POSTNATAL DEPRESSION AMONG RURAL, URBAN, AND RURAL-MIGRANT WOMEN IN KARACHI, PAKISTAN: A COMPARATIVE CROSS-SECTIONAL STUDY

Objective: To examine whether social support predicts postnatal depression (PND) among women in Karachi, and to identify other determinants of PND across rural, urban, and rural-migrant groups. Design: The study is comparative cross-sectional type with retrospective data collection. Setting: The study was conducted in rural areas (Gadap Town and Malir Thano) and urban areas (Saddar, DHA, Gulshan-e-Iqbal, Nazimabad) of Karachi, Pakistan. Participants: 207 women aged 20–40 years who had given birth within the preceding 12 months. These cases were further divided into 3 groups consisting 69 subjects per group: Group A (rural residence, rural birth), Group B (urban residence, urban birth), and Group C (rural residence, urban birth). Outcome measures: Postnatal depression (self-reported), social support variables (husband's respect, husband's love, domestic violence, autonomy, mother alive, mother in same city, father alive, father in same city, discrimination feeling), and a composite social support score (0–8). Results: PND prevalence was 16.4%. The composite social support score did not predict PND (OR = 0.75, 95% CI: 0.44–1.28, p = .292). Three variables independently predicted PND: rural-migrant status (Group C vs A: OR = 3.70, 95% CI: 1.20–11.36, p = .023), first-cousin marriage (OR = 2.53, 95% CI: 1.13–5.65, p = .024), and mother living in the same city (OR = 3.14, 95% CI: 1.06–9.25, p = .038). Conclusions: Social support does not protect against postnatal depression in this study population. Migration, consanguinity, and — unexpectedly — proximity to the mother are the strongest predictors of PND. Policymakers should not assume that social support alone reduces PND risk; interventions must address migration-related stress and the specific vulnerabilities associated with consanguineous marriage.