Abstract
Common mental disorders are highly prevalent among pregnant women in low- and middle-income countries, yet prenatal anxiety remains poorly understood, particularly in the sociocultural context of South Asia. Our study explored sources, mitigators, and coping strategies for anxiety among symptomatic pregnant women in Pakistan, particularly in relation to autonomy in decision-making and social support. We interviewed 19 pregnant married women aged 18–37 years recruited from 2017–2018 at a public hospital in Rawalpindi who screened positive for anxiety. Thematic analysis was based on both inductive emergent codes and deductive a priori constructs of pregnancy-related empowerment. Gender norms emerged as an important dimension of Pakistani women’s social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women’s avenues of self-advocacy were largely limited to indirect means such as appeals to the husband for intercession or return to her natal home. The levels of autonomy during pregnancy depended on the area of decision-making, and peer/family support was a critical protective factor and enabling resource for maternal mental health. Women’s disempowerment is a key contextual factor in the sociocultural experience of prenatal maternal anxiety in South Asia, and further examination of the intersections between empowerment and perinatal mental illness might help inform the development of more context-specific preventive approaches.
Highlights
With available data indicating the high prevalence of common mental disorders (CMDs) among pregnant women in low- and middle-income countries (LMICs) [1], maternal depression has remained a key focus of research and healthcare, while prenatal maternal anxiety in LMICs remains poorly understood [2,3]
Our findings suggest that barriers to gaining voice in pregnancy for Pakistani women include fears of upsetting her susral and that such fears are significant subjective contributors to prenatal anxiety
This study represents the first qualitative investigation of how perinatal anxiety in South Asia is potentially shaped by pregnancy-related empowerment based on descriptions of the sociocultural dimensions of anxiety from the perspectives of symptomatic expectant mothers
Summary
With available data indicating the high prevalence of common mental disorders (CMDs) among pregnant women in low- and middle-income countries (LMICs) [1], maternal depression has remained a key focus of research and healthcare, while prenatal maternal anxiety in LMICs remains poorly understood [2,3]. Anxiety in pregnancy is a significant risk factor for poor maternal and child outcomes, including postnatal depression and preterm birth [4,5,6,7], and of particular concern in LMIC contexts like Pakistan where access to mental health services is scarce and the prevalence of preterm births is persistently high [8,9,10]. Public Health 2020, 17, 4926; doi:10.3390/ijerph17144926 www.mdpi.com/journal/ijerph
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