Women's Postpartum Sexual and Reproductive Health: A Qualitative Study in an Iranian setting

Women's Postpartum Sexual and Reproductive Health: A Qualitative Study in an Iranian setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Women's Postpartum Sexual and Reproductive Health: A Qualitative Study in an Iranian setting Nazanin Rezaei, Masoumeh Namazi, Atbin Tahmasebi, Somayeh Moukhah, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7349600/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Dec, 2025 Read the published version in Reproductive Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background Despite the significance of the postpartum period, women's postpartum sexual and reproductive health (SRH) has been neglected. This study examines women's perceptions and experiences of SRH in the postpartum period. Methods This qualitative study utilized conventional content analysis. The research was conducted in health centers in Ilam, Iran. The target population comprised parous women (six weeks to one year after childbirth). Sampling took place from November 5, 2022, to March 16, 2023. In-depth, semi-structured, face-to-face interviews were conducted with 17 women in the first postpartum year and six service providers. Sampling continued purposively until data saturation. All interviews were audio-recorded and then transcribed. The transcripts were analyzed based on the steps proposed by Zhang and Wildemuth Results Twenty-three women participated in the study (six midwives and 17 mothers). The analysis of the interviews led to the emergence of four categories: marital dissatisfaction, husband's and family's supportive role, psychological conflicts, and a defective health system, with 14 subcategories. These findings highlight the complex interplay of emotional, social, and systemic factors that influence women's postpartum sexual and reproductive health, emphasizing the need for comprehensive support and targeted interventions. Conclusion The study results indicate that women's postpartum SRH has been neglected for various reasons, and women themselves do not have a comprehensive and correct perception of this period. Multifaceted interventions are needed in the postpartum period to improve women's SRH. Females Women's qualitative study Postpartum Sexual Health Reproductive Health Plain language summary The postpartum period is associated with fundamental physical and mental changes in the mother. Many mothers and even service providers do not have enough knowledge and information about the rights and needs of sexual and reproductive health of mothers in the postpartum period. The present qualitative study examines the concept of reproductive and sexual health in the postpartum period among Iranian women. This study shows the low quality and quantity of sexual and reproductive health care during the postpartum period and calls for improving the quality and quantity of these cares. 1. Introduction The postpartum period is a phase in which women undergo significant physiological and psychological changes after childbirth. This stage involves physical recovery, hormonal adjustments, and adaptation to the new role of motherhood. The significance of the postpartum period for mothers, newborns, parents of newborns, and their families [ 1 ] important that in some countries, the birth of a child is the ultimate goal of marriage and a symbol of femininity [ 2 ] The postpartum period is a time when spouses adapt to their parenting roles and resume their sexual activities [ 3 ]. Most mothers face many complications during pregnancy and childbirth, including vulnerability [ 4 ], physical problems [ 5 – 7 ], psychological problems and suicidal ideations [ 8 , 9 ], and sexual problems [ 3 , 10 ]; these factors eventually cause disruption in marital relations[ 11 ]. Physiological, psychological, social, and cultural changes occurring during this period all affect women's sexual health and reproductive behavior [ 12 , 13 ]. Potential stressors for the mother in the postpartum period cause sleep deprivation, interference in relationships (personal, sexual, and social), anxiety about parenting skills, lifestyle changes, and increased need for social support [ 8 , 14 , 15 ], which eventually reduce the mother's quality of life [ 1 ]. Due to the impact of unequal decision-making and societal gender roles in relationships, women in the postpartum period face significant challenges in both developing and even developed countries [ 8 ]. Still, in many developed and developing countries, most women are deprived of the necessary postpartum health and care services [ 4 , 16 ]. The lack of comprehensive perception among women regarding postpartum sexual and reproductive health (SRH) is often attributed to insufficient education, cultural taboos, and the overemphasis on neonatal care, which leaves postpartum women's SRH needs largely unaddressed. Women's sexual health is often defined only in relation to their reproductive capacity, and in most cases, women's sexual function or dysfunction is ignored [ 17 ]. Health systems tend to neglect postpartum care services related to the mother’s sexual and reproductive health (SRH) when providing reproductive health care during or before pregnancy [ 14 , 18 , 19 ]; healthcare staff often focus on prenatal care [ 14 ] or care related to the newborn or child [ 1 , 14 , 20 ]. Meanwhile, women in this period visit health centers to receive routine postpartum care for themselves and postnatal care for their child