Roberts Lisa R, Renati Solomon J, Solomon Shreeletha, Montgomery Susanne
School of Nursing, Loma Linda University, Loma Linda, CA, 92350, USA.
Psychology Department, Veer Wajekar A. S. & C. College, University of Mumbai, Navi Mumbai, 400702, India.
Int J Womens Health. 2021 Mar 9;13:305-315. doi: 10.2147/IJWH.S297292. eCollection 2021.
Given the pressures surrounding women's reproductive role in India, and persistent high rates of perinatal death, the purpose of this study is to describe and compare poor rural and urban Indian women's experiences of perinatal grief.
Two cross-sectional studies were compared on shared quantitative variables. Poor rural (N = 217) and urban, slum-dwelling (N = 149) Central Indian women with a history of stillbirth, and/or infant death were recruited with the aid of local community health workers. Trained, local, gender, and linguistically matched research assistants conducted the structured interviews. Shared quantitative variables include demographics, Social Provision Scale, Shortened Ways of Coping-Revised, Perinatal Grief Scale, social norms and autonomy.
While similar with respect to SES, age, number of living sons and perinatal loss experiences, these samples of poor women differed significantly across many variables, most notably women's household position, joint family living, number of live daughters, religious coping, autonomy, and degrees of perinatal grief. While perinatal grief was significantly associated with many variables bi-variably, most lost their relative influence in our stepwise multivariable modeling within site (rural/urban), with only social norms and social support remaining significant for rural (31% of variance) and wishful thinking and social norms for urban participants (38.4% of variance). In the combined sample household position, social support and social norms remained significant and explained 53.6% of the adjusted variance.
In both samples, perinatal grief was high following perinatal loss. Both groups of women with perinatal loss have increased risk of mental health sequelae. Notably, the context affected how they experienced perinatal grief, with rural women's grief being higher and more affected by their societal pressures and isolation. Such nuances are important considerations for much-needed tailored approaches to future interventions.
鉴于印度女性在生殖角色方面面临的压力以及围产期死亡率持续居高不下，本研究旨在描述和比较印度农村和城市贫困女性的围产期悲伤经历。
对两项横断面研究的共享定量变量进行比较。借助当地社区卫生工作者，招募了有死产和/或婴儿死亡史的印度中部农村贫困女性（N = 217）和城市贫民窟居住女性（N = 149）。训练有素、当地的、性别和语言匹配的研究助理进行结构化访谈。共享定量变量包括人口统计学、社会支持量表、简化应对方式修订版、围产期悲伤量表、社会规范和自主性。
虽然在社会经济地位、年龄、在世儿子数量和围产期损失经历方面相似，但这些贫困女性样本在许多变量上存在显著差异，最明显的是女性在家庭中的地位、大家庭生活、在世女儿数量、宗教应对、自主性以及围产期悲伤程度。虽然围产期悲伤在双变量分析中与许多变量显著相关，但在我们按地点（农村/城市）进行的逐步多变量建模中，大多数变量失去了相对影响，农村地区只有社会规范和社会支持仍然显著（占方差的31%），城市参与者则是一厢情愿和社会规范仍然显著（占方差的38.4%）。在合并样本中，家庭地位、社会支持和社会规范仍然显著，解释了调整后方差的53.6%。
在两个样本中，围产期损失后围产期悲伤程度都很高。两组有围产期损失的女性心理健康后遗症风险都有所增加。值得注意的是，环境影响了她们围产期悲伤的体验方式，农村女性的悲伤程度更高，且受社会压力和孤立的影响更大。这些细微差别是未来干预措施急需的针对性方法的重要考虑因素。
