https://orcid.org/0000-0001-6111-1386
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ABSTRACT
The Czech Republic represents a very secular, Post-Socialist country, with top-ranking medical care in biomedical standards. Nevertheless, issues of death, bereavement and associated rituals have been displaced to the very edge of both social policy and public debate. The article analyses the context of perinatal loss as an experience of end of life at its very beginning. It frames the institutional setting and symbolic context of and for such ‘inappropriate’ event, employing conceptual approaches of authoritative knowledge associated with perinatal loss. The article elaborates the current medicalised practice and cultural rituals. One perspective is the ambiguity of the definition of a stillbirth with competing sets of knowledge claiming their expertise over this issue. Another perspective is represented by the rules and practice for burying bodies treated until very lately as biological waste and disposed accordingly. The appeal to ‘healthy population’ forms the atmosphere for dealing with death itself. Third, interplay among interest groups advocating for or against the status quo is elaborated on. These are complemented by two additional perspectives; the ceasing practice of public last rites and by evidence from parental discussion forum, helping us diversify the subject matter under study in a specific Post-Socialist context.
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No potential conflict of interest was reported by the author.
Notes
1. I use the term Post-Socialist here to refer to the period after 1989 in the Czech Republic (and Central Eastern Europe). Some authors use other terms, such as Post-Communist or post-totalitarian or even Post-Soviet, which refers in my understanding more narrowly to countries originally forming parts of the Soviet Union. I refer to Soviet, however, when the period between 1948 and 1989 is targeted – I do so in order to distinguish current socialist (democratic) countries from the totalitarian version of state socialism under the Soviet regime. These terminological issues have not been finally resolved yet, despite many thematic studies and even journals.
2. The average figure of perinatal deaths in the Czech Republic (for the years 2000–2016) is less than 447 babies a year. (http://reporting.uzis.cz/cr/index.php?pg=statisticke-vystupy–mortalita–mortalita-indikatory-zdravotniho-stavu-echi–perinatalni-umrti-podle-pohlavi&studie=070608&analyza=xi, accessed on 10 April 2018), more figures and definitions are provided further down in the text.
3. Another text drawing from this study is currently under review.
4. This number, however, depends on the (legal) definition used for categorising life births and deaths. Legislative changes made in the Czech Republic in 2011 and 2012 ceased to define stillbirths as such (this has changed again in the Autumn of 2017). Only miscarried/aborted foetuses have had a legal definition. Such changes bring a certain uncertainty to the regularly collected health statistics in this respect as explicitly noted also in the Methodology section of the Statistical Yearbook of the Czech Republic (CZSO/ČSÚ, Citation2017).
5. The legal limit between a miscarriage and birth is twofold: either 22 completed gestation weeks or a foetus bigger than 500 g. However, health-indicated abortions can be performed until the 24th completed gestation week (abortions upon the mother’s request are legal until the 12th completed gestation week). For a death in utero, an often induced vaginal birth is practiced if the estimated weight and gestation age complies with the limit.
6. The methodology used in these statistical calculations is important. A look behind the numbers reveals how complicated a picture of these numbers make and the differences in measurement methods resulting in problematic interpretations of national situations (see for example Liu, Moon, Sulvetta, & Chawla, Citation1992).
7. Two pioneering thematic books have been published only very recently. One is by a psychotherapist Ilona Špaňhelová: ‘An Emty Craddle’ (Špaňhelová, Citation2015) and it is a handbook for the bereaved; the other one is written by Kateřina Ratislavová, a research nurse and a midwife: ‘Perinatal Palliative Care’ (Ratislavová, Citation2016) and targets professional healthcare personnel. Sporadic references to the issue are scattered in earlier publications as well, but no systematic research attention has been documented.
8. For example, the organiser of the only annual interdisciplinary conference also thematising issues of perinatal deaths, the BIOS – Bioethical Society, has strong links to the Czech pro-life movement and the ultra-conservative segment of the Czech catholic church (conference web: www. nejmensiznas.cz). This observation is based on my personal attendance of the event in 2015 and analyses of their web content including annual conference proceedings.
9. Empty Cradle – Prázdná kolébka – http://www.prazdnakolebka.cz/prakticke-rady-a-zakony (last visited on 2 August 2016). All quotes used in the chapter were translated by the author.
10. This was changed by the novelised Funeral Act in September 2017. However, public awareness of the change and its implementation into everyday practice is very low and slow so far (as reflected in research interviews conducted in the period between Autumn 2017 and Spring 2018).