and can easily benefit from such care as well [ 19 , 21 ]. The differing and insufficient perceptions of midwives[ 11 , 14 , 19 , 22 , 23 ], mothers, or their families regarding the importance of mothers' postpartum SRH[ 19 , 24 , 25 ], men's lack of cooperation [ 26 ], and the low quality and quantity of care provided in health centers [ 19 , 27 ] are factors that affect mothers' postpartum SRH[ 25 , 27 , 28 ]. To achieve Sustainable Development Goals (SDGs), particularly Goal 3 (Ensure healthy lives and promote well-being for all at all ages) and Goal 5 (Achieve gender equality and empower all women and girls), it is essential to address postpartum health challenges and ensure equitable access to healthcare services for women [ 29 , 30 ]. Although SRH care has generally improved through measures such as increased access to healthcare services, implementation of maternal health programs, community-based education initiatives, and policy reforms aimed at reducing barriers to care. These efforts have enhanced awareness, accessibility, and quality of postpartum SRH services, we are still far from the initial target, especially with regard to women's SRH[ 28 , 31 , 32 ]. Collecting data related to mothers' physical, sexual, and psychological complications in the postpartum period can help promote their postpartum SRH [ 19 ]. Therefore, the present study was conducted to explain women's perceptions and experiences about their postpartum SRH. 2. Materials and Methods This qualitative study was designed based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 33 ]. 2.1. Study Design and Subjects This is the qualitative part of a mixed-methods research conducted using conventional content analysis. 2.2. Sample Recruitment The study was conducted in five districts of Ilam: North, South, East, West, and Central Cluster sampling of health centers was performed in five different districts of Ilam city in Iran: North, South, East, West, and Central. The samples included 17 eligible mothers (service recipients) visiting the health centers and six midwives (service providers). Qualitative purposive sampling was performed from November 5, 2022, to March 16, 2023, and continued until data saturation. After ensuring participants' eligibility, explaining the purpose of the study to the participants, semi-structured, in-depth, face-to-face interviews were held with them in a private place by an interviewer of the same sex (researcher), with their coordination and consent, in health care centers and in a private place. All interviews were conducted in the local languages, Kurdish and Luri, to ensure participants’ comfort and accurate data collection. (The researcher is a member of the Faculty of Nursing and Midwifery, one of the universities of medical sciences. The researcher has many years of experience working in maternity hospitals and health-treatment and educational centers). The inclusion criteria for the mothers were as follows: Being in the postpartum period (six weeks to 12 months after childbirth), being literate, having only one living healthy child, no experience of stressful events over the past six months, and no childbirth complications having led to the mother's hospitalization. The credibility, dependability, confirmability, and transferability of data were checked using Lincoln and Guba's criteria [ 34 ]. To ensure dependability of the data, two research team members carefully read the interview transcripts and performed coding, categorization, and review. For credibility, the researcher engaged with the participants through semi-structured in-depth interviews and constant review of the interview notes and data. The confirmability of the data was checked by giving the extracted codes to the participants. To ensure data transferability, purposive interviews were held with maximum variation, and the research procedure and a sample of participants' statements were presented in full. The mean duration of each interview was 57.92 minutes. MAXQDA software (v. 20) was used to manage the data. 2.3. Data Collection Tool. After permission from the participant, their voice was recorded. The interviews began with general questions and continued with probing questions to obtain more detailed information. Some of the questions to the service recipients were: - What changes do you feel in your sexual relationship with your husband and your feelings towards him in the postpartum period? - What do you think about your husband's and your families' cooperation and support in the postpartum period? - How do you feel about the changes in your breasts, genitals, and body? Some of the questions to the service providers included: - What are the postpartum SRH needs of women? - Which postpartum SRH needs of women are not met in health centers? - What skills do midwives need to acquire to train mothers about postpartum SRH? 2.4. Data Analysis. The interviews were carefully typed verbatim on the same day of the interview and then coded. In this type of study, themes do not exist in advance and are extracted from information. Each subsequent interview was conducted after the previous one was analyzed. Data analysis was performed by Zhang & Wildemuth's method: - Preparing the data for qualitative content analysis: The recorded interviews were converted into text format. - Defining the unit of analysis: Each transcript was entered into the qualitative data analysis software as a unit of analysis; then, the transcripts were coded by identifying the meaningful