Abstract
Public discussions of miscarriage in the UK frequently describe it as a stigmatised phenomenon that is ‘shrouded in silence’. And in turn, ‘breaking the silence’ is presented as the means of defeating the stigma. In this article, however, I argue that it is time to abandon the ‘breaking the silence’ frame. This is not only because it overstates the public silence it condemns, but also because it is rooted in an inadequate understanding of stigma, which keeps us stuck in a cycle of talking more, rather than doing more, about miscarriage, and failing to connect miscarriage as a feminist issue with wider struggles for social justice. Drawing on critical sociologies of stigma developed by Imogen Tyler and others, I propose a paradigm shift: from a narrow liberal understanding of miscarriage stigma as a problem of social norms that can be alleviated through ‘breaking the silence’ and ‘awareness raising’, to a critical ‘stigma power’ approach which understands miscarriage stigma as a ‘machinery of inequality’ that fulfils a core function for patriarchal, racialised, neoliberal capitalist power structures, and hence requires transformative socioeconomic solutions. To this end, I call for a new research and activism agenda that fully incorporates miscarriage within the wider movement for Reproductive Justice.
Keywords
Introduction
The terms ‘silence’, ‘stigma’ and ‘taboo’ are ubiquitous across discourses of miscarriage in the UK. Miscarriage is consistently said to be ‘shrouded in silence’, and public conversations about miscarriage are framed as ‘breaking the silence’, taboo or stigma in return. Over the past few years, however, there has been more and more coverage of miscarriage in the public arena, with ‘celebrity miscarriage stories’ and ‘listicles’ becoming something of a genre (Garrard, 2020; Hamilton, 2020; Mitrokostas and Edmonds, 2021). Just this week as I write, for example, Nicola Sturgeon (former leader of the Scottish National Party) has appeared on the ITV show Loose Women and discussed a personal experience of miscarriage, which all major UK newspapers across the political spectrum have reported, from the Guardian (2023) to the Daily Mail (Heffer, 2023).
As a topic for public discussion, then, miscarriage arguably cannot be categorised as strictly ‘taboo’ any longer – in the literal sense of being ‘forbidden’ or publicly ‘unspeakable’ – as the silence surrounding it is being broken on a fairly regular basis. 1 The ‘breaking the silence’ frame itself, however, is showing no sign of fading into obsolescence. New books or articles about miscarriage, for example, are still consistently presented as ‘speaking out’ against a backdrop of silence or embarking on unchartered territory; and ‘Let’s break the silence’ remains the slogan of the UK’s Baby Loss Awareness Week (https://babyloss-awareness.org), 2 over twenty years after it was first launched. So how do we make sense of this situation, where we are now talking so much more about miscarriage, yet continue to say that miscarriage is something that we don’t talk about?
Health writer Jennie Agg suggests that the ‘breaking the silence/taboo’ trope retains its resonance because there is a ‘gulf between the public conversation around miscarriage and the private, lived experience that doesn’t seem to have narrowed’, regardless of how many articles, books or podcasts now exist (2023: 13). That is, although there may be an ‘illusion’ of greater openness brought about by the increased media coverage, silences and awkwardness continue to proliferate at the level of everyday interpersonal interactions, such that many people still experience miscarriage as profoundly isolating. Moreover, ‘stories of miscarriage tend to be told only in certain spaces, from a certain angle, from certain kinds of people’ (Agg, 2023: 9), with the psychological aspects so often prioritised over the physical. We keep labelling miscarriage ‘taboo’, therefore, because so much more needs to be said and done (Agg, 2023: 17).
The question, then, is how might we move out of this cycle of perpetual ‘silence breaking’ and achieve genuine social and material change? A common assumption is that we just need more time and more stories. From this perspective, the celebrity stories serve as a kind of ‘relief valve’ (Agg, 2023: 8), giving ‘ordinary’ people a sense of ‘permission’ to openly discuss their own experiences, such that over time the stigma will eventually wither away and miscarriage will receive the support it requires. My own view, however, is that the ‘breaking the silence’ frame itself is a significant part of the problem. As I have argued elsewhere (Browne, 2022), it precludes the emergence of more radical responses to miscarriage because it frames all miscarriage narratives as inherently transgressive and progressive by virtue of the fact that they are ‘breaking the silence’ or ‘taboo’, even when very conservative ideas about femininity, pregnancy and maternity are being recycled, and when our gaze is being directed upwards, yet again, to the lives of the wealthy and powerful.
In this article, I expand on this argument by suggesting that the ‘breaking the silence’ frame is rooted in, and perpetuates, an inadequate understanding of stigma, which keeps us stuck in a cycle of talking more, rather than doing more, about miscarriage, and failing to connect miscarriage as a feminist issue with wider struggles for social justice. Drawing on critical sociologies of stigma developed by Imogen Tyler (2020) and others, I argue for a paradigm shift: from a narrow liberal understanding of miscarriage stigma as a problem of social norms that can be alleviated through ‘breaking the silence’ and ‘awareness raising’, to a critical ‘stigma power’ approach which treats miscarriage stigma as a ‘machinery of inequality’ (Tyler, 2020) that fulfils a core function for patriarchal, racial, neoliberal capitalist power structures, and hence requires transformative socioeconomic solutions. Accordingly, I call in this article for a new research and activism agenda that fully incorporates miscarriage within the wider movement for Reproductive Justice (RJ) – a movement inaugurated by Black women in the USA in the 1990s, most famously by Loretta Ross, which is now becoming much more prominent in the UK.
