Challenges and opportunities of providing evidence based perinatal psychological care for couples with stillbirth (SB) in Lagos Nigeria

Sub-Saharan Africa faces the highest burden of stillbirths with Nigeria contributing around 12% of global burden of stillbirth (with about 314,000 stillbirths/year) and an estimated stillbirth rate of 42.9 per 1000 births . Stillbirth is associated with substantial psychological, social, economic and intangible cost to women, their families, healthcare providers and the wider society . Stillbirth in SSA countries brings many challenges to the mother including poor health, grief, sadness, and coping with community perceptions. The mothers' grief experiences following stillbirth are further complicated by the biological fact of death occurring within the body; generating feelings of anxiety, failure, and guilt. Studies have shown that guild and shame plays a very important role in predicting the intensity of later grief . The father is not left out of these difficulties. High rates of depression, anxiety, post-traumatic stress disorders and marital breakup has been observed in couples with stillbirth. For many couples in SSA, it takes a long time to recover from stillbirth, and in many instances only when another baby is born and survives, some few other never recovers. In Nigeria and many parts of SSA, the couple's grief is further compounded by many of the communities deeply rooted cultural practices and beliefs.

Many Africa communities attribute stillbirth to spirits or supernatural powers, so bereaved parents avoid public burials and displays of grief, fearing such action could evoke future malice or lead to infertility. In many Africa traditions, women with stillbirth are accused of induced abortion and couples with stillbirth are forbidden from mourning and those who repeatedly lose their babies are blamed, mistreated, and dishonored. These harsh traditional value judgments about stillbirth in most African communities' results in high level of stigma and pushes many couples to keep stillbirths a secret. Problem with health systems:

Apart from the stigma from the community, mothers who experience stillbirths are often overlooked midwives and other perinatal health workers who tend to focus on maternal and child health. Many health workers are ill equipped to handle grief that comes with stillbirth. Also, studies have shown that many healthcare providers may be avoidant, feel helpless and guilty or they may experience a sense of failure when the baby dies. Many health workers are not equipped to handle perinatal bereavement care. Also most of the guidelines of care after stillbirth reflect the western sociocultural perspectives and may not be appropriate in the African setting in view of the socio-cultural norms and nuances regarding stillbirth.

In order to design a n effective, sociocultural acceptable intervention package of care and support for couples with stillbirth in Nigeria, it is necessary to first have a detail understanding of the peculiar sociocultural issues regarding stillbirth in the community, the specific psychological and social impacts of stillbirth that needs to be prevented, the preferences and perception of the affected couple to perinatal bereavement care and the health systems challenges and opportunities for delivering the intervention. Outcome expected as immediate result of the proposal:

TThe results of this proposal will provide a deeper understanding of social perceptions of stillbirth in Nigeria and other SSA countries which is a crucial step towards reducing the isolation, grief, and stigma attached to stillbirth. It will also provide insight into the psycho-social burden of stillbirth, enumerate the challenges and opportunities for providing socio-culturally relevant bereavement care to coupes with stillbirth and most importantly lead to the development and feasibility assessment of an intervention package for support and care for Nigerian women with stillbirth

Sub-Saharan Africa faces the highest burden of stillbirths with Nigeria contributing around 12% of global burden of stillbirth (with about 314,000 stillbirths/year) and an estimated stillbirth rate of 42.9 per 1000 births . Stillbirth is associated with substantial psychological, social, economic and intangible cost to women, their families, healthcare providers and the wider society
High rates of depression, anxiety, post-traumatic stress disorders and marital breakup has been observed in couples with stillbirth. Many Africa communities attribute stillbirth to spirits or supernatural powers, so bereaved parents avoid public burials and displays of grief, fearing such action could evoke future malice or lead to infertility
Apart from the stigma from the community, mothers who experience stillbirths are often overlooked midwives and other perinatal health workers who tend to focus on maternal and child health. Many health workers are ill equipped to handle grief that comes with stillbirth.
Most of the guidelines of care after stillbirth reflect the western sociocultural perspectives and may not be appropriate in the African setting in view of the socio-cultural norms and nuances regarding stillbirth.
The Overall objective of this study is to examine the socio-cultural and health systems challenges and opportunities regarding the provision of evidence based perinatal psychological care for couples with stillbirth (SB) in Lagos, Nigeria.
This study will provide a deeper understanding of social perceptions of stillbirth in Nigeria and other SSA countries . It will also provide insight into the psycho-social burden of stillbirth, enumerate the challenges and opportunities for providing socio-culturally relevant bereavement care to coupes with stillbirth and most importantly lead to the development and feasibility assessment of an intervention package for support and care for Nigerian women with stillbirth.

The Overall objective of this study is to examine the socio-cultural and health systems challenges and opportunities regarding the provision of evidence based perinatal psychological care for couples with stillbirth (SB) in Lagos, Nigeria.

The project aims to answer the following research questions; (1) what are the common short and long term psychological and social problems experienced by couples and families with stillbirth in Nigeria?; (2) What are the socio-cultural issues pertaining to the definition, meaning and causes of stillbirth in Nigeria and how do these factors impact on the psychological response, coping, and help seeking behavior of the affected couples? (3) What are the ingredients of bereavement care and support that couples with stillbirth in Nigeria would prefer? (4) What are the sociocultural and health systems challenges and opportunities towards provision of an effective psychological support for those affected? (5) What are the current evidences for immediate and long-term support and care after stillbirth and which of their recommendations can useful and adaptable in designing a socio-culturally acceptable package of care and support for Nigerian couple after stillbirth?


The results of this proposal will provide a deeper understanding of social perceptions of stillbirth in Nigeria and other SSA countries which is a crucial step towards reducing the isolation, grief, and stigma attached to stillbirth. It will also provide insight into the psycho-social burden of stillbirth, enumerate the challenges and opportunities for providing socio-culturally relevant bereavement care to coupes with stillbirth and most importantly lead to the development and feasibility assessment of an intervention package for support and care for Nigerian women with stillbirth

The project offers a potential for significant impact both in terms of generating new evidence and influencing policy and practice in Nigeria and other LMICs. At the individual level, couples with stillbirth will benefit from expanded scope, increased reach and sustained level of evidence based mental health interventions leading lead to better outcomes and improved quality of life. For health workers, this study will enhance their knowledge, motivation and attitude in providing effective bereavement care and support that is culturally appropriate. This project will help build interdisciplinary research and add to the field of maternal and neonatal medicine as demonstrated by the arrays of other experts from various fields (psychiatry, psychology, public health, medical sociology, social work, anthropology and political science).