Patrilocality in South Asia as a determinant of maternal mental health: A scoping review

Abstract

Patrilocality (post-marital residence in the husband’s natal household) is common across South Asia and shapes women’s autonomy, caregiving roles, and exposure to conflict, violence, and economic control, yet it is rarely defined or measured consistently in perinatal mental health research. We conducted a scoping review (Arksey and O’Malley; Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR]) of studies from South Asia and South-Asian diaspora populations published since 2000, searching eight databases and Google Scholar (last search November 2025). Thirty-two studies met inclusion criteria, spanning cross-sectional surveys, longitudinal cohorts, qualitative work, medico-legal series, intervention evaluations, and policy analyses. Evidence linked patrilocal residence and in-law co-residence to poorer maternal mental health through household status practices (for example, eating last), reduced decision-making power and mobility, relationship conflict, caregiver identity, and frequent in-law and partner violence and economic abuse. Associations with mother-in-law involvement varied by timing and conflict: some studies reported lower depressive symptoms early postpartum but higher symptoms later in conflictual households. Across studies, patrilocality was often invoked but operationalized heterogeneously (family-type categories, co-residence rosters, status markers, relationship-quality scales, or violence and economic-abuse measures), limiting comparability and obscuring patrilocality as a primary perinatal exposure. Perinatal research and services should specify residence patterns, adopt standardized measures of patrilocality and household authority, assess in-law relationship quality and violence and economic abuse, and evaluate family-centered interventions that engage supportive in-laws while addressing harmful dynamics.

1. Significance to public health

Patrilocal living arrangements are common in South Asia and shape women’s lives. Patrilocality often determines who controls money, food, and mobility within the household, as well as the nature and location of care for mothers during pregnancy and the postpartum period. These household power dynamics may amplify stress and isolate new mothers, thereby increasing the risk of depression, domestic violence, and suicidal behavior, even when formal health services are available. Public health programs that focus only on the mother often miss key decision-makers within the home. Routine perinatal screening should ask about living arrangements and in-law relationships and include assessment of violence and economic abuse. Community- and facility-based interventions can be strengthened by engaging husbands and in-laws in supportive caregiving. However, the involvement of in-laws is not relationally neutral: it can be beneficial where relationships are supportive but harmful where they are conflictual or coercive. Any family-centered approach must therefore include explicit safeguards for women’s physical safety, decision-making autonomy, and confidential access to care. Creating support systems outside the family, such as peer support groups, may protect against social isolation. Improved measurement of patrilocality and its contribution to mental health in perinatal mental health research will help target resources to higher-risk households and evaluate family-centered prevention approaches.

2. Introduction

Patrilocality is the post-marital residence pattern in which a married woman moves to live with her husband’s family, most often with his parents. In South Asia this pattern is common across large parts of India, Pakistan, Bangladesh, Nepal, and parts of Afghanistan and Sri Lanka, and it persists at lower levels in Indian diaspora populations.^1–3 Although patrilocality is fundamentally a residential arrangement, life within a patrilocal household is shaped by a set of interrelated relational dynamics that operate within it, including the quality of the relationship with the mother-in-law and other affinal kin, household decision-making hierarchies, gendered status practices, and exposure to in-law violence or economic control. These dynamics are not synonymous with patrilocality itself; rather, they function as mediators and moderators through which residence patterns influence women’s autonomy, wellbeing, and mental health. Clarifying this distinction is important because empirical studies frequently invoke patrilocality as a structural context while measuring, in practice, one or more of these relational exposures. Population analyses show that districts and states with higher levels of patrilocal marriage have more skewed child and birth sex ratios, consistent with stronger son preference and structural effects of residence norms. ⁴ Analyses of Demographic and Health Survey data also find that patrilocal residence is associated with lower autonomy for women in economic and health decisions, mobility, and visits to natal kin, and that the presence of a mother-in-law further reduces autonomy. ⁵

Patrilocal co-residence remains a defining feature of married women’s lives across much of the region. In India, National Family Health Survey (NFHS-5) data show that nearly 42 percent of households are non-nuclear, rising to 43 percent in rural areas, indicating that a substantial share of married women live with extended kin including parents-in-law. ⁶ In the same survey, only 42 percent of women were allowed to go alone to the market, a health facility, and places outside the village, and 11 percent of currently married women reported participating in none of three key household decisions.^5,6 Normative support for gendered authority within the marital household is also widespread: 32 percent of women and 31 percent of men agreed that a husband is justified in beating his wife if she shows disrespect for her in-laws, the most commonly endorsed justification out of seven circumstances assessed. ⁶ Within these households, daily status practices are common: in state-representative survey data from Bihar, Jharkhand, and Maharashtra, women who reported consistently eating after all other family members had significantly worse mental health even after adjustment for socioeconomic status. ⁷ Violence by intimate partners and in-laws is frequent: in rural Afghanistan, women experiencing combined husband and in-law physical violence had the highest levels of depression, PTSD, and suicidality, ⁸ and in the Nepali Terai, women with disability had markedly higher odds of in-law violence and all forms of intimate-partner violence. ⁹ Economic abuse is also widely reported: focus-group work in Maharashtra and Rajasthan identified four recurrent forms of abuse by husbands and in-laws, including economic control, sabotage of women’s earning or education, appropriation of wages and dowry assets, and refusal to contribute to household essentials. ¹⁰ These patterns show that patrilocal residence in South Asia is not simply a residential arrangement but a structural context that shapes daily status, access to resources, and exposure to harm.

Against this structural background, perinatal mental health is a major public-health concern worldwide. A large meta-analysis of more than 500 studies estimated that about 17 percent of women worldwide experience postpartum depression, with higher prevalence in low and middle income countries and in settings with greater income inequality and poorer maternal-child health indicators.^11,12 In some low income settings, 20 to 40 percent of women have significant depressive symptoms during pregnancy or after birth. ¹³ These disorders are linked to impaired maternal functioning and poorer social, cognitive, and physical outcomes in children. ¹⁴

Adolescence and early adulthood are particularly vulnerable periods. Studies from Kenya and Bangladesh highlight high rates of depression, suicidal ideation, and suicide attempts among pregnant adolescents, and in Bangladesh adolescent pregnancy is associated with elevated risk of suicide attempts, particularly in the first postnatal year.^15,16 Reviews and commentaries from sub-Saharan Africa argue that pregnant adolescents and adolescent mothers experience a double burden of perinatal mental disorders and social disadvantage, and are often not the focus of perinatal mental-health services.^17–20 In South Asia, where many women marry and have their first child at young ages within patrilocal households, these age-related risks intersect with the constraints of extended-family living.

Within patrilocal households, daily practices and relationship patterns further shape women’s wellbeing. One key status practice is the norm that the daughter-in-law eats last. In a cohort of newly married women living with mothers-in-law in rural Nepal, “always” eating last was associated with higher depressive symptoms and with higher odds of probable depression, and this association did not vary by food insecurity. ²¹ Representative survey data from India show similar associations between eating last and poorer mental health. ⁷ Longitudinal data from Nepal indicate that depressive symptoms track the quality of relationships with both the husband and the mother-in-law, and that mother-in-law relationship quality can moderate the impact of spousal relationship quality. ²² Panel data from Uttar Pradesh and Bihar further show that marriage into a household with parents-in-law reduces women’s mobility and limits gains in decision making power, and that although some of this loss is recovered after childbirth, women do not gain additional decision-making power simply because they have a son. ²³

Perinatal studies from India and Pakistan link patrilocal family structures to maternal mental health more directly. Community and hospital-based studies report postpartum depression prevalences between about 9.5 and 14 percent and identify poor relationships with in-laws, marital conflict, husband substance use, and son preference as key correlates, with antenatal symptoms often persisting into the postpartum period.^24–26 A systematic review of South Asian studies similarly highlights low social support and poor relationships with husbands and parents-in-law as consistent risk factors. ²⁷ Work on caregiving and perinatal grief shows that maternal grandmothers’ involvement is associated with better maternal wellbeing than mother-in-law primary caregiving, and that rural daughters-in-law in joint families have higher grief after perinatal loss, partly explained by restrictive norms and low support.^28–30 Diaspora research with Bangladeshi mothers in the United Kingdom describes limited postnatal help and language barriers that restrict access to appropriate mental-health care. ³¹

