Silence and Sorrow: A Qualitative Exploration of the Hidden Role of Communication Failures in Perinatal Care.

INTRODUCTION

Perinatal mortality remains high in low- and middle-income countries, with Tanzania bearing one of the greatest burdens. The Three Delays framework is often used to analyze preventable perinatal deaths and includes care seeking, reaching care, and receiving definitive care. This study explores Tanzanian mothers' experiences of perinatal loss, focusing on delays and gaps in care.

METHODS

This study was conducted at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women who experienced stillbirth or neonatal death completed intake surveys about their perinatal loss experience. Of these, 40 completed semi-structured in-depth interviews 8 weeks post-loss. Interviews explored barriers in care seeking, access, delivery, and communication. Survey data were analyzed with descriptive statistics. Interview data were thematically coded using a directed content analysis combining a priori codes from the three delays framework and inductive coding.

RESULTS

Participants perceived delays in seeking care (50%), receiving care at initial facilities (27.5%), referral processes (12.5%), and care at KCMC (17.5%). Nearly half (45%) reported inadequate communication from healthcare providers. Three key themes emerged: (1) women perceived delays in care at all points along their care trajectory (2) gaps in communication impacted medical care for women and newborns, and hindered healing after perinatal loss; and (3) women emphasized the need for emotional support and compassionate communication following loss.

DISCUSSION: While structural, process, and financial barriers persist, informational and relational communication gaps represent an under-addressed challenge across the perinatal loss care pathway. Rather than being viewed in isolation, efforts to strengthen communication should be integrated into broader health system strategies aimed at reducing delays, improving access to timely and quality care, and supporting families after stillbirth or neonatal death. Strengthening communication within health systems, both as an informational and relational process, has the potential to enhance care experiences, build trust, and support emotional healing after perinatal loss.