Challenges and opportunities of providing evidence based perinatal psychological care for couples with stillbirth (SB) in Lagos Nigeria

撒哈拉以南非洲面临着最高的死产负担，尼日利亚占全球死产负担的12%左右（每年约有31.4万例死产），估计死产率为每1000例分娩42.9例。死胎会给妇女、其家庭、保健提供者和更广泛的社会带来巨大的心理、社会、经济和无形成本。SSA国家的死产给母亲带来了许多挑战，包括健康状况不佳、悲伤、悲伤和应对社区观念。死产后母亲的悲伤经历因身体内死亡的生物学事实而进一步复杂化；产生焦虑、失败和内疚的感觉。研究表明，行会和羞耻感在预测后期悲伤的强度方面起着非常重要的作用。父亲并没有被排除在这些困难之外。在死胎夫妇中观察到抑郁、焦虑、创伤后应激障碍和婚姻破裂的高发率。对于SSA的许多夫妇来说，从死产中恢复需要很长时间，在许多情况下，只有当另一个孩子出生并存活下来时，其他一些人永远不会康复。在尼日利亚和SSA的许多地方，这对夫妇的悲伤因许多社区根深蒂固的文化习俗和信仰而进一步加剧。许多非洲社区将死产归因于神灵或超自然力量，因此失去亲人的父母避免公开埋葬和表现悲伤，担心这样的行为会引起未来的恶意或导致不孕。在许多非洲传统中，死产的妇女被指控为人工流产，死产的夫妇被禁止哀悼，而那些反复失去孩子的人则受到指责、虐待和羞辱。在大多数非洲社区，对死胎的这些严厉的传统价值判断导致了高度的耻辱，并迫使许多夫妇对死胎保密。卫生系统的问题：除了社区的耻辱感之外，经历死产的母亲往往被忽视的助产士和其他围产期卫生工作者往往侧重于孕产妇和儿童健康。许多卫生工作者没有能力处理死产带来的悲痛。此外，研究表明，许多医疗保健提供者可能是逃避型的，感到无助和内疚，或者当婴儿死亡时，他们可能会经历一种失败感。许多卫生工作者不具备处理围产期丧亲护理的能力。此外，大多数死产后护理指南反映了西方社会文化观点，鉴于死产的社会文化规范和细微差别，可能不适合非洲环境。为了设计一套有效的、社会文化上可接受的对尼日利亚死产夫妇的护理和支持干预方案，有必要首先详细了解社区中与死产有关的特殊社会文化问题，以及需要预防的死产的具体心理和社会影响。受影响夫妇对围产期丧亲护理的偏好和看法以及卫生系统提供干预措施的挑战和机遇。该提案的预期结果：该提案的结果将使人们更深入地了解尼日利亚和其他撒哈拉以南非洲国家对死产的社会看法，这是朝着减少与死产有关的孤立、悲伤和耻辱迈出的关键一步。它还将深入了解死产的心理和社会负担，列举向死产夫妇提供与社会文化相关的丧亲护理的挑战和机遇，最重要的是，它将导致制定和可行性评估一揽子干预措施，以支持和照顾尼日利亚的死产妇女

Sub-Saharan Africa faces the highest burden of stillbirths with Nigeria contributing around 12% of global burden of stillbirth (with about 314,000 stillbirths/year) and an estimated stillbirth rate of 42.9 per 1000 births . Stillbirth is associated with substantial psychological, social, economic and intangible cost to women, their families, healthcare providers and the wider society . Stillbirth in SSA countries brings many challenges to the mother including poor health, grief, sadness, and coping with community perceptions. The mothers' grief experiences following stillbirth are further complicated by the biological fact of death occurring within the body; generating feelings of anxiety, failure, and guilt. Studies have shown that guild and shame plays a very important role in predicting the intensity of later grief . The father is not left out of these difficulties. High rates of depression, anxiety, post-traumatic stress disorders and marital breakup has been observed in couples with stillbirth. For many couples in SSA, it takes a long time to recover from stillbirth, and in many instances only when another baby is born and survives, some few other never recovers. In Nigeria and many parts of SSA, the couple's grief is further compounded by many of the communities deeply rooted cultural practices and beliefs. Many Africa communities attribute stillbirth to spirits or supernatural powers, so bereaved parents avoid public burials and displays of grief, fearing such action could evoke future malice or lead to infertility. In many Africa traditions, women with stillbirth are accused of induced abortion and couples with stillbirth are forbidden from mourning and those who repeatedly lose their babies are blamed, mistreated, and dishonored. These harsh traditional value judgments about stillbirth in most African communities' results in high level of stigma and pushes many couples to keep stillbirths a secret. Problem with health systems: Apart from the stigma from the community, mothers who experience stillbirths are often overlooked midwives and other perinatal health workers who tend to focus on maternal and child health. Many health workers are ill equipped to handle grief that comes with stillbirth. Also, studies have shown that many healthcare providers may be avoidant, feel helpless and guilty or they may experience a sense of failure when the baby dies. Many health workers are not equipped to handle perinatal bereavement care. Also most of the guidelines of care after stillbirth reflect the western sociocultural perspectives and may not be appropriate in the African setting in view of the socio-cultural norms and nuances regarding stillbirth. In order to design a n effective, sociocultural acceptable intervention package of care and support for couples with stillbirth in Nigeria, it is necessary to first have a detail understanding of the peculiar sociocultural issues regarding stillbirth in the community, the specific psychological and social impacts of stillbirth that needs to be prevented, the preferences and perception of the affected couple to perinatal bereavement care and the health systems challenges and opportunities for delivering the intervention. Outcome expected as immediate result of the proposal: TThe results of this proposal will provide a deeper understanding of social perceptions of stillbirth in Nigeria and other SSA countries which is a crucial step towards reducing the isolation, grief, and stigma attached to stillbirth. It will also provide insight into the psycho-social burden of stillbirth, enumerate the challenges and opportunities for providing socio-culturally relevant bereavement care to coupes with stillbirth and most importantly lead to the development and feasibility assessment of an intervention package for support and care for Nigerian women with stillbirth