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Pregnant Women’s Condition and Awareness About Mood Swings: A Survey Study in Bangladesh

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Abstract and Figures

Mood swing is a widespread problem during pregnancy. However, in the developing country like Bangladesh where 38% populations are women and their family never seek for any help during pregnancy, even they do not become aware of this complication which can be harmful to fetal. They cannot imagine it may cause miscarriage, and even a mother is suffering from a severe mood swing can deliver an abnormal baby. This paper presents findings from a three-month-long ethnography and online survey conducted in Bangladesh where the total number of the participant was 207. Our analysis surfaces necessary care and cure of mood swing problem for pregnant women. We also proposed an application using which a woman can get initial suggestion and also can enjoy an environment she prefers to make her happy for instance.
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Pregnant Women’s Condition
and Awareness About Mood Swings:
A Survey Study in Bangladesh
Nusrat Jahan, Umme Salma Fariha, Musfika Rahman Ananna,
and Amit Kumar Das(B
)
East West University, Dhaka, Bangladesh
jahannira@gmail.com, salmafariha13@gmail.com,
musfika.ananna2015@gmail.com, amit.csedu@gmail.com
Abstract. Mood swing is a widespread problem during pregnancy. How-
ever, in the developing country like Bangladesh where 38% populations
are women and their family never seek for any help during pregnancy,
even they do not become aware of this complication which can be harm-
ful to fetal. They cannot imagine it may cause miscarriage, and even a
mother is suffering from a severe mood swing can deliver an abnormal
baby. This paper presents findings from a three-month-long ethnography
and online survey conducted in Bangladesh where the total number of
the participant was 207. Our analysis surfaces necessary care and cure of
mood swing problem for pregnant women. We also proposed an applica-
tion using which a woman can get initial suggestion and also can enjoy
an environment she prefers to make her happy for instance.
Keywords: Pregnancy ·Mood swing ·Bangladesh ·Wome n ·Fe tal
1 Introduction
Pregnancy is a precious feeling for every woman. Every woman wishes to give
birth to her child. The average pregnancy lasts around 37 weeks to 40 weeks
which is full of physical and emotional changes. This mood swings percent-
age increase massively during pregnancy because of the changes in metabolism,
stress, tension, fatigue and hormones named ‘Estrogen’ and ‘Progesterone’. How-
ever, mostly during the first trimester between 6–10 weeks and then again in the
third trimester, women experience this problem. The changes in hormone levels
affect the level of neurotransmitters, where the neurotransmitter is the brain
chemical which can regulate mood [1]. Moreover, 14%–23% of women are expe-
riencing this problem in the whole world [13].
Psychologist defines ‘mood swing during pregnancy’ as ‘a sharp and inexpli-
cable change in mood during pregnancy for hormonal change’ or, ‘extreme or
rapid change in mood. Such a mood swing can play a positive part in promot-
ing problem-solving and in producing flexible planning. However, when a mood
c
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https://doi.org/10.1007/978-3-030-19063-7_60
750 N. Jahan et al.
swing is also so strong that they are disruptive, they may be the main part of a
bipolar disorder’. This is so normal, but sometimes in extreme case, it is treated
as one of the risk factors which can causes miscarriage or, maternal death [6].
Women in developing countries like Bangladesh where women of the house
treated as a sad part of the family and society may face more depression, stress
and mental difficulties. Here, women may never realize, they are going through a
‘mood swing’ for their pregnancy. Women may never feel any need to share this
issue with friends and family or, doctor. They do not know it can be harmful to
their child in their womb if it reaches in extreme mood. Especially changes about
appetite, changes in sleep, lack of energy, feeling sad, hopeless or, worthless,
frequently weeping with no reasons, loss of interest in doing regular work was
the common problem [10]. The women who live with their in-laws may don’t
have enough food or preferable food if she wants so, may don’t have enough
sleep, medical facilities though she needs it, she may not have an opportunity
to take rest, or, may have to hear or bear something very unpleasant during
her pregnancy. According to doctors, all these reasons may lead to some serious
problem like miscarriage, preterm, low birth weight [3].
