‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan

Christou, Aliki; Alam, Ashraful; Hofiani, Sayed Murtaza Sadat; Mubasher, Adela; Rasooly, Mohammad Hafiz; Rashidi, Mohammad Khakerah; Raynes-Greenow, Camille

doi:10.1038/s41372-020-00907-5

Cited by 11Grief, Bereavement, and Mental HealthGlobal Maternal and Child HealthPalliative Care and End-of-Life Issues

‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan

Christou, Aliki, Alam, Ashraful, Hofiani, Sayed Murtaza Sadat, Mubasher, Adela, Rasooly, Mohammad Hafiz, Rashidi, Mohammad Khakerah, Raynes-Greenow, Camille·2021·Journal of Perinatology

DOI 10.1038/s41372-020-00907-5

Open this paper in CoChat — free account

Abstract

Objective This study aimed to explore bereaved parents' and healthcare providers experiences of care after stillbirth.Study design Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants in Kabul province, Afghanistan between October and November 2017.Results Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying disclosing the stillbirth were recurring concerns. There was a disconnect between parents' desires and healthcare provider's perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as profound regret. Health providers' reported hospitals were not equipped to separate women who had a stillbirth and acknowledged that psychological support would be beneficial. However, the absence of trained personnel and resource constraints prevented provision of such support.Conclusion Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.

