The Effectiveness of Healing Interventions for Post-Abortion Grief: A Systematic Review and Meta-Analysis

  • Leila BAGHERI Department of Reproductve Health, Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
  • Ali Mohammad NAZARI Department of Reproductve Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
  • Reza CHAMAN Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
  • Ashraf GHIASI Department of Reproductve Health, Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
  • Zahra MOTAGHI Reproductive Studies and Women’s Health Research Center, School of Nursing and Midwifery, Shahroud University of Medical Scienc-es, Shahroud, Iran
Clinical trial, Psychological intervention, Post-abortion grief


Background: Abortion is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. Some women suffer from psychological disorders such as anxiety, depression and grief after abortion. Early detection of high-risk women after abortion and psychological intervention is one of the healing methods than can lead to improving outcomes but its effectiveness is not clear. The present meta-analysis evaluated the efficacy of this approach.

Methods: The international and national electronic databases were searched from Jan 1998 until Aug 2018 including Medline, Web of Knowledge, Ovid, Embase, PubMed, Scopus, Cochrane, ScienceDirect, PsycINFO, ProQuest, Google Scholar, Iranmedex, Scientific Information Database (SID), and Magiran. The pooled mean difference with the random-effects model was used for meta-analyses. The preferred reporting items for systematic reviews and meta-analyses guidelines adhered in this study.

Results: We enrolled 7 relevant studies involving 918 subjects into the meta-analysis process. The meta-analysis of the interventions aiming at prevention of post-abortion grief yielded a pooled standardized mean difference (SMD) of −0.03 (95% CI: −0.40−0.34; Z=0.16; P=0.87) at post-test and of -0.21 (95% CI:-0.53-0.10; Z=1.32; P=0.19) at follow-up.

Conclusion: This systematic review found psychotherapy-based interventions are effective in post-abortion grief treatment but; we found psychotherapy-based interventions are somewhat effective in short-term post-abortion grief and it has a better effect on long-term grief.


