Experiences of women regarding gaps in preconception care services in the Iranian reproductive health care system
A qualitative study
Keywords:
Preconception care, Reproductive Health Care, Women, Qualitative Study, IranAbstract
Introduction: Despite the beginnings of preconception care (PCC) delivery around a decade ago in Iran, there are still significant gaps in its service delivery. The purpose of this study was to explore the perceptions and experiences of women as well as midwives toward gaps in PCC delivery in the Iranian reproductive health care system.
Methods: In this exploratory qualitative study, 27 married women and 13 midwives were recruited using purposive sampling from five health centers in Mashhad, Northeast of Iran. Respondents participated in semi-structured, in-depth, individual and focus-group interviews to express their perceptions and experiences about gaps in PCC. Data were analyzed using conventional content analysis adopted by of Graneheim and Lundman (2004) with MAXQDA software.
Results: Analysis of data revealed four themes: 1) missing men and adolescents from PCC; 2) insufficient PCC package; 3) inadequate PCC strategies; and 4) health care providers’ incompetency.
Conclusion: It is recommended to deliver gender-sensitive PCC through addressing couples’ instead of just women’s PCC and to take into account the adolescent girls’ health in order to improve their preconception health. Standardization of protocols and attention of health professionals toward occupational–environmental hazards and sexual and reproductive issues as well as enhancing professional capability of health care providers could improve PCC service delivery.
References
Centre BSR. Preconception health: Research and strategies. Toronto, Ontario, Canada; 2001.
Program APH. Preconception health framework 2007. Available from: www.aphp.ca/pdf/Preconception
Report proof 04.26.07.pdf.
Reeve ME. Preconception health: The missing link in the MNCH continuum of care. Beijing Da Xue Xue
Bao. 2009; 41(4): 383-8. PMID: 19845066.
Wilkinson H, Trustees and Medical Advisers. Saving mothers’ lives. Reviewing maternal deaths to make
motherhood safer: 2006–2008. BJOG. 2011; 118(11): 1402-3. doi: 10.1111/j.1471-0528.2011.03097.
PMID: 21906238.
Mander R, Smith GD. Saving Mothers’ Lives (formerly Why Mothers die): Reviewing maternal deaths to
make motherhood safer 2003–2005. Midwifery. 2008; 24(1): 8-12. doi: 10.1016/j.midw.2008.01.008.
PMID: 18282645.
Khosravi A RMR. Indicators of health measures In the Islamic Republic of Iran: Ministry of Health; 2008.
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm
birth: a systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization.
; 88(1): 31-8. doi: 10.2471/BLT.08.062554. PMID: 20428351, PMCID: PMC2802437.
Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: a systematic review. Matern Child
Health J. 2002; 6(2): 75-88. PMID: 12092984.
Moosazadeh M, Nekoei moghadam M, Emrani Z, Amiresmaili M. Prevalence of unwanted pregnancy in
Iran: a systematic review and meta analysis. Int J Health Plann Manage. 2014; 29(3): 277-90. doi:
1002/hpm.2184. PMID: 23630092.
Asadi Y, Meshkat M, Talaee B. Determination prevalence and causes of unwanted pregnancy in Mashhad.
Med Sci J Islamic Azad University of Mashhad. 2007; 3: 91-5.
Mansoory A, Hossainy SH, Dadgar S. Unexpected pregnancy and relative factors in pregnant women
referring to Mashhad maternity wards in 2004. Journal of Birjand University of Medical Sciences. 2009;
(1): 65-70.
Posner SF, Broussard DL, Sappenfield WM, Streeter N, Zapata LB, Peck MG. Where are the data to drive
policy changes for preconception health and health care? Women's Health Issues. 2008; 18(6): 81-6. doi:
1016/j.whi.2008.07.001. PMID: 19059552.
Guidelines on reproductive health for the un resident coordinator system United Nations Population
Information Network (POPIN). 2012. Available from:
http://www.un.org/popin/unfpa/taskforce/guide/iatfreph.gdl.html.
Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J 2006;
(1): 29-35. doi: 10.1007/s10995-006-0091-1. PMID: 16710763, PMCID: PMC1592155.
Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing : Advancing the humanistic
imperative: Lippincott Williams & Wilkins; 2011.
