Kriti, 33, from Suryabinayak, Bhaktapur, had always wanted a daughter. When her son turned five, she and her husband decided to try for a second child. In March 2021, she became pregnant. “We were overjoyed for the new little one to join the family,” she recalls.

But, just 10 weeks later, she miscarried at home. “I was in so much pain, sitting in the bathroom, bleeding, and with every drop, I felt my baby’s life slipping away.”

Later, when she went for a check-up at Civil Hospital in New Baneshwar, a gynaecologist brushed off her grief. “You still have a son, right? So what’s there to worry about? There’s no issue with the uterus; in a few weeks, you can conceive again.”

Kriti, who the Post is identifying with a pseudonym for privacy, was told by everyone to ‘try again,’ and had her loss treated as if it didn’t matter. “From my in-laws and relatives to doctors, nobody seemed to understand. I wasn’t even allowed to cry or mourn properly. Everyone said I could conceive again soon. But what about the child I lost?”

Stories like Kriti’s are common in Nepal, says mental health expert Bina Shrestha from Mankaa Kura, a mental healthcare platform providing online counselling. Grief tied to miscarriage or terminated pregnancy due to foetal anomaly is often invisible, pushed aside at home, ignored in families, and trivialised in hospitals.

This ‘silenced grief’ when women are denied the space to mourn openly leaves them vulnerable to lasting mental health problems, says Shrestha.

Globally, there are an estimated 23 million miscarriages annually, which means 44 pregnancy losses each minute. The Nepal Demographic and Health Survey 2022 found that 9 percent of women aged 15–49 have experienced miscarriage.

At Paropkar Maternity and Women’s Hospital in Thapathali, Kathmandu, 522 women received emergency PAC (Postabortion Care) in fiscal year 2023-24, for complications from miscarriage or unsafe abortion.

“We don’t have exact data, as many women experience them at home and only a fraction come to the hospital,” said information officer Ranu Thapa at the maternity hospital.

Following the gynaecologist’s remark that she could again conceive soon, her in-laws pressured Kriti to try for another pregnancy. She became pregnant again in September 2021.

“Everyone around me was so happy. But I couldn’t stop thinking about the baby I had lost,” adds Kriti.

She suffered sleeplessness, loneliness, and depression. Every change in her body from the new pregnancy reminded her of her loss. Whenever she tried to share, people told her she was being ‘too emotional’, so she stopped talking about it altogether.

Research backs her experience. A 2021 Lancet (international medical journal) editorial based on three research articles on miscarriage noted that the condition is too often managed in silence. It pointed out that both health systems and society treat miscarriage as something inevitable. This approach, the journal noted, creates a culture where women are told to ‘just try again,’ while the emotional impact of miscarriage is overlooked.

The result: women are left unsupported, even as miscarriage increases the risk of anxiety, depression, post-traumatic stress disorder (PTSD), and suicide.

When Kriti’s daughter was born, she struggled to bond with her. Later, she went to see a psychologist and was diagnosed with PTSD and depression.

Grief is often described in five stages: denial, anger, bargaining, depression, and acceptance, a framework first introduced by Swiss American psychiatrist Elisabeth Kübler-Ross.

But in the case of miscarriage, women either don’t get the space to go through these phases or must navigate these stages alone, says Parbati Shrestha, project coordinator and counsellor at TPO (Transcultural Psychosocial Organisation), a mental health organisation.

Instead of support, many face blame, she adds. Families accuse women of eating the wrong food, skipping medicine, or somehow causing the loss.

The same was the case with Sudhira (name changed for privacy), from Khariyani in Janakpur, who lost her baby at 14 weeks. After the loss, she started hearing rumours that she had caused the miscarriage by eating something wrong and not being careful.

“I wanted to talk to someone and share my experience, but I realised if I spoke, they would only blame me more,” said Sudhira.

The practice of barring women who miscarry from touching pregnant women or newborns in her village further led her to stay silent.

