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“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

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA
2
Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(14), 4926; https://doi.org/10.3390/ijerph17144926
Received: 16 March 2020 / Revised: 5 June 2020 / Accepted: 29 June 2020 / Published: 8 July 2020
(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)
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. View Full-Text
Keywords: prenatal anxiety; women’s empowerment; mental health; anxiety; pregnancy; South Asia prenatal anxiety; women’s empowerment; mental health; anxiety; pregnancy; South Asia
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MDPI and ACS Style

Rowther, A.A; Kazi, A.K; Nazir, H.; Atiq, M.; Atif, N.; Rauf, N.; Malik, A.; Surkan, P.J. “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. Int. J. Environ. Res. Public Health 2020, 17, 4926. https://doi.org/10.3390/ijerph17144926

AMA Style

Rowther AA, Kazi AK, Nazir H, Atiq M, Atif N, Rauf N, Malik A, Surkan PJ. “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. International Journal of Environmental Research and Public Health. 2020; 17(14):4926. https://doi.org/10.3390/ijerph17144926

Chicago/Turabian Style

Rowther, Armaan A; Kazi, Asiya K; Nazir, Huma; Atiq, Maria; Atif, Najia; Rauf, Nida; Malik, Abid; Surkan, Pamela J 2020. "“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" Int. J. Environ. Res. Public Health 17, no. 14: 4926. https://doi.org/10.3390/ijerph17144926

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