“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

Bibliographic Data

ID17801142
AuthorsArmaan A Rowther (0000-0002-2490-0076, Johns Hopkins University, corresponding author), Asiya K Kazi (0000-0001-9259-6726, Johns Hopkins University), Huma Nazir (0000-0001-8166-4463, Human Development Research Foundation), Maria Atiq (0009-0002-2669-367X, Human Development Research Foundation), Najia Atif (0000-0002-9540-9356, Human Development Research Foundation), Nida Rauf (0000-0003-2018-9667, Human Development Research Foundation), Abid Malik (0000-0002-9084-2185, Human Development Research Foundation), Pamela J Surkan (0000-0002-0334-5931, Johns Hopkins University)
Year2020
Volume17
Issue14
Pages4926-4926
Publication date2020-07-08
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueInternational Journal of Environmental Research and Public Health (JOURNAL)
Journal identifiersISSN: 1661-7827 • E-ISSN: 1660-4601
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/ijerph17144926
PMID32650551
OpenAlexW3041206713
LanguageEN
Citations received13
References cited31

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

Anxiety · Autonomy · Developmental psychology · Empowerment · Mental health · Psychiatry · Qualitative research · Social support · Thematic analysis · Attachment and Relationship Dynamics · Clinical Psychology · Maternal and Perinatal Health Interventions · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Psychology · Social Psychology