A socio-ecological analysis of parents’ experiences of stillbirth in Limpopo, South Africa

Abstract

Background: Stillbirth is a profoundly personal experience shaped by sociocultural norms, healthcare systems, and policies. Limited research exists on parents’ lived experiences in South Africa. This study explored socio-ecological factors influencing parents’ experiences of stillbirth in Limpopo, South Africa.
Methods: This qualitative exploratory study used in-depth interviews with 12 purposively selected parents. Interviews were conducted in Xitsonga, transcribed, translated, and thematically analysed using ATLAS.ti.
Results: The findings revealed that parents’ experiences of stillbirth were shaped by a range of interconnected factors across multiple levels of the socio-ecological framework. At the individual level, participants expressed varying understandings of stillbirth, emotional distress, self-doubt and fear of recurrence. Interpersonal relationships played a dual role, with some participants receiving strong emotional support from partners and family members, while others experiencing blame and stigma. Organisational factors included positive and negative experiences with religious institutions and healthcare services, with reports of compassionate care and critical gaps in communication and response time. Societal influences were reflected in cultural beliefs, such as Xirheti, which shaped perceptions of repeated stillbirths and contributed to stigma. At the policy level, participants not only recognised the importance of antenatal care as promoted by national guidelines but also highlighted systemic barriers such as delayed transport and limited access to timely healthcare services.
Conclusion: Addressing the impact of stillbirth requires a multi-level approach that integrates personal, social, cultural, healthcare, and policy dimensions to support parents.
Contribution: This study offers evidence to inform more family-centred and system-responsive approaches in primary and maternal healthcare.