In the United States, approximately 10 to 15 percent of known pregnancies end in miscarriage. But this doesn’t capture the full picture. In reality, studies show that as many as half of all pregnancies may end in miscarriage, with the vast majority occurring before people realize they are pregnant. A miscarriage is defined as pregnancy loss before 20 weeks gestation. While some health conditions such as autoimmune disorders, polycystic ovary syndrome (PCOS), and diabetes can exacerbate the risk of having a miscarriage, the exact causes of pregnancy loss are largely unknown.

Miscarriage does not impact all pregnant people equally. Black pregnant people are at a higher risk of experiencing pregnancy loss than pregnant people of other races and ethnicities. A recent study published in The Lancet found that the risk of miscarriage is 43 percent higher for Black women compared to white women. Possible contributors to this disparity include the effects of systemic racism and discrimination, which can result in Black pregnant people not accessing prenatal care and experiencing increased risk factors such as obesity, exposure to pollutants, and high stress. The data on miscarriages across other races and ethnicities are limited, which makes it hard to identify the impact of pregnancy loss on pregnant people of all races.  

A miscarriage can last from days to weeks, and the emotional fallout of losing a pregnancy can continue even longer. People who experience miscarriage can develop mental health issues that persist for months or years following pregnancy loss, even after having future healthy babies. Research shows that pregnancy loss is tied to anxiety, depression, and posttraumatic stress even nine months after a miscarriage. The mental health repercussions of pregnancy loss can be isolating, especially when 80 percent of pregnancy loss happens in the first trimester – typically before a pregnancy has been announced publicly. The invisibility of a first trimester miscarriage contributes to the stigma and silence associated with pregnancy loss.

Perceptions and Misconceptions Lead to Stigma

Miscarriage can lead to overwhelming feelings of personal guilt, shame, and loss, often exacerbated by misconceptions of the causes of pregnancy loss. One such misconception is on the perceived rarity of miscarriage. A survey across 49 states found that the majority of respondents thought miscarriage was rare, occurring in less than five percent of all pregnancies. This misconception is especially persistent both within and regarding the Black population in the United States. Since the time of slavery, a widely held belief is that Black women are “naturally fertile” and childbearing, which can exacerbate feelings of shame and inadequacy for Black people who experience pregnancy loss, sometimes keeping them from seeking care. Structural racism further limits Black people’s access to medical care for pregnancy complications and loss. There is a long history of health care providers inadequately addressing their experiences—even labeling them “incompetent” for losing a pregnancy.

Often, medical guidance around pregnancy can add further stigma for miscarriage. Medical professionals often advise pregnant people to focus on healthy eating, exercise, avoidance of harmful substances, and stress management to prevent miscarriage. In fact, in an early draft of a global action plan on alcohol, the World Health Organization advised that all “women of childbearing age” should be the focus of alcohol prevention efforts, regardless of their pregnancy status. Such outlandish guidance places an unnecessary burden on women and reinforces an outdated idea that a woman’s main purpose is procreation. This thinking exacerbates a pregnant person’s guilt and shame associated with pregnancy loss, when in reality, miscarriage is often unpredictable and due to chance rather than personal behavior. For example, chromosomal abnormalities – when an embryo receives the wrong number of chromosomes during fertilization – can cause over half of all miscarriages and are beyond the control a pregnant person has during pregnancy.

Consequences of Stigma Around Miscarriage

The stigma of pregnancy loss can also result in barriers to seeking care for miscarriage. While miscarriage and pregnancy loss are distinctly different from abortion, the policies restricting abortion often impact miscarriage care. For example, the American College of Obstetricians and Gynecologists (ACOG) recommends a combination of misoprostol and mifepristone to manage miscarriage. However, this treatment is also used to induce abortion in the first trimester of pregnancy, and therefore is more heavily restricted. Due to U.S. Food and Drug Administration (FDA) restrictions and state laws, this treatment can only be dispensed by certain providers in limited healthcare settings, making it inaccessible for many people experiencing a miscarriage.

In recent years, there have even been legal ramifications for pregnancy loss. Due to the rise of fetal personhood laws across the United States, people who have had a miscarriage can be criminally charged for “concealing a birth” or neglecting the life of the fetus. People have historically been investigated under these laws to ensure that there was no intent to terminate their pregnancy, which adds an additional level of scrutiny for people going through the mental health burden of having a miscarriage. It also adds barriers to seeking care due to the fear that healthcare providers may report patients to law enforcement after a pregnancy loss. While cases of pregnant people being criminally charged for their pregnancy loss can be rare, they gain wide media attention because they ultimately blame women and pregnant people for a miscarriage or stillbirth that they had no control over. Conflating miscarriage with abortion and creating legal consequences for pregnancy loss creates an environment where these issues carry even more stigma, and where the barriers for seeking care or speaking out can be insurmountable.

Policy and Institutional Support

Sharing stories and raising awareness for the prevalence of miscarriage is one of the best ways to overcome these stigmas. In recent years, celebrities and public figures such as Michelle Obama, Beyoncé, Meghan Markle, and Chrissy Teigen, have spoken publicly about their own miscarriages and the isolating nature of pregnancy loss. By speaking out, they have started raising awareness for how common and unpredictable miscarriage can be. They have also established a safe community for people, especially people of color, to share their struggles with pregnancy loss without stigma or judgement.

In July 2020, Representative Ayanna Pressley (D-MA-7) and Senator Tammy Duckworth (D-IL), who herself experienced a miscarriage during her Senate campaign, proposed the Support Through Loss Act in Congress to shine a light on pregnancy loss in the United States. The bill would ensure that employers provide three days of paid leave following a miscarriage, stillbirth, unsuccessful in-vitro fertilization or other fertility procedure, failed adoption or surrogacy, or any other fertility-related diagnosis or event. The bill also calls for a $45 million annual investment for federal research into pregnancy loss and for the Centers for Disease Control and Prevention (CDC) to widely disseminate information regarding pregnancy loss.

The stigma around miscarriage has delayed research on pregnancy loss and led people to suffer in silence. “They have felt great cultural stigma,” said Rep. Pressley in a recent interview. “They’ve felt personal shame for something completely outside of their control. I want to bring some attention and dignity to their stories, and hopefully in our collective advocacy, support to keep them on a pathway to healing.”