Mental Health,Family,and Work-Life Consequences of Pregnancy Loss: A Qualitative Study of Black Canadian Women

Abstract

Pregnancy loss is a traumatic event that has far-reaching consequences for affected women and their families. While most studies have focused on the immediate stressors Black women face after a pregnancy loss, little is known about the consequences beyond this period. The purpose of this study was to explore the experiences of Black Canadian women beyond the immediate period of pregnancy loss. Using an exploratory qualitative design, we purposely recruited and interviewed 32 Black Canadian women with lived experience of pregnancy loss. Guided by thematic analysis approach, we identified three themes: (a) experiencing mental health breakdown, (b) struggling to maintain emotional connection with family, and (c) dealing with the stress of returning to work. The findings provide a comprehensive understanding of the long-term impact of pregnancy loss on Black Canadian women's mental health, family, and work-life. Providing ongoing follow-up care is crucial to identifying and addressing the risk of depression and suicide that Black Canadian women experience after a pregnancy loss.

Introduction

Pregnancy loss is a deeply traumatic experience that is associated with a wide range of mental health issues in the immediate and long-term period (Cuenca, 2023; Sun et al., 2023). The loss of a pregnancy goes beyond the physical demise of an expected child to encompass the end of dreams, hopes, and aspirations of becoming a mother (Bailey et al., 2019; Kirui & Lister, 2021). Regardless of the stage of the pregnancy loss, the individual grapples with intense grief, sadness, agony, hopelessness, and a deep sense of loss. These complex reactions to pregnancy loss, if not managed well, can have a long-term impact on the mental health and well-being of women, including an increased risk of depression, anxiety, and post-traumatic stress disorder (PTSD) (Cuenca, 2023; Mainali et al., 2023; Westby et al., 2021).

Studies have consistently demonstrated that depression is a common outcome among women who have experienced pregnancy loss (Mergl et al., 2024; Nynas et al., 2015; Westby et al., 2021). A study among Black participants who experienced pregnancy loss reported a 57% increased risk of depression compared to non-Black cohorts (Shorter et al., 2021). Pregnancy loss is accompanied by a perceived sense of failure, guilt, and shame. These experiences along with feelings of isolation and lack of support have been found to exacerbate depressive symptoms (Lewkowitz et al., 2022; Nynas et al., 2015). The experience of depression after a pregnancy loss is further complicated by silence and stigma which in turn contributes to a lack of open discussion and limited access to social support (Bellhouse et al., 2018; Pollock et al. 2021). Furthermore, the sudden and traumatic nature of pregnancy loss, combined with the birthing process and associated medical interventions, have been linked to intense psychological reactions consistent with symptoms of PTSD (Abiola et al., 2022; Krosch & Shakespeare-Finch 2017; Kuhlmann et al., 2023; Kukulskienė & Žemaitienė, 2022a, 2022b). The trauma accompanying a pregnancy loss can also induce a state of hyperarousal leaving many individuals in a constant state of alertness and nervousness (Abiola et al., 2022; Mergl et al., 2024), which may negatively affect their quality of life.

Navigating pregnancy loss can have a profound impact on marital and family relations (Delgado et al., 2023; Gold et al., 2010; Human et al., 2014). Coping with the emotional and physical strain of pregnancy loss, along with the perceived lack of support and understanding, contributes to tension and conflict between affected women and their partners (McDonald et al., 2022; Swanson et al., 2003). The differences in grief response between women and their partners can lead to misunderstanding, as each person process and cope with the loss in their own way, often leaving women feeling unsupported (McDonald et al., 2022). This, combined with the emotional strain and grief, can result in withdrawal and breakdown in communication, further reducing social support from partners and family members.

Following pregnancy loss, women grapple with intense grief that affects their level of concentration and engagement in work-related activities ultimately impacting on their productivity and performance levels (Beaudry & Gagnon, 2013; Donaghy et al., 2024; Gilbert et al., 2023; Maitlis & Petriglieri, 2019). In the absence of workplace support and accommodation, women face undue pressure to return to work and perform as expected, thus, hindering their ability to fully process the grief and heal from the loss (Donaghy et al., 2024; Maitlis & Petriglieri, 2019). Additionally, the workplace may trigger memories of the loss, as fellow employees and employers who cannot fully comprehend the gravity of the loss or engage in sensitive conversations may make dismissive or hurtful comments further exacerbating the emotional distress of affected women. Besides these work-related issues, there may be socio-economic consequences for women who choose to leave their jobs when they deem the workplace to be unsupportive.

