Why is there a stigma surrounding miscarriage?

Why do women feel ashamed and embarrassed about miscarriage? Why don’t we talk about it? Towards the end of last year I read Caroline Criado Perez’s visceral and heart breaking account of her miscarriage in her widely circulated newsletter. She talked about the humiliation of having to go to hospital alone because of pandemic conditions but essentially she was revealing the humiliation of miscarriage under any circumstance. As she bluntly described it, “try not feeling humiliated bleeding with your pants off in front of strangers while being told that your body has failed in one of its most basic functions”. This is a really striking statement which on the surface is totally understandable, bleeding from your genitals is more embarrassing than from anywhere else but why did she feel her body should at the very least be able to reproduce and the failure to do is humiliating? Having a heart attack is also your body failing at one of its most basic functions but I don’t think she would feel humiliated by it, nor embarrassed. This is what I wanted to focus on, why is miscarriage a taboo and what does the stigma reveal about our understanding of what it is to be a woman?

There’s been increasing public discussion about miscarriage and last year celebrities including Meghan Markle and Chrissie Teigan ‘went public’ with their experiences. They wanted to end the stigma surrounding miscarriage and felt that by being open about what had happened to them and allowing themselves to grieve publicly they would help others in similar situations.  What I found interesting about this is that the power of stigma is that no-one really talks about what the stigma is. Just saying you’ve had a miscarraige will indeed break the silence that accompanies miscarriage but it doesn’t actually look the stigma in the eye. Why do women feel ashamed in the first place? I’ve looked into miscarriage in three places to get some different perspectives and found some interesting research that’s been conducted in Tanzania, Qatar and the UK.

Despite the cultural, economic and social differences between these places I found that when it comes to miscarriage there were a lot of similarities and it’s these themes I’ll be exploring. Whilst shame wasn’t quite the same in Qatar as in Tanzania and the UK all three places encouraged women not to announce their pregnancies ‘too early’, emphasised women’s responsibility for miscarriage, placed a taboo on public grief and that statistics or any kind of research on miscarriage is scant at best right across the world. In looking at all these factors I want to properly acknowledge the shame around miscarriage and show that it won’t go away just by saying it’s okay to talk about it – we need more than that. The first step is understanding where the shame comes from and the wider context of pregnancy.

‘Henry Ford Hospital” by Frida Kahlo

The Shame of Miscarriage

In Tanzania whilst an involuntary miscarriage carries no social stigma a miscarriage which is perceived to have been caused intentionally, ie an abortion, carries a heavy social stigma. How can people tell if a woman has induced an abortion rather than had a miscarriage? According to one respondent, A woman who had involuntary pregnancy loss will recover quickly, she is not sick, she won’t even stay inside to sleep for many days…if a woman has an abortion she will get very sick”. As you can imagine this means women make very little fuss and do their best to hide miscarriages as best they can despite the obvious risks to their health. Up to half of the research respondents were accused of having carryied out abortions when they miscarried and were the subject of local gossip and recriminations in a society in which women already have a low social status.

In Qatar however, miscarriage doesn’t carry the same social stigma. It’s considered a normal part of pregnancy which whilst it may have been inadvertently caused by the pregnant woman it is nonetheless not something she will be ashamed of. Women are encouraged to have a lot of children so as a consequence of many pregnancies, frequent miscarriages are accepted. Miscarriage it seems, is just considered part of the process of ultimately becoming pregnant.

In the UK study women reported feelings not just of shame but also guilt that perhaps they had caused the miscarraige. Whilst Qatari women mentioned similar potential causes as those mentioned by the UK women, such as lifting a heavy object or being very stressed, the British women did not feel this was normal and often felt responsible. 

The key thing is that in all three places there is a strong belief that in many cases miscarriage is caused by the actions of the pregnant woman whether intentionally or not.

Keep Pregnancy a Secret

Woman are encouraged to keep early pregnancy a secret in all three locations but for slightly different reasons. In Tanzania the women only tell their husbands they are pregnant for fear of gossip about any pregnancy loss and to avoid other jealous women from cursing their pregnancies. Similarly, whilst aware of the medical causes for miscarriage women in Qatar also keep pregnancies secret for fear of ‘jinn’ or the evil eye which can be caused by infertile women jealous of pregnancy. Bit of an unsisterly theme in both places.

In the UK women report keeping pregnancy secret ‘just in case anything goes wrong’ or to not ‘jinx it’ which doesn’t sound that dissimilar. In my own case, at work, I felt it might lead to being excluded from certain projects or generally diminish my role, so I kept quiet. But in my personal life I told most people as I thought I’d want them to know even if I did have miscarriage. However, the second time around I started to think about the possibility of perhaps a medical condition in me or the baby leading me to choose an abortion and how in that case I would rather not have to explain myself so I kept quiet for a little bit longer ‘just in case’.

Again I wonder whether keeping quiet about pregnancy generally points to women feeling that pregnancy diminishes them, puts them at risk from others ill will and they don’t want to have explain or acknowledge miscarriage in public.

