“Leaving the hospital empty-handed was the worst. Where could I go?”. Silvia pauses as she wipes her tears. The silence in our conversation reflects the silence she encountered when she lost her baby boy Victor a few years earlier. Towards the end of her (otherwise non-problematic) pregnancy, Silvia had felt unwell and had visited a hospital in Bucharest, where she underwent an emergency C-section as soon as doctors detected a placental abruption. Nobody informed her about her condition; nobody told her what was going to happen. She just remembers how, not much later, she got a glimpse of her baby being resuscitated on a table in the operating room. Her repeated questions about his well-being were met with silence. It was her husband who, after the surgery, told her that she had lost both her baby and her uterus in the process. Silvia’s desperate attempts to see the boy that she had wanted to call Victor were in vain. Access to the anatomic pathology lab was restricted and nobody was willing to take him out of there, for Silvia to hold him for the very first and very last time in life. It is a profound feeling of emptiness – in her arms, in her belly, in her life – that pervades her memories of the immediate aftermath of the loss. In the years after, this feeling would only grow as she encountered more instances of silence and social exclusion.

In Romania, parenthood is considered a major achievement in life. To start a family is not only the expected, but for many also the desired, next step after getting married and building or buying a house. However, the pervasive financial insecurities, crumbling social welfare services, perceived lack of opportunities and increasing emigration resulting from post-communist reforms seriously impede processes of family formation. Most people cannot afford to start the family-building process until their late twenties, and choose to have only one child, or two at most. In this context, the pregnancies that they conceive often come with considerable hopes and investments (for those who can afford it); their potential losses are rarely considered. Even Silvia, who got pregnant when she was 35 years old and who saw this as one of the last opportunities to reach the goal of motherhood after a long medical training and career, never imagined that the pregnancy would not end well. Generally, people tend to be profoundly disappointed, then, when their reproduction goes awry.

It is these unexpected moments of loss that I have studied as an anthropologist, over 15 months between 2012 and 2015. In a semi-urban and urban setting in Brașov county, as well as in Bucharest, I met a wide variety of women who had all experienced one or another form of loss: miscarriage, stillbirth, or the death of a baby around or after birth. I listened to these women’s stories and tried to get a sense of the environment in which they had had to deal with their misfortunes by “hanging around” in maternity hospitals, by observing prenatal and parenting courses, by attending self-help groups for parents mourning their dead babies, and by visiting online fora where bereaved parents discussed their experiences.

Almost all women with whom I talked expressed intense regret about the lost hopes of their future babies, or lamented the painful absence of a child they had seen, held, and loved. Deprived of the life-long intimate bond that they had imagined for themselves and the baby, they often experienced deeply-felt emptiness and loneliness. But they commonly asserted that they had lost more than just this intimate connection with the child; in the process of loss and mourning, they had also become disconnected from their social surroundings. Irrespective of the exact nature and cause of their losses, all women denounced various societal dynamics in present-day Romania that, in their own words, had made the experience even worse. Their sense of isolation and exclusion was fed by the reactions of the medical professionals and religious clergy they consulted for medical and spiritual care, as well as by the opinions of people in their social networks to whom they turned for day-to-day support.

First, in Romanian public hospitals, where all women with reproductive problems end up (as private clinics only accommodate uncomplicated cases), reproductive losses are dealt with quickly and uniformly. Women were critical of the poor, or even absent, communication with doctors handling their uncertain situations. Not only were few words spent on the state of the pregnancy or the baby when loss was imminent; there was also very little follow-up enabling women to deal with their emotions after the loss had happened. In Silvia’s case, the silence was omnipresent and only broken by her husband – himself in shock – who was asked to transmit the bad news to his wife. Doctors with whom I spoke recognized the importance of a psychological care provider, but claimed that financial resources were too limited to ensure such support in public hospitals. Additionally, they felt that their own heavy workloads, their psychological stress, and their lack of training prevented them from providing women with appropriate support themselves.