In Canada, there is insufficient understanding of the long-term impact of pregnancy loss on Black women beyond the immediate aftermath. This lack of insight may underestimate the full impact of pregnancy loss among Black Canadian women. Identifying these long-term consequences of pregnancy loss is crucial for implementing programs and policies to support the mental health of affected women. Therefore, this study aims to address these gaps by exploring the experiences of Black Canadian women beyond the immediate period of pregnancy loss. The findings of this research are critical for informing and mobilizing resources needed to provide comprehensive and ongoing support at the health system and workplace levels to address the needs of Black Canadian women affected by pregnancy loss.

Methods

This article constitutes part of a larger exploratory qualitative study investigating the experiences of Black Canadian women following a pregnancy loss. A total of 32 participants who identified as Black and had experienced either miscarriage, stillbirth, or neonatal death were recruited from across the Greater Toronto Area. We shared the recruitment flier via Black community groups, associations, and organizations. Participants who expressed interest and contacted the research team were provided with a copy of the informed consent form to review and decide if they wanted to participate. The informed consent form was shared with the participants about a week before the interviews were scheduled to ensure they had ample time to ask for clarification. Once a participant completed and returned the signed informed consent form, an interview was scheduled at a time that was convenient for them. We approached the interviews with sensitivity as we were conscious of the distressful and provocative nature of the topic. We intentionally started with less triggering questions before delving into the deeper aspect of their experience. PB and NP conducted the interviews on Zoom while OA and DM wrote notes. After the interview, each participant was given a $50 honorarium as a token of appreciation. Of the 32 participants interviewed, 78.1% were married and 67% were employed. More than half of the participants earn less than CAD 50,000. Approximately 53% had a miscarriage, 40.6% had a stillbirth, and 6.3% had a neonatal death.

Thematic analysis was used to organize the data into meaningful themes (Braun & Clarke, 2021). We started by familiarizing ourselves with the data by reading and re-reading the transcripts to gain deeper insight into the data. PB and NP, with the assistance of OA and DM, identified and coded key statements that were significant to our research questions. Similar codes that reflected patterns in the data were grouped to generate meaningful themes. The research team refined and reviewed the themes in relation to the data to ensure they were accurately reflective of the participants’ experiences. The themes were defined and named to highlight their essence and meaning. Each theme was supported with quotes to illustrate their meaning. The analysis was managed with NVivo R1/2020. During the analysis, we kept an audit trail of the analytic processes and reflexively discussed our preconceptions openly during our research team meetings.

Ethical Consideration

Following approval by the Toronto Metropolitan University Research Ethics Board (Reference number 2023-374), each participant provided written informed consent. Considering the distress-provoking nature of the phenomenon being researched, the participants were given ample time to review the consent form and decide whether they were willing to participate and share their experiences. At the time of the interviews, participants were reminded of their right to discontinue if they were emotionally distressed. Prior to the interview, each participant received an electronic brochure containing institutions that provide free counseling. During each interview, we checked on participants to ensure they were not experiencing emotional distress. The interviews were audio recorded and transcribed into text. All transcripts were de-identified of personal information and stored securely on a Google Drive license by Toronto Metropolitan University.

Findings

Three overarching themes were generated: (a) experiencing mental health breakdown, (b) struggling to maintain an emotional connection with family, and (c) dealing with the stress of returning to work. The themes are discussed along with supporting quotes to highlight their essence.

Experiencing Mental Health Breakdown

Enduring the Emotional Agony

Participants described the abrupt interruption of their pregnancy was accompanied by complex emotions and mental anguish as the reality of the loss became apparent. The intensity of this emotional pain was triggered by incomprehensible thoughts of the loss.

