P2C115: Provider Perceptions on Perinatal Loss: A Knowledge Attitudes and Practices Survey in Moshi Tanzania

Background: Over 98% of stillbirths and neonatal deaths occur in Low and Middle Income Countries, such as Tanzania. Women who experience loss during childbearing are more vulnerable to social and physical harm, which is exacerbated in settings with high rates of stigma associated with perinatal loss and poor social support mechanisms. Scant literature exists on provider knowledge and perspectives of care for perinatal loss in LMICs.

Methods: A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to physicians, nurses, and midwives working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed with descriptive statistics.

Results: 74 providers completed the survey. Pediatric providers saw a yearly average of 4.98 stillbirths and 32.37 neonatal deaths. Obstetric providers saw an average of 11.54 stillbirths and 13.18 neonatal deaths annually. Over half (54.1%) said the youngest gestational age at which they would provide resuscitation was 28-weeks. 17.6% would withhold resuscitation until 30+ weeks. When justifying their cut-off, a majority selected “there is a low chance of survival below this point”. No provider selected the option “the family would not want me to resuscitate below this point”. Providers felt that infants have a 50% chance of survival at 28-weeks at KCMC and nationally. (Figure 1) At KCMC, 24.3% of providers stated there was a 90% chance of survival at 28 weeks gestation while 39.3% felt this rate of survival occurred at or after 34 weeks gestation.
Most providers felt that stillbirth and neonatal mortality were not the mother’s fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth.(Figure 2) A majority indicated that women wanted to see (79.7%) and hold (63.0%) their baby after stillbirth. For neonatal death, 82.4% and 70.3% of providers agreed that women wanted to see and hold their baby after death. More providers (66.2%) felt that KCMC provides support for women who experience stillbirth than for those who experience neonatal death (39.2%). A minority felt that the local community provides support for women after stillbirth (45.9%) or neonatal death (37.8%).

Conclusion: The majority of providers at KCMC reported that women are at greater risk of psychosocial harm, abuse, and/or abandonment following perinatal loss, while affirming that perinatal loss is not the woman’s fault. How women prefer to engage with their deceased infant, and how they can best be supported by both the health system and their community, remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.