units. - Categorization and coding: Categories were extracted from the data inductively with constant comparison. - Testing the coding plan in the text sample: Coding was performed in a sample of the text; then, to ensure the stability of the coding, the data were controlled by two other research team members. - Coding the entire text: After the research team reached consensus regarding the stability of the coding, the coding process was applied to the entire text. - Re-examining the codes regarding coding stability: The primary codes, sub-categories, and categories were rechecked by two research team members and those experienced in qualitative research to prevent human error. - Drawing conclusions from the coded and categorized data: This step involved identifying the features and dimensions of the categories, the relationships between the categories, discovering the patterns, and testing the codes against the full range of the data. - Finally, to ensure the study's replicability, the categories were reported [ 35 – 38 ]. 3. Results In the analysis of the transcripts, 14 subcategories and four categories emerged. The total number of interviews was 23 (six with midwives and 17 with mothers). All the mothers reported that their pregnancy was planned. Four of them reported that they had not received any support during their postpartum period. Six mothers had one source of support, and seven mothers had all three sources of support (husband, own family, and in-laws). Thirteen mothers were housewives and four were employed. The mean duration of each interview was 57.92 minutes. Additional demographic data pertinent to the study participants are summarized in (Table 1 ). Table 1 Demographic characteristics of the participants of the individual interviews Variable Number Mean age Level of education Type of childbirth Time elapsed since childbirth (months) Service providers (midwives) 6 44. 52 ± 8.9 Bachelor's degree, n = 3 - - Master's degree, n = 3 Service recipients (mothers) 17 4.00 ± 30.94 Master’s degree or higher, n = 5 9 = NVD 8 = C/S 1.5–3 months: n = 4 Bachelor's degree, n = 6 3–6 months: n = 4 Below high school diploma, n = 1 6–9 months: n = 5 9–12 months: n = 4 The results of the conventional content analysis led to four categories and 14 subcategories. These categories are summarized in Table 2 . Table 2 The results of the conventional content analysis categories subcategories Marital dissatisfaction Fear Distorted body image Fatigue Worrying about the husband's extramarital affairs The husband's and family's supportive role Lack of support from the husband Men's lack of participation in counseling Training sessions, and having the support of the family Psychological conflicts Worrying about the child's health Worrying about the child's future Ambivalence towards the child's birth Worrying about personal health Defective health system The lack of proper counseling by trained personnel Non-standard physical space Inadequate number of healthcare service providers. 3.1. Marital dissatisfaction: This category has four subcategories: Fear, distorted body image, fatigue, and worrying about the husband's extramarital affairs. 3.1.1. Fear: Due to the physical and psychological changes occurring in women during pregnancy and after childbirth, some women are afraid of having sex at this time due to possible complications: - A mother (nine months after childbirth) said: "My body felt dry. I was afraid because of this dry sensation in my body. I didn't like to have sex before two months had passed since my childbirth because I was afraid the stitches would open up" (participant 5). - Another mother (five months after childbirth) said: "I was afraid of intercourse because of my bleeding. I was afraid that if I had sex, my bleeding would get worse, or that my uterus would rupture due to bleeding and I'd get hurt" (participant 11). 3.1.2. Distorted body image: Some changes occurring during pregnancy take a long time to return to their original state after childbirth, or they rarely do. These changes, which include skin discoloration (face, genitals, and breasts), weight gain, hair loss, or sagging breasts, cause worries for many mothers or reduce the quality of sex for many couples. - A mother who had a five-month-old infant said, "I feel that my body is not stitched up properly and its shape is distorted and looks all weird. I don't like my vagina myself. My breasts are sagging, and I don't like them either" (participant 15). - Another mother (seven months after childbirth) said worriedly: "I’m very upset that my body has become dark and I've gotten fat. I don't feel alright. I'm always browsing [social media] channels that discuss how you can lose weight. My husband tells me to do something for myself because I'm a mess" (participant 7). 3.1.3. Fatigue: Having gone through pregnancy and childbirth as well as the restlessness and excessive crying of the infant in the first weeks cause excessive fatigue in the mother, which can reduce sexual desire and affect the sexual relationship of the couple: - A mother with a seven-month-old infant noted: "I distance myself a lot from my husband because I'm tired and have insomnia. I think everyone likes sex. It's a lie to say I don't like it. My husband wants it too, but I tell him I'm tired" (participant 7). - Another mother with a five-month-old infant stated: "I don't think a mother hates having sex, but what can she do? Fatigue makes people assign the least priority to these things. Sometimes my husband gets nervous and disappointed because we haven’t had sex for a while" (participant 17). 