I mean immediately after her death; no number of words can describe the pain that I felt after the stillbirth. I don't know if I can put it into words, it is the worst type of pain, the type of pain you no one wants to experience. It was the worst pain knowing that my baby girl was gone, and I cannot take her home. I'm going to leave her alone by herself. It was really, really painful. [Participant 21]

In the aftermath, the participants described feeling emotionally drained as the reality and weight of the loss took its toll on them. Many participants described enduring very intense emotional agony beyond their coping, which left them feeling mentally depleted.

I would say apart from the physical pain that I felt there was also this emotional pain that I would say is even more. The emotional pain is much more…I was mentally exhausted…So the emotional pain was more than the physical pain I felt when they were removing the baby. I always felt there was this pain in my heart in my chest that I could just not explain. I had so much emotional pain. [Participant 19]

The thought of leaving the hospital empty-handed without a baby became a constant agony and a reminder of the hope and dreams of a future they had planned. For many participants, the hospital initially fostered a sense of hope and anticipation of welcoming their baby. Several participants felt their agony intensified when they witnessed other mothers interacting with their babies and from seeing the items they had acquired in preparation for their babies.

Leaving the hospital without my baby was the difficult and agonizing experience for me because I saw other mothers in the maternity room with their babies, I heard babies crying and their mum consoling them and I had to leave without my own baby, it was really difficult for me and till this moment it still traumatizes me. We actually made preparation to welcome my baby, we set the room for my baby, and the little crib was actually designed, decorated and a lot of things. Seeing those things broke my heart and it was really painful. [Participant 8]

For these participants, the baby items were not only a reminder of the loss, but also symbolized the unfulfilled dreams and aspirations of becoming a parent. Returning home without a baby was filled with a deep sense of yearning and sorrow as indicated by one participant who said “coming back home without the baby that I started bonding with while it was still in the womb was painful…I felt a lot of sadness and sorrow. [Participant 29]. Another participant also stated “it was so painful because we had already prepared for the future, I already imagined the future with my child and getting home without the child was agonizing” [Participant 26]. For several of the participants, pregnancy loss represents a broken dream and a future they had envisioned.

Grappling With Intense Grief

Participants described an overwhelming sense of grief as they grappled with pregnancy loss. In recounting her experience after the loss one participant said: “I was really overwhelmed with grief after the loss of my baby. I found myself in deep sadness that made it difficult for me to engage with people or do anything” [Participant 8]. Further, participant 8 poignantly described the nature of the grief she experienced.

The grief was really raw and overwhelming for me. Because I find myself wrestling with really intense grief and emotions, from sadness to despair to anger and disbelief that I actually lost my baby…I felt a very raw grief and pain that actually drove me mentally insane. [Participant 8]

Similarly, other participants felt a profound sense of grief that was accompanied by intense feeling of sadness, sorrow, and anger. To minimize the overwhelming impact of this grief and as a coping mechanism, one participant narrated how she had to conceal her loss and grief when she said: “it was like let me pretend it did not exist, even though the pain and grief was crushing me. I was buried in my own grief. It was not really easy for me” [Participant 13]. Participants also shared that the grief surrounding pregnancy loss was often invisible, unnoticed, and misunderstood by family members.

Other family members didn’t understand. They would say you didn’t have it, you didn’t feel it, you didn’t hold it, they could not comprehend what I was going through, and they didn’t really understand why it really took a long time to grief and why I was so sad, bitter and hysterical. [Participant 19]

Some participants expressed how family members perceived grieving after pregnancy loss as unnecessary or inappropriate because they did not have any physical interaction with the baby. As a result, many had to grieve in silence or suppress their grief. For many of the participants, pregnancy loss “is something that a lot of people could not understand or relate to” [Participant 24] and therefore “so many Black women will not grieve to the fullest because of the belief that they are Black, and they’re not supposed to show weakness” [Participant 22]. Participants felt that the expectation to show strength by suppressing or concealing their grief disenfranchised them and made their grief “felt heavy and complicated” [Participant 24].

