When the doctor told Rajita that he couldn’t find her foetus’ heartbeat during an ultrasound, she was heartbroken. It was her first pregnancy. At 12 weeks, she was told to take a pill that would result in a medical abortion and Rajita passed the pregnancy tissue at home. She hadn’t told anyone about her pregnancy, apart from her husband and parents, and she didn’t know anyone else who had had a miscarriage.

“For the longest time, I felt guilty and suffered in silence,” said Rajita, who like other women interviewed for the story, requested to be identified by pseudonyms because they feared being stigmatised.

Rajita is not alone in fearing that her miscarriage will lead to social shaming and stigma, many times by family members themselves who blame women for the miscarriage. According to the Nepal Demographic Health Survey 2016, nine percent of pregnancies across the country result in miscarriage. The World Health Organization regards miscarriage as one of the most common reasons for losing a baby during pregnancy. Estimates from the UN body suggest that globally about 10 to 15 percent of pregnant women, on average, miscarry. But despite how common the phenomenon is, miscarriages continue to be associated with secrecy, taboo and shame, leading to emotional distress and anxiety.

“However early in the pregnancy, it is still the loss of a baby, and the loss is sudden,” said Dr Suman Prasad Adhikari, a psychiatrist and executive director at the ManoShastra Counselling and Research Center. “At that time, many women may not have told anyone about their pregnancy, leaving them to grieve alone, without any emotional support.”

According to Adhikari, while the miscarriage itself is a traumatic event, suffering in silence only leaves women at increased risk of mental health sequelae. According to research, those not offered the opportunity to discuss their feelings show anxiety, among other mental health problems. It is estimated that 30 to 50 percent of women experience symptoms of anxiety and 10 to 15 percent experience depressive symptoms after miscarriage.

Adhikari believes that most women don’t discuss their miscarriage because they don’t find other women talking openly about it. Even in Rajita’s case, prior to her miscarriage, she didn’t know anyone else who had experienced a miscarriage, and no one had talked to her about what happens when pregnancies go wrong. So when she went through the miscarriage, she blamed herself.

“I felt that I might have done something to cause this. I was embarrassed of myself and I used to cry every day. I felt like I was slipping into depression,” said the 30-year-old from New Baneshwor.

For Rajita, opening up and talking about her traumatic experience with others who had also experienced miscarriage eventually helped her cope with her grief and get much-needed emotional support.

“When I finally talked about it with my family, I was surprised to learn that both my mother and aunt had suffered from early pregnancy losses,” she said. “I realised that I wasn’t the only one.”

The reluctance to talk about miscarriage stems from the societal stigma that is associated with losing a baby, women say. When Subina had her first miscarriage three years ago, her in-laws held her responsible for the loss.

“While I was bedridden with excessive bleeding during the miscarriage, my in-laws accused me of being careless during my pregnancy. Instead of giving me emotional support, they blamed me,” said Subina, who was 24 at the time.

In Subina’s case, things were so bad that she was forbidden from going near other pregnant women.

“I was treated like someone who would bring bad luck to other pregnant women. I was treated as an untouchable,” she said. “What hurt me more than the miscarriage was the treatment that I received from my family and society.”

Things only got better when she finally gave birth, she said.

There are a wide range of factors attributed to a predisposition to miscarry, ranging from foetal anomalies, age at pregnancy, infections, smoking, and stress. But regardless of the cause, there is almost always a stigma, which has consequences on women’s health. Researchers believe that miscarriage is one factor that can trigger low self-esteem among women.

Hospitals prioritise the physical aspect of the miscarriage but don’t focus much on the psychological, said Adhikari.

Hospitals need to carry out a psychosocial assessment for women who have recently suffered from a miscarriage, according to Adhikari. Such an assessment, which takes sources of support, quality of relationships, and recent life stressors into account, would help health professionals identify women at a high risk of depression so that they can be offered preventive interventions.

Dr Surya Prasad Rimal, a gynaecologist at the BP Koirala Institute of Health Sciences, believes that the stigma surrounding miscarriage will only end once women themselves begin to speak up.

“Many women may not want to share the news of their miscarriage,” said Rimal. “But if they share their experiences, others who have also suffered similarly won’t feel lonely and emotionally isolated.”