Antenatal depression and anxiety in Pakistan
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Antenatal depression and anxiety in Pakistan
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[post_date] => 2025-01-03 12:51:39
[post_date_gmt] => 2025-01-03 17:51:39
[post_content] => Practice Passage (Question 1-6)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
An interesting finding in our study of antenatal depression and anxiety among women in Pakistan was the correlation between the occupation of pregnant women and antenatal depression and anxiety. In contrast to studies in western populations, which mention employment as a strong protective factor against major depression in pregnancy, our study found that pregnant women employed outside the home were actually more depressed and anxious than pregnant housewives. A study in Karachi, Pakistan apparently contradicts our findings by concluding that housewives, in general, are more depressed than working women. Several factors might explain this contradiction. Most studies with such findings mention education as an important protective factor against antenatal anxiety and depression. Therefore, the lower educational level of housewives compared to working women was associated with higher levels of anxiety and depression. However, our study included respondents from low and lower-middle socioeconomic classes, and 54% of the women in our sample were educated to less than the 10th grade level. So even most of the working women may not have been educated highly enough for their employment status to have a positive effect on their mental health. Secondly, in recent years inflation has increased and socioeconomic conditions have deteriorated in Pakistan, and these changes have led to increased stress and the pressures on working women to meet the economic needs of their household. This increased stress, combined with the demands of pregnancy, might be responsible for greater depression and anxiety in working women compared to housewives, who are relatively protected from work stress. Finally, another factor might also be operative in the social environment of Pakistan. In many orthodox Pakistani families, most of which belong to lower and lower-middle social classes, working women are highly stigmatized. In this socioeconomic setting, the home is considered the appropriate place for women, and being an obedient wife and a loving mother are considered their appropriate roles. Negative attitudes among relatives towards their work might contribute to depression and anxiety among working pregnant women from the lower and lower-middle social classes who participated in our study; housewives, in contrast, may have been protected from such discrimination.
A novel and important finding in our study is the relationship between the gender of previous children and the level of antenatal depression and anxiety. Having daughters was significantly associated with antenatal depression and anxiety, whereas having sons was a protective factor. In Pakistan the family system is predominantly patriarchal. Women are treated as second-class citizens and denied certain social rights. Among the consequences of this social structure are honor killings, the bride price and dowry, the disputed status of female testimony, forced marriages and denial of a woman’s right to have a career. Parents view their sons as bread-earners and agents of continuation of the family name, and view their daughters as an economic burden. This is partly due to the tradition of providing a large dowry when a daughter marries, especially in India and Pakistan. The dowry may be in the form of land, money, jewelry or household items. Even after birth, sons are given preference over daughters with respect to access to healthcare and educational opportunities. Considering these societal pressures, pregnant women who have already given birth to one or more daughters are not only concerned about their future offspring’s gender, but are also subject to harassment, taunting and stigmatization by their family and relatives.
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[post_modified] => 2025-01-03 12:51:39
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[questions] => Array
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[0] => Array
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[quiz_unique_key] => 578908434
[question] => In the passage, which of the following facts does the author NOT use to support their explanation for the increased incidence of antenatal depression and anxiety in women who have previously had girls?
[value] => Array
(
[answer] => 4
[description] => Reason for the Correct Answer:
This is a “Reasoning Within the Text” question. These items generally ask you to think about the author’s reasoning, such as what claim an author is trying to support with a piece of evidence, what assumption underlies a specific statement, or whether an argument is flawed.
Since girls face greater hardship in Pakistan than boys do, the author argues that women who have had girls may experience depression during pregnancy, perhaps in anticipation of having more girls. The author provides all of the following examples of girls experiencing greater hardship: girls’ testimony is not taken as seriously (option 1), boys perpetuate the family name in a patrilineal family structure (option 2) and boys are seen as breadwinners while girls are often denied work opportunities (option 3). While the passage mentions economic inflation generally increasing stress on working mothers (option 4), this is not offered as part of an explanation for the effect that previously having girls has on antenatal depression.
Option 4 is correct.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. Females are perceived to have less credibility.
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[1] => Array
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[each_answer] => B. Daughters do not carry the family name.
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[2] => Array
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[each_answer] => C. Girls are often denied the right to work.
