Research question
- Which interventions are the most impactful in improving mental health outcomes in women or/and partners experiencing a pregnancy not ending in a live birth in the UK?
Despite its high prevalence, pregnancy loss is rarely discussed, which creates barriers to support. Experiencing a pregnancy not ending in a live birth is a distressing life event for many parents regardless of gestational age and the experience is very individualised. Parents who have experienced a pregnancy loss have reported varying and at times lower levels of support, compared with support following other types of bereavement. A pregnancy not ending in live birth encompasses miscarriage, ectopic pregnancy, medically indicated and choice termination, stillbirth and neonatal deaths.
In the UK it is estimated that one in four pregnancies end in miscarriages and one in 250 pregnancies end in stillbirth. Pregnancy loss is associated with substantial medical, psychological, social and economic costs to women, their partners and families, health-care providers, the government and wider society. Many women and partners face enormous stigma and shame when they lose a baby. Many feel discouraged from talking about their experience and loss. This can lead to isolation and disconnection, even from their partners and close family, and can leave either parent experiencing their grief in isolation.
The psychosocial effects of pregnancy loss may be profound. Pregnancy loss can affect parents’ mental health and general wellbeing. For some this can lead to post traumatic stress disorder (PTSD), as well as increased rates of anxiety, distress and depression. The negative psychological impacts of pregnancy loss have been reported to persist into and far beyond the next pregnancy. It is a common misconception that the birth of a subsequent child will resolve the grief and loss. Women have reported increased levels of stress, cycles of fear and relief, disturbed sleep, and insomnia in subsequent pregnancies.
Some of the negative health impacts following a pregnancy not ending in live birth are preventable. Research has shown that psychological interventions have the potential to improve health outcomes for women and their families after pregnancy loss. Social networks also play an important role in supporting parents following a pregnancy loss. However, more research is needed to ensure support is effective and targeted appropriately. Moreover, there are gaps in the research around how to best support partners and certain population sub-groups experiencing pregnancy loss.
The Public Health Research (PHR) Programme wishes to commission research on the health impact of interventions supporting women and partners experiencing a pregnancy loss, affects could be positive or negative. Risk factors for pregnancy loss include very young or older maternal age (younger than 20 and older than 35 years), older paternal age (older than 40 years), very low or high BMI, Black and Asian ethnicity, previous pregnancy loss or stillbirths, social deprivation, smoking, alcohol and drug use. A range of biological, socioeconomic or environmental contributors may combine to amplify individual risk and may in turn go on to influence the post-pregnancy loss support that women and partners access and receive.
This call is not focussed on the prevention of pregnancy loss, but rather on interventions to support and improve health outcomes for parents after the experience. The PHR Programme is predominantly interested in interventions operating at a population level rather than at an individual level, which should address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways, and encourages researchers to explore such disparities in their study design.
PHR recognises that this call is broad in its nature but would like researchers to be targeted in their chosen research area. PHR recognises that partnerships can take many forms and the use of the words “parent” and “partner” are used inclusively. The programme also recognises that a small number of births in the UK are to trans men who are also covered in this brief. Suggested research areas of interest could include (but are not limited to):
- Evaluations of interventions to support parents from a diverse range of cultural and socio-economic backgrounds who have experienced pregnancy not ending in live births
- Evaluations of interventions delivered by charities, for example support phone lines, peer-support groups and counselling groups
- Evaluation of interventions aimed to reduce the stigma associated with pregnancy not ending in live births
- Research of interventions aimed at women experiencing pregnancy loss, prior to a subsequent pregnancy
- Explorations of how workplace policy and interventions can support parents experiencing pregnancy loss
- Interventions aimed at supporting women who had experienced termination of a pregnancy. This may be for either reasons of choice or due to medical reasons (e.g. tests showing foetal anomaly)
- Explorations of interventions aimed at intended parents following pregnancy loss through surrogacy
- Research to compare the effectiveness of different types of psychosocial interventions on different types of pregnancy loss
- Research on why some women and/or partners who have experienced pregnancy not ending in live birth do not access support, either through lack of awareness of services, the nature of the services themselves or because of personal preference. Likewise, what are the consequences of the lack of engagement with services.
- Evidence synthesis on the support for women and/or partners who have experienced pregnancy not ending in live birth.
- Explorations of how bereavement interventions for other types of loss can be adjusted and used to support parents experiencing pregnancy loss
Evaluation of interventions targeted at supporting LGBTQ+ people following pregnancy not ending in live births are of interest. Parenthood in LGBTQ+ people is an emerging area where were is little underpinned evidence. Because of this the programme is willing to consider epidemiological research or expanded development of an intervention. Please contact the programme to discuss before applying.
Primary outcomes must be health related a range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of health outcomes, target population group, as well as rationalise the most suitable methodological approach. Researchers are encouraged to consider other outcome measures including the broader determinants of the inequalities of health, which should be specified and justified. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term. Cost-effectiveness, sustainability and data linkage are always of interest to policy makers and the PHR Programme encourages researchers to consider including economic considerations in their application.
Researchers are strongly encouraged to ensure that service users, including people with lived experience from the target audience, are involved in the design and planning of the intervention and/or as potential costed members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practise and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the supporting information for applicants submitting stage 1 and stage 2 applications.