Social determinants of mental health of pregnant women in Nepal: a sequential exploratory mixed methods research study

Women during pregnancy are at risk of developing poor mental health, and it is one of the major concerns in low- and middle-income countries, including Nepal. This PhD study employed a sequential exploratory mixed methods approach to understand social determinants of the mental health of pregnant women by exploring their lived experiences within the socioeconomic and cultural context of Nepal, availability and accessibility of health services and social support, and how these aspects impact their mental health. Data collection included in-depth interviews with eight key informants and twenty pregnant women, followed by a survey with one hundred and twenty-eight pregnant women. The study used purposive sampling to recruit pregnant women through a district hospital in an Eastern region of Nepal, and key informants were recruited based on their experiences. Thematic analysis was used for qualitative data, and descriptive and inferential statistics were applied to analyse quantitative data. The theoretical underpinnings of the study were based on ecological theory and intersectionality.

Qualitative findings highlighted the importance of social support for pregnant women’s mental health and reported a lack of structured social support during pregnancy, and this was prominent for those women from poorer socioeconomic backgrounds. Participants also raised concerns about the availability and accessibility of maternal health services that did not meet their mental health needs, mainly due to limited care provision, overcrowded hospitals, and shortages of skilled health professionals. The lived experiences of Nepalese pregnant women highlighted how they saw themselves within the sociocultural and economic context of Nepal and its impact on their mental health. In particular, the analysis highlighted how sociocultural factors intersect with individual and economic circumstances to present compounded risks of poor mental health for many pregnant women. The quantitative findings suggested that there was an association between poor mental health and experience of unsuccessful pregnancy, receiving social support other than husband during pregnancy, and early age of pregnancy. The study findings suggested that a better and more in-depth understanding of various social determinants of mental health are important prerequisites in meeting the mental health needs of women during pregnancy and to design appropriately tailored maternal health services.