"Fewer Children, Better Life" or "As Many as God Wants"?

Religious Affiliation and Childbearing Preferences of Iranian Women

Religious differences in fertility are one of the essential issues in health and demographic research in Western societies. However, they have received less attention in Muslim countries. This study aims to investigate Shiite and Sunni religious groups' childbirth preferences in Iranian society. It also seeks to analyze their differences based on socioeconomic and demographic factors. We used data from 1020 married women aged 18-44 surveyed as part of Iran's National Family Survey in 2018. The study was designed quantitatively with a cross-sectional approach, and samples were selected using multi-stage cluster sampling. SPSS26 was used to run logistics and Poisson regression models. The results revealed that the means (± SD) of ideal family sizes for Shiite and Sunni women were 2.6 (± 1.0) and 3.4 (± 1.3) children, respectively. Sunni women (49%) had a higher intention to have a (or another) child than Shiite women (35%). According to the multivariate analysis findings, religion alone significantly affected the ideal family size, even when other socioeconomic and demographic variables were controlled. However, it had no significant effect on the intention to have a (or another) child within the next three years. Therefore, it is possible to conclude that within the specific social structure and cultural context of Iran, religion has explanatory power regarding childbearing beliefs and values. Furthermore, regarding fertility intentions and behaviors, demographic and socioeconomic factors become more important than religion.

Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies

BACKGROUND

The re-emerging dominance of the Taliban in Afghanistan in 2021 caused a new wave of Afghan refugees heading Iran and neighboring countries. Iran in the Middle East and Germany in Europe are two major host countries to the largest populations of Afghan refugees. In both countries, several studies have been done to assess the health condition of refugees.

OBJECTIVES

To systematically review the existing literature to identify similarities and differences of health conditions of Afghan refugees living in the two countries, and to synthesize evidence on the health status and health care access of these populations.

METHODS

Related electronic databases and grey literature of Iran and Germany on the health of Afghan refugees were scanned and searched up for the period 2000-2020. Key terms were formed by combining "Afghan refugees or immigrants or populations or asylum seekers", "Physical or mental health", "Healthcare service or access or use", "Iran or Germany". Empirical studies were considered if they contained samples of Afghan refugees with particular outcomes for Afghans. Results were categorized for both countries in the three main areas of physical health, mental health, and access/use of healthcare services.

RESULTS

Nine hundred twenty-two documents were extracted, of which 75 full-texts were finally reviewed. 60 documents belonged to the health condition of Afghan refugees residing in Iran including 43 in physical health, 6 in mental health, 8 in healthcare access and use, and 3 in multiple aspects of health, and 15 belonged to Germany including 7 in physical health, 4 in mental health, 2 in healthcare access and use, and 2 in multiple aspects of health. A less explicit evaluation of the overall health condition of Afghan refugees was observable, particularly for Germany. While matches on the study subject exist for both countries, in comparison to Germany, we extracted more quantitative and qualitative health studies on Afghan refugees of the mentioned areas from Iran. German health studies were rare, less qualitative, and more on the health condition of diverse refugee groups in general.

CONCLUSIONS

Wide gaps and unanswered questions related to mental health and overall health status of the Afghan refugee population are observable, especially in Germany. Our systematic review identified the gap in evidence, which we would recommend to bridge using a wider lens to comprehensively assess the overall condition of refugees considering associations between health and socio-economic and cultural determinants instead of a one-dimensional approach. Further, within health studies on refugee populations, we recommend stratification of results by the country of origin to capture the within-group diversity among refugees with different countries of origin.

‘Life Is Tight Here’

Since the civil war began in 2011, 5.5 million Syrians have fled their home country and are now living as refugees. Building upon anthropological studies of precarity, the article draws upon 14 months of person-centered ethnographic fieldwork to examine the contextual specificities of Syrian women’s protracted displacement in Jordan. By foregrounding bodily experience as described by three interlocutors during person-centered interviews, the article considers how subjectivities are reshaped under such conditions. The narratives analysed here illustrate how the precarity of displacement fosters an embodied sense of tightness, constriction and stagnation while reconfiguring temporal horizons and rendering visions of imagined futures increasingly myopic.

