RANZCOG is a proud organisational member of the Early Pregnancy Loss Coalition (ELPC) but what is EPLC, why was it formed and what does it seek to achieve? Co-founder and Chair, Isabelle Oderberg, explains.

Miscarriage has existed since the dawn of time. It is the most common pregnancy ‘complication’ and almost everyone has been touched by it, whether directly or indirectly. Despite this, a huge number of patients who experience miscarriage aren’t receiving adequate care, understanding or referrals, sometimes despite the best intentions of caregivers.

This lack of appropriate care can take many forms; it could be medical practitioners using the word “spontaneous abortion” in front of a patient, or dismissing someone’s grief with “don’t worry, just go home and try again” and failing to refer them to support services. It could be a patient developing septicaemia because there was retained pregnancy tissue and no one believed them when they said something wasn’t right after a dilation and curettage. Or it might be a doctor not making appropriate care options available to their patient, whether through conscientious objection, funding restrictions or personal belief.

As a journalist who’s covered this topic for the last eight years, and the author of a book on the topic (Hard to Bear: Investigating the Science and Silence of Miscarriage), it was disarming how easy it was to find patients who had —and were willing to talk about— substandard care that compounded the trauma of their losses¹, sometimes emotionally and sometimes physically.

…it was disarming how easy it was to find patients who had experienced – and were willing to talk about – substandard care that compounded the trauma of their losses, sometimes emotionally and sometimes physically

EPLC acknowledges that all medical practitioners are operating in an environment that is under-funded and under-resourced. This is something all health advocates must address in our work, and we must also be mindful that we are all on the same side, the side of better care for patients.

We are buoyed by the appetite among policy makers and health leaders to address how issues of medical misogyny have affected quality of care and the desire to address the historic gender imbalance in medical funding, research and understanding.

Research shows us that clinically significant levels of anxiety, depression and post-traumatic stress disorder following miscarriage are common^2-4 and gestational age and other obstetric factors have little association with the level of psychological distress^5-8.

Following miscarriage, up to 40% of women experience grief of a similar intensity and duration to other major losses⁹, including late or perinatal death. Future pregnancies are also often adversely affected due to heightened grief, fear and anxiety during the subsequent pregnancy ¹⁰.

Evidence also indicates that positive support experiences can buffer the loss and lead to better psychosocial outcomes^11-12.

Additionally, miscarriage can be a physiological marker for other conditions, including preterm birth and a higher likelihood of heart attack, thrombosis or stroke later in life¹³.

Explaining why gaps in care occur for reasons that are structural, cultural or due to a lack of resources wasn’t enough. I wanted to come up with a constructive way to achieve genuine, quantifiable change, harnessing the knowledge that no one wants to see patients suffer. I wanted to know I could leave the miscarriage space healthier for the patients to come than when I found it, going through my own seven pregnancy losses.

I wanted to know I could leave the miscarriage space healthier for the patients to come, than when I found it, going through my own seven pregnancy losses.

One challenge that intimidated me the most was convincing doctors that this change was both necessary and achievable. The responsibilities that doctors, nurses and midwives shoulder are immense, and they are often carried out in environments where they are under-resourced and under-appreciated. These pressures have only intensified in the wake of the pandemic, which has placed additional strain on an already stretched healthcare system. As a result, medical practitioners can sometimes react poorly to feedback or input that can be interpreted as criticism.

This is probably the reason that while “lived experience” or “patient representatives” appear repeatedly in strategy documents, sometimes their feedback or constructive criticism can be dismissed without due consideration.

The idea of EPLC was to echo the achievements of lobbies such as those for stillbirth and endometriosis, both of which had united to present a single voice calling for change and outlining a path forwards. Both of these strategies had been effective, and we sought to emulate them.

The structure we deployed was twofold. We have organisational members from across the sector, each represented by a staff-member. We also have policy advisors from across the sector. EPLC is a registered charity and has deductable gift recipients (DGR) status and its running is overseen by a volunteer board.

Miscarriage overlaps many areas of care and involves many practitioners, including but not limited to obstetricians, gynaecologists, fertility specialists, nurses, midwives, GPs, counsellors, psychologists and so many more.

The sector is also in desperate need of research, so we needed to include academics, researchers and so on.

My co-founders and I were cognisant that certain demographics were more likely to experience miscarriage or sub-optimal care, including Aboriginal and Torres Strait Islander peoples, those from lower socio-economic groups, LGBTIQ+ patients, those whose first language isn’t English and so on.  Getting a diverse range of voices involved in setting the agenda was non-negotiable.

What we have ended up with is a broad coalition of activists, service providers, researchers and experts in their field who can steer our work in a unanimously constructive direction, offering a united voice to government and a forum to bring together all of the people who want to see improvements in order to collaborate, share information and support each other in our work.

Together we need to look at what is needed to effect both short-term and long-term change and improvements. There is low-hanging fruit we can address reasonably quickly (such as more inclusive and empathetic language) and then the more long-term goals, such as the collation of miscarriage data and improvements in frontline care and resourcing.

EPLC was established by me, Dr Jade Bilardi and Dr Melanie Keep. It is now chaired by me, and the Deputy Chair is Elizabeth Chatham. Since its launch in 2023, in an Australian first, EPLC was successful in securing $10 million in dedicated federal budget funding for the miscarriage sector, funding frontline psychosocial support, education and research.

We have made multiple submissions and contributed to final recommendations of inquiry reports. We took part in the first ever national miscarriage roundtable convened by Assistant Minister for Health and Aged Care, the Honourable Ged Kearney, and Senator Marielle Smith. We have appeared at hearings and are contributing to some of the research and project work funded under the government’s $10 million package.

The most important aspect of any position that EPLC takes is that it is underpinned by recognised best-practice and peer-reviewed, quality research. While there are gaps in what we know about miscarriage (for instance whether Australian rates are going up or down and whether there are any specific inputs that lead to these results), there is enough work that has been done, both in Australia and overseas, that we can and should be implementing.

In 2024, EPLC received a grant from the Deborah Ganderton & John Henry Sub-Fund (Victorian Women’s Trust) to support our strategic planning initiatives. The board met in February 2025 to develop a three-to-five-year strategy to be put to members.

Once this strategy has been approved by key stakeholders—including RANZCOG, an EPLC member—we will make it public and further develop it into a National Miscarriage Roadmap, echoing the path taken to reduce rates of stillbirth and improve education.

The future of better care lies in partnership, collaboration and the centring of lived experience and care for those who need it most. There is much work to do, but EPLC, along with our organisational members and policy advisors, are already kicking goals and can see many more in our short and long-term future.