A Reproductive Justice approach to miscarriage
In 1997, feminist anthropologist Linda Layne published ‘Breaking the Silence: An Agenda for a Feminist Discourse of Pregnancy Loss’: a landmark article that explored the ‘taboos and silences’ surrounding miscarriage. Layne recognised the efforts of pregnancy loss support groups to create ‘a space in which to speak’ but was also clear that women-led advocacy and mutual support does not necessarily align with feminist principles. In fact, some of the pregnancy loss groups and individuals she encountered in her research were actively anti-abortion. Accordingly, the article identified a pressing need for an explicitly feminist framework for researching and understanding miscarriage. Though feminists may be fearful that acknowledging miscarriage-related grief might strengthen the anti-abortion movement, Layne argued that maintaining a ‘studied silence’ is not an option, as this simply ‘[gives] the field to the antichoice activists while adding to the silence members of pregnancy-loss support groups find so painful’. The article therefore concludes by laying down a challenge to feminist activists and scholars as well as healthcare providers and clinicians – to articulate a robust feminist agenda and ‘invent a new and more liberatory discourse’ on miscarriage and other forms of pregnancy loss.
Nearly three decades later, the Feminist Miscarriage Project is taking stock and assessing the extent to which this agenda has been realised within the changed cultural and political terrain we now operate within. When feminist academics were writing about miscarriage in the 1990s and 2000s, they did so against a backdrop of relative cultural silence; though as Layne demonstrates, the pregnancy loss community had already achieved a lot in terms of making themselves heard by a broader audience. Today, while miscarriage is still often described as ‘taboo’, it’s actually discussed much more frequently in the public arena, with celebrity miscarriage stories, for example, being regularly shared and reported, and well over a million Instagram posts using #miscarriage and #miscarriageawareness by late 2023.
The contemporary challenge, therefore, is less about ‘breaking the silence’, and more about making feminist interventions into how miscarriage is spoken of – by complicating, challenging and adding to the narratives already circulating. As media scholar Zelly Martin shows, for instance, miscarriage stories in news media and magazines often perpetuate conservative ideas about gender and reproduction, inscribing a formulaic narrative of miscarriage as ‘the worst thing that can happen to a woman’, which bolsters the ‘cult of true motherhood’ and ‘racialized notions of women as domestic, submissive, pious, and pure’.
Since Layne wrote her article in the 1990s, a small but growing body of feminist scholarship has been established across various disciplines, though it remains rather fragmented. One core aim of this research has been to challenge the false binary between supporting abortion and supporting miscarriage, and hence to dissolve feminist anxiety about broaching the subject. For example, anthropological studies adopting what Layne calls the ‘cultural model of personhood’ show how the process of constructing or ‘calling into’ personhood may be undertaken with some embryos/foetuses and not others. This model is complemented by work in feminist philosophy taking a relational view, which proposes that the ontological and moral status of an embryo/foetus – the kind of being it is – is not absolute. Instead, it depends upon how the pregnant person, within whom that particular foetal being is enmeshed, relates to and understands it. In other words, because a foetus is not independent of a pregnant person’s body, its status is not independent of that pregnant person. Such perspectives affirm that one can advocate for abortion and for miscarriage support without contradiction, as long as we put the people who actually are, or have been, pregnant at the centre.
Feminist researchers also emphasise that miscarriage carries different meanings for different people. For some, it’s a source of profound grief and trauma; for others, it may be a relief, or pass with minimal emotional impact. Moreover, as sociologist Gayle Letherby noted back in 1993, these different meanings will be affected by ‘commitment to and expectations of individual pregnancies, as well as specific medical, social, and material circumstances’. Feminist research, she argued, needs to examine how miscarriage experiences are ‘mediated by things such as class, race, and disability’ and develop deeper understandings of how the ‘negative aspects of the experience of miscarriage are compounded by patriarchy and capitalism’.
Yet while the number of studies has been growing, much of the research on miscarriage continues to disproportionately focus on white, middle-class, cis-het women, even though marginalised groups often experience higher miscarriage rates. For example, it’s been estimated that Black women in the UK are 43% more likely than white women to experience miscarriage, and without centring these lived experiences, the statistics can erase the people most affected. This persistent imbalance reflects a broader issue in miscarriage scholarship: a lack of thorough attention to power, privilege and structural inequality. While there are increasing calls for recognition and awareness, material change requires addressing the systemic forces – racism, capitalism, patriarchy, ableism – that determine who is most at risk, who receives adequate care, and whose experiences are counted.
