Regaining agency and autonomy: A grounded typology of concealed pregnancy

Aim: To explore and understand the experience of concealed pregnancy and develop a framework for practitioners. Background: Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence. Design: A Glaserian grounded theory study was undertaken. Data Sources: Thirty women were interviewed, between 2014 – 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data. Methods: The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology. Results: Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many women's relationships were characterized by emotional, mental, sexual, or physical violence. Fear for one's survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone. Conclusions: This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.