Lack of information regarding the whereabouts of a dead fetus or baby was also a key concern. Children that show no sign of life upon birth are immediately taken away, and are rarely mentioned or shown to the parents afterwards. There is no clear law in Romania stipulating how medical professionals should deal with “products of conception” (before 26 weeks of gestation) or stillborn babies (after 26 weeks of gestation). Some Civil Code articles, however, mention that “a child that is born dead does not exist” (art. 654) and that “the rights of a child are recognized from the moment of conception, but only if he is born alive” (art. 36). In line with such conceptualizations, hospital workers told me that lifeless fetuses are by default sent for laboratory investigations to establish the cause of death, and then incinerated together with other forms of “medical waste”. Fetal remains are, in other words, dehumanized and rendered invisible in the system.

Officially, parents do have the possibility to contest such medical procedures and take their lifeless fetus home instead, but it requires several bureaucratic steps (order 359/2012) of which most are unaware. Like Silvia, the majority returns home empty-handed. Not even the paperwork received upon discharge acknowledges the previous existence of their little one: pregnancy losses before 26 weeks are referred to as “abortions” for which often no paperwork is completed; a death certificate for a fetus stillborn after 26 weeks of gestation does not include any first name; and contrary to the law on birth registration (law no. 199/1996), those who are born alive but die soon afterwards often do not receive a birth certificate. This emptiness in the records exacerbates the emptiness many of my research participants physically experienced when leaving the hospital after loss.

Second, the Romanian Orthodox Church to which parents may turn for emotional relief after loss often leaves them feeling excluded rather than spiritually supported. This has to do with the perceived spiritual status of their little ones. All Orthodox priests with whom I spoke explained that, according to the Orthodox belief, there is no significant distinction between aborted fetuses, miscarried fetuses, stillborn babies, and even children that were born alive but died before baptism. The dividing line is not between early and late pregnancy losses or between fetuses that died as a result of a willful act and those that left spontaneously. Rather, what matters is the distinction between unbaptized and baptized babies. Baptism occurs from the fortieth day after birth and officially initiates a baby into the religious community by giving it an Orthodox name, identity, and life-long spiritual protection. Upon their death, baptized members of the community are entitled to a funeral service and a proper burial place in the Orthodox cemetery, while those who died before being baptized are, at best, buried without a full service and without a tombstone, at the margins of the graveyard, next to those who committed suicide. Unlike those who received the blessing of baptism, these babies are said to continue their afterlife in a “dark world” rather than in heaven. Lacking an official Orthodox name and identity, unbaptized babies cannot be commemorated in the usual way either.

Many bereaved mothers felt that, by indistinctively excluding all deceased unbaptized babies from the customary services, the Orthodox Church misrecognized their previous existence. They called such exclusion an unfair act of “painful discrimination”. In an online forum, one woman wrote: “There is no difference between a hospital that incinerates [dead fetuses] and the church that, instead of saying a small prayer for their soul – which does not have any personal sins – throws them at a margin of the cemetery like a kitten or a puppy”. Like the procedures of disposal and discharge in the hospital, women felt that the rules and regulations in the Orthodox Church rendered their little ones invisible and irrelevant.

But they also felt unseen as mourning mothers. This is because they were often subjected to rituals of confession and repentance similar to the ones used to relieve the sin of induced abortion. In such rituals, explicit reference was sometimes made to the act of “getting rid of the child” despite the fact that they had lost their babies against their will; at other times, their previously committed sins were invoked as a potential cause of the loss. Either way, Orthodox priests would generally propose a personalized process to find redemption. This process usually involved a period of exclusion from the Orthodox service, of inner prayer and reflection, and of moral redress through fasts, alms and good deeds. Only when sufficient moral “work” had been done would a bereaved mother regain access to service and the larger Orthodox community. Some of my interviewees claimed to have found great psychological relief going through this process; it helped them to find the space and silence they needed to come to terms with the loss. But quite a few others were critical of the cloud of culpability in which the Orthodox Church shrouded their loss. They experienced the imposed exclusion and moral regime as punishments which overlooked, and even aggravated, their feelings of emptiness, sadness, and isolation.

