Perceptions of Risk and the Management of Miscarriage Among Under-served Populations and Health Providers in Indiana: A Case Study Perspective Open Access

Upton, Rebecca (2014)

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The purpose of this study is to determine what behavioural or environmental factors are perceived by individuals in this rural area as contributing to their experience of miscarriage or subsequent unexplained fetal loss. In addition, interviews with local care providers will help to ascertain and assess the extent to which community health care providers are equipped to discuss and provide information to under-served populations in rural communities in Indiana with respect to reproductive health and fertility outcomes. This assessment allows for the identification of gaps to initiate targeted remediation, as well the identification of strengths in order to reinforce successes in provider services. It also raises awareness of miscarriage as a significant reproductive and public health problem and suggest ways in which supportive programming could be implemented into current provider services in rural communities.

Recent research indicates that the experience of miscarriage is both ubiquitous and under-recognized by patients, providers and the public writ large. Miscarriage, or fetal death prior to the 20th week of gestation, is an experience, which while common goes largely un-discussed in contemporary culture or public health discourse. Statistically, miscarriage occurs in approximately 10 to 15 percent of clinically recognized pregnancies under 20 weeks of gestation (cf. Stirrat GM. Recurrent miscarriage. Lancet 1990; 336:673), often before a woman even knows she is pregnant. In this study I investigate perceptions of risk based upon socio-cultural behavior and environment among women and men who knew of the pregnancy and experienced miscarriage in the first trimester or who experience recurrent (consecutive) pregnancy loss.

A qualitative approach was utilized to assess perceptions by individuals and providers of the risk and subsequent management of miscarriage. Recruitment of individuals via snowball sampling methodology provided the basis for the case study participants. Open-ended qualitative interviews provided the basis for the case study analysis. Transcribed narrative data were analyzed using standard coding procedures and MAXQDA software.

Table of Contents

Table of Contents

Introduction 1

Literature Review 6

Methodology 15

Findings 21

Discussion 45

Conclusion 51

References 53

Appendix 58

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