It was quite evident that Fathima (name changed) was elated at the news that she was expecting twins. The knowledge brought her unbridled joy.  Her husband was also excited that he would be a doting father to not just one but two children. Despite the low-resource setting of our workplace in rural Tamil Nadu, a first-trimester scan revealed this surprise.

Given the expertise available at our hospital and the mutual support mothers typically receive during a twin pregnancy, we were confident that, from a medical standpoint, the pregnancy would progress without complications.

As Fathima neared her due date, she began experiencing mild lower abdominal pain, leading us to perform an additional ultrasound, which is usually not warranted at this stage. The scan showed no signs that the fetuses were in distress, and we advised her to continue monitoring fetal movements at home. However, no one could have foreseen what would happen next.

The next day, the labour room was in chaos. Admissions kept pouring in, and babies were being delivered almost every hour, leaving all of us fully occupied.

Fathima returned once again, this time deeply worried about the fact that she could perceive a troubling decrease in her babies’ movements. A cardiotocograph (a device we relied on to track fetal heartbeats) confirmed our worst fear - the twins were showing signs of distress. An emergency caesarean section was carried out without delay.  However, despite every effort, both the babies did not make it and were delivered as stillborn.

The silence in the operating room was deafening.

Throughout her postoperative stay, Fathima needed gentle conversations  to help her process the weight of her loss. The emotional burden was quietly shared between Fathima, her family of origin, and the clinicians attending to her, each trying in their own way to ease the heaviness in the room. After two to three days of close observation and care, she was finally discharged.

A week later, she returned to the outpatient department, complaining about sleepless nights and persistent headaches. It was clear that the weight of her loss was taking a toll, and managing her distress within our limited setting proved challenging. We decided it was best to refer her for a psychiatric evaluation. She received counselling, and after careful assessment, was started on antidepressants before being sent home.

Home visits to discharged patients in nearby villages were part of my routine as a community medicine postgraduate. But visiting Fathima felt different. I knew it would bring more heaviness than closure, but my conscience told me it was necessary.

Fathima lived in one of the villages under our care. While her marital home was in a different area, it was common for women in Tamil Nadu to come to their families of birth for their own childbirths.  I asked my health worker if we could stop by. The air inside her home felt heavy the moment we stepped in. Her father greeted us, his eyes carrying the weight of what the family had been through. When Fathima entered the room, it was hard to find the right words.

Slowly, it became clear that her husband had left. I asked about him, not expecting what followed. Fathima shared that her in-laws had blamed her for the stillbirths, accusing her of causing harm during the brief minutes an intern had spent time alone while evaluating her in the labour room. The cruelty of those words stunned me. Adding to her pain, her in-laws had told her not to return to their home until she was ready to conceive again.

What stayed with me was when she asked, “Isn’t this the time when my husband is needed the most? Where is he now?” I had no answer. I held her hands, and we wept together. For a moment, the world felt darker for both of us.

As I stepped outside her home, the world felt vast yet strangely empty. It was a world that often silences the voices of women, leaving behind only echoes of grief that quietly deepen over time.

But her story is not unique.

According to the World Health Organisation (WHO), nearly 2 million stillbirths occur annually, one every 16 seconds even today. And beyond the financial and physical toll, the emotional scars, stigma, and societal blame weigh heavily and solely on women.  A recent preprint study by Wadhwani et al. highlights the economic impact in India, estimating a staggering loss of ₹6.4 trillion in 2019 alone due to stillbirths.

Is Miscarriage a Woman’s Fault?
A study by Gopichandran et al. found that women who experienced stillbirths grappled with profound grief and guilt, intensified by an unsupportive health system, indifferent healthcare providers, and social stigma. Families, shaken by the suddenness of the loss, often searched desperately for answers and, in the absence of clarity, perceived healthcare services as inadequate and insensitive.

Despite clear medical evidence dispelling myths about pregnancy loss, society continues to unfairly place the burden of blame on women. In many cultures, including parts of India, a woman’s worth is still closely tied to her ability to bear children. This makes miscarriage and stillbirth deeply stigmatized, laden with guilt and shame. Families and communities often perpetuate these harmful narratives as in Fathima’s case, where her in-laws refused to view the stillbirths as tragic accidents and instead placed the blame squarely on her.

Medical professionals can play a crucial role in challenging these stigmas by providing factual, empathetic explanations to families. Yet, this requires a systemic shift toward compassionate care and better communication training in medical education.

