A review of research on stillbirth in low and middle-income countries touches on the important family dimension of grief and support, but makes no practical recommendations for how to respond to this.

The review acknowledges the importance of family support: “Family presence and involvement, especially from their spouse, from time of diagnosis and throughout care, were seen as beneficial by women. Women did not want to be left on their own.” The review also makes a reference to the grieving of others in the family: “Fathers also experienced grief and sadness, but this was often suppressed”.  The review suggests that support by family and friends could be promoted. Whilst admitting this may require changes in attitudes and behaviours that might be difficult to achieve, the reviewers suggest this approach does not require any investment. The reviewers only propose investment in health systems.

The dominant theme of the review is the need for women to have more support from all sides:

• From the community, where women are often stigmatized and blamed after a still birth.
• Specialised bereavement care from professionals.
• Information, advice information and individualised discussions about future pregnancies.
• Respect from the health system, frequently described by women as neglectful, insensitive and bad at communicating. The reviewers recommend staff training and support.
• Proper investigation to understand the physical causes of still-birth, to counteract supernatural explanations that can lead to stigma.

The reviewers sum up their recommendations in three words: educate, investigate, respect. Engaging with spouses and families, as partners in support, and as further individuals experiencing grief, is not included.

Shakespeare C et al (2018), Parents’ and healthcare professionals’ experiences of care after stillbirth in low- and middle-income countries: A systematic review and meta-summary, British Journal of Obstetrics and Gynaecology

Photo: Hernán Piñera. Creative Commons.