Struggling With Depressive Symptoms

The loss of a pregnancy was accompanied by profound sadness and despair. Participants described how experiencing pregnancy loss triggered intense and complex emotions that impacted their mental health and well-being, as expressed in one woman's statement: “it has really made me feel depressed. I have been depressed. I was mentally down” [Participant 20]. Another participant also recounted the intense emotion she experienced after her pregnancy loss left her feeling emotionally wounded and depressed.

I became depressed at some point. So, the whole process of going through the loss really, really messed with my mental health. It really put me in a different state of mind I never thought was possible…because the loss scorches your mental health. [Participant 21]

More than half of the participants reported feeling depressed as they grappled with the overwhelming impact of the loss. Participants felt the depressive symptoms interfered with their ability to engage in everyday activities, including eating and sleeping, which in turn affected their physical health.

I was moody. I had a lot of mood swings, it affected my well-being also in the sense that I couldn’t eat well, I couldn’t sleep well. I looked so malnourished. My mental health was crashing…it was a terrible experience. [Participant 22]

I could not do things for myself. I lost my appetite; I could not eat and do things that I used to do. I was always crying, and my health was actually going down because I actually lost weight. [Participant 12]

The lack of support further intensified these symptoms and made it difficult for women to cope and heal after pregnancy loss.

Experiencing Post-Traumatic Stress Symptoms

Participants indicated that the traumatic nature of pregnancy loss affected their overall mental health and well-being. For participants who experienced stillbirth, the laboring process and the interventions required to remove the deceased baby were extremely traumatizing. One participant shared the trauma she experienced below.

I was very traumatized when I saw the body parts coming out. You know that it is something you can't heal from. You’re just seeing the baby's head, legs. It was traumatizing for me and affected my ability to heal properly. I went through some series of panic attacks and anxiety thinking about that very day…it has really affected me in a way that I can't really explain. I rarely sleep at night because of the trauma, leading to me having a series of nightmares. I have this series of panic attacks and anxiety. Sometimes when I’m just stressed, I get panic attacks and anxiety most of the time and I could not actually go about my normal way of life… I had feelings and anxiety, which became a constant combat company of mine. [Participant 8]

Other women also recounted similar experiences with one participant describing it as a “living nightmare that had come to reality because I was like a ghost in my house” [Participant 30]. The trauma following pregnancy loss inflicted on participants deep and lasting emotional wounds.

People often think of trauma as something that just really happens to some people, but people don’t really see the trauma that is associated with pregnancy losses. The trauma, the embodiment of that trauma and how you carry it has a long-term impact. It is an experience you will never forget because it's like part of you has been bruised for life. [Participant 32]

The trauma, although unacknowledged, is an experience many have embodied long after the pregnancy loss has occurred.

Contemplating Suicide

Pregnancy loss triggered an existential crisis as participants struggled to make sense of the loss. For many of the participants, the intense grief they experienced after pregnancy loss overshadowed any effort to move forward. Some participants described contemplating suicide as the burden of sorrow became unbearable to overcome.

I had contemplated suicide a couple of times…I was emotionally exhausted and mentally tired… I tried to inflict pain on myself just to distract me from reality. I thought the other side would be better if I took my life. It got bad for me, because I felt like if I’m dead I could see my child…So at some point, I really wanted to take my life. [Participant 21]

I was on edge at some point, and I felt like someone who wanted to jump off the cliff. At that point I wanted to take my life. I wanted to overdose and die, I actually planned on doing so but my friend said that will not let the child come back… I tried to cut myself and I did it once. [Participant 30]

The intense sorrow made it difficult for participants to envision a future beyond the grief they were enduring. Coping with pregnancy loss can be emotionally exhausting in the face of lack of support, understanding, and acknowledgement of the loss. Such experiences left many trapped in a cycle of trauma and grief.

I felt I was going through a lot because you remain alone and people who were supposed to be your support systems don’t seem to care about you …I had some weird thoughts especially during the stillbirth, I had some suicidal thoughts because I could not deal with the pain anymore. I really felt very bad about what happened. [Participant 15]

Without an outlet for relief or support from family and healthcare providers, participants became isolated, which in turn, intensified their sorrow and led some to consider taking their lives. For many of the participants, “pregnancy loss is something that should not be taken lightly and women who have lost a child need to be taken care of and should be offered the mental health support they need” [Participant 3]. This should include “access to affordable therapy sessions that we don't really need to pay for because it can be costly” [Participant 7]. More than half of the participants felt promoting access to mental health support is essential to overcoming the long-term complex emotions they had experienced.

