Women's experiences of the consenting process for pregnancy remains disposal following early miscarriage

BACKGROUND AND METHODOLOGY

UK clinical practices around managing pregnancy remains after pregnancy loss involve a process of documenting consent. Women are typically offered options for disposal, which may include cremation, burial, releasing for private arrangements, releasing to a funeral director and, in some cases, sensitive incineration. A single researcher conducted 20 months of ethnographic fieldwork in one National Health Service (NHS) Trust including observing the consenting process for pregnancy remains disposal (n=28) and interviewing 27 women, including 19 who had experience of the consent process for pregnancy remains disposal, about their understanding, attitudes and experiences of pregnancy remains disposal. Transcripts were analysed for representative themes.

RESULTS

Prior to the discussion and consenting process most participants had not given consideration to disposal methods. Participants expressed surprise about the discussion and disposal pathways with most suggesting it was inappropriate, particularly given the early stage of their pregnancy (<12 weeks' gestation). In some cases, the consenting process caused distress due to the way the participant framed their pregnancy remains being divergent from implied meaning in discussions about disposal.

CONCLUSIONS

Current practices appear discordant with the views of some women experiencing miscarriage. A person-centred approach to pregnancy remains disposal is recommended to accommodate a diverse range of approaches so as not to challenge a woman's experience of and agency about her body, pregnancy and pregnancy remains.

Further Hierarchies of Loss: Tracking Relationality in Pregnancy Loss Experiences

The article extends Robson and Walter's concept of hierarchies of loss by describing further factors which afford differential social legitimacy to death-related losses. Drawing on our separate research with women in England who have experienced pre-viability pregnancy loss through different types of miscarriage and termination for foetal anomaly, we note that closeness of relationship to the object of loss does hierarchise pregnancy loss. However, other relational elements are also implicated, including ontological positions on what it was which was lost, in relation to other individually and socially experienced losses. Hierarchies are both imposed and agentially used by those who are implicated. This wider analysis extends the concept of hierarchies of loss so it can include experiences which do and do not involve grief and bereavement, and experiences of social recognition alongside those where loss is disenfranchised, marginalised, or ungrievable.

Culpability, blame, and stigma after pregnancy loss in Qatar

Background

Following a miscarriage many women report feeling guilty and culpable for what has happened particularly when aspects of societal blame and stigma are involved. This research investigated the impact of cultural context on the experience of miscarriage. In particular, it focused on how elements of stigma and blame are linked to notions of miscarriage etiology and risk among Qatari women.

Methods

The research used an ethnographic approach. The data was collected over 18 months of fieldwork in Qatar, using semi-structured face to face interviews, and participant observation. A purposive sample of 40 women (primary participants) who had recently miscarried, participated in the study. Potential subjects were initially identified in the Women’s Hospital and were consented, and then interviewed in Arabic either in the hospital or at their preferred location. The interviews were audio recorded, transcribed and translated into English. Additional key interviews were performed with 20 secondary participants related to the miscarriage cohort including family members and husbands. Inductive thematic analysis of content was performed manually to extract themes.

Results

Two main themes emerged from the material looking specifically at miscarriage aftermaths: rhetorics of blame, self-blame and feelings of guilt; and miscarriage attitudes. Overall society is sympathetic and miscarriage is seen as normal and not particularly worrying, but understood to be upsetting to women. However, findings suggest there is some ambivalence around blame, culpability and stigma applied to miscarriage; some participants perceived miscarriage as a relatively normal and common event, whereas, others felt that miscarriage is resounding stigma and shame.

Conclusion

Miscarriage aftermaths are embedded in social, cultural and religious frameworks in relation to notions of risk and causation. Attention should be paid to ensure women and those around them are given appropriate and robust information about miscarriage causation to deflect discourses of blame that may be employed and reduce harm to women who suffer miscarriage.

Causal explanations of miscarriage amongst Qataris

BACKGROUND

Despite its commonality, there is a paucity of literature on miscarriage in non-Western societies. In particular, there is little understanding of how people ascribe cause to miscarriage. This research sought to gain an in-depth understanding of notions of miscarriage causality and risk amongst Qataris.