The prevalence of risk factors associated with non-communicable diseases in Afghan refugees in southern Iran: a cross-sectional study

BACKGROUND

Refugees are highly vulnerable to many health-related risks. Monitoring non-communicable diseases (NCDs) is of overriding importance in these populations. This study aimed to investigate the prevalence of risk factors for NCDs amongst Afghan refugees in a refugee camp located in southern Iran.

METHODS

This cross-sectional sturdy was conducted in 2018. Risk factors such as inadequate nutrition, physical inactivity, tobacco smoking, obesity and overweight, hypertension (HTN), elevated fasting plasma glucose (FPG), and dyslipidaemia were assessed. Data were gathered with a modified WHO STEPS procedure. Prevalence and age-standardized prevalence and their 95% confidence intervals (CI) were estimated.

RESULTS

The estimated prevalence were 94% for inadequate fruit/vegetable consumption, 18% for physical inactivity, 9% for tobacco smoking, 3% for FPG, 20% for HTN, 51% for central obesity, 24% for overweight, 19% for obesity, and 69% for dyslipidaemia.

CONCLUSIONS

Except for inadequate fruit and vegetable intake and dyslipidaemia, the prevalence of other NCD risk factors was low among Afghan refugees in Iran. Raising awareness about healthy diet and its importance and the provision of more affordable fruit and vegetables are two effective measures toward improving the health of refugees in Iran.

The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; Findings from community-based survey

Backgrounds

An estimated 2.5 million Afghans are living in the Iran and almost half of them are young women at the childbearing ages. Although the evidence indicates lower rates of antenatal care and higher incidence of pregnancy complications in Afghan compared to Iranian women, the underlying reasons are not well defined. Therefore, in the present study, we aimed to explore the prevalence and associated sociodemographic factors of adverse pregnancy outcomes and examine the impact of intimate partner violence, food insecurity, poor mental health, and housing issues on pregnancy outcome in Afghan women living in Iran.

Methods

In July 2019, we enrolled 424 Afghan women aged 18–44 years old using the time-location sampling at three community health centers in the south region of Tehran province. The data was collected through face to face interviews using the researcher-developed questionnaire. Using bivariate and multivariate analysis, the impact of poor antenatal care, intimate partner violence, food insecurity, and poor mental health was assessed on the incidence of adverse pregnancy outcome.

Results

More than half (56.6%) of Afghan women reported at least one pregnancy complication in their recent pregnancy. The results showed that undocumented, illiterate, and unemployed Afghan women with lower socioeconomic status are more likely to experience adverse pregnancy outcomes. Furthermore, we observed lower prevalence of adverse pregnancy outcomes among documented immigrants with health insurance compared to those with no health insurance. It is also been found that the food insecurity [Adjusted OR = 3.35, 95% CI (1.34–8.36)], poor antenatal care [Adjusted OR = 10.50, 95% CI (5.40–20.39)], intimate partner violence [Adjusted OR = 2.72, 95% CI (1.10–6.77)], and poor mental health [Adjusted OR = 4.77, 95% CI (2.54–8.94)] could adversely impact the pregnancy outcome and we observed higher incidence of adverse outcomes among those suffering from these situations.

Conclusion

To our knowledge, this is the first study that explored the prevalence and associated factors of adverse pregnancy outcomes and the impact of intimate partner violence, food insecurity, poor mental health on pregnancy outcome among Afghan women in Iran. Enhancing the psychosocial support and empowering Afghan women through expanding the social network and safety net should be a priority for the central government and international parties. Psychological counseling should be incorporated into routine maternity care for Afghan refugees. Access to free antenatal care is a right for all Afghan women and it should be facilitated by universal health insurance for all Afghans regardless of their legal status.