The third area of contention relates to the daily-life social world within which women try to make sense of their loss. Most complained about the absence of a space to talk about what happened. Any attempts in this direction would quickly evoke reactions such as: “don’t think about it anymore,” “don’t cry,” “maybe it’s better like this,” or “you are young and can have another one.” In Romania, reproductive mishaps are silenced for various reasons. The general idea is that excessive mourning and speaking about the dead would be bad both for the mourner and for the deceased. In the Orthodox belief system, the realm of the dead and the realm of the living are distinct; this separation can be seen in church where prayers and candles for living people (vii) are separated in time and space from those for the dead (morţi). Commemorative practices, though very present in Romanian daily life, are confined to special days devoted to the deceased only. Invoking the deceased or crying about them beyond such regulated moments would dangerously blur this order and bother both the mourner and the spirit of the deceased.

Public speech about reproductive loss is also perceived to be potentially dangerous for anyone listening to it. Apart from being potentially painful or creating uncomfortable situations, words about loss are feared to be “contagious.” For this reason, bereaved mothers are told to refrain from mentioning their loss especially in the presence of pregnant women; having them think or talk about a reproductive misfortune could cause exactly that. Silencing the event renders it non-existent and thereby harmless to others.

Several interviewees also linked the silence around pregnancy loss to the past communist oppression. Between 1966 and 1989, dictator Nicolae Ceauşescu had subjected the Romanian population to extreme pro-natalist interventions, such as an abortion ban (the infamous Decree 770), the unavailability of contraception, forced gynecological examinations, and a childlessness tax. Under his regime, any form of reproductive loss was suspicious and liable to police investigation and/or punishment. If it happened – which it did frequently, given that women increasingly found illegal means to abort the pregnancies they did not want – it was unwise to publicly reveal any information about it, even in the smallest social circles. As a result, reproductive misfortunes became shrouded in silence; when revealed, they were treated as suspicious and politically problematic. Although the political landscape changed drastically after the Revolution, some claim that remnants of the past are still visible today, when any public mention of pregnancy loss is generally met with unease and a desire to avoid the topic altogether.

Not only verbal but also visual recollections of reproductive loss are perceived to be damaging. Pregnant women are discouraged from buying clothes or furniture for their expected child because the presence of these items would be too painful a contrast with the baby’s absence, should reproduction go awry. Those who actually lost their babies are advised, by priests and by others, to give away any of their baby’s items as alms to needy children. Other visual clues that could be used in practices of commemoration are generally taken away too. As such, the women I spoke to often felt that not only their deceased babies were not welcomed into their social circles, but they themselves, as mourning mothers, had no place there either. They found this social obliteration of reproductive loss the most painful manifestation of misrecognition – since it was not coming from doctors or priests, but from those to whom they used to be most closely connected.

It is these different forms of emptiness and exclusion that awaited Silvia after she left the hospital as well. She felt less affected by the Orthodox exclusions, because she did not identify as actively religious. But she said there had been no space to share her sadness about Victor anywhere – not with her husband (with whom the marital relationship deteriorated and eventually broke down), not with friends or family members. Like many other women who participated in my study, Silvia saw her social self challenged by social norms highlighting reproductive success, and felt isolated and out of place as a result.

Great was her relief, then, when she encountered Organizaţia EMMA, an NGO serving and representing the interests of bereaved parents. The self-help groups and the public commemoration events organized by this organization helped her turn her personal tragedy of loss into a social (and socially supported) event. Her suffering became shared rather than solitary. Although she still felt empty-handed, her life was not devoid of direction anymore like when she exited the hospital after losing Victor. Silvia had been lucky, as she lived in Bucharest and found the organization at the peak of its activity (which is, by now, much reduced). Others, losing their little ones in different times and places, may have a harder time navigating the various societal impediments, and may continue to suffer in silence.

Any future attempts to relieve this suffering would probably benefit from addressing the pervasive silence and taboos around reproductive loss, and would focus best on offering women more support in their medical, religious and social environments. Possible examples are the provision of ‘memory boxes’ to women who experience loss in maternity hospitals; the distribution of information leaflets and other resources among medical personnel and religious clergy; the organization of public lectures and events for a wider audience; and the creation of safe spaces where fellow sufferers can share, care and commemorate together. These were some of the interventions with which Organizaţia EMMA – in its heyday – tried to raise awareness of, and improve, the fate of those having lost a little one. They had some impact at the public level and definitely changed the private lives of many beneficiaries, including Silvia. It was a promising pathway that merits further exploration in the future.