About a year ago, Jane Uwera, a 23-year-old university student, faced an unplanned pregnancy that led to a miscarriage due to academic pressure, stress, and financial difficulties.

"I had a lot going on at the time, including my living environment, which was in a school hostel, and I was dependent on the school’s diet. I did not have enough money to look after myself and so many other things that bothered me,” she said.

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Despite her ex-boyfriend’s reluctance to proceed with the pregnancy, Uwera, driven by her religious beliefs, chose to continue. However, her decision faced opposition from friends, given her boyfriend’s dependency on a small government bursary.

"I would say I was in all this alone as friends didn’t support me, and my family back home wasn’t aware that I was pregnant,” she said.

During an exam revision session in a crowded school hall, Uwera began experiencing cramps, initially dismissing them. However, as the cramps intensified, accompanied by bleeding, her friends rushed her to the hospital, where she learned she had miscarried at 27 weeks.

The aftermath was characterised by stigma; students speculated she had undergone an abortion, which worsened her depression, and triggered fear of future pregnancies or relationships.

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Mental health and miscarriage

Adelphine Uwiduhaye, a psychologist at Kigali Psycho-Medical Center, a private mental health clinic, outlined the range of mental health issues following miscarriage, including anxiety, stress, depression, anger, mood swings, and trauma-related fears. Signs include disinterest in daily activities, communication difficulties, altered thoughts, and behavioural changes.

"A lot of people who are affected normally lose interest in their day-to-day activities (like jobs, getting simple chores done, and working out). The communication skills normally lower and it becomes hard for them to communicate with their friends,” she added.

Dr David Mwesigye, a fertility specialist at Women’s Health and Fertility Clinic, elucidated various miscarriage causes, including genetic anomalies, vaginal infections, uterine issues, maternal age, and uterine tumours. He emphasised the impact of lifestyle factors such as stress, trauma, alcohol, smoking, and poor diet.

Mwesigye advises pregnant women to seek early medical consultation, avoid harmful substances like tobacco, alcohol, and drugs, and adhere to prescribed medications. He stressed the importance of prenatal vitamins, stress management, and a balanced diet.

Navigating miscarriage and its mental health repercussions necessitates understanding, support, and proactive self-care measures to foster healing and resilience.

Getting treatment, support

Uwiduhaye provided some tips on how to cope when experiencing mental distress caused by miscarriage.

"Seek support, reach out to friends, family, or a support group that can provide understanding and empathy during this difficult time. Talking about your feelings with someone you trust can help ease the burden.

"Take care of yourself. Prioritise self-care activities such as getting enough rest, eating healthily, and engaging in gentle exercise like walking or yoga. Taking care of your physical health can positively impact your mental well-being.

"Seek professional help. If you find that your feelings of anxiety, stress, or depression are overwhelming and interfering with your daily life, consider seeking help from a mental health professional, therapy can provide a safe space to process your emotions and develop coping strategies.”

She said it is important to allow oneself to grieve, and acknowledge and validate the feelings of loss and grief. "Allow yourself to mourn the hopes and dreams you had for your pregnancy and be gentle with yourself as you navigate through the healing process.

"Practice self-compassion, be kind and compassionate towards yourself during this challenging time. Avoid self-blame and recognise that miscarriage is a common experience that many women go through. Treat yourself with the same kindness and understanding that you would offer to a loved one in a similar situation.”

Engage in relaxation techniques, she recommends, and explore relaxation techniques such as deep breathing, meditation, or mindfulness exercises to help reduce feelings of stress and promote emotional healing.

Uwiduhaye said they offer some online assistance for people with mental problems.

"We have a number that patients call for help but it’s normally for emergencies, but I could still advise a patient to come to the clinic as that’s when they are offered a full package,” she said.

"It’s through contact sessions that we can be able to see the non-verbal communication of a patient, but on a call, we can’t see all of that.”

Uwera also mentioned having a women’s group that unites women facing various mental health challenges, providing a sense of support and solidarity through shared discussions.

"The very first treatment that we offer to people with mental distress is re-assurance, helping the patients to understand that it’s not their fault, because many come thinking that what they did that might have caused the miscarriage, yet it’s not usually on them,” Uwiduhaye said.

"Other treatments involve therapy where the patient is advised to feel free and let the emotions out, they can cry, express the anger within, let the anxiety out, and we advise them to come to the sessions like a couple because the man can help with the journey.”