METHODS

The study adopted an exploratory descriptive qualitative approach and collected data during 18 months of ethnographic research in Qatar, including semi-structured interviews. The sample includes 60 primary participants (20 pregnant women and 40 women who had recently miscarried), and 55 secondary participants including family members, health care providers, religious scholars and traditional healers. Informed consent was obtained from all participants. Primary participants were interviewed in Arabic. The interviews were audio recorded, transcribed and translated into English. Data was analysed using an inductive thematic approach, which involved identification and application of multiple codes to different text segments. Data were encoded manually and examined for recurrences across the data set. Similar quotations were grouped into subcategories and further categorized into main themes.

RESULTS

A number of key themes emerged, revealing Qatari women attributed miscarriages to a number of factors including: supernatural forces, such as God's will and evil eye; lifestyle, such as physical activities and consuming particular substances; medical conditions, such as diabetes; and emotional state, such as stress, and emotional upset. Resting, avoiding stress and upset, maintaining healthy diet, and spiritual healing (ruqyah) are seen as a means to avoid miscarriage.

CONCLUSION

Practices and beliefs around miscarriage are embedded in social, cultural, religious and medical frameworks. Understanding the socio-cultural context and understandings of explanatory theories can enhance health care providers' understandings, resulting in improved communication and care.

Qatari intersections with global genetics research and discourse

Genetic discourses have taken a predominant role in approaches to combating a number of conditions that affect Qataris. This paper is derived from an exploration of Qatari encounters with globalizing discourses of genetics, particularly as they relate to notions of risk. It explores Qataris negotiations of global interactions and influences, including the discourses around genetic risk and cousin marriage. It suggests that family marriage can be seen as one of the main platforms of resistance and a means for modern, cosmopolitan and tradition to be negotiated.

Arranging marriage; negotiating risk: genetics and society in Qatar

This paper considers how the globalized discourse of genetic risk in cousin marriage is shaped, informed and taken up in local moral worlds within the context of Qatar. This paper investigates the way Qataris are negotiating the discourse on genetics and risk. It is based on data from ongoing ethnographic research in Qatar and contributes to anthropological knowledge about this understudied country. Participants were ambivalent about genetic risks and often pointed to other theories of causation in relation to illness and disability. The discourse on genetic risk associated with marrying in the family was familiar, but for some participants the benefits of close marriage outweighed potential risks. Furthermore, the introduction of mandatory pre-marital screening gave participants confidence that risks were monitored and minimized.

Gulf war syndrome: a reaction to psychiatry's invasion of the military?

Following the 1991 Gulf War, a number of soldiers who fought there began to complain of various symptoms and disorders, the collection of which came to be known as Gulf War syndrome (GWS). A debate has raged about the nature and cause of this illness, with many suggesting that it is a psychiatric condition. GWS continues to be a contested illness, yet there is no disputing that many Gulf veterans are ill. This article considers the way in which GWS sufferers understand their illness to be physical in nature and the way in which they negotiate and resist psychological theories of their illness. Based on 14 months of ethnographic fieldwork in the United Kingdom, data for this article were collected mainly by in-depth, semistructured interviews with GWS sufferers, their family members, doctors, and scientists, as well as healthy Gulf veterans. A total of 93 informants were interviewed, including 67 UK Gulf veterans, most of whom were ill. The paper argues that despite the increasing presence of psychiatry in military discourse, GWS reveals the way that people are able to transform, negotiate and even negate its power and assumptions.

On being a Gulf veteran: an anthropological perspective

There is no doubt that Gulf service has affected the well-being of some of the members of the UK armed forces who served in that conflict, yet the reason for this remain unclear. At present, the debate surrounding Gulf War Syndrome (GWS) has become stagnant and highly polarized. This paper argues that a new perspective is needed to further improve our understanding of the problem and suggests that the methods and theories of anthropology, with its focus on nuances and subtleties, can provide new insights. Data were generated from 14 months of ethnographic fieldwork in the UK including participant observation, semi-structured interviews and document analysis. Anthropology provides a unique way of approaching and understanding somatic symptoms and suggests that GWS symptom reporting can be seen as a form of communication. The work focuses on the sufferers' accounts, the symptoms themselves and the context within which we find them in order to better understand what was being expressed and commented upon. Although necessary to contextualize GWS through situating it among other emergent illnesses and widespread health beliefs, this paper shows there is a need to bring back the particular. This work seeks to make sense of the cultural circumstances, specific and general, which gave rise to the illness.