Violence and economic abuse in patrilocal households are also common and have clear mental-health consequences. In Afghanistan, many women report both intimate partner violence and physical violence from mothers-in-law or siblings-in-law, and combined exposure is associated with worse depression, suicidality, and PTSD than either exposure alone. ⁸ In Nepal’s Terai, disability is associated with higher odds of in-law violence, increased emotional, economic, physical and sexual intimate-partner violence, and lower perceived support from in-laws. ⁹ Qualitative work from India identifies four recurrent forms of economic abuse in patrilocal settings, including economic control, interference with employment or education, exploitation of women’s wages and dowry assets, and refusal to contribute to essentials, ¹⁰ while medico-legal series describe dowry-related deaths of young wives, often within the first few years of marriage and frequently occurring in in-laws’ homes.^32–34

Finally, studies on connectivity and systems highlight how wider structures shape these risks. In rural Bangladesh, women who migrate for marriage begin married life with very few local close kin but gradually rebuild networks through affinal kin and non-kin friends. ³⁵ In rural central India, phone access is constrained by who owns and carries the device, network quality, credit, digital skills, and time norms, limiting contact with natal kin and access to information and services. ³⁶ A situational analysis in India reports the absence of a national perinatal mental-health policy and limited perinatal-specific services at district level despite general mental-health programmes, ³⁷ while emerging family-centered interventions in Nepal and task-shared perinatal depression programs in Pakistan suggest that engaging husbands and in-laws and strengthening women’s economic position may improve outcomes.^38,39

Taken together, this work indicates that patrilocal residence and in-law co-residence are central contexts for maternal mental health in South Asia. At the same time, measures of residence, household position and in-law dynamics are heterogeneous and often not treated as primary exposures. This scoping review maps how patrilocality is defined and measured in empirical studies and synthesizes evidence on its links to depression, anxiety, grief, self-harm, and key determinants such as violence, economic abuse, caregiver roles, and communication access during pregnancy, postpartum, and early motherhood in South Asia.

3. Method

This scoping review followed the framework proposed by Arksey and O’Malley, which includes five stages: (1) identifying a broad research question, (2) identifying relevant studies, (3) applying clear inclusion and exclusion criteria to select studies, (4) charting data in a structured way, and (5) collating, summarizing and reporting findings. ⁴⁰ The review did not include a stakeholder consultation stage, which is an optional sixth step. Reporting follows the PRISMA extension for scoping reviews. ⁴¹

3.1. Identifying the research question

The main question for this review was: How is patrilocal residence and in-law co-residence related to maternal mental health in South Asia? Because many studies examine women’s mental health in marriage without restricting to the perinatal period, we also asked: How do patrilocal and joint-family living arrangements relate to mental health and violence among married women in South Asia more generally, and what do these findings imply for maternal and perinatal mental health?

We addressed four sub-questions.

• 1. How do studies define and measure patrilocality and related household structures in perinatal and married-women samples?

• 2. Which maternal and women’s mental-health outcomes and related determinants are examined?

• 3. What pathways are described between patrilocality and mental health (for example, status, relationship quality, violence, economic control, and communication)?

• 4. Where are the main gaps in the evidence and methods?

3.2. Identifying relevant studies

We searched the following electronic databases for relevant records in English: PubMed (MEDLINE), Embase, APA PsycINFO, CINAHL, Scopus, Web of Science Core Collection, and Cochrane CENTRAL. We also searched Google Scholar for additional articles not indexed in these databases. Searches covered studies published from 2000 onwards; the final search was conducted in November 2025. For each database we used parallel search strategies with two variants: perinatal or maternal samples and general adult women. The exposure block combined terms for patrilocal or virilocal residence and in-law co-residence (for example “patrilocal*”, “postmarital residence”, “mother-in-law”, “parents-in-law”, “joint family”, “living with”, “multigeneration*”). The outcome block included terms for mental health and violence, such as “depression*”, “anxiety*”, “mental health”, “psychological distress”, “postpartum depression”, “intimate partner violence”, “domestic violence”, “gender based violence”, and “violence against women”. We restricted searches to the South Asian region using country names (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives, Afghanistan). Full search strings for each database are provided in Supplementary Table S1.

3.3. Study selection (inclusion and exclusion)

Search results were imported into a reference manager and duplicates were removed. One reviewer screened all titles and abstracts against the eligibility criteria. Two reviewers then independently assessed the full texts of potentially relevant articles, and any disagreements were resolved through discussion with the senior authors.

Titles and abstracts were screened against the inclusion and exclusion criteria set out in Box 1.

Box 1. Inclusion and Exclusion Criteria for the scoping review of patrilocality and maternal mental health in South Asia

Inclusion criteria

• 1. Published in English.

• 2. Conducted in South Asia or with South Asian populations in diaspora (India, Nepal, Bangladesh, Pakistan, Afghanistan, Sri Lanka).

• 3. Study population includes any of the following groups:

  • a. Pregnant women, postpartum women, or mothers of young children (up to child age 3 years).
  • b. Married women, newly married women, or adolescent wives.
  • c. Adult women in patrilocal, extended family, or marriage based household structures.
• 4. Study reports at least one of the following mental health or gender related outcomes:

  • a. Depressive symptoms, common mental disorders, suicidality, psychological distress, or other validated mental health measures.
  • b. Intimate partner violence (physical, sexual, emotional).
  • c. In law violence or harassment (for example mother-in-law, father-in-law, siblings-in-law).
  • d. Autonomy, agency, mobility, decision making power, or gendered household constraints (for example eating last, restricted movement, family control over reproduction).

• 5. Any study design, including cross sectional, cohort, qualitative, mixed methods, randomized or non-randomized intervention studies, and ecological or demographic analyses.

• 6. Publication years 2000 to 2025.

Exclusion criteria

• 1. Studies not conducted in South Asia or with South Asian diaspora populations.

• 2. Studies unrelated to mental health, gendered household dynamics, marriage practices, or patrilocality.

• 3. Studies focused exclusively on men or male family members without women centered outcomes.

• 4. Commentaries, opinion pieces, conference abstracts without primary data, and book reviews.

3.4. Charting the data

We developed a data-charting form based on the PRISMA-ScR checklist ⁴¹ and piloted it on a small set of studies. For each included paper we recorded: author and year, country and setting, study design, sample size and population (for example, pregnant women, postpartum women, married women), and the time point in relation to pregnancy or postpartum. We then extracted all information on how patrilocality or related household structures were measured (for example, co-residence with parents-in-law, joint family, status practices such as eating last, caregiver identity, in-law violence, economic abuse, or phone access). We also recorded the maternal or women’s mental-health outcomes and instruments used (for example, EPDS, HSCL-D, GHQ-12, SRQ-20, Perinatal Grief Scale), key quantitative results (effect estimates where reported), and main qualitative themes. Notes on contextual factors and potential moderators, such as household conflict, disability, timing in the perinatal period, and network or phone access, were tabulated in line with the review questions.

3.5. Reporting the results

We used a narrative approach to organize and present the findings. AB and SC independently reviewed the charted data and discussed each study. They grouped studies into key exposure domains that reflected how patrilocality was conceptualized: co-residence and household position; status practices; relationship quality and conflict; caregiver identity and timing; in-law violence and maltreatment; economic abuse; networks and phone access; and macro-level or system studies. Because included studies used different instruments and constructs to assess mental health — for example, validated depression scales such as the EPDS and HSCL-D, broader measures of psychological distress such as the GHQ-12 and SRQ-20, and composite outcomes combining depression with anxiety, PTSD, or suicidality — we did not impose a single outcome hierarchy. Instead, we reported the specific outcome and instrument used in each study and noted where findings converged across different measures. We also distinguished findings by timing relative to pregnancy and birth (antenatal, postnatal, or broader reproductive-age samples) when studies provided this information, and flagged where perinatal-specific conclusions were extrapolated from studies of married women across the wider reproductive age range.

