Discussion
miscarriages, ’
MISCARRIAGES, MISCARRIAGE
This qualitative analysis of FGD data considered the reasons for which women in urban Gambia might choose to conceal a pregnancy. It identified ‘pregnancy outside of marriage’ and ‘evil spirits and miscarriage’ as two distinct reasons a woman may wish to conceal a pregnancy, including from healthcare workers by not attending early ANC.Women were understood to conceal those pregnancies which occurred outside of marriage for as long as possible. Previous research in The Gambia has shown that not wanting to be the subject of gossip and avoiding the stigma of unwed motherhood drive this type of concealment among women of various ethnic groups [Regarding the question of miscarriage attributable to evil spirits, participant familiarity with both the phenomenon and individuals who have suffered such miscarriages indicates that far from an isolated or fringe cultural belief, the presence of spirits continues to inform lived pregnancy experiences for many women in The Gambia as it does other aspects of daily living. Indeed, as anthropologist Susannah Chapman has described for The Gambia, ‘it is not uncommon for If public disclosure of a pregnancy is understood to be extremely dangerous to the life of the foetus on account of harm from spirits, active concealment and reluctance to speak about a pregnancy may be read not as negligence born of ignorance of biomedical treatments and interventions, but rather, a considered act of care practiced by the woman for the benefit of her motherhood. Study participants were aware that early ANC attendance would have certain beneficial health outcomes. Yet some women continued to conceal pregnancies for the threat of evil spirits, revealing that this fear of spiritually-induced miscarriage can outweigh the recognized benefits of attending ANC early. In other words, though traditional beliefs and biomedical knowledge around causality may exist together in The Gambia, that does not mean they are weighted equally in all situations.While several studies have identified concerns about evil spirits as a driver for women to conceal pregnancies in Gambia and elsewhere across SSA [Both the fear of social stigma associated with unwed motherhood and fear of miscarriage caused by evil spirits can lead to late ANC attendance on account of non-disclosure of pregnancy in the early months. The invocation of such terms and beliefs as ‘spirits’ may appear to some biomedical practitioners as irrational or without basis. However, we can consider evil spirits as a motivation for concealment to exist, like social stigma related to being an unmarried mother, as a reflection of the multiple considerations, both medically and culturally informed, mothers must entertain in the name of caring for and protecting their unborn children. Further, there have been some noted links between gossip about a pregnancy (as was discussed by participants in relation to unmarried mothers) and miscarriage: gossip can alert evil spirits to the pregnancy in the first place, thereby making the mother a target [We call attention to the ways in which Gambian women’s concealment of pregnancy shares characteristics with other pregnancy (non) disclosure strategies already substantially accounted for in academic and clinical literature in relation to the Global North, and which all share the characteristic of being a way to manage uncertainties and fears [