The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; the possible impacts of domestic violence, poor mental health, housing issues, and food security

Backgrounds: Afghans are the largest refugee population in Iran and an estimated 2.5 million Afghans are living in the country. Although Afghan women constitute less than half of this population, they are young and at the childbearing ages. Evidence indicates lower rates of antenatal care and higher incidence of pregnancy complications in Afghan compared to Iranian women. 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 (IPV), 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. Results: More than half of Afghan women reported at least one pregnancy complication in their recent pregnancy. The results showed that illegal, 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 legal immigrants with health insurance. It is also been found that food insecurity, poor antenatal care, IPV, and poor mental health 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 outcomes 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 could be incorporated into routine maternity care for Afghan refugees. Access to free antenatal care is a right for all Afghan women and it could be facilitated by universal health insurance for all Afghans regardless of their legal status.