The RJ framework is premised on three core principles: the right to have a child; the right not to have a child; and the right to parent the children we have in safe and healthy environments (Ross, 2017: 290). It does not overtly reference miscarriage and stillbirth. But one of the overall points of the RJ movement is that fighting for universal access to care structures and services which support all kinds of pregnancy and pregnancy endings is just as essential as securing positive reproductive rights. Another core pillar of the RJ movement is that we have to put the situation of the most marginalised and disadvantaged at the centre of our analysis if we want to challenge structural inequalities and achieve genuine reproductive liberation (Ross, 2017; Ross and Solinger, 2017; Ross et al., 2017). RJ is thus a vital framework for thinking about miscarriage and its stigmatisation in structural terms and developing the holistic collective approach we urgently need.
The article begins with a brief sketch of the sociology of stigma, from the classical account articulated by Erving Goffman in the 1960s to developments of the ‘stigma power’ approach since the 2000s. Then, in the second and third sections, I show how adopting the latter approach can transform our theoretical and empirical understanding of miscarriage stigma, by pushing us to explore how social inequalities and ‘stratified reproduction’ shape differential enactments and experiences of miscarriage stigma, and moreover, to grasp the interests at stake in these processes of stigmatisation. Next, in the fourth section, I discuss some practical implications of this theoretical reconceptualisation, highlighting the limitations of ‘breaking the silence’ and ‘awareness raising’ as orientating frameworks for miscarriage research and activism. Finally, in the fifth section, I offer some concluding ideas as to what an alternative RJ approach to miscarriage will entail.
Sociologies of stigma
Within the social sciences, the term ‘stigma’ has been applied to a diverse range of circumstances – including mental illness, HIV/AIDS, poverty and abortion – but there is one text that has consistently served as the departure point for analysis. This is Goffman’s book Stigma: Notes on the Management of a Spoiled Identity, in which he defines stigma as ‘the situation of the individual who is disqualified from full social acceptance’ (1963: 9), because of a trait or characteristic that deviates from the dominant ‘standard of judgment’ (1963: 16). Goffman identifies three types of stigma: ‘abominations of the body’ (including ‘physical deformities’ as well as conditions not immediately discernible); ‘blemishes of character’ (inferred from a known record of, for example, ‘mental disorder’ or ‘radical political behaviour’); and ‘tribal stigma’ of ‘race, nation, and religion’ (1963: 14). What these types of ‘shameful differentness’ (Goffman, 1963: 21) all have in common, he contends, is their social devaluation in relation to hegemonic social norms, standards and ideals, such that the bearer is ‘reduced in our minds from a whole and usual person to a tainted, discounted one’ (Goffman, 1963: 12).
The core sociological claim of Stigma, then, is that stigmas are determined by contingent social relations and consensus around what is deemed ‘normal’ and desirable, and conversely what is not. Of particular interest to Goffman (1963) is how stigmatisation is enacted and experienced within micro-social personal interactions, through looks and body language, for example, as well as comments and modes of address. Throughout the book, he documents how a ‘normal’ person interacting with someone with a stigmatised status may behave with hesitance, awkwardness, aloofness, superiority or even excessive kindness; and in turn, how stigmatised people develop ‘management’ techniques that include withdrawing from potentially threatening or difficult interactions and concealing their stigmatised attribute or status where possible through ‘information control’. ‘Silencing’, then, manifests through practices of concealment or self-silencing by the stigmatised, as well as through the avoidance and disavowal of ‘shameful differentness’ by ‘normals’. Goffman also discusses how stigmatised people may come to judge themselves against prevailing social norms, internalising ‘the standards against which they fall short’ and developing low self-esteem, depression and anxiety (1963: 24).
In the wake of Goffman’s pivotal text, sociological and psychological research has largely followed suit in exploring various manifestations of what has since been termed by Gregory Herek (2009) as ‘internalised’, ‘enacted’ and ‘perceived’ stigma within interpersonal relations, and the coping responses of those who are stigmatised. Since the late 2000s and 2010s, however, the Goffman-inspired approach has been subjected to serious critique for failing to grapple with the macro-level material dimensions of stigma or to analyse the structural causes for its production and perpetuation (Clair, 2018). Though Goffman does recognise that stigma functions to ‘keep people in their places’ as a means of ‘social control’ (1963: 105, 139), he assigns responsibility to ‘the stigmatised’ themselves for easing social discomfort and reducing tension, so that ‘normals’ can be ‘tactfully helped to act nicely’ (1963: 141). His approach has thus been described not only as ‘excessively individualistic’ (Link and Phelan, 2014: 30) but also as conservative and ‘politically anaesthetised’ (Tyler, 2018: 746), because it focuses on ‘stigma management’ and changing individual behaviours and beliefs, rather than ‘changing the structures that shape social relationships’ (Pescosolido and Martin, 2015: 101). It has thereby ‘[unplugged] the concept of stigma from power: both the power-inflected micro-aggressions of the everyday social interactions that he was ostensibly interested in, and the larger structural and structuring power relations which shape the societies in which we live’ (Tyler, 2020: 22).
