Written by Mihlali Simukandla
Working for an insurance company straight after university, I was placed in a trainee management position. Part of my job specification included heading the death claims section in the branch operations. The branch was in one of the busy towns of the rural Eastern Cape province. Declining or paying out death claims was based on set criteria according to company policy. I always found myself dealing with irate clients who were unhappy and needed a more senior person to explain the reasons for the decline of the claim. As a senior person, I would patiently explain to irate clients why their claim could not be paid. Looking back, the contents of my patient approach were only about company rules and policies. My motivation in writing this story is the realisation that I had no empathy or understanding of what some of these clients were going through. Mostly, I look back at clients who would try to motivate their claims with handwritten letters from village “homeopaths” as proof of lost pregnancies. Whilst we declined claims for miscarriages, some of the handwritten letters would refer to the lost pregnancies as abortions and this would further strengthen the reasons of declining the claim.
Claims would be paid only for miscarriages that happened after a given period of time in utero. Currently most insurance death claims are considered to be valid after 182 intrauterine days (6 months). Out of interest, it turns out that employers also grant maternity leave only if the lost pregnancy lasted for at least 6 months (third trimester). The amount of leave granted to employees befallen by this situation is usually 6 weeks against four months leave granted to those who give birth to live babies. The Basic Conditions of Employment Act no.75 of 1997 provides for six weeks maternity leave if miscarriage happened in the last trimester.
Women who have miscarried in their first or second trimester have no claim to loss of life benefits nor maternity benefits. Legislation segregates according to time in utero which implies that some miscarriages are to be taken more seriously than others. Are there different levels of seriousness to miscarriages?
Literature states that a miscarriage, also medically known as spontaneous abortion, requires a medical diagnosis, as this means an abrupt end to a pregnancy. This means a woman has had no choice in the termination of their pregnancy. In many cases no apparent cause can be found as it can happen for a range of reasons. Miscarriages may be seen as no big deal because they are really common yet it can be an extremely traumatic and devastating experience.
Every woman (without even mentioning partners) is affected differently hence grief, anxiety, depression, and even symptoms of Post-traumatic Stress Disorder (PTSD) can be experienced. PTSD symptoms include nightmares, flashbacks, and re-experiencing feelings associated with the loss. An article written in 2018 by the International Federation of Gynaecology and Obstetrics (FIGO) indicates that thirty to fifty percent of women experience anxiety after miscarriage, 10-15% experience depression. It is also mentioned that psychological effects of a miscarriage can last up to 4 months. Pregnancy hormones can also remain in the blood for up to 2 months after miscarrying. Is it likely that society is unaware of the unique physical and emotional challenges that come with the experience?
There is an assumption in our society that pregnancy should not be disclosed until after 12 weeks. Couples who experience a miscarriage in this time do not tell anyone. It is considered socially unacceptable to reveal a pregnancy before 12 weeks. Psychological effects of early pregnancy loss end up being brushed under the carpet. There is a stigma of shaming women for sharing their news before 12 weeks and then suffering a miscarriage. The miscarriage is seen as their own fault. Women grieve in private, weighed down by feelings of guilt and failure. Miscarriages can feel very lonely although they are so common. Many women suffer repeated miscarriages, never find out why and they blame themselves.
According to the National Institute of Health and Care Excellence (NICE), grief following miscarriage is the same grief suffered for any major loss. The 12-week rule perpetuates the notion that early pregnancy loss is something to hide and no fuss should be made about early pregnancy loss. There seems to be a hierarchy of grief determined by the stage of pregnancy and only third trimester losses seen as worthy of mourning. Pregnancy is deeply personal and women go through the whole grief cycle no matter how early their pregnancy stage was.
Psychological care for women who have miscarried needs to be strengthened. A 2013 World Health Organization (WHO) review suggests that support should be offered to such women who are already in distress and follow-up appointments should be made to identify women at risk of developing mental health problems. Perhaps this indicates that miscarriage is a significant cause of distress. Women grieve for their miscarriages in the shadows. More understanding and empathy could alleviate much of this pain. Taking the conversation to public platforms might help alleviate the pain, even though it may not solve the unknown causes of miscarriage. Women bond with their unborn babies whether they are six weeks or six months pregnant. The same psychological care and empathy should be shown regardless of the time at which the pregnancy was lost.