We want to provide them an environment which may release them from the
difficulty of their life and can enjoy something that they wish to, will help them
to give birth to a healthy baby and to avoid those risk factors. So, for doing
something new, we might gather more knowledge about it. So, we talk to them
and try to find out what they are going through during their pregnancy and
what they need to stay happy, relax, refresh all the time. It is not possible to
change the mentality or attitude of the people surrounding those women, but
we may do something for them in which they can enjoy some moment as they
want to spend.
2 Related Work
In this decade, some research took place on the mental health of pregnant women
where it is concluded as financial concerns. These were strongly and indepen-
dently associated with the mental health, and it is a factor such as working
status, education, and family structure. From some of them, we inspired to do
something new [7]. The diversity between and within ethnic groups need to take
into consideration individual social, migration and economic circumstances [4].
Our work builds upon this concept of the researches.
Existing many types of research analyze the reasons behind poor mental
health during pregnancy, when, why and what kind of psychological change hap-
pens and what could be the solution. Some of them directly talk to the patient,
some of them take interview of psychologist, gynecologist to do so [13]. In those
extreme case, the contextual factors can be the cultural and religious factors,
physical and psychological readiness, time pressure, economic factors, family his-
tory, social support, local service provision, fear like fear of becoming ill, fear of
medication causing harm to the baby, fear of being a lousy parent [10]. However,
as a developing country, Bangladesh has entirely a very different environment
Pregnant Women’s Condition and Awareness About Mood Swings 751
than the western world. Here the relationship between the pregnant women and
other family member is altogether different. In the rural areas, women even don’t
have the right to share their every feeling and also believe in prejudice in this
era. So, that women even don’t know what is ‘mood swing,’ do women can have
a mood! In other words, they may face almost all the contextual factors.
Some study took place in the last some years, which shows that how women
valued apps. The researchers reveal the importance of using digital information
for establishing and maintaining social connections and intimate relationships
with other mothers [12]. With the increasing development of Bangladesh here,
the people are getting more conscious about the risk factors of pregnancy as a
result now 30% of women taking treatment due to different pregnancy-related
difficulties. Women of Bangladesh are getting more familiar to the internet world.
In this decade, the internet is now 300,000 monthly ‘pregnancy’ searches on
Google BD and 10,000,000(est.) female internet users in Bangladesh. Women
are 62% more active on Facebook than before, they are joining different types
of pregnancy-related groups or community and sharing their problems [5]. They
are also using android apps related to the risk factors of pregnancy. ‘Aponjon
Pregnancy-Shogorbha’ is a free health and fitness categorized application which
was launched by the Government of Bangladesh where the estimated number of
the app downloads range between 10000 and 50000 as per Google play store.
Regardless of how important the care of a pregnant woman who is passing
through mood swing and what should the family member do for that, should
be known by all. Our application is going to help the women who have no
opportunity to have family support during this hard time by giving them a
touch of their excellent environment for some instance which make her happy
and hopefully will reduce the percentage of mentally abnormal childbirth.
3 Survey and Analysis
We conducted a three-month ethnographic study in some places by visiting some
hospitals and houses from Dhaka, Cumilla, Lakshmipur, Narayanganj, and Mun-
shiganj of Bangladesh to study the psychological states of the pregnant women
during different phases of pregnancy. In the semi-structured interviews, the num-
ber of the participants were 186 who willingly participated in the study. We tried
to cover women from different socioeconomic classes (low income is below 10,000
Taka per month, high income is above 30,000 Taka per month, middle income is
between 10,000 to 30,000 Taka per month), and also who are educated or, uned-
ucated and lives in rural, town and city areas and most importantly we covered
women aged 17 to 45 years. We asked them some questions which can reveal their
mental condition during that time like did they ever experience any miscarriage,
how their family members were supporting them, any problem related to food
habit, sleeping routine, financial problems, the baby in their womb was expected
or not, with who, where and how they like to pass their days.