Within each domain, AB and SC summarized the characteristics of the studies, the measures used, the maternal or women’s mental-health outcomes examined, and the main directions and strengths of association. They described common patterns and differences across settings, identified where findings were inconsistent or sparse, and noted recurring methodological issues that affect interpretation. All selected studies were then reviewed by PC and VS.

4. Results

4.1. Study selection

Searches across seven electronic databases and Google Scholar identified a large number of records. After removal of duplicates and screening of titles and abstracts against the eligibility criteria, full texts of potentially relevant articles were retrieved and assessed. Following full-text review, 32 studies met the inclusion criteria and were included in the scoping review. The PRISMA-ScR flow diagram summarizing the selection process is presented in Figure 1. We produced the PRISMA 2020 flow diagram using the PRISMA2020 R package and Shiny app. ⁴²

Figure 1.

PRISMA-ScR flow diagram of study selection for the scoping review of patrilocality and maternal mental health in South Asia.

4.2. Study characteristics

The 32 included studies were published between 2004 and 2025. Most were conducted in India and used cross-sectional surveys, clinic-based studies, qualitative studies, or medico-legal series.^{4,7,10,23–26,29,32–34,36,37,43,44} Additional studies were from Nepal, including longitudinal cohorts and cross-sectional surveys on newly married women and mothers,^21,22,38,45 from Pakistan,^9,28,39 from Bangladesh,^35,46 from Afghanistan, ⁸ and from the United Kingdom. ³¹ Several papers drew on multi-country or regional data or provided theoretical framing.^20,27,40,41 Most empirical studies used cross-sectional designs; a smaller number were longitudinal cohorts,^21–23,28 intervention evaluations,^38,39 or policy and situational analyses. ³⁷

Mental-health outcomes included postpartum or perinatal depression measured with the EPDS,^24–26 depressive symptoms measured with HSCL D,^21,22 general psychological distress assessed with GHQ 12 or similar scales,^7,45 perinatal grief measured with the Perinatal Grief Scale, ³⁰ and outcomes such as depression, suicidality, and PTSD in the context of violence. ⁸ Several studies focused on proximal determinants, including intimate-partner violence, in-law violence, and economic abuse, rather than symptom scales, but were included because of their relevance for perinatal mental health.^{9,10,32–34,44}

Across the included studies, only a subset reported women’s ages explicitly, but where age bands were given they were almost entirely within the reproductive age range. The newly married cohort studies from rural Nepal by Gopalakrishnan et al. enrolled women 18 to 25 years old, and their panel work in Bihar and Uttar Pradesh followed adolescent girls and young women from 15 to 19 years at baseline to 18 to 22 years at follow up.^21,23 Rahman et al. in Bangladesh focused on married adolescents aged 15 to 19 years. ⁴⁶ State-representative survey work from India by Hathi et al. included ever-married women aged 18 to 65 years, while the Afghanistan violence study by Jewkes et al. covered women aged 18 to 48 years.^7,8 Roberts et al. reported on women aged 18 to 49 years in central India in the context of perinatal loss. ³⁰ Medico-legal series on dowry-related deaths described very young brides, typically between 16 and 30 years of age, with most cases in the 18 to 26 year range.^32,33 Many perinatal mental-health and postpartum violence studies did not give exact age bands but clearly recruited pregnant or postpartum women, so it is reasonable to infer that their samples also fall within the late-teen to early-forties age range (Tables 1 and 2).

Table 1.

Studies on perinatal and early maternal mental health (pregnancy to child age ≤ 3 years).

SNo.	Author(s), year	Country and study design	Sample characteristics	Mental health outcomes and measures	Patrilocality or gendered norm exposures	Other key social or clinical variables
1	Aslam et al., 2022	India; community based cross sectional study	304 postpartum women, 6 weeks to 6 months after delivery, recruited from urban and rural areas of Aligarh district. Age range not reported but all within reproductive age.	Postpartum depression assessed using the Edinburgh Postnatal Depression Scale (EPDS) with a cut off of 10 or more, and confirmed by ICD-10 clinical diagnosis. Prevalence of postpartum depression and associated risk factors estimated.	Patrilocal context is implicit; key gendered exposures include relationship quality with in laws and experiences of domestic violence in the marital home.	Husband’s substance use, level of social support from family, nature of relationship with in laws, husband’s employment status, unplanned pregnancy, obstetric complications, and socioeconomic status.
2	Chung et al., 2022	Pakistan; longitudinal cohort study nested within the Bachpan birth cohort	783 mothers followed at 3 and 12 months postpartum in rural Pakistan. All women were married and living in extended family settings with varying levels of mother in law involvement.	Major depressive episode at 3 and 12 months postpartum assessed using SCID based diagnostic interviews. Depression prevalence and persistence across time examined in relation to caregiving patterns.	Mother in law childcare involvement classified as none, low, or high, based on a detailed 24 hour recall of caregiving activities. Family conflict (arguments, troubled relationships, marital problems) captured using a life events checklist. Baseline intimate partner violence measured using the WHO Violence Against Women instrument.	Maternal age, education, parity, wealth, and village cluster; husband’s education and employment; household food insecurity; and pregnancy related factors. Analyses assess how mother in law support in caregiving interacts with family conflict to influence maternal depression. Association varies by timing and family conflict context.
3	G. N. and Haritha, 2022	India (Kerala); prospective observational hospital based study	387 women recruited in pregnancy and followed into the postpartum period at a referral care teaching hospital. Assessments conducted antenatally, immediately after delivery, and at 4 to 6 weeks postpartum.	Depressive symptoms measured using the EPDS. Broader emotional state assessed with the Depression Anxiety Stress Scale (DASS-21). Change in scores over time used to describe antenatal and postnatal mood patterns.	Family type (nuclear vs joint) assessed; joint family associated with antenatal EPDS depression (p=0.001) but not associated with immediate postpartum EPDS depression. Sex of baby examined; male baby associated with lower depression risk and prior female births increased risk in antenatal analyses.	Parity, obstetric complications, mode of delivery, history of mental illness, marital dissatisfaction (measured using marital satisfaction scales), stressful life events, and husband’s substance use.
4	Nazir et al., 2022	Pakistan; qualitative study using in depth interviews	19 pregnant women with anxiety symptoms and 10 female healthcare providers recruited from a public urban tertiary teaching hospital in Rawalpindi; women were ≤20 weeks’ gestation.	Participants were screened for anxiety symptoms using HADS-anxiety (HADS-A) and then interviewed qualitatively; no quantitative symptom severity outcome was analyzed.	Gendered mobility restrictions and dependence on husbands or in laws for permission and accompaniment to care. Expectations around ideal daughter in law behavior and family honor create barriers to disclosure of symptoms.	Perceptions of health system quality, trust in providers, structural barriers such as transport and cost, and social stigma related to mental illness.
5	Parvin et al., 2004	UK; qualitative study using focus groups. 25 first-generation Bangladeshi women (little English) in three community groups in Tower Hamlets (1999–2000).	Bangladeshi first generation migrant mothers and carers with limited English proficiency in an inner city London borough. Participants were all mothers in the postnatal period, living in transnational and often extended family networks.	Postnatal distress explored through women’s narratives; no standardized scale used, but the study documents symptoms, coping strategies, and service use.	Gendered obligations around rest, work, and childcare within extended families, expectations from mothers in law, and the influence of husbands in decision making about health care.	Language barriers, migration related isolation, access to interpreters, trust in midwives and health visitors, and cultural expectations regarding postnatal practices such as rest and confinement.
6	Rajeev et al., 2025	India; Scoping review of 24 English-language studies (2012–2023) on PPD awareness and prevalence in India; evidence base largely hospital-based with limited geographic coverage.	Scoping review of Indian studies on postpartum depression, including facility and community based samples of postpartum women across multiple states.	Synthesizes reported prevalence of postpartum depression, screening instruments used (primarily EPDS) plus limited evidence on awareness (PoDLiS), and help seeking patterns among postpartum women.	Summarizes how individual studies incorporate family structure, support from in laws, and gendered expectations (for example son preference and joint family living) as risk factors.	Documents geographic coverage, study designs, and quality of the Indian postpartum depression evidence base, highlighting gaps in rural coverage and lack of longitudinal data.
7	Roberts et al., 2021	India; comparative analysis of two cross-sectional studies (mixed-methods informed	Poor rural (N=217) and urban slum-dwelling (N=149) women aged 18–49 in Central India with a history of stillbirth and/or infant death; rural data collected in Chhattisgarh (2012) and urban data collected in Mumbai slums (2020)	Perinatal grief measured using the Perinatal Grief Scale (PGS). Social support measured using the Social Provision Scale (SPS). Coping assessed using the Shortened Ways of Coping–Revised (SWC-R). Social norms and autonomy assessed with study-developed scales.	Household position (e.g., daughter-in-law vs wife), joint-family living, autonomy restrictions, and endorsement of traditional maternal-role social norms (measured).	Rural vs urban residence, type of perinatal loss (stillbirth/infant death), number of losses, household position, social support, coping style, autonomy, and social norms.
8	Scott et al., 2021	India; qualitative study using semi structured interviews and focus groups	Mothers of 1-year-old children with some access to a mobile phone (n=29); husbands interviewed when possible (n=23); additional family members via interviews/group discussions (n=25).	Determinants of women’s mobile phone access and use (not a mental health outcome).	Patriarchal gender norms (domesticity, subservience, purity, patriarchal exogamy) constrain women’s phone use; dependence on husbands/in-laws for handset access and socially acceptable uses.	Phone ownership/proximity, phone functionality, digital skills, time allocation constraints, and narrow expectations for “appropriate” women’s phone use.
9	Sidhu et al., 2019	India; hospital based cross sectional study	“Peripartum women (antenatal and postnatal) attending immunization clinics in Bathinda district (100 rural + 100 urban). Sample size 200.”	Peripartum depression screened using the EPDS. Prevalence and association with obstetric and social variables assessed using chi square tests.	Family structure (nuclear vs joint) and gender of the newborn examined; depression higher in nuclear (20%) than joint families (10%) (p = 0.046). Social support from in-laws significantly protective (p = 0.027); male-child preference increased risk (p = 0.003).	Parity, planned versus unplanned pregnancy, obstetric complications, mode of delivery, and history of mental illness.
10	Suri et al., 2025	India; multi-site cross sectional study of mother–caregiver dyads (4 states).	551 dyads comprising postpartum mothers and the person the mother identified as her primary caregiver. Caregivers included husbands, mothers, mothers in law, and others.	Maternal mental wellbeing measured using a composite index based on self-reported emotional health and functioning. Breastfeeding practices, postpartum recovery, and health service use also measured. Index constructed from yes/no items (higher = poorer well-being); standardized; not validated elsewhere.	Identity of the primary caregiver (husband, mother, mother in law, or other relative) and alignment between mother and caregiver on decision making regarding maternal and infant care.	Household decision making patterns, type of family (nuclear or joint), socioeconomic status, mode and place of delivery, and exposure to complications.
11	Wagman et al., 2018	India; cross sectional survey in urban health centers	1038 postpartum women with infants aged six months or younger attending urban health centers in Mumbai’s informal settlements.	The study focuses on postpartum intimate partner violence and gender based household maltreatment rather than depression symptoms. Postpartum IPV (physical/sexual) and gender-based household maltreatment (GBHM) measured; no maternal mental health outcome measured.	Measures postpartum physical and sexual intimate partner violence using items adapted from NFHS and the Conflict Tactics Scale. Gender based household maltreatment is captured through a composite index of multiple maltreatment items including restrictions on food, rest, and health care, dowry related demands, and pressure to have a son, perpetrated by husbands and in laws. Women treated badly for not having a boy child (husband and/or in-laws).	Husband’s past-month alcohol use (main predictor), family type (nuclear vs joint), and demographics; models estimate associations with postpartum IPV and GBHM and their overlap.
12	Waqas et al., 2022	Pakistan; secondary analysis of a randomized controlled trial	Depressed perinatal women recruited to the Thinking Healthy Program in Pakistan. The analysis uses 903 women with baseline depression and follow up data.	Major depressive episode diagnosed using SCID. Severity and symptom dimensions captured using the Hamilton Depression Rating Scale and functioning scales. Prediction models identify factors associated with persistence or remission of perinatal depression.	Gender related constructs include social support and family context variables that may reflect patrilocal living, although patrilocality is not explicitly modelled.	Maternal age, education, parity, economic status, baseline depression severity, social support, and engagement with the peer delivered psychological intervention.

