WHY SHOULD I BOTHER ABOUT THE EFFECTS OF MISCARRIAGE?

Miscarriage, the emotional response to it and the mental health risks following it are significant. But are they important?

One of the Millennium Development Goals (MDGs) is to improve maternal health. A lot of health ministers in the developing world seem to have interpreted this to be: to reduce maternal deaths. Of course, this is important but maternal health has to be more than surviving; the mother should be thriving. This focus of governments and NGOs on mortality ignores other health issues related to reproduction that cause significant distress in women’s lives¹.

First trimester miscarriage is classed under gynaecology. In general, there is a “culture of silence”¹ which prevents women from seeking healthcare for gynaecologic conditions.  Interestingly, there is no disease burden attached to miscarriage; it is not identifiable within the Global Burden of Disease. 
Women need the health services to respond to their perceived needs². After a miscarriage, they need their doctors and nurses to be a source of support to them. I confirmed this in the research I conducted among women in Lagos, Nigeria.

Fertility levels are very high in Nigeria, more than twice the accepted rate for population maintenance (accepted rate = 2, Nigeria = 5.2 according to UNICEF). If at least 15% of all recognised pregnancies result in miscarriage, then miscarriage is an even bigger problem in Nigeria than in the developed world.

Depression is chronically disabling³ and the WHO estimates that mental health disorders are the leading cause of poor health and disability globally⁴. Mental health, however, is another health issue with an “appalling lack of interest” from governments and NGOs⁴; this stigma makes it impossible to generate appropriate attention and support. All this is despite the fact that mental health disorders are very important to public health³.

Mental health affects progress towards achievement of the MDGs particularly the empowerment of women and improvement of maternal health³. The mental distress suffered as a result of a miscarriage needs to be widely appreciated in healthcare circles.

It is pertinent that the combined effects of stigmatised mental health and pregnancy loss do  not defeat the efforts of public health and maternal health advocates to arrest their effects on women’s lives. Dealing with mental health issues after a miscarriage and incorporating psychosocial support into antenatal care may seem like a waste of valuable resources (time, money and staff) but “there is no health without mental health”³.

REFERENCES

1.            Stones RW, Matthews Z, Gynaecological disease in developing countries: whose burden? Opportunity and Choices Working Paper, Reproductive Health Research, University of Southampton.
2.       Filipi Z, Ronsmanns C, Campbell OMR, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D, Maternal Health in poor countries: the broader context and a call for action. The Lancet (published online) DOI:10.1016/S0140-6736(06)69384-7. September 28, 2006.
3.       Prine M, Patel V, Saxena S, Maj M, Maselko J, Phillips M, Rahman A, No health without mental health. The Lancet 370 (9590) pp859-877, 2007.
4.       Chambers A, Mental illness and the developing world, www.guardian.co.uk, Monday May 10, 2010. Accessed on September 17, 2011.