In light of such critiques, stigma research in the social sciences has increasingly come to conceptualise stigma more as an operation of power than an individual situation, broadening out to the macro level to identify how stigmatisation produces and reproduces social injustices and inequalities of class, race, nation, gender, sexuality, dis/ability and more through the maintenance of group hierarchies (Parker and Aggleton, 2003; Clair, 2018). The collaborative work of Bruce Link and Jo Phelan has been highly influential in pushing the sociology of stigma in this direction, proposing the concept of ‘stigma power’ to ‘refer to instances in which stigma processes achieve the aims of stigmatizers with respect to the exploitation, control or exclusion of others’ (2014: 24). While Goffman says that ‘normals’ ‘really mean no harm’, Link and Phelan (2014) argue that stigma is not just an unfortunate part of social life that can be tackled through education and ‘benevolent social action’ (Goffman, 1963: 15). Rather, stigmatisation needs to be understood as a ‘resource’ which serves the aims and interests of ‘stigmatisers’ – often indirectly through shaping the perceptions and behaviours of stigmatised people themselves (Link and Phelan, 2014: 30). Stigma processes thereby function via disciplinary forms of ‘soft power’ to keep stigmatised people ‘in’ (compliant with hierarchical social structures and normative boundaries), ‘down’ (exploited, controlled) and ‘away’ (excluded, incarcerated) (Link and Phelan, 2014: 31).
Imogen Tyler has built further on this analysis of ‘stigma power’, examining how in liberal democratic societies, ‘the violence of stigma is often symbolic, diffuse, slow and indirect’, though not always (2020: 15). Like Link and Phelan (2014), Tyler (2020) contends that stigma is ‘engineered’ and ‘deliberately crafted’ into systems of social provision: a ‘machinery of inequality’ that attempts to ‘manage and/or change the behaviour of populations through deliberate stigma strategies which inculcate humiliation and shame’ (Tyler and Slater, 2018: 727). Yet while influenced by Link and Phelan (2014), Tyler’s work argues that their work remains hampered by a limited understanding of power, where power is imagined in rather binary terms as a force exercised by some individuals over others – ‘the aims of stigmatizers’ (Link and Phelan, 2014: 24) – rather than ‘conceptualised vis-a-vis the motives of institutions and states within a broader political economy of neoliberal capitalist accumulation’ (Tyler, 2020: 15).
Tyler therefore urges us to develop a critical account of stigma which interrogates ‘the role played by stigma power in the distribution of material resources and the transformation of cultural values, the crafting of stigma in the service of governmental and corporate policy goals, and the cultivation of stigma to extract political and economic capital’ (2020: 26). Stigmatisation may indeed be ‘experienced intimately’ through stigmatising 'looks, comments, slights’, but stigma categories precede and exceed individual encounters and are ‘always enmeshed with wider capitalist structures of expropriation, domination, discipline and social control’ (Tyler, 2020: 17). To give one example, the production of ‘welfare stigma’ is not simply ‘an effect of neoliberal ideologies and policies’ but instead needs to be conceptualised as ‘a core organ’ of neoliberal governmentality (Tyler, 2013: 212). Through the speeches of politicians and policy publications, alongside multiple media genres such as reality TV and tabloid journalism, the UK public have been deliberately ‘tutored’ to feel revulsion, anger and contempt for those in receipt of welfare. The enactment of ‘stigmacraft’, argues Tyler, has thereby served as a crucial mechanism for winning public consent and legitimacy for the ‘architects of austerity’ (2020: 193).
What I want to consider now is how this critical sociological literature on stigma might help us move the miscarriage agenda forward and break out of the circles of ‘silence breaking’. What happens when we turn our attention to the socioeconomic and ideological forces that produce and reproduce miscarriage stigma, and the political functions that this stigma serves?
Miscarriage stigma and stratified reproduction
Broadly speaking, miscarriage stigma can be defined as the negative valuation of miscarriage within the dominant sociocultural order due to its contravention of normative ideals of reproductive womanhood and ‘successful’ child-producing pregnancy. ‘Having a live birth and becoming a mother’, as Aalap Bommaraju and colleagues put it, ‘is an idealized outcome of pregnancy, and is frequently deployed as the taken-for-granted cultural standard against which other outcomes are compared and found wanting’ (2016: 63). Though miscarriage can be concealed from public knowledge (often while it is actually occurring), it is nevertheless commonly understood to be something that could ‘discredit’ or embarrass the miscarrying/unpregnant person if revealed.
Within existing sociological and psychological qualitative research into lived experiences of miscarriage in the UK, North America and Australia, there is little detailed theoretical conceptualisation of miscarriage stigma. Nonetheless, the research attests empirically to what can be understood as ‘internalised stigma’ (Herek, 2009), as the women interviewed in the studies often speak of feeling ‘like a failure’, or to use Goffman’s phrase, a ‘tainted, discounted’ person (1963: 3). 3 This is sometimes expressed as a sense of shame that one’s body, and by extension oneself, is inadequate or ‘broken’ (Zucker, 2021), or through guilt and self-blame for ‘doing something wrong’. 4 In the research studies, participants also describe the behaviours and attitudes of those around them, with disappointing and upsetting responses from family, friends, acquaintances and colleagues frequently reported. These include avoidance, awkwardness, ‘displays of discomfort’ and insensitive comments like ‘you can always try again’ or ‘at least you weren’t further along’. Tactless language and dismissive treatment by medical practitioners is also reported (see, for example: Frost et al., 2007; Cosgrove, 2014; Bellhouse et al., 2018).