This is why the Feminist Miscarriage Project is calling for a renewed feminist research and activism agenda that fully incorporates miscarriage within the wider movement for Reproductive Justice (RJ). Developed by Black feminists and women of colour in the 1990s, RJ is grounded in three core principles: the right to have children, the right not to have children, and the right to parent children in safe and healthy environments. Although miscarriage and stillbirth weren’t explicitly named in the original RJ framework, the philosophy behind RJ provides a crucial foundation for including them. As RJ advocates like Loretta Ross argue, abortion doesn’t stand alone – it must be understood within the full scope of reproductive experiences, which includes miscarriage and stillbirth as well as live birth and parenting.
This ‘full-spectrum’ approach goes further than demonstrating that advocating for both miscarriage and abortion is a consistent position to take. Rather, it insists that support for one kind of pregnancy ending requires support for all others. Legal scholar Sheelagh McGuinness underscores this point, explaining that it’s not always straightforward to distinguish between induced and spontaneous pregnancy endings, and so in contexts where abortion is criminalised, suspicion is cast ‘across the piste’, leading to invasive scrutiny and criminal investigations of miscarriages and stillbirths as well as abortions. In West Virginia in the US, a state with a total abortion ban, a prosecutor has even suggested that people report miscarriages to law enforcement pre-emptively to stave off potential investigation.
Such cases demonstrate how closely linked pregnancy outcomes are, and why solidarity across pregnancy’s many possible endings is essential. Full social support and acceptance for miscarriage can’t be achieved until abortion too, in all its forms, is supported and accepted. But RJ isn’t only about fighting for legal rights and decriminalisation, as rights can’t be exercised where there’s no meaningful access to vital support systems. The RJ approach therefore directs our attention to broader socioeconomic structures, demanding that all people are enabled to access reproductive services and care as well as basic necessities such as nutritious food and clean water. This structural approach is grounded in an understanding of intersectionality drawn from the Black feminist tradition of scholars and activists – such as the Combahee River Collective – who have shown how gendered, sexualised, and racialised systems of domination combine to produce inequality at all levels of capitalist societies. Recent studies, for example, indicate that factors like night shift work, air pollution, and job loss can all increase the risk of miscarriage.
The RJ approach, therefore, is about seeing miscarriage not just in terms of social taboos and individual experiences, but also in terms of the socioeconomic inequalities and injustices that shape them. Moreover, it means connecting the local to the global, as miscarriage is affected not only by domestic politics but also by geopolitical relations and conditions. In Gaza, for example, healthcare workers have reported a huge rise in miscarriage under the Israeli government’s blockade, bombardment and attacks on healthcare facilities. As the collective statement ‘Resistance is Fertile: No reproductive justice without freedom for Palestine’ makes clear, occupation, invasion, and genocide are clearly ‘in direct violation of reproductive justice and should therefore be a matter of concern for all advocates for reproductive justice, health, and freedom’.
So as we build a renewed liberatory agenda for miscarriage research and activism, we need to be asking how we can connect up with broader struggles for truly universal care systems, situating miscarriage within broader national and international political contexts and understanding it as part of a complex web of reproductive experiences, each shaped by power, inequality, and resistance.
On the complexity and diversity of miscarriage experiences
When my first pregnancy ended in miscarriage at 13 weeks, I was devastated. Over the years – and after experiencing two more pregnancy endings – I came to understand what anthropologist Linda Layne meant when she described the ‘taboos and silences’ surrounding miscarriage in her 1997 article ‘Breaking the Silence: An Agenda for a Feminist Discourse of Pregnancy Loss.’ Nearly 30 years later, much has changed. Miscarriage is no longer hidden from public view. Celebrities now openly share their experiences, and events like Baby Loss Awareness week have helped bring the topic into the spotlight.
However, as the silence has faded, it’s been replaced by certain dominant narratives. For the past 15 years, I’ve followed Layne’s lead by conducting anthropological research on miscarriage. During this time, I’ve seen a shift in how miscarriage is treated in both medical and non-medical settings. In the past, it was often seen as an unfortunate but routine event, something women were expected to recover from quickly. After my own miscarriages, I received no aftercare – I went straight back to work, and there was little or no recognition of any potential physical or emotional effects.
Thankfully, things have improved. Today, there’s more empathy in how miscarriage is handled. In my recent research, I’ve observed healthcare providers regularly giving women information about specialist counsellors they can contact. This kind of dedicated support shows a change in how miscarriage is understood – there is more recognition of its potential impact. Such changes are supported by recent UK government initiatives, which reflect the broader societal move to emphasise the seriousness of miscarriage. Last year, the UK government launched the Baby loss certificate scheme so that people could receive official recognition, and more recently, it announced that people who experience pregnancy loss before 24 weeks will have the legal right to bereavement leave.
