IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v367y2025ics0277953625000334.html

Female agency and probable depression in the perinatal period and beyond: Longitudinal findings from rural Pakistan

Author

Listed:
  • Haight, Sarah C.
  • Shartle, Kaitlin
  • Kachoria, Aparna G.
  • Hagaman, Ashley
  • Gupta, Sugandh
  • Escobar Carias, Michelle S.
  • Bibi, Amina
  • Bates, Lisa M.
  • Maselko, Joanna

Abstract

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.

Suggested Citation

  • Haight, Sarah C. & Shartle, Kaitlin & Kachoria, Aparna G. & Hagaman, Ashley & Gupta, Sugandh & Escobar Carias, Michelle S. & Bibi, Amina & Bates, Lisa M. & Maselko, Joanna, 2025. "Female agency and probable depression in the perinatal period and beyond: Longitudinal findings from rural Pakistan," Social Science & Medicine, Elsevier, vol. 367(C).
    • Handle: RePEc:eee:socmed:v:367:y:2025:i:c:s0277953625000334
    DOI: 10.1016/j.socscimed.2025.117704
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625000334
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.117704?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. repec:qeh:ophiwp:ophiwp004 is not listed on IDEAS
    2. Solava Ibrahim & Sabina Alkire, 2007. "Agency and Empowerment: A Proposal for Internationally Comparable Indicators," Oxford Development Studies, Taylor & Francis Journals, vol. 35(4), pages 379-403.
    3. Shireen J. Jejeebhoy & Zeba A. Sathar, 2001. "Women's Autonomy in India and Pakistan: The Influence of Religion and Region," Population and Development Review, The Population Council, Inc., vol. 27(4), pages 687-712, December.
    4. Pratley, Pierre, 2016. "Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world," Social Science & Medicine, Elsevier, vol. 169(C), pages 119-131.
    5. Zohra S. Lassi & Anna Ali & Salima Meherali, 2021. "Women’s Participation in Household Decision Making and Justification of Wife Beating: A Secondary Data Analysis from Pakistan’s Demographic and Health Survey," IJERPH, MDPI, vol. 18(19), pages 1-11, September.
    6. Mahmud, Simeen & Shah, Nirali M. & Becker, Stan, 2012. "Measurement of Women’s Empowerment in Rural Bangladesh," World Development, Elsevier, vol. 40(3), pages 610-619.
    7. Hill, Terrence D. & Needham, Belinda L., 2013. "Rethinking gender and mental health: A critical analysis of three propositions," Social Science & Medicine, Elsevier, vol. 92(C), pages 83-91.
    8. Wilkins, Arjun S., 2018. "To Lag or Not to Lag?: Re-Evaluating the Use of Lagged Dependent Variables in Regression Analysis," Political Science Research and Methods, Cambridge University Press, vol. 6(2), pages 393-411, April.
    9. Stanislav Kolenikov & Gustavo Angeles, 2009. "Socioeconomic Status Measurement With Discrete Proxy Variables: Is Principal Component Analysis A Reliable Answer?," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 55(1), pages 128-165, March.
    10. Lucia Hanmer & Jeni Klugman, 2016. "Exploring Women's Agency and Empowerment in Developing Countries: Where do we stand?," Feminist Economics, Taylor & Francis Journals, vol. 22(1), pages 237-263, January.
    11. Quisumbing, Agnes & Meinzen-Dick, Ruth & Malapit, Hazel, 2022. "Women’s empowerment and gender equality in South Asian agriculture: Measuring progress using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI) in Bangladesh and India," World Development, Elsevier, vol. 151(C).
    12. Kanako Yoshikawa & Yusuke Kamiya, 2019. "Married couples’ perceptions on women’s autonomy and subjective well-being in Lao PDR," International Journal of Social Economics, Emerald Group Publishing Limited, vol. 46(6), pages 792-804, June.
