Abstract
Objectives
Psychological distress in pregnancy is associated with adverse postnatal outcomes. We aimed to identify how social support and women’s empowerment are associated with pregnancy-specific daily experiences among women suffering antenatal anxiety in Pakistan.
Methods
Data were collected as part of a randomized controlled trial of a psychosocial intervention for antenatal anxiety in a tertiary hospital in Pakistan. We included 594 women in early pregnancy (≤ 22 weeks) who endorsed mild to severe anxiety symptoms. Generalized linear regression models were used to analyze the associations of perceived social support and women’s empowerment in relation to pregnancy-specific daily hassles and uplifts using a culturally adapted and psychometrically validated version of the Pregnancy Experience Scale-Brief.
Results
High social support was positively associated with frequency and intensity of positive pregnancy-specific experiences (B = 0.39, 95% CI 0.23–0.54 uplifts frequency; and B = 0.17, 95% CI 0.12–0.22 uplifts intensity), and was inversely associated with frequency of negative pregnancy-specific experiences (B = − 0.44, 95% CI − 0.66, − 0.22). Women’s household empowerment was associated with greater uplifts frequency and intensity (B = 0.55, 95% CI 0.20–0.90 frequency; and B = 0.28, 95% CI 0.17–0.40 intensity). High social support and household empowerment were inversely related to PES hassle-to-uplift ratio scores.
Conclusions for Practice
Greater social support and household empowerment were associated with positive pregnancy-specific experiences in the context of antenatal anxiety in Pakistan.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Not applicable.
Code Availability
Not applicable.
References
Acharya, D. R., Bell, J. S., Simkhada, P., van Teijlingen, E. R., & Regmi, P. R. (2010). Women’s autonomy in household decision-making: A demographic study in Nepal. Reproductive Health, 7(1), 15. https://doi.org/10.1186/1742-4755-7-15
Ahmed, S., Creanga, A. A., Gillespie, D. G., & Tsui, A. O. (2010). Economic status, education and empowerment: Implications for maternal health service utilization in developing countries. PLoS ONE, 5(6), e11190. https://doi.org/10.1371/journal.pone.0011190
Atif, N., Nazir, H., Zafar, S., Chaudhri, R., Atiq, M., Mullany, L. C., Rowther, A. A., Malik, A., Surkan, P. J., & Rahman, A. (2020). Development of a psychological intervention to address anxiety during pregnancy in a low-income country. Frontiers in Psychiatry, 10, 927. https://doi.org/10.3389/fpsyt.2019.00927
Bushra, A., & Wajiha, N. (2015). Assessing the socio-economic determinants of women empowerment in Pakistan. Procedia—Social and Behavioral Sciences, 177, 3–8. https://doi.org/10.1016/j.sbspro.2015.02.321
Cardwell, M. S. (2013). Stress: Pregnancy considerations. Obstetrical & Gynecological Survey, 68(2), 119–129. https://doi.org/10.1097/OGX.0b013e31827f2481
Central Intelligence Agency (2020). Central intelligence agency world Factbook South Asia: Pakistan. https://www.cia.gov/library/publications/the-world-factbook/geos/pk.html
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179
DiPietro, J. A., Christensen, A. L., & Costigan, K. A. (2008). The pregnancy experience scale–brief version. Journal of Psychosomatic Obstetrics & Gynecology, 29(4), 262–267. https://doi.org/10.1080/01674820802546220
DiPietro, J., Ghera, M., Costigan, K., & Hawkins, M. (2004). Measuring the ups and downs of pregnancy stress. Journal of Psychosomatic Obstetrics & Gynecology, 25(3–4), 189–201. https://doi.org/10.1080/01674820400017830
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). User’s guide for the Structured clinical interview for DSM-IV axis I disorders SCID-I: Clinician version. American Psychiatric Press. https://onesearch.nihlibrary.ors.nih.gov/discovery/fulldisplay/alma991000219939704686/01NIH_INST:NIH.
Graham-Bermann, S. A., & Miller, L. E. (2013). Intervention to reduce traumatic stress following intimate partner violence: An efficacy trial of the Moms’ Empowerment Program (MEP). Psychodynamic Psychiatry, 41(2), 329–349. https://doi.org/10.1521/pdps.2013.41.2.329
Hughes, B. M. (2002). Research on psychometrically evaluated social support and cardiovascular reactivity to stress: Accumulated findings and implications. Studia Psychologica, 44(4), 311–326.
Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14. https://doi.org/10.1016/j.ajog.2009.09.007
Mahmood, N. (2002). Women’s role in domestic decision-making in Pakistan: Implications for reproductive behaviour. The Pakistan Development Review, 41(2), 121–148.
Mahmud, S., Shah, N. M., & Becker, S. (2012). Measurement of women’s empowerment in rural Bangladesh. World Development, 40(3), 610–619. https://doi.org/10.1016/j.worlddev.2011.08.003
Mandal, M., Muralidharan, A., & Pappa, S. (2017). A review of measures of women’s empowerment and related gender constructs in family planning and maternal health program evaluations in low- and middle-income countries. BMC Pregnancy and Childbirth, 17(Suppl 2), 342. https://doi.org/10.1186/s12884-017-1500-8.
Masitoh, D., & Pramesti, F. A. (2020). Gender inequality in Pakistan caused by domestic factors and conflict resolving based on CEDAW. Nation State: Journal of International Studies, 3(2), 241–258.
McCauley, M., Madaj, B., White, S. A., Dickinson, F., Bar-Zev, S., Aminu, M., Godia, P., Mittal, P., Zafar, S., & van den Broek, N. (2018). Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi. BMJ Global Health, 3(3), e000625. https://doi.org/10.1136/bmjgh-2017-000625.
McDonald, C. R., Weckman, A. M., Wright, J. K., Conroy, A. L., & Kain, K. C. (2020). Pregnant women in low- and middle-income countries require a special focus during the COVID-19 pandemic. Frontiers in Global Women’s Health. https://doi.org/10.3389/fgwh.2020.564560
Menger, L. M. (2016). Promoting psychosocial health and empowerment among female sex workers in Nepal: A pilot peer education intervention [Ph.D., Colorado State University]. https://www.proquest.com/docview/1815536401/abstract/77C0333EDAFD41AFPQ/1
Mujahid-Mukhtar, E., Mukhtar, H., & Abbink, G. A. (1991). Female participation in household decision-making: An analysis of consumer durables’ acquisition in Pakistan [with Comments]. The Pakistan Development Review, 30(4), 953–964.
Mumford, D. B., Tareen, I. K., Bajwa, M. Z., Bhatti, M. R., & Karim, R. (1991). The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 83(2), 81–85. https://doi.org/10.1111/j.1600-0447.1991.tb07370.x.
National Institute of Population Studies - NIPS/Pakistan and ICF (2019). Pakistan Demographic and Health Survey 2017-18.
National Institute of Population Studies - NIPS/Pakistan and ICF (2020). Pakistan Maternal Mortality Survey 2019.
Rahman, A., & Creed, F. (2007). Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: Prospective study from Rawalpindi, Pakistan. Journal of Affective Disorders, 100(1), 115–121. https://doi.org/10.1016/j.jad.2006.10.004
Rahman, A., Sikander, S., Malik, A., Ahmed, I., Tomenson, B., & Creed, F. (2012). Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country. The British Journal of Psychiatry, 201(6), 451–457. https://doi.org/10.1192/bjp.bp.112.109207.
Raza, A., & Murad, H. S. (2010). Gender gap in Pakistan: A socio-demographic analysis. International Journal of Social Economics, 37(7), 541–557. https://doi.org/10.1108/03068291011055478
Rowther, A. A., Kazi, A. K., Nazir, H., Atiq, M., Atif, N., Rauf, N., Malik, A., & Surkan, P. 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. International Journal of Environmental Research and Public Health, 17(14), E4926. https://doi.org/10.3390/ijerph17144926
Schuler, S. R., Hashemi, S. M., & Riley, A. P. (1997). The influence of women’s changing roles and status in Bangladesh’s fertility transition: Evidence from a study of credit programs and contraceptive use. World Development, 25(4), 563–575. https://doi.org/10.1016/S0305-750X(96)00119-2
Sharif, M., Zaidi, A., Waqas, A., Malik, A., Hagaman, A., Maselko, J., LeMasters, K., Liaqat, R., Bilal, S., Bibi, T., Ahmad, I., Sikander, S., & Rahman, A. (2021). Psychometric validation of the multidimensional scale of perceived social support during pregnancy in rural Pakistan. Frontiers in Psychology, 12, 601563. https://doi.org/10.3389/fpsyg.2021.601563
Staneva, A., Bogossian, F., Pritchard, M., & Wittkowski, A. (2015). The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review. Women and Birth: Journal of the Australian College of Midwives, 28(3), 179–193. https://doi.org/10.1016/j.wombi.2015.02.003.