Yet while some of these negative responses may be interpreted as instances of ‘enacted stigma’ and ‘perceived stigma’ (Herek, 2009), we need to be careful of letting assumptions about stigma overdetermine our analysis. As Anuradha Kumar has cautioned in relation to abortion scholarship, not ‘every negative reaction or attitude’ can be ‘heap[ed] … in the stigma basket’ (2013: 329–330). Dismissive responses from medical staff, for example, may in some cases be more attributable to staff shortages and overwork than anything else. It must also be recognised that ‘positive support experiences’ (Bellhouse et al., 2018: 8) such as kindness, openness and empathy are also reported within these studies, and not all participants report negative self-conceptions or ‘internalised stigma’ following miscarriage. Overly generalised claims about miscarriage being stigmatised and ‘surrounded by silence’, therefore, may preclude more fine-grained enquiry into the variability of social responses, and the multiple ways in which people negotiate and resist the forces of stigmatisation.
It must also be acknowledged that white, middle-class, cis-het women have been overrepresented in much of the research literature to date; 5 and broader questions about power relations and inequalities tend to be left unaddressed. Consequently, the impression can emerge that miscarriage stigma is simply there as a social fact: manifested in ‘specific sets of beliefs and behaviours’ (Millar, 2020: 1) which all who experience miscarriage must navigate. In contrast, the ‘stigma power’ approach is rooted in the assumption that stigma ‘is not an overarching constant with an objective (and thus fixed) basis that impacts on its targets evenly, even within particular historical and geographical contexts’ (Millar, 2020: 5). Research into abortion stigma, for example, has increasingly been considering how this stigma attaches in different ways to unequal social groups within contexts of ‘stratified reproduction’ – stratified reproduction being a feminist concept that names the ‘power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered’ (Ginsburg and Rapp, 1995: 30), and is at the heart of RJ theory (see also: Colen, 1986). For example, Sian Beynon-Jones (2013) finds evidence that working-class women, especially young women, are viewed by medical professionals as less capable of raising a child than middle-class women in stable relationships, and as such their abortion requests may be received more approvingly than the latter’s.
Adopting the ‘stigma power’ approach within miscarriage research would similarly require investigation into the differences that class, race, ethnicity, gender, sexuality and dis/ability make to experiences of ‘internalised’, ‘perceived’ and ‘enacted’ miscarriage stigma. In the US context, for example, a study by Bommaraju et al. (2016) shows that ideologies and material systems of stratified reproduction significantly impact experiences of both abortion stigma and miscarriage stigma. In their study, white women overall ‘reported higher levels of abortion stigma perception than Black and Latina women’, and also ‘perceived stigma from miscarriage more keenly than these women’ when they had no background experience of abortion. Yet among women who reported having an abortion, the study found that ‘Black women had greater miscarriage stigma perception than white women’ (Bommaraju et al., 2016: 66). According to the authors, these findings – that ‘miscarriage is more stigmatizing than abortion to Black and Latina women who have had an abortion while abortion is more stigmatizing than miscarriage among white women with similar reproductive histories’ – are consistent with the realities of ‘racial reproductive stratification’ in the USA (Bommaraju et al., 2016: 69). Just as ‘women whose fertility has traditionally been encouraged’ may be more likely to perceive negative judgement for having an abortion, ‘women whose childbearing is viewed with suspicion may be more vulnerable to allegations of poor caretaking’ and stigmatisation in the event of miscarriage (Bommaraju et al., 2016: 64). 6
No studies of miscarriage stigma like this have been conducted in the UK, though it has been well established that similar structures of stratified reproduction are operative (see e.g.: Lonergan, 2012; Bhatia, 2023). As well as undergoing higher rates of miscarriage, stillbirth and maternal death, research shows that Black and ‘minority ethnic’ pregnant people in the UK report dismissive and hostile treatment by reproductive healthcare practitioners more commonly than those who are white. Women seeking asylum also speak of ‘getting blocked’ by reception staff in NHS settings acting as gatekeepers of the ‘hostile environment’ (Maternity Action, 2018). To be sure, racial disparities in pregnancy outcomes in the UK have become much more widely reported over the past few years. Yet the public discussion of miscarriage stigma tends to occur in parallel with and is largely focused on how miscarriage is experienced by more privileged women (Martin, 2022). As media topics, for instance, ‘The Black Maternal Health Crisis’ and ‘Breaking the Silence Around Miscarriage’ tend to occupy separate columns.
If we take the ‘stigma power’ approach, however, we see that these issues are inextricably connected, as miscarriage stigma must never be ‘unplugged’ – to use Tyler’s (2020) phrasing – from broader questions of political and material injustice. Crucially, then, a much deeper understanding is required of how social inequalities shape not only differential rates of miscarriage in the UK but also differential experiences of miscarriage stigma amongst all those whose pregnancies do not conform to normative standards of affluent white cis-het femininity. Moving beyond generalised claims about miscarriage being stigmatised and ‘shrouded in silence’, academic and public discussions must now fully consider the multidimensional and variable nature of miscarriage stigma, and how it is unequally distributed and filtered through wider power structures. Why are some people more likely to experience miscarriage, and miscarriage stigma, than others? What does miscarriage stigma look like and feel like for different groups of women and those of other genders? How does miscarriage stigma interact with other kinds of reproductive stigma? How do ideologies and structures of stratified reproduction designate some miscarriages worthy of grief, sympathy and support, and others less so or not at all?