)
[3] => Array
(
[each_answer] => D. Economic inflation increases stress on working women.
)
)
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[1] => Array
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[quiz_unique_key] => 3873426850
[question] => According to the passage, which of the following cultural factors has been shown to affect antenatal depression and anxiety in Western populations?
[value] => Array
(
[answer] => 1
[description] => Reason for the Correct Answer:
This is a “Foundations of Comprehension” question which is asking you to recognize an accurate paraphrase or summary of the central theme or of particular statements in the passage, or to interpret word choices made by the author.
In the second sentence in paragraph 1, the author notes that studies in Western populations mention employment as a strong protective factor against major depression in pregnancy (option 1), which would not apply to a claim about women in general who may not be pregnant (option 2). The only study about “housewives, in general” and not just those who are pregnant was the one from Karachi, Pakistan rather than from Western samples (option 2). The author then goes on to discuss studies that have pointed to “education as an important protective factor against antenatal anxiety and depression”, meaning that education would decrease rather than increase anxiety (option 3). The author notes that orthodox Pakistani families may stigmatize working women, but this is not shown for Western populations (option 4).
Option 1 is correct.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. Employment is a strong protective factor against major depression in pregnancy.
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[1] => Array
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[each_answer] => B. Housewives, in general, are more depressed than working women.
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[2] => Array
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[each_answer] => C. Education increases antenatal anxiety and depression.
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[3] => Array
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[each_answer] => D. Working women in orthodox families are highly stigmatized.
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[2] => Array
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[quiz_unique_key] => 83407773
[question] => Based on the passage, which of the following social changes is MOST LIKELY to cause a decrease in antenatal depression and anxiety?
[value] => Array
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[answer] => 3
[description] => Reason for the Correct Answer:
This is a “Reasoning Beyond the Text” question, which means that it wants you to either apply or extrapolate the ideas in the passage to new situations or to assess how new information would impact the ideas presented in the passage. It is important to understand the assumptions underlying the article, and how new information may or may not shift the central thesis.
The passage explains that women in Pakistan are often stigmatized for working outside the home (paragraph 1). Thus, an increase in the number of women working outside the home (option 1) may actually cause higher rates of depression if the social stigma associated with working remains the same. A decrease in the number of women in the workforce (option 2) may not meaningfully reduce depression and anxiety, given the different findings regarding effects of employment on Pakistani women (paragraph 1). An increase in the percentage of female newborns (option 4) implies more pregnant women will previously have had girls, which would increase rather than decrease anxiety according to the results of the author’s study. The only option that is likely to decrease antenatal depression and anxiety would be a decrease in stigmatization of women in the workforce (option 3).
Option 3 is correct.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. an increase in the number of women in the workforce.
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[1] => Array
(
[each_answer] => B. a decrease in the number of women in the workforce.
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[2] => Array
(
[each_answer] => C. a decrease in the stigmatization of women in the workforce.
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[3] => Array
(
[each_answer] => D. an increase in the percentage of newborns who are female.
)
)
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[3] => Array
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[quiz_unique_key] => 872728905
[question] => The main function of the statement in paragraph 2, “pregnant women who have already given birth to one or more daughters are not only concerned about their future offspring’s gender, but are also subject to harassment, taunting and stigmatization by their family and relatives” is to:
[value] => Array
(
[answer] => 4
[description] => Reason for the Correct Answer:
This is a “Reasoning Within the Text” question. These items generally ask you to think about the author’s reasoning, such as what claim an author is trying to support with a piece of evidence, what assumption underlies a specific statement, or whether an argument is flawed.
This statement comes from the second paragraph in this passage. The main thing that the author is trying to explain in the second paragraph is the “novel and important finding” that women in Pakistan who have previously had female children have a stronger chance of becoming depressed and anxious during pregnancy. The author describes the hardships that women and young girls face in Pakistani society in order to offer some insight. Thus, the main function of the sentence is not merely to emphasize the general idea that there is gender discrimination (option 1) or that women are living in a male-dominated society (option 2). The author also is not trying to excuse or justify the cultural attitudes that favor boys over girls (option 3) Instead, the main purpose is to conclude that the various ways in which women are treated differently serve as multiple sources of stress (option 4). The sentence structure of “not only X, but Y” signals that the point is to delineate multiple possibilities.
