This study aimed to understand women’s lived experiences of maternal morbidities during pregnancy and postpartum and their impacts on QoL, across five countries in sub-Saharan Africa and South Asia. Participants described experiencing a range of physical and emotional challenges, many of which prevented them from carrying out daily activities such as completing household chores, obtaining food and necessities, and/or maintaining self-care. Consistent with existing literature, participants reported severe backaches and musculoskeletal strain, often prompting them to avoid or modify strenuous tasks like fetching water g [16]. Fatigue, driven by hormonal changes and sleep disruptions, emerged as a major barrier, aligning with previous studies on postpartum exhaustion [17]. This reflects how sociocultural expectations intensify the burden on women, despite their physical limitations. Financial barriers, limited social support (particularly from partners), and sociocultural expectations further exacerbated these difficulties.

Nevertheless, family and community support emerged as critical mitigating factors, underscoring the importance of informal networks in improving maternal well-being. The importance of receiving social support during the perinatal period has been described previously [18, 19]. Poor social support during pregnancy and postpartum is associated with perinatal depression, post-traumatic stress, and other mental health concerns [20]. A systematic review on women’s experiences of social support during pregnancy found that pregnant women lacking emotional connection and reassurance from their partners were more likely to experience anxiety and depression [18]. Previous research in India and Pakistan showed that women with perinatal depression had lower scores on QoL domains [21]. Postpartum depression has also been linked to poor physical health and insomnia, further exacerbating the functional impacts of maternal morbidities [10, 22, 23]. Conversely, several prior studies demonstrate that social support is positively associated with QoL [24, 25] and receiving emotional support from family improves maternal mental health outcomes [18, 26, 27].

The extent to which women negatively described interactions with the baby’s father and/or their mother-in-law was notable, though not altogether surprising. In sub-Saharan Africa, cultural norms discourage male involvement in caregiving roles [26, 28–30] and similar trends have been observed in parts of Asia, where patriarchal norms restrict male engagement in maternal care [31, 32]. The cultural acceptance of infidelity, especially in sub-Saharan Africa, further fosters feelings of abandonment and neglect, which heightens the risk of postpartum depression [32].

Mistreatment from partners—including intimate-partner violence, rejection, and infidelity—has been previously shown to worsen maternal physical and mental health outcomes [33–35]. Intimate-partner violence has been associated with adverse birth outcomes including preterm birth and low birth weight [36]. Community and family pressures, such as the stigmatization of single mothers and societal expectations regarding the sex of the baby, further exacerbate feelings of social isolation and emotional challenges, which are disproportionately prevalent in patriarchal societies [35, 37, 38]. Importantly, as research by Cumber and colleagues (2024) reveals, fathers’ motivations to be more supportive may also be hindered by cultural stigma, financial barriers, or exclusion from maternity services [39]. This calls for intentional involvement of expectant fathers in prenatal care to foster their participation.

Women in the present study cited economic challenges as a barrier to accessing care or purchasing necessities, such as transportation, food, and clothing for themselves and/or their baby. Existing literature emphasizes how financial insecurity—particularly a lack of financial contributions from the baby’s father—can severely restrict access to prenatal care and nutritious food [18, 40, 41]. A lack of prenatal care worsens maternal morbidities [41, 42], whereas timely prenatal care reduces pregnancy-related complications and adverse fetal outcomes [43–46]. Maternal malnutrition during pregnancy is further tied to maternal morbidities [47–49] and nutritional deficiencies postpartum increase women’s vulnerability to illness, reducing their capacity to care for themselves and their newborns [50]. Economic hardships also presented women with stressful decisions; for example, postpartum participants described needing to choose between earning money and caring for their child, which further restricted their financial independence [51–54]. This is particularly relevant in patriarchal societies where traditional gender roles place the burden of childcare on women.

Key strengths of the study include data collection across five LMICs on two continents, which allowed us to capture and compare women’s experiences during pregnancy and postpartum in different cultural contexts. Another strength of the study was the enrollment of women across trimesters and at varying time points postpartum, which allowed us to more comprehensively assess women’s experiences of maternal morbidities and their impacts on QoL. Several limitations also warrant consideration. Considering the hierarchical nature of study contexts, participants may have responded in a socially desirable manner. The added group dynamic of the FGDs or lack of privacy of IDIs—given they occurred within the participants’ homes—may have further discouraged women from engaging in open dialogue.