I feel there needs to be long term support for Black women who have experienced pregnancy loss. Because I feel that people who experience stillbirth especially have difficulty healing from the things that happened. I feel there needs to be long-term and ongoing support for Black women that extends beyond the immediate aftermath of the pregnancy loss. This will help these women navigate their grief process as time goes on. [Participant 8]

Struggling to Maintain Emotional Connection With Family

Participants described pregnancy loss exerted an enormous strain on their marital and family relationships in profound ways. Processing the ensuing emotional turmoil and grief in the aftermath of pregnancy loss can be an isolating experience and may contribute to emotional withdrawal and disconnection. In sharing her experience of how pregnancy loss affected her relationship with her partner, one participant said:

At some point, it really affected my marriage because everything was overwhelming. I was stressed with the loss…So I was really pushing him [husband] away…I really felt overwhelmed at some point. I felt like it was drawing us apart and far away. [Participant 15]

Participants described the stress of coping with the loss and the emotional turmoil affected their ability to maintain emotional connection and led them to distance themselves away from their partners. For some of the women, in addition to dealing with the agony of the loss, their partners blamed them for contributing to the loss. Some participants described how this led to feelings of abandonment and threatened their marital relationship.

When I got home after my stillbirth my husband started throwing tantrums and tried to put everything on me. So I asked him to leave the house, which I thought was the best thing I did at that time because he literally pretended I wasn’t in the house…I almost got divorce because I couldn’t really see the need for the relationship because if you’re not there for me what's the essence of the marriage. [Participant 21]

Other participants felt that rather than being their source of support and comfort, the attitude of their partners hindered their ability to effectively share their feelings and receive support. Some participants also described experiencing challenges caring for surviving younger children.

After the loss, I still needed to be a mother and a wife even though I was really grieving, and in pain from the loss…but I stopped attending my children's games and other school activities. I really stopped putting a lot of effort into making them look good. And I really didn’t pay much attention to their day-to-day life the way I used to, and they noticed, and they started having conversations with me. Somehow your own child is trying to give you a call that mom something is not right. You’re not behaving the way you used to be. You don’t care about us anymore. Something is wrong. What is it, talk to us that for me was a wake-up call. [Participant 13]

Participants described how dealing with the pain, grief, and sorrow following a pregnancy loss contributed to their inability to emotionally connect and engage with their children which in turn made it difficult to remain responsive to the day-to-day needs of their children. Some also described experiencing relationship strain with family members as indicated by one participant: “it has brought so many problems in my family, my relationship with my extended family…it has caused a lot of strain in my relationship with my mom” [Participant 21]. Other participants called for a comprehensive approach to address the psychosocial and family reintegration challenges.

The health system needs to show concern and care because even if the health care system provides immediate support, there also needs to be follow up to see if women have gotten back the respect and regard from their families and loved ones. Because if there is no follow up by the healthcare system to check how women are doing or if they are not being treated well, then this person will literally bounce back into sadness and depressive state. As you know not everyone is lucky to have their husbands who will stand firm for them and a lot of women lose their marriages, their loved ones, friends, and people because of the experience. So, I’ll say ongoing support, not just a one time follow up. [Participant 22]

Dealing With the Stress of Returning to Work

Participants described experiencing pregnancy loss had a profound impact on their work life. The intense grief and mental health challenges hindered their ability to focus and function within their workplace. For many of the participants, the grief affected their concentration and made it difficult to complete their assigned duties, affecting their productivity at work.

The grief really affected me at work because my level of concentration was not high. I felt like I was at work but not actually at work. My concentration level was really low, so it affected my productivity at the workplace. [Participant 15]

Some participants felt the emotional turmoil they experienced made it impossible for them to return to work as they needed the space and time to process their grief and heal.

