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Parents’ and healthcare professionals’ experiences of care after stillbirth in low‐and middle‐income countries: a systematic review and meta‐summary
Open accessAbstract
BACKGROUND: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.
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Child Death and Mothers’ Subsequent Mental Health in a High‐Mortality African Community
Smith‐Greenaway, E., Weitzman, A., & Lungu, E. (2024) · Population and Development Review · doi:10.1111/padr.12682 · Cited by 1
“Such reactions can mean bereaved mothers experience not only social isolation and strain (Pollock et al. 2020) but also intimate partner violence (Shakespeare et al. 2019; Weitzman and Smith-Greenaway 2020) and divorce (Sisay et al. 2014), both of which can harm their mental health (Clark et al.…”
Stevenson, G., Namukwaya, S., Katongole, J., Tumukunde, V., Blencowe, H. K., Seeley, J., Tann, C. J., Lawn, J. E., Elbourne, D. R., & Medvedev, M. M. (2025) · Women and Birth · doi:10.1016/j.wombi.2025.101890 · Cited by 1
Yatera, H., Joho, A. A., & Masika, G. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0331319 · Cited by 1
“Another study conducted by Shakespeare et al [18] women who experienced stillbirth wished to have received information in their local language could have improved their grief, fear of delivery of stillbirth, fear of their health and could have controlled the grieving process.”
Al‐Mamun, F., Das, P., ALmerab, M. M., Muhit, M., & Mamun, M. A. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.121018 · Cited by 1
Stillbirth in Low-Resource Settings
Blencowe, H. K., Suárez‐Idueta, L., Jayaratne, K., Kidanto, H., & Aggarwal, N. (2025) · Clinics in Perinatology · doi:10.1016/j.clp.2025.11.003 · Cited by 1
Improving perinatal bereavement care in settings with the highest mortality
Mills, T. A., Ayebare, E. O., Chaudhry, N., Mwamadi, M., Nsemwa, L., & Lavender, T. (2026) · BMJ · doi:10.1136/bmj-2025-086555 · Cited by 1
Improving Monitoring Data Systems to Count and Account for Stillbirths
Holschneider, S., & Morgan, A. (2022) · World Bank, Washington, DC eBooks · doi:10.1596/38068 · Cited by 1
Shifts in social support: A phenomenographic study of Nigerian women who have had a stillborn baby
Popoola, T. (2019) · doi:10.26686/wgtn.17138765.v1 · Cited by 1
Serrano, P. M. (2020) · Tesis Doctorals en Xarxa (Consorci de Serveis Universitaris de Catalunya) · doi:10.6035/14103.2020.686142 · Cited by 1
Somaliland women’s perception of stillbirth - a descriptive survey study
Malm, M.-C., Osman, F. A., Ibrahim, A., Hasan, H., Erlandsson, K., Kiruja, J., & Kalucza, S. (2021) · Somali Health Action Journal · doi:10.36368/shaj.v1i1.259
“HCPs who encourage women to see their baby and hold it, and reassure them that they need not be afraid of their feelings, can greatly improve the birth experience and help women to cope with their grief [9, 13].”
BackgroundInfluentialImportancia de la Psicología en la atención y cuidados perinatales. Una revisión sistemática
Baró, S. (2022) · RihumSo Revista de investigación del Departamento de Humanidades y Ciencias Sociales · doi:10.54789/rihumso.22.11.21.2
Morte fetal - a urgência da observação psiquiátrica
Costa, A. L. D., Guedes, B. D. D. M., Soares, A. P. D., Brás, J. M. D. N., de Sousa, R. C. M., Vaz, R. P. H., Martins, J. R. L., & Oliveira, A. I. M. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n6-001
Pesar por la muerte fetal: duelo sin voz
de Oliveira, H. T. L., Fonseca, L. F., Estancione, L. M. B., Corrêa, M. C. S. M., Oliveira, N. D. R., & Dias, V. D. V. V. A. (2022) · Revista Bioética · doi:10.1590/1983-80422022303558es · Cited by 1
Bazaraah, R., Fouly, H., & de Beer, J. (2023) · Saudi Journal for Health Sciences · doi:10.4103/sjhs.sjhs_137_22
Damerow, S. M., Yeung, D., Martins, J. S., Pathak, I., Chu, Y., Liu, L., & Fisker, A. B. (2023) · Journal of Global Health · doi:10.7189/jogh.13.04086
“…knowledge of the child’s vital status at birth, including avoiding or delaying informing the mother about the child death [22], avoiding showing her the deceased child [22-24], spending little time on providing information about the death [25], and more generally, poor communication [26-29].”
