Psychosocial predictors of women's mental health in Bangladesh: Evidence from BDHS-2022 data on fertility, empowerment, decision-making, child loss, and sex-affective behaviours

OBJECTIVES: In light of ongoing transitions in gender roles in Bangladesh-including declining fertility, greater women empowerment and participation at work, and increased decision-making capacity-it is crucial to understand how these changes affect women's mental health using nationally representative data. STUDY DESIGN: A cross-sectional design was followed. METHODS: The present study utilized data from the BDHS-2022, and assessed the relationships between mental health (anxiety and depression risk), and fertility, child mortality, empowerment, decision-making, sex-affective behaviours, household members, and other sociodemographic variables on ever-married women aged 15-49. Mental health was assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Multivariate logistic regressions revealed that having a bank account, longer time since last sexual intercourse, pressure to get pregnant, and fewer years of education were associated with higher risk of both anxiety and depression. Moreover, greater number of children ever born was related to anxiety while female child mortality and being currently employed were related to depression. However, decision-making autonomy in health and household finances was not significantly associated with anxiety or depression in the adjusted models. CONCLUSIONS: This study suggests that empowerment indicators such as financial inclusion and employment may not consistently protect against poor mental health, and may act as stressors for women in the absence of supportive environments. Promoting women's agency and empowerment at the social and family levels, minimizing discrimination, ensuring their access to education, and promoting healthy sexual and emotional relations should be a priority among the new generations of Bangladeshi women.