Exploring the Challenges in Delivering Sexual and Reproductive Healthcare in Iran

BACKGROUND: Sexual and reproductive healthcare (SRH) is key to achieving sustainable development goal (SDG) 5 but remains a challenge for women in Iran. In 2012 the government discontinued funding for the Family Planning Programme which provided free contraception and recently mass civil unrest has swept country wide. Healthcare workers (HCWs) are legally inhibited with the care they can provide, with the population resorting to unsafe practices. This study aims to explore the challenges in accessing SRH services, provide insight into the barriers HCWs face, and guide policy recommendations to improve the delivery of SRH. METHODS: A mixed methods approach was conducted for this study: a scoping review was performed using Arksey and O'Malley's framework, and qualitative semi-structured interviews were conducted in English and Farsi remotely with HCWs who have practised in Iran in the last 10 years. An inductive and deductive approach was used to guide thematic analysis. RESULTS: 37 studies exploring barriers of accessing SRH in Iran were identified. Six qualitative semi-structured interviews were conducted. Main emerging themes included 1) Lack of education in SRH leading to knowledge gaps, 2) “Fear and shame” culture created by sociocultural taboos, resulting in unsafe abortions, 3) Gender inequality with increasing violence during civil unrest and 4) Inadequate investment in public health, with financial burden on patients. DISCUSSION: The basic SRH needs of women in Iran are not being met with a concerning regression in women's rights over the last decade. Socio-political factors underpin a lack of education, inadequate public health and gender inequality. Policy recommendations include ratification of women's rights to health protected by legislation, commitment to investment into preventative services for SRH and formal education. Empowerment of women and commitment to building a strong public health system will greatly facilitate the attainment of SDG 5. KEY MESSAGES: • SRH barriers are inadequate legalisation, poor education and lack of universal health coverage. This results in harmful practices, like unsafe abortions, and over-reliance on costly private health. • To sustainably fulfil the SRH needs there must be a realisation of women's rights, restoration of state-funded reproductive health programmes and implementation of formal SRH education.