I must note, though, that these initiatives typically don’t come with real material change such as paid leave for those experiencing early pregnancy endings. While I welcome increased support, I’ve also noticed a new problem, as these initiatives demonstrate: miscarriage is now framed as the loss of a baby, and the assumed emotional response is grief or bereavement. For some people, this is welcome and resonates with their feelings of loss. Yet for others, this framing doesn’t reflect their experience. As a result, they may feel out of step with the dominant narrative and with the care that is offered.
My most recent research into the ‘remains and remnants’ of miscarriage, broadly conceived, has included an exploration of how the physical remains of miscarriage are handled. This work has revealed that bereavement narratives and memorial practices promoted by charities and other groups play a dominant role in shaping public understandings and inform clinical care of miscarriage in England. Hospital practices around what happens to pregnancy tissue, however, can be inconsistent and contradictory with disposal practices producing foetal personhood. Most hospitals offer ceremonial disposal, such as cremation or burial, which reinforces the idea that a baby has died. But these same institutions may also use processes that don’t support that framing.
I’ve argued that structuring miscarriage care around the assumption of grief can be problematic. It doesn’t consider the complexity and diversity of lived experience. When hospitals focus on ceremonial disposal without offering real choices, this approach isn’t inclusive. Many of the women I spoke to did experience grief after miscarriage, but not all did. And that matters – because in focusing so heavily on grief and memorialisation, current care models risk making those who don’t feel that way think there is something wrong with them. Some women end up feeling alienated or abnormal when their response doesn’t match the expected one.
I’ve seen firsthand how current clinical practices can offer real comfort to those who experience miscarriage as the loss of their baby. Using the term ‘baby’, providing counselling, and offering options like burial, cremation, or memorials can be deeply meaningful for people in grief. But not everyone relates to their miscarriage in this way. Some people – even those who feel grief – find ceremonial practices like funerals or burial unsettling. They don’t necessarily see the biological remains as central to their loss. Others feel sadness, frustration, or disappointment, but not grief. And some feel relief. One woman I spoke to had planned to terminate her pregnancy, and her miscarriage meant she didn’t have to go through with an abortion with conflicted feelings. What my research consistently shows is that there is no single way to feel after a miscarriage. One woman, firmly committed to ending her pregnancy, was shocked by her unexpected grief after miscarrying before her appointment for an abortion. Another, who had an abortion, was devastated – and went on to mourn and memorialise the loss of her baby.
These stories reveal a crucial truth: when care systems assume a ‘right’ or ‘normal’ emotional response to miscarriage or abortion, they risk excluding and even harming those who don’t fit the mould. Miscarriage care needs to be more flexible, more inclusive, and more responsive to the wide range of experiences people have – not just the ones we expect them to have.
The Feminist Miscarriage Project was born out of real people’s stories – like those described above – that reveal just how blurry the boundaries can be between miscarriage, abortion, and other forms of pregnancy endings. These categories, while useful in some contexts, often fail to reflect the complexity of lived experiences. One of our central goals is to challenge and rethink these fixed labels, and to explore how care, advocacy, and academic work on pregnancy endings might be more connected, inclusive and responsive to diversity.
Take the National Bereavement Care Pathway for example: it’s a national programme designed to guide healthcare providers in delivering compassionate, consistent care to those who experience pregnancy loss. While this kind of support is essential for those who are grieving, it must be accessible to all who experience pregnancy endings – no matter the stage of gestation or the circumstances of the end of the pregnancy. Counselling and sensitive hospital services like cremation can bring real comfort to those who need them. But my research has shown that when healthcare assumes every miscarriage is a bereavement, it can do more harm than good. Many women I spoke to didn’t relate to this model of care. Some even experienced distress when faced with language or practices that presumed grief or treated their pregnancy as the loss of a baby.
As Vic wrote in her first blog post, ‘the contemporary challenge is less about “breaking the silence”, and more about making feminist interventions into how miscarriage is spoken of – by complicating, challenging, and adding to the narratives already circulating.’ That’s exactly what The Feminist Miscarriage Project is working to do: to broaden the conversation, to include a diversity of voices and experiences, challenge dominant assumptions, and to ensure that every experience of pregnancy ending – whether marked by grief, relief, or something else entirely – is considered and respected.