Stapleton, L. R. T., Schetter, C. D., Westling, E., Rini, C., Glynn, L. M., Hobel, C. J., & Sandman, C. A. (2012). Perceived partner support in pregnancy predicts lower maternal and infant distress. Journal of Family Psychology: JFP: Journal of the Division of Family Psychology of the American Psychological Association (Division 43), 26(3), 453–463. https://doi.org/10.1037/a0028332
Surkan, P. J., Dong, L., Ji, Y., Hong, X., Ji, H., Kimmel, M., Tang, W. Y., & Wang, X. (2019). Paternal involvement and support and risk of preterm birth: Findings from the Boston birth cohort. Journal of Psychosomatic Obstetrics & Gynecology, 40(1), 48–56. https://doi.org/10.1080/0167482X.2017.1398725
Surkan, P. J., Hamdani, S. U., Huma, Z. E., Nazir, H., Atif, N., Rowther, A. A., Chaudhri, R., Zafar, S., Mullany, L. C., Malik, A., & Rahman, A. (2020). Cognitive-behavioral therapy-based intervention to treat symptoms of anxiety in pregnancy in a prenatal clinic using non-specialist providers in Pakistan: Design of a randomised trial. British Medical Journal Open, 10(4), e037590. https://doi.org/10.1136/bmjopen-2020-037590
Waqas, A., Raza, N., Lodhi, H. W., Muhammad, Z., Jamal, M., & Rehman, A. (2015). Psychosocial factors of antenatal anxiety and depression in Pakistan: Is social support a mediator? PLoS ONE, 10(1), e0116510. https://doi.org/10.1371/journal.pone.0116510
Yu, M., Qiu, T., Liu, C., Cui, Q., & Wu, H. (2020). The mediating role of perceived social support between anxiety symptoms and life satisfaction in pregnant women: A cross-sectional study. Health and Quality of Life Outcomes, 18(1), 223. https://doi.org/10.1186/s12955-020-01479-w
Zaidi, A., Khan, A., Rowther, A., Nazir, H., Perin, J., Rauf, N., Mumtaz, S., Naseem, H., Atif, N., Rahman, A., Surkan, P. J., & Malik, A. (2022). Cultural adaptation and psychometric validation of the Pregnancy Experience Scale—Brief version (PES-Brief) in Pakistani women with antenatal anxiety symptoms. SSM— Mental Health, 2, 100055. https://doi.org/10.1016/j.ssmmh.2021.100055
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Funding
This study was funded by the National Institutes of Mental Health, United States of America (Grant No. R01MH111859).
Author information
Authors and Affiliations
Contributions
AM was responsible for the original draft and supervised the data collection in the field. SP analyzed the data and drafted the results section. AR drafted the methods section. All authors SZ, JP, AZ, NA, AR and PS were involved in writing, reviewing and editing of the final draft. AM and PS conceptualized the research idea.
Corresponding author
Ethics declarations
Conflict of interest
The authors report there are no competing interests to declare.
Ethical Approval
1—Name of Ethics committee: IRB Human Development Research Foundation (HDRF), Pakistan. Approval number: IRB/001/2017. Date of approval: March 10, 2017. 2—Name of Ethics committee: Johns Hopkins Bloomberg School of Public Health IRB. Approval number: 00007592. Date of approval: December 7, 2016.
Consent to Participate
All participants were given verbal and written information about the study prior to recruitment, and provided written informed consent prior to screening and data collection.
Consent for Publication
The article is the author’s original work. The article has not previously been published elsewhere (either partly or totally), and is not in the process of being considered for publication in another journal. All authors meet the criteria for authorship. All authors have approved the manuscript and those entitled to authorship are listed as authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Malik, A., Park, S., Mumtaz, S. et al. Perceived Social Support and Women’s Empowerment and Their Associations with Pregnancy Experiences in Anxious Women: A Study from Urban Pakistan. Matern Child Health J 27, 916–925 (2023). https://doi.org/10.1007/s10995-023-03588-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03588-6