Depression and anxiety are among the most frequently observed adverse emotional states in pregnant women. The inadequacy of mental health services and the paucity of external support often result in the psychological well-being of rural expectant mothers being overlooked, thereby exerting a profound impact on both maternal and neonatal health.

This study, adopting a socio-ecological framework, explores the emotional regulation experiences of rural pregnant women in China, aiming to furnish empirical insights that may inform early intervention strategies for primary healthcare practitioners.

A purposive sampling strategy was utilized to recruit rural pregnant women exhibiting negative emotional experiences from villages under the jurisdiction of Anda City, Suihua, Heilongjiang Province, and Honggang District, Daqing, Heilongjiang Province, during the period spanning October 1 to December 1, 2023. Participants were enlisted through outreach medical consultations and maternal health record registration conducted by higher-tier maternal and child health institutions. Semi-structured interviews were employed for data collection, with information gathered via audio recordings and subsequently transcribed verbatim. The collected data underwent rigorous analysis through Colaizzi's descriptive phenomenological framework, executed by two independent coders.

A total of 13 participants were incorporated into the study. Through meticulous examination of the interview data, three principal themes and eleven subordinate sub-themes were delineated: (1) Microsystemic level: the ramifications of somatic symptoms, amplified anxieties regarding childbirth, perturbations in self-perception, and substantive alterations in lifestyle. (2) Mesosystemic level: the precipitous escalation in child-rearing expenditures, pronounced familial discord, and a dearth of peer support mechanisms. (3) Macrosystemic level: suboptimal healthcare encounters, insufficiencies in informational support, structural disequilibrium between service provision and demand, and intensifying societal pressures.

The emotional adversities confronted by rural pregnant women emanate from a constellation of interwoven determinants. Mitigating these psychological challenges necessitates a holistic and stratified approach that engages the expectant mothers themselves, their familial environments, and the grassroots medical infrastructure. Recognizing and refining the emotional regulation experiences of rural pregnant women through empirically substantiated, tailored interventions is paramount. Such efforts are pivotal in augmenting their emotional resilience and, consequently, advancing maternal and neonatal health outcomes.