Social determinants of access to reproductive health services among Afghan migrant women in Iran: A qualitative study
4 affiliations
- 1Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- 2Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
- 3Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- 4Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
Abstract
Migrant women, particularly those from low-resource settings, often face restricted access to reproductive health services in host countries due to intersecting social, economic, and structural barriers. This study explored these barriers among Afghan migrant women in Iran using the World Health Organization's Social Determinants of Health (SDH) model. This qualitative study employed semi-structured, in-depth interviews with 20 purposively sampled Afghan migrant women of reproductive age and 10 key informants from healthcare, midwifery, NGO, and policy backgrounds. Maximum variation sampling was used to ensure diversity in residency status, socioeconomic background, and service experiences. Data collection took place in Tehran from April 2024 over six months and analyzed using directed content analysis guided by the World Health Organization's Social Determinants of Health (SDH) framework. Prolonged member checking and peer debriefing enhanced the credibility and confirmability of the final categorization of structural and intermediary determinants. Three interconnected levels of determinants shape Afghan migrant women’s reproductive health access. Structural determinants include a restrictive legal and macroeconomic context, undocumented status, banking and communication barriers, and high out-of-pocket costs, compounded by patriarchal norms that limit women’s agency. Intermediary determinants include poor material circumstances, psychosocial stressors, and bio-behavioral responses, with care-seeking delays reflecting legal insecurity. Health system and cross-cutting factors, including the lack of migrant-sensitive facilities, linguistic mismatches, and perceived discrimination, further deter service utilization. Social capital and NGO support provide vital bridges to care, yet the intersection of these determinants creates a vulnerability that perpetuates health inequities and restricts access to essential services. This study clarifies how structural and intermediary determinants interact to shape the barriers Afghan migrant women face in accessing reproductive health services in Iran. These findings can inform targeted, migrant-sensitive policy and programmatic interventions to enhance service equity and lower long-term healthcare costs for both migrant populations and the host country.
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BibTeX
@article{mirmolaei2026social,
title = {{Social determinants of access to reproductive health services among Afghan migrant women in Iran: A qualitative study}},
author = {Seyedeh Tahereh Mirmolaei and Zohreh Mahmoodi and Amirhossein Takian and Zahra Bayat Jozani},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0007406},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007406},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Social determinants of access to reproductive health services among Afghan migrant women in Iran: A qualitative study
AU - Seyedeh Tahereh Mirmolaei
AU - Zohreh Mahmoodi
AU - Amirhossein Takian
AU - Zahra Bayat Jozani
PY - 2026
DA - 2026/10/15
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007406
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007406
AB - Migrant women, particularly those from low-resource settings, often face restricted access to reproductive health services in host countries due to intersecting social, economic, and structural barriers. This study explored these barriers among Afghan migrant women in Iran using the World Health Organization's Social Determinants of Health (SDH) model. This qualitative study employed semi-structured, in-depth interviews with 20 purposively sampled Afghan migrant women of reproductive age and 10 key informants from healthcare, midwifery, NGO, and policy backgrounds. Maximum variation sampling was used to ensure diversity in residency status, socioeconomic background, and service experiences. Data collection took place in Tehran from April 2024 over six months and analyzed using directed content analysis guided by the World Health Organization's Social Determinants of Health (SDH) framework. Prolonged member checking and peer debriefing enhanced the credibility and confirmability of the final categorization of structural and intermediary determinants. Three interconnected levels of determinants shape Afghan migrant women’s reproductive health access. Structural determinants include a restrictive legal and macroeconomic context, undocumented status, banking and communication barriers, and high out-of-pocket costs, compounded by patriarchal norms that limit women’s agency. Intermediary determinants include poor material circumstances, psychosocial stressors, and bio-behavioral responses, with care-seeking delays reflecting legal insecurity. Health system and cross-cutting factors, including the lack of migrant-sensitive facilities, linguistic mismatches, and perceived discrimination, further deter service utilization. Social capital and NGO support provide vital bridges to care, yet the intersection of these determinants creates a vulnerability that perpetuates health inequities and restricts access to essential services. This study clarifies how structural and intermediary determinants interact to shape the barriers Afghan migrant women face in accessing reproductive health services in Iran. These findings can inform targeted, migrant-sensitive policy and programmatic interventions to enhance service equity and lower long-term healthcare costs for both migrant populations and the host country.
SN - 2767-3375
ER -