Option 4 is correct.
)
[answers] => Array
(
[0] => Array
(
[each_answer] => A. emphasize that women in Pakistan face severe gender discrimination.
)
[1] => Array
(
[each_answer] => B. clarify the patrilineal context in which pregnant women in Pakistan live.
)
[2] => Array
(
[each_answer] => C. justify the strong preference women show for having boys instead of girls.
)
[3] => Array
(
[each_answer] => D. show the multiple ways that the Patriarchal system creates stress on pregnant mothers who have previously had girls.
)
)
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[4] => Array
(
[quiz_unique_key] => 3143847772
[question] => Suppose a brand new study showed that women who were NOT pregnant experienced more stress if they were housewives than if they were working. What would the implications of this study be for the author’s study and the other study done in Karachi?
[value] => Array
(
[answer] => 4
[description] => Reason for the Correct Answer:
This is a “Reasoning Beyond the Text” question, which means that it wants you to either apply or extrapolate the ideas in the passage to new situations or to assess how new information would impact the ideas presented in the passage. It is important to understand the assumptions underlying the article, and how new information may or may not shift the central thesis.
At a superficial level, the new study would seem to be more consistent with the Karachi study than the author’s study. However, the result would not imply that either prior study is wrong (options 1, 2, and 3). In paragraph 1, the author describes their own study as being specifically about “pregnant women”, whereas the Karachi study is about housewives and working women “in general”, meaning it included both pregnant and non-pregnant women. Thus, a new third study only about non-pregnant women could show any result and not actually support or contradict either of the first two studies (option 4). It is possible for the effect of working on stress to be different or even opposite, depending on whether the woman is pregnant. In fact, many of the work-related stress factors discussed by the author are tied to women’s expected roles as mothers and caregivers.
Option 4 is correct.
)
[answers] => Array
(
[0] => Array
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[each_answer] => A. It would show that the author’s study is wrong and the Karachi study is more valid.
)
[1] => Array
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[each_answer] => B. It would show that the Karachi study is wrong and the author’s study is more valid.
)
[2] => Array
(
[each_answer] => C. It would show that both the author’s study and the Karachi study are wrong.
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[3] => Array
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[each_answer] => D. It would neither support nor contradict either the author’s or the Karachi study.
)
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[5] => Array
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[quiz_unique_key] => 3143847772
[question] => The passage author’s study found that pregnant women in Pakistan employed outside the home are more depressed and anxious than housewives. Other studies in Pakistan have found that women employed outside the home are less depressed. The apparently contradictory findings are MOST LIKELY viewed by the author as being:
[value] => Array
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[answer] => 2
[description] => Reason for the Correct Answer:
This is a “Foundations of Comprehension” question which is asking you to recognize an accurate paraphrase or summary of the central theme or of particular statements in the passage, or to interpret word choices made by the author.
In paragraph 1, the author responds to the apparent contradiction in the findings. The author points out that while other studies ascribed the lower depression rates in working pregnant women to higher education, the author’s study included women from low and lower-middle socioeconomic classes. In fact, 54% of the women in the study sample were educated to less than the 10th grade level. The author concludes that the working women in the study may not have been educated highly enough for their employment status to meaningfully improve their lives. The passage then goes on to discuss how the author’s study was conducted during a time of great economic deterioration, and how this may have created additional stress on the working women (option 2). The finding that previously giving birth to girls increases stress is a separate issue discussed later and not relevant to the apparent contradiction (option 1). The reasons given all apply to Pakistan in general and the specific locations of the studies never mentioned as a factor (option 3). Finally, the author never denigrates the other study or implies that one is superior to the other (option 4).
Option 2 is correct.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. the result of differences in the gender of prior offspring.
)
[1] => Array
(
[each_answer] => B. due to differences in the economy and education of the working women.
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[2] => Array
(
[each_answer] => C. the different specific locations of the studies.
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[each_answer] => D. the author’s own study having more accurate data.
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[559783|1] => D
[559783|2] => A
[559783|3] => C
[559783|4] => D
[559783|5] => D
[559783|6] => B
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