“A Woman Is a Puppet.” Women’s Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy

Abstract

<jats:p>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.</jats:p>

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“…Seeking and receiving social support to assist with coping is well-known to mitigate the effects of distress experienced during the perinatal period (Ibrahim et al 2019 ; Khatri et al 2019 ; Rowther et al 2020 ). Social support network size, satisfaction with close relationships, and degree of social involvement can all act as buffers against stress and its negative impacts (Goletzke et al 2017 ; Taubman-Ben-Ari 2019 ) and are identified as a key resource to reduce stress during pregnancy (Bloom et al 2012 ; Rowther et al 2020 ). An important facet of social support is the degree to which one’s preferred type of social support is accessible at the time it is needed most (Leahy-Warren et al 2018 ).…”