Mental Health After Pregnancy Loss

A systematic review by Westby et al. found that parents who experience stillbirth face significantly higher levels of depression, anxiety, and post-traumatic stress disorder both in the short term and, in some cases, long after the loss compared to those who have a live birth. Studies have shown that those mothers who lack spousal support have four times higher risk of developing postpartum depression and anxiety following Stillbirth. The psychological burden often goes unaddressed, especially in resource-limited settings where mental health services are scarce. In India, where only 0.75 psychiatrists are available per 100,000 people, many women like Fathima are left to cope alone.

Fathima’s insomnia and headaches were clear signs of her mental distress. However, the societal taboo around discussing mental health compounded her isolation. What she needed was a safe space to grieve, counseling support, and assurance that her feelings were valid. Unfortunately, these remain luxuries in many parts of our world.

Partners need to recognize their role in providing emotional support. Fathima’s husband’s abandonment highlights the need for societal shifts in how men view their responsibilities during crises.

The Pressure to Conceive Again

Many women face immense pressure to “replace” their lost child by conceiving again, often before they are ready. This demand stems from societal expectations and the fear of being deemed “inadequate.” For women like Fathima, this pressure can lead to anxiety, fear, and further strain on their health and relationships. Acknowledging and respecting a woman’s recovery is essential for her well-being.

Approaches that have shown success

The aftermath of stillbirth requires comprehensive interventions to support bereaved mothers. Evidence shows that Cognitive Behavioral Therapy (CBT) can significantly reduce grief, while other psychotherapeutic approaches help manage stress and promote emotional healing. Religious coping strategies, when integrated into grief counseling, further strengthen resilience by addressing spiritual needs.

Physical activity has also been linked to reduced depressive symptoms and improved emotional well-being. Apart from physical activity, the role of Yoga has also shown positive outcomes in preventing depression and Post traumatic stress disorder  among parents. Training healthcare providers to deliver empathetic, respectful care is equally vital, as it improves coping strategies and reduces stigma.

Together, these psychological, spiritual, physical, and social interventions form a holistic framework for addressing the complex grief associated with stillbirth.

Although these approaches seem feasible, reality can be harsh. Despite evidence supporting interventions such as cognitive behavioural therapy (CBT) being effective, access to such structured mental health services is severely limited in many parts of India, especially for perinatal women. 

In many rural setups, women face deep-rooted cultural norms, heavy domestic workloads, and limited autonomy, which restrict their ability to prioritise their health and engage in physical activity. These cultural and infrastructural barriers make solutions that seem straightforward practically inaccessible, also leaving a significant gap.

Compassion at the centre of care

Compassion must be at the core of how stillbirths are addressed, both by healthcare providers and families. In a highly patriarchal context like India, providers can play a key role in reducing stigma and easing psychological pressure on women by sensitively explaining the various factors that can lead to stillbirths to family members. They can also advocate for a supportive and caring home environment that allows the woman to rest, recover, and be relieved of domestic responsibilities. Additionally, reassuring the woman and her family about her future fertility can help alleviate anxiety and give her the time and space she needs before attempting another pregnancy.

Peer-support groups for mothers who have experienced stillbirth can help reduce isolation and stigma. Establishing small, confidential groups within existing women’s networks (Self Help Groups, Mahila Mandals, Anganwadis), complemented by helpline services and hybrid approaches such as home visits and digital support, could make these initiatives more culturally acceptable and sustainable.

Hospitals can adopt more sensitive practices by creating a supportive and compassionate environment for mothers who have experienced stillbirth. There should be a designated area for admitting women who have experienced a stillbirth, as they are often placed in postnatal wards alongside mothers with healthy babies, which can further intensify their emotional distress.

In the policy front, allowing ASHA workers to conduct home visits on women who have miscarried postnatally and offering them counselling services can be incorporated. There is currently no structured provision in the national guidelines for ASHAs to specifically support mothers who have experienced a stillbirth. Furthermore, creating awareness among working women that they are entitled to paid maternity leave even after miscarriages can help them feel more empowered to seek the help they need to rest up adequately. However, the majority of women in India are employed in the informal sector, where these legal protections are not applicable.

Fathima’s story is a poignant reminder of the silent struggles many women endure. Stillbirth is not just a medical event but a deeply personal tragedy with far-reaching emotional and social implications. Addressing these challenges requires systemic changes in healthcare, societal attitudes, and family dynamics.

As healthcare professionals, families, and communities, we must create an environment where women feel supported rather than shamed, understood rather than judged. Only then can we hope to bring light back into the lives of mothers like Fathima.

By acknowledging their pain and advocating for better support systems, we can begin to mend the wounds left by stillbirth and pregnancy loss, one compassionate step at a time.

Edited by Christianez Ratna Kiruba
Image by Gayatri