Stillbirth and Baby Loss: The Taboo Subject in South Asian Culture
I still recall a time when I was younger, attending an extended family member’s wedding and hearing some whispers among the women: “NO! Not her!”, “we can’t ask her!”, “she’s not allowed to be involved in these things”.
If a South Asian woman has sadly endured the experience of a miscarriage, stillbirth or neonatal death, she is often prohibited from engaging in rituals or activities associated with any auspicious occasion, such as a wedding or baby shower. Within South Asian culture, the same “rule” applies to women who are struggling with reproductive difficulties, in which being unable to conceive and bear children, is conceptualised as a bad omen.
Research evidence highlights that women who have experienced a miscarriage, stillbirth or neonatal death often experience symptoms of trauma, grief, shame and depression. There is also a sense of a loss of status, loss of self-esteem and a general feeling of stigmatisation. These experiences or symptoms seem universal in the context of perinatal loss.
I’ve worked with women (not always from South Asian backgrounds) who have walked through this dark valley and have described how supposed friends or acquaintances have crossed streets to avoid seeing them after “hearing the news”, struggling to come face-to-face with the woman who has birthed the “dead baby”. Women describe feeling like social pariahs, questioning “am I fucking social leper!??”. The very time, women need love, compassion and support is when many seem to face social isolation and a type of distance from their social group, all the while enduring the aching arms. Perhaps the most profound is the salient impact on a woman’s identity, within the context of womanhood as well as motherhood.
So, what happens when we bring culture, race and ethnicity into the equation? Well, being of South Asian ethnicity, I will discuss what I have witnessed and researched within this specific culture. As South Asian culture is particularly marriage and child-centric, South Asian women’s identities are often rooted in procreativity. For example, within Hinduism, janam, lagan and maran (birth, marriage and death) are pre-destined. Marriage and child-rearing are also perceived to be a religious duty, which indicates that childbearing is tied up with religious beliefs and spirituality.
But what happens at a personal level? Stillbirth and neonatal deaths have a profound impact on a woman’s identity. For many women who want children, the identity of mother often begins before conception and pregnancy can serve as psychological preparation for this role. An identity that was consciously or unconsciously committed to the role of motherhood, will often form psychological meaning around the role. Loss of this identity is also a loss of the future status as a mother. Such a life event can almost disrupt an individual’s identity, creating a shift in self-concept.
The difficulty I have often seen with this issue in South Asian culture, is that there is usually little room for the perinatal loss and the change in self-concept within the social domain because perinatal loss remains largely a taboo subject. However, it needs to be held in mind, that perinatal loss remains as a taboo issue across cultures too and most women report a change in how others view them after the loss of their baby. So, what is different or specific to South Asian women? Before answering this, lets dig deeper into the psychological processes involved and some of the research statistics.
Psychological research in the field of stillbirth and neonatal death is still limited, despite being a complex, global public health concern. Not only is the UK part of this narrative of “limited research”, but it also seems South Asian women again seem left behind due to the lack of attention on the psychology of their perinatal loss. This is despite figures demonstrating that South Asia has one of the highest rates of stillbirth in the world. The UK figures have also come under scrutiny as the country has one of the fourth highest rates of infant mortality in high-income countries (although rates seem to be declining since 2017, which is welcomed news). MBRRACE-UK 2018 (Mother and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, 2018), produced a report stating that babies of British Asian or Asian ethnicity are at greater risk of dying.
Research has also highlighted that low birth weight is a risk factor for infant mortality and the knowledge that low birth weight is commonly found in infants of South Asian mothers is well-documented. Yet, perinatal loss in South Asian women, is not given enough attention from the psychological research world, particularly from a lived experience perspective.
This sort of dynamic between the research community and South Asian women parallels the dynamic these women face in their personal lives and communities. The dynamic is of silencing, overlooking and excluding. There is a magnitude of cultural competency that needs to be gained from this sort of research. What is not being heard and known enough about, is that South Asian women not only experience this perinatal loss marred with trauma, but also experience blame, shame, stigma and a stripping of inclusivity from the community. How are South Asian women in the UK experiencing this? What are their thoughts and feelings about this issue? What needs to be done to improve how women are perceived and treated within the community? These questions (and more!) are not being asked or answered.
"The community" often plays a large part in South Asian families lives. Let’s remember, our social groups or communities fulfil parts of our attachment needs. A change in the way the South Asian woman is viewed by her community (especially if its negative), often creates injury to her social identity. After all, groups and communities give us a social identity, which is essentially - a sense of belonging in the social world. It is this social belonging, which can create a sense of safety for us as humans and we almost see ourselves through the eyes of the community. Therefore, our self-image and self-concept can be enhanced as well as lowered through the eyes of the group. Moments within a family or community event, should provide an opportunity to be part of a group celebration, but instead the spotlight is placed on a woman’s stillbirth experience, which only serves to demoralise and potentially devalue the South Asian woman who has endured this plight. It creates the narrative of the social pariah. This type of ostracization or exclusion I have witnessed, brings into focus that aspects of South Asian women’s perinatal loss, may be experienced quite differently in comparison to White-British women.
As a young person, when I heard those whispers of women saying that one of their own, was prohibited from inclusion in wedding related rituals, I remember saying to someone – “What do you think will happen! Do you think you’re going to catch her sadness or misfortune!?”. I was quickly silenced. I was quite a “sassy teenager” at the time, so all I recall is walking off and rolling my eyes, but also feeling angry that people in my community were treating their own, another woman, in this way. It left me questioning the position of women in society.
Now, as an adult, as a Psychologist, I make sense of this in a different way. I suppose I have channelled my anger by dedicating my life to women’s well-being, breaking down taboos and questioning patriarchal values where I can.
I now see there was a sort of social fear attached to the woman who had experienced a perinatal loss. Religious rituals within events seem to hold great meaning and significance in South Asian communities and I see how it may feel grounding for so many members in a community to fulfil these rituals and events in “the right way”, for fear that if they don’t, “something bad” will befall them. Carrying out rituals in the “right way” can be seen as a way to appease God and attain some sort of closeness to the Almighty. It can also be a way to hold on to a piece of country and culture that so many are far away from and were potentially even torn away from.
But I also wonder whether these women who exclude one of their own have also unconsciously internalised the misogyny and patriarchy that they have known all their life.
From what I have seen, it seems the South Asian woman with the story of the dead baby, becomes the casualty. Their story demonstrates the very real social exclusion that is exercised against a South Asian woman for not being able to fulfil the cultural representation of womanhood (of bearing a live child), and therefore she experiences a further assault to her identity, self-esteem, self-worth and value. And I can’t help but wonder…… has she not been through enough?