Abstract
BackgroundLittle is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. The study aim was to evaluate maternal and paternal pregnancy intentions (and intention discordance) in relation to perinatal depressive symptoms among rural Bangladeshi women.MethodsData come from a population-based, community trial of married rural Bangladeshi women aged 13–44. We examined pregnancy intentions among couples and pregnancy-intention discordance, as reported by women at enrollment soon after pregnancy ascertainment, in relation to depressive symptoms in the third trimester of pregnancy (N = 14,629) and six months postpartum (N = 31,422). We calculated crude and adjusted risk ratios for prenatal and postnatal depressive symptoms by pregnancy intentions.ResultsIn multivariable analyses, women with unwanted pregnancies were at higher risk of prenatal (Adj. RR = 1.60, 95% CI: 1.37–1.87) and postnatal depressive symptoms (Adj. RR = 1.32, 95% CI: 1.21–1.44) than women with wanted pregnancies. Women who perceived their husbands did not want the pregnancy also were at higher risk for prenatal (Adj. RR = 1.42, 95% CI: 1.22–1.65) and postnatal depressive symptoms (Adj. RR = 1.30, 95% CI: 1.19–1.41). Both parents not wanting the pregnancy was associated with prenatal and postnatal depressive symptoms (Adj. RR = 1.34, 95% CI: 1.19–1.52; Adj. RR = 1.13, 95% CI: 1.06–1.21, respectively), compared to when both parents wanted it. Adjusting for socio-demographic and pregnancy intention variables simultaneously, maternal intentions and pregnancy discordance were significantly related to prenatal depressive symptoms, and perception of paternal pregnancy unwantedness and couple pregnancy discordance, with postnatal depressive symptoms.ConclusionsMaternal, paternal and discordant couple pregnancy intentions, as perceived by rural Bangladeshi women, are important risk factors for perinatal maternal depressive symptoms.
Highlights
Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries
While there is a substantial literature on unintended pregnancy and mental health in developed countries, little is known about the relation between unwanted pregnancy and maternal mental health in lower- and middleincome countries [8]
A total of 127,282 women were placed under 5-weekly pregnancy surveillance, of whom 59,666 became pregnant, of whom 16,792 were in the subsample that was eligible for assessment of depressive symptoms while pregnant during the eligible period that, for pregnant women, ran from February 2004 through November 2006
Summary
Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. Gendered inequalities related to reproductive decision-making and control exist within South Asia, with 48% of women in Bangladesh reporting that their husbands make decisions about their health and accessing healthcare services [12, 13]. Given this context, we were interested in studying discordance of wantedness between couples in relation to depressive symptoms
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