Miscarriage: how we stigmatise uncontrollable trauma

If a miscarriage is beyond the control of an expecting mother, why do we blame her for it?



As soon as a girl is married, she is barraged with embarrassing questions as to when she will conceive a child. The frequency of such questions and their underlying fervour imply that pregnancy is somewhat sacred, nothing short of a blessing.

Ever notice how expecting mothers do not disclose their pregnancy until way past the first trimester? That is a consequence of such a mindset. Once the initial stages have passed, women rarely have a problem with speaking about pregnancy, morning sickness and delivery options, etcetera. Everything under the sun, from potty training to nursery decorations is discussed. But when it comes to one aspect of motherhood, everyone falls silent.

It is surprising that the topic of miscarriage still evokes such fear and rejection among women, regardless of their social class. This stigmatisation of miscarriages — which, medically and logically speaking, are beyond an individual’s control — leads to the demeaning of women everywhere.

What is miscarriage?

Although every woman has a different experience of a miscarriage, the typical physical symptoms include cramping and bleeding. This is contingent upon a variety of factors, such as the stage of the pregnancy as well as medical history.

According to the Medical Encyclopaedia of the United States Library of Medicine, a miscarriage is a spontaneous loss of the developing foetus usually within the first 20 weeks of a pregnancy. Almost half of miscarriages occur even before a woman knows she is pregnant. “My patients are often concerned about whether any of their routine activities or eating habits could have been one of the causes of the miscarriage,” informs Dr Shameem, a gynaecologist and private practitioner. “However, the major cause is a chromosomal inadequacy,” she adds. Scientifically, when a foetus has an inadequate number of chromosomes, it begins to separate, therefore causing external bleeding.

Moreover, other causes such as unprompted termination of pregnancy due to excessive drug usage or smoking can also lead to a miscarriage. Infections or diseases such as obesity, or age and medical issues relating to a woman’s reproductive organs are amongst the perpetrators as well. Polycystic ovarian syndrome (PCOS) for instance — a condition wherein tiny cysts develop on the uterus — is a leading cause of infertility and miscarriages. 

The spiral of silence

Although miscarriages are a common occurrence in the medical world, they are regarded as a taboo in our society. As a result, women who experience a miscarriage often refrain from talking about it, out of shame or because they are made to feel that the loss of the child was their fault.

For 27-year-old mother of one, Manahil Zaidi*, her miscarriage led to divorce. “The first time I miscarried was while I was climbing the stairs to my bedroom. The bleeding began out of the blue, suddenly, half way up the stairs.” recalls Manahil. Her husband and in-laws accused her of having aborted the child by taking pills. “Despite the incident, I kept trying for a baby. But then I had another miscarriage and ultimately, my husband and I divorced,” she adds. Fortunately for Manahil, she experienced no complications conceiving a child from her second marriage.

The ideology of blaming the expecting mother for her miscarried child is deeply ingrained in our minds and made all the worse by the culture of silence surrounding it. In fact, many doctors advise patients not to reveal their pregnancy until after the first trimester, in order to avoid having to announce a possible miscarriage as well. This, in turn, implies that miscarriage is a rare event and hence, something one should be ashamed of.

However, this could not be further from the truth. Globally, about one out of five pregnancies results in a miscarriage. According to a research published in the Pakistan Journal of Medical Sciences in 2013, almost 50% of pregnancies result in a miscarriage. Out of these, 69% of the incidents occur in the first trimester.  

Speculating miscarriage

Another misconception people entertain about miscarriage is that physical and mental stress can trigger it. For instance, arguments, exercising, eating certain foods or perhaps even climbing stairs are cited as causes of miscarriages. “Families of some of my patients who have miscarried blame them for it,” says Dr Huma, a gynaecologist at Al-Shifa Hospital. “They credit the patient’s alleged lack of responsibility when in reality, the reason for a miscarriage is usually idiopathic, that is that it remain unknown,” informs Dr Huma.

On the other hand, laboratory tests that can determine the actual causes of a miscarriage are not readily available in Pakistan and are expensive. As a result, many doctors and members of society speculate about what caused the miscarriage. For instance, 42-year-old Farah Shahid*, a senior management officer at a private bank, suspected that walking up to her office on the fourth floor caused her first miscarriage and surprisingly, her doctor agreed. However, after the multiple miscarriages that followed, Farah’s doctor found a cyst on her uterus. Therefore, attributing miscarriage to physical or mental stress is, arguably, speculative unless and until one is doing extremely strenuous physical activity. 

Breaking the silence

The stigma surrounding miscarriage not only makes women feel isolated — that too, after losing their child — but the silence makes them internalise the entire experience. Women are rarely prepared for the deep psychological effects of miscarrying and often tend to blame themselves. This constant worry and the inability to discuss the issue can ultimately, lead to depression. “Women may suffer trauma, anxiety and depression after losing a baby, especially if a couple lacks emotional support for one another,” informs Dr Huma.

In a study published in the British Journal of Psychiatry in 2011, it was stated that about 50% to 80% of women who experience the loss of pregnancy do conceive again. But for many, the symptoms of depression from the first miscarriage continue to linger for years, even after giving birth to another healthy baby. Therefore, experts believe that the only way to minimise the pain is to speak up.

Last year, Los Angeles-based psychologist Dr Jessica Zucker wrote an article for The New York Times, detailing her own experience of miscarriage. To broaden the scope of dialogue, Jessica also took to social media and created the hashtag #IHadAMiscarriage on Twitter, hoping to galvanise conversation about lost pregnancy and shed some layers of shame from the topic. The number of responses the hashtag was able to generate was surprisingly high and its success helped both men and women realise just how common a miscarriage is.

Pakistan may still have a long way to go before we can talk about miscarriages openly but as least we can try. The first step is to recognise that a miscarriage is not the woman’s fault nor does it warrant shame, blame or stigma. It’s crucial for not only women but men as well to be educated about the condition.

*Names have been changed to protect privacy

Kanwal Tariq is a bio-technologist, a writer and a feminist. She blogs at Whirling Cosmos (kanwalmeghjii.wordpress.com)

Published in The Express Tribune, Ms T, August 2nd, 2015.

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