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.