Burns N, Grove SK. The practice of nursing research: Appraisal, synthesis, and generation of evidence:
Saunders Elsevier St Louis^ eMO MO, 2009.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):
-88. doi: 10.1177/1049732305276687. PMID: 16204405.
Adib Hajbagheri M, Parvizi S, Salsali M. Qualitative research methods. Tehran: Booshra Publication. 2004.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and
measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2): 105-12. doi:
1016/j.nedt.2003.10.001. PMID: 14769454.
Polite DF, Beck CT, Hungler BP. Essentials of nursing research; methods, appraisal and uitilization, 5 ed.
Philadelphia: Lippincott Co. 2006.
Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve
preconception health and health care- United States. MMWR Recomm Rep. 2006; 55(4): 1-23. PMID:
Gavin L, Moskosky S, Carter M, Curtis K, Glass E, Godfrey E, et al. Providing quality family planning
services: recommendations of CDC and the US Office of Population Affairs. MMWR Recomm Rep. 2014;
(4): 1-54. PMID: 24759690.
Choiriyyah I, Sonenstein FL, Astone NM, Pleck JH, Dariotis JK, Marcell AV. Men Aged 15–44 in Need of
Preconception Care. Matern Child Health J. 2015; 19(11): 2358-65. doi: 10.1007/s10995-015-1753-7.
PMID: 26112749.
Tuomainen H, Cross Bardell L, Bhoday M, Qureshi N, Kai J. Opportunities and challenges for enhancing
preconception health in primary care: qualitative study with women from ethnically diverse communities.
BMJ open. 2013; 3(7): 2977. doi: 10.1136/bmjopen-2013-002977. PMID: 23883884, PMCID:
PMC3731794.
Bayrami R, Ebrahimipour H, Ebrahimi M, Froutani MR, Najafzadeh B. Health care provider s’ knowledge,
attitude and practice regarding pre-conception care. Journal of Research & Health. 2013; 3(4): 519-26.
Riazi H, Bashirian S, Amini L. Awareness of pregnant women about folic acid supplementation in Iran.
Journal of Family and Reproductive Health. 2012; 6(4): 159-63.
Merghati Khuiee E, Adab Z, Vahedi F, Farajvand N, Afzalinia T, Rahmanpour L. Compare the Checklist
and guidline of preconception care between Iran and some developed countries. Behdad. 2011; 3: 33-5.
Teramoto S, Soeda A, Hayashi Y, Urashima M. Physical and socioeconomic predictors of birthweight in
Japan. Pediatr Int. 2006; 48(3): 274-7. PMID: 16732794.
Cory Slechta DA, Virgolini MB, Thiruchelvam M, Weston DD, Bauter MR. Maternal stress modulates the
effects of developmental lead exposure. Environ Health Perspect. 2004; 112(6): 717-30. PMID: 15121516,
PMCID: PMC1241967.
Khayatan M, Nasiri Pour AA, Amini M, Mohamad Nejad SM. The Effective factors on recievers' access to
health care services in urban health care centers. Payavard Salamat. 2011; 4(3): 18-27.
Bayrami R, Latifnejad Roudsari R, Mirzaee Rabor F. The principles of preconceptional health promotion.
tabriz: elvin. 2012.
van den Hazel P, Zuurbier M, Babisch W, Bartonova A, Bistrup ML, Bolte G, et al. Today's epidemics in
children: possible relations to environmental pollution and suggested preventive measures. Acta Paediatr
Suppl. 2006; 95(453): 18-25. PMID: 17000565.
Weselak M, Arbuckle TE, Wigle DT, Walker MC, Krewski D. Pre-and post-conception pesticide exposure
and the risk of birth defects in an Ontario farm population. Reprod Toxicol. 2008; 25(4): 472–80. doi:
1016/j.reprotox.2008.05.060. PMID: 18586452.
Sardasht FG, Shourab NJ , Jafarnejad F, Esmayli H. Comparing the quality of preconception care provided
in healthcare centers in Mashhad in 2012. Electron. Physician. 2015; 7(2): 1039-46. doi:
14661/2015.1039-1046, PMID: 26120412, PMCID: PMC4477763
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.