Gynecology World Conference 2026

Abstract

Background: Reproductive health is one of the subcategories of health and one of the basic needs of individuals; a need that has even been mentioned in the Sustainable Development Goals. Among the groups in which the provision of these reproductive health services should be done with greater care are vulnerable populations, including migrants and nationals of other countries.

In this regard, attention to the social determinants effective on health is also necessary because it leads to improving individuals' health for participation in society, economic growth, and cost reduction. Also, for access to services and improving people's health, using structured platforms and existing models is very helpful. The social determinants model introduced by the World Health Organization's Commission on Social Determinants of Health, given the importance it attaches to different political and socio-economic sections, is a suitable model that can be examined in the case of migrants considering the context of each host country. Therefore, developing the aforementioned existing model based on socio-cultural factors and Iran's conditions along with a proposed policy package for better provision of reproductive health services to Afghan migrants is the aim of the present study.

Methodology: The present study is a multi-stage mixed-methods research comprising a literature review, a qualitative phase, an expert panel, and a quantitative phase, ultimately leading to the formulation of a policy package. Initially, two scoping reviews were conducted to address the specific question: "What are the barriers and factors most strongly associated with access to reproductive health services among Afghan migrants in Iran?" and to define the thematic framework for the qualitative phase.

Subsequently, a qualitative study was performed through 30 semi-structured interviews (20 migrant women and 10 service providers) to identify factors and barriers related to reproductive health access based on the Social Determinants of Health (SDH) framework. Purposive sampling with maximum diversity was employed among Afghan clients at health centers affiliated with Tehran University of Medical Sciences (TUMS) and municipal health facilities until data saturation was reached. To enhance accessibility, residential hangouts of Afghan women were utilized with guidance from the Tehran Municipality.

Finally, to identify the most practical factors and to develop the initial WHO-based hypothetical model, the findings from the interviews and literature reviews were presented to an expert panel. Based on their consensus, the preliminary model and the quantitative questionnaires were finalized.

In the quantitative phase, 350 Afghan women referring to TUMS health centers participated. The data collection tool was a researcher-developed questionnaire, validated for reliability and validity by ten experts. The minimum acceptable Content Validity Ratio (CVR) was set at 0.62. The final questionnaire consisted of 69 items (refined from an initial 83). Data were analyzed using SPSS, and model testing was performed via Structural Equation Modeling (SEM) using LISREL. Ultimately, the final model-based policy package was shared with policymakers as part of a knowledge translation (KT) strategy. This package was finalized through supplementary interviews with ten health policy experts from the Ministry of Health, insurance organizations, Parliament, and UN agencies (UNHCR and UNFPA).

Results: Qualitative findings highlighted structural factors—such as stringent immigration regulations, lack of insurance, financial constraints, and cultural stigma—as prominent barriers that restrict access even before health-seeking behavior initiates. Intermediary factors, including poor living conditions, fear of deportation, psychosocial stress, socio-cultural and linguistic incongruity within the healthcare system, and a lack of social capital (e.g., low trust and weak support networks), significantly increased women's vulnerability. These results suggest that health-seeking behavior is often suppressed by these structural and intermediary obstacles, rendering individual-level interventions insufficient.

Quantitatively, the mean age of participants was 31.4 ±7.8 years. Path analysis revealed that NGOs had the strongest positive direct effect on access (B = 0.15), while social capital exerted the strongest negative direct effect (B = -0.12). Indirectly, education showed a positive causal effect (0.015) on access through improved living conditions and health-seeking behaviors. Governance regulations (B = 0.25) and social class (B = 0.14) demonstrated the strongest positive relationships with access across both direct and indirect paths.

Conclusion: Given the factors identified, it is recommended that macro-level policies (e.g., governance and population policies), the performance of intermediary institutions (e.g., NGOs, increasing trust, and social network development), and individual/social empowerment (e.g., education and health-seeking behavior) be prioritized to ensure equitable access. Therefore, designing intersectoral, participatory, culturally sensitive, and data-driven interventions within a localized WHO-SDH framework is both essential and urgent.