Breaking the Silence: Why Maternal Health Literacy Is Essential for Miscarriage Care
By: Diana Peña Gonzalez, MPH, MCHES
Keywords: maternal health literacy, miscarriage care, pregnancy loss, reproductive health education, patient empowerment
She sat on the ER waiting room chair, cradling her stomach, panic rising as blood began to soak her clothing and the chair beneath her. She knew she was miscarrying but had no idea what to do or who to ask for help. After hours of waiting, she was briefly examined, given pain medication and reading materials, and sent home to miscarry alone.
She locked herself in the bathroom and whispered to her husband through the door, “Whatever you hear, I’m okay. I just need to do this alone.” Her abdomen was filled with pain that only those who have given birth can understand. When the miscarriage occurred, she reached into the toilet, held what she’d lost, and let go.
My best friend told me this story, but it could have easily been your friend. This story highlights the painful reality that many birthing people experience. The people who bear the physical toll of creating and sustaining human life should be met with dignity, clarity, and compassion, but instead often receive unclear information, a lack of emotional support, and suffer embarrassment, making an isolating experience even more painful. To understand why stories like hers are so common, we must look at maternal health literacy and how it impacts care.
What Is Maternal Health Literacy?
Maternal health literacy is the skills people need to access, understand, evaluate, and use health information during pregnancy. These skills ensure pregnant people can make informed decisions to keep themselves and their fetus healthy (Putri & Lu, 2024).
Who Is Impacted by Low Maternal Health Literacy?
Research shows that 72% of low-income mothers have low maternal health literacy, even if they have a higher level of education (Lee et al., 2022). Low maternal health literacy is especially prevalent among racial and ethnic minorities, rural residents, and those with lower education (Bello et al., 2022; Edum-Fotwe, 2010).
While maternal health literacy equips individuals with the tools to make informed decisions during pregnancy, it does not exist in a vacuum. According to a 2025 scoping review, women from socioeconomically disadvantaged or ethnic minority backgrounds face layered challenges, including language barriers, limited awareness of danger signs, and mistrust or unfamiliarity with healthcare services that increase their risk of stillbirth and related complications (Kim et al., 2025). These disparities persist despite efforts to improve personal health literacy, highlighting that deeper systemic issues drive miscarriage care inequities.
Systemic Issues in Miscarriage Care
Public Policy
Currently, there are no federal guidelines that mandate the reporting of miscarriages. Instead, each state determines its reporting requirements, and many only require reporting fetal deaths after 20 weeks of pregnancy, leaving miscarriages unreported and misunderstood (Gregory et al., 2025; Studnicki et al., 2016).
Community Awareness
An estimated 25% of pregnancies end in miscarriage (Lee et al., 2022). However, public awareness drastically underestimates this reality, with people believing miscarriages occur at a rate of only 5% (Bardos et al., 2015; Cesare et al., 2020). This belief perpetuates stigma and shame. Research on miscarriages has focused on white, middle-class, heterosexual couples, neglecting the groups disproportionately impacted (deMontigny et al., 2020).
Institutional and Organizational Barriers
Most patient education materials produced by the leading obstetrics and gynecology societies are written at a 9th to 12th-grade reading level (Fahimuddin et al., 2019). This means 54% of Americans who read at or below a 6th-grade level (Kutner et al., 2006) are likely not receiving clear, accessible information.
4 Actionable Solutions to Improve Miscarriage Care
1. Empower Patients with Advocacy Scripts
Tell patients to ask clear questions, such as:
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“Can you show me a picture of what to expect?”
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“What’s the ONE symptom I should look out for?”
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“Who can I call at 2 AM if I need help?”
2. Improve Organizational Practices
3. Support Policy Reform and Advocacy
Support data equity and policy reform through organizations like:
4. Normalize Conversations About Miscarriage
Share clear information with materials comparing myths versus facts:
Amplify awareness by sharing helpful resources, such as PBS NewsHour’s short video on miscarriage.
Conclusion
As health literacy professionals, we have a responsibility to do more than offer treatment; we must offer understanding, empathy, and clear and accessible information. When prioritizing maternal health literacy, we equip people with the tools to face one of life’s most vulnerable moments with clarity, dignity, and real support. By breaking the silence around miscarriage, we don’t just improve care, we restore trust and humanity to the patient’s experience. Whether you’re a provider, policymaker, or someone who’s been through it yourself, your voice matters. Let’s work together to make sure no one must face miscarriage in silence.
Whether you have experienced miscarriage firsthand, supported someone through it, or work in a setting connected to this kind of care, your perspective matters. We invite you to share a story, a resource, or an idea about how we can continue this conversation and improve the quality of care. Together, we can make sure no one has to face miscarriage alone or without support.
References
- Bardos, J., Hercz, D., Friedenthal, J., Missmer, S. A., & Williams, Z. (2015). A national survey on public perceptions of miscarriage. Obstetrics & Gynecology, 125(6), 1313-1320. https://doi.org/10.1097/AOG.0000000000000859
- Bello, C. B., Esan, D. T., Akerele, S. A., & Fadare, R. I. (2022). Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria. Public Health in Practice, 3, 100266. https://doi.org/10.1016/j.puhip.2022.100266
- Cesare, N. L., Oladeji, O., Ferryman, K., Wijaya, D. T., Hendricks-Muñoz, K., Ward, A., & Nsoesie, E. (2020). Discussions of miscarriage and preterm births on Twitter. Paediatric and Perinatal Epidemiology.
- deMontigny, F., Verdon, C., Meunier, S., Gervais, C., & Côté, I. (2020). Protective and risk factors for women’s mental health after a spontaneous abortion. Revista Latino-Americana de Enfermagem.
- Edum-Fotwe, E. (2010). Comparison of maternal health literacy between rural and urban women in Komenda-Edina-Eguafo-Abrem district of Ghana. [Thesis, University of Cape Coast]. http://ir.ucc.edu.gh/jspui/handle/123456789/1143
- Fahimuddin, F. Z., Sidhu, S., & Agrawal, A. (2019). Reading level of online patient education materials from major obstetrics and gynecology societies. Obstetrics & Gynecology, 133(5), 987-993. https://doi.org/10.1097/AOG.0000000000003214
- Gregory, E. C. W., Valenzuela, C., & Hoyert, D. (2025). Fetal mortality: United States, 2023. National Vital Statistics Report.
- Kim, J., Heazell, A. E. P., Whittaker, M., Stacey, T., & Watson, K. (2025). Impact of health literacy on pregnancy outcomes in socioeconomically disadvantaged and ethnic minority populations: A scoping review. International Journal of Gynaecology & Obstetrics, 168(1), 69-81. https://doi.org/10.1002/ijgo.15852
- Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. National Center for Education Statistics.
- Lee, L., Ma, W., Davies, S., & Kammers, M. (2022). Toward optimal emotional care during the experience of miscarriage: An integrative review of the perspectives of women, partners, and health care providers. Journal of Midwifery & Women's Health.
- Putri, A. P., & Lu, Y. Y. (2024). Maternal health literacy in pregnant women: A concept analysis. Maternal and Child Health Journal, 28(8), 1272-1282. https://doi.org/10.1007/s10995-024-03945-z
- Studnicki, J., MacKinnon, S. J., & Fisher, J. (2016). Induced abortion, mortality, and the conduct of science.
About the Author:
Diana Gonzalez, MPH, MCHES, is a public health leader at the Health Literacy Solutions Center, dedicated to advancing equity, accessibility, and inclusive health communication. She is currently pursuing her EdD at Johns Hopkins University, researching maternal health literacy and organizational strategies to improve experiences and outcomes related to pregnancy loss.
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