    13. Naila Kabeer & Lopita Huq, 2010. "The Power of Relationships: Love and Solidarity in a Landless Women's Organisation in Rural Bangladesh," IDS Bulletin, Blackwell Publishing, vol. 41(2), pages 79-87, March.
    14. Yount, Kathryn M. & Dijkerman, Sally & Zureick-Brown, Sarah & VanderEnde, Kristin E., 2014. "Women's empowerment and generalized anxiety in Minya, Egypt," Social Science & Medicine, Elsevier, vol. 106(C), pages 185-193.
    15. David Fielding & Aurélia Lepine, 2017. "Women’s Empowerment and Wellbeing: Evidence from Africa," Journal of Development Studies, Taylor & Francis Journals, vol. 53(6), pages 826-840, June.
    16. Muhammad Asim & Waqas Hameed & Sarah Saleem, 2022. "Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-13, January.
    17. Naila Kabeer, 1999. "Resources, Agency, Achievements: Reflections on the Measurement of Women's Empowerment," Development and Change, International Institute of Social Studies, vol. 30(3), pages 435-464, July.
    18. Najaf Zahra & Amna Javed & Ana Maria Munoz Boudet, 2022. "What do We Know About Interventions to Increase Women’s Economic Participation and Empowerment in South Asia?," World Bank Publications - Reports 38078, The World Bank Group.
    19. Kathryn M. Yount & Kristin E. VanderEnde & Sylvie Dodell & Yuk Fai Cheong, 2016. "Measurement of Women’s Agency in Egypt: A National Validation Study," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 128(3), pages 1171-1192, September.
    20. Platt, Jonathan & Prins, Seth & Bates, Lisa & Keyes, Katherine, 2016. "Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders," Social Science & Medicine, Elsevier, vol. 149(C), pages 1-8.
    21. Richardson, Robin A. & Harper, Sam & Bates, Lisa M. & Nandi, Arijit, 2019. "The effect of agency on women's mental distress: A prospective cohort study from rural Rajasthan, India," Social Science & Medicine, Elsevier, vol. 233(C), pages 47-56.
    22. Xavier Giné & Ghazala Mansuri, 2018. "Together We Will: Experimental Evidence on Female Voting Behavior in Pakistan," American Economic Journal: Applied Economics, American Economic Association, vol. 10(1), pages 207-235, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Miedema, Stephanie Spaid & Haardörfer, Regine & Girard, Amy Webb & Yount, Kathryn M., 2018. "Women’s empowerment in East Africa: Development of a cross-country comparable measure," World Development, Elsevier, vol. 110(C), pages 453-464.
    2. Robin A. Richardson, 2018. "Measuring Women’s Empowerment: A Critical Review of Current Practices and Recommendations for Researchers," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 137(2), pages 539-557, June.
    3. Wole Kinati & Elizabeth C. Temple & Derek Baker & Dina Najjar & Reta Hailu, 2024. "Understanding Agency Within Context: The Case of Breeding Cooperatives Program for Transforming Small Ruminant Value Chain in Ethiopia," SAGE Open, , vol. 14(2), pages 21582440241, April.
    4. Sojin Yu & Feinian Chen & Sonalde Desai, 2023. "Aligning household decision-making with work and education: A comparative analysis of women’s empowerment," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 48(19), pages 513-548.
    5. Yasmin, Nazia & Grundmann, Philipp, 2020. "Home-cooked energy transitions: Women empowerment and biogas-based cooking technology in Pakistan," Energy Policy, Elsevier, vol. 137(C).
    6. Trommlerová, Sofia Karina & Klasen, Stephan & Leßmann, Ortrud, 2015. "Determinants of Empowerment in a Capability-Based Poverty Approach: Evidence from The Gambia," World Development, Elsevier, vol. 66(C), pages 1-15.