Integrity signals

Registry

Crossref · 10.1038/s41372-020-00907-5

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability
Guest, G., Bunce, A., & Johnson, L. (2006) · Field Methods · doi:10.1177/1525822x05279903 · Cited by 20,808 · see citing works
National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis
Blencowe, H., Cousens, S., Jassir, F. B., Say, L., Chou, D., Mathers, C., Hogan, D., Shiekh, S., Qureshi, Z. U., You, D., et al. (2016) · The Lancet Global Health · doi:10.1016/s2214-109x(15)00275-2 · Cited by 1,062 · see citing works
Stillbirths: economic and psychosocial consequences
Heazell, A. E. P., Siassakos, D., Blencowe, H., Burden, C., Bhutta, Z. A., Cacciatore, J., Dang, N., Das, J., Flenady, V., Gold, K. J., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00836-3 · Cited by 792 · see citing works
From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth
Burden, C., Bradley, S., Storey, C., Ellis, A., Heazell, A. E. P., Downe, S., Cacciatore, J., & Siassakos, D. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0800-8 · Cited by 445 · see citing works
Systematic review to understand and improve care after stillbirth: a review of parents’ and healthcare professionals’ experiences
Ellis, A., Chebsey, C., Storey, C., Bradley, S., Jackson, S., Flenady, V., Heazell, A., & Siassakos, D. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0806-2 · Cited by 322 · see citing works
Navigating care after a baby dies: a systematic review of parent experiences with health providers
Gold, K. J. (2007) · Journal of Perinatology · doi:10.1038/sj.jp.7211676 · Cited by 219 · see citing works
Support for mothers, fathers and families after perinatal death
Koopmans, L., Wilson, T., Cacciatore, J., & Flenady, V. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000452.pub3 · Cited by 216 · see citing works
Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis
Kelley, M. C., & Trinidad, S. B. (2012) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-12-137 · Cited by 164 · see citing works
Bereaved parents’ experience of stillbirth in UK hospitals: a qualitative interview study
Downe, S., Schmidt, E., Kingdon, C., & Heazell, A. E. P. (2013) · BMJ Open · doi:10.1136/bmjopen-2012-002237 · Cited by 134 · see citing works
The impact of stillbirth on bereaved parents: A qualitative study
Nuzum, D., Meaney, S., & O’Donoghue, K. (2018) · PLoS ONE · doi:10.1371/journal.pone.0191635 · Cited by 127 · see citing works
The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study
Nuzum, D., Meaney, S., & O'Donoghue, K. (2014) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12695 · Cited by 113 · see citing works
Improving Access to Mental Health Care and Psychosocial Support within a Fragile Context: A Case Study from Afghanistan
Ventevogel, P., van de Put, W., Faiz, H., van Mierlo, B., Siddiqi, M., & Komproe, I. H. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001225 · Cited by 102 · see citing works
Parents’ and healthcare professionals’ experiences of care after stillbirth in low‐and middle‐income countries: a systematic review and meta‐summary
Shakespeare, C., Merriel, A., Bakhbakhi, D., Baneszova, R., Barnard, K., Lynch, M., Storey, C., Blencowe, H., Boyle, F., Flenady, V, et al. (2019) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.15430 · Cited by 102 · see citing works
Stillbirth and perinatal care: Are professionals trained to address parents’ needs?
Ravaldi, C., Levi, M., Angeli, E., Romeo, G., Biffino, M., Bonaiuti, R., & Vannacci, A. (2018) · Midwifery · doi:10.1016/j.midw.2018.05.008 · Cited by 98 · see citing works
Clinical practice guidelines for perinatal bereavement care — an overview
Boyle, F. M., Horey, D., Middleton, P. F., & Flenady, V. (2020) · Women and Birth · doi:10.1016/j.wombi.2019.01.008 · Cited by 90 · see citing works
Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country
Gausia, K., Moran, A. C., Ali, M., Ryder, D., Fisher, C., & Koblinsky, M. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-451 · Cited by 82 · see citing works
The psychological, social, and economic impact of stillbirth on families
Murphy, S., & Cacciatore, J. (2017) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2017.02.002 · Cited by 82 · see citing works
Caring for parents at the time of stillbirth: How can we do better?
O’Connell, O., Meaney, S., & O’Donoghue, K. (2016) · Women and Birth · doi:10.1016/j.wombi.2016.01.003 · Cited by 79 · see citing works
All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (<scp>INSIGHT</scp>)
Siassakos, D., Jackson, S., Gleeson, K., Chebsey, C., Ellis, A., Storey, C., & the INSIGHT Study Group (2018) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14765 · Cited by 75 · see citing works
Psycho-social impact of stillbirths on women and their families in Tamil Nadu, India – a qualitative study
Gopichandran, V., Subramaniam, S., & Kalsingh, M. J. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1742-0 · Cited by 74 · see citing works
The RESPECT Study for consensus on global bereavement care after stillbirth
Shakespeare, C., Merriel, A., Bakhbakhi, D., Blencowe, H. K., Boyle, F. M., Flenady, V., Gold, K. J., Horey, D., Lynch, M., Mills, T. A., et al. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13110 · Cited by 74 · see citing works
Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents
Murphy, S., Shevlin, M. E., & Elklit, A. (2012) · Journal of Loss and Trauma · doi:10.1080/15325024.2012.735531 · Cited by 72 · see citing works
Provision of meaningful care at diagnosis, birth, and after stillbirth: A qualitative synthesis of parents’ experiences
Lisy, K., Peters, M. D. J., Riitano, D., Jordan, Z., & Aromataris, E. (2016) · Birth · doi:10.1111/birt.12217 · Cited by 70 · see citing works
Care following stillbirth in high-resource settings: Latest evidence, guidelines, and best practice points
Bakhbakhi, D., Burden, C., Storey, C., & Siassakos, D. (2017) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2017.02.008 · Cited by 66 · see citing works
Barriers to appropriate care for mothers and infants during the perinatal period in rural Afghanistan: a qualitative assessment
Newbrander, W., Natiq, K., Shahim, S., Hamid, N., & Skena, N. B. (2014) · Global Public Health · doi:10.1080/17441692.2013.827735 · Cited by 61 · see citing works
Supporting women, families, and care providers after stillbirths
Homer, C., Malata, A. M., & ten Hoope‐Bender, P. (2016) · The Lancet · doi:10.1016/s0140-6736(15)01278-7 · Cited by 49 · see citing works
Providing meaningful care for families experiencing stillbirth: a meta-synthesis of qualitative evidence
Peters, M. D. J., Lisy, K., Riitano, D., Jordan, Z., & Aromataris, E. (2016) · Journal of Perinatology · doi:10.1038/jp.2015.97 · Cited by 45 · see citing works
The Association of Stillbirth with Depressive Symptoms 6–36 Months Post‐Delivery
HOGUE, C. J. R., Parker, C. B., Willinger, M., Temple, J. R., Bann, C., Silver, R. M., Dudley, D. J., Moore, J., Coustan, D. R., Stoll, B. J., et al. (2015) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12176 · Cited by 44 · see citing works
“I'll Never Forget Those Cold Words as Long as I Live”: Parent Perceptions of Death Notification for Stillbirth
Pullen, S., Golden, M. A., & Cacciatore, J. (2012) · Journal of Social Work in End-Of-Life & Palliative Care · doi:10.1080/15524256.2012.732022 · Cited by 42 · see citing works
How community and healthcare provider perceptions, practices and experiences influence reporting, disclosure and data collection on stillbirth: Findings of a qualitative study in Afghanistan
Christou, A., Alam, A., Hofiani, S. M. S., Rasooly, M. H., Mubasher, A., Rashidi, M. K., Dibley, M. J., & Raynes‐Greenow, C. H. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112413 · Cited by 40 · see citing works
Self-citation
Risk and protective factors associated with the mental health of young adults in Kabul, Afghanistan
Alemi, Q., Stempel, C., Koga, P. M., Montgomery, S., Smith, V. J., Sandhu, G., Villegas, B. E., & Requejo, J. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1648-4 · Cited by 39 · see citing works
Women’s experiences of stillbirth in Somaliland: A phenomenological description
Osman, H. M., Egal, J. A., Kiruja, J., Osman, F., Byrskog, U., & Erlandsson, K. (2017) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2016.12.002 · Cited by 36 · see citing works
Trauma exposure and IPV experienced by Afghan women: Analysis of the baseline of a randomised controlled trial
Jewkes, R., Corboz, J., & Gibbs, A. (2018) · PLOS ONE · doi:10.1371/journal.pone.0201974 · Cited by 36 · see citing works
Experiences and needs of Nigerian women after stillbirth
Kuti, O., & Ilesanmi, C. E. (2011) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2010.11.025 · Cited by 30 · see citing works
Depression among Nigerian women following pregnancy loss
Obi, S. N., Onah, H. E., & Okafor, I. I. (2008) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2008.11.036 · Cited by 30 · see citing works
Sociocultural Understanding of Miscarriages, Stillbirths, and Infant Loss: A Study of Nigerian Women
Adebayo, A. L., Liu, M., & Cheah, W. H. (2018) · Journal of Intercultural Communication Research · doi:10.1080/17475759.2018.1557731 · Cited by 29 · see citing works
Seeing or not seeing: Taiwan's parents’ experiences during stillbirth
Sun, J., Rei, W., & Sheu, S. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.11.009 · Cited by 27 · see citing works
Women's perceptions of Nurse-Midwives' caring behaviours during perinatal loss in Lilongwe, Malawi: an exploratory study.
Simwaka, A., de Kok, B. C., & Chilemba, W. (2014) · PubMed Central · Cited by 22 · see citing works
Communication skills in Obstetrics: what can we learn from bereaved parents?
Nuzum, D., Meaney, S., & O'Donohue, K. (2017) · PubMed · Cited by 20 · see citing works
Understanding pathways leading to stillbirth: The role of care-seeking and care received during pregnancy and childbirth in Kabul province, Afghanistan
Christou, A., Alam, A., Hofiani, S. M. S., Rasooly, M. H., Mubasher, A., Rashidi, M. K., Dibley, M. J., & Raynes‐Greenow, C. H. (2020) · Women and Birth · doi:10.1016/j.wombi.2020.02.012 · Cited by 19 · see citing works
Self-citation
IMPROVING CARE AFTER STILLBIRTH AND NEONATAL DEATH: THE PSANZ/STILLBIRTH CRE CLINICAL PRACTICE GUIDELINES UPDATE 2018
(2019) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.14410_29 · Cited by 1 · see citing works

