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Thursday, October 15, is International Pregnancy and Infant Loss Remembrance Day. And it’s another opportunity to break the silence around pregnancy loss and infant death, and offer families a dedicated space to honour their babies.
Pregnancy loss is not rare. The Lancet’s 2021 research estimated that 23 million pregnancies worldwide end in miscarriage every year, which amounts to 44 every minute and about 15% of all pregnancies. That works out to roughly one in ten women experiencing a miscarriage in her lifetime.
Stillbirth puts Nigeria near the centre of the global picture. UNICEF estimates that 1.9 million babies were stillborn worldwide in 2021, and that sub-Saharan Africa’s share of those losses has climbed from 26 per cent in 2000 to 45 per cent. For Nigeria specifically, UNICEF estimated 171,428 stillbirths in 2019, a rate of 42.9 per 1,000 births, the second highest in the world.
More recent analysis by Nigeria Health Watch places Nigeria among the six countries with the most stillbirths, at a rate of 24 per 1,000, twice the global target of 12. That means one out of every four stillbirths in sub-Saharan Africa happens in Nigeria. Yet, discussions on maternal and child health rarely highlight this crisis.
Researchers at the Institute of Human Virology Nigeria say the country’s stillbirth data are not visible or accessible to decision-makers. A study of deliveries in Kano also pointed to an inadequate reporting system, with stillbirths going unregistered at one hospital. An unregistered loss isn’t budgeted for, and a mother whose loss isn’t counted will not be asked how she is.
Blame Arrives Before Condolences
Where the system looks away, the community steps in with a verdict. Researchers working with bereaved mothers in Kano note that women who turn to family and community for support are often met with stigma, self-blame, isolation and ostracism, leaving them unable to grieve.
Nigeria Health Watch adds that in some communities a stillbirth is read as spiritual misfortune or pinned on the mother, which shuts down open conversation. Interviews with twenty bereaved mothers found that superstition, religion and social expectation shaped how women made sense of their loss.
The medical evidence tells a different story. In a five-year study across four tertiary hospitals in south-east Nigeria, there were 1,294 stillbirths in 23,101 deliveries; more than half were preterm, and hypertensive disorders of pregnancy were the commonest probable cause of macerated stillbirth. UNICEF also notes that more than half of stillbirths in Nigeria occur during labour and delivery. These are failures of the healthcare system, not failures of the affected women.
The stigma also does its own damage. Deep-rooted beliefs and stigma often keep women away from antenatal care and from delivering in health facilities, which raises the risk of complications. Blame meant to explain one loss can help produce the next.
A Law Written for Women Who Go Home with a Baby
The Labour Act’s section 54 gives female workers twelve weeks of maternity leave, which can begin six weeks before delivery on a medical certificate. It allows extended leave on medical grounds for complications of pregnancy or childbirth, but does not clearly say that such leave is paid. Published summaries of the section do not appear to mention miscarriage or stillbirth at all. It also provides no statutory paternity leave.
Other countries have done better. India’s Maternity Benefit Act entitles a woman to six weeks of paid leave after a miscarriage. Filipino mothers are entitled to 60 days of paid leave for pregnancy loss. New Zealand approved three days of bereavement leave after miscarriage in 2021, and it was the only country at the time to extend that leave to partners as well.
What Must Change
First, Nigeria must count its losses. Stillbirths should be registered, and the data made public, because policy cannot respond to grief it has not recorded.
Secondly, the law must catch up with the loss. Section 54 should be amended, or employers should adopt policies to give clear leave after miscarriage and stillbirth, for women and their partners.
Thirdly, stigma must be treated as a public health problem. There should be bigger investment in maternity care, health education and public enlightenment to reduce stigma around stillbirth. Health workers, faith leaders and families all have a part in replacing “what did she do?” with “what does she need?”
Lastly, bereaved women need access to counselling and respectful care, and fathers need to be included in the grieving rather than assigned to guard its door.
