{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:38:32Z","timestamp":1792474712480,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014367","name":"National Palliative Care Research Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014367","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Perinatal mortality remains high in low\u2010 and middle\u2010income countries, with Tanzania bearing one of the greatest burdens. The Three Delays framework is often used to analyze preventable perinatal deaths and includes care seeking, reaching care, and receiving definitive care. This study explores Tanzanian mothers' experiences of perinatal loss, focusing on delays and gaps in care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women who experienced stillbirth or neonatal death completed intake surveys about their perinatal loss experience. Of these, 40 completed semi\u2010structured in\u2010depth interviews 8\u2009weeks post\u2010loss. Interviews explored barriers in care seeking, access, delivery, and communication. Survey data were analyzed with descriptive statistics. Interview data were thematically coded using a directed content analysis combining a priori codes from the three delays framework and inductive coding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants perceived delays in seeking care (50%), receiving care at initial facilities (27.5%), referral processes (12.5%), and care at KCMC (17.5%). Nearly half (45%) reported inadequate communication from healthcare providers. Three key themes emerged: (1) women perceived delays in care at all points along their care trajectory (2) gaps in communication impacted medical care for women and newborns, and hindered healing after perinatal loss; and (3) women emphasized the need for emotional support and compassionate communication following loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>While structural, process, and financial barriers persist, informational and relational communication gaps represent an under\u2010addressed challenge across the perinatal loss care pathway. Rather than being viewed in isolation, efforts to strengthen communication should be integrated into broader health system strategies aimed at reducing delays, improving access to timely and quality care, and supporting families after stillbirth or neonatal death. Strengthening communication within health systems, both as an informational and relational process, has the potential to enhance care experiences, build trust, and support emotional healing after perinatal loss.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/birt.70143","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:45:28Z","timestamp":1792471528000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Silence and Sorrow: A Qualitative Exploration of the Hidden Role of Communication Failures in Perinatal Care"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-478X","authenticated-orcid":false,"given":"Sharla","family":"Rent","sequence":"first","affiliation":[{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"},{"name":"Duke Global Health Institute  Durham North Carolina USA"},{"name":"Global 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getrude","family":"Nkini","sequence":"additional","affiliation":[{"name":"Global Emergency Medicine Innovation and Implementation Research Center  Durham North Carolina USA"},{"name":"Kilimanjaro Christian Medical Center  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0173-4703","authenticated-orcid":false,"given":"Enna Geofrey","family":"Sengoka","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Center  Moshi Tanzania"},{"name":"KCMC University  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5796-157X","authenticated-orcid":false,"given":"Cheryl A.","family":"Moyer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Learning Health Sciences University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Lemmon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"},{"name":"Department of Population Health Sciences Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Matthews","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute  Durham North Carolina USA"},{"name":"Global Emergency Medicine Innovation and Implementation Research Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5263-6612","authenticated-orcid":false,"given":"Elizabeth M.","family":"Keating","sequence":"additional","affiliation":[{"name":"Global Emergency Medicine Innovation and Implementation Research Center  Durham North Carolina 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