I'm Sorry for My Loss: An Urgent Examination of Reproductive Care in America

by Rebecca Little

Ten to 20 percent of known pregnancies end in miscarriage annually, affecting about 750,000 to one million women every year.1 Stillbirths are a smaller subset of that number, closer to 1 to 5 percent, yet not as rare as people assume.

Most people don’t realize that third-trimester abortions—those twenty-eight weeks and after, which are almost always for a fetal anomaly or a threat to the mother’s life—also involve giving birth to a dead fetus. The only difference is the fetus’s heartbeat is usually stopped by a euthanizing injection before induction, followed by suction and aspiration for remaining tissue.

When slaveholders profited from Black children, that reproduction was encouraged. When there was no longer a white capitalist profit to it, there ensued a long trail of eugenics and forced sterilizations on people of color.

Miscarriages and stillbirths were rampant. The infant mortality rate for enslaved babies in 1850 was twice that of whites, with fewer than two out of three Black children surviving to age ten, usually from malnutrition and disease.

Immigration and industrialization weren’t going to be reversed, but those in charge were rattled and doing their best to halt changes that threatened their dominance. One way to do that was to assert their sole control over women’s reproduction, which included limiting abortion unless they deemed it necessary.

Women who have experienced stillbirth are almost five times as likely to experience another stillbirth or severe maternal complications, and up to a quarter are preventable, according to the Rainbow Clinic.

The United States has 32.9 maternal deaths per 100,000 live births. (The next closest, by comparison, is the United Kingdom with 10.9 per 100,000 births.)2 The data for Black women is 69.9 deaths per 100,000 live births, making them nearly three times more likely to die than white women during pregnancy or within a year of the end of the pregnancy.3 Black women are also far more likely to suffer miscarriage, stillbirth, and other complications.

“Maternal mortality ratios tell us how well a country’s healthcare system in general is functioning. In America, our maternal mortality rates are a stark reminder of how little we actually value women’s health.”4

Miscarriages account for roughly nine hundred thousand emergency department visits in the United States each year.23 But in some hospitals, doctors aren’t trained in procedures to manage the care.

The “gold standard” in medical miscarriage management is the abortion regimen—mifepristone combined with misoprostol. But due to the FDA’s extra regulation of mifepristone—and numerous lawsuits—many patients are only offered misoprostol.24 The FDA currently allows for medication abortion up to nine weeks, while the World Health Organization says it’s safe for up to twelve weeks.25 Inevitably, more pregnant people will rely on the medication later in pregnancy in states where a procedure is not available.

Such concerns over privacy invasion are growing. In Nebraska, for example, prosecutors used Facebook messages between a mom and her daughter that discussed an effort by the mother to help her daughter procure abortion medication. The teenager was past the twenty-week mark where it becomes illegal in the state, and the two were accused of burning and burying the remains. They were charged with crimes including concealing a death and mishandling human remains; the daughter, who was then seventeen, was initially charged as an adult.9 Facebook, now called Meta, turned over the messages to law enforcement after it was served a warrant. The girl was sentenced to ninety days in jail following a plea agreement.10 Her mother got two years in prison.

“Public health experts predict that in a few years, patients in abortion prohibited states, where the ranks of obstetricians are already shrinking, will experience even greater barriers to reproductive health care,” wrote Jan Hoffman in the New York Times.40 This problem too may lead to worse care in those states because there will be fewer doctors willing to practice there.41 And that doesn’t just extend to obstetrics—the slight majority of medical school graduates are female and ending their training in their early thirties, prime baby-making time. Those oncologists, pulmonologists, and cardiologists may not want to themselves be patients in abortion-restricted states.

Nationwide, pregnant women who use certain drugs have been jailed for this, but so have women who have refused C-sections or medical advice, delivered their children without medical supervision at home, been suicidal, or suffered accidental falls. They are charged with crimes like manslaughter, endangerment, criminal recklessness, and neglect.

In Oklahoma alone, forty-five women were charged with pregnancy-related crimes from 2017 through 2021, almost entirely for drug use, according to the Frontier, a nonprofit Oklahoma news site. But only eighteen of them received drug treatment as part of pretrial or an order to complete it, the news site found.

In 2017, a woman named Adora was charged with murder after she delivered a stillborn baby at Adventist Health Hanford in California. The baby tested positive for methamphetamine, and a doctor told police he thought the drug caused the death. She pleaded guilty to a charge of “voluntary manslaughter of a fetus”—a charge that doesn’t actually exist in California law—and was sentenced to eleven years in prison. Her conviction was overturned in 2022.26

The National Center for Health Statistics tracks fetal deaths after twenty weeks, but it was only in 2018 that every state adopted a standardized report on deaths, which would make it easier to count them and derive any data on causes. Miscarriages are not counted in any tally. Abortions are.

Isabel, who works for a federal agency in Washington, DC, had a thirty-nine-week stillbirth due to an umbilical cord knot in 2023. She wasn’t eligible for paid parental leave, “because I no longer had a baby to bond with,”

Illinois passed a fairly comprehensive Family Bereavement Leave Act that went into effect in 2023, which requires companies to provide ten days of unpaid leave for employees who experience a miscarriage, stillbirth, unsuccessful fertility treatment (IUI or IVF), failed surrogacy agreement, failed or nonfinalized adoption, or diagnosis affecting fertility.

Of those surveyed who had experienced a miscarriage, 37 percent felt they had lost a child, 47 percent felt guilty, 41 percent felt they had done something wrong, 41 percent felt alone, 28 percent felt ashamed. If no one talks about any of these experiences—either in a medical or a personal setting—the gaps in knowledge get filled with googling (oh, the googling), message boards, and online information of varying quality. Zucker refers to it as the “strident trifecta” of miscarriage—silence, stigma, and shame.7