Women and Reproductive Loss: Client-Worker Dialogues Designed to Break the Silence

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. …