Objective <p>Prevalence rates of perinatal depression are especially high among women living in lower-middle-income countries (LMICs) when compared to higher-income countries. This is especially true for women living in Bangladesh, an LMIC in South Asia, a country that has limited mental health infrastructure and high rates of poverty. Women living in rural, impoverished communities in Bangladesh have been identified as being at high risk for prenatal depression. However, there is limited understanding of variability of prevalence rates across rural communities. To address this gap in understanding, we examined prevalence rates and correlates of prenatal depression among women living in two rural Bangladesh communities, Matlab and Ariahizar.</p> Methods <p>During a prenatal health care visit, 60 women in two rural communities in Bangladesh, completed a survey battery asking about household income, education, depression symptoms, autonomy over household technology, and financial decision-making ability.</p> Results <p>On average, prenatal depression was experienced by 31.6%, of women enrolled in this study, although rates varied significantly across communities. Around 50% of all women in the higher-risk, more underserved, Arihaizar community experienced clinically significant symptoms of prenatal depression in comparison with only 13.3% of women who experienced clinically significant levels of prenatal depression in Matlab, a higher resourced rural community. Across both communities, perceived autonomy and independence (based on reports of having control over resources in the home) were associated with lower depression symptoms.</p> Conclusions for Practice <p>Prevalence of prenatal depression is highest in the most underserved communities. Additionally, we found preliminary associations between women’s autonomy and depression during pregnancy.</p>