Dr. Lisa R. Roberts - Virginia Henderson and Acknowledgements »Key Personnel: ~Dr. Lisa R. Roberts (PI) and Dr. Susanne Montgomery (Co-investigator) »Disclosures: ~No conflict of

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Item type Presentation

Format Text-based Document

Title The Critical Role of Fathers to Reduce Stillbirth in India

Authors Roberts, Lisa R.; Montgomery, Susanne

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Link to item http://hdl.handle.net/10755/621662

The Critical Role of Fathers to Reduce Stillbirth in India

Dr. Lisa R. Roberts

Disclosures and Acknowledgements»Key Personnel:

~ Dr. Lisa R. Roberts (PI) and Dr. Susanne

Montgomery (Co-investigator)

»Disclosures:

~ No conflict of interest to declare

»Funding:

~ LLU School of Nursing Seed Fund and the Rambo

Committee

»Acknowledgements:

~ Christian Hospital Mungeli nurses and health care

professionals who collaborated with us, local Mitanins

who facilitated village visits, community stakeholders,

and the participants.

Purpose»To explore how men and women experience stillbirth in

India and their respective needs

~ To inform locally sustainable interventions

Background»MDG 4 cannot be achieved without reducing stillbirths

»Globally 3.3 million stillbirths per year1

~ India has the highest number of stillbirths in the world2

Stillbirths in India

»National average stillbirth rate (SBR) 4-8

~ 27/1000 live births

»Estimates of variance in SBR rate

~ from 20 to 66 by region

»Certain subpopulations 75-78

»SBR in Chhattisgarh 64

»SBR as high as 103/1000 in some communities

»Usually third trimester SB

~ Most potentially avoidable

Stillbirths risks in India

»Medical and sociocultural factors6

~ Lifelong malnutrition

~ Girls/women receive less food; food of less quality

~ Young mothers (due to early marriage)

~ Advanced maternal age

~ Lack of reproductive health choice and resources

~ Son preference

~ Maternal socioeconomic disadvantage

~ Short birth intervals

~ Lack of antenatal care

~ Lack of skilled birth attendants

Perinatal Grief

»Acute perinatal grief

~ Significant psychosocial burden on women’s health

»Complicated grief > 6 months

~ Impairment of social, occupational, other functioning

»Sequelae

~ Depression

~ Anxiety

~ Somatic symptoms

~ Decreased functioning

~ Domestic violence

~ Stigma, abandonment or isolation7,8

Confluence of Risk factors

Medical

Socio-cultural

Previous stillbirth

Quest for sons

Stillbirth

9-11

Fathers’ experiences

Western Context:12

»Psychological symptoms

~ Increased with more time

before next pregnancy

~ Pressure to be strong

Indian Context:13

~ Son preference

~ Fertility expectations

Mixed-Methods, 2 parallel studies:

~ Evaluation of a short

mindfulness-based pilot

intervention for women

• N = 22

• 5-week intervention

• 6-week and 12-month follow-up

assessments

~ Formative work exploring men’s

SB experiences

• 5 key informant interviews

• 23 structured interviews

Overview of Results

Women

~ History of 1 – 3 stillbirth

~ Reductions:

• Anxiety, depression

• Perinatal grief

~ Increases:

• Mindfulness

• Resilience

~ Still using skills at 1 year

~ Reported benefits:

• Increased calmness

• Sense of peace

• Positive energy

Men

~ Medical/reproductive decision power and burden

~ Lack of knowledge, readiness

~ Fertility issues/solutions

~ With history of stillbirth

• > anxiety/depression

• Perceived less support

• More egalitarian attitude

• More abusive

• Grieving seen as ‘normal’

• Frustration

~ Supportive of MBI for women

Qualitative themes among men

»Reproductive rights determined by men:

~ #’s of children

~ Obtaining prenatal care

~ Facility birth or home delivery

~ Timing of attempt to conceive again after stillbirth

»Family obligations expected of men

~ Caring for elderly parents

~ Financial solvency, shelter

~ Enforcing family piety

Husband of a woman with SB history

“I alone had to decide. Everybody was telling

(me) make a decision. Last time we went to the

private doctor and even after so much money we

spent the baby was born dead. This time we

went to the government hospital. . . it was also

stillborn. I think my wife is not alright yet but

everyone is telling to have another baby.”

Items of perpetration endorsed by all men (N = 28)

0

5

10

15

20

25

30

35

1-10 times in the last 3 months

Stillbirth

No stillbirth0

5

10

15

20

25

30

35

40

45

10-20 times in the last 3 months

Stillbirth

No stillbirth0

0.5

1

1.5

2

2.5

3

3.5

4

More than 20 times in the last 3 months

Stillbirth

No stillbirth

Predictors of mental health among men

with a history of stillbirth experienceVariable β B 95% CI

Constant 8.79 2.54, 15.04

Time since stillbirth 0.19 0.001 -0.002, 0.004

Gender of stillborn 0.40 0.24* 0.006, 0.47

Where stillbirth occurred -0.08 -0.06 -0.77, 0.53

Wife had antenatal care 0.31 0.18 -0.06, 0.41

Birth attendant 0.42 0.15* 0.04, 0.26

Number of stillbirths -1.49 -1.16* -1.85, -0.47

Ethnicity -0.99 -0.30* -0.52, -0.09

Attitude Towards Women -0.15 -0.20 -0.07, 0.03

Social Provision of Support -0.32 -0.42 -0.13, 0.04

Physical abuser -1.20 -0.70* -1.00, -0.40

Emotional abuser -0.16 -0.11 -0.35, 0.12

Life satisfaction -0.72 -0.13* -0.22, -0.04

Positive religious coping -0.26 -0.18 -0.49, 0.13

Negative religious coping -0.56 -0.25 -0.55, 0.05

*p < 0.05

Significant Predictors of mental health among men with history of stillbirth

» Gender of baby (male)

» Skilled birth attendant (no)

» Number of stillbirths (more)

» Ethnicity (lower caste)

» Physical abuser (no)

» Life satisfaction (low)

Comparing men and women

Conclusion»MBI for women effective in reducing perinatal grief

»Men often unaware of need or intervention offered

»Fathers of stillborns have unmet needs

~ Some positive outcomes:

• Gained insight

• Personal growth

• Developed empathy

~ Support needed

»Opportunities

~ Community engagement

~ Education

~ Community-based intervention

“When women thrive, all of

society benefits and

succeeding generations are

given a better start in life.”

~ Kofi Annan

References1. Yoshida, S., et al., Setting research priorities to improve global

newborn health and prevent stillbirths by 2025. Journal of global

health, 2016. 6(1).

2. Blencowe, H., et al., National, regional, and worldwide estimates

of stillbirth rates in 2015, with trends from 2000: a systematic

analysis. The Lancet Global Health, 2016.

3. Worldmapper. The new Worldmapper: Mapping your world as

you've never seen it before; Available from:

http://www.worldmapper.org/.

4. Bhati, D.K., Stillbirths: A high magnitude public health issue in

India. South East Asia Journal of Public Health, 2014. 3(1): p. 3-9.

5. International Institute of Population Studies, National Health and

Family Survey 3, Chhattisgarh Report. 2006, International Institute

of Population Studies: Mumbai.

6. McClure, E.M., et al., Stillbirth rates in low-middle income countries 2010-2013: a population-based, multi-country study from the Global Network.Reproductive health, 2015. 12(Suppl 2): p. S7.

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