Perinatal mortality (stillbirth or death within the first 7 days of life) is widespread in low income countriesa and the burden of perinatal mortality falls disproportionately on low income populations including Bangladesh. Indeed, the World Health Organization estimates that the overall perinatal mortality rate in low income countries in 2000 was 61 per 1000 total births compared with 10 per 1000 in high income more developed countries . Like all deaths, perinatal mortality can have a major emotional impact on members of the affected family, particularly the mother, with significant repercussions on the health and well-being of the family.
Studies have shown an increased incidence of depressive symptoms, guilt, prolonged grieving, and feelings of loss of control among parents after a perinatal loss [3–5]. Mothers who have lost their babies either by stillbirth or neonatal death are 7-9 times more likely to suffer from depression than women with a live baby . As time elapses after bereavement, the degree of distress in parents can gradually decrease [7, 8]. A 30 month follow up study on bereaved mothers noted a substantial reduction in the incidence of distress over the study period, from 21% at 2 months, 14% at 8 months to 10% at 30 months .
However, there is also evidence that some bereaved mothers suffer from long term psychological distress after such loss. For instance, a number of studies have documented that some bereaved women encounter long term consequences including depression in subsequent pregnancies and prolonged grief reactions and marital disharmony that lead to separation and divorce [9–11]. Beutel et al. (1995) followed up women up to 1 year after miscarriage and found that bereaved women suffered longer lasting negative psychological, physical and social changes following initial depression . Depressed mothers often felt guilt and shame at losing their unborn babies. Such women were often profoundly sad, cried, and yearned for their lost child. Although baseline depression status was not associated with partnership breakdown, poor perceived support from partner at times of loss predicted subsequent partnership breakdown, as seen in a Swedish study that followed a cohort of women for 7 years after perinatal loss . The risk of partnership breakdown was 4 times higher among women with stillbirths compared to the women who had live babies.
Regarding social consequences, data shows that grieving parents also have to contend with a wide range of negative social effects following a perinatal death, such as isolation from friends, extended family members, and others in their social networks leaving them more emotionally vulnerable . While these psychological and social consequences have been quite well studied and identified in developed countries, there is considerably less information about these from developing countries.
The limited data available from developing countries shows that a significant proportion of women experience depression after perinatal loss. Recent cross-sectional studies in Africa (n = 108) and in Malaysia (n = 62) indicate that around half of all women with perinatal death have high levels of depressive symptoms in the postnatal period [13, 14]. Factors significantly associated with perinatal losses were poor support from husband, pregnancy complications and previous history of perinatal loss in the African study, whereas previous history of perinatal loss was not associated with depression status among Malaysian women. Bereaved Malaysian women who had no support from their friends experienced significantly higher depressive symptoms. However, the results of these studies should be interpreted cautiously because of the study design, selection of the study participants, small sample size and hospital based data. Therefore, there is a need to explore in greater depth the community based data and from larger samples to understand the implications of perinatal death on affected women.
In Bangladesh, the perinatal mortality rate is 55/1000 pregnancies, most of which occur in the rural areas . While many medical and socio-cultural reasons have been identified for this loss [16, 17], there is very little known about the psychological and social consequences for the women who have lost their babies. An earlier study we carried out in rural Bangladesh indicated that perinatal death was one of the strongest predictors of postnatal depression . However, the rate of depression and social sequel among women with perinatal loss are largely unknown.
The purpose of this prospective community-based study was to estimate the magnitude of psychological and social consequences of childbirth resulting in perinatal death in rural Bangladeshi women. We hypothesized that women who had experienced perinatal loss (e.g. stillbirth, early neonatal death) would be more likely to have depression and will encounter impaired social function compared to those with normal deliveries with no complications. We hope that the study findings can be used to inform discussions around programme interventions and policies to address maternal psychosocial health and welfare following perinatal death.