Stigma and trauma around miscarriages

Teary-eyed at her home in Kisumu, Agnes Chebet* (not her real name), 35, recounted what it felt like to suffer 11 miscarriages. 

“I felt lost and alone, like I had been possessed by evil spirits and was a bad omen in the society,” she said.

A miscarriage is the loss of a pregnancy before 20 weeks’ gestation. Chebet's series of miscarriages has made her feel insufficient and barren.

As she wipes away her tears, Chebet says her first miscarriage happened in 2014, when she had just conceived her first pregnancy with her boyfriend.

“It was a normal pregnancy that was okay until it was three months and I started having backaches, cramps then bleeding,” she says.

Chebet rushed to the hospital just to ensure that everything was okay.

“I was told I was in the process of miscarrying the baby that I had conceived,” she says.

However, what astonished Chebet was the fact that the doctors said it was ‘very normal for miscarriages to happen’.

“So I was treated then I went back home. My then boyfriend assured me that there is always a next time and he even encouraged me not to feel bad about it,” she says.

MARRIAGE KILLER

But after a week, Chebet’s boyfriend of nine years dumped her, saying he was not ready to marry a barren woman.

“When he left, I asked him where the problem was. He told me he cannot stay with a barren woman,” she says.

Chebet moved on. After all, the doctors said this was okay. She met another man and got pregnant but after two months, she had another miscarriage. 

“I started asking myself questions. Why is this happening to me, is there a problem? And you see when you go to the hospital, you are told it's normal for such things to happen during the first trimester,” she says.

“So I went to the hospital because I felt stressed. I felt like things were not working out the way I wanted.”

Shortly after, she got pregnant again. 

“When I conceived, the man told me, 'Make sure you do not lose this one’,” she recalls.

According to the Nairobi IVF Centre, miscarriage occurs in one in four pregnancies. 

However, it's not easy to get the data around miscarriages since they are not recorded, suggesting that the numbers could be even higher, WHO says.

Chebet says they got into an argument because this was not her fault.

“So again, I lost the pregnancy with the same symptoms. This time, I had a very painful headache. I rushed to the hospital. I told the nurse on duty I'm having a headache and lower back pains,” she said.

“She asked when my last monthly period occurred, and I told her I was pregnant,” she said.

“She told me if you are pregnant, then just go home and rest. So I called this guy and told him I have the same symptoms and he told me 'hio ushapoteza' like it's not reversible.” 

NOT NORMAL

The doctors explained that her foetus was not growing and that a miscarriage happened, but the nurse told her it was normal again.

But Kenyatta National Hospital obstetrician and gynaecologist John Ong’ech says doctors who keep saying that it is normal are not specialised enough.

“Those people do not have the capacity to even determine where the problem is. As a mother, you need to check the people you are informing that you are pregnant,” he says.

Ong’ech says the nurses or doctors should know what can be done to manage or prevent miscarriages in future.

“Nurses and doctors should take personal responsibility and handle these women with the care they need. They should be doing preconception care,” he says.

“Do not wait for you to have more than two miscarriages. Seek a second opinion, seek specialists who have track records, not just any doctor," he says.

According to WHO, miscarriages have been associated with high vitamin A intake within 60 days of conception.

However, a WHO expert group consultation in 1998 concluded that daily doses of up to 3000 µg per day after day 60 are probably safe, especially in areas where vitamin A deficiency is common. 

Chebet took a break from dating in 2020, and when she was taken to a different hospital in Eldoret, the doctors said miscarriage is only normal when it occurs twice or thrice.

“Fertility tests were done and the conclusion was that I was fertile so the problem was with my cervix,” she says.

“I was told I have an incompetent cervix. So I was told when I conceive, they have to hold the cervix and the baby until I deliver.”

An incompetent cervix happens when weak cervical tissue causes or plays a part in a premature birth or the loss of a healthy pregnancy.

Chebet said a cervical cerclage was done on her six times to allow her cervix to hold a baby.

“That thing is painful. Even after the stitch, I couldn't hold my babies. I had a miscarriage and it was the most painful one because the stitch had to be removed,” she says.

The stitches had to be removed so that her uterus was cleaned. 

