The best way to cope with miscarriage is for men and women to talk – to their partners, to their friends, to a counsellor. After a rich, successful man like Mark Zuckerberg publicly shared his grief about his wife’s miscarriages, it may make it easier for more men to finally open up about their own feelings of loss. There is nothing unnatural about grieving for the loss of your unborn child.
Feelings of guilt and shame in women who experience miscarriages are exacerbated by misconceptions over the causes, a US study suggests.
An online survey of 1,084 people, which formed the basis for research published in the Obstetrics & Gynecology journal on Monday, found that almost half of those who had a miscarriage felt guilty. Two in five said they felt like they had done something wrong, and the same number reported feeling alone.
A significant number of the respondents were under misapprehensions as to what caused the loss of the pregnancy. Three-quarters believed that a stressful event could bring about a miscarriage, 64% thought that lifting a heavy object could be a cause, and a fifth that previous use of oral contraceptives could induce pregnancy loss.
Coupled with the fact that 57% of those who had suffered a miscarriage said they were not given a cause for the loss, the researchers, from the Albert Einstein College of Medicine at Yeshiva University and Montefiore Medical Center, both in New York, believe such misapprehensions could contribute to the the negative feelings experienced.
Dr Zev Williams, the director of the programme for early and recurrent pregnancy loss, said: “The results of our survey indicate widespread misconceptions about the prevalence and causes of miscarriage. Because miscarriage is very common but rarely discussed, many women and couples feel very isolated and alone after suffering a miscarriage. We need to better educate people about miscarriage, which could help reduce the shame and stigma associated with it.”
The respondents, who were self-selecting, filled in a 33-question survey, which was open for three days in 2013, to assess perceptions of miscarriage, with 10 of the questions specifically directed at men or women reporting a history of miscarriage.
Of those who took part 15% said they or their partner had suffered a miscarriage, but the majority of respondents (55%) believed that miscarriages are uncommon (defined as less than 6% of all pregnancies). The truth is that miscarriages end one in four pregnancies and are by far the most common pregnancy complication, the paper says.
A fifth of people incorrectly believed that lifestyle choices during pregnancy, such as smoking or using drugs or alcohol, were the single most common cause of miscarriage, more common than genetic or medical causes. In reality, 60% of miscarriages are caused by a genetic problem.
The importance of hearing from others who have gone through the same experience was highlighted by a significant minority of those who had suffered a loss in pregnancy. Almost half said they felt less alone when friends disclosed their own miscarriage and 28% stated that celebrities’ disclosure of miscarriage had eased their feelings of isolation.
The authors concluded: “Patients who have experienced miscarriage may benefit from further counselling by healthcare providers, identification of the cause, and revelations from friends and celebrities. Healthcare providers have an important role in assessing and educating all pregnant patients about known prenatal risk factors, diminishing concerns about unsubstantiated but prevalent myths and, among those who experience a miscarriage, acknowledging and dissuading feelings of guilt and shame.”
The majority (55%) of respondents were women and all were aged 18-49. The sociodemographic distribution across gender, age, religion and geographic location and household income was consistent with 2010 national census statistics but race and ethnicity were not.
abortion, abuse, alcohol, child sexual exploitation, Children, control, crime, drugs, gangs, humiliation, mental health issues, miscarriage, perpetrators, power, pregnancy, punish, rape, sexual assault, smartphones, social networks, STDs, support, threaten
Thousands of children are raped and abused each year, with many more cases going unreported by victims and unrecorded by the authorities, according to an official study presented as the most comprehensive inquiry to date of the scale and prevalence of child sexual exploitation in England.
The disturbing and at times horrific study, which describes a range of traumatic and violent sexual crimes perpetrated mainly against girls, by male teenage gang members and groups of older men, was described as a “wake-up call” for safeguarding professionals by the Office of the Children’s Commissioner for England (OCCE).
It draws an alarming picture of serious sexual crimes against children: girls groomed, then drugged and raped at seedy “parties” in private homes and warehouses organised by groups of men, for profit or pleasure; assaults in public parks, schools and alleyways by gang members influenced by violent pornography, and intent on threatening, punishing or controlling young women by means of forced oral sex, and anal and vaginal rape.
