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‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan

Authors:
  • The University of Sydney Faculty of Medicine and Health
  • Afghanistan National Public Health Institute
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Abstract

This study aimed to explore bereaved parents’ and healthcare providers experiences of care after stillbirth. Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants in Kabul province, Afghanistan between October and November 2017. Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying disclosing the stillbirth were recurring concerns. There was a disconnect between parents’ desires and healthcare provider’s perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as profound regret. Health providers’ reported hospitals were not equipped to separate women who had a stillbirth and acknowledged that psychological support would be beneficial. However, the absence of trained personnel and resource constraints prevented provision of such support. Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.
Journal of Perinatology (2021) 41:21822195
https://doi.org/10.1038/s41372-020-00907-5
ARTICLE
I should have seen her face at least once: parents and healthcare
providersexperiences and practices of care after stillbirth in Kabul
province, Afghanistan
Aliki Christou 1Ashraful Alam 1Sayed Murtaza Sadat Hoani2Adela Mubasher3
Mohammad Haz Rasooly2Mohammad Khakerah Rashidi4Camille Raynes-Greenow 1
Received: 29 June 2020 / Revised: 15 November 2020 / Accepted: 1 December 2020 / Published online: 6 January 2021
© The Author(s), under exclusive licence to Springer Nature America, Inc. 2021
Abstract
Objective This study aimed to explore bereaved parentsand healthcare providers experiences of care after stillbirth.
Study design Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants
in Kabul province, Afghanistan between October and November 2017.
Results Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying
disclosing the stillbirth were recurring concerns. There was a disconnect between parentsdesires and healthcare providers
perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as
profound regret. Health providersreported hospitals were not equipped to separate women who had a stillbirth and
acknowledged that psychological support would be benecial. However, the absence of trained personnel and resource
constraints prevented provision of such support.
Conclusion Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication
training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.
Introduction
Stillbirth is a devastating and traumatic loss for parents and
families and associated with long-term psychological and
social consequences [1,2]. The psychological and emo-
tional impacts of stillbirth include post-traumatic stress,
anxiety and depression [36]. Parents wellbeing is further
affected by the care and treatment received after a stillbirth
from healthcare providers [7,8]. The practices and beha-
viours of care providers during their interactions with par-
ents at each point around their stillbirth, from diagnosis
through to the birth and post-natal period, can affect how
and if families cope with the death and the extent of psy-
chological trauma [9]. These impacts are being increasingly
recognised with many studies now describing and investi-
gating these experiences to improve care and minimise the
psychosocial effects [1012].
Stillbirth can cause prolonged grief comparable to the loss
of any child, but is complicated and intensied because of the
lack of an equivalent recognition and acceptance of this grief
by society and healthcare providers [7]. Evidence from studies
conducted in several low- and middle-income countries
(LMIC) suggests that stigmatisation around stillbirth due to
sociocultural beliefs and societal pressure means women and
men often cannot openly grieve their loss [13]. There are few
studies from LMICs examining the experiences of parents of
the care received just before or following stillbirth, yet these
countries account for 98% of the global burden of stillbirths
[14].Two recent systematic reviews have examined the
experiences of care received after stillbirth including one
focused on studies from LMICs, although most included
studies were from middle-income countries with only ve
from low-income countries [13,15].
Afghanistan is a high stillbirth burden country with a
stillbirth rate of 27 per 1000 birthsalmost nine times
*Aliki Christou
aliki.christou@sydney.edu.au
1Sydney School of Public Health, Faculty of Medicine and Health,
The University of Sydney, Sydney, NSW, Australia
2Afghanistan National Public Health Institute, Ministry of Public
Health, Kabul, Afghanistan
3World Health Organisation, Kabul, Afghanistan
4Ministry of Public Health, Kabul, Afghanistan
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