Background. Rural pregnant women in have unique challenges that can negatively impact maternal well-being and outcomes. Research on anxiety among pregnant women in rural settings remains limited. This photovoice (PV) study examined pregnant women’s experiences in six counties in the rural Texas to gain insights, needs, barriers, and facilitators related to anxiety to inform subsequent evidence-based interventions

Methods. This qualitative PV study utilized semi-structured interviews and group debriefs with pregnant women (n=19), incorporating participant-selected photos to facilitate discussion. IRB approval was obtained; participants received incentives. Recruitment used a convenience sample of pregnant women in the study counties. ATLAS.ti was used to conduct thematic analysis to identify recurring patterns in participants' narratives.

Results. Main codes emerging from the analysis related to anxiety were: stressors, coping strategies, and perceptions of available mental health resources. Findings suggest that geographic isolation, limited prenatal care options, lack of pregnancy-related nutrition knowledge, and economic hardships significantly increase anxiety levels. Further, participants reported inadequate access to mental health resources and limited social support networks, which worsened feelings of stress and uncertainty. Some participants shared adaptive coping strategies, such as reliance on family and community support for anxiety management.

Conclusion. This PV study demonstrates the need for appropriate mental health interventions, increased access to prenatal care, prenatal nutrition education, and community-based support programs tailored for rural pregnant women. Findings should inform policymakers, healthcare providers, maternal and public health researchers, and local organizations in developing specific initiatives to reduce anxiety and enhance maternal health and outcomes in underserved areas.