The report says that victims commonly suffer serious physical and emotional harm as a result of their experiences, including severe mental illness, and drug and alcohol problems. Some victims contract sexually transmitted diseases, become pregnant, have terminations or suffer miscarriages.
“The reality is that each year thousands of children in England are raped and abused by people seeking to humiliate, violate and control them. The impact on their lives is devastating,” said the inquiry chair, deputy children’s commissioner Sue Berelowitz.
The inquiry was established in 2011 to investigate what it saw as mounting concern about child sexual exploitation. The inquiry team, comprising academics and senior safeguarding professionals from the police, NHS and charities, collected data and evidence from local authorities, police forces and primary care trusts. It took oral evidence from 68 professionals and 20 sexually exploited children across the country.
It concluded that too often police, local authorities and other safeguarding agencies have failed to spot or act on the warning signs of sexual exploitation, despite what it says is 20 years of evidence that large numbers of children are being sexually exploited in the UK. “Too many child victims are not getting the protection and support they need,” writes Berelowitz in the foreword to the report.
It criticises safeguarding professionals who labelled victims as “promiscuous” or “asking for it”. This “worrying perspective” suggested officials too often assumed that sexually exploited children, many of whom exhibited disruptive or aggressive behaviour, were “complicit in, and responsible for, their own abuse”.
Debbie Jones, president of the Association of Directors of Children’s Services, said: “It is clear that we cannot make assumptions about victims or perpetrators based on their age, ethnicity or whether they are in care. Making such assumptions will risk some children not being identified as being sexually exploited and not receiving the protection that they so desperately need.”
The inquiry’s interim report published by the OCCE says that despite media attention surrounding a number of high-profile court cases involving groups of Pakistani men and white British female victims, sexual exploitation was widespread. There was no evidence that perpetrators belonged disproportionately to a particular ethnic group.
“The vast majority of the perpetrators of this terrible crime are male. They range in age from as young as 14 to old men. They come from all ethnic groups and so do their victims – contrary to what some may wish to believe,” writes Berelowitz.
The study found the largest group of perpetrators were classed as “white” males, but because there were gaps in official data recording, and because many victims found it hard to identify their attackers, it was impossible to estimate accurately who and how many people were sexually exploiting children.
“What all perpetrators have in common – regardless of the differences in age, ethnicity, or social background (information on disability or sexual orientation was rarely available) – was their abuse of power in relation to their victims, and that the vast majority were male,” the report said.
Although it identified 2,409 children and young people as “confirmed victims” of sexual exploitation in gangs or groups over a 14-month period, and estimated that 16,500 children were at “high risk” of sexual exploitation during a 12-month period, the report said this was an undercounting of the true scale of the problem. The report did not consider cases of sexual exploitation by “lone perpetrators”.
Anne Marie Carrie, chief executive of Barnardo’s, which works with 1,000 victims of child sexual exploitation each year, agreed that the figures were undercounted: “We agree with the OCCE that it is likely that the figures of both confirmed victims and those at high risk only show us the tip of the iceberg.
All kinds of children and young people, both male and female and across a range of ethnic backgrounds, were sexually exploited, the report found. Although vulnerable youngsters in care or from dysfunctional families were most at risk, children “from loving and secure homes” were also abused by gangs and groups.
“The characteristics common to all victims are not their age, ethnicity, disability or sexual orientation, rather their powerlessness and vulnerability,” the report states.
The study found that 28% of the victims reported to the inquiry were from black and minority ethnic backgrounds. The report says: “This information is significant, given that the general perception appears to be that sexual exploitation by groups, in particular, is primarily a crime against white children.”
Technology was used widely to initiate, organise and maintain child sexual exploitation. Victims reported being harassed through text messages, and perpetrators would often film and distribute incidents of rape via smartphones and social networking. Younger perpetrators had in many cases been exposed to violent pornography, the inquiry found, and it speculated that this informed abusers’ understanding of sexual relationships.
