"The Impact of Culture on Grief Experiences After Stillbirth for Mothers Living in Sub-Saharan Africa: A Systematic Review and Meta-synthesis"

Abstract

Objective: The highest burden of stillbirth occurs in sub-Saharan African countries, where cultural norms, religious beliefs and community understandings of stillbirth can significantly influence how the community may understand stillbirth, as well as how mothers grieve. Through four research questions, this study aimed to explore how culture impacts mothers’ grief experiences after stillbirth. Methods: A systematic review and meta-synthesis was conducted using a meta aggregative approach to create synthesised findings. Five databases were searched from inception until January 2023, with eligible studies appraised for quality using the QualSyst Quality Assessment Checklist. Results: Sixteen studies contributed to the four final synthesised findings: (i) after stillbirth, most mothers endure a complex and overwhelming emotional experience that encompasses blame, guilt, relationship impacts and long-term coping efforts including hope and gratitude; (ii) stillborn babies are often not recognised as human by communities, with mothers finding it difficult to understand their stillbirth, attributing it to religious or spiritual explanations; (iii) cultural and societal norms place high value on motherhood, with mothers questioning their identity and pressured to internalise their emotions; and (iv) mothers want accurate and timely information, consistent hospital care, opportunities for memory-making and support from family and community. Conclusion: This meta-synthesis emphasises the need for guidelines to ensure appropriate and supportive care is provided to mothers in sub-Saharan Africa following stillbirth. Additional research across sub-Saharan Africa is required to understand the nuances in various cultural norms and religious beliefs regarding stillbirth and how this impacts mothers’ grief experiences. Effective guidelines would consider these nuances and address the impact of cultural/societal norms on support provided.