Table 2.

Studies on adult women’s mental health, patrilocality, and gendered constraints (non-maternal samples or broader life-course focus).

SNo.	Author(s), year	Country and study design	Sample characteristics	Mental health outcomes and measures	Patrilocality or gendered norm exposures	Other key social or structural variables
1	Dixit et al., 2022	India; qualitative focus group study	Ten focus group discussions with mothers in law of young married couples in rural Maharashtra, conducted within CHARM2 trial clusters.	Mental health is not directly measured; the study documents stress and pressure around fertility and family planning decisions through qualitative narratives.	Most couples co-resided with the mother-in-law in joint households (common in the CHARM2 sample). Mothers in law describe controlling couples’ fertility, son preference, and expectations that daughters in law seek their permission for contraception and childbearing.	Attitudes towards modern contraceptive methods, preference for female sterilization, perceptions of younger women’s autonomy and education, and intergenerational changes in gender norms.
2	Dube, 1988	India; conceptual/theoretical paper (not an included empirical study).	Conceptual analysis drawing on ethnographic work in Indian households; no sample in the quantitative sense.	No mental health outcomes measured, but the work provides a framework for thinking about how gender is constructed in the Indian household.	Describes how patrilocal joint families, inheritance rules, and household organization naturalize gender hierarchy and position daughters in law in subordinate roles.	Division of labor, authority structures within joint families, and the socialization of boys and girls into gendered expectations.
3	Goli et al., 2024	India; ecological and multilevel quantitative analysis	District and state level data from Census, health surveys, and administrative sources across India.	No individual symptom outcomes; focus is on demographic indicators such as child sex ratios and sex ratios at birth and at last birth.	Patrilocality constructed as the ratio of female to male marriage migrants aged 10–49 at the district level (Census migration tables), capturing the extent to which women move to their husband’s household after marriage. Links between higher patrilocality and more male skewed child sex ratios are analyzed.	Measures of women’s autonomy such as female education, age at marriage, and labor force participation, as well as fertility rates, use of antenatal ultrasound, household wealth, caste composition, and urbanization.
4	Gopalakrishnan et al., 2023 (UDAYA empowerment)	India (Bihar and Uttar Pradesh); two-wave prospective panel study (UDAYA), ∼3-year follow-up.	Adolescent girls and young women (AGYW) from Bihar and Uttar Pradesh followed from Wave 1 (2015–16; ages 15–19) to Wave 2 (2018–19; ages ∼18–22), including unmarried girls and married AGYW.	No mental health symptom measure; outcomes are three empowerment domains: freedom of movement (mobility), household decision-making, and access to economic resources (bank account/ability to operate account/savings).	Key transitions: marriage, motherhood (live birth), and having at least one son (vs daughters only/no children). Patrilocal residence operationalized as co-residence with in-laws and tested as an effect modifier of the marriage–empowerment association (co-residence with in-laws measured at Wave 2).	Education, paid work, caste, religion, household wealth index, rural/urban residence, and mass media exposure; models also account for family type (nuclear vs joint) and household in-law presence.
5	Gopalakrishnan et al., 2023 (eating last, Nepal)	Nepal; longitudinal cohort study	Two hundred newly married women aged 18 to 25 years living with their husbands and in laws in rural Nawalparasi district, followed over four survey rounds.	Depressive symptoms measured using the Hopkins Symptom Checklist depression subscale (HSCL-D). Probable depression defined using a standard cut off.	Eating last measured by self-report frequency (‘never’ to ‘all the time’); primary exposure coded as ‘all the time’ vs all other responses. Household food insecurity is captured using HFIAS.	The paper’s covariates include age, education, ethnicity/caste, wealth quintile, arranged marriage, and time-varying HFIAS, paid work, and childbirth since last round. It does not list husband’s migration as a covariate in the methods.
6	Gopalakrishnan et al., 2023 (spousal and mother in law relationship quality)	Nepal; longitudinal cohort study	Same cohort of 200 newly married women in rural Nawalparasi district.	Depressive symptoms assessed using HSCL-D across multiple waves.	Relationship quality with husband and with mother in law measured using scales capturing trust, commitment, and satisfaction. Sample restricted to newly married women co-residing with their mother-in-law (patrilocal household context).	Household food insecurity, wealth, and work status. Results show that better relationship quality with both husband and mother in law is associated with lower depression, and that mother in law relationship quality can buffer or exacerbate the effect of spousal relationship quality.
7	Gupta et al., 2018	Nepal; cross sectional survey	Married women in the rural Terai region, with a focus on women with and without disability. Sample size n =1800 women aged 18-49 baseline 2016.	Outcomes: past-year physical/sexual IPV, emotional IPV, economic IPV, and in-law violence; plus perceived social support from natal family and in-laws	Intimate partner violence measured using physical and sexual IPV items. In-law violence and perceived supportive in-laws; disability severity as a gradient linked to dependence and social exclusion.	Disability status, social support, household food insecurity, poverty, and caste. The study shows strong associations between disability, IPV, and poor mental health.
8	Hathi et al., 2021	India; phone survey with state representative sampling	Ever married women aged 25+ years in Bihar, Jharkhand, and Maharashtra, interviewed through a mobile phone survey.	Common mental disorders assessed using a short six item version of the WHO Self Reporting Questionnaire. Outcome is total SRQ symptom count (0–6), higher = worse mental health.	“Eating last” within the household, meaning the woman consistently eats after all other family members, used as a marker of low intra household status. Autonomy proxied in SARI by needing permission to go to a neighbor’s house; additional decision-making-power measures examined using IHDS (separate dataset).	Wealth, caste, education, sanitation, and latrine ownership (rural only). The study shows that women who eat last have significantly worse mental health even after adjusting for socioeconomic status.
9	Hruschka et al., 2022	Bangladesh; community-based social network study in 10 rural communities (patrilocal vs more matrilocal groups).	Women from four ethnolinguistic groups across 10 rural communities (Bengali n=317; Santal n=36; Hajong n=39; Mandi n=36). Compares women who entered a new village by marriage with women who stayed in their natal village at marriage.	No mental health outcomes. Outcomes are social network composition (number of close genetic kin, close affinal kin, spouse, and non-kin friends) and supportive ties in domains of advice, support in disputes, and small monetary loans.	Patrilocality operationalized as post-marital migration to husband’s village (village exogamy). Residence norms vary across groups, enabling comparison between more strictly patrilocal Bengali communities and higher-matrilocality communities (Mandi, Hajong, Santal).	Age patterns in ties (life-course change), relationship type (close kin/affines/friends/spouse), and support domains (advice, disputes, loans). Includes analysis of how often migrants have siblings in the marital village and differences in friend/support nominations (subsample with photos n=398).
10	Jayachandran, 2015	Global; narrative review	Review paper synthesizing evidence on gender gaps in developing countries, with substantial emphasis on South Asia.	No direct mental health outcomes; the review provides background on how gender gaps in health, education, and labor emerge.	Discusses patrilocality, son preference, and marriage practices as key structural drivers of gender inequality in South Asia.	Economic development mechanisms (technology, returns to education, fertility change), and policy approaches to address gender inequality; emphasizes that development explains much of the GDP–gender inequality relationship but society-specific cultural factors also matter.
