Weeping in silence: community experiences of stillbirths in rural eastern Uganda

Abstract

Background

Stillbirths do not register amongst national or global public health priorities, despite large numbers and known solutions. Although not accounted in statistics – these deaths count for families. Part of this disconnect is that very little is known about the lived experiences and perceptions of those experiencing this neglected problem.

Objective

This study aimed to explore local definitions and perceived causes of stillbirths as well as coping mechanisms used by families affected by stillbirth in rural eastern Uganda.

Design

A total of 29 in-depth interviews were conducted with women who had a stillbirth (14), men whose wives experienced a stillbirth (6), grandmothers (4), grandfathers (1), and traditional birth attendants (TBAs) (4). Participants were purposively recruited from the hospital maternity ward register, with additional recruitment done through community leaders and other participants. Data were analysed using content analysis.

Results

Women and families affected by stillbirth report pregnancy loss as a common occurrence. Definitions and causes of stillbirth included the biomedical, societal, and spiritual. Disclosure of stillbirth varies with women who experience consecutive or multiple losses, subject to potential exclusion from the community and even the family. Methods for coping with stillbirth were varied and personal. Ritual burial practices were common, yet silent and mainly left to women, as opposed to public mourning for older children. There were no formal health system mechanisms to support or care for families affected by stillbirths.

Conclusion

In a setting with strong collective ties, stillbirths are a burden borne by the affected family, and often just by the mother, rather than the community as a whole. Strategies are needed to address preventable stillbirths as well as to follow up with supportive services for those affected.

• stillbirth
• pregnancy loss
• Uganda
• maternal health
• postpartum depression
• traditional birth attendants

This paper is part of the Special Issue: Newborn health in Uganda. More papers from this issue can be found at http://www.globalhealthaction.net

This paper is part of the Special Issue: Newborn health in Uganda. More papers from this issue can be found at http://www.globalhealthaction.net

Disclaimer

The contents of this publication are solely the responsibility of the authors and do not necessarily reflect the views of Sida/SAREC, Save the Children, the Bill & Melinda Gates Foundation, nor any of the authors’ institutions of affiliation.

Acknowledgements

We thank the study participants, research assistants, Iganga/Mayuge Health Demographic Surveillance Site, and the Study Policy Advisory Group (Iganga and Mayuge districts, World Health Organization Uganda, United Nations Children's Fund Uganda, Save the Children Uganda, and the Ministry of Health Uganda). We also thank the INDEPTH Network for supporting the HDSS, and Agnes Kayego and Xavier Nsabagasani for their valuable comments on the paper.

Conflict of interest and funding

This study was supported by the Sida/SAREC-Makerere University-Karolinska Institutet Research collaboration as well as by funds provided by Save the Children through a grant from the Bill & Melinda Gates Foundation. This supplement was funded by Save the Children's Saving Newborn Lives programme through a grant from the Bill & Melinda Gates Foundation.

Notes

This paper is part of the Special Issue: Newborn health in Uganda. More papers from this issue can be found at http://www.globalhealthaction.net