BackgroundCultural differences on baby loss experiences: A comparison of the US and New Zealand
Minton, E. A., Krszjzaniek, E., Wang, C. X., Fox, A. K., & Anthony, C. M. (2025) · Death Studies · doi:10.1080/07481187.2025.2454494
“…Ayebare et al. (2021) research focuses on two countries that share not only a border but also a spillover of cultural beliefs and practices, while Shakespeare et al. (2019) research involves a meta-analyses on care in the aggregate that removes the lived experience of the bereaved and strips the…”
Unveiling the unseen: Exploring stigma in stillbirth care through interdisciplinary narratives
Freedle, A., Nurse-Clarke, N. J., Sember, J., Bindeman, J., Major-Kincade, T. L., & Jones, C. J. (2025) · Death Studies · doi:10.1080/07481187.2025.2561081
Risk factors for stillbirth in Freetown, Sierra Leone – The StillFree studyPreprint
Sala, A., Orsi, M., Parisi, F., Kargbo, H., Turay, M., Bah, A. K., Kanu, S., Tiru, N. A., Driul, L., Pisani, L., et al. (2025) · Research Square · doi:10.21203/rs.3.rs-7889661/v1
Peven, K., Day, L. T., Ruysen, H., Tahsina, T., KC, A., Shabani, J., Kong, S., Ameen, S., Basnet, O., Haider, R., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14314738
Stefano, L. M. D., Bottecchia, M., Yargawa, J., Akuze, J., Haider, M. M., Galiwango, E., Dzabeng, F., Fisker, A. B., Geremew, B. M., Cousens, S. N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13787769
Milton, R., Alkali, F. I., Modibbo, F., Sanders, J. P., Mukaddas, A. S., Kassim, A., Sa’ad, F. H., Tukur, F. M., Pell, B., Hood, K., et al. (2021) · Figshare · doi:10.6084/m9.figshare.17204797
Stefano, L. M. D., Bottecchia, M., Yargawa, J., Akuze, J., Haider, M. M., Galiwango, E., Dzabeng, F., Fisker, A. B., Geremew, B. M., Cousens, S. N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13787757
Stefano, L. M. D., Bottecchia, M., Yargawa, J., Akuze, J., Haider, M. M., Galiwango, E., Dzabeng, F., Fisker, A. B., Geremew, B. M., Cousens, S. N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13787754
Peven, K., Day, L. T., Ruysen, H., Tahsina, T., KC, A., Shabani, J., Kong, S., Ameen, S., Basnet, O., Haider, R., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14314735
Stefano, L. M. D., Bottecchia, M., Yargawa, J., Akuze, J., Haider, M. M., Galiwango, E., Dzabeng, F., Fisker, A. B., Geremew, B. M., Cousens, S. N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13787760
Peven, K., Day, L. T., Ruysen, H., Tahsina, T., KC, A., Shabani, J., Kong, S., Ameen, S., Basnet, O., Haider, R., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14313932
Stefano, L. M. D., Bottecchia, M., Yargawa, J., Akuze, J., Haider, M. M., Galiwango, E., Dzabeng, F., Fisker, A. B., Geremew, B. M., Cousens, S. N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13787766
Jacob, D., Lavender, T., Goshomi, U., Chilinda, I., Smith, D. M., & Mills, T. A. (2026) · African Journal of Midwifery and Women s Health · doi:10.12968/ajmw.2025.0004
“ I expected to be called ‘mother’ : exploring mental health needs of bereaved mothers in Tanzania
Rent, S. M., Bassett, E., Nkini, G., Sengoka, E. G., Moyer, C. A., Lemmon, M. E., Matthews, N., Keating, E. M., Mmbaga, B. T., Staton, C. A., et al. (2026) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2026.2675713
Stage-based bereavement support for parents after stillbirth: an umbrella review
Chen, L.-L., Tsai, C.-H., & Yang, C. (2026) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2026.2675706
Chilinda, I., Goshomi, U., Smith, D. M., Chimwaza, A. F., Lavender, T., & Mills, T. A. (2026) · Global Health Action · doi:10.1080/16549716.2026.2709907
“Other research recommends that culturally appropriate guidelines may positively impact on the confidence and competence of healthcare workers to offer bereavement support and improve health outcomes of bereaved mothers and families [27,29,31– 33].”
InfluentialArgaheni, N. B., Stacey, T., & Taylor, B. L. (2026) · Women and Birth · doi:10.1016/j.wombi.2026.102411
Midwives’ Experiences With Prenatal Loss: A Phenomenological Study
ÇOBAN, S., & Altınayak, S. Ö. (2026) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228261499818
Metadata
- Authors
- Shakespeare, C., Merriel, A., Bakhbakhi, D., Baneszova, R., Barnard, K., Lynch, M., Storey, C., Blencowe, H., Boyle, F., Flenady, V, Gold, K., Horey, D., Mills, T., & Siassakos, D.
- Affiliations
- Southmead Hospital (GB)
- University Hospital Bratislava (SK)
- North Bristol NHS Trust (GB)
- International Stillbirth Alliance Bristol UK
- London School of Hygiene & Tropical Medicine (GB)
- The University of Queensland (AU)
- University of Michigan (US)
- La Trobe University (AU)
- University of Manchester (GB)
- Corresponding author
- Shakespeare, C
- ORCID
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2018-09-17
- Volume
- 126
- Issue
- 1
- Pages
- 12-21
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2886009481
- Cited by
- 102
- References
- 46
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 13 · 2023: 13 · 2022: 15 · 2021: 23 · 2020: 8 · 2019: 5
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Explore Bristol Research (acceptedVersion, other-oa)
- Deep Blue (University of Michigan) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (DRF-2017-10-130, CL-2016-25-001, ACF-2015-25-006)
- 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 › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- stillbirth, grief, stigma, respectful maternity care, parental experiences, health professionals' experiences, low- and middle-income countries, social status loss, bereavement support
- MeSH terms
- Disenfranchised Grief, Attitude of Health Personnel, Developing Countries, Female, Humans, Parents, Postnatal Care, Pregnancy, Stereotyping, Qualitative Research, Stillbirth
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