Women are not being offered the mental health support they need after experiencing a miscarriage in the first trimester of pregnancy, despite healthcare workers recognising it as a significant loss, researchers from the University of Otago, Wellington, have found.
Dr Jessica Yang says although health professionals are aware of the potential impact of miscarriages on women's mental health, access to support from mental health services is inequitable and fragmented.
A quarter of women will experience a miscarriage in their lifetime, with 99 per cent occurring in the first 12–14 weeks. International research suggests early pregnancy loss can have a lasting effect on mental health, ranging from mental distress to post-traumatic stress disorder and anxiety.
Dr Yang, who recently graduated from the University as a doctor, conducted the research as a medical student for a summer research project. She interviewed 10 health professionals, asking their views on the psychological impact of early miscarriage, the barriers women faced in getting mental health support and their ideas for improving access.
She says while the health professionals who took part in the study acknowledge early pregnancy loss can have wide ranging and long-lasting impacts on women's and their families' mental health and wellbeing, this is not matched by an appropriate level of support.
One of those interviewed says the voices of the women who go on to experience depression after a miscarriage are silent:
"Their voice isn't heard. Fifteen per cent of all women who have an identified pregnancy will miscarry, so it's not an insignificant number. We estimate that if there are 60,000 births in New Zealand each year, there are 85,000 pregnancies … So that gives you an idea of the size of the reproductive morbidity in New Zealand. So what is happening to those 20,000 odd women? Who's looking after them? How good is their care?"
Dr Yang says women experiencing miscarriage frequently seek medical care in emergency departments, where staff may not be equipped to support their mental health needs.
"We need to investigate how to support emergency staff in Aotearoa to care for the mental health of women and their whānau when they experience miscarriage."
She says the cost of counselling, the lack of services in rural and remote areas, a lack of mental health professionals, and gaps in communication between and within services, such as between GPs and hospitals, all contribute to inequitable and fragmented access to mental health support services.
Dr Yang says inequity is a major issue, with mental health services failing in particular to make care available to rural and young Māori and Pacific Island women.
One of those interviewed notes:
"There is a lot of inequity … People that are poor, haven't got transport, haven't got financial security, who can't necessarily speak our language, who can't necessarily understand medical jargon or hospital jargon … this isn't their place of comfort … They don't want to be here, this isn't where they feel safe."
Associate Professor Sara Filoche from the Department of Obstetrics, Gynaecology and Women's Health at the University of Otago, Wellington, says the findings highlight a significant area of unmet need in healthcare, which is likely to have become worse during the COVID-19 pandemic.
Dr Yang says all those interviewed believe more affordable or free access to mental health services would make a significant difference to women and their whānau. Making talk therapy or psychotherapy services available through primary health care organisations would also improve access.
Many of the health professionals interviewed said it would improve the coordination of follow-up care if they had defined clinical pathways to follow, which included links to local support groups and services.
"Making sure health professionals are aware of the community support available and having community-based care available are areas which could really improve access."
This could involve reinstating government funding for community drop-in centres or coffee groups where women could find support, she says.
Publication details
Jessica Yang, Anthony Dowell, Sara Filoche
The New Zealand Medical Journal