    7. Jones, Rebecca E. & Haardörfer, Regine & Ramakrishnan, Usha & Yount, Kathryn M. & Miedema, Stephanie S. & Roach, Timmie D. & Girard, Amy Webb, 2020. "Intrinsic and instrumental agency associated with nutritional status of East African women," Social Science & Medicine, Elsevier, vol. 247(C).
    8. Seymour, Greg & Peterman, Amber, 2018. "Context and measurement: An analysis of the relationship between intrahousehold decision making and autonomy," World Development, Elsevier, vol. 111(C), pages 97-112.
    9. Laszlo, Sonia & Grantham, Kate & Oskay, Ecem & Zhang, Tingting, 2020. "Grappling with the challenges of measuring women's economic empowerment in intrahousehold settings," World Development, Elsevier, vol. 132(C).
    10. DeJaeghere, Joan & Pellowski Wiger, Nancy & Le, Hue & Luong, Phuong & Ngo, Nga Thi Hang & Vu, Thanh Thi & Lee, Jongwook, 2022. "Why do aspirations matter for empowerment?: Discrepancies between the A-WEAI domains and aspirations of ethnic minority women in Vietnam," World Development, Elsevier, vol. 159(C).
    11. Rania Salem & Yuk Fai Cheong & Kathryn M. Yount, 2018. "Is Women’s Work a Pathway to their Agency in Rural Minya, Egypt?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 136(2), pages 807-831, April.
    12. O'Hara, Corey & Clement, Floriane, 2018. "Power as agency: A critical reflection on the measurement of women’s empowerment in the development sector," World Development, Elsevier, vol. 106(C), pages 111-123.
    13. Susana Martínez-Restrepo & Laura Ramos-Jaimes & Alma Espino & Martin Valdivia & Johanna Yancari Cueva, 2017. "Measuring women’s economic empowerment: Critical lessons from South America," INFORMES DE INVESTIGACIÓN 015825, FEDESARROLLO.
    14. Muhammad Qahraman Kakar, 2021. "Ethnic Disparities, Women Education and Empowerment in South Asia," Erudite Ph.D Dissertations, Erudite, number ph21-01 edited by Manon Domingues Dos Santos, December.
    15. DiClemente-Bosco, Kira & Weber, Alison Z. & Harrison, Abigail & Tsawe, Nokwazi & Rini, Zanele & Brittain, Kirsty & Colvin, Christopher J. & Myer, Landon & Pellowski, Jennifer A., 2022. "Empowerment in pregnancy: ART adherence among women living with HIV in Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 296(C).
    16. Peterman, Amber & Schwab, Benjamin & Roy, Shalini & Hidrobo, Melissa & Gilligan, Daniel O., 2021. "Measuring women’s decisionmaking: Indicator choice and survey design experiments from cash and food transfer evaluations in Ecuador, Uganda and Yemen," World Development, Elsevier, vol. 141(C).
    17. Mishra, Khushbu & Sam, Abdoul G., 2016. "Does Women’s Land Ownership Promote Their Empowerment? Empirical Evidence from Nepal," World Development, Elsevier, vol. 78(C), pages 360-371.
    18. Eom, Yun-Jung & Chi, Hyejun & Bhatia, Amiya & Lee, Hwa-Young & Subramanian, S.V. & Kim, Rockli, 2025. "Individual- and community-level women's empowerment and complete use of maternal healthcare services: A multilevel analysis of 34 sub-Saharan African countries," Social Science & Medicine, Elsevier, vol. 370(C).
    19. Sajid Hussain & Shafiq Jullandhry & Taimoor ul Hassan, 2022. "Is there any relationship between TV morning shows and urban women’s empowerment in Pakistan? A case study from Lahore," Quality & Quantity: International Journal of Methodology, Springer, vol. 56(2), pages 557-587, April.
    20. Saha, Shree & Narayanan, Sudha, 2022. "A simplified measure of nutritional empowerment: Using machine learning to abbreviate the Women’s Empowerment in Nutrition Index (WENI)," World Development, Elsevier, vol. 154(C).

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:367:y:2025:i:c:s0277953625000334. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.