When evaluating health issues relating to maternal health, some major themes that immediately come to the forefront include maternal mortality rate, rights to an abortion, and quality of healthcare provided throughout the term of a pregnancy. These concerns are critical issues to address if the United States hopes to join other affluent countries in their higher standard of maternal healthcare. However, there is a “silent society” amongst the population that is afflicted with a largely different issue with respect to maternal health. In a TED Talk titled “Breaking the Silence of Pregnancy Loss,” aspiring mother Tanika Dillard narrates a firsthand account of her sentiments of alienation as she grieved the loss of four preterm births. A comprehensive analysis of Tanika’s personal experience during and after her pregnancy losses can establish why Tanika’s anecdote is indicative of a larger-scale public health problem and associated health inequities, investigate this facet of maternal health utilizing the social determinants public health framework, and overall reflect on how my personal perspective has been affected upon learning Tanika Dillard’s story.
On May 17, 2016, Tanika Dillard brought much needed attention to the lack of discussion and support for parents who have suffered pregnancy loss in a TED Talk by recounting her personal experience. Tanika, like many young women, dreamed of emulating her mother and grandmother’s footsteps of serving as a nurturing mother to a large family. When Tanika reached the 16th week of her first pregnancy, her water broke unexpectedly, and she delivered a baby that lived for nine hours. Overwhelmed with feelings of devastation, shame, and desolation, yet never losing hope, Tanika and her husband tried two more times, which unfortunately resulted in the same outcome: miscarriage during her second trimester. She attempted to cope with her grievances privately but felt defeated and alone in what is a more widespread battle than she presumed. Tanika Dillard is an example of how mourning women across the country are not adequately supported during the post-partum period of a pregnancy loss.
Despite Tanika Dillard’s initial belief that her pregnancy loss experience was alienating, upon closer examination, it is evident that she is one of millions of women that face this large public health problem and the intricacies of the health inequities within. According to the National Library of Medicine, 11.2% of women experience postpartum depression if the baby is delivered safely and this percentage increases to 35% if the woman experiences pregnancy loss. Further, the institute reports that “over 99% of women with a history of MHT [mental health treatment] one year prior to their first pregnancy loss required PPT [postpartum psychiatric treatment] after their first live births” (Reardon, 2021). This supports the fact that pregnancy loss exacerbates the already prominent risk of postpartum depression and poor mental health amongst women that have recently undergone delivery. Additionally, although Tanika Dillard, a Black woman, does not overtly mention how her identity as being Black affects her pregnancy loss journey, substantial = research indicates that Black women have worse maternal health outcomes due to the quality of healthcare they receive compared to their white counterparts. Yale professor Connie Cheng finds that Black women are twice as likely to experience spontaneous abortion (pregnancy loss) compared to white women (Heng, 2016). A few reasons as to why include Black women “having lower health insurance coverage, less prenatal care, and later initiation of care during pregnancy” (Heng, 2016). Therefore, pregnancy loss is a prominent public health issue in the United States, and Black women like Tanika face even greater adversities due to the systematic racism present in healthcare.
When analyzing the social determinants of health in the context of Tanika’s pregnancy loss experience, one of the most relevant determinants to her situation is provider availability within the healthcare system. Tanika repeatedly underwent the unbearable pain of three identical miscarriages before she herself decided to seek out a different expert. She had the same OB-GYN for the first three pregnancies who was evidently unable to diagnose the cause of the pregnancy losses. Only when Tanika found a more specialized expert was she able to have a successful delivery, which demonstrates that she was initially suffering from one of the social determinants of the healthcare system relating to provider availability and quality of care. In the context of United States population health, over half of the counties in the United States lack a single OB-GYN (Marsa, 2018). Women that are more socioeconomically stable, like Tanika, are fortunate to be in proximity to a maternal health professional, but the overall scarcity of OB-GYNs alludes to the unfortunate reality that most women must travel to seek specialized medical attention. Women that cannot afford transportation or to miss work to receive treatment from an OB-GYN truly encounter the disadvantages of not having provider availability and thus quality of care, which makes their risk of suffering pregnancy loss even greater.
Another social determinant that is a recurring theme in Tanika personal account of pregnancy loss concerns community and social context. Without a community or professional guidance on how to navigate an emotionally desolating experience like a pregnancy loss, Tanika’s grief almost prevented her from being able to fulfill her lifelong dream of becoming a mother. A study conducted by BMC Womens Health Journal following women with miscarriages finds that Tanika was not nearly alone in her initial described solitude; in fact, “Approximately half of the women expressed feeling that others often did not understand their experience and therefore struggled to empathize with them and support them at the time of their miscarriage” (Bellhouse, 2018). The article further corroborates that women found a large amount of solace in others who had also experienced pregnancy loss, whether these women were family or from a support group. Both Tanika’s experiences with pregnancy loss and that of the overall population substantiate the idea that community and social context is a crucial social determinant to pregnancy loss, as well as whether or not the mother has a support system or the community engagement to process such a devastating event with less discomfort.
In final analysis, Tanika Dillard’s first hand narrative of pregnancy losses is a touching inside perspective on the large-scale public health issue of how countless women across the country silently grieve their miscarriages. The United States, despite self-proclaiming to be progressive in feminist ideologies and advanced in technological growth, has consistently been proven to be behind in providing adequate maternal healthcare. However, as women like Tanika Dillard come forward and demonstrate how their grief can be channeled into strength, tenacity, and advocacy, we as a public must collectively listen and care for these strong women to the best of our capacity.
References
Bellhouse, C., Temple-Smith, M. J., & Bilardi, J. E. (2018, October 29). "it's just one of those things people don't seem to talk about..." women's experiences of social support following miscarriage: A qualitative study. BMC women's health. Retrieved November 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206670/
Dillard, T. (2016, May 17). Breaking the silence of pregnancy loss | Tanika Dillard | TEDxGreenville. YouTube. Retrieved November 10, 2022, from https://www.youtube.com/watch?v=o2BJsFkzSYU
Heng, C. Y. (2016). Effects of Race, Socioeconomic Factors on Emergency Management of Threatened and Early Pregnancy Loss. ProQuest. Retrieved November 11, 2022, from https://www.proquest.com/
Local Support Groups and Organizations - United States. Return to Zero: H.O.P.E. (2022). Retrieved November 10, 2022, from https://rtzhope.org/groups-us Marsa, L. (2018, November 15). Labor pains: The ob-gyn shortage. AAMC. Retrieved November 10, 2022, from https://www.aamc.org/news-insights/labor-pains-ob-gynshortage
Reardon, D. C., & Craver, C. (2021, February 23). Effects of pregnancy loss on subsequent postpartum mental health: A prospective longitudinal cohort study. International journal of environmental research and public health. Retrieved November 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926811/