Miscarriage in Psychosocial Context: Findings From a National Sample of Childbearing Women

Background and Purpose:

Although pregnancy loss is a common experience occurring in approximately one-fourth of all currently parenting women, the differential impact of miscarriage on psychosocial well-being and future childbearing decisions is less clearly defined in the literature (Price, 2008). The present study is a secondary data analysis from the National Survey of Fertility Barriers (NSFB), a representative telephone survey conducted in 2004-2007 targeting women age 25-45 and their partners. The NSFB includes information on infertility and loss as well as extensive data on family patterns, childbearing choices and social/ethical beliefs. Four research questions are explored in order to situate miscarriage in psychosocial context: 1) What are the familial and social patterns most closely identified with miscarriage? 2) What is the relationship between miscarriage and mental health? 3) What social, cultural, and religious beliefs and practices vary based on the experience of miscarriage? 4) How does the experience of miscarriage impact future parenting decisions?

Methods:

The NSFB interviewed 4,712 women and 936 of their partners. In this secondary analysis, all cases of primary respondent data were considered since the variable of interest was the woman's experience of miscarriage. Data was weighted in a three-tiered manner to infer findings to the overall United States population; all results reported are at a nationally representative level of inference. Data analysis was performed using STATA 11.0 survey command procedures for univariate, bivariate, and multivariate regression models.

Results:

In this study sample, 27% of women self-report having ever experienced a miscarriage. Miscarriage was more common in women who reported being married (OR = 1.40) than those who reported being separated/divorced, single, or in lesbian partnered relationships. Miscarriage was not significantly associated with variations in social support, religiosity, stigma of childlessness, emotional well-being, or depressive symptoms. However, women experiencing miscarriage were significantly more likely to have utilized mental health services (OR = 1.31). Indeed, the increased use of mental health services by women who miscarry remained significant even in models controlling for depression, anxiety, and substance use. Women experiencing miscarriage also had a higher likelihood of future parenting intention (OR = 1.12) which increased when accompanied by stigma of childlessness and spouse/partner desire to have a child (OR = 4.40).

Conclusions and Implications:

A compelling finding from this study is that mental health service utilization is increased for women experiencing miscarriage, even in the light of relatively equal psychosocial risk; one explanation may be that the experience of loss is an impetus for help-seeking at a time of disequilibrium in women's lives. The future parenting model also suggests a heightened importance of subsequent pregnancy intention to women who miscarry, particularly when partners also report a desire to have a child. For social work practice, this analysis suggests that miscarriage may be an important contextual factor in family parenting decisions, rather than a presumed detriment to women's long-term psychosocial well-being. Similarly, future research efforts may focus on both normative experience and adaptive coping, as well as understanding the nuances of complicated grief responses to pregnancy loss.