P3.H159: Tanzanian Mothers’ Experiences and Preferences Following Perinatal Loss

Background: Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries (LMICs), such as Tanzania. Across sub-Saharan Africa, perinatal loss is often underreported and there is limited discussion of pregnancy loss in society. This study aimed to understand the clinical experience and preferences surrounding perinatal loss for women in Northern Tanzania.

Methods: This study took place at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. Women who experienced stillbirth or neonatal death were recruited to complete a survey focused on their preferences and experiences surrounding perinatal loss. Eligible women included those who delivered at or after 28 weeks gestation and experienced either a stillbirth or an early neonatal death, defined as death within 7 days of delivery. 50 women (25 stillbirth and 25 neonatal death) were recruited between May 2023 and March 2024. A female research assistant, fluent in Swahili, verbally collected survey responses 8 weeks after perinatal loss. Results were entered into REDCap and analyzed with descriptive statistics.

Results: The average age of respondents was 29.8 (SD=6.0), 75% were married, and average parity was 2.58 (SD=1.4). Half of stillbirths (48%) occurred at 32-35 weeks; The largest proportion (40%) of neonatal deaths occurred among more preterm infants who were born at 28-31 weeks. Additional demographics are shown in Table 1. Following stillbirth, 84% of women wanted to see and 72% wanted to hold their baby, but fewer were allowed to do so (64% see, 44% hold). For neonatal death, preference rates were 100% for seeing and 92% for holding, and associated permission rates were 64% and 4%. Reasons given for not wanting to see or hold the baby after perinatal loss included it being too emotional and concern about what the baby would look like. All 50 women reported wanting a healthcare worker to explain what happened, but only 72% experienced a helpful a post-loss conversation with their provider. Women described a range of symptoms following their perinatal loss, with 96% reporting sadness and 94% reporting grief. (Figure 1) When asked about a desire to get pregnant again soon, 4 women who experienced stillbirth and 1 woman who experienced neonatal death stated this applied to them. In contrast, only 1 mother who experienced stillbirth but 6 mothers who experienced neonatal death stated that they wanted to avoid pregnancy. Lastly, 32% of mothers whose child died in the neonatal period cited financial hardship or debt as an outcome of their perinatal loss, compared to 8% of those who experienced stillbirth.

Conclusion: Women who experienced perinatal loss in Tanzania have unmet bereavement and post-loss socio-emotional needs. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.