"These are not good things for other people to know": How rural Tanzanian women's experiences of pregnancy loss and early neonatal death may impact survey data quality
Social Science and Medicine
Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe St., Baltimore, MD 21205, United States; Ifakara Health Institute, Dar es Salaam, Tanzania; Department of Public Health and Epidemiology, University of Basel, Switzerland; Department of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, United Kingdom
Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers' ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing. We found that like pregnancy, stillbirth and early neonatal death are hidden because they heighten women's vulnerability to social and physical harm, and women's discourse and behaviors are under strong social control. To protect themselves from sorcery, spiritual interference, and gossip-as well as stigma should a spontaneous loss be viewed as an induced abortion-women conceal pregnancies and are advised not to mourn or grieve for " immature" (late-term) losses. Twelve of 30 respondents with pregnancy losses had been accused of inducing an abortion; 3 of these had been subsequently divorced. Incommensurability between Western biomedical and local categories of reproductive loss also complicates measurement of losses. Similar gender inequalities and understandings of pregnancy and reproductive loss in other low-resource settings likely result in underreporting of these losses elsewhere. Cultural, terminological, and methodological factors that contribute to inaccurate measurement of stillbirth and early neonatal death must be considered in designing surveys and other research methods to measure pregnancy, stillbirth, and other sensitive reproductive events. © 2010 Elsevier Ltd.
childbearing; cultural influence; demographic survey; gender issue; gender relations; infant mortality; infertility; low income population; pregnancy; rural population; rural society; womens status; adult; article; attitude to death; controlled study; cultural factor; female; female infertility; health survey; human; induced abortion; interview; maternal attitude; maternal behavior; maternal welfare; newborn death; pregnancy outcome; rural population; social control; spontaneous abortion; stillbirth; Tanzania; Abortion, Spontaneous; Adult; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Hierarchy, Social; Humans; Infant Mortality; Infant, Newborn; Infertility; Poverty Areas; Pregnancy; Qualitative Research; Research Design; Rural Health; Social Stigma; Stillbirth; Tanzania; Women; Tanzania