Psychosocial Challenges Faced by Women After Perinatal Loss in Pakistan and the Need for Supportive Interpregnancy Care.

Miscarriage and stillbirth can have lasting adverse effects on the mother and on her subsequent pregnancies. We retrospectively explored the postpartum experiences of women in Pakistan who experienced a prior miscarriage or stillbirth, subsequently conceived, and had symptoms of anxiety in their current pregnancy. We conducted in-depth interviews with 18 pregnant married women ≥18 years old in early to mid-pregnancy ( ≤22 weeks) in Rawalpindi, Pakistan, from September 2021 to June 2022, who scored at least mild ( ≥8) on the anxiety subscale of the Hospital Anxiety and Depression scale, without meeting criteria for Major Depressive Episode on a structured clinical interview, and had at least one prior pregnancy loss. We analyzed interview transcripts using an inductive thematic framework. Self-recrimination for pregnancy loss was common, often enmeshed in stories attributing the pregnancy loss to inappropriate diet or lack of precautions against travel, heavy chores, or other physically demanding tasks. Spirituality appeared in women's accounts of miscarriage and stillbirth in two ways: as consolatory beliefs about qadar (fate) or as suspicions of nazar (evil eye) resulting from another's envy. Following pregnancy loss, women described specific responses by family and providers as contributing to their distress (e.g. withholding information about the deceased fetus). Reactions by family and others to the loss were often stigmatizing in that they were perceived by women as reinforcing notions of personal blame for their pregnancy loss. Our findings point to natural targets for preventive psychosocial interventions and the need for postpartum and supportive interpregnancy care after perinatal loss.