1. WHO. Clinical practice handbook for Safe abortion (2014).
2. Murphy FA, Lipp A, Powles DL (2012). Follow-up for improving psychological well being for women after a miscarriage. Cochrane Database Syst Rev, (3):CD008679.
3. Motaghi Z, Keramat A, Shariati M, Yunesian M (2013). Triangular assessment of the etiology of induced abortion in iran: a qualitative study. Iran Red Crescent Med J, 15(11):e9442.
4. Motaghi Z, Poorolajal J, Keramat A et al (2013). Induced abortion rate in Iran: a meta-analysis. Arch Iran Med, 16(10):594-8.
5. Wijesooriya's LRA, Palihawadana TS, Rajapaksha RNG (2015). A study of psychological impact on women undergoing miscarriage at a SriLankan hospital setting. Sri Lanka J Obstet Gynaecol, 37:10-13.
6. Capitulo KL (2005). Evidence for healing interventions with perinatal bereavement. MCN Am J Matern Child Nurs, 30(6):389-96.
7. Brier N (2008). Grief following miscarriage: a comprehensive review of the literature. J Womens Health (Larchmt), 17(3):451-64.
8. Corless IB, Limbo R, Bousso RS et al (2014). Languages of Grief: a model for understanding the expressions of the bereaved. Health Psychol Behav Med, 2(1):132-43.
9. Badenhorst W, Hughes P (2007). Psychological aspects of perinatal loss. Best Pract Res Clin Obstet Gynaecol, 21(2):249-59.
10. MAPS CH(2011). Beyond Kübler-Ross: Recent developments in our understanding of grief and bereavement.
11. Nanda K, Lopez LM, Grimes DA et al (2012). Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev, (3):CD003518.
12. Neilson JP, Gyte GM, Hickey M et al (2010). Medical treatments for incomplete miscarriage (less than 24 wk). Cochrane Database Syst Rev, (1):CD007223.
13. Adolfsson A, Bertero C, Larsson PG (2006). Effect of a structured follow‐up visit to a midwife on women with early miscarriage: a randomized study. Acta Obstet Gynecol Scand, 85:330-5.
14. Swanson KM, Chen HT, Graham JC et al (2009). Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions . J Womens Health (Larchmt), 18(8):1245-57.
15. Kerns JL, Mengesha B, McNamara BC et al (2018). Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications. Contraception, 97(6):520-3.
16. Tseng YF, Cheng HR, Chen YP, Yang SF, Cheng PT(2017). Grief reactions of couples to perinatal loss: A one-year prospective follow-up . J Clin Nurs, 26(23-24):5133-42.
17. Wilson PA, Boyle FM, Ware RS(2015). Holding a stillborn baby: the view from a specialist perinatal bereavement service . Aust N Z J Obstet Gynaecol, 55(4):337-43.
18. Broen AN, Moum T, Bodtker AS, Ekeberg O (2005). The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Med, 3:18.
19. Jacob L, Polly I, Kalder M, Kostev K(2017). Prevalence of depression, anxiety, and adjustment disorders in women with spontaneous abortion in Germany – A retrospective cohort study. Psychiatry Res, 258:382-6.
20. Volgsten H, Jansson C, Svanberg AS, Darj E, Stavreus-Evers A (2018). Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage . Midwifery, 64:23-8.
21. Kulathilaka S, Hanwella R, de Silva VA(2016). Depressive disorder and grief following spontaneous abortion. BMC Psychiatry, 16:100.
22. Hunter A, Tussis L, MacBeth A(2017). The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. J Affect Disord, 223:153-64.
23. Klier CM, Geller PA, Ritsher JB(2002). Affective disorders in the aftermath of miscarriage: a comprehensive review. Arch Womens Ment Health, 5(4):129-49.
24. Enez Ö(2017). Effectiveness of Psychotherapy-Based Interventions for Complicated Grief: A Systematic Review. Psikiyatride Guncel Yaklasimlar, 9(4):441-63.
25. Currier J, Neimeyer R, Berman J(2008). The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review . Psychol Bull, 134(5):648-61.
26. Wittouck C, Van Autreve S, De Jaegere E et al (2011(. The prevention and treatment of complicated grief: A meta-analysis. Clin Psychol Rev, 31(1):69-78.
27. Ashford MT, Olander EK, Ayers S (2016). Computer- or web-based interventions for perinatal mental health: A systematic review . J Affect Disord, 197:134-46.
28. Nardi B, Laurenzi S, Di Nicolo M, Bellantuono C (2012). Is the cognitive-behavioral therapy an effective intervention to prevent the postnatal depression? A critical review. Int J Psychiatry Med, 43(3):211-25.
29. Boulind M, Edwards D (2008). The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa . J Psychol Afr, 18(4): 539-47.
30. Charles VE, Polis CB, Sridhara SK, Blum RW(2008). Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception, 78(6):436-50.
31. Van P, Meleis AI(2003). Coping With Grief After Involuntary Pregnancy Loss: Perspectives of African American Women. J Obstet Gynecol Neonatal Nurs, 32(1):28-39.
32. Butler M(2000). Facilitating the grief process. The role of the midwife. Pract Midwife, 3(9):36-7.
33. Cohen J(2001). From grief to action: meeting the needs of bereaved families. AWHONN Lifelines, 5(1):11-3.