Flagged first, then by citations

Sorted by citations

Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review
Roberts, L. R., Nick, J. M., Sarpy, N. L., Peters, J., & Tamares, S. (2024) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00149 · Cited by 27 · see citing works
Capturing parents’ and health professionals’ experiences of stillbirth bereavement photography: A systematic review and meta-synthesis
Oxlad, M., Franke, E. F., Due, C., & Jaensch, L. (2023) · Women and Birth · doi:10.1016/j.wombi.2023.03.001 · Cited by 18 · see citing works
Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain
Martínez-García, E., Lara-Rodríguez, H., Álvarez‐Serrano, M. A., González‐García, A., Salvador, A. M., Gázquez‐López, M., & Pérez‐Morente, M. Á. (2023) · Midwifery · doi:10.1016/j.midw.2023.103749 · Cited by 13 · see citing works
Midwives' support for parents following stillbirth: How they practise and resources they need from a phenomenological perspective
Linares‐Gallego, M. D. L. Á., Martínez‐Linares, J. M., Moreno‐Ávila, I. D. M., & Cortés‐Martín, J. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16385 · Cited by 6 · see citing works
Impact of contact with the baby following stillbirth on parental mental health and well‐being: A systematic review and meta‐analysis
Sun, S., Qian, J., Wang, F., Tian, Y., Sun, Y., Zheng, Q., & Yu, X. (2023) · International Journal of Nursing Practice · doi:10.1111/ijn.13146 · Cited by 4 · see citing works
Nursing care for parents who have experienced fetal demise: integrative review
Bezerra, N. D. A., dos Santos, C. N. S., da Silva, A. T. C. S. G., Linhares, F. M. P., & Morais, S. C. R. V. (2024) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2022-0811 · Cited by 2 · see citing works
O cuidado de enfermagem aos pais que vivenciaram o óbito fetal: revisão integrativa
Bezerra, N. D. A., dos Santos, C. N. S., da Silva, A. T. C. S. G., Linhares, F. M. P., & Morais, S. C. R. V. (2024) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2022-0811pt · Cited by 1 · see citing works
Women’s lived social-cultural and clinical experiences and navigation process after stillbirth in Dodoma Region, Tanzania: A phenomenological study
Yatera, H., Joho, A. A., & Masika, G. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0331319 · Cited by 1 · see citing works
Lessons from Research to Normalize Perinatal Bereavement Photography
Vivekananda, K., Knipe, K., & Wurf, G. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2499875
The association between seeing the stillborn baby and risk of postpartum depression and anxiety in Chinese women undergoing pregnancy termination: a prospective cohort study
Qian, J., Yang, M., Wang, M., Sun, S., & Yu, X. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-026-09240-9
Navigating stillbirth in low- and middle-income countries: A systematic review of maternal experiences
Argaheni, N. B., Stacey, T., & Taylor, B. L. (2026) · Women and Birth · doi:10.1016/j.wombi.2026.102411

