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Article Excerpt
One in every four currently parenting women in the United States also experienced a pregnancy loss during her lifetime (Price, 2006), on the basis of data from the Early Childhood Longitudinal Study, Birth Cohort (National Center for Education Statistics (2005). However, the questions that emerge from individual women encountered during my practice and research experience suggest that loss events during a woman's reproductive years are challenging and, at times, isolating experiences: "Am I the only person who feels this way? Why doesn't anyone know what to say to me now? Will this happen again?" These concerns, voiced by women spanning a range of socioeconomic, political, religious, and racial-ethnic backgrounds, convey the intrinsic tension between individual experience and societal perceptions of reproductive loss.
This article asserts that there is a silence around reproductive loss within our profession that limits flail individual, familial, and social awareness surrounding this issue. The silence does not emerge from an inability to discuss individual women's self-initiated concerns about their reproductive loss experiences; many practitioners are trained and competent to do exactly that. Silence results from passive oversight of reproductive losses as significant life events from which rich and detailed information about women's self-identity can emerge. Silence is magnified when reproductive losses are relegated to specialized areas of social work practice, such as grief counseling, rather than recognized as significant life course events that may affect identity, social role, self-image, and conceptualization of a woman's reproductive history and human sexuality across the entire range of practice settings.
The information and dialogues presented in this article strive to break this silence. The discussion opens with a synthesis of knowledge from theory and empirical literature that could help every social work practitioner understand the impact of reproductive loss on women's lived experience. Then, my professional experiences frame the presentation for four suggested worker-client dialogues applicable to social work practice across multiple service settings. Together, both informed knowledge and the proactive initiation of open dialogues should provide a receptive and secure environment for women to disclose and discuss their reproductive loss experiences in the context of social work practice in numerous settings.
CONCEPTUALIZING REPRODUCTIVE LOSS
Loss events that occur during the reproductive years of women's lives encompass a variety of experiences and medical diagnoses, labeled with such terms as miscarriage, stillbirth, pregnancy loss, spontaneous abortion, induced abortion, ectopic pregnancy, and medical terminations of pregnancy. For some women, the challenge of coping with infertility also presents as a reproductive loss; for example, one young, Latina woman who attended a presentation stood up to express her experience of monthly feelings of anger and betrayal at her own body because she struggled with infertility and felt overwhelming social pressure to produce a child to assert her womanhood. For her, the onset of each menstrual cycle marked her own struggle with reproductive loss. This article addresses the wide range of loss events that do not result in live births under the umbrella term of "reproductive loss."
Reproductive loss events may rise to the forefront of social work practice when a woman, as in the example in the preceding paragraph, chooses to vocalize and define a psychosocial problem on the basis her own experience. Self-motivated disclosure is unlikely when women are disempowered by social stigmas surrounding loss events such as abortion, when victimized by rape or incest, or when a loss occurs during an unplanned or undesired pregnancy that perhaps she has not been able, willing, or ready to disclose. Regrettably, under these circumstances, some losses may never be voiced within the context of social work practice. Another noteworthy issue is that women living with multiple psychosocial stressors, low socioeconomic status, or a lack of social and tangible resources may experience "just one more loss" in the current complexities of their lives. However, an openness to exploring reproductive loss experiences can make the social work practitioner aware of patterns of coping, self-conceptualization, relationship and family dynamics, and the client's sense of fit within her social and cultural environment.
THEORETICAL PERSPECTIVES ON REPRODUCTIVE LOSS
Attachment theory is widely used as a general explanation for the way individuals respond to loss as well as the effect of reproductive losses on subsequent pregnancy and parenting. In large part, on the basis of the writings of Bowlby (1980), the theorized interrelationships among separation, loss, and later relationship formation suggest that individuals display attachment behavior because of an intrinsic need to create and preserve bonds of affection. When relationships are lost, the individual responds with powerful emotional reactions in an attempt to resolve the intensity of the broken affective bond.
The application of attachment theory to pregnancy loss is rooted in the belief that expectations of parenthood develop along with the fetus, creating attachment bonds during pregnancy. Several authors argue that the use of modern medical practices such as early and routine monitoring through Doppler and ultrasound technologies may heighten early attachment formation (Layne, 2003; Robinson, Baker, & Nackerud, 1999). The conflict between normal expectations surrounding pregnancy as an opportunity for relationship formation with the developing fetus or baby and the psychological blow when that experience ends may create a rift in the individual's understanding of fairness and justice. This incongruity creates a loss of security, which may be reinforced by early attachment experiences (Uren & Wastell, 2002).Whether life, or attachment, begins at conception is as much a matter of personal ethics as it is of theoretical significance however.
Cognitive stress theory (Lazarus & Folkman, 1984) asserts that the situations that produce stress also produce the need for cognitive processing and restructuring. Even in the best of circumstances, pregnancy and adaptation to the birth of a child are generally regarded as stressful experiences, both biologically and psychosocially. A loss within this period of adaptation is likely to produce even greater levels of stress, requiring additional cognitive processing.
Whether a woman conceptualizes reproductive loss in terms of a relationship loss or a role adaptation, cognitive stress theory characterizes adaptive bereavement as...
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