Miscarriage stigma and the question of interests
So far, I have claimed that the ‘stigma power’ approach requires us to explore how social inequalities and stratified reproduction shape differential experiences of internalised, perceived and enacted miscarriage stigma. But it is important to stress that taking this approach to miscarriage stigma is not just about investigating and becoming aware of stratified reproduction and its experiential effects. In theoretical terms, it is also about developing a deeper understanding of the interests at stake in the stigmatisation of miscarriage: the ‘processes of power, privilege and profit that motivate the manufacture of stigma’ (Paton, 2018: 921).
The question of interests might initially seem unconnected to miscarriage research: is there really anyone who wants miscarriage to be stigmatised or benefits from its stigmatisation? Surely the mission to eradicate miscarriage stigma is something that everyone would get behind, or at least would not be opposed to? But as Tyler (2020) demonstrates, consideration of interests need not proceed in individualistic, voluntaristic terms, or according to a binary understanding of power relations between ‘the stigmatised’ and ‘the stigmatisers’. Instead, the aim is to examine how power operates and interests are served through forms of governance in diffuse and indirect ways (Tyler, 2020). Similarly, Loretta Ross insists that ‘RJ encourages thinking structurally about the matrix of domination individuals and communities are caught up in’ and ‘addressing government and corporate responsibility’ (2017: 300–301).
Most obviously, taking a ‘stigma power’ approach must entail examining how miscarriage stigma serves the interests of patriarchy as a ‘method of social governance’ (Millet, 1970: 177). Public discussions of miscarriage do frequently acknowledge that miscarriage stigma stems from patriarchal archetypes of normative womanhood and procreative feminine sexuality, alongside depictions of the childfree woman as ‘barren’, ‘tragic’ or unfulfilled. Within these discussions, however, as noted above, the intersections of patriarchy with racial, class and other oppressive social structures are rarely explored, and patriarchy tends to be referenced as simply part of the social and cultural fabric, and moreover an outdated set of values and misconceptions out of which we can educate people through ‘awareness raising’. But within feminist scholarship, ‘patriarchy’ is a political term, naming a power structure in which many people – including many women themselves – are deeply invested due to the material and psychic benefits it can bestow (Millar, 2020: 5).
Accordingly, when we adhere to this strong feminist understanding of patriarchy, as a power system driven by cohering interests (Howie, 2010), miscarriage stigma can be grasped as much more than just a patriarchal hangover. Rather, it serves a core function for the ongoing reproduction of patriarchal power because it shores up essentialist ideals of women as child-producers by marking those whose pregnancies end in miscarriage as inferior by contrast. Patriarchy as an ideological and material system rests fundamentally on the principle that childbearing is a primary generator of women’s ‘use value’ and locus of identity, a principle that rebounds across hierarchies of stratified reproduction and pertains to a wide range of unequal subject positions (Browne, 2022). And miscarriage stigma in all its forms helps to maintain assumptions that producing and nurturing children is ultimately what women are for, or supposed to be able to do, by rendering anything else a matter of shame and falling short. The veneration of ‘successful pregnancy’ and the stigmatisation of miscarriage as ‘failed pregnancy’ are different sides of the same coin.
To take a ‘stigma power’ perspective, then, is to see that miscarriage stigma functions as a vital ideological ‘resource’ for patriarchy in sustaining ideals of normative pregnancy, ideals which secure and legitimate gendered divisions of labour and gendered imbalances of power and wealth, moreover. Looking at it this way, it becomes clear that the only way to defeat miscarriage stigma is via the transformative feminist project of overturning normative pregnancy and stratified reproduction more generally. It is simply impossible for miscarriage stigma to be eradicated while ‘pregnancy world’ turns on as usual. But there are a host of forces that are deeply invested in keeping normative pregnancy and stratified reproduction in play, including reactionary mobilisations of heteronormative ‘family values’, white nationalist pronatalist ‘birth rate’ panics and a profit-driven pregnancy industry whose expansion depends on amplifying the cultural celebration of ‘successful’ pregnancy as having-a-baby.
Tyler’s analysis of ‘stigmacraft’ as a neoliberal technique of power also pushes us to consider how miscarriage stigma serves contemporary neoliberalism as an orchestrated capitalist project of state abandonment (Harvey, 2005; Tyler, 2013, 2020). The immediate point to emphasise here is that the precarious and harmful living conditions which many pregnant people are subjected to in the UK – and which produce such unequal pregnancy outcomes – result from deliberate government policies of austerity and the ‘hostile environment’. Studies, for example, have demonstrated a correlation between financial insecurity and increased probability of miscarriage (Bruckner et al., 2016; Di Nall and Selin Köksal, 2023), while links are currently being drawn between the squalid conditions and overcrowding at Manston detention centre – the ‘holding facility’ for asylum seekers in Kent – and miscarriage among the detained 7 (Bancroft, 2023). But further to this, it can be argued that the production of miscarriage stigma itself serves neoliberal policy goals, by encouraging us to think of pregnancy outcomes in highly individualistic terms which absolve our elected government and wider society of any collective responsibility.