I didn’t resume work immediately. I needed to heal, and it takes time to heal from something like that…Even when I started, I wasn’t really able to focus most of the time. And some people at work understood what I was going through while others really expected me to put in the same amount of energy I used to when I was not pregnant, but I wasn’t really able to perform very well at work and so I had to stay away. [Participant 20]

Other participants described the lack of understanding regarding their emotional struggles, and the pressure to maintain the same level of job performance left them with no option but to leave their employment.

I actually had to quit the job after I started because I just wasn’t getting enough, and I didn’t want my absence to cost them so I just said I wouldn’t be able to work. And they said they could give me some time, but I said I did not know how long it would take…So it is better I just take my mind off everything. Because if I have to wait, I might have to rush my recovery and not take time to recover. So, I quit the job at that time. [Participant 4]

For those who returned, many described having to deal with stress from colleagues whose well-meaning statements or comments, yet awkward, made them more sorrowful and inadvertently caused them distress.

Going back to work was really a stressful experience for me. Everybody was like I’m sorry, I’m really sorry. So, the sorry's were very, very stressful…You find some stuff you’re assigned to, and some colleagues will feel like “no she's healing, let her heal” I feel at some point they made me more sorrowful. [Participant 17]

Another participant who could not withstand the stress said: “I literally resigned and stayed at home… because I was scared of people at my workplace asking me oh what is wrong, where's your baby?” [Participant 21]. The fear of dealing with unintentional but hurtful questions made the workplace unwelcoming for the participants. However, not all participants could leave their job due to financial constraints. One participant said: “my work was the only source of income, so I strive to work. It was tough, but I still had to work” [Participant 2]. Some participants expressed the need for workplace systems that support women’s transition to work without pressure.

So many women go through loss… people will just keep going to work because they’re not going to talk about it and no workplace support…people feel like they don’t have a choice, they just go to work after miscarrying their baby. I mean it just doesn’t seem right. We need systems in place, so people don’t feel they have to go back to work. [Participant 24]

Discussion

This study explored the experiences of Black Canadian women beyond the immediate period of pregnancy loss. Our findings contribute to broadening the understanding of both the mental and work impact of pregnancy loss on Black Canadian women. Consistent with previous studies (Antilla & Johnson, 2024; Evans et al., 2022; Jones et al., 2021), Black Canadian women's grieving process and their response to the loss were deeply influenced by cultural expectations and widely held beliefs about their ability to endure pain. The expectation to show strength, a characteristic of the strong Black woman trope, contributed to participants in our study suppressing their grief. Previous studies have reported that the obligation to show strength in the face of adversity has direct consequences on the physical and mental health of Black women (Abrams et al., 2019). Our findings revealed that this expectation to show strength led to disenfranchised grief and complicated the grieving process. Women also felt their families were unable to comprehend the extent of their grief, which consequently contributed to the lack of acknowledgement and validation of their experience. Additionally, the lack of open discussion about pregnancy loss hindered access to support from family and friends and exacerbated the mental health vulnerabilities of Black women.

Pregnancy loss triggered intense feelings of sorrow, sadness, and hopelessness. When these emotions prolong and intensify in the face of an overwhelming lack of support, it heightens the risk of depression for Black Canadian women. Women in our study reported symptoms of depression that were consistent with those identified in previous research (Nynas et al., 2015). Depressive symptoms, including mood swings, loss of interest, decreased appetite, and insomnia affected the ability of Black Canadian women to function and engage in activities they once enjoyed. Black Canadian women also reported experiencing flashback, panic attack, nightmare, and anxiety. A study found that women who experienced late pregnancy loss were at an increased risk of exhibiting PTSD symptoms (Abiola et al., 2022). In our study, Black Canadian women embody the trauma of pregnancy loss, which they felt was invisible and overlooked by others. Literature on pregnancy loss shows that the embodiment of trauma is expressed through a wide range of reactions including being hypervigilant in the absence of threat to subsequent pregnancies, obsessive and repetitive thoughts, perceived sense of bodily failure, low self-esteem, and identity betrayal (Garrod & Pascal, 2019; Kukulskienė & Žemaitienė, 2022a, 2022b). These authors further argued that such experiences influence and shape how affected women make sense of their present and future reproductive health decisions. As a result of these mental toll, the findings of our study showed that pregnancy loss was associated with a higher risk of suicidal tendencies. This is supported by an earlier study that found an increased risk of suicide among women who experience stillbirth, miscarriage, or termination of pregnancy within the first year (Weng et al., 2018). This finding highlights the importance of screening for suicide to identify and intervene among those at risk.