Parents’ experiences of care and support after stillbirth in rural and urban maternity facilities: a qualitative study in Kenya and Uganda
Mills, T., Ayebare, E., Mukhwana, R., Mweteise, J., Nabisere, A., Nendela, A., Ndungu, P., Okello, M., Omoni, G., Wakasiaka, S., et al. (2021) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16413 · Cited by 44 · see citing works
‘My baby and I counted’: Parents’ experiences of care before and after stillbirth: framework analysis of an international surveyPreprint
Atkins, B., Boyle, F. M., Sacks, E., Horey, D., Ravaldi, C., Vannacci, A., Flenady, V., & Blencowe, H. K. (2025) · doi:10.22541/au.173779565.54965752/v1
Bereavement Care Practices Following Stillbirths: Health-Care Provider's Perspective
Sharma, B., Kulshreshtha, S., Aggarwal, N., Suri, V., & Nehra, R. (2022) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_676_21 · Cited by 11 · see citing works
PA.17 Joint perspective, joint decision making; improving maternity bereavement care for stillbirth. A mixed methods multicentre study in the UK providing an in-depth understanding of maternity bereavement care
Chebsey, C., Jackson, S., Gleeson, K., Winter, C., Storey, C., Hillman, J., Lewis, J., Cox, R., Heazell, A. E. P., Fox, R., et al. (2014) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2014-306576.61 · Cited by 3 · see citing works
All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (<scp>INSIGHT</scp>)
Siassakos, D., Jackson, S., Gleeson, K., Chebsey, C., Ellis, A., Storey, C., & the INSIGHT Study Group (2018) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14765 · Cited by 75 · see citing works

Authors: Christou, A., Alam, A., Hofiani, S. M. S., Mubasher, A., Rasooly, M. H., Rashidi, M. K., & Raynes-Greenow, C.
Affiliations: The University of Sydney (AU)
Ministry of Public Health (AF)
World Health Organization - Afghanistan (AF)
Corresponding author: Christou, Aliki
ORCID: Christou, Aliki
Alam, Ashraful
Hofiani, Sayed Murtaza Sadat
Raynes-Greenow, Camille
Venue: Journal of Perinatology
Publisher: Springer Science and Business Media LLC
Published: 2021-01-06
Volume: 41
Issue: 9
Pages: 2182-2195
ISSN: 0743-8346 (ISSN-L)
1476-5543
DOI: 10.1038/s41372-020-00907-5
OpenAlex: W3119241293
Cited by: 11
References: 42
Citations by year: 2026: 2 · 2025: 2 · 2024: 4 · 2023: 3
FWCI: 1.20
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Journal of Perinatology (publishedVersion)
PubMed (publishedVersion)
The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
Funders: University of Sydney (NA)
Department of Health | National Health and Medical Research Council (1087062)
Topics: Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: stillbirth, perinatal bereavement, bereaved parents, provider communication, shared decision-making, memory formation, psychological support, resource constraints
MeSH terms: Afghanistan, Aged, Bereavement, Female, Health Personnel, Humans, Male, Parents, Pregnancy, Qualitative Research, Stillbirth

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan

Abstract

Integrity signals

Claims the paper makes

Cites

Cited by

Related

Record

About these checks