Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana

Abstract

The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.