Berelowitz writes: “We need to ask why so many males, both young and old, think it is acceptable to treat both girls and boys as objects to be used and abused. We need to know why so many adults in positions of responsibility persist in not believing these children when they try to tell someone what they have endured.”
ammunition, Basra, battle, birth defects, bombardment, brain dysfunctions, Children, Fallujah, health crisis, heart defects, Iraq, lead, malformed limbs, mercury, metals, miscarriage, neuro-toxic metal contamination, pregnancy, stress, toxicology, war, white phosphorus shells, WHO
It played unwilling host to one of the bloodiest battles of the Iraq war. Fallujah’s homes and businesses were left shattered; hundreds of Iraqi civilians were killed. Its residents changed the name of their “City of Mosques” to “the polluted city” after the United States launched two massive military campaigns eight years ago. Now, one month before the World Health Organisation reveals its view on the legacy of the two battles for the town, a new study reports a “staggering rise” in birth defects among Iraqi children conceived in the aftermath of the war.
High rates of miscarriage, toxic levels of lead and mercury contamination and spiralling numbers of birth defects ranging from congenital heart defects to brain dysfunctions and malformed limbs have been recorded. Even more disturbingly, they appear to be occurring at an increasing rate in children born in Fallujah, about 40 miles west of Baghdad.
There is “compelling evidence” to link the increased numbers of defects and miscarriages to military assaults, says Mozhgan Savabieasfahani, one of the lead authors of the report and an environmental toxicologist at the University of Michigan’s School of Public Health. Similar defects have been found among children born in Basra after British troops invaded, according to the new research.
US marines first bombarded Fallujah in April 2004 after four employees from the American security company Blackwater were killed, their bodies burned and dragged through the street, with two of the corpses left hanging from a bridge. Seven months later, the marines stormed the city for a second time, using some of the heaviest US air strikes deployed in Iraq. American forces later admitted that they had used white phosphorus shells, although they never admitted to using depleted uranium, which has been linked to high rates of cancer and birth defects.
The new findings, published in the Environmental Contamination and Toxicology bulletin, will bolster claims that US and Nato munitions used in the conflict led to a widespread health crisis in Iraq. They are the latest in a series of studies that have suggested a link between bombardment and a rise in birth defects. Their preliminary findings, in 2010, prompted a World Health Organisation inquiry into the prevalence of birth defects in the area. The WHO’s report, out next month, is widely expected to show an increase in birth defects after the conflict. It has looked at nine “high-risk” areas in Iraq, including Fallujah and Basra. Where high prevalence is found, the WHO is expected to call for additional studies to pinpoint precise causes.
The latest study found that in Fallujah, more than half of all babies surveyed were born with a birth defect between 2007 and 2010. Before the siege, this figure was more like one in 10. Prior to the turn of the millennium, fewer than 2 per cent of babies were born with a defect. More than 45 per cent of all pregnancies surveyed ended in miscarriage in the two years after 2004, up from only 10 per cent before the bombing. Between 2007 and 2010, one in six of all pregnancies ended in miscarriage.
The new research, which looked at the health histories of 56 families in Fallujah, also examined births in Basra, in southern Iraq, attacked by British forces in 2003. Researchers found more than 20 babies out of 1,000 were born with defects in Al Basrah Maternity Hospital in 2003, a number that is 17 times higher than recorded a decade previously. In the past seven years, the number of malformed babies born increased by more than 60 per cent; 37 out of every 1,000 are now born with defects.
The report’s authors link the rising number of babies born with birth defects in the two cities to increased exposure to metals released by bombs and bullets used over the past two decades. Scientists who studied hair samples of the population in Fallujah found that levels of lead were five times higher in the hair of children with birth defects than in other children; mercury levels were six times higher. Children with defects in Basra had three times more lead in their teeth than children living in non-impacted areas.
Dr Savabieasfahani said that for the first time, there is a “footprint of metal in the population” and that there is “compelling evidence linking the staggering increases in Iraqi birth defects to neuro-toxic metal contamination following the repeated bombardments of Iraqi cities”. She called the “epidemic” a “public health crisis”.
“In utero exposure to pollutants can drastically change the outcome of an otherwise normal pregnancy. The metal levels we see in the Fallujah children with birth defects clearly indicates that metals were involved in manifestation of birth defects in these children,” she said. “The massive and repeated bombardment of these cities is clearly implicated here. I have no knowledge of any alternative source of metal contamination in these areas.” She added that the data was likely to be an “underestimate”, as many parents who give birth to children with defects hide them from public view.