34. Geerinck-Vercammen CR, Kanhai HH(2003). Coping with termination of pregnancy for fetal abnormality in a supportive environment . Prenat Diagn, 23(7):543-8.
35. Glatfelter KS. Understanding and addressing the needs of women experiencing perinatal loss leading to hospital protocol change [D.S.W. thesis]. School of Public Service Leadership, Minnesota Capella's School of Social Work, United States ; 2017.
36. Whitaker C, Kavanaugh K, Klima C(2010). Perinatal Grief in Latino Parents. MCN Am J Matern Child Nurs, 35(6):341-5.
37. Golmakani N, Ahmadi M, Asgharipour N, Esmaeli H (2018). The Relationship of Emotional intelligence with Women's Post-abortion Grief and Bereavement. J Midwifery Reprod Health, 6 (1):1163-9.
38. Franche RL (2001). Psychologic and obstetric predictors of couples' grief during pregnancy after miscarriage or perinatal death. Obstet Gynecol, 97(4):597-602.
39. Hutti MH, Armstrong DS, Myers J(2013). Evaluation of the perinatal grief intensity scale in the subsequent pregnancy after perinatal loss. J Obstet Gynecol Neonatal Nurs, 42(6):697-706.
40. Nardi A E(2011). Cognitive-behavioral therapy to miscarriage: results from the use of a grief therapy protocol . Rev Psiquiatr Clín, 38 (3):122-124.
41. Bryant RA, Kenny L, Joscelyne A et al (2014). Treating prolonged grief disorder: a randomized clinical trial. JAMA Psychiatry, 71(12):1332-9.
42. Rosner R, Pfoh G, Kotoucova M, Hagl M(2014). Efficacy of an outpatient treatment for prolonged grief disorder: a randomized controlled clinical trial. J Affect Disord, 167:56-63.
43. Johnson JE, Price AB, Kao JC et al (2016). Interpersonal psychotherapy (IPT) for major depression following perinatal loss: a pilot randomized controlled trial . Arch Womens Ment Health, 19(5):845-59.
44. Baron C, Cameron S, Johnstone A(2015). Do women seeking termination of pregnancy need pre-abortion counselling? J Fam Plann Reprod Health Care, 41(3):181-5.
45. Bhat A, Byatt N (2016). Infertility and Perinatal Loss: When the Bough Breaks. Curr Psychiatry Rep, 18(3):31.
46. Brandon AR, Ceccotti N, Hynan LS et al (2012). Proof of concept: Partner-Assisted Interpersonal Psychotherapy for perinatal depression . Arch Womens Ment Health, 15(6):469-80.
47. Cote-Arsenault D, Schwartz K, Krowchuk H, McCoy TP (2014). Evidence-based intervention with women pregnant after perinatal loss . MCN Am J Matern Child Nurs, 39(3):177-86.
48. Engelhard IM, van den Hout MA, Arntz A (2001). Posttraumatic stress disorder after pregnancy loss . Gen Hosp Psychiatry, 23(2):62-6.
49. Grote NK, Swartz HA, Geibel SL et al (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression . Psychiatr Serv, 60(3):313-21.
50. Simon W, Sliwka P (2012). Effectiveness of group psychotherapy for adult outpatients traumatized by abuse, neglect, and/or pregnancy loss: a multiple-site, pre-post-follow-up, naturalistic study . Int J Group Psychother, 62(2):283-308.
51. Roose RE, Blanford CR (2011). Perinatal grief and support spans the generations: parents' and grandparents' evaluations of an intergenerational perinatal bereavement program . J Perinat Neonatal Nurs, 25(1):77-85.
52. Higgins J, Green S (2011). Cochrane Handbook for Systematic Reviews of Interventions
53. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses . BMJ, 327(7414):557-60.
54. Faraone SV(2008). Interpreting estimates of treatment effects: implications for managed care. P T, 33 (12):700-11.
55. Nikcevic AV, Kuczmierczyk AR, Nicolaides KH (2007). The influence of medical and psychological interventions on women's distress after miscarriage . J Psychosom Res, 63(3):283-90.
56. Kersting A, Kroker K, Schlicht S, Wagner B (2011). Internet-based treatment after pregnancy loss: concept and case study . J Psychosom Obstet Gynaecol, 32(2):72-8.
57. Kersting A, Dolemeyer R, Steinig J et al (2013). Brief Internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial . Psychother Psychosom, 82(6):372-81.
58. Zisook S, Shear K(2009). Grief and bereavement: what psychiatrists need to know. World Psychiatry, 8(2):67-74.
59. Dennis CL (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review . BMJ, 331(7507):15.
60. Daugirdait, V, van den Akker O, Purewal S (2015). Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review . J Pregnancy, 2015:646345.
61. Yazdkhasti M, Pourreza A, Pirak A, Abdi F (2015). Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article. Iran J Public Health, 44(1):12-21.
62. Sriarporn P , Turale S , Lordee N et al (2017). Support program for women suffering grief after termination of pregnancy: A pilot study. Nurs Health Sci, 19 (1): 75-80.
63. Johnson O P. Langford R. W (2015). A Randomized Trial of a Bereavement Intervention for Pregnancy Loss. J Obstet Gynecol Neonatal Nurs, 44 (4) : 492-9.
How to Cite
BAGHERI L, NAZARI AM, CHAMAN R, GHIASI A, MOTAGHI Z. The Effectiveness of Healing Interventions for Post-Abortion Grief: A Systematic Review and Meta-Analysis. Iran J Public Health. 49(3):426-436.
Review Article(s)