The rate of participation in standard pregnancy health care in China is gradually increasing, highlighting the imbalance and insufficiency in women's and children's health development between urban and rural areas. The potential of rural women's self-management as the cornerstone of pregnancy health care has not been fully utilized.

To examine the current status of standard pregnancy health care among rural women, assess their level of self-management behavior, and identify the factors influencing their self-management behavior in pregnancy health care.

The research was conducted from January to August 2023, involving rural women in Suihua City and Daqing City in Heilongjiang Province, as well as Changchun City in Jilin Province, all selected through convenience sampling. Various tools such as the Basic Information Questionnaire, Maternal Self-Management Scale, A5-item Short Form of the Edinburgh Postnatal Depression Scale (EPDS-Dep-5), and Maternal Social Support Scale (MSSS) were employed to gather data. Data in relation to the present condition of standard pregnancy health care among rural women were counted. The self-management behavior scores of different characteristics of rural women in pregnancy health care were compared. Multiple linear regression was used to assess the factors that impact rural women's self-management behavior in pregnancy health care.

A total of 493 questionnaires were distributed, and 470 valid questionnaires were collected, with a valid questionnaire collection rate of 95.33%. The findings revealed that 218 rural women (46.4%) underwent pre-pregnancy checkups, with 388 (82.6%) having their first checkups within 12 weeks. There were 303 cases (64.5%) where obstetric examinations took place in medical and health institutions at the county level or higher. Of 276 cases (58.7%), the number of obstetric examinations satisfied the requirements for the respective pregnancy week. However, only 103 cases (21.9%) adhered to the required number of obstetric examination items for the pregnancy week. The average score for self-management of health care during pregnancy was (70.18±16.42). The scoring indicators for each dimension, in descending order, were medical compliance behavior (79.75%), routine life behavior management (77.33%), self-protection behavior (76.73%), and fetal monitoring behavior management (70.43%). The findings from the multiple linear regression analysis indicated that the distance of family residence from the closest antenatal care facility (B=0.732, 95%CI=0.139-1.325), gestational week (B=-1.336, 95%CI=-2.119 to -0.553), pregnancy complications (B=3.776, 95%CI=1.532-6.019), risk of depression during pregnancy (B=-0.356, 95%CI=-0.663 to -0.049), and social support status (B=2.635, 95%CI=2.508-2.762) were identified as significant factors influencing the self-management behaviors of pregnancy health care among rural women (P<0.05) .

Rural women exhibited low rates of participation and eligibility for standardized pregnancy health care, along with moderate scores for self-management behaviors related to pregnancy health care. The distance of family residence from the nearest antenatal care facility, gestational week, pregnancy comorbidities, risk of depression during pregnancy, and social support were found to be the factors influencing the self-management behaviors of pregnancy health care among rural women. It is recommended that health care providers at all levels focus on rural women during pregnancy, standardize their pregnancy health care behaviors, enhance their self-management skills, and establish a scientifically sound, cost-effective, simple, and easily operable self-management intervention model for pregnancy health care among rural women.