“The physical and emotional pain and everything around it. I had to take a break from work and stay at home because I was also not doing well psychologically,” she says.

The 11th miscarriage happened this year in April, and Chebet decided to let go of trying to get a baby.

POINTING FINGERS

Chebet blames doctors, her friends and close family for her woes.

“You get statements like 'you're expecting too much from people'. I've heard statements like 'miscarriages are normal'. Even from close family members,” she says.

“So I sometimes blame them because they don't try to understand me. It's like I'm on my own and you see when you go for family meetings, they still talk.”

She says she has seen a specialist who tried to understand her situation, and even for the first time, they did not say it was a normal occurrence.

“I have seen a specialist who has begun taking me through hormonal treatment. Unlike in other hospitals, where I was just treated and told ' Uko sawa, hauna shida (You are fine, you have no problem),” she says.

“They are the same doctors who tell you, 'Wacha kulialia. Wamama hapa wanazaa, watoto wanakufa (Stop crying, some women deliver babies and their babies die).' Such mean statements.”

WHO assistant director general Nono Simelela says every woman deserves respectful and dignified healthcare that acknowledges her loss.

“We have worked on guidelines for healthcare professionals on how to provide respectful care during pregnancy and childbirth, including guidance on how to deal with miscarriage or stillbirth,” she says.

She says the Network for Improving Quality of Care for Maternal, Newborn and Child Health has 10 participating countries established to ensure that women receive the highest quality of care during pregnancy and childbirth.  

Kenya is among the countries in the network and is expected to give that quality access, though there are no statistics on miscarriages. 

THE CAUSES

Gynaecologist Ong’ech says one of the commonest causes of miscarriages is genetic chromosomes.

“This is where you have a chromosome error and nature is actually helping you not to have a deformed pregnancy or any other defects with the baby,” he says.

“As much as it is painful, the abnormalities that come with pregnancies have to be cleared, and that is how miscarriages happen.”

Ong’ech says another reason why this might be happening is because of hormonal infections.

“So any woman who has undergone many miscarriages should undergo a thorough examination so they are told where the issue is,” he says.

He says in scenarios such as that of Chebet, one should seek more advanced healthcare.

“The doctors should do a chromosome analysis and establish where the real issue lies. We realise that sometimes, partners are incompatible when chromosomes are analysed,” he says.

HOPELESSNESS AND DESPERATION

Millicent Akoth* says her own child loss journey bore hopelessness and desperation during the entire process.

She was newly married and when the news of the pregnancy kicked in, she and her partner were excited.

“My partner told everyone in our circle, of which I did not approve. But the foetus was nine weeks and we hadn't started buying clothes. However, we had one onesie, to keep the idea of the baby coming,” she says.

Akoth, who lives in Kisumu’s Nyalenda area, says as they celebrated and googled baby names, she had no idea she would have a miscarriage.

“All this while, we were happy. My partner was excited about the baby but he was not around. We used to talk on video call and I would see how excited he was,” she says.

But then on the day the miscarriage occurred, she was not prepared for the next phase of their relationship.

“First, I had severe symptoms and would experience serious morning sickness. So on that day, I had cramps and vomited a lot,” she says.

“I assumed it to be part of the symptoms but at around 5pm, I started bleeding, and of course as an expectant woman, I was shocked and started crying.”

Akoth says she decided to rest a bit but the bleeding got heavier, making her confused. At this time, she was alone since her husband was in Dubai for work.

“I first panicked and ordered an Uber to the nearest hospital. I called my family and they came to the hospital for emotional support. I feel that it wasn't adequate from the people I expected it from, I must say I self-healed.”

She says after she was cleaned, the reality of not having the morning sickness checked in.

“It wasn't easy coming to terms with the loss, questioning God, blaming myself for not taking the much-needed rest or precaution, and a series of cries probably five times a day,” she says.

Akoth tried to persuade her partner to come home to offer her  emotional support but he was unable to.

“I felt alone at the time and hoped he would cancel the trip. But again, he had a choice and he didn't come. Emotionally, I'm not fully healed,” she says.

As she struggled with the process, she says their union also experienced instability, which is still persistent up to now.

