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.
In rural areas, the self-management levels of pregnant women not only remain generally low but also vary significantly among individuals, thereby necessitating a detailed investigation into their behavioral patterns to facilitate their classification into distinct groups.
This analysis explores the types and characteristics of self-management among pregnant women in rural areas to provide references for devising targeted management strategies.
From January to August 2023, a convenience sampling method was employed to select pregnant women from Suihua City and Daqing City in Heilongjiang Province, and Changchun City in Jilin Province. Surveys were conducted using a general data questionnaire, a self-management scale for pregnant women, a general self-efficacy scale, an internal motivation scale, and a prenatal care knowledge scale. Cluster analysis was performed using SPSS 25.0 to classify the subjects into different types based on their self-management traits and compare their general characteristics.
A total of 481 questionnaires were distributed, and 470 valid questionnaires were retrieved, with a valid questionnaire recovery rate of 97.7%. It was found that the total score for self-management behaviors among the surveyed rural pregnant women stood at (70.2±16.4). Four distinct types were identified through optimal clustering: typeⅠ, characterized by low awareness non-participants (25.3%, n=119) ; typeⅡ, those who engage through guided cooperation (29.4%, n=138) ; typeⅢ, those under supervised directive (18.7%, n=88) ; and typeⅣ, proactive participants (26.6%, n=125). Noteworthy were the significant statistical differences that emerged across such variables as educational backgrounds, occupations, annual incomes, number of pregnancies, gestational weeks, whether pregnancies were planned, histories of chronic diseases, and complications during pregnancy among the four types (P<0.05). Furthermore, the comparison of scores across different self-management dimensions revealed significant statistical differences, with adherence to medical advice scoring the highest and fetal monitoring behavior scoring the lowest (P<0.05) .
The four types of self-management among rural pregnant women, identified based on differentiated characteristics in prenatal care knowledge, self-efficacy, and behavioral motivation, exhibit a high degree of heterogeneity. Type Ⅰ, characterized by low awareness non-participants, faces the dual challenge of inadequate knowledge reserves and lack of behavioral motivation. Type Ⅱ, those who engage through guided cooperation, is marked by low self-efficacy but good compliance with external guidance. TypeⅢ, those under supervised directive, lacks intrinsic motivation and relies heavily on external supervision for regulating self-management behaviors. Type Ⅳ, proactive participants, represents the most optimal group, possessing strong prenatal care knowledge, high self-efficacy, and effective self-management behaviors. Therefore, in clinical practice, targeted intervention strategies can be developed according to each type, in order to further enhance the self-management capabilities of rural pregnant women and optimize prenatal care services.
Despite ongoing adjustments and optimizations to fertility policies, deficiencies persist in contraceptive service provision for pregnant and postpartum women, potentially increasing the risk of unintended and short-interval pregnancies. Currently, contraceptive decision-making is largely concentrated in the postpartum period, with relatively delayed timing, whereas prenatal contraceptive decision-making remains insufficiently addressed.
To investigate maternal preferences and associated factors regarding the three contraceptive decision-making models—physician-led, patient-led, and shared decision-making—with a particular focus on their needs for postpartum contraceptive decision-making during the prenatal period.
A cross-sectional survey was conducted among women aged 18-45 years who delivered healthy live births between January and July 2023 at Wuzhong People's Hospital and Yinchuan Maternal and Child Health Hospital and attended postpartum follow-up visits at (42±7) days. The questionnaire gathered information on participants' demographic characteristics, the current status of prenatal contraceptive decision-making services, postpartum contraceptive practices, and contraceptive decision-making preferences. Maternal contraceptive decision-making preferences were assessed using the Problem Solving Decision-making (PSDM) Scale. Multiple Logistic regression analyses were performed to identify factors influencing maternal preferences for contraceptive decision-making.
In this study, a total of 650 questionnaires were collected. After excluding 34 due to duplicate data and significant missing values, 616 valid questionnaires were included in the final analysis. Among these, 612 postpartum women (99.4%) had not received any antenatal contraceptive decision-making services, while only 4 (0.6%) had. Of the 4 women who received such services, 1 relied on doctor- (or nurse-) led decision-making, while 3 preferred autonomous decision-making. A total of 533 (86.5%) participants expressed a need for shared decision-making regarding postpartum contraception during the prenatal period, and 545 (88.5%) were willing to receive shared decision-making services for postpartum contraception before delivery. Multiple Logistic regression analysis indicated that, compared with a preference for autonomous decision-making, acceptance of postpartum shared decision-making services was a significant factor influencing the preference for shared decision-making (OR=0.231, 95%CI=0.062-0.864, P<0.05) .
Maternal acceptance of the shared decision-making model for contraception is relatively high, yet the actual receipt of related services remains low. Efforts should be made to enhance pregnant and postpartum women's awareness of and participation in shared decision-making during the prenatal period, promoting the integration of prenatal and postpartum contraceptive services to further safeguard maternal and infant health.