Our study revealed that women felt emotionally detached from their partners as they attempted to cope and make sense of their loss. Prior researchers have indicated that the weight of grief and the stress of dealing with the loss affects women's ability to remain emotionally engaged with their partners (McDonald et al., 2022). Women in our study reported their relationship was further strained when their partner blamed them for contributing to the loss. This lack of support from partners compounded their feelings of isolation and abandonment. Pregnancy loss also impacted on how Black Canadian interacted, engaged, and cared for their living children. The grief and stress affected the responsiveness of Black Canadian women to the physical and emotional needs of their children resulting in feelings of neglect.

The long-term impact of grief and the ensuing mental crisis interfered with the ability of Black Canadian women to fulfill their work-related responsibilities. Unlike giving birth to a live baby, women who experience pregnancy loss are expected to return to work within a limited period. As a result, many are unable to fully process the unfolding grief. Additionally, the lack of understanding, empathy, and support from the workplace coupled with the need to suppress their grief and maintain professional composure, have been found to compromise women's ability to engage fully with their work (Cavalo & Rodriguez, 2024; Donaghy et al., 2024). Women in our study described being pressured by colleagues to engage in work-related assignments with the same level of energy as before with no consideration given to their situation. Other studies have reported that there is a pervasive culture of silence around pregnancy loss in the workplace that contributes to women feeling hesitant to share their feelings and to request for workplace accommodation (Dimoff, 2021). Such experiences deemed the workplace hostile and led to feelings of alienation and the decision to leave their job. However, for those whose current work was their ‘only source of income,’ the financial cost of staying away from their job can be consequential. Black women working in low-paying jobs with no job security or workplace support may feel pressure to keep working to sustain their income. This may be unsustainable as the pressure to function in the face of an overwhelming lack of workplace support may contribute to stress and burnout, further affecting their productivity at work and threatening their job security.

Implications and Recommendations

Given the profound impact of pregnancy loss on the mental health of affected women, providing comprehensive access to ongoing professional therapy and counseling is necessary to help Black women manage the emotional turmoil; identify effective coping strategies to deal with the grief; and reduce the risk of depression, PTSD, and suicidal thoughts. We recommend integrating mental health support into existing provincial health coverage to address existing inequities and offer access to culturally concordant therapy regardless of insurance coverage or socio-economic status. Creating awareness campaign and education about pregnancy loss will help community members understand and acknowledge the significance of the loss and grief and facilitate open conversation and dialogue. This will ensure a platform is created to support and empower women to discuss their experiences openly without feeling the need to suppress them. Promoting a workplace culture supportive of Black women is critical to facilitate coping and healing. Additionally, providing training to employees on how to initiate conversation around pregnancy loss with empathy and sensitivity along with instituting workplace accommodation will help to reduce the pressure and stress women endure when transitioning back to work.

Strength and Limitations

To the best of our knowledge, this is the first qualitative study in Canada to provide valuable insight into the mental health, family, and work-life impact of pregnancy loss among Black women. This study was conducted in Canada with different social and healthcare contexts, which may influence the generalizability of the findings to other settings. Future research must examine the extent and prevalence of mental health issues among this population to inform and support the development of interventions to address thier needs. Additionally, it is imperative to investigate the economic impact of pregnancy loss on women who choose to leave their jobs.

Conclusion

The aftermath of pregnancy loss has far-reaching consequences for the mental health and well-being of Black women. The absence of follow-up care, access to affordable therapy, and workplace support have an impact on Black women's journey toward healing and recovery. Implementing comprehensive, affordable, and culturally congruent mental health and workplace support programs is crucial to meeting the needs of Black women after a pregnancy loss.