11. There has been no change to this time limit even in the amendment act.
12. An example of such polarisation was demonstrated in the discussion show ‘You have your word!’ on a major public TV channel (Czech Television, the program ‘Máte slovo!’ on 2 June 2016) on changing funeral practices in the Czech Republic. The issue of missing standards for stillborn funerals was raised as one of the three major topics. The ideological clash in ‘human waste’ treatment was obvious and evolved around the concealment of death as a positive (protective for the bereaved) or negative (disrespectful of the deceased) approach.
13. The open letter from the Association of Private Funeral Homes (ASPS) of the Czech Republic, dated 2 April 2016 – approx. 3000 words long – in Czech is available for download online. However, this association (ASPS) is a minor one, representing few organisations.
14. This NGO procures funerals for stillborn babies that have not been picked up by their parents in collaborating hospitals. They label the urns and commit them to a common burial chamber, where the urn can be traced and visited by the relatives if they realise in later stages of their lives that they want to. The cost of such procedure is higher than the funeral benefit provided by the state.
15. There is yet one more that is specific related partly to the Post-Socialist condition and the lack of a socialisation environment with transcendental or ethical stimuli in combination with very permissive liberal reproductive health politics. The WHO statistics indicate that Russia and the countries of former Soviet bloc have the highest rates of abortions, situating the Czech Republic somewhere in the middle of this set of countries (ÚZIS, Citation2013, p. 13).
16. The ISSP 2008 data that Nešporová uses (Nešporová, Citation2011) are representative for the Czech population aged 18+, and the analysed question was: ‘When you die, what kind of funeral ceremony would you like to have?’: 21.4% of respondents chose a religious ceremony, 26.3% a secular one, 19.2% answered that no funeral ceremony was their choice and 26.5% indicated that they did not really care whether religious, secular or none, and 2.8% of respondents were not able to choose.
17. Radka Dudová analysed the policies and practices of abortions in the Czech Republic (then Czechoslovakia) during the Soviet times. They were very liberal and rates of abortions were very high. She discusses hidden eugenics in such practices directed towards the creation of a healthy population (Dudova, Citation2012b; Dudová Citation2012a) and, in combination with the illegal sterilisations of the Roma women, also a deliberate policy to eliminate the reproduction of ‘socially undesired’ segments of population. Cultural remnants of such an approach still resemble some of the more recent practices and attitudes in the Czech context. In the case of the unlawful (forced) sterilisations of Roma women at childbirth during the Soviet period (1973–1989), there was a combination of class issues and ethnic marginalisation. They still have not been compensated for it, despite international criticism. A debate on the issue was opened by an ombudsman only in 2005. Moreover, the Act that have been under preparation since 2013 (and which was rejected by the government in 2015) included financial compensation for women who have not given free informed consent and those who were under age at the time of the procedure or legally incompetent (Otáhalová in Smetáčková, Citation2015, p. 52, Szénássy in, Citation2015, p. 158, Sokolová, Citation2005).
18. Altogether more than 60 stories have been collected online. These were all 33 stories published on the web of the Czech NGO ‘Dlouhá cesta’ (Long Journey) in its section ‘Prázdná kolébka’ (The Empty Cradle), 17 (non-duplicit) stories published on an associated web page ‘Nenarozené miminko’ (The Unborn Baby) and a few ad-hoc collected stories gathered by email, personal contacts, with a pro-link or referred to in visited thematic online discussions. These were complemented by extracts used in the book ‘The Empty Cradle’ (Špaňhelová, Citation2015), composed as a parental guide by a psychotherapist working for the NGO’s division on perinatal loss. The NGO Long Journey targets parents and close relatives bereaved by the loss of their children (not limited to perinatal or infant death) and the Empty Cradle specifically addresses those bereaved with a stillbirth, neonatal death or late pregnancy loss.
19. The author has been a member of this discussion group on Facebook (anonymised for confidentiality reasons). The group has its public profile and 193 members whose posts are concealed to the general public. No specific condition is requested to be able to join the discussion. Permission is granted by the administrators. The post appeared there on 17 August 2016.
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Iva Smidova
Iva Smidova is a sociologist, an Associate Professor at the Department of Sociology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic. She has worked in the field of gender studies since the early 1990s, with a particular focus on Critical Studies on Men and Masculinities (CSMM). Her more recent research focus is in the Sociology of health, illness and medicine with particular interest in the Czech reproductive medicine and practises of and around birth (2011 – 2014). Currently, she explores perinatal loss (2017-2019).