It has now been well established that a key ingredient of neoliberal ideology is the shifting of responsibility for public health on to individuals. Neoliberal logics of personal responsibility, productivity and bodily control command individuals to take charge of their own well-being, to think and act in more ‘healthy’ and ‘productive’ ways and make the right ‘life-style choices’. Nutrition, for example, thus becomes a matter of individual choice that has to be responsibly ‘budgeted for’, rather than a matter of fair distribution (Mooney, 2012; Schrecker and Bambra, 2015; Viens, 2019). Various feminist researchers have also demonstrated how pregnancy under neoliberal governance has been made into a ‘project’ for the pregnant individual, who must take responsibility for ensuring their own ‘personal health and fitness’ as ‘integral to safe and fulfilling childbearing’ (National Maternity Review, 2015). And though affluent and well-supported individuals are able to conform most fully to these pregnancy ideals and patterns of ‘healthy’ consumption, they ‘set the standard against which even those with the fewest resources are judged’ (Freidenfelds, 2020: 9).
If the pregnant person is understood as the ‘project manager’ of their pregnancy, it is unsurprising if people overestimate the role of individual behaviours as causal factors of miscarriage, and if those who go through a miscarriage so often experience internalised stigma and blame themselves (Browne, 2022). The production of miscarriage stigma can thereby be regarded as a kind of side-effect of the neoliberal governance of pregnancy to which even the most privileged and socially supported people can be susceptible. Yet if we apply Tyler’s argument here, this should not be understood as merely an unfortunate or accidental consequence. Recall her claim, for example, that the production of welfare stigma is ‘not simply an effect of neoliberal ideologies and policies’ but instead is a ‘core organ’ of neoliberal governance (Tyler, 2013: 212). Along such lines, we might say that the production and reproduction of miscarriage stigma is a ‘core organ’ of the neoliberal governance of pregnancy, because it bolsters the idea that ‘optimal results’ are down to individual will and constitution, which comes with the implication that the people most affected by negative pregnancy outcomes (who are most affected by austerity and the ‘hostile environment’) are themselves the problem. That is, as long as miscarriage is understood to be something that ‘taints’ or devalues a miscarrying/unpregnant individual, this only strengthens the individualising neoliberal ideology that pregnancy outcomes, negative or positive, are attributable above all to the behaviour, life-choices and ‘childbearing capacity’ of the one who is or has been pregnant.
Miscarriage stigma can therefore be theorised as an integral component of the neoliberal promotion of ‘pregnancy success’ as an individual achievement requiring, above all, personal vigilance and diligence. Stigmatisation serves intertwined forms of neoliberal and patriarchal power by entrenching pregnancy hierarchies, deepening divisions and inculcating blame and shame: making us look inwards and ask ‘what did I do wrong?’ or ‘what is wrong with me?’, rather than looking outwards and asking questions about inadequate public services and medical care. Corporate interests, moreover, are served by stigma production because the neoliberal responsibilisation of the pregnant individual opens up ever-expanding opportunities to promote ‘must-buy’ pregnancy products to ‘optimise’ the pregnancy. Yet at the same time, miscarriage stigma gets seized on as a public relations opportunity by the very corporate entities that benefit from neoliberal economic policies. The NatWest Group, for example, has been a major sponsor of the UK’s Baby Loss Awareness Week, hosting panel discussions on social media and participating in the ‘Turning the UK pink and blue’ campaign, which illuminates public buildings in pink and blue light to ‘raise awareness of pregnancy and baby loss’.
Peeling away this veneer of corporate ‘pink-and-blue-washing’ as we might call it, the ‘stigma power’ approach brings back into focus the role played by the NatWest Group in the decimation of the UK’s public services and deepening of social and health inequalities. During its previous incarnation as the Royal Bank of Scotland (RBS) Group under the reign of Fred Goodwin, for example, the bank had a department specifically dedicated to tax avoidance which enabled it to withhold £500 m of tax owed – a department that had to be closed after the Group was bailed out by public money in 2008 (Lawrence and Leigh, 2009). In late 2010, more than 100 senior bank executives at RBS were paid more than £1 million in bonuses, even though the bailed-out bank reported losses of £1.1 billion (Treanor, 2011), just as the British government’s ‘austerity’ response to the banking crisis was getting underway, implementing ‘the deepest and most precipitate cuts ever made in social provision’, including to pregnancy services (Taylor-Goodby, cited in Tylor and Slater, 2018: 726).
The limits of ‘breaking the silence’ and ‘awareness raising’
In the discussions above, I have argued that the ‘stigma-power’ approach developed by Tyler (2020) and others provides valuable conceptual tools for developing a much deeper critical understanding of how miscarriage stigma functions as a fundamental component of patriarchal, neoliberal, racialised systems of normative pregnancy and stratified reproduction. Instead of treating it as an unfortunate social fact, I have suggested, we must examine how miscarriage stigma operates as a ‘machinery of inequality’ (Tyler, 2020) and identify the various intersecting interests that drive the continuing stigmatisation of miscarriage. The question to address now, then, is what are the practical implications of reconceptualising the problem of miscarriage stigma in this way?
Campaigns to tackle miscarriage stigma – led by charitable organisations as well as individuals on social media – have generally subscribed to what Tyler calls the ‘weak understanding’ of stigma, wherein stigma is conceived in liberal terms as ‘a social problem that can be ameliorated through education, by changing individual attitudes and/or by teaching the stigmatised how to better manage the stigma pinned on them’ (2020: 17). These campaigns, like the #MisCourage campaign launched by Tommy’s in 2015 or #IHadAMiscarriage led by psychologist Jessica Zucker in 2017, have diagnosed the core problem as ‘the silence around the subject’ that makes miscarriage a profoundly isolating experience and allows pervasive misunderstandings of it among the public to go unchallenged. Accordingly, when the identified problem is silence, the solution becomes ‘speaking out’ and ‘replac[ing] silence with storytelling’ (Zucker, 2021: 210). As Agg puts it, ‘miscarriage is almost always presented this way: a silent problem that can be fixed by talking about it’ (2023: 8–9).