11	Jewkes et al., 2019	Afghanistan; cross sectional survey	932 currently married women aged 18 to 48 years from six villages in Kabul and Nangarhar provinces.	Depression, suicidal ideation, PTSD symptoms, and disability measured using validated scales; physical health also assessed.	Violence from husbands, mothers in law, and siblings in law measured using adapted WHO and Conflict Tactics items. Food insecurity and borrowing for food used as markers of economic strain. Co-residence with in laws and polygamy captured as household structure variables.	Socioeconomic status, province, and education. The study demonstrates very high levels of violence from both husbands and in laws and strong associations with poor mental health. MIL violence associated with elevated distress, suicidality, PTSD; depression strongest when combined with spousal violence
12	Kaur et al., 2024	India and diaspora; quantitative analysis of survey microdata	Married women of Indian origin in India, the United States, the United Kingdom, and Canada, using census and labor force survey datasets.	No mental health outcomes; focus is on who married women live with after marriage (living with their partner).	Intergenerational patrilocal residence patterns analyzed by age, education, and employment.	Country context, generation (migrant versus non migrant), education, employment, and age, allowing comparison of patrilocality patterns within India and in the diaspora.
13	Khalil and Mookerjee, 2019	India; cross sectional analysis using large household survey data	Married women (15–34) from DHS in India, Pakistan, Bangladesh, and Nepal; patrilocal residence coded from household roster as co-residence with husband’s natal family.	No direct mental health outcomes. Outcomes include women’s autonomy indicators: decision-making about health care and household purchases, mobility/visiting natal family, and access to money; plus domestic abuse outcomes from the DHS module (minor vs major abuse and injuries).	Primary exposure is patrilocal residence (co-residence with husband’s natal family). Analysis tests associations of patrilocal residence with autonomy and domestic abuse, and considers mechanisms related to marital household hierarchy.	Age, education, household wealth, caste, and state. The study assesses whether living closer to natal kin is associated with higher autonomy and lower IPV.
14	Kumar et al., 2013	India; medico legal record review	456 cases of unnatural deaths among women aged 16 to 30 years in Lucknow over one year, including dowry deaths.	Mental health is not directly measured, but the study provides epidemiological data on causes and circumstances of death, including suicide, accident, and homicide.	Family-context factors described include cruelty by in-laws, dependence on in-laws, and joint-family structure as contributing circumstances in some cases (descriptive, not formally modeled).	Age, marital status, time since marriage, method of death, and location of incident.
15	Marphatia et al., 2023	Nepal; cross sectional follow up study	444 mothers from a rural lowland cohort, with school aged children, living in different co residence patterns with husbands and parents in law.	Psychological distress measured using the GHQ-12. Economic decision making power and autonomy in daily life assessed.	Co residence categories defined as living with husband only, parents in law only, both husband and parents in law, or neither. These patterns reflect varying degrees of patrilocality and migration.	Household food insecurity, women’s time use in paid and unpaid work, and control over economic decisions including borrowing, lending, and spending. The study shows tradeoffs between autonomy and mental health across co residence types.
16	Mellers et al., 2025	India; desk review and key informant situational analysis	Multi-level situational analysis of perinatal mental health systems in two Indian states (Haryana and Telangana), drawing on policy documents, routine data, and informant interviews.	No individual mental health outcomes; focus is on system readiness for perinatal mental health care.	Community/context section highlights barriers and sociocultural factors relevant to PMH support (e.g., stigma, isolation, transport barriers); includes discussion of family support patterns around pregnancy/postpartum (e.g., returning to natal home in late pregnancy and reduced support after moving back to husband’s family) and gendered pressures such as male child preference and dowry practices as potential influences on perinatal mental health.	National and state policies, human resources, training, referral pathways, and monitoring indicators for perinatal mental health.
17	Mohanty et al., 2013	India (Odisha); prospective forensic autopsy-based study of established dowry deaths at MKCG Medical College, Berhampur (Aug 2007–July 2009).	140 established dowry death cases undergoing medico-legal autopsy; most victims were young married women aged 18–26 years; majority were childless; most incidents occurred at night and within the matrimonial/in-laws’ home.	No direct mental health measures; study categorizes cause and manner of death and sociodemographic characteristics of the victims.	Dowry-related harassment and violence in marital households; majority from joint families; suspected perpetrators most often husbands alone or husbands with in-laws; deaths frequently by burns in the matrimonial/in-laws’ home.	Age, education, rural/urban background, socioeconomic status, childlessness, family type (joint vs nuclear), timing (night), place of occurrence (matrimonial/in-laws’ home), suspected offender category, and method/cause of death.
18	Rahman et al., 2023	Bangladesh; cross sectional survey	1846 married adolescent girls aged 15 to 19 years.	Outcome is physical intimate partner violence in the last year; mental health symptoms are not directly measured but IPV is a major proximal determinant of mental health.	Living arrangement after marriage (living with husband alone vs living with parents-in-law/parents) is modeled; co-residence with parents-in-law/parents is protective compared with living with husband only (AOR 0.56). Gender norms/attitudes and relationship dynamics are included.	Education, wealth, husband’s age and education, rural versus urban residence, and family structure.
19	Sathyanarayana and Sundaragiri, 2017	India; medico legal record review	212 burn deaths among married women attributed to dowry related violence in a tertiary teaching hospital in Telangana between 2012 and 2013.	No mental health scales; study describes extent and pattern of burn injuries and circumstances of death.	Dowry related harassment in patrilocal marital homes, often involving husbands and in laws, with incidents commonly occurring within a few years of marriage.	Age, duration of marriage, percentage of total body surface area burned, place of occurrence (kitchen, home), and time to death.
20	Shai et al., 2020	Nepal; mixed methods evaluation of a gender transformative intervention	Approximately 200 women and 157 men from two migrant communities in Nepal, with repeated surveys and qualitative work around the Sammanit Jeevan intervention.	Depression symptoms and functioning measured using standard scales such as CES-D and functioning indices.	Physical, sexual, and emotional intimate partner violence, controlling behaviors, and cruelty from in laws. The intervention aims to shift gender norms and reduce violence.	Women’s earnings and savings, gender attitudes, relationship power, joint and nuclear family structures, and community level activism.
21	Steinert et al., 2023	India; qualitative study using focus group discussions (thematic analysis) on economic abuse in marital households.	Women employed in fair trade producer groups in Maharashtra and Rajasthan, along with a small number of husbands and mothers in law.	No mental health scales; study focuses on economic abuse, which has clear implications for mental health.	Economic abuse analyzed in relation to socio-cultural factors including patrilocality, patriarchal gender norms, women’s exclusion from household financial decision-making, and limited acceptance of female employment; perpetrators include husbands and parents-in-law.	Identifies four forms of economic abuse: economic control, employment/education sabotage, economic exploitation (including debt in women’s names and misuse of wedding endowments/streedhan), and refusal to contribute to necessary household/health/child expenses; links to dowry-related practices and other domestic violence.

