Female agency and probable depression in the perinatal period and beyond: Longitudinal findings from rural Pakistan.
Sarah C Haight, Kaitlin Shartle, Aparna G Kachoria, Ashley Hagaman, Sugandh Gupta, Michelle S Escobar Carias, Amina Bibi, Lisa M Bates, Joanna Maselko
Author Information
Sarah C Haight: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Rural Health Research and Policy Analysis Center, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, USA.
Kaitlin Shartle: Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA.
Aparna G Kachoria: Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
Ashley Hagaman: Department of Social and Behavioral Sciences, Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT, 06510, USA.
Sugandh Gupta: Department of Anthropology, College of Arts and Sciences, University of North Carolina, 207 E. Cameron Ave, Chapel Hill, NC, 27599, USA.
Michelle S Escobar Carias: Department of Economics, University of Melbourne, 111 Barry Street, Carlton, VIC, 3053, Melbourne, Australia.
Amina Bibi: Human Development Research Foundation, 963W+WWV, Boocha, Rawalpindi, Punjab, Pakistan.
Lisa M Bates: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA.
Joanna Maselko: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA; Carolina Population Center, University of North Carolina, 123 W Franklin Street, Chapel Hill, NC, 27516, USA.
In Pakistan, a setting with high gender inequality, the relationship between female agency and mental health has not been studied longitudinally or beyond a defined life stage like pregnancy. Using data from the Bachpan cohort of mother-infant dyads in Pakistan, we investigated female agency and depression at two life stages: perinatal (third trimester to 6-months postpartum; n = 1154) and beyond (3- to 4-years postpartum). Modified Poisson models estimated adjusted prevalence ratios (PR) for probable depression (PHQ-9) associated with female agency (freedom of movement and participation in household decision-making) at the two life stages. Among 1154 mothers (average age 26.6 years), female agency was substantially lower during pregnancy than it was at 3-years and depression was more common during postpartum than at 4-years. Low freedom of movement during pregnancy nominally increased the likelihood of postpartum depression (PR: 1.33; 95% CI: 0.98, 1.80). The risk of depression was higher for low- (PR: 1.01; 95% CI: 0.72-1.41) and high- (PR: 1.24; 95% CI: 0.65-2.36) participation in household decision-making compared to moderate, but estimates were imprecise. Results from beyond the perinatal period indicated a stronger relationship between low freedom of movement and subsequent depression (PR: 1.89; 95% CI: 1.12, 3.20; Table 3). Low- (PR: 1.19; 95% CI: 0.67-2.12) and high- (PR: 1.21; 95% CI: 0.67-2.17) decision-making continued to demonstrate a nominal U-shaped relationship with depression, but estimates were imprecise. Overall, restricted freedom of movement beyond the perinatal period, may increase the likelihood of depression. Future research should explore the nuances of participation in decision-making and how it impacts women's mental health.
