Kelsey Christensen, 29, has been a health teacher at a public school in Maryland for three years. Part of her job is to teach sex education to her students, and she spends a good portion of her summer writing sex ed curricula. Yet, it never occurred to her to question why miscarriage and infant loss aren’t included in sex education until she experienced a miscarriage at 10 weeks along in her pregnancy last summer.
“It just wasn’t on my radar to even bring up to my students and it hasn’t been something that’s been brought up at school to discuss,” Christensen told me. But Christensen says her students will often ask her about miscarriage, usually after someone in their family experiences a pregnancy loss.
“I had three kids this morning bring up miscarriages of their family members,” she says. “They talked about how devastating it was for their family and [wanted to understand] why not every pregnancy results in a live baby.”
A reported one in four pregnancies will end in miscarriage; the number may even be higher, given that many people do not know they’re pregnant when their body passes a non-viable pregnancy. Yet to Christensen’s knowledge, miscarriage, much like abortion, is not included in public sexual education curricula.
“Honestly, probably because it’s too close to abortion,” Christensen says. “People are so uneducated about [miscarriage], and abortion is so politicized, that I think it’s one of those things where we leave it out in an effort not to get into trouble for something seen as controversial.”
US sex ed, depending on the state, is notorious for the information it often doesn’t teach – be it discussions of how to have safe sex, the myriad birth control options, gender identity and fluidity, and sexual orientation. In Massachusetts, for example, the curriculum hasn’t changed in more than 20 years.
“So few sex ed classes even discuss anything pregnancy-related. They just say ‘Don’t have sex!’ and leave it at that,” Dr Jennifer Lincoln, a board-certified OB-GYN, told me. “Politics and fear have taken hold of the sex ed conversation and in many states we have very incomplete sex education programs. Only 18 states even require sex ed to be medically accurate! I can guarantee hardly any are covering pregnancy loss or miscarriage in any depth.”
But mental health experts such as Dr Ellen Vora, a New York City-based psychiatrist, say that much in the same way that affirming and affirmative discussions about LGBTQ+ sexuality and identity can improve the mental health of trans or queer students, including fertility struggles and the normality of miscarriage in sex ed curriculums could undoubtedly improve the mental health of those who later experience pregnancy loss.
“We have nothing in place to respond to [miscarriage] loss because it’s often a secret,” Vora explains. “It’s something we as a society don’t talk about publicly, not even with our family and friends, let alone have a public conversation about the supports that are in place (or not), what’s available to you, and what you should be looking out for.”
Discussing the realities of fertility challenges and pregnancy loss in middle and high school sex ed classes – why those complications happen, how they happen, and the physical and mental health ramifications – would de-stigmatize miscarriage and better support those who need help after pregnancy loss.
“I can’t tell you how many times I’ve had to reassure a couple that nothing they did caused their miscarriage,” Lincoln told me. “I wish pregnancy loss was better understood so people didn’t have to carry that shame or guilt in the first place.”
The majority of miscarriages are the result of a genetic abnormality, yet a 2015 study published in Obstetrics & Gynecology found that 76% of respondents believed miscarriage is a result of a stressful event, 64% said it was the result of lifting something heavy, 22% blamed birth control, and 21% said it could be the result of an argument.
People need to know that miscarriage occurs by biological design, Vora says. “When there are genetic errors in the sperm, in the follicles, this is the system for protecting our offspring – by making sure that a non-viable pregnancy doesn’t go to term, which could possibly be an even more tragic experience.”
There is another added benefit to including pregnancy loss in sex ed classes. Not only will it better prepare students for the myriad potential reproductive outcomes if and when they decide to begin their own family planning, it will help parents better discuss their own fertility journeys, including miscarriages, with their children.
“It just opens up the lines of communication within a family system that parents can talk to kids about,” Vora says. Vora has had two miscarriages, and says that after her first, she and her husband discussed it with their then-four-year-old daughter. “She was involved in the conversation about it, in an age and developmentally appropriate way. By sharing this with my daughter, I was modeling that miscarriage is not something scary or wrong or bad, it’s just part of the spectrum of our child-bearing years.”
I have also had conversations about my own second-trimester miscarriage with my children. After I lost my pregnancy at 16 weeks, I spoke to my son about what happened. It’s a moment I detail in my recently released memoir I Had a Miscarriage: A Memoir, a Movement, and another example of how adults can have straightforward, age-appropriate conversations with children about miscarriage. Because while my son had long known that I am a psychologist who specializes in reproductive and maternal mental health (he refers to me as a “doctor of the heart”), he did not know that his own mother had experienced pregnancy loss first-hand. But once he did, that knowledge helped him better crystalize what pregnancy loss truly is and how it can impact those who experience it.
“Well, Mommy, at least you never went through what those women went through,” he said once, after I described counseling women who had miscarriages. “Actually, though … I guess if you had, you’d be able to understand them even better.”
Here we were, I realized. It was time. I seized the opportunity and let him guide our way through it.
“Well, sweetie, I did, actually,” I said.
“Wait, what?!” he replied. “You did? When?”
I brought him back to the day it happened, and piqued his memory by reminding him about how he’d had his first-ever semi-sleepover that evening, and that this was what led to it.
He pressed further.
“She was a girl,” I told him, “and I named her Olive.”
“I’m sorry, Mommy,” he offered. His questions continued: “Why do babies die too soon?”
“Sometimes it happens because the baby isn’t healthy, like Olive,” I explained, “and sometimes it’s because of other complications.”
“So the baby’s heart is beating one minute, and then not the next? Does it hurt the mommy’s heart when that happens?” he asked, curious and concerned.
“They hurt indescribably so,” I told him.
“But what do the mommies do the next day? Without the baby?”
“They rest. They cry. They remember. They receive support,” I replied.
And at that, he asked to feel my heartbeat, and offered to let me feel his.