Miscarriage stigma campaigns therefore tend to focus strongly on encouraging and enabling more individuals to ‘share their stories’, alongside developing support networks and providing informational support and best-practice guidance. Yet as Tyler (2020) and other ‘stigma power’ theorists demonstrate, efforts to ameliorate stigma of any kind can only have minimal impact if they do not grapple seriously with political-economic conditions. To give an example, Tyler and Slater shine a critical light on some of the leading UK mental health charities, which offer important programmes of mental health support through the provision of information, helplines and online forums, but do not and cannot provide ‘the kinds of intensive counselling and/or acute psychiatric health services that many people in Britain are currently having problems accessing’ (2018: 726). While affirming that talking about mental distress with friends and families can contribute to lessening social stigma, the point here is that ‘anti-stigma initiatives which want to remove barriers to help-seeking, but which do not simultaneously address either the erosion of public service provision or the deeper social causes of increased levels of mental distress’, can only scratch the surface of the problem (Tyler and Slater, 2018: 726).
We can say of miscarriage campaigns and support charities, likewise, that while they offer vital forms of recognition and validation for many individuals, and important information for the general public and professionals, the effect will be limited while the systemic inequalities entrenched by racialised neoliberal patriarchy continue to deepen, and early pregnancy units, maternity services and mental health services are desperately understaffed and cut to the bone. As Kirsten Leng (2023) argues, miscarriage and stillbirth tend to be treated ‘through a therapeutic lens, as an unavoidable personal tragedy rather than a public health or social justice issue … resigned to the seemingly apolitical world of bereavement support groups and grief counselors’. To be sure, most miscarriage advocates in the UK context do insist on the need for significant infrastructural change, and various careful policy recommendations and protocols have been crafted. But calls for more investment in the health system are usually issued in a rather unspecified and de-politicised register; 8 and when miscarriage advocacy becomes directly policy orientated, it demands ‘technocratic reforms’ like the provision of official state certificates (Leng, 2023), or work-related reforms that can slot into existing legal and socioeconomic structures. Take, for example, the Miscarriage Bill currently going through UK parliament, which would mandate three days of statutory paid leave for those entitled as a form of ‘bereavement leave’. An entitlement like this would undoubtedly be welcomed by many people in employment, but while advocates insist that three days would in many cases be insufficient (see e.g.: Tommy’s, 2024b), there is a general lack of critical acknowledgement that it would make no difference at all to those with no right to paid leave, no right to work or no recourse to public funds, nor that it would automatically (and problematically) identify anyone who wanted to claim the leave as ‘bereaved’. 9
What Tyler (2020) calls the ‘weak’ understanding of stigma also carries over into the media sphere, where the ‘breaking the silence’ frame is just as prevalent as in the advocacy field, and has functioned to shield the prevailing narratives of miscarriage from any serious critique or contestation. Feminist scholars are increasingly pointing out, for example, the reactionary nature of much of the media representation of miscarriage. Yet in being framed as ‘breaking the silence’, this coverage can present itself as part of the de-stigmatisation of miscarriage and therefore as ‘good for women’ (Martin, 2022). Rebecca Feasey (2022), for example, points out that the celebrities who disclose a miscarriage tend to speak retrospectively about miscarriage from their position as a mother following at least one ‘successful’ pregnancy. These stories of miscarriage as part of the ‘bumpy journey to motherhood’, she argues, thereby sidestep many of the complex and difficult realities of pregnancy and miscarriage, and end up perpetuating ideologies of normative pregnancy in promoting ‘a consensus that miscarriage should be followed by motherhood’ (Feasey, 2022: 1437). Zelly Martin further demonstrates how miscarriage stories in news media and magazines repeatedly reinscribe a monolithic narrative of miscarriage as ‘the worst thing that can happen to a woman’ (2022: 2350), thus bolstering the ‘cult of true motherhood’ and ‘racialized notions of women as domestic, submissive, pious, and pure’, as well as trafficking in ‘grief capitalism’, where the suffering of celebrities is sensationalised for profit (2022: 2339). And the framing of celebrity miscarriage stories as ‘revealing’ and ‘opening up’ about something silent or ‘hidden’ or ‘invisible’, she argues, only adds to the ‘sensationalization of the miscarriage experience’, drawing ‘eyes to the page and profits to the publications’ (Martin, 2022: 2349–2350).
To make such critiques of the ‘breaking the silence’ frame is not to minimise the damage and violence of silencing as a method of patriarchal control. The ability to speak and be heard is vital to the realisation of our embodied agency, and there are life and death consequences to not being able to speak, and not being listened to, within contexts of obstetric violence, racism and neglect (Dotson, 2011; Chadwick, 2021; Ray, 2023). I also do not mean to diminish the bravery it can take to speak publicly about personal experiences like miscarriage, nor the difference that story-centred campaigns like #IHadAMiscarriage have made to many people’s lives. But within the current climate, being able to ‘tell our stories’ and ‘speak our truths’ so often gets reified as the end goal of progressive initiatives, such that ‘talking about miscarriage’ appears as a ‘self-contained solution’ rather than just one part in bringing about change (Agg, 2023: 9). The emphasis on individual storytelling may thus prevent us from seeing miscarriage stigma in terms of socioeconomic inequalities and injustices, while at the same time placing excessive pressure upon individual disclosure as the means to de-stigmatisation.
