This is the first study that quantified preferences for supportive care of both men and women affected by RPL and explored the existence of different needs within couples. Overall, men expressed a significantly lower need for supportive care compared to women. Regarding medical supportive care, preferences of both genders were largely similar and in line with the previous study in women by Musters et al.. For the other domains of supportive care, several between-gender differences were observed.
Although the majority of both men and women preferred a doctor that takes the patient seriously, listens, informs on emotional needs, informs on wellbeing and shows understanding, a significantly smaller proportion of men appreciated the last two options (differences of 28% and 22% compared to women, respectively). In addition, the majority of women expressed a need for support from family, friends and peers; men preferred this less. This is in accordance with previous research showing that men are typically more hesitant to disclose their feelings after pregnancy loss.[5, 21] Although men do experience feelings of grief, stress and vulnerability, these emotions may be less manifested.[22, 23] Men are thought to employ different coping strategies compared to women, including ‘active avoidance’ and distractive behavior, related to more frequently observed risk behaviors such as excessive alcohol consumption and smoking.[5, 21] Multiple studies showed that a significant part of men affected by pregnancy loss experienced little support from their social network and a reluctance to share their loss and feelings with them; their family and friends tend to direct their acknowledgement and support largely toward the female partner.[5, 24, 25]
Also in hospital settings where support activities are profoundly targeted on or delivered by women, men have indicated that they feel excluded or marginalized from care compared to their partner. In our study, remarkable gender differences were observed regarding the overall need for supportive care (mean grade 6.8 in men vs. 7.9 in women) and the need for more involvement of the male partner at the RPL outpatient clinic (desired by 37% of men and 70% of women). This seems in contrast with other studies indicating that male partners of RPL couples want to be more included.[11, 14] Multiple explanations may be underlying here. In some men’s responses, a social desirability bias may be present. Various studies on experiences following pregnancy loss showed that it is not uncommon for men to view their role as primarily being a ‘supporter’ to their female partner, leading to a barrier to seek support for themselves.[21, 27-29] Another possibility is that the approach at the clinic and the supportive care as it is currently being offered, do not completely meet the needs of men.
Furthermore, our results suggest that it is important to offer supportive care services to both partners individually. Although men and women may show similar preferences on group level, this does not automatically imply a high level of intra-couple agreement. For instance, while an equal percentage of the total groups of women and men (52%) preferred counselling from a specialized nurse during a next pregnancy, in almost one in five couples the partners had opposing opinions regarding this aspect (level of intra-couple discrepancy 17%). Moreover, in 28% of couples, one partner expressed a need for peer-support, while the other partner did not consider this necessary.
The major strength of this study is that it is the first that quantified the need for different aspects of supportive care of both men and women affected by RPL. In a recent exploratory study in 13 couples with RPL, both members of the couples were interviewed simultaneously on their need for treatment, support and follow-up. This likely resulted in each partner influencing the other’s perspectives, which was also recognized as a limitation by the authors themselves. In our study, the questionnaires returned by both members of each couple were carefully compared and no obvious overlap in their responses was present. This makes it credible that the questionnaires were completed independently of one another (as requested), although we cannot entirely rule out the possibility of some couples having discussed their responses. The study has several limitations. First, it is a single center study and although the sample is representative for our RPL clinic, differences with RPL couples elsewhere may exist, for instance in terms of education level, being relatively high in our population. Second, the panel of supportive care options evaluated in this study was based on previous research restricted to women. It may be that some men desire other possibilities for supportive care, not being covered in this study.
It should be considered to develop supportive care programs for RPL specifically aimed at men, as supportive care in its current form may not entirely suit their needs. In a previous qualitative study, men affected by (single) pregnancy loss expressed a desire for informally catching up with another man with the same experience. In a hospital setting, they suggested the option of a male support worker. Such possibilities may be further explored for men affected by RPL, for instance using focus group research.