We also conducted an online survey where the participants were the members
of different Facebook groups related to pregnancy, and it was an anonymous
752 N. Jahan et al.
online survey which was seven days long. That survey form was in two formats
Bengali and English. We asked the same questions to them too. Moreover, it was
about 21 women who shared their data with us.
3.1 Urban (City and Town) Women
Increased motorization, mechanization related activities lack of civic amenities
like park and other recreational facilities, worsened air quality makes the urban
women physically unfit. In another case, if they conceive at the early of their
working carrier, then they feel insecure about their future, and if they suffer
from extreme depression, in some case they may harm themselves or their baby
too. We met with one woman in Holy Family Red Crescent Hospital who was
admitted there for menstrual problems. She was having the problem of several
time bleeding. So, her doctor suggested her to get admitted in the hospital so
that she can observe her on a regular basis. The city women who are highly
educated with substantial financial support, mostly working women, even some
of them are an entrepreneur. She was saying
–“I am troubling from bleeding problem frequently from the beginning of my preg-
nancy, and my doctor suggested me to inject a medicine named ‘HPC’ one per
week until my delivery and she may suggest me to stop taking this one any time if
I get well but before this I will do this as I’m already experiencing a miscarriage”.
(27 years old, BSc completed city woman, Dhaka).
Another was saying,
–“I got married too late for completing my study and now I have experienced
five miscarriage due to chromosomal complications, and this is my sixth time I
become pregna nt, and I do not know a m I ever be able to be a mom or, not”.
(40 years old woman, Dhaka).
Moreover, in case of middle class educated women some of them get married
before completing their higher studies and conceive too early are also become
depressed in the worry about their future, and stay upset by seeing their dreams
are broken. Moreover, others who want to support their husband financially by
doing job or business may have to leave their job in most of the cases due to
their upcoming child’s health and care, and in some case, they are in fear in that
after maternity leave the company may not receive her again. Such as woman
we met in another hospital who was saying
–“I do not know, will it ever be possible for me to complete my study or not?”
(26 years old woman, Dhaka).
She became stressed and crabbed after she became pregnant and behaved
very rude to her family members and the relations were being worse day by day.
Moreover, some of them who lives with their in-laws or already having children
or as a working woman, may not get an opportunity to think about their own
or upcoming baby. One of this kind of woman was saying,
–“Sometimes I daunt and feel lonely too.” (22 years old woman, Dhaka).
Pregnant Women’s Condition and Awareness About Mood Swings 753
One was saying,
–“Due to the shortage of time it is not possible for me to know or think something
new or needed, as I have to handle all my housework in a single hand.” (31 years
old, housewife, Dhaka).
In case of the lower class women of Dhaka city where a maximum of them
lives in slums and are uneducated or less educated, have to handle all the house
chores, manage expenditure in a single hand or, as a partner of her husband by
doing work on garments factory or as a maid. When we asked her about sickness,
then she said,
–“I feel back pain, headache and feel irritated most of the time.” (27 years old,
maid, Dhaka).
3.2 Rural Women
The village women who are treated as the most neglected person in their family
may never think about themselves and may never get any extra care during
their pregnancy mostly. Though the scenario is changing day by day as people
are getting connected to the technological world and getting educated more
than before, so they have an opportunity to know the right things now. The
mass media plays a vital role, and the government of Bangladesh has taken
many steps to increases awareness about pregnancy care which is being very
active. Nowadays as using the Android phone is being more available and they
are getting connected to the internet world so the use of app may get famous
to them. There is some pregnancy Bengali app which makes it easier to use it
for the women who are less educated or at least can read Bengali. Although we
had to face some difficulties like, we have stayed some much unknown places
outside of Dhaka, have encountered so many challenges to get permission from
the hospital’s authorities and so on to collect data.
The practical data collection method helps us to know the thinking of the
pregnant women and their family in Bangladesh with a very close view.
