Postpartum Maternal Stress in Rural and Urban Areas: A Cross-Sectional Study in Indonesia

Abstract

Perinatal mental health, including postpartum stress, is a global health issue with a high prevalence, particularly in low- and middle-income countries. Nearly 1 in 5 women experience mental disorders during pregnancy or in the year after delivery, and postpartum stress can persist and progress to depression or anxiety disorders if left untreated. Multiple risk factors, such as age, socioeconomic status, stressful life events, and domestic violence, contribute to maternal vulnerability. Several studies have shown that environmental contexts, including rural and urban differences, contribute to maternal vulnerability. urban areas , influencing the experience of stress through variations in social support, economic stress, and access to health services. This study aims to analyze differences in postpartum stress levels between mothers living in urban and rural areas in Indonesia, and to identify sociodemographic factors associated with postpartum stress. This is an observational analytical study with a cross-sectional design conducted on 309 postpartum mothers (155 rural, 154 urban) in South Sulawesi, Indonesia. The sample was selected using consecutive sampling technique with the inclusion criteria of postpartum mothers ≤ 6 months. Data were collected through face-to-face interviews using a demographic questionnaire and a validated Perceived Stress Scale (PSS-10) . Data analysis was performed using the Chi-Square test for categorical variables and the Mann–Whitney U test to compare stress scores, with a significance level of p < 0.05. The study showed that the majority of postpartum mothers in both rural and urban areas experienced moderate levels of stress, at 91.0% and 96.1%, respectively. Low and high stress levels were only found in a small proportion of respondents (<7%). Demographic characteristics analysis showed that age and income variables differed significantly between the two regions, while education, occupation, and place of residence did not show significant differences. However, there was no significant difference in stress levels between mothers in rural and urban areas (p = 0.163). These findings indicate that postpartum stress is a common condition experienced by mothers after childbirth, regardless of differences in social and economic environments, and emphasize the importance of social support and psychological interventions to maintain maternal mental well-being in the postpartum period. Overall levels of postpartum stress are similar in rural and urban areas, but certain dimensions are more prominent in urban areas. Age and income emerged as key factors, so interventions need to be tailored to the socioeconomic conditions of each region.