Miscarriage Exists Too Much and it Doesn’t Exist Enough
In all three sites the statistics on miscarriage are scant and inconsistent at best. Because of the frequency of miscarriage and the lower status of women in all three sites (just look at the recent history of medical research massively biased against women) it is often not recorded. It both happens all the time and doesn’t exist. In the UK and Tanzania along with the shame and silence which makes it hard to get good data on miscarriage, this is also made worse by inconsistent data collection. For example in the UK if a woman reports a miscarriage at a hospital it is recorded but it isn’t if she goes to her GP. In Tanzania there is no local distinction between a still birth and a miscarriage so WHO surveys do not reflect local categories nor do they acknowledge the difficulty many women have in reporting at all. Health data in Qatar is lacking in general but in particular for women.

All of this points to women’s health not mattering as much as it should and that miscarriage in particular is often not considered worth recording. 

It’s Women’s Fault
I’ve mentioned how in Qatar women are not exactly blamed for their own miscarriages however, they do nonetheless think pregnancy is caused by the actions of the pregnant woman even if it doesn’t quite carry the shame it does here and in Tanzania. Reasons for miscarriage range from eating the wrong herbs, too much physical exertion, letting yourself get too stressed as well as the more familiar medical conditions such as chromosomal abnormalities in the foetus. In some cases the pregnant woman’s in-laws especially her mother in law is blamed for making her work too hard or as I stated, infertile jealous women curse the newly pregnant woman and cause her to miscarry. Although it’s worth noting that a lot of the time it’s considered as an act of God that can’t be helped.

In the UK women are often told that it’s ‘not their fault’ which would only make sense in a context in which it possibly being her fault was an option, otherwise why would they say it? I’m sure there’s historical research on this somewhere but it seems like it’s a relic of a time when women were in fact blamed for miscarriage. Similarly, women respondents were found to go into the most detail about their lifestyle when they felt they might be at fault saying things like ‘I didn’t know I was pregnant when I went to the Hen Do. I normally drink very little.’ Whereas if they were given medical causes they would state them succinctly. So, like in Tanzania, if it’s not ‘your fault’ the miscarriage doesn’t need as much explaining but if the woman felt she’d maybe made a mistake then she felt at pains to explain her actions in order to absolve herself of the guilt.

In Tanzania there’s such a fear of being accused of causing the miscarriage that one of the respondent’s asked the researcher to take her relative to hospital, when she was bleeding, rather than ask a local, for fear of the wider community finding out. Fear of local gossip and bad treatment from their husbands mean women are loath to tell anyone about their miscarriages. 

You cry only silently, kimoyo moyo (in your heart) 
In all three locations there is very little to no public grief over miscarriage, there are no rituals or ceremonies that I know of. The heading of this section is a quote from one of the Tanzanian responders about her own miscarriage. In Qatar the absence of grief is largely explained by the frequency and acceptance of miscarriage as a part of becoming pregnant. However, I don’t know how still births are experienced and as I said the research is scant so there may be more to it. As one woman in the UK stated “Most people treat miscarriage as not very important ‘‘everybody has them’’ etc. but it was very traumatic for me.” So, if Qatari women don’t grieve there must be more to it than it just being ‘normal’. It seems that in the UK being allowed to grieve is something many women want and being told it’s common or normal doesn’t necessarily help.  

In Criado Perez’s newsletter she writes about how despite being told that miscarriage is common and that we don’t really know why it happens it didn’t make her feel better and her understandably angry account makes this abundantly clear. The women in the UK research expressed a very strong desire to be given a medical reason for their miscarriage. What all of this adds up to is the unspoken feeling of guilt and shame that surrounds miscarriage that the women seek absolution for.

I wonder if what might make women in the UK feel better is understanding and acknowledging where the shame and humiliation comes from and I would say that it comes from the same place it does in Tanzania. It comes from the belief that women’s bodies belong to the community, that their personal inability to stay pregnant is a failure to the community and that their role and position as women is to bear children. There is silence around miscarriage in large part because deep down many women feel it is their fault and this is a consequence of centuries of female oppression of which we are not yet entirely free nor honest about. I think allowing women to speak of their miscarriages and allowing both parents to grieve seem to be essential in lifting the stigma but I also think that stigma carries more weight when it is not properly acknowledged. Women need to believe that they are still good and whole women even if they miscarry.

Tell me what you think

I haven’t experienced miscarriage and in keeping with the article my friends haven’t really spoken to me about theirs but I’d love to hear what you think. If you think I’ve got this wrong or there are other points I should have considered I’d love to hear about it. Comment here or contact me or we can chat here on the Facebook group.

Reading List

Caroline Criado Perez who I mention in the paper is the woman who wrote Invisible Women about the gender bias in data and design, totally brilliant. Here’s a link to her book: https://www.waterstones.com/book/invisible-women/caroline-criado-perez/9781784706289

These are all academic papers and the UK one might be of particular interest to some of you.

Experience of miscarriage in the UK: Qualitative findings from the National Women’s Health Study
by Rebecca K. Simmonsa,􏰀, Gita Singhb, Noreen Maconochiea, Pat Doylea, Judith Greena (2006)

“These are not good things for other people to know”: How rural Tanzanian women’s experiences of pregnancy loss and early neonatal death may impact survey data quality
by Rachel A. Hawsa,*, Irene Mashasib, Mwifadhi Mrishob, Joanna Armstrong Schellenberg, Gary L. Darmstadt, Peter J. Winch (2010)

Causal explanations of miscarriage amongst Qataris
by Susie Kilshaw , Nadia Omar , Stella Major , Mona Mohsen , Faten El Taher , Halima Al Tamimi ,
Kristina Sole and Daniel Miller (2017)

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