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Stillbirth, Miscarriage, & Abortion: Broadening the Discussion about Reproductive Rights

When I was 25 I knew a woman who struggled to conceive with her husband of several years. She was young and healthy, with a vibrant personality and deep desire to start a family. I first met her just weeks after she lost her first child—she was more than 20 weeks into the pregnancy. In the next three years, two more friends would have similar experiences, losing their children late-term or shortly after birth, for reasons unknown or that they kept private.

While stillbirths can result from developmental abnormalities, problems with the umbilical cord or placenta, or maternal diabetes or high blood pressure, in about half of cases the cause cannot be determined. Similarly, miscarriages often remain unexplained, commonly occurring in the first trimester and frequently even before the mother realizes they’re pregnant.

In fact, 1 in every 160 pregnancies in the United States results in stillbirth, up to 27 percent in miscarriage (in 25-29 year olds), 21 percent in abortion, and about 1 percent in adoption (for never-married women)—yet these pregnancy outcomes are often obfuscated in open discussions.

In many ways, our culture has all but chosen to deny their existence. We simply turn a blind eye, lumping these outcomes together with teen sex, postpartum depression, female masturbation, birthing the placenta, and death, placing them neatly into the “uncomfortable” box and throwing away the key. And even when someone wants to begin a dialogue, they often don’t know where to turn.

“My First Son, a Pure Memory”, a 2008 essay from the New York Times’ Modern Love series, eloquently chronicles David Hlavsa’s painful journey as a father coping with the death, and subsequent stillbirth, of his first child with his wife. Long before publishing this piece in the Times, and only weeks after his son’s heart stopped beating, Hlavsa returned to the small college at which he worked, struggling to find a way to share the news with his colleagues.

“When a parent dies or a partner — when we lose someone who has lived in the world — there are customs, worn paths to follow, ways to talk about it. But I didn’t see any path with this. Was I supposed to keep quiet and pretend nothing had happened? I couldn’t accept that.”

Hlavsa crafted a brief email simply stating the truths of the situation, and hit “send”, unprepared for the response that would follow. What he got was an outpouring of suppressed emotion.

“For weeks after, people I barely knew would come into my office, gently shut the door and burst into tears. I heard stories of single and serial miscarriages, pregnancies carried nearly to full term, stillbirths — all the lost, lost children. Grief hauled about, and nowhere to put it down. Some said they had never told anyone; who would understand?” he recalls.

Hlavsa’s story echoes the experiences of thousands navigating the sadness of losing a child. There seems to be no collective social template for coming to grips with this type of loss, and “nowhere to put” the emotion. Whether stillbirth, abortion, miscarriage or adoption, so many confine the truths of each impactful experience to the recesses of their memories, while others share with only their closest confidants.

“No one tells you how to deal with that grief. They don't tell you how to react when you find yourself sitting on floral chairs in a dimly lit room in an avuncular funeral director's office discussing why even though he is waiving his fee, it will cost almost $1,000 for New York State to cremate your baby. Or what to do when letters start arriving from well-meaning social service groups inviting you to talk to grief counsellors about Sudden Infant Death Syndrome and it becomes clear they've mixed your dead baby up with another child,” recalls Sarah Hughes, who lost her child after 35 weeks of pregnancy.

Perinatal losses can also affect families for years psychologically, being linked to post-traumatic stress, depression, anxiety, sleeping disorders, and heightened anxiety in subsequent pregnancies. Yet, mimicking limited social dialogue, research around perinatal loss and grief is lacking.

An integral part of reproductive justice is truly providing each person the access to quality sexual health information and the opportunity to make autonomous decisions based on that knowledge that best suit their life. One decision doesn’t fit all, yet all choices and outcomes require respect.

When we create space for open conversation that daylights the challenges, risks, and anxieties that could accompany pregnancy—miscarriage, adoption, abortion, safe surrender, ectopic pregnancy, and stillbirth included (while acknowledging each is uniquely different)—the more we can support those navigating the aftermath of challenging reproductive circumstances and decisions.

Through altering the ways in which we collectively communicate, we not only offer emotional and psychological support that strengthen interpersonal and community connections, but we can also empower individuals to take control of their health without fearing shame and judgement. From normalizing language around adoption processes to defining terms like dilation and curettage, as health educators in particular, we can make strides toward validating the diversity of others’ experiences, helping to realize each person’s right to make autonomous decisions about their body.

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