Pregnancy Under Pressure: A Socioecological Understanding of Pregnancy and Mental Well-Being in Nepal

Pregnancy and childbirth are seen as embedded within sociocultural norms that shape the experience of maternal well-being and women’s identity. In this article, we will present the sociocultural norms of pregnancy and childbirth through the lived experiences of pregnant women in Nepal. We utilize the findings from 20 in-depth interviews with pregnant women and analyze them using thematic analysis. Themes are interpreted using the social ecological model, which frames how individual experiences are shaped by interpersonal, community, and societal structures. The findings reveal that pregnancy and childbirth soon after marriage are the most common social norms, and giving birth to a baby boy is the most desired social and family expectation. The research presents a distinct finding that women may conceal pregnancy in the first trimester due to shyness and embarrassment, which impacts the woman’s health and well-being. The research also found that acceptance of unplanned pregnancy is a social norm that exists in the sociocultural context of Nepal, and women have very limited decision making in pregnancy planning, with women accepting the decision to have a child despite it not being their preferred option. The study found that women experience extensive mental distress in such a sociocultural environment, where they are expected to meet and maintain these social expectations. Based on the findings, we highly recommend that the sociocultural context of childbirth and pregnancy should be acknowledged and addressed in future maternal health promotion initiatives, policies and maternal health service provision in Nepal.