Prepared by: Mary Gibbons
HDFS Graduate Student mary.gibbons@okstate.edu
Kami L. Schwerdtfeger, Ph.D., LMFT
HDFS Faculty
Stillwater, OK 74078 kami.schwerdtfeger@okstate.edu
Schwerdtfeger, K. L., & Shreffler, K. M. (2009). Trauma of pregnancy loss and infertility among mothers and involuntarily childless women in the United States. Journal of Loss and Trauma (14) 3, 211-227. doi:
10.1080/15325020802537468
IMPLICATIONS FOR COOPERATIVE
EXTENSION: The findings show that women experiencing pregnancy loss and involuntary childlessness experience long-term, traumatic effects on their psychological well-being.
Unfortunately, it also tends to be a private experience that often goes unrecognized by professionals and the community at large.
Given that social support plays an important role in buffering the psychological impact of this trauma, it is important that professionals work towards building greater awareness and services for this population. By reducing the stigma that these women feel, they will be more likely to seek out help. In addition, by better understanding the experience of infertility and pregnancy loss, professionals will be better able to assist these families in a meaningful and compassionate way.
Overview:
In 2007, the National Survey of Fertility
Barriers (NSFB) found that almost 30% of women experience fertility problems, either difficulty conceiving or carrying a pregnancy to term. Because of this significant statistic, researchers have increasingly turned their attention to the subject of infertility and women. The study hypothesizes that there will be elevated levels of distress in this population when compared with women who had not experienced a loss. A traumatic event is one that involves threatened or actual loss where the person’s response is one of “intense fear, helplessness, or horror” (APA, 2000, p. 467).
Method:
Sample: This study was based on data gathered from the National Survey of Fertility
Barriers between 2004 and 2007 during a random-digit-dial nationally representative data set. Participants were females of child-bearing age (25-45). Of the 4,712 women that were called, 2,894 chose to participate. The sample was divided into four groups: mothers who did not experience fertility problems (n=1,444) , mothers who experienced pregnancy loss
(n=1,107), childless women who experienced pregnancy loss (n=104), and involuntarily childless women who had not yet conceived and considered themselves to be infertile (n=239).
Information was gathered about participants’ fertility status, psychological status, fertilityrelated distress, and other moderating variables including social pressure and relationship quality. Data was weighted as to ensure the pregnancy loss. Many studies have shown a relationship between pregnancy loss and posttraumatic stress disorder; however, few have explored the possible trauma induced by the loss. This study is noteworthy as its focus is on traumatic psychological outcomes of pregnancy loss among mothers and involuntarily childless sample was representative of the national population regarding fertility barriers, education, race, and household income.
Measures: Information on fertility status was gathered by asking several questions.
Mothers, no fertility problems were categorized as such if they answered “yes” to the question,

“Have you ever given birth?” and failed to indicate any biomedical barriers to conceiving.
Participants were categorized as mothers, pregnancy loss if they currently have children but answered “yes” to the question, “Have you ever had a miscarriage?” The childless, pregnancy loss group answered “yes” to having a miscarriage, but haven’t given birth. Lastly, participants were categorized as childless, infertile if they answered “no” to the question,
“Have you ever been pregnant?” and indicated a biomedical barrier to conception.
Psychological outcomes were broken down into three groups: life satisfaction, depression, and self-esteem. Life satisfaction was assessed on a scale ranging from 1 (low satisfaction) to 4 ( high satisfaction) . Depression was measured by a modified CES-D (Center for Epidemiologic
Studies-Depression) scale (Radloff, 1977).
Items were coded or reverse coded so higher scores indicated higher depression. Self-esteem was measured using three scale questions, which were coded so that high scores indicated higher self-esteem.
Fertility related distress was measured by asking the following, dichotomous ( yes =1, no =0) questions, “I felt cheated by life,” “I felt that I was being punished,” “I felt angry at God,” “I felt inadequate,” “I felt seriously depressed,” and “I felt like a failure as a woman.”
Finally, moderating variables were measured.
Social pressure was assessed by asking a scale question, “How important is it to your parents and spouse/partner that they have children?”
(0= not at all important , 8= very important ).
Relationship quality was determined by asking participants how happy they were with their relationship (1= not too happy , 3= very happy ).
Results:
Supporting the hypothesis, the results show that mothers who reported no fertility barriers or pregnancy loss had significantly lower depression and significantly higher life satisfaction ( p< .001). Childless women (either infertile or experienced a loss) had lower life satisfaction on all measures when compared with mothers who had experienced a loss. The group that fared the worst in reporting the greatest levels of fertility-related included childless women who had experienced a loss.
When moderating variables were considered, no significant differences were found in regard to education level, race/ethnicity, income, , union status, or rural/urban residence. However, there were two significant differences when considering relationship quality and social pressure. Women that reported the greatest feelings of social pressure and lowest relationship satisfaction also reported the highest levels of fertility related distress.
Discussion:
This is a preliminary study on the traumatic effects of pregnancy loss and infertility among mothers and involuntarily childless women. When compared with mothers with no fertility problems, this population showed significantly lower life satisfaction and self-esteem and higher levels of depression. In addition, the study suggests that pregnancy loss may further compound distress for those women already dealing with involuntary childlessness.
Most other studies related to pregnancy loss are conducted within a year of the event. This study is unique in that the data was gathered almost a decade after the loss or attempted pregnancy.
Therefore, the research highlights the negative, long-term impact of pregnancy loss and infertility on women.