Family planning and Afghan refugee women and men living in Melbourne, Australia: new opportunities and transcultural tensions

This research aimed to explore the family planning perspectives and experiences of Afghan women and men living in Melbourne. A total of 57 Afghan women and men participated in six focus groups and 20 semi-structured interviews. The majority of participants indicated a preference for two or three children and were open to using modern contraception. However, many women described experiencing negative side effects when using hormone-based contraception and expressed difficulty negotiating condom use with their husbands as an alternative. Some women described how these difficulties resulted in inconsistent contraceptive practices and, at times, unintended pregnancy. Participants recognised that health professionals have an important role in addressing their family planning needs. This study highlights the ways in which Afghan women and men are changing in relation to their family planning beliefs and practices, and the opportunities, challenges and transcultural tensions they experience as they navigate these issues in Australia.

Lived Experience of Afghan Refugees in Iran Concerning Primary Health Care Delivery

OBJECTIVE

Access to primary health care (PHC) is very important for refugees. The aim of this study was to illuminate lived experience of Afghan refugees in Iran regarding PHC delivery.

METHODS

This qualitative study was conducted in 2016-2017 by using the content analysis technique. Data were collected through individual deep interviews with Afghan refugees who lived in Iran. The data were analyzed by using a method by Graneheim and Lundman.

RESULTS

Four main categories and 12 subcategories were emerged, including (1) challenges before PHC delivery: large number of children, high service cost, not having medical insurance, access to health centers, appointment to get services, simultaneity of breastfeeding, and pregnancy; (2) challenges during PHC delivery: understanding Iranian words, health care provider's behavior, delay in getting service in PHC centers; (3) challenges after delivery PHC: referral patient, high costs of paraclinics; and (4) free and good services.

CONCLUSION

Our results showed that Afghan refugees have several challenges in every stage of PHC delivery. Awareness of such problems can help medical personnel improve delivery of service to Afghan refugees, as well as using trained Afghani nurses to serve the refugees.

Marriage and Family Formation of the Second-Generation Afghans in Iran: Insights from a Qualitative Study

In 2006, around 1.2 million documented Afghans remained in Iran, of whom half were second generation. This paper is based on the results of a qualitative study conducted in three settings: Tehran, Mashhad and Isfahan, and draws on data collected via 80 in-depth interviews and six focus group discussions with second generation Afghans in Iran. The aim of the paper is to explore the adaptation of second-generation Afghans in Iran, particularly in relation to marriage and family formation. The results show that educational achievements and occupational skills of the second-generation Afghans in Iran facilitated their adaptation to the host society, and inspired different marriage and family behaviors and aspirations in comparison with the first generation.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.

Migration and its influence on the knowledge and usage of birth control methods among Afghan women who stay behind

OBJECTIVE

The objective of this article is to investigate the link between migration and knowledge and use of birth control methods among female household members (of migrants) who stay behind in Afghanistan. Migrants can remit birth control information received in the destination country to non-migrants staying in the origin country, who may as a consequence adjust their health behaviour accordingly. The consequences of this interaction for knowledge and use are what we aim to test.

STUDY DESIGN

Population-based secondary analysis of cross-sectional data.

METHODS

This study used cross-sectional data from the Afghan Mortality Survey (2010). Using ordinary least squares regression and propensity score matching, this research studies to what extent having a migrant in the household influences the knowledge and use of birth control among non-migrant Afghan women. Women who stay behind are defined in this research as those with a migrant household member who moved between 2005 and 2010.

RESULTS

Results indicated that non-Pashtun women with a migrant household member showed greater knowledge of contraceptive methods using injectables, birth control pill and lactational amenorrhea method compared to those women without a migrant household member. Less knowledge of male sterilisation and emergency contraception is observed for all women (both Pashtun and non-Pashtun) with a migrant in their household on male sterilisation and emergency contraception compared to the women without a migrant in the household. In addition, we show that Pashtun women with a migrant in the household had lower levels of overall knowledge and were less likely to use birth control methods than women without a migrant household member.