Now the mother of a three-year-old son, Sudhira says the memory of her lost baby still troubles her. “I haven’t been able to move on… I never got the chance to grieve properly.”

Most hospitals offer little to no mental health counselling for pregnant women, and almost none for those who experience miscarriage, say experts.

Some hospitals make referrals to a psychiatrist or a psychologist only if gynaecologists see a need.

“Although our gynaecology and obstetrics department does not have dedicated mental health counselling units,” says Jamun Prasad Singh, director at the Janakpur Provincial Hospital, “gynaecologists refer patients experiencing distress, infertility, or pregnancy loss to the psychiatry department, which has two psychiatrists and one psychologist.”

Civil Service Hospital follows the same process, according to Jitendra Pariyar, head of the department of obstetrics and gynaecology.

Yet the referral culture and active screening of women who have lost babies seem weak.

Kriti, who visited Civil Hospital for consultations, was never informed that she could see a psychologist. It was the same for Sudhira, who sought post-abortion care at Janakpur Provincial Hospital.

Psychologist Shrestha says this is common across hospitals. What hospitals call ‘counselling’ is often limited to medical advice, like when to try conceiving again after loss, rather than covering the ensuing emotional upheaval and the management process.

There are signs of change, though. Last year, Paropakar Maternity Hospital at Thapathali started a mental health unit with a psychiatrist and a psychosocial counsellor. Psychiatrist Pratistha Ghimire says the programme has offered group counselling to 170 patients, including those with early pregnancy loss or subfertility.

But for patients like Laxmi (Nani) Thapa, a lawyer and psychologist who has endured three pregnancy losses, even Paropakar Hospital feels unsafe. “Even in spaces like Paropkar meant to support solely motherhood, dignified care is largely absent,” she says.

During her third pregnancy loss, Thapa struggled to climb to the fourth floor as she was bleeding. When she tried to use the lift, a security guard pushed her out, saying it was “only for the sick.”

She recalls another incident from last year when she was five months pregnant. Unable to remove her shoes fully because of extreme back pain and swelling, she kept her feet hanging off the bed. The ultrasound staff scolded her rudely for that, saying, “Is this your maternal uncle’s house? Should we open your shoes, queen?” Then another male staff member ridiculed, “Are you even sick? What kind of patient are you?”

In government hospitals, such humiliating experiences are common for pregnant women or those experiencing loss, Thapa adds.

Thapa explains that silenced grief following pregnancy loss is widespread as hospitals and medical practices fail to recognise pregnancy or loss as a condition requiring special care. “People think, ‘Giving birth and experiencing miscarriage is normal; everyone goes through it,’” she says. “As a result, women’s grief is rarely taken seriously by society or the medical system.”

Even government policies reveal an imbalance. Shrestha from TPO points out that while paid maternity leave is guaranteed after childbirth, women who experience miscarriage get no such benefit.

A mother’s identity, psychologist Shrestha from Mankaa Kura adds, is tied so tightly to the presence of a living child that when pregnancy ends in miscarriage, her grief is disregarded. Even though miscarriage brings the same intense physical and emotional pain as labour, she gets none of the rest or support she would have if she had carried the pregnancy to term.

Shrestha stresses that gynaecologists should listen to women who have experienced miscarriage, asking about their emotional well-being instead of offering remarks like, “You can try again in two or three months.” Referrals to counsellors or psychologists are ideal, but even simple, empathetic communication can provide support.

Just as new mothers are taught about breastfeeding after delivery, women who miscarry should be guided through the grieving process and taught strategies for emotional regulation during hospital visits, adds Shrestha, program coordinator at TPO.

Experts suggest hospitals should actively screen women who have experienced miscarriage for mental health issues and refer them to the mental health department for counselling.

Kriti, who still continues therapy, says it was only in therapy that someone finally acknowledged her loss.

“For the first time, someone said, ‘I’m sorry for your loss’ instead of the usual, ‘You can try again,’” said Kriti. “If my gynaecologist had offered that kind of concern during my pregnancy visits, I don’t think my condition would have worsened.”