3.3 Data Analysis
The data we got from our survey, evaluated and analyzed by us to find the appro-
priate feature for our application [11]. We found 83% pregnancy was unplanned
and the rest of the 17% was planned. We also tried to find out the complications,
the women of Bangladesh go through during pregnancy. Moreover, we got nine
victims of Gestational Diabetes, 8 of Stomach Ache, 7 of Anemia, 5 of Asthma,
Malnutrition, Hypertension, Premature rupture of amniotic membrane, Bleed-
ing/Spotting, 4 of back pain, 3 of Overweight, many of them have vomiting
problem. Many women face another complications also. So, this is important to
alert them for which complication they need to consult with a doctor as soon as
possible to save their baby from any harm.
Here in Fig. 1most of the pregnant women become tensed, crabbed after
the 32th week of pregnancy. As they are exceeding their delivery date, so it is
obvious to happen to them. They remain happy, stable at their 28th week.
754 N. Jahan et al.
Fig. 1. Emotional condition of the pregnant women
In Fig. 2(a) we can see among all the participant 59% women have behavioral
change during their pregnancy. Where 41% of women have no change, or they
cannot understand that. Where in Fig. 2(b) among all the participant 78% of
women get mental support from their family during pregnancy.
Although most of them told us they never feel any psychological change
due to their pregnancy, among the women who noticed anger, irritation, caprice,
crabbiness due to their pregnancy was prevalent for all the three trimester. When
we talk to their family member, some of them told us something about the
patient’s mood swing. Like, one of the children who came with her mother to a
hospital told us,
–“Ammu forget things frequently, but never can feel that. Moreover, she is becom-
ing caprice day by day.”
However, when we asked them
–“Did you ever discuss this issue with the doctor?”,
They answered,
–“No! This is not any serious issue.”
This is the way people accept any psychological change during pregnancy.
Pregnant Women’s Condition and Awareness About Mood Swings 755
Fig. 2. (a) The pregnant women go through behavioral change due to pregnancy,
Bangladesh during different periods of their pregnancy, (b) The pregnant women of
Bangladesh get mental support during pregnancy.
In Fig. 3(a) among all of our participant, 71% of women (including the vil-
lage/illiterate women) were familiar with the Internet world, and only 29% had
no idea about it.
Moreover, in Fig. 3(b) where it shows the demand of feature what they think,
these should be included in a pregnancy-related app. Although, 123 pregnant
women among 180 don’t have any suggestion about the mobile application. The
main features they suggested are a consultation of a doctor during an emergency,
a reminder of their daily chores, know the baby growths and foods value, cautions
before and during the pregnancy, any exercise (all first knowledge) and so on.
The result of the data analysis portion gives us the main feature of our
application as output. For example, when we analyzed the collected data about
the suggestion said by the participant then most of them demand an option
through which they can consult with a doctor on an emergency, they require a
756 N. Jahan et al.
Fig. 3. (a) The idea about internet world among the pregnant women of Bangladesh,
(b) The demand of features from the pregnant women of Bangladesh.
reminder system which will remind them about their essential chores, the baby
picks up time, etc.
4 Proposed Application
Based on analyzed survey data, we have introduced an application for the preg-
nant women of Bangladesh. In that application, we tried to meet up all the
necessities of upcoming mothers which they have desired to have or to get the
services during pregnancy. We develop an application named “Matritto.”
Pregnant Women’s Condition and Awareness About Mood Swings 757
Fig. 4. The flow-chart of the work.
According to the rules of software engineering, we need to design the system
before developing it. So, we create a use-case diagram to follow that rules which
makes our work easier. Any user can take a quick and clear overview of the
system by this diagram and Fig. 5represents that diagram. Where Fig.4shows
the flow of the whole work.
According to the design, we develop our application. Through Due Date Pre-
diction option, user can know her delivery date. Through the Advice of Doctor,
option user can view four more options named what to do, what shouldn’t do,
risk signs of pregnancy and doctor’s contacts. Each option will provide relevant
information which a doctor also suggests a pregnant woman. A more important
part of our app is we are giving some trusted doctor’s contact which will help
them in their emergency condition.