Professor Alastair Hay, a professor of environmental toxicology at Leeds University, said the figures presented in the study were “absolutely extraordinary”. He added: “People here would be worried if there was a five or 10 per cent increase [in birth defects]. If there’s a fivefold increase in Fallujah, no one could possibly ignore that; it’s crying out for an explanation as to what’s the cause. A rapid increase in exposure to lead and mercury seems reasonable if lots of ammunition is going off. I would have also thought a major factor would be the extreme stress people are under in that period; we know this can cause major physiological changes.”
A US Defense Department spokesperson said: “We are not aware of any official reports indicating an increase in birth defects in Al Basrah or Fallujah that may be related to exposure to the metals contained in munitions used by the US or coalition partners. We always take very seriously public health concerns about any population now living in a combat theatre. Unexploded ordnance, including improvised explosive devises, are a recognised hazard.”
A UK government spokesperson said there was no “reliable scientific or medical evidence to confirm a link between conventional ammunition and birth defects in Basra”, adding: “All ammunition used by UK armed forces falls within international humanitarian law and is consistent with the Geneva Convention.”
Dr Savabieasfahani said she plans to analyse the children’s samples for the presence of depleted uranium once funds have been raised. She added: “We need extensive environmental sampling, of food, water and air to find out where this is coming from. Then we can clean it up. Now we are seeing 50 per cent of children being born with malformations; in a few years it could be everyone.”
Throughout pregnancy, lead can pass from a woman’s bones to her child; the levels of lead in maternal and foetal blood are almost identical. Children and particularly the unborn are more susceptible to lead than adults. At high levels of exposure, lead attacks the brain and central nervous system, causing comas, convulsions and even death, according to the WHO. Children who survive acute lead poisoning are typically left with mental defects and behavioural problems.
Exposure to metallic, inorganic or organic mercury can permanently damage the brain, kidneys and developing foetus. Mercury can enter the air, water and soil. Its harmful effects can be passed from mother to the unborn child, leading to brain damage, mental defects, blindness, seizures, muteness and lack of co-ordination.
A toxic heavy metal, depleted uranium is what is left over after natural uranium has been enriched, either for use in weapons or for reactor fuel. While the US and UK acknowledge that the dust can be dangerous if inhaled, the jury is still out when it comes to long-term damage to people and their children. Scientists have suggested that its molecules can travel to the sperm and eggs, increasing the probability of cancer and damage to genes.
When her baby Angel died in her arms at 1.30am on 3 January 2011, Bei Bei Shuai was so distraught she was instantly transferred to the mental health wing of the Methodist hospital in Indianapolis. Grief stricken and under heavy sedation, she was unaware that within half an hour of her baby’s death a detective from the city’s homicide branch had arrived at the maternity ward and had begun asking questions.
While Shuai was embarking on a journey into bereavement that continues to this day, the Indianapolis authorities were also setting out, albeit along a very different path. On 14 March last year Shuai was arrested and taken into custody in the high-security Marion County prison, where she was held for the next 435 days, charged with murdering her foetus and attempted feticide. If convicted of the murder count she faces a sentence of 45 years to life.
Bei Bei Shuai is at the sharp end of the creeping criminalisation of pregnancy across America. Women who lose their unborn babies – whether in cases of maternal drug addiction or in Shuai’s case a failed suicide attempt – are increasingly finding themselves accused of murder.
Speaking publicly for the first time, Shuai told the Guardian she is determined to defend herself as she prepares for a murder trial scheduled for December. “I have a strong desire to stay in America,” she said, three days after she had been released from jail on $50,000 bail. “I want to stay and fight this case. I have the best legal team, and I’m not afraid anymore to face the charges.”
On 23 December 2010 Shuai became so depressed after she had been abandoned by her boyfriend – a married Chinese man who broke his promise to set up a family with her – that she decided to end her life. She consumed rat poison, and after confessing to friends was rushed to the Methodist hospital.
Doctors took steps to save her, but on 31 December there were signs that the baby, then at 33 weeks gestation, was in distress and a Caesarian was performed. On the second day of Angel’s life the baby was found to have a massive brain haemorrhage and on 2 January was taken off life support.