4.3. Conceptualization and measurement of patrilocality

Studies varied in how they defined and operationalized patrilocality. Several measured co-residence with in-laws or joint-family living directly. For example, Indian perinatal surveys defined joint families as households in which the woman lived with her husband’s parents or other adult in-laws.^24–26 A panel study from Uttar Pradesh and Bihar measured whether women lived with a husband only, with husband plus parents-in-law, or with other kin. ²³ Nepali cohorts recruited “newly married women living with husbands and in-laws” and used household rosters to confirm co-residence.^21,22 Macro-analytic work used census-derived measures of patrilocal marriage ⁴ or co-residence with parents-in-law in Demographic and Health Survey data. ⁵

Other studies captured patrilocal dynamics through status and role indicators rather than residence alone. The Nepali cohort and a large Indian survey measured whether women “always ate last” compared with other household members, treating this as a core status marker, and both found strong associations with depressive symptoms.^7,21 Relationship quality and conflict with husbands and mothers-in-law were measured using validated scales such as the Spousal Relationship Quality Scale and a parallel mother-in-law relationship scale. ²² Perinatal studies also recorded caregiver identity and timing, for example whether the primary postpartum caregiver was a maternal grandmother or a mother-in-law, and at what postpartum time point.^28,29

Further operationalizations focused on violence and economic control. Afghan and Nepali surveys included specific items on physical violence from mothers-in-law and other in-laws, as distinct from partner violence.^8,9 Indian studies measured nonphysical maltreatment by in-laws, such as withholding food, sleep, or healthcare, and denigration. ⁴⁴ Work on economic abuse in Maharashtra and Rajasthan characterized four forms of abuse involving husbands and in-laws, including control of earnings and appropriation of dowry and other assets. ¹⁰ Medico legal studies used police and hospital records to identify dowry-related deaths among married women, often specifying whether events occurred in the in-laws’ home and within the first years of marriage.^32–34

Several studies also addressed networks and communication as features of life in patrilocal settings. In Bangladesh, marriage migrants were compared with non-migrants on the number and type of close social ties, showing that migrants initially had almost no local kin but gradually built new networks. ³⁵ In rural India, qualitative work described how norms around phone ownership, control over devices, and expectations about women’s time and privacy limited their ability to contact natal kin or seek help. ³⁶

4.4. Patrilocality and maternal mental health

Across cross-sectional perinatal studies, living with in-laws, status markers, and relationship quality were consistently linked to maternal mental health. In Aligarh, India, postpartum depression (9.5 percent by EPDS and ICD 10) was more common among women who reported poor relationships with in-laws (adjusted odds ratio 5.1), serious marital conflict (adjusted odds ratio 13.3), or husbands’ substance use (adjusted odds ratio 3.1). ²⁴ In Punjab, peripartum depression (14 percent) was less likely among women living in joint families and those reporting support from in-laws, and more likely among women facing pressure to bear a son. ²⁵ In a hospital cohort from Kerala, antenatal depression was associated with joint-family living, low marital satisfaction, and husband’s alcohol use, and a large proportion of women with antenatal symptoms remained depressed postpartum. ²⁶

Longitudinal studies in Nepal showed that status and relationship quality are closely tied to depressive symptoms. In the newly married cohort, always eating last was associated with higher HSCL D scores and an increased risk of probable depression at follow-up. ²¹ In a related cohort, higher-quality relationships with husbands and mothers-in-law were linked to lower depressive symptoms over time, and mother-in-law relationship quality moderated the association between spousal relationship quality and depression. ²² A cross-sectional analysis from lowland Nepal further showed that women living only with their husbands had higher distress but greater economic autonomy, whereas those living with parents-in-law had lower autonomy and similar or worse distress. ⁴⁵

Evidence on caregiver roles pointed to differences between maternal and affinal kin. In a four state Indian study, mothers whose own mothers were the main postpartum caregivers reported better mental wellbeing and recovery; those whose mothers-in-law were primary caregivers had lower wellbeing and were less likely to report being well after childbirth. ²⁹ In Pakistan, mother-in-law childcare was associated with reduced depression symptoms at three months postpartum in both high and low conflict households, but at twelve months high levels of mother-in-law involvement within conflictual households were associated with increased depression. ²⁸

Studies of perinatal grief and diaspora experience highlighted the role of household position and support. In central India, rural women living as daughters-in-law in joint families had higher perinatal grief scores than women in urban slums, with multivariable models indicating that restrictive norms and low social support partly explained this difference. ³⁰ In the United Kingdom, first-generation Bangladeshi mothers described limited postnatal help and language barriers, reporting that emotional distress after childbirth was rarely discussed or addressed. ³¹

4.5. Proximal determinants: Violence, economic abuse, networks and phones

Several studies documented intimate-partner and in-law violence and their mental-health consequences. In Afghanistan, women experiencing both husband and in law physical violence had the highest levels of depression, PTSD symptoms, and suicidal thoughts, compared with those experiencing only one type of violence or none. ⁸ In the Terai region of Nepal, women with severe disability had higher odds of in-law violence and all forms of intimate-partner violence, as well as lower perceived support from in-laws. ⁹ In Mumbai, postpartum women married to men who used alcohol had approximately twice the odds of intimate-partner violence and were more likely to report family maltreatment by husbands or in-laws, including being denied food, sleep, or medical care. ⁴⁴

Economic abuse and dowry-related harms formed another important pathway. Focus-group data from Maharashtra and Rajasthan showed that women, husbands, and mothers-in-law recognized patterns of economic control, sabotage of women’s earning and education, seizure of wages and dowry assets, and refusal to contribute to household essentials; these practices were embedded in local expectations about patrilocal marriage and female obedience.^10,47–50 Medico legal series from Lucknow and South India described high rates of fatal burns and other violent deaths among young wives, typically within a few years of marriage and often linked to dowry demands and cruelty by in-laws.^32–34