The user may want to know how is her baby developing in her womb. Using
the Development of Baby option, she can know about her baby growth develop-
ment through reading and also week by week pregnancy videos. The user may
forget what the doctor suggested to follow regarding foods. Through suggestion
for food option, she can recall that. The food suggestion sector divided into
758 N. Jahan et al.
Fig. 5. The use-case diagram for the system.
three parts: first trimester, second trimester and third trimester. There has a
suggestion of food for pregnant women which is good for baby and mother both.
Through Alarm option, the user will input their alarm name and set the
alarm time. When the set alarm time and the current time are the same, then
the alarm will ring and show the notification. The alarm notification will work
even after the application close. Through My World option, the user will find
more three options which are the place, music, and community. Through the
place option, pregnant women can visualize three different 3-dimensional natural
views. The videos will help a pregnant woman who desires to roam in nature.
In music option, she can hear smooth music which is suitable for unborn baby
and mother. In the community option, she will be able to connect a pregnancy-
related Facebook group where pregnant women share their problems, views,
feelings, and knowledge about other women condition during their pregnancy.
Pregnant Women’s Condition and Awareness About Mood Swings 759
The interactive part of our application is Emergency option, through which
user can communicate with our doctors. When any pregnant women face any
problems, they need to consult a doctor but can’t go at that time. They can use
an emergency option and can directly call a doctor. In this way, it can primarily
help a woman from any severe problems.
For solving their mood swing problem, we created a 3-dimensional video play
list where she can visit at any time when her mood wants. During pregnancy,
many women told us that they want to go out but because of their condition
can not go out. So, in this way, they can view hills, seas, sunsets, mountains. We
also created a smooth music play list which also suggests the doctors. According
to the doctor, those smooth music helps in the development of the baby brain
in their mother’s womb. As hearing that music, a mom can feel relief during
pregnancy especially. They also can connect with a Facebook community group
if they have an account. So, My world option, will help the user to stay calm
during their depressed period.
5 Conclusion
The sections above present a qualitative analysis of our ethnographic findings and
key observations from our online and physical survey in addition to developing
a vibrant, field-level understanding, regarding the implementation of the mood
swing problems on the pregnant women. Our ethnography has demonstrated
what kind of mood swings occur, and how it can be prevented. Our participants
expressed their feelings, complications what they face and suggestion to develop
our app. These findings help us to understand a pregnant woman’s mood swings
and develop a pregnancy-related mobile application. However, before synthe-
sizing our findings into a set of key takeaways, we want to acknowledge that
there are some limitations to our study. Our research only reveals a subset of
the challenges encountered in some part of the country, Bangladesh. The preg-
nant woman’s and the families that were studied were chosen based on conve-
nience and participant availability. Hence, the findings of our study should not
be generalized over the entire country. Also, the participants in our online survey
represent only a small portion of the Bangladeshi population. Many pregnant
women do not use the internet during her pregnancy. Many don’t feel any need
for a pregnancy-related application. We design some of our app works in the app
simulator which should be done in our app but we could not. When we develop
our app we planned to do virtual reality to give them a real scenario of their
desirable places but we unable to do that exact way. We thought of connecting
the database with our app so that we can find the other desires of pregnant
women through our app. Despite these limitations, our research offers several
key insights and takeaways that will be beneficial for the HCI community at
large.
760 N. Jahan et al.
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... Pregnant women were in negative states of mind, such as being fearful and anxious, and these could have exposed them to increased risks of preeclampsia, pre-term birth, and low birth weight ( Faisal-Cury et al., 2010 ;Kim et al., 2013 ). To avoid such unfavorable outcomes, it is imperative to provide timely psychological support to pregnant women during epidemics and pandemics as they are already experiencing fluctuating hormonal levels and are at higher risks of experiencing anxiety, depression, and obsessive-compulsive disorders ( Jahan et al., 2019 ;Vigod, Buist, and Steiner, 2016 ). Amid a public health emergency, restrictive control measures are imposed, and these may limit accessibility to psychological support as the main focus remains on the physical wellbeing of pregnant women and their babies. ...
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