In the United States, as many as 20 percent of known pregnancies end in miscarriage (before the end of the twentieth week of pregnancy) and approximately 1 percent in stillbirth (after the twentieth week, including time of delivery).
Parents who experience pregnancy loss are often left to grieve not only the child they never had the opportunity to know but also the loss of a future they had envisioned. The fact that such losses are often sudden and unexpected and may involve invasive medical intervention can lead to grief complicated by depression, anxiety, and even post-traumatic stress disorder.
Many parents find their grief goes unrecognized or that support networks do not know how to provide effective social and emotional support. This can result in disenfranchised grief which is not acknowledged or understood by others, leaving parents feeling isolated without safe places to process complex thoughts and emotions, receive social support, or participate in grief-related rituals.
Studies focusing on grief after pregnancy loss have tended to focus on women, but a small body of research on grief experienced by men suggests that they are more likely than women to view their grief as unimportant, suppress or deny emotions, and less likely to seek support.
A meta-study by Due, Chiarolli, and Riggs found that men who experienced pregnancy loss “often feel that their role is primarily as a “supporter” to their female partner and that this precludes recognition of their own loss. Men often felt overlooked and marginalized in comparison to their female partners, whose pain is typically more visible.”
After he and his wife lost a second child to miscarriage, Kelly Jean-Philippe wrestled with painful thoughts and emotions. “I started to internalize certain negative assumptions,” he recalls, “and question whether I was the cause of our miscarriages. I asked myself, “What do I need to do to make stronger, healthier sperm? Am I ever going to have my own children? It’s my fault these people are about to scrape my wife’s insides a second time. I’m failing my wife as a husband.
He felt excluded and ignored by a physician who “positioned himself with his back to me, making no attempt to acknowledge my existence” and who, after speaking to his wife, “left as quickly as he came. He never once acknowledged my presence in the room. I felt invisible. I felt powerless. I felt out of place. My grief, my pain, and my experience were not validated and perhaps not even valid. My wife was the patient. Not me.”
Obst, Due, Oxlad, and Middleton have described this combination of a man internally dismissing his grief as unimportant, even blaming himself for failing to protect a partner or infant, and an external lack of inclusion, recognition, or support for his loss, as a “double-disenfranchised grief.”
Looking back on his experience, Jean-Philippe, who is Black, wondered whether his race may have further complicated his experience.
“I’ve wondered whether my experience is indicative of that of other fathers in these spaces, especially Black fathers. There are reputable research studies that draw attention to how implicit bias plays a role in how Black pregnant women perceive and receive care in health care settings. There is less research about how these biases frame the experiences of men and fathers — particularly Black fathers—in these same spaces with their pregnant partners.”
According to an analysis by the Lancet, miscarriage rates for Black women are around 43 percent higher than for white women. The Centers for Disease Control notes that overall infant mortality rates in Black infants are more than twice that of whites. Yet there has been little research interest in the experience of Black mothers and even less of fathers.
Research by Jones et al. on the experiences of Black women following the death of an infant underscores Jean-Phillipe’s sense of exclusion. Subjects reported “not being included in what was happening to their infants … Some women indicated they were not able to see what was going on once the infant was born. Health care professionals administering treatment blocked the mothers’ view of the infants, causing them to feel left out. The women also indicated not understanding the medical jargon being spoken by health care professionals regarding medical procedures and their infants’ prognoses. These experiences amplified women’s anxiety and stress.”
Research by Kavanaugh and Hershberger into the grief of low-income Black parents after perinatal loss found that “fathers often kept their emotions under control for fear of further upsetting the mother, but yet were also unsure how to support their partners.” Moreover, fathers resisted expressing emotions due to uncertainty and/or discomfort about how to do so, and desires to “move on.”
Given that the subjects reported low income, it’s not surprising that Black parents faced disproportionately high levels of stress related to “economic hardship” such as limited finances, inadequate insurance, and lack of job flexibility. They also contended with high levels of non-economic stress, which complicated their grief, including having family members who were seriously ill and/or hospitalized during a mother’s pregnancy, recent deaths of family members or friends, and prior deaths of “other infants, nieces and nephews, siblings, parents, grandparents, and young male cousins or friends” which, even if the death had not been recent, “triggered painful memories of the other deaths.”
Research has documented disparities in health care outcomes for Blacks and historical patterns of negative racial bias (structural and cultural) contributing to higher adverse outcomes for Black patients compared with whites. Rates of maternal mortality in Black women, for example, are over two and a half times as high as the rate for white women. Black men have been found to be at higher risk for adverse health and mental health outcomes, including early mortality, compared with other ethnicities.
This can lead to an increased distrust by Blacks of medical professionals and institutions. Kavanaugh & Hershberger found Black parents often perceived inequities and unfairness in care received during pregnancy. These included perceptions that a mother and infant received inadequate care, lack of continuity of care, unfair treatment related to poor insurance and/or financial factors, lack of privacy, disrespect, and not being included in care discussions.
Lekuti found that Black men who experience perinatal loss often feel pressure to behave in accordance with an ideal she calls the “strong, silent African American man,” characterized by tendencies to grieve in isolation, equate masculinity and strength with independence and protect loved ones, and pushing through adversity without asking for help.
Some Black men felt additional pressure to suppress emotions like anger or rage due to awareness of negative racial stereotypes that characterize Black men as aggressive or violent or that minimize their roles as caring fathers. Suppression of emotions often left men in a double bind in which they were perceived as not caring if they did not express emotions but as weak, unmanly, or aggressive if they did.
Research also suggests that as a group Black men are less likely to seek psychological counseling than white men due to distrust of mental health providers or perceived stigma, but are receptive to support within their families and religious communities.
Unfortunately, too little attention has been paid to the grief of Black men following pregnancy loss to answer Jean-Philippe’s question about whether their experiences are complicated by implicit or structural racial biases. The scant research that does exist, however, raises important questions:
Are the pressures men as a group feel to suppress and dismiss their grief further complicated for Black men due to cultural expectations, cultural insensitivity in health care staff, and/or negative racial stereotypes?
Is the responsibility many men feel to protect and support their partners complicated in Black fathers by perceptions of inferior care or distrust of medical institutions and professionals, or additional perceived threats related to racism and/or racial bias?
Are there concurrent stressors grieving fathers may face that are more closely associated with being Black?
What can be done to ensure the inclusion of Black fathers in care conversations, support, and decision-making during pregnancy?
How can we reduce barriers to and enhance the effectiveness of professional mental health support for Black men who have survived pregnancy loss?
Unless researchers take more interest in the experiences of grieving Black fathers, these questions will remain unanswered.
Scott Janssen is a social worker.
