The unspoken grief of multiple stillbirths in rural Pakistan: an interpretative phenomenological study

Abstract

Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan. Objective The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan. Methods An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach. Results The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large. Conclusions The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.

Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff

“…We have previously conducted studies on women’s experiences of childbirth in health facilities and reported our findings. 20 , 36 , 73 Second, the sensitive nature of the topic may have introduced a bias of social desirability whereby providers might have felt reluctant to speak, resulting in the under-reporting of disrespectful and abusive behaviors prevalent at the health facility. Third, study participants were selected from secondary-level health facilities in 2 districts of Sindh.…”

Trends and risk factors of stillbirth among women of reproductive age in Pakistan: A multivariate decomposition analysis

“…Stillbirths decreased among highly educated women over the entire study period compared to uneducated women due to the change in characteristics, but a surprising result from the behavioral changes showed that highly educated women contributed more to the change in stillbirth rates from 2012 to 2017. This surprising result of a higher uptake of stillbirth among highly educated women might be because uneducated mothers may underreport stillbirths due to social stigmas and taboos (16). However, other studies found that the risk of stillbirth was less likely to occur among educated mothers (37-39).…”

“…Underreporting these issues due to social taboos is one of the reasons for this unrecognized health problem (13). Pakistani women are reluctant to discuss stillbirths for fear of being stigmatized as infertile or being subject to misconceptions such as the influence of an evil eye or black magic (16). Globally, stillbirths were not a priority within the Millennium Development Goals (MDGs).…”

Intimate partner violence against women in Southern Punjab, Pakistan: A phenomenological study

“…The researchers used the concept of bracketing during the analysis of the data. All the preconceived ideas, personal observations, and reflexive notes were written by the authors before the data analysis [ 32 ]. The inductive method was used to identify significant themes [ 33 ].…”