Social networks and communication channels also shaped conditions for mental health. In rural Bangladesh, marriage migrants rebuilt their networks over time, but the initial near absence of local kin and reliance on affinal relations underlined the vulnerability of newly patrilocally married women. ³⁵ In the Bangladeshi adolescent survey, co-residing with parents or parents-in-law was associated with lower odds of recent physical intimate-partner violence, whereas not owning a mobile phone increased intimate-partner violence risk, suggesting that co residence and communication access can function as protective factors in some settings. ⁴⁶ Qualitative work from rural India showed that even where women technically had access to a household phone, men’s control over the device, intermittent network coverage, lack of digital skills, and heavy domestic workloads substantially restricted their independent use of mobile phones. ³⁶ These qualitative and survey findings are consistent with multi country analyses of Demographic and Health Survey data showing that women’s mobile phone ownership is often associated with lower odds of recent physical and sexual intimate-partner violence in many low and middle income countries. ⁵¹

4.6. System-level responses and interventions

Only a few studies directly evaluated interventions or system responses that engage patrilocal households. In Nepal, the Sammanit Jeevan family-centered project, which worked with young married women, husbands, and in-laws, reported increases in women’s earnings and savings, reductions in perceived mother-in-law cruelty, and some reduction in physical intimate-partner violence, although the single group design and reliance on self-report limit causal inference. ³⁸ In Pakistan, a prognostic model based on data from a task shared perinatal depression program found that women with support from mothers or mothers-in-law, joint family residence, higher socioeconomic status, and financial empowerment were more likely to remit from depression within the intervention period. ³⁹

At the policy level, a situational analysis in India highlighted major gaps: despite national mental-health programs, there is no dedicated perinatal mental-health policy, and few districts offer structured perinatal mental health services or integrate partners and in-laws into care pathways. ³⁷ Reviews of perinatal depression in India and South Asia also note the absence of standardized measures for patrilocality, in-law dynamics, and economic abuse, and call for future interventions to address these household-level determinants more explicitly.^27,43

6. Limitations

This scoping review has several limitations that should be considered when interpreting the findings. First, the review followed a scoping design and did not include a formal risk of bias assessment or quantitative meta-analysis. Many included studies were cross-sectional and relied on self-report questionnaires, which limits inferences about direction of effect and makes estimates vulnerable to recall and reporting biases.^7,24,25 Longitudinal studies were fewer in number and often had modest sample sizes and loss to follow-up.^21,22,28 The predominance of cross-sectional designs is a particular concern because the relationship between patrilocal living conditions and depressive symptoms is unlikely to be unidirectional: women with poorer mental health may also be less able to negotiate household arrangements, access support, or leave harmful situations, and behavioral and contextual factors can influence depressive symptoms in nonlinear ways. ⁵² As a result, the review can describe patterns of association but cannot establish causal directionality, and future longitudinal and intervention research will be needed to disentangle these pathways.

Second, measurement of both exposures and outcomes was heterogeneous. Patrilocality and related constructs were defined and operationalized in different ways across studies. Some used household rosters to identify co-residence with parents-in-law, others used family-type variables, status practices such as eating last, caregiver identity, or items on violence and economic abuse as proxies.^10,21,44 Depressive and psychological outcomes were assessed with a wide range of instruments — including the EPDS, HSCL-D, GHQ-12, SRQ-20, PHQ-9, DASS-21, CES-D, and SCID-based diagnostic interviews — each with different cut-offs, reference periods, and construct coverage. Some instruments capture clinical depression, others broader psychological distress, and several studies focused on proximal determinants such as intimate-partner violence or in-law violence rather than symptom scales.^8,30 This variability means that nominally similar outcomes (for example, “depression” measured by EPDS versus “psychological distress” measured by GHQ-12) may not be directly comparable, and effect estimates cannot be pooled or ranked across studies.

Third, there are constraints related to coverage and generalizability. We restricted inclusion to studies in English with full texts available, which may have excluded relevant work published in regional languages or in local journals. Most empirical studies came from India, Pakistan, Nepal, Bangladesh, and Afghanistan. There was very little evidence from Sri Lanka, Bhutan, or the Maldives. Within countries, many studies were conducted in single districts, tertiary hospitals, or specific communities, which limits generalization to national populations.^24,26,30 Several hospital-based studies may also be affected by selection bias, because women who seek facility care or are referred for mental-health assessment are not representative of all women in patrilocal households.

Fourth, although we searched eight databases and used Google Scholar to identify additional records, the search may not have captured all relevant grey literature, including theses, reports, or program evaluations that are not indexed or are poorly indexed. In addition, the review focused on South Asia and South-Asian diaspora populations, so findings may not apply to patrilocality in other regions such as East Asia, where legal frameworks, welfare systems, and gender norms differ. Not all included studies focused on women in the perinatal period; some examined patrilocality and mental health among married women in the broader reproductive age range, and we extrapolated their patterns to perinatal contexts. The effects of patrilocality may differ for older women, multiparous women and those who have had time to rebuild kinship and friendship networks after marriage. Finally, the review treats patrilocality as a unifying concept across diverse domains, including status, relationship quality, violence, economic abuse, networks, and system responses. While this reflects the way household structure is embedded in many aspects of women’s lives, it also means that some included studies had only partial data on perinatal mental-health outcomes or examined determinants rather than symptoms directly. The synthesis of such diverse materials required interpretive judgement, and different reviewers might group or emphasize findings in slightly different ways. These limitations underline the need to develop robust, context-sensitive measures of patrilocality and its consequences, capturing both risks and potential sources of support across different stages of women’s lives.

5. Discussion

This scoping review synthesized evidence from 32 studies that examined how patrilocal residence and in-law co-residence relate to maternal and married women’s mental health in South Asia. Across diverse designs and settings, women’s position as daughters-in-law, their relationships with husbands and parents-in-law, and everyday status practices were consistently associated with depressive symptoms, anxiety, perinatal grief, self-harm, and exposure to violence and economic abuse. These associations appeared in community surveys, clinic-based studies, qualitative work, medico-legal series, and a smaller number of intervention and policy analyses from India, Nepal, Pakistan, Bangladesh, Afghanistan, and diaspora populations. The consistency of these associations across varied methodologies and South Asian national contexts strengthens confidence that patrilocal household structures operate as a meaningful contextual determinant of perinatal mental health, rather than as an artefact of specific samples or study designs, and supports their explicit recognition within perinatal research frameworks and service planning.

The age profiles of the included samples are relevant for interpreting these findings, because both biological and social risks for perinatal mental disorders vary across adolescence and early adulthood. Studies from Kenya and Bangladesh highlight high rates of depression, suicidal ideation, and suicide attempts among pregnant adolescents, and in Bangladesh adolescent pregnancy is associated with elevated risk of suicide attempts, particularly in the first postnatal year.^15,16 Reviews and commentaries from sub-Saharan Africa similarly argue that pregnant adolescents and adolescent mothers experience a double burden of perinatal mental disorders and social disadvantage, and are often not the focus of perinatal mental-health services.^17–20 In South Asian settings, adolescent wives and newly married young women living in patrilocal households often have limited decision making power, greater dependence on husbands and in-laws, and higher exposure to discriminatory practices such as consistently eating last, all of which are associated with worse mental health.^7,21 At the same time, studies of married women across the wider reproductive age span, including women aged 18 to 48 years in Afghanistan, highlight the mental-health impact of chronic exposure to intimate partner and in-law violence in the context of poverty and food insecurity. ⁸ Situating the included samples within these age ranges clarifies how developmental stage, marital timing and household position intersect with patrilocal residence and related gendered constraints to shape perinatal mental-health outcomes. This argues for age-stratified analysis in future perinatal mental-health research and for developmentally tailored screening and support in clinical practice, with particular attention to adolescent wives and newly married young women, who combine biological, social, and hierarchical vulnerabilities that general adult maternal health services are not designed to address.

