Just wait until I speak in French.
I hold a Canadian research chair on family psychosocial health.
I am the senior research fellow at the Fonds de recherche du Québec en santé.
As well, I am the Director of the Centre for Studies and Research on Family Intervention. Chantal is co-P.I.
We have done about seven research works mostly over the last 15 years, but I've been doing research for the past 20 years on prenatal bereavement. We're both clinicians. We've been doing prenatal support groups for the past 20 years at Université du Québec en Outaouais. We keep seeing families every month, and we also hold groups for the next pregnancy. All that is volunteer work.
I will be providing an overview of perinatal death and talking briefly about the impact on parents' mental health, marital relationships and child development. I will also address the effects of the lack of recognition of bereavement in society and the workplace, as well as the economic consequences of the cost of absenteeism/presenteeism. Lastly, I will discuss what Canadian families need.
It is estimated that one in five pregnancies ends in early or late perinatal death. By the way, I encourage committee members to ask why I say “it is estimated”. In Canada, that represents around 100,000 deaths a year.
Health and social services for bereaved families are uneven across provinces, as well as within and between regions. That means a parent can access a given service if they live in Laval, for instance, but not if they live in Montreal. Consequently, they have to go to another region in order to receive the service.
In addition, access to paid parental leave is unequal between mothers and fathers, and varies for mothers depending on the province of residence and the length of pregnancy. I also welcome any questions on that point.
This contributes to the non-recognition of perinatal bereavement and, in our view, reduces the father to the role of progenitor and financial provider. This perpetuates the stereotype that the father's involvement in the family project is limited to conception and excludes any emotional commitment.
Yet the consequences of perinatal death are real in the short and long term. The committee has heard from families. Both parents experience a heavy loss and intense grief. Perinatal death, and subsequent bereavement, have deleterious effects on the mental health of women and men up to five years after the death. That includes persistent depression, anxiety and grief. The research refers to post-traumatic stress and somatization.
In the course of our research, we have met with thousands of parents over the past 15 years. Women talked about having suicidal thoughts, 16% in fact. We are currently following up with parents as part of another longitudinal research study. We learned that some fathers have suicidal thoughts after the birth of the next child. Symptoms persist during the next pregnancy and even after the birth of a healthy child.
With respect to the conjugal relationship, there is increased risk of marital tensions, separations and divorces. Although some couples are able to come together and grow stronger after such a tragedy, it depends greatly on the support they receive and the way they deal with the event together. When the father goes back to work on Monday morning, after the miscarriage or loss, and the mother is home alone crying, it's easy to imagine the tension that can result.
There is increased risk of mental health problems such as anxiety in subsequent pregnancies. There is increased risk of other perinatal deaths. During a first pregnancy, a 25-year-old woman has a one in five chance of experiencing a miscarriage or perinatal death, and that goes up to a one in four chance after the first event. The likelihood of the mother experiencing multiple perinatal deaths over a lifetime therefore increases.
Both international and Canadian studies have examined postnatal effects. In Calgary, babies born to mothers who were initially depressed, not necessarily further to a death, were more likely to develop depression later on. Therefore, the research points to an immune disorder that is genetically passed on from mother to child during pregnancy. If the mother is carrying a girl, she will pass it on to her daughter, who will in turn pass it on to the next generation. That signals an intergenerational transmission of mental health disorders, and there are costs associated with that.
Certain postnatal effects have also been identified. Some of our American colleagues have studied cohorts of parents who have experienced trauma, including death, over a period of 25 years. They observed that babies with depressed parents have an increased risk of depression and of internalized and externalized disorders in childhood and adulthood. It varies depending on the parent's gender. I can talk more about that later.
The effects of the lack of recognition of bereavement in society and at work are experienced in medical, family and social spaces. The work space is the one where bereavement is the least recognized. I can come back to that afterwards.
The silence surrounding the suffering and distress of grieving men, who, like women, must learn to live with the death of a baby, forces them to return to work when they are physically and psychologically shaken. The result is a high rate of presenteeism or absenteeism.
I will now get right into the cost of presenteeism and absenteeism. Canadian estimates indicate that productivity costs associated with mental health disorders are $17.7 billion annually. The costs of presenteeism are usually 5 to ten times higher than those of absenteeism. Symptoms of depression, grief and anxiety are associated with lower productivity, problems with concentration, poor problem-solving and decision-making skills, as well as more workplace accidents.
Direct and indirect economic consequences arise from the increased use of health and social services. Without the necessary support at the time of the event, people repeatedly access the health care system for the same event. The consequences on children already in the family and those born afterwards are not yet well known. The same is true of the consequences on extended family—which the gentleman spoke about earlier—including grieving grandparents. Similarly, the consequences on families of diverse cultural origins are not well known. We know very little about what they experience.
What families need—mothers and fathers alike—is to have their grief acknowledged. This can be achieved through social awareness-raising campaigns, workplace programs and bereavement leave for both parents. They need to be supported by sensitive and competent staff who recognize their cultural specificity and their bereavement pathways throughout the continuum of care. Programs not only need to be implemented, but they also need to be evaluated. Once programs are developed and put in place, it is not known whether parents derive any benefit. We need more accurate statistics to tell us the number of early and late deaths. We also need longitudinal research studies so that we are not always relying on research findings from other countries. Canada has a cultural specificity, and we lack information on the bereavement pathways of families and the long-term repercussions because the research hasn't been done.
We also lack studies on the impacts of bereavement on work. A qualitative study is coming out soon, but we don't have any quantitative studies. We have little in the way of studies. We conducted a small study on cultural specificity as it relates to family support, but we need programs to be evaluated. Bereavement groups, among other services, have rarely been evaluated. We don't know whether they should comprise two volunteer parents or a professional together with a parent.
Thank you.