Anxiety among pregnant women in the second and third trimesters: A qualitative study

• Antenatal anxiety is prevalent but under-identified in rural Rajasthan, India. • Pregnant women reported anxiety due to gender bias, past trauma, and poor family support. • Healthcare providers lacked training and tools to identify or manage maternal anxiety. • Cultural norms and infrastructure gaps hinder mental health screening during ANC visits. • Integrating mental health into ANC via provider training and counselling is urgently needed. : Antenatal anxiety is a common mental health concern affecting pregnant women globally, with higher prevalence reported in low- and middle-income countries, including India. Despite its known adverse effects on maternal and child health outcomes, qualitative evidence on the lived experiences and contextual drivers of antenatal anxiety in rural, resource-constrained settings remains limited. : A qualitative study was conducted across four primary healthcare facilities in Nagaur district, Rajasthan, India. In-depth interviews were carried out with 14 participants, including eight pregnant women in their second or third trimester and six healthcare providers (doctors and auxiliary nurse midwives). Data were collected using semi-structured interview guides and analysed thematically. Six key themes emerged: (i) multidimensional experiences of antenatal anxiety, (ii) pregnancy-related challenges and facilitators, (iii) coping strategies and perceived support needs, (iv) healthcare providers’ knowledge and understanding of antenatal anxiety, (v) challenges faced by providers in identifying and addressing anxiety, and (vi) provider-recommended strategies for improving antenatal mental health care. Women’s anxiety was shaped by obstetric concerns, sociocultural pressures, and limited emotional support, while providers highlighted systemic constraints such as heavy workloads, limited mental health training, and weak referral mechanisms. : Antenatal anxiety among pregnant women in rural Rajasthan is influenced by a complex interplay of obstetric, sociocultural, and health-system factors. Strengthening routine mental health screening, enhancing provider capacity, and integrating accessible counselling within primary healthcare settings may improve maternal mental health outcomes in low-resource contexts.