3.1.4. Worrying about the husband's extramarital affairs: Due to the physical and psychological changes during pregnancy and after childbirth, the sexual relationship of the couple sometimes gets disturbed. This issue makes some men seek to satisfy their unfulfilled sexual needs during pregnancy and after childbirth through extramarital affairs. Although most women do not express this concern, they always feel its possibility: - A service provider with about 30 years of experience in service provision to mothers said: "I remember that a patient had come to the clinic once. According to her, her husband said that her body had become loose after childbirth and wasn't like it was before, so he didn't feel the way he used to about it. She said she was afraid he might sleep with someone else" (participant 23). - Another employee of the health centers with 15 years of work experience believed that: "The conditions of a mother have changed a lot in the postpartum period compared to before pregnancy; one must understand when this woman can be mentally and physically ready to have sex. Sometimes, the husband doesn't understand the mother well and goes after extramarital affairs" (participant 21). 3.2. The husband's and family's supportive role: This category has three sub-categories: Lack of support from the husband, men's lack of participation in counseling and training sessions, and having the support of the family. 3.2.1. Lack of support from the husband: The mother becomes very fragile and irritable during this period due to experiencing problems related to the postpartum period, such as bleeding, pain, insomnia, fatigue, and worrying for the infant. Not having the support of the husband during this period can aggravate her problems. Nonetheless, mothers who benefit from the support of close people, especially their husband, during this period feel more capable of tolerating and adapting to the stress and hardships of this period: - A mother with a three-month-old infant noted: "I was completely alone for about ten days. I had no one to take care of me. My husband was at work until the evening, slept in a separate room at night and closed the door so that the baby's crying wouldn't bother him" (participant 6). - Another mother with an 11-month-old infant said: "My husband is a bank employee; he should focus all his attention on his job so that he makes no mistake. I have to do everything by myself. Sometimes, he says, 'Well, you're the mother; it's the mother’s duty!'" (participant 8). 3.2.2. Men's lack of participation in counseling and training sessions: Men's participation in various areas of SRH can strengthen relationships within the family and increase the sense of responsibility in men. Nonetheless, despite the importance of their participation, their place in important life events, including the postpartum period, is still not well discussed: - An employee with 27 years of experience providing services in health centers believed: "The husband is abandoned during pregnancy and after childbirth and is not involved in any training anywhere. There's no role mentioned for the husband in maintaining and improving the family's reproductive health. Our main problem is the husband! Husbands either don't visit or don't believe in training" (participant 22). - A mother whose child was three months old said: “When I visit the health center, I only go to get the baby vaccinated, not to get care for myself. Because my husband wants to go to work afterwards, he doesn't let me ask any questions about myself. He insists that I hurry up, get the baby vaccinated and leave. When he gets angry, it gets out of control. So, I say, ‘OK, let's go back” (participant 6). 3.2.3. Having the support of the family: Having family support in the postpartum period can help the mother both physically and psychologically and also effectively reduce her physical and psychological illness: - One of the service providers said: "The mother is supported by many family members when she is pregnant, but as soon as she gives birth, the family’s entire attention goes to the infant, and the mother gets abandoned" (participant 22). - A mother whose infant was two months old and who complained about the lack of support during this time noted: "I had no support at all, neither from my family nor my in-laws. Because I don't sleep well at night, I'm really suffering. I'm having a hard time –a very hard time!" (participant 1). 3.3. Psychological conflicts: This category emerged with four subcategories: Worrying about the child's health, worrying about the child's future, ambivalence towards the child's birth, and worrying about personal health. 3.3.1. Worrying about the child's health: Worrying about the child's health is the first subcategory of psychological conflicts. Mothers’ worries are considered normal in some cases, but sometimes, they get abnormally frightened and anxious about their infant's health: - A mother who had a three-month-old infant said: "I heard that some infants get choked to death. I have sometimes breastfed the child and burped him too, but then, he threw up again and might have choked if I weren't nearby" (participant 16). - Another mother, who was a midwife and whose baby was 11 months old, said: "My biggest concern right now is that I'm not with the baby. Although I trust the nanny, I’m more worried about the baby; what if something gets stuck in his throat and the nanny can't do anything about it?” (participant 8). 