Relationship quality and household conflict were central mechanisms. Longitudinal data from rural Nepal showed that higher-quality relationships with both husbands and mothers-in-law were associated with lower depressive symptoms, and that mother-in-law relationship quality moderated the association between spousal relationship quality and depression. ²² Panel data from Uttar Pradesh and Bihar showed that marriage into a household with parents-in-law reduced women’s mobility and limited gains in decision-making power, while motherhood restored only part of this loss and did not confer additional empowerment based on the birth of a son. ²³ Evidence from Bangladesh suggested that co-residing with parents or parents-in-law can protect some married adolescents from recent physical intimate-partner violence, particularly when elders intervene, while lack of phone access increases risk. ⁴⁶ Taken together, these findings indicate that joint-family living is not uniformly protective or harmful. Its effects depend on the balance between support, surveillance, and control within specific households. Accordingly, perinatal assessment tools and intervention designs should move beyond treating joint-family residence as a uniform categorical exposure and incorporate measures of relationship quality, household conflict, and decision-making autonomy, which more accurately reflect the conditions that shape mental-health risk within patrilocal homes.

Perinatal depression studies in India and South Asia consistently identified poor relationships with in-laws, marital conflict, husband substance use, and son preference as major correlates of postpartum depression, and antenatal symptoms often persisted into the postpartum period.^24–27,43 Even in patrilocal settings, support in caregiving of the infant and its timing further shaped maternal wellbeing. In the Bachpan cohort in Pakistan, mother-in-law childcare predicted lower depression at three months postpartum in both high and low conflict households, but at twelve months high levels of mother-in-law involvement in conflictual households were associated with increased depression. ²⁸ In a multi-state Indian study, mothers whose own mothers were the main postpartum caregivers reported better mental wellbeing and recovery, whereas those whose mothers-in-law were primary caregivers had lower wellbeing and were less likely to report being well after birth. ²⁹ These findings indicate that the role of the support provider for the postpartum woman identity and the presence of conflict influences depressive symptoms. These findings have direct clinical relevance: postnatal assessment should identify not only whether the woman has a primary caregiver but also who that caregiver is and the quality of their relationship, since in-law caregiving in a conflictual household can itself function as a risk factor rather than a source of protection.

Violence, economic control and social isolation are key pathways linking patrilocal arrangements to maternal mental health. Across Afghanistan, Nepal and India, women living in patrilocal households report high levels of intimate-partner and in-law violence, economic abuse and dowry-related harms, and these exposures are consistently associated with worse depression, anxiety, PTSD, suicidality, and poorer physical health.^{8–10,32–34,47–50,53} In Afghanistan, women who experience both husband and in-law violence have the poorest mental-health profiles, ⁸ and Indian hospital-based work shows that suicidality can appear as early as the first trimester. ⁵³ Disability in the Nepali Terai further amplifies risk of partner and in-law violence and erodes perceived support. ⁹ Qualitative and medico-legal studies from India show how economic abuse by husbands and in-laws, and dowry-related violence and deaths, are embedded in expectations of obedience and dependence in the marital home.^10,32–34 An important methodological caveat is that the studies reviewed here used different screening tools and definitions to assess violence — including adapted WHO instruments, Conflict Tactics Scale items, NFHS-derived modules, and study-specific items for in-law violence — making direct comparison of prevalence estimates across studies and across types of violence (physical, sexual, psychological, and economic) difficult. This heterogeneity in measurement is well documented in the broader literature on intimate partner violence in perinatal populations, where a recent systematic review and meta-analysis found substantial variability in screening instruments, prevalence definitions, and reference periods across studies, concluding that standardization of tools remains a major barrier to comparability. ⁵⁴ These regional findings are consistent with emerging evidence from high income settings that domestic violence is often accompanied by traumatic brain injury and long-term psychiatric morbidity. ⁵⁵ These findings support integrating routine, confidential screening for intimate-partner, in-law, and economic abuse into antenatal and postnatal care pathways, alongside trauma-informed referral systems; at the research level, standardization of violence-assessment tools across South Asian perinatal studies is a priority for enabling comparative evidence and evaluating intervention effects.

Social networks, communication channels and system responses shape how women can respond to these risks. Marriage migrants in rural Bangladesh start married life with almost no local kin and gradually rebuild ties through affinal kin and friends, ³⁵ while qualitative work from rural India shows how men’s control over phones, patchy connectivity, limited digital skills and time norms constrain women’s ability to contact natal kin or seek help. ³⁶ Quantitative analyses from multiple low and middle income countries suggest that women’s phone ownership is often associated with lower odds of recent IPV, although patterns vary by setting. ⁵¹ At the same time, intervention and system studies indicate that change is possible but still rare. In Nepal, a family-centered intervention that engaged young married women, husbands and in-laws and combined gender-norms work with economic strengthening produced improvements in women’s earnings and savings and reductions in perceived mother-in-law cruelty and some physical violence.38 In Pakistan, a prognostic model from a task-shared perinatal depression program identified support from mothers or mothers-in-law, joint-family living, higher socioeconomic status and financial empowerment as predictors of remission. ³⁹ A situational analysis in India documented the absence of a dedicated perinatal mental-health policy and the scarcity of perinatal-specific services at district level despite general mental-health programmes, ³⁷ and reviews of perinatal depression highlight that in-law relationships and domestic violence are rarely addressed systematically in routine care.^27,43 These gaps mirror global concerns that pregnant adolescents and young women, particularly those facing structural disadvantage, are often excluded from mainstream perinatal mental-health services despite being at high risk for perinatal disorders and suicidal behaviour.^17–20,56 Closing these system-level gaps will require integrating family-centered components into existing perinatal platforms in South Asia, designing mobile-health interventions that account for asymmetries in phone access and control, and elevating perinatal mental health as a named priority within national and state policy frameworks rather than an optional adjunct to general maternal health services.

Taken together, these findings indicate that patrilocal residence and in-law dynamics shape household hierarchies, relationship quality, caregiving patterns, economic control, and access to support, and that these domains are strongly linked to maternal mental health across pregnancy, postpartum, and early motherhood. At the same time, definitions and measures of patrilocality, in-law relationships, and economic abuse remain heterogeneous across studies. Few studies treat these constructs as primary exposures, and there is limited prospective or interventional research that tests whether modifying them improves perinatal mental-health outcomes. These gaps highlight the need for future work that measures patrilocality consistently, distinguishes different forms of co-residence and authority, and evaluates family-centered and structural interventions that can safely address harmful aspects of patrilocal life while recognizing the support that some joint families provide.

7. Conclusions

This scoping review shows that patrilocal residence and in-law co-residence are central to understanding maternal and married women’s mental health in South Asia. Across 32 studies, women’s status as daughters-in-law, their position in joint or extended families, and everyday practices such as eating last, together with relationship quality, household conflict, caregiver identity, disability, and access to social networks and phones, were repeatedly linked to depressive symptoms, anxiety, perinatal grief, suicidality, and exposure to partner and in-law violence and economic abuse. Yet patrilocality itself is rarely defined or measured consistently, and very few longitudinal or intervention studies test whether modifying specific household-level dimensions alters mental-health outcomes. Future work should therefore develop robust, context-sensitive measures of patrilocality that capture both risks and potential sources of support, and use them to examine residence patterns, household position, relationship quality, status practices, and in-law violence in dedicated perinatal cohorts. Perinatal services should incorporate brief, structured questions on these domains into routine antenatal and postnatal care and should design and evaluate family-centered interventions that engage supportive in-laws while building in safeguards for women’s safety, given that in-law involvement can reinforce harmful dynamics in conflictual households and that women may not be able to disclose distress or violence in the presence of family members. Even though brief screening measures could meaningfully align antenatal and postnatal care with the lived realities of patrilocal households, their implementation remains constrained by systemic limitations in South Asian public-health systems, such as overburdened providers and inconsistent service availability. Strengthening delivery platforms and ensuring consistent, feasible pathways for referral and follow-up will be necessary for these approaches to improve perinatal mental-health outcomes in ways that reflect women’s lived realities in South Asia.

ORCID iDs

Anjali Brown https://orcid.org/0009-0004-1035-3018

Prabha S. Chandra https://orcid.org/0000-0003-2902-6389

Ethical considerations

Not applicable. This study is a scoping review of published literature and did not involve human participants or primary data collection.

Data Availability Statement

All data are extracted from published sources cited in the reference list.*