Campaigners regularly point, for example, to the ‘twelve-week rule’ – the social expectation that people will not publicly declare their pregnancies until after the first trimester when the miscarriage risk is lower – as an enforcer of the ‘miscarriage taboo’, and suggest that if we break the twelve-week rule and disclose our pregnancies earlier, the stigma will begin to disappear (see e.g.: Zucker, 2021). But while no one should feel compelled to stay silent or keep quiet, it should be emphasised just as strongly that disclosing pregnancy must not be made into a feminist imperative. No one should worry they are letting down the ‘sisterhood’ by not announcing to the world that they are seven weeks’ pregnant. This latter point is particularly relevant to those in precarious or marginalised positions for whom disclosure of a pregnancy, or a miscarriage or abortion, might be particularly risky and fraught. For instance, just as there are ‘substantive differences between a Prince or a pop star disclosing their struggles with mental health to the public, a precarious worker disclosing to an employer, or a mother disclosing to a social worker’ (Tyler and Slater, 2018: 723), there are serious differences between a celebrity discussing their miscarriage in a magazine interview and a precarious worker disclosing a miscarriage to their boss. Indeed, the celebrities who do tell their miscarriage stories are themselves regularly subjected to an onslaught of abuse. The ‘communication technologies which have ostensibly been designed to enhance, facilitate and democratise public speech’, as Tyler points out, ‘are also experienced as stigma machines – spiked with threats of violence’ (2020: 49).
Towards a Reproductive Justice approach to miscarriage
In conclusion, it is time for a shift away from anti-stigma interventions framed in terms of ‘breaking the silence’, which overstate the role of individual storytelling in de-stigmatisation and so often end up centring women who have the most voice in the first place. We do need stories – as many diverse stories as possible. They enable more complex understandings and vital forms of connection. But to harness the discursive power of personal stories we must proceed in the tradition and spirit of feminist consciousness-raising, in which storytelling is a means to collective action and changing the world, rather than seeking mutual recognition as an end in itself. As Ross writes of the emergence of the RJ movement, ‘we understood that we could not build a movement … based on stories of individual women’s experiences’ alone (2017: 299). Instead: In the tradition of the Combahee River Collective… [we] coined the term ‘reproductive justice’ to ‘recognize the commonality of our experiences and, from the sharing and growing consciousness, to build a politics that will change our lives and inevitably end our oppression’, changing ‘economic, social, and political realities through social justice actions based on theoretical reflections’ (Ross, 2017: 286–287).
It must be emphasised, moreover, that defeating miscarriage stigma entails pushing back against all forms of reproductive stigma, including abortion stigma, that stem from stratified reproduction and normative pregnancy. At present, miscarriage advocacy in the UK operates as a relatively autonomous field, incorporating ‘termination for medical reasons’ under the ‘pregnancy loss’ umbrella, but otherwise subscribing to the principle that ‘abortion limits and rights are a separate issue and should be treated as such’. 10 As I have urged elsewhere, however, taking an RJ approach means extending solidarity beyond the boundaries of the ‘pregnancy loss community’ (Browne, 2018, 2022), forging alliances with pro-abortion as well as birthing justice activism. The RJ approach, further, means ‘connect[ing] the dots’ between social issues that are not usually connected to reproductive politics (Ross and Solinger, 2017: 69), from food insecurity to environmental degradation. And though the focus in this article has been on the UK, RJ is also about ‘connect[ing] the local to the global’ (Ross, 2017: 301) and adopting a transnational outlook, as miscarriage is shaped not only by domestic politics but also by geopolitical relations and events. For example, health care workers have reported a 300% increase in the miscarriage rate among pregnant people in Gaza since Israel’s assault began in October 2023 11 (Cheung, 2024), which has been legitimated by the UK government and for which it has supplied weapons export licences (Abdul, 2023).
So as we build a new agenda for miscarriage research and activism in the UK and beyond, we need to be asking how we can connect up with broader struggles for truly universal care systems – joining forces, for example, with groups like Docs Not Cops (2021), who have been at the forefront of anti-racist campaigns to scrap the current NHS charging regulations that target migrant communities, and make pregnancy-related services free, accessible and high quality for all. We also need to be situating miscarriage within the broader political economy and considering how miscarriage research and activism can tap into more ambitious medium-term and long-term programmes for economic redistribution and systemic change. Reaching further than ‘miscarriage leave’ for those in employment, for instance, how might miscarriage research and activism connect with the growing movement for an unconditional Universal Basic Income, which would be paid regardless of citizenship, employment or parental status, and so could sustain us all through experiences like miscarriage? 12 And how can we resist the profit-driven promotion of normative pregnancy, alongside the ‘pink-and-blue-washing’ culture that surrounds miscarriage and its corporatisation?
In saying this, it must be recognised that when public funds are minimal or non-existent, non-profit organisations operate in an impossible situation in which accepting corporate sponsorship might appear as the only option; and my intention here is not to blame and shame any organisation taking this route by engaging in a destructive kind of purity politics. I do want to insist, however, that miscarriage advocacy should not be off-limits for critical feminist analysis or cordoned off from wider social justice struggles. The aim, therefore, must now be to reach beyond the limits of reform and recognition, building emancipatory forms of miscarriage theory and activism that ask what miscarriage would be like, and would mean, in an equal feminist world, and how that world is to be struggled for. 13