CONCLUSION

In Afghanistan, given the proximity, religious similarity and sociocultural customs mainly men migrate either to Pakistan or Iran. The findings suggest that migrants in different destination countries transfer different information (or fail to successfully transfer information) about birth control methods to members of their transnational networks, compounding disparities in knowledge and use of birth control methods among women staying in the origin country. Migrants have the potential to be health-related development agents, but the health information migrants receive while abroad and remit back to their home countries varies by destination country context.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

Background

With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran.

Objectives

This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare.

Design

This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis.

Results

The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services.

Discussion

According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

Designing Evidence-Based Family Planning Programs for the Marginalized Community: An Example of Muslim Community in Nepal

CONTEXT

Family planning (FP), considered as an encouraging trend for development, is thought to be positively correlated with family health and well-being and negatively correlated with poverty levels. Despite being a priority goal of government and development agencies, in a heterogeneous society like Nepal, FP can be an issue that needs to be dealt with consideration for religious and cultural beliefs of different sections of society. Despite steady progress in achieving FP goals, minority populations have lagged behind the rest of the country in achieving improved family health outcomes; Muslim community being one such example.

OBJECTIVES

This study aims to explore the existing situation of FP use in Muslim communities and to identify key policy-related issues affecting the access to and utilization of FP services.

SETTINGS AND DESIGN

Mixed approach was used in Kapilbastu district, which accommodated the larger proportion of Muslims in Nepal.

MATERIALS AND METHODS

Interview was conducted among 160 married women using semi-structured questionnaire. Focus group discussion, key informant interviews, and consultative meeting were the qualitative techniques employed in this study. Quantitative data were analyzed using descriptive and inferential statistics (Chi-square test), while qualitative data by thematic approach.

RESULTS

More than half of women (56.0%) expressed their interest in FP use, while reported users were just below the quarter (24.0%). Husband approval and secrecy of their personal identity affect use of any method of contraception. Future plan for children and prior information regarding FP found to affect current use of FP, significantly. FP word itself was found to be stigmatizing, so women prefer replacing the word FP with culturally appropriate one. Furthermore, incorporating it into comprehensive package for improving women's health will definitely contribute to improve access and uptake of services.

CONCLUSION

Discrepancy exists between current use and desire for use of FP among Muslim women in future. This highlights the inadequacy of implementing the current blanket policy and programs related to FP and offer ways to move forward with the national FP agenda ensuring the cultural rights and non-discrimination of women.

Male Reproductive Disorders and Fertility Trends: Influences of Environment and Genetic Susceptibility

It is predicted that Japan and European Union will soon experience appreciable decreases in their populations due to persistently low total fertility rates (TFR) below replacement level (2.1 child per woman). In the United States, where TFR has also declined, there are ethnic differences. Caucasians have rates below replacement, while TFRs among African-Americans and Hispanics are higher. We review possible links between TFR and trends in a range of male reproductive problems, including testicular cancer, disorders of sex development, cryptorchidism, hypospadias, low testosterone levels, poor semen quality, childlessness, changed sex ratio, and increasing demand for assisted reproductive techniques. We present evidence that several adult male reproductive problems arise in utero and are signs of testicular dysgenesis syndrome (TDS). Although TDS might result from genetic mutations, recent evidence suggests that it most often is related to environmental exposures of the fetal testis. However, environmental factors can also affect the adult endocrine system. Based on our review of genetic and environmental factors, we conclude that environmental exposures arising from modern lifestyle, rather than genetics, are the most important factors in the observed trends. These environmental factors might act either directly or via epigenetic mechanisms. In the latter case, the effects of exposures might have an impact for several generations post-exposure. In conclusion, there is an urgent need to prioritize research in reproductive physiology and pathophysiology, particularly in highly industrialized countries facing decreasing populations. We highlight a number of topics that need attention by researchers in human physiology, pathophysiology, environmental health sciences, and demography.

