The AFIN-UAB group presents the results of a research on early gestational losses

The AFIN research group from the Department of Social and Cultural Anthropology at the UAB, in coordination with the Gynaecology and Obstetrics Service of the Hospital Santa Creu i Sant Pau, participates in the project entitled "Early reproductive losses: from physical discomfort and emotional invisibility to possible personal, family and social mourning". The project is an initiative by the Convocatòria Connecta of the "la Caixa" Foundation and is foreseen to end in November.

17/10/2024

With the aim of disseminating the results of the project, the conference “Early gestational losses: breaking down taboos, building bridges, adding voices” was held on 15 October in the auditorium of the Hospital Santa Creu i Sant Pau, in Barcelona. The meeting aimed to promote visibility and reflection, both at the healthcare level and in society in general, on early gestational losses, coinciding with the international day of perinatal bereavement. With this aim, it brought together experts from different fields: anthropology, sociology, medicine, nursing, psychology and law.

The principal investigators are Diana Marre (AFIN-UAB), María José Rodríguez Jaume (University of Alicante) and Elisa Llurba (director of the Gynaecology and Obstetrics Service and principal investigator of the Perinatal Medicine research group at the University Hospital of Santa Creu i Sant Pau in Barcelona). Carolina Remorini, AFIN-UAB researcher, coordinates the team, which includes Bruna Alvarez, Alexandra Desy, Giulia Colavolpe, Lynne McIntyre, Ana Sanchez Larrosa and Vanessa Mantilla, all from AFIN-UAB. The project team also includes researchers from the UA and physicians from the Sant Pau Research Institute and the Puigvert Foundation.

The project focuses on losses in the first trimester of pregnancy, which are the least considered and most silenced, although this concept includes those occurring before 22 weeks. Most of the people interviewed are over 36 years old, more than 50% have had two or more miscarriages, and more than 70% have undergone assisted reproduction treatments.

Problems in acknowledging the loss

The AFIN-UAB research team conducted a profound analysis of the peoples stories, finding variability in the way they named, categorised, and gave importance to their experience. Not all people speak of mourning or death when refrring to these weeks, although a high percentage do speak of losing a son or baby, regardless of the gestational week and size of the embryo. There is a diversity in the terms and associated meanings, and the study aims to highlight this diversity.

All the persons interviewed - whether women or their male partners - generally state that this experience of suffering due to loss has not been recognised or legitimised sufficiently or accordingly by professionals, family members, friends or even their own partners. They emphasise, therefore, that they have encountered, in a more generalised manner, attitudes of incomprehension, silence, underestimation, as well as an attitude of little respect for their feelings, preferences or values.

While the emotional aspects are fundamental, researchers focused specifically on the social aspects - role of the social environment, organisation of daily life, socio-material living conditions - and on the practice of care.

The team verified the impact of these losses and their therapeutic management on the physical and emotional state of those affected, on their present and future health, on their daily life and on their parenthood projects. They also verified the scarce opportunities to talk about the subject, to share the experience with other people, and the scarcity of tools society disposes of when accompanying our loved ones in these moments.

As for the care aspects, problems were detected in the health care of these losses, ranging from the treatment received to the inadequacy of the care circuits for losses before 12 weeks, including the regulations in force that deal with losses later in the pregnancy. Also detected were a lack of comprehensive support, as well as of complete and appropriate information, both to anticipate this possibility in the development of the pregnancy and to evaluate alternatives for the management of a loss. Participants reported that, on several occasions, they made management decisions hastily, without sufficient information or time to consult with the people they trust.

In contrast, professionals mention that there are too many people they must provide care for, which sometimes prevents them from dedicating the necessary time to respect the time and needs of each person or couple . At the same time, they acknowledge that they do not have sufficient training and not always have the appropriate institutional resources to support this task. These situations have a negative impact on their own wellbeing and how they perceive the quality of care offered.

Researchers conclude that it is necessary to pay attention to what people need and to their ways of facing this experience, rather than presuppose more “normal” forms or homogenising care under the assumption of what is “better or correct”, based on the positions of some sectors of civil society and professional societies that promote protocols, forms of accompaniment or the construction of memory, without respecting diversity.

Research in two phases

This research project consists of a mixed design of two phases, a qualitative one led by AFIN and a quantitative one led by UA's POMADE, the team of Professor Maria José Rodriguez. The qualitative phase consisted of observations of visits and different consultations in hospital services and sexual and reproductive health care centres (ASSIR), as well as interviews with people - pregnant women and their partners - who went through a loss in those weeks, people from their close environment and professionals who care for them.

For the quantitative phase, three instruments were designed to compare the experiences of people who have experienced losses before 12 weeks and before 22 weeks, in an attempt to obtain evidence that allows comparison with other studies available nationally and internationally. After undergoing expert validation, the instruments are now in the testing phase and the survey will be launched at the end of the year. This is a complex and unprecedented process, not only because it focuses on the first trimester of pregnancy and distinguishes it from the losses that occur later, but also because of the rigour of the methodology.

Dissemination of the results

The event held on 15 October was aimed at an academic audience as well as at health professionals, women's rights institutions, civil associations linked to the subject, secondary and higher education teachers, people who have experienced loss along with their families and close friends, and the general public.

The project also generated a series of podcasts entitled “The invisible trimester: silence and taboo in the first 12 weeks”, within the framework of Converses Afins, available on Spotify and Ivoox. Episodes 3, 4 and 5 address the topic. In addition, throughout 2024, the research team has been launching other products to disseminate the results of the project: publications, seminars, audiovisual materials released on the day of the event, and several presentations at conferences.

Good health and well-being