As a 32-year old, married woman without children, I am constantly reminded that procreation is still largely considered the logical next life stage expected of me. This sense is exacerbated by the fact that I live in India, where traditional gender roles are particularly pronounced. Every time I have to answer an intrusive question, and I am judged by my choice to not have children, I realize that successfully birthing a child is but another measure of perfection that women are held up to. While it's a choice for me, for women who have experienced a miscarriage, there is little choice involved. But this naturally occurring, common phenomenon is seen as a failure, too.
A study about recurrent miscarriages published in the Journal of Obstetrics and Gynecology of India in 2015 revealed that 32 percent of approximately 2,400 women between the ages of 18 and 45 who were screened to participate had experienced at least one spontaneous miscarriage. More significantly, the study found that 7.46 percent of women in the sample had experienced recurrent miscarriages, or the spontaneous termination of three pregnancies before 20 weeks in a row, which is significantly higher than the global average. According to the American Pregnancy Association, anywhere from 10 to 25 percent of pregnancies recognized clinically end in miscarriage; according to the National Institutes of Health, 15 to 20 percent of American women who know they are pregnant will miscarry. Worldwide, the percentage of women who experience three pregnancy losses in a row is about 1 percent.
Yet despite these figures, taking about miscarriage is still considered taboo, and this has resulted in a skewed understanding of the causes and prevalence of miscarriage. "I'm tired of everything to do with women and sex so shrouded in silence. We don't hide the loss of a parent or sibling, so why this hush-hush around a child?" says Sunaina*. "Why build it into something sacred? It makes it harder for the next generation of women who are struggling with the same thing."
While I was reporting this piece, a friend told me that it was only after she had suffered the premature termination of her pregnancy that several women close to her opened up about their own miscarriages. It wouldn't be wrong to say we are a culture that glorifies childbirth—often at the risk of painting an unrealistic picture that doesn't prepare women for this very real outcome of any pregnancy.
"We don't hear people talking about [miscarrying] much, so it doesn't seem common," Anjali* says. "You don't want to be the one people do talk about, and that reinforces the notion of it being an exception rather than common."
In India, a woman who has miscarried is often perceived as "barren" or "infertile" — labels loaded with shame. "Social conditioning works insidiously even when you're liberal and aware" says Aanchal. "With the emphasis placed on a woman's role as a vessel for progeny, even the very-common occurrence of the woman's body expelling a fetus is seen as 'not normal' and hence, 'shameful.'"
I can't forget the midwife's matter-of-fact reaction. She said something like, 'You don't have a baby anymore.'
Closely tied to miscarriage is grief, and often, the fear of being labeled barren, incomplete, or somehow damaged forces many women who have miscarriages to grieve privately, even though what they may actually want, and need, is support.
"The more I talk about it, the more I process, it," Anjali says. "I know what a relief it was to hear that it had happened to others. Each new story made me feel part of a group who were coping with this loss, rather than mourning alone."
Most of the nearly two dozen women I spoke to agreed that it was hard enough dealing with the trauma of miscarrying without having to cope with the shame and secrecy, too.
"There's nothing I could have done to keep it going; I'm not ashamed, so why should I hide it?" Cara* says. "Our bodies made a child and then couldn't keep it. That's sad. We need to let mothers grieve if they need to."
Many women choose silence to avoid the inevitable speculation that follows when a woman shares news of her miscarriage. It's not uncommon for friends and relatives to inaccurately connect pre-marital sex or masturbation to the inability to carry a pregnancy to term. Several other completely baffling myths and taboos still persist; they usually place the responsibility for a miscarriage on the shoulders of women.
It was as natural a process as conceiving, except that doctors made a horror out of it.
"A friend who miscarried at five months received a lot of sympathy from someone, but the email ended with, 'Next time, just don't tell people you're expecting'—almost suggesting that that was the reason for the miscarriage," Anjali says.
Another woman, Oormila, had a friend suggest she may have inadvertently caused her own miscarriage by being "hyperactive." "I was very cut up by it," she says. "It was cruel coming from a friend."
So deep is the shame, that sometimes it can permeate even the most rational mind. Niv says she sensed a "bubble of superiority within the family" when she miscarried, and it left her wondering, "if there was indeed something wrong with me. [The feeling] lasted until I became pregnant for the third time," she says.
"You are given to believe that your body is capable and should handle pregnancies, and when that doesn't happen, you are left with the deepest sense of horror and shame," says Nitya. "I am fairly well-read. Despite that, I blamed myself."
Other women I spoke to told stories of doctors and nurses unceremoniously instructing them to stop crying, not make a big deal, and get on with life.
"I can't forget the midwife's matter-of-fact reaction," says Cara. "After the scan was over, we were called to a small room where the midwife handed over a brochure or two that discussed miscarriages, and [she] said something like, 'You don't have a baby anymore.' She probably didn't mean it that way, but it completely broke my heart."
Some other women, like Kamini, received no information from their doctors at all. "The doctor didn't speak to me after the D&C [dilation and curettage, the procedure used to remove tissue from the uterus after an abortion or miscarriage] and disappeared once the procedure was done," Kamini says. "The nurse at the clinic wouldn't say anything either. The chart had no information on post-op care, just a list of medicines. I felt both the doctor and nurse were treating me like I had done something wrong."
"It was as natural a process as conceiving," says Priti* of her own miscarriage, "except that doctors made a horror out of it."
Most of the women I spoke to agree that talking openly about miscarrying is the first step to changing the conversation otherwise only dominated by age-old myths and stereotypes. Many women believe it is the only way.
"The more people know why it happens, and how often it happens, the less likely they'll be to convert this loss into long-term grief," Aanchal says.
*Names have been changed.