3.3.2. Worrying about the child's future: Since becoming a mother, women often consider their child and everything about them as the most important concern in their life. Some get worried about their child's future due to unfavorable and unstable economic conditions or for other reasons: - A mother with a three-month-old infant noted: "Now I'm mostly concerned about my child. I don't want my child to experience the hardships that I went through. God gave me this child, but now I'm responsible for him. This sense of responsibility towards the child is very consuming" (participant 6). - A mother who had a four-month-old child said: "Sometimes, I worry a little. Sometimes, I wonder what happens if I'm not there, how will my child grow up?" (participant 2). 3.3.3. Ambivalence towards the child’s birth: During the postpartum period, although the mother is experiencing the joy of motherhood, she might occasionally feel psychological conflicts and ambivalence, especially if it is her first experience of motherhood, and she might therefore develop concerns about the baby’s future in addition to the happiness she feels: - A mother who had given birth three months before said: "I worry sometimes. I think that becoming a mother is a positive emotion given by God. Before becoming a mother, I wasn't ready to give up my sleep for anyone or anything, but now, when I'm woken up, I'm happy and not angry. You know, the arrival of the child has given my life a purpose. It's like a dirt road that was messy, and now, there's asphalt pavement with a clean and tidy end" (participant 14). - Another mother whose infant was three months old said: "Becoming a mother is a very good feeling, a very special sense. You feel a big change has happened in your life. But at first, I was worried and saw the birth of our child as a bad thing. It was as if my freedom was taken away from me” (participant 6). 3.3.4. Worrying about personal health: Physical and psychological changes during pregnancy and after childbirth lead to worries about personal health disorders in the mother. At this time, the mother is worried that she may not be able to regain her lost energy or that the problems created will be permanent: - A mother who had given birth nine months before and complained deeply about the poor quality of postpartum care said: "I don't want to have children anymore because I'm afraid that the problems I faced after this delivery will happen again. When I was discharged after giving birth and came home, I had problems urinating, and I was in pain until the morning. I could've died, but no one believed me!" (participant 5). - A mother who had a five-month-old infant said: "One of the midwives told me that you have varicose veins on your legs. This worried me a lot. I’m worried that something might happen to me. Overall, pregnancy, childbirth, and child care harm the body way too much. How should I put it? The body becomes weak and may suffer severe complications later!" (participant 5). 3.4. Defective health system: This category has three sub-categories: The lack of proper counseling by trained personnel, non-standard physical space, and inadequate number of healthcare service providers. 3.4.1 The lack of proper counseling by trained personnel: Due to the changes in the job title of midwives and other healthcare workers in the Ministry of Health and Medical Education, where all of them are now called healthcare workers , many caregivers who provide services to clients do not have sufficient information about the subject due to their having multiple professions or not having the time or required expertise about the services they provide: - A mother whose child was eight months old said: "I'd like them to give me info about how to have sex or use methods of contraception or disease prevention. But no one provides such training. They don't spend enough time with the mother during this period. Sometimes, they just ask a general question, like 'Do you have any marital problems?' If I say no, the doctor or midwife won't ask me anything else" (participant 13). - A healthcare worker with 15 years of experience said, "I think it would be very good for us as midwives to get some training on communication with the clients, especially with regards to sexual problems and so on. We have issues with this subject. We don't know what's right and what's wrong. Sometimes I don't know the answer to a mother's questions or don't have the confidence to answer them" (participant 19). 3.4.2. Non-standard physical space: In order to provide SRH-related care, it is necessary to have a suitable physical space so that mothers and families can easily use these services: - A service provider with 15 years of experience said: "Due to our culture and lack of ability to respect privacy, the mother or her husband can’t easily tell us about their sexual problems. For example, I had a client whose husband only had anal sex with her, and although the woman was upset about this, it took her a long time to tell me about it with great difficulty" (participant 22). - A service provider noted: "To be honest, we don't ask in detail about the mother's problems. We share the hallway in which we work, and everyone's listening. Even if we ask, the mother won't tell the truth in this situation" (participant 18). 3.4.3. Inadequate number of service providers: Another crucial factor in providing quality SRH services is having an adequate number of service providers for the family and clients. