“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

Armaan A Rowther, Asiya K Kazi, Huma Nazir, Maria Atiq, Najia Atif, Nida Rauf, Abid Malik and Pamela J Surkan
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Armaan A Rowther: Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA
Asiya K Kazi: Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA
Huma Nazir: Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
Maria Atiq: Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
Najia Atif: Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
Nida Rauf: Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
Abid Malik: Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
Pamela J Surkan: Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA

IJERPH, 2020, vol. 17, issue 14, 1-19

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.

Keywords: prenatal anxiety; women’s empowerment; mental health; anxiety; pregnancy; South Asia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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