“It has not been easy because of that; I kept on asking why he was not there for me. We lost a baby, was it not a loss? Was I not supposed to cry like the society has put it?" she asked.

But during this time, she put all her problems to God and had some self-fulfilling games.

“I also got closer to God during that season, trusting that I'll one day carry to term. I also self-healed by crying a lot, it really helped me to shed weight and do things that made me happy, like swimming.”

WIFE BLAMED

Samuel Wanjala*, who has been married for 10 years, says some miscarriages are self-inflicted.

Wanjala, who lives in Eldoret, says his wife has had three miscarriages, and she is to blame for all of them.

“With me, she lost three babies and it turns out it is a family issue. Sometimes it is genetic and stressful. Your wife brings her stresses to you, you have your own stress. Like my wife used to work round the clock,” he says.

Wanjala says his wife used to work without resting.

“So then we began having blame games. I asked her to quit her job and she refused. But on the other hand, she used to say it was witchcraft, so which is which?” he asked with frustration.

These brought a lot of mixed questions in his head because he didn’t know what to do.

“As a man, I started questioning myself on where I went wrong to an extent I started blaming myself for something I knew nothing about,” he says.

“I started to ask myself that maybe we had rough sex that might have made this happen. So at one point, I felt maybe I had a problem.”

Wanjala says men also suffer in silence.

“Your neighbours start gossiping and at home, you and your wife are arguing. She starts speculating and telling her sisters and mother. And men start saying things," he says.

He says emotional attachment becomes broken.

“The closeness you had with your wife just drops. Financially you suffer because you have to use a lot of money. For example, for the operation and cleaning of the womb, you need around Sh400,000,” he said.

But one of his key concerns was how a couple would deal with grief and loss of a baby.

“At one point, I came to understand that things happen for a reason, but there is also a human hand. Some people aborted a lot in their youth and these vices seem to catch up with them,” he says.

Wanjala says the only way to overcome the pain of miscarriage is to stay together despite the difficulties.

“Ask for help and do not think you are alone in this. Pointing fingers is not new. Not everyone knows how to deal with miscarriage, but we can pray for children,” he says.

His frustrations are shared with Tobias Onyango*, who says in his case, he supported his wife but he had many questions and he didn’t know who to ask.

With four miscarriages, he says they became hopeless and are still in search of a baby.

“We were counselled and given miscarriage information by the doctors, but I didn’t know what my role was in all this. I was fertile and I feel the problem was with my wife,” he says.

Onyango said counselling was not going to help him but his God.

“The doctors talked to my wife because women in the apartment came to mourn with her, but they were looking for information just to gossip,” he says.

“I did not blame her openly but inwardly I thought she was the cause. She used to call doctors every now and then, and most of these doctors just want money.”

WHAT NEXT

Chebet says Kenya should invest in women's reproductive health specialists and rights.

“The government should also come up with a sensitisation programme. I think this cannot be a monthly thing, but they should say for a week or two in a specific month,” she says.

She adds that they should sensitise women on miscarriage and how to handle it and how to go through it.

“And then we should also have special counsellors for that. They counsel women who have gone through miscarriages. They just walk them through the journey. Because when I got to Eldoret, I was alone,” she says.

Mbita MP Millie Odhiambo says miscarriage policies are contained in the draft Reproductive Healthcare Bill and the Assisted Reproductive Healthcare Bill, which she is sponsoring.

In the draft, she says women who miscarry will be allowed time to grieve their loss.

“This time will allow the mother to recover mentally. With somebody who has miscarried, people treat them like it is not a problem, yet it breeds stigma,” she says.

“When you provide it in the law, you can then provide allocation, and any resources primarily will be in mental health care.”

Millie says in the bill, women will get assistance to have children through other means.

“Part of that information includes those who may want to adopt and people who also may want to have a surrogate mother to help them carry their babies for them,” Millie said.

She says it's time the society normalises talking about miscarriages.

“There are a lot of issues in reproduction that have not been normalised, including not having children, and one of the ways is to encourage the leaders to speak about such issues frequently,” she says.

“That goes a long way in destigmatising, and that is why I do that a lot. I talk about reproductive issues, which people consider taboo.”