Society does not talk much about miscarriages.

Some of that silence is ancient. When child mortality was high, grief had to be rationed just to keep living. Babies sometimes weren’t named until they’d survived their first year. Tears weren’t withheld because people were heartless, but because loss was a fact of life and a community couldn’t fall apart every season.

But here’s the strange thing: civilization changed the facts, yet we kept the habit.

In modern life, the death of a child is no longer normal. It’s not the default expectation. It’s a rupture. And still, early pregnancy loss often sits in this cultural half-light—spoken about in euphemisms, treated like an awkward weather report, filed under “these things happen” and quickly moved past.

That gap—between what we feel and what we count—is where my thinking changed.

Deaths Not Counted

After our second miscarriage, I was surprised by how little anyone could tell us about why it happened.

I wasn’t expecting every doctor to be House MD. Doctors are real people doing the best they can inside a system that does not give them infinite time, infinite tests, or infinite certainty. To say the medical system is complex is an understatement. So much goes on that is different from ordinary life, it may as well be another world. (My favourite medical drama is Scrubs)

Still, I couldn’t shake the feeling that “we don’t know” arrived too quickly.

Not because doctors are lazy, but because the system is built around a particular kind of visibility. Some outcomes are measured, tracked, and interrogated until patterns become policies. Others are treated like noise—common, sad, and therefore strangely un-actionable.

That’s when I stumbled into a principle that felt less like a theory and more like a key:

Deaths Not Counted refers to the principle that:

Outcomes that are not consistently measured, standardized, and publicly reported tend to receive less causal investigation, less accountability, and less institutional urgency.

What is not counted does not disappear — it becomes epistemically invisible.

This isn’t an accusation. It’s a description of incentives.

Counting creates visibility.

Visibility creates responsibility. Responsibility creates pressure. And pressure is what forces systems to learn.

If you want to know why infant mortality rates are tracked so carefully, the answer is simple: they are countable. There’s a clear definition, a clear denominator, mandatory reporting, and political agreement that the outcome matters.

With miscarriage, the ground is foggier. The denominator is uncertain because many losses occur before a pregnancy is even confirmed. Reporting standards vary. The language is inconsistent. The event is emotionally enormous to the parents but statistically slippery to institutions.

So miscarriage becomes a kind of background condition—real, tragic, but not engineered into the system as a problem that must be solved.

That’s what “Deaths Not Counted” looks like in practice.

A Grey Area Called “Common”

Once you notice this, you see a pattern in the explanations people reach for.

When fetal death is not measured tightly, it is rarely investigated deeply. And when it isn’t investigated deeply, the explanations default to the ones that are easiest to say without opening further work:

• Genetics
• Bad luck
• “Most miscarriages are chromosomal”
• “These things happen”

Those statements can be true. But they also function as conversation-stoppers. They close the loop before the loop has really been examined.

This is where the experience becomes surreal: you’re living through something that feels like a disaster, and the world treats it like static.

Mechanisms Exist, But Attention Doesn’t Follow

In that fog, I did what people do when their reality is bigger than the explanation offered: I started reading.

That’s how I encountered a chemical word that keeps appearing in quiet corners of reproductive medicine: progestin.

Progestins are synthetic versions of progesterone, used in many contraceptives for good reasons. They’re effective. They’re widely prescribed. They’re part of modern life.

But progestins also have known physiological effects. One of them is that they can affect tubal transport—the movement of the egg (and, if fertilization occurs, the embryo) through the fallopian tube. That movement depends on cilia and muscular contractions, and it is not arbitrary. Timing matters.

In simplified terms: if transport is delayed, the wrong implantation can happen in the wrong place.

In combined pills, this is sometimes described as being “offset” by added estrogen. (The body is not a simple machine, but the idea is that estrogen can counterbalance some progestin effects in certain tissues.)

Now, to be absolutely clear: I am not claiming, from a kitchen table, that “the pill causes miscarriages” or that “the pill causes ectopic pregnancies.” That would be irresponsible.

What I am saying is something narrower and, I think, more important:

There are plausible mechanisms that are real enough to be discussed, yet they are not widely integrated into the narrative patients receive.

And that absence isn’t necessarily because anyone is hiding anything. It can be because the system doesn’t have a strong way to force inquiry into this category of outcome.

Because here we hit another wall: research.

People often say, “There are no studies on this,” and sometimes that’s presented like a moral fact—we can’t know. But that’s not quite right.

It might be unethical to run a randomized trial designed to cause harm. You can’t assign people to risk.

But you can do careful observational research: long-term follow-up, registries, post-marketing surveillance, better classification of pregnancy outcomes, clearer denominators, real-world data. The problem is not that knowledge is forbidden. The problem is that knowledge is expensive—and without counting the causes, there is no pressure to pay for it.

So we live in an undiscussed grey area where the options often feel emotionally binary:

1. Blanket trust the pill as a shield against a worse mistake or
2. Distrust it based on skepticism without evidence

Both extremes are attractive when you’re in pain. Neither is fully rational.

The rational position is harder: acknowledge what is known, admit what is not, and build better measurement so the “unknown” shrinks.

The Tradition We Never Updated

This is the part that keeps returning to me.

We inherited a cultural silence about fetal death from a time when death was everywhere. That silence made sense when naming a child was an act of hope.

But in the modern world, that inherited silence has consequences. It doesn’t just shape feelings; it shapes data. And data shapes attention.

So miscarriage reporting often treats fetus deaths like background noise rather than discrete, causally interrogated outcomes.

Not because anyone thinks they don’t matter.

But because the system is not built to make them matter in the way that forces learning.

And when a system can’t see something clearly, it cannot correct itself clearly. It cannot distinguish “random tragedy” from “preventable pattern.” It cannot tell a grieving couple, with integrity, whether there’s a factor worth changing—or whether the universe simply rolled snake eyes twice.

In other words: what is not counted does not disappear.

It becomes epistemically invisible.

What I Want (Not Blame)

I’m not asking for certainty where certainty is impossible. I’m not asking for a villain.

I’m asking for a better map.

A civilization capable of IVF, laparoscopic surgery, and gene sequencing is also capable of building better ways to count, classify, and investigate early pregnancy loss—without turning it into ideology or litigation.

If we tracked fetal outcomes with the same seriousness we track infant outcomes, some suspected causes would be confirmed, some would be ruled out, and some would demand change. That is how progress works: not by perfect knowledge, but by refusing to let loss remain statistical fog.

Maybe the deepest problem isn’t that miscarriages happen.

It’s that we still treat them like they are too ordinary to understand.

And that is a tradition we can finally afford to outgrow.

If you or anyone you know gets pregnant, please get the earliest possible ultrasound available to you, it may save you/them from a lot of heartache.