“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

Rowther, Armaan A.; Kazi, Asiya K.; Nazir, Huma; Atiq, Maria; Atif, Najia; Rauf, Nida; Malik, Abid; Surkan, Pamela J.

doi:10.3390/ijerph17144926

Cited by 18 publications

(15 citation statements)

References 59 publications

(81 reference statements)

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“…In rural and traditional families in Pakistan, women are usually not allowed to go alone to seek health care. They remain dependent on their husband, or elder family members for going outside of home to visit relatives, shopping and seeking health care [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

2022

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Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women’s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods We used Pakistan Demographic and Health Survey 2017–18 (PDHS) data which comprises of 6,602 currently married women aged between 15–49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women’s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30–2.10) and 1.45 (95% CI 1.19–1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44–2.43) and 2.78 (95% CI 2.04–3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60–2.44) and 1.56 (95% CI 2.17–1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. Conclusion The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women’s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

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Section: Discussionmentioning

confidence: 99%

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

2022

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“…al. found gender norms to be a major cause of constrained agency, decision-making, and prenatal anxiety amongst pregnant women [9]).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a Birth-cohort In Pakistan: Evidence For Better Lives Study

Anwer

Abbasi

Dar

et al. 2021

Preprint

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BackgroundEvidence for Better Lives Study (EBLS) is an endeavour to establish a global birth cohort with participants from resource poor settings across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor settings taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan.MethodFrom March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support related information and stress related biomarkers in a peri-urban area of Islamabad Capital Territory. From October 2019 to December 2019, we re-contacted and followed 121 between 8-24 weeks postnatal period. All interviews were done after consent and data was collected electronically. Results150 (98%) third trimester pregnant women consented and were interviewed, 111 (74%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (5.18) and 7.77 (4.79) respectively. Majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers while 63% of women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (32.20) & PHQ-9 mean scores 8.23 (7.0)). About 22% of women reported four or more adverse childhood experiences; 12.2% reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 58% of the women reported breastfeeding their infants. ConclusionThe study demonstrated Pakistan site could identify, approach, interview and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Thus, a larger scale pregnancy birth cohort study in Pakistan is feasible to conduct.

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“…Coping refers to “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Lazarus and Folkman 1984 , p. 141). 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 ).…”

Section: Prenatal Mental Health and Coping Strategiesmentioning

confidence: 99%

“…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 ).…”

Section: Prenatal Mental Health and Coping Strategiesmentioning

confidence: 99%

Pregnancy during the COVID-19 pandemic: a qualitative examination of ways of coping

Reynolds

Pankratz

Cameron

et al. 2022

Arch Womens Ment Health

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The COVID-19 pandemic and related public health restrictions have impacted the mental health and coping strategies of many population groups, including people who are pregnant. Our study sought to explore the ways that pregnant people described coping with stressors associated with the pandemic. N = 5879 pregnant individuals completed the pan-Canadian Pregnancy During the COVID-19 Pandemic Survey between April and December 2020. We used descriptive statistics to quantify sociodemographic characteristics and thematic analysis (Braun & Clarke, 2006, 2019) to analyze n = 3316 open-ended text responses to the question “Can you tell us what things you are doing to cope with the COVID-19 pandemic?” The average age of participants was 32 years ( SD = 4.4), with the majority identifying as White (83.6%), female (99.7%), married (61.5%), having completed post-secondary education (90.0%), and working full-time (75.4%). We categorized participant responses into two overarching thematic dimensions: (1) ways of coping and (2) coping challenges. Ways of coping included the following main themes: (1) taking care of oneself, (2) connecting socially, (3) engaging in pandemic-specific coping strategies, (4) keeping busy, (5) taking care of others, (6) creating a sense of normalcy, (7) changing perspectives, and (8) practicing spirituality. Coping challenges included the following: (1) the perception of coping poorly, (2) loss of coping methods, (3) managing frontline or essential work, and (4) worries about the future. Findings highlight important implications for targeted prenatal supports delivered remotely, including opportunities for social support, prenatal care, and mental health strategies.

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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

Cited by 18 publications

References 59 publications

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

Feasibility of a Birth-cohort In Pakistan: Evidence For Better Lives Study

Pregnancy during the COVID-19 pandemic: a qualitative examination of ways of coping

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