a little empathetic, but they too gave unsolicited advice. In my experience, out of 100, only 5 % people felt my pain genuinely and didn’t judge me, didn’t make stories.” Umrigar says, “Social reaction could lead to internalization of the grief.” Those experiencing recurrent miscarriage like Anupama have it worse with the stigma of pregnancy loss exacerbated in a largely traditional society like India.
In case of women from less-advantaged socio-economic sections of society, a miscarriage changes power equations within the household as well. Researchers Lisa Roberts, Barbara A. Anderson, and Susanne B. Montgomery assert that “for poor women with low autonomy and low education levels, from low castes, who are socially isolated and highly dependent on their husbands, fertility is ubiquitous to their identity and worth.”
Self-image as derived from social identity is crucial in emotional recovery from the grief experienced as a result of miscarriage. Social derision or lack of empathy adds to an Indian woman’s trauma of pregnancy loss. While Anupama had her husband’s support, she says, “Only my family and few of my close friends supported me… otherwise, everyone… either office colleague, relatives, neighbours… is still asking me when will we have baby. That is the reason I have stopped/ reduced attending any family function, social gathering, or other ceremonies.” Additionally, those who empathise with the women experiencing miscarriages often are ill-equipped to provide emotional support.
In many countries, memorial ceremonies are held to bring closure to losing the unborn child which include naming the baby and planting a tree in their memory. Umrigar suggests to support the individual, “Allow the person to go through the grief. Don’t push it under the carpet. Allow the person to talk, talk about their emotions. If the person is crying, it’s fine… it’s an expression of emotion. Don’t alienate the person, don’t let them feel like they are going through it alone. Social interactions should be such that they are supportive and also productive for the individual… even if the person doesn’t feel like going out, (you could consider) coming over, being there for the person.”
Ultimately, it is essential to ensure the mother does not blame herself for the pregnancy loss, as many are prone to do. With non-invasive prenatal screening (NIPS) available nowadays, it is also possible to identify potential risks early to be better prepared for possible eventualities. Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School, suggests that “Exercise supports nerve cell growth in the hippocampus, improving nerve cell connections, which helps relieve depression.” In the aftermath of a miscarriage, it is essential that individuals allow themselves to go through the bereavement process and slowly get involved with activities that motivate them out of the spiral of grief or guilt. As social awareness regarding mental health improves in India, there is hope that women will have increased support through such traumatic experiences which often have a deep psychological impact.
Special thanks to Malini’s Girl Tribe and Miss Malini for their assistance.