Islamic logics, reproductive rationalities: family planning in northern Pakistan

This paper explores the use of Islamic doctrine and jurisprudence by family planning organizations in the Gilgit-Baltistan region of northern Pakistan. It examines how particular interpretations of Islam are promoted in order to encourage fertility reductions, and the ways Muslim clerics, women and their families react to this process. The paper first discusses how Pakistan's demographic crisis, as the world's sixth most populous nation, has been widely blamed on under-funding for reproductive health services and wavering political commitment to family planning. Critics have called for innovative policy and programming to counter 'excessive reproduction' by also addressing socio-cultural and religious barriers to contraceptive uptake. Drawing on two years of ethnographic research, the paper examines how family planning organizations in Gilgit-Baltistan respond to this shift by employing moderate interpretations of Islam that qualify contraceptive use as a 'rational' reproductive strategy and larger families as 'irrational'. However, the use of Islamic rhetoric to enhance women's health-seeking agency and enable fertility reductions is challenged by conservative Sunni ulema (clergy), who seek to reassert collective control over women's bodies and fertility by deploying Islamic doctrine that honors frequent childbearing. Sunnis' minority status and the losses incurred by regional Shia-Sunni conflicts have further strengthened clerics' pronatalist campaigns. The paper then analyses how Sunni women navigate the multiple reproductive rationalities espoused by 'Islamized' family planning and conservative ulema. Although Islamized family planning legitimizes contraceptive use and facilitates many women's stated desire for smaller families, it frequently positions women against the interests of family, community and conservative Islam.

Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care

Globalization, including the global flows of people, is clearly linked to disease transmission and vulnerability to health risks among immigrant populations. Anthropological research on transnational migration and health documents the implications of population movements for health and well-being. Studies of immigrant health reveal the importance of the social, political, and economic production of distress and disease as well as the structures and dynamics that produce particular patterns of access to health services. This review points to underlying political, economic, and social structures that produce particular patterns of health and disease among transnational migrants. Both critical and phenomenological analyses explore ideas of alterity and community, which underlie the production and management of immigrant health. Research on immigrant health underscores the importance of further attention to policies of entitlement and exclusion, which ultimately determine health vulnerabilities and accessibility of health care.

Cross-sectional analysis of factors associated with prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan

OBJECTIVE

This study was conducted to assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan.

STUDY DESIGN

Medically eligible (e.g., conditions not requiring urgent medical attention, such as eclampsia, or not imminently delivering [dilation > or =8 cm]) obstetric patients admitted to three Kabul public hospitals were consecutively enrolled in this cross-sectional study. An interviewer-administered questionnaire assessed demographic information, health utilization history, including prior contraceptive use, and intent to use contraception. Correlates of prior contraceptive use were determined with logistic regression.

RESULTS

Of 4452 participants, the mean age was 25.7 years (SD, +/-5.7 years), 66.4% reported pregnancy before the presenting gestation, 88.4% had > or =1 prenatal care visit and 82.4% reported the current pregnancy was desired. Most (67.4%) had no formal education. One fifth (22.8%) reported using contraception before this pregnancy. Among women with any pregnancy before the current gestation (98.6% of prior users), prior contraceptive use was independently associated with having lived outside Afghanistan in the last 5 years (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI], 1.12-1.63), having a skilled attendant at the last birth (AOR, 1.35; 95% CI, 1.07-1.71), having a greater number of living children (AOR, 1.30; 95% CI, 1.20-1.41), longer mean birth interval (years) (AOR, 1.21; 95% CI, 1.11-1.38) and higher educational level (AOR, 1.16; 95% CI, 1.09-1.22). Immediate desire for another pregnancy and spousal disapproval were the most common reasons for not utilizing contraception.

CONCLUSION

Prior contraceptive use is low among the women in Kabul, Afghanistan, particularly for younger less educated women. Programming in Kabul to strengthen postpartum contraceptive counseling should address barriers to contraceptive use, including immediate desire for pregnancy and spousal attitudes.