News

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Rural miscarriage care ‘fragmented, dismissive’

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A report from an early pregnancy loss support agency has called for national reforms to address what it says is ‘fragmented, dismissive’ miscarriage care for people in rural, regional and remote Australia.
 
However, a women’s health expert has criticised the lack of focus on general practice care in the report, calling it ‘a big oversight’.
 
The Pink Elephants’ Support Network report, Not Just a Loss – early pregnancy loss in regional, rural and remote communities, has offered five key recommendations to address care inequities beyond cities, following a global review of miscarriage data and recommendations for best-practice care.
 
Among the report’s more sobering statistics is that women in remote areas are 1.6 times more likely to experience perinatal death compared to women in major cities.
 
It also revealed that in 2013–20, the perinatal death rate for babies born to Aboriginal and Torres Strait Islander mothers was 1.7 times higher than the rate born to non-Indigenous mothers.
 
The report said 75% of women feel unsupported through their miscarriage experience, 68% receive no support when told their pregnancy has ended, and no formal support pathways exist.
 
‘Unlike other forms of loss, pregnancy loss occurs without recognised rites or rituals, often leaving women and families to navigate devastating grief alone,’ it said.
 
The report recommends: 

• improving data collection systems to capture the ‘true scope’ of early pregnancy loss
• establishing early pregnancy loss care standards, with mandated trauma-informed communication training for all healthcare professionals
• midwifery continuity of care
• culturally safe early pregnancy loss care
• implementation of the Pink Elephants Care Standards.

 
Associate Professor Magdalena Simonis, who is a GP and leading women’s health expert, said the continuity of care the report calls for is ‘actually provided primarily in general practice’.
 
‘There’s a big oversight here in terms of general practice, and that’s not to take away from their recommendations made here, but general practice is where the longitudinal care is provided,’ Associate Professor Simonis told newsGP.
 
‘We provide most of the antenatal pre care, pre-pregnancy counselling, the antenatal screening, the postnatal visit … in a general practice setting, especially with GPs who do shared care, such as myself.
 
‘We are very well positioned to provide that longitudinal care, which is what we are experts in.’
 
Associate Professor Simonis agrees that women in regional, rural and remote areas are ‘underserved in so many places’.
 
‘Obviously in that context, one size does not fit all.’
 
‘What we’ve found is, the further away from central business districts where you have services and where you have access to GPs, for all the pre-pregnancy counselling and antenatal management, that standards of health and outcomes are poorer, which is where having continuity of care with GPs is really important.
 
‘That reflects the significance of general practice and the significance of that longitudinal care that we provide.’
 
In calling for a national data collection system, Pink Elephants said while one in four pregnancies end in miscarriage, recent studies suggest the figure may be as high as 37%, ‘yet this widespread experience remains universally neglected by Australian healthcare systems’.
 
In releasing its report, Pink Elephants said a request to the Australian Bureau of Statistics (ABS) to document early pregnancy loss in the Census was rejected, and ‘exemplifies how institutional decisions render this statistically invisible’.
 
An ABS spokesperson told newsGP that the topic of pregnancy loss was considered in the first phase of the 2026 Census topic consultation process, but did not meet the criteria for the second consultation phase as ‘the data need is partially met by alternative data sources such as the Australian Longitudinal Study on Women’s Health.’
 
The spokesperson also said the addition of new Census content ‘needs to be carefully considered’, given the burden additional questions may place on households and the risk of a longer Census potentially decreasing the quality of data collected.
 
Pink Elephant said the lack of data created ‘profound blind spots for Australia’s most vulnerable communities’.
 
‘This absence of culturally and geographically specific data means that the unique challenges faced by these communities, from cultural safety concerns to travel distances for care, remain unmeasured and unaddressed,’ it said.
 
‘The systematic exclusion of these voices from data collection inadvertently disenfranchises their experiences by removing recognition of their losses and specific support needs.’
 
In the report, Chair of RACGP Specific Interests Antenatal and Postnatal Care, Dr Ka-Kiu Cheung, said it is ‘crucial’ to make diverse community groups heard.
 
‘We need to go beyond the well-funded groups and make space for others, whether it’s First Nations women or those in culturally diverse communities,’ she said.
 
Looking to the future, Pink Elephants said the Federal Government has funded and commenced the AIHW scoping review of Sexual and Reproductive Health data collection.
 
‘This is currently underway with specific pregnancy loss data to be collected. This is a significant step in the right direction. Pink Elephants is a key stakeholder that supports this work.’
 
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data collection early pregnancy loss miscarriage perinatal death perinatal support regional rural regional and remote

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