Navigating Miscarriage: Social, Medical & Conceptual Perspectives. Susie Kilshaw and Katie Borg, editors, New York: Berghahn, 2020, 252 pp.
College of Wooster
In the context of recent Baby Loss awareness campaigns, the growing market for miscarriage support resources and memorials and activism to provide death certificates for miscarriages before 24 weeks, publications on loss and miscarriage have boomed in the past decade. These have taken the form of memoirs, self-help books, and professional health guides, as well as scholarly contributions across a wide range of disciplines. Most of this literature centers on the experiences of Euro–American women in biomedical contexts.
Navigating Miscarriage: Social, Medical & Conceptual Perspectives brings greater depth to this scholarship by using miscarriage as a lens through which to contest biomedical understandings of loss and personhood as universal. A significant contribution of this edited collection is its geographical scope, drawing together ethnographic, historical, and clinical research in Cameroon, India, Qatar, Pakistan, Romania, and the United Kingdom. Edited by anthropologist Susie Kilshaw and clinical research nurse Katie Borg, the collection highlights the fluidity of miscarriage definitions, categories, and meanings, and uses rich cross-cultural examples to demonstrate that this framing is not static, but rather culturally dependent and often in flux.
The genesis of the collection was a seminar series at Oxford University hosted by the Fertility and Reproduction Study Group. Sponsored by the Institute of Social and Cultural Anthropology, the series brought together anthropologists, historians, and sociologists, as well as health care practitioners and health policy experts, to interrogate the hegemonic biomedical framing of miscarriage in the U.K. National Health Service. The series, and subsequent book, does the important interdisciplinary work of drawing social scientists, clinicians, and policymakers into conversation, however the reliance on the British health care system as the primary referent for comparative analysis is also a limitation of the collection. Probing the variations among and within different biomedical contexts would allow for a more robust challenge to assumptions about the universality of experiences with pregnancy loss.
While there are no named sections in the collection, central themes such as anxieties about the causation of miscarriage and culpability, kinship and inter-relational economic losses, and ritual and funerary practices are interwoven throughout. Kilshaw’s introductory chapter situates the volume within the anthropology of reproduction, particularly regarding reproductive disruptions, noting that the scholarly and public contributions of anthropologists like Linda Layne and Marcia Inhorn have made public discourse about miscarriage, loss, and infertility far more common in northern Euro–American contexts and increased the availability of support resources. This collection adds depth to this previous work in its expansive geographical scope and its interrogation of miscarriage as an event that universally elicits distress, grief, and depression.
Collectively, the first two chapters provide an excellent primer on how biomedical technology has shaped Western understandings of miscarriage. Obstetrician–gynecologist Pedro Melo and reproductive medicine specialist Ingrid Granne explore how medical classification—such as terminology like “spontaneous abortion” and “missed miscarriage,” and detached explanations of miscarriage among medical professionals as “quality control”—has fostered the popular characterization of miscarriage as a woman’s failure. Indeed, as economic and social historian Rosemary Elliot emphasizes, as scientific developments during the 20th century expanded reproductive health options for women, pregnant bodies also came under increased scrutiny. Because these reproductive technologies rely on increased surveillance, they have also contributed to placing the burden of preventing miscarriage on women.
Within this context, the subsequent chapters present long-term ethnographic research across a wide range of social landscapes. Erica van der Sijpt observes that ambiguity surrounding the causes of miscarriage can create opportunities for women to assert agency through what she terms “creative manipulation” of religious and political power. Among Gbigbil women in Cameroon, religious notions of women’s powerlessness to fate became a manifestation of their power to control narratives surrounding loss, whether spontaneous or induced. In Romania, women asserted their experience as bereaved mothers by going against traditional Orthodox Christian doctrine to reappropriate rituals following death that were typically reserved for those who had been baptized. Kaveri Qureshi’s chapter on miscarriage among Punjabi women in Pakistan interrogates the effects of prenatal testing and ultrasound technology that imbue pregnancies with value at earlier and earlier stages. In the context of intergenerational tensions between natal and marital families regarding the causation of miscarriage, biomedical technology introduced new complexities in how culpability for miscarriage is negotiated. Similarly, Kilshaw notes in the Introduction that increasingly sensitive and inexpensive pregnancy tests have meant that women in many cultural contexts who might previously have experienced miscarriage as late menstruation are now more likely to experience it as the loss of pregnancy.
In a chapter on her ethnographic fieldwork in England and Qatar, Kilshaw explores cultural distinctions between miscarriage and infertility as they relate to cultural, religious, and political beliefs surrounding choice and destiny. Women in both cultural contexts experienced suffering and sadness as a result of miscarriage. However, Kilshaw found that Qatari women normalized their experience as one that ultimately demonstrated their fertility and was an experience shared among many women. In contrast, English women actively sought to reject the normalization of miscarriage by focusing on individual suffering and memorialization through personalized rituals and memorial tattoos. Shifting focus to how bereaved mothers in the United Kingdom experience subsequent pregnancies, Aimee Middlemiss’s chapter explores the use of technology to manage post-loss anxiety. In the past decade, handheld doppler machines that amplify fetal heartbeat have shifted from being a medical device typically employed during prenatal visits to one that is widely available commercially. By providing evidence of life in the home setting, the technology has become an everyday form of relief and reassurance for women who can afford them.
Sayani Mitra’s chapter unpacks the multifaceted losses surrounding miscarriage that occurs during the commercial surrogacy process in India. While these losses are experienced differently by the surrogates, intended parents, other kin, and professionals, it is notable that the narrative of “success” constructed by fertility clinics had particularly deleterious effects on the commercial surrogates. Surrogates described the manifestation of guilt both from failing intended parents, as well as their family who depended financially on their ability to carry a child to term. In the final chapter, Karolina Kuberska explores how funeral services and shared cremation of pre-24-week fetal remains in England demonstrate the affective power of ritual. Kuberska attended these ceremonies, which were typically arranged by hospital personnel. While the services go unwitnessed by parents or other family, she details the ways that clergy and health care workers attempt to imbue ceremonies with respect and sensitivity when the disposal of pregnancy remains are largely dictated by bureaucratic processes. As a whole, Navigating Miscarriage offers conceptual depth that will contribute to important conversations in advanced anthropology classrooms. Some chapters will also be accessible to earlier students. I look forward to assigning Kilshaw’s incisive introduction and chapters such as Mitra’s on surrogacy in India and Kuberska’s on funeral services and shared cremations in England the next time I offer my undergraduate course Global Politics of Reproduction. The collection would also be well placed in training programs for health care professionals to encourage greater intercultural competency and empathy for patients with a wide range of experiences and expectations.