{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:42:06Z","timestamp":1791841326004,"version":"4.3.4"},"reference-count":71,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T00:00:00Z","timestamp":1594166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["RO1 MH111859-01"],"award-info":[{"award-number":["RO1 MH111859-01"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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\u201337 years recruited from 2017\u20132018 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\u2019s social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.3390\/ijerph17144926","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T11:47:46Z","timestamp":1594208866000},"page":"4926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["\u201cA Woman Is a Puppet.\u201d Women\u2019s Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2490-0076","authenticated-orcid":false,"given":"Armaan A","family":"Rowther","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9259-6726","authenticated-orcid":false,"given":"Asiya K","family":"Kazi","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huma","family":"Nazir","sequence":"additional","affiliation":[{"name":"Human Development Research Foundation House No 06, Street No 55, F-7\/4, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Atiq","sequence":"additional","affiliation":[{"name":"Human Development Research Foundation House No 06, Street No 55, F-7\/4, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Atif","sequence":"additional","affiliation":[{"name":"Human Development Research Foundation House No 06, Street No 55, F-7\/4, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nida","family":"Rauf","sequence":"additional","affiliation":[{"name":"Human Development Research Foundation House No 06, Street No 55, F-7\/4, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abid","family":"Malik","sequence":"additional","affiliation":[{"name":"Human Development Research Foundation House No 06, Street No 55, F-7\/4, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0334-5931","authenticated-orcid":false,"given":"Pamela J","family":"Surkan","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139H","DOI":"10.2471\/BLT.11.091850","article-title":"Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: A systematic review","volume":"90","author":"Fisher","year":"2012","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rahman, A., Surkan, P.J., Cayetano, C.E., Rwagatare, P., and Dickson, K.E. (2013). Grand challenges: Integrating maternal mental health into maternal and child health programmes. 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