Shuai held Angel for five hours as the baby gradually faded and died. “Why do they want to take my baby away?” she kept asking, in between bouts of fainting. Shuai begged for her own life to be taken so that her child’s might be spared.
‘No one wins from the criminalisation of pregnant women’
“There is no doubt that Shuai was suffering from a severe mental illness,” her defence lawyer Linda Pence said. She first met the defendant when she was in the mental wing, a few days after Angel died. “I personally observed a very depressed woman, a grief-stricken individual.”
That is not how the prosecutor saw it. For the first time in Indiana‘s 196-year history, the state has applied felony charges against a woman that hold Shuai criminally liable for the outcome of her pregnancy. Earlier this month the Indiana supreme court declined to hear the case, rendering a 3 December murder trial almost inevitable.
Lawyers and women’s advocates in Indiana were astonished by the prosecution’s hard line. To attempt to take one’s own life is not a crime in Indiana, so the decision to charge a pregnant woman appeared to be creating a double standard.
The feticide law, introduced in Indiana in 1979, was designed with violent third parties in mind: abusive boyfriends or husbands who attacked their pregnant partners, causing them to lose their unborn babies. It was enhanced to carry a maximum sentence of 20 years in 2007 after a bank robbery in which a pregnant woman was shot in the stomach, killing her fetus but leaving her alive.
“From a legal standpoint, this case is absolutely frightening,” said Pence, who has set up a website and fighting fund to support Shuai’s defence.
Pence fears that Shuai’s prosecution could set a precedent that will catch others in its trap. In the future, could women who smoke or drink during pregnancy and suffer a miscarriage be prosecuted for murder, or women with HIV who pass it on to their child in the womb? “No one wins from the criminalisation of pregnant women – all this will do is persuade women to flee the state, avoid treatment or have an abortion,” Pence said.
‘I knew America as the best country in the world’
Shuai sees the threat now facing her from a different perspective – as the obliteration of her American dream. She was raised as a single child in Shanghai by parents she described as loving and caring. She graduated from Shanghai university as an accountant, worked for a year in a Chinese government department and then came to the US about 10 years ago as a legal immigrant with her then-husband, who was offered a job in Indianapolis as a mechanical engineer.
Shuai said she was delighted to come to the US. “I knew America as the best country in the world, with the best education system. People get more freedom. I really wanted to see what it was like.”
She found the initial arrival in her Indiana town – a tiny one compared to Shanghai – a bit of a culture shock, but over time she said she came to appreciate it more and more: “Seeing all the natural trees and flowers, the fresh air.”
She was full of dreams – the dream of continuing her studies, the dream of forming her own family, of owning a house and car. “Everybody tells me that they have their American dream, trying to make their life better. People tell me that all the time, and I am the same, I am one of them,” she said.
The dreams didn’t work out so easily. She couldn’t afford to go back to college, so instead studied under her own steam using the local library. Her marriage collapsed, and then when she did finally become pregnant it was with a married man.
When he abandoned her, he left Shuai on her hands and knees in a parking lot as he drove away.
Shuai is not allowed to discuss the events that led up to her suicide attempt, as that might prejudice her trial. But she can talk about the deep sense of shame she felt when she was arrested for killing her foetus.
“I remember the day I had to turn myself in. I felt hopeless and ashamed, for myself and my parents. I had never worn handcuffs before – when they put the cuffs on me it chilled me to my bones.”
Now released, her hands are free. But she is forced to wear a GPS ankle bracelet that is causing her feet to swell.
Shuai’s lawyers wonder whether it is coincidental that such an aggressive application of a law originally designed to protect pregnant women against violent men should first be applied against a woman who is Chinese. The question is all the more pertinent given the current spat between the US and Chinese governments over the treatment of the blind dissident Chen Guangcheng.
Lynn Paltrow, head of National Advocates for Pregnant Women that is co-counsel in Shuai’s defence, said: “It’s an irony that the US has paid such close attention to violations of human rights in China while at the same time Indiana has absolutely deprived a woman who is a legal immigrant from China of her constitutional human rights.”
Prosecution is determined to push on
The only hope for Shuai to avoid a murder trial is if the prosecutor, Terry Curry, decides to drop the charges. There is little chance of that, given his firm belief that he is following the correct path.
“It’s my job to enforce the criminal code as enacted by our legislature and that’s what our legislature has determined,” he said. Curry pointed to a suicide note that Shuai left the former boyfriend in which she wrote that she was “taking this baby with me”.
“What we allege is that her actions were directed specifically at the unborn child. It’s not that she was trying to take her own life, it was that she was trying to take the life of her foetus,” Curry said.
Curry’s determination to press ahead to trial is matched by Shuai’s determination to fight on. During her year in prison, she has improved her English language skills and now speaks fluently without a translator. Though there were dark times inside, including anxiety attacks and moments of despair, she said she has emerged stronger for it.
“It was a really bad experience. I thought nobody would care about me anymore, that I was a worthless person with no future,” she said. “But I learned a great deal. I learned that my life wasn’t the worst as I thought it was. Everything that has happened has made me think that I am so blessed. I have a second family here, and that gives me hope.”
Shuai kept the truth about her suicide attempt and prosecution for murder from her mother back in Shanghai for almost a year. But a couple of months ago, with the help of her lawyer, she finally confessed.
“My mother was so wonderful and supportive. She told me you don’t need to care about other people’s judgment, as she knew that was what hurt me most. There’s a Chinese saying: ‘A people’s mouth can be sharper than a knife.'”
Despite her ordeal, Shuai insists she remains dogged in her intention to make a life for herself in America, a country that she still regards as the greatest on Earth. But in the last analysis her decision to stay and protest her innocence is made on behalf of only one person.
“I want to prove to my daughter that her mother is not a murderer, and that she has been loved.”
Mothers will receive one-to-one care from a named midwife during labour and birth as part of government plans to combat postnatal depression.
Women who have a miscarriage or stillbirth and parents who are forced to cope with the death of a baby will also be offered increased support from theNHS.
Under the plans, health workers will be given enhanced training so they can spot the early signs of postnatal depression.
The move was welcomed by the Royal College of Midwives (RCM) and parenting forums. Cathy Warwick, chief executive of the RCM, said the pledges were “very good news” for women and midwives.
“These are positive plans from the government targeting areas of maternity care that are under-prioritised and under-resourced,” she said.
“The impact of a miscarriage or a stillbirth can be devastating for the woman and her family and postnatal depression can be a crippling and sometimes fatal illness. Early detection and treatment is crucial.
“It is also excellent to see an intention to ensure that long-standing NHS commitments, such as one-to-one care in labour and choice about where and how women give birth, become a reality for all women.”
According to the RCM, 5,000 more midwives would be needed to deliver the care proposed.
Justine Roberts, co-founder of Mumsnet, welcomed the renewed support but said a sustained effort was needed to ensure mothers benefited from the changes.
“Sadly there are many experiences shared on Mumsnet of women not getting the best care when they need it,” she said.
“The announcement that services provided during miscarriage are to be monitored is a real advance towards identifying best and worst practice and therefore towards improving the care received.”
Sally Russell, co-founder of Netmums, also welcomed plans to address postnatal depression – a common condition that is often kept hidden.
“Most mums and dads find it difficult to admit they are suffering and yet it can be a blight on their lives,” she said. “Having better support from local services could make a big difference and we’re delighted that the government has identified this as a priority.”
Alongside beefed-up training for health visitors – who provide services for expectant and new parents after birth – the government has pledged to improve maternity care by ensuring women have one named midwife to oversee their care during pregnancy and after they have their baby, making sure every women has one-to-one midwife care and giving parents-to-be the choice over where and how they give birth.
The NHS will also be judged on how well it looks after parents who have miscarried, suffered a stillbirth or cot death, with patients asked to rate their care.
According to the Royal College of Psychiatrists, 10-15% of women who have a baby suffer from postnatal depression.
Several celebrities, including actor Gwyneth Paltrow, have spoken of their experience of the condition, which usually starts within a few months of birth. Around one in three women experience symptoms in pregnancy, which then continue. Treatment options depend on the severity of the depression, but include medication and counselling.
The health secretary, Andrew Lansley, said: “We have listened to the concerns of women about their experiences of maternity care, which is why we are putting in place a ‘named midwife’ policy to ensure consistency of care.
“Not least, we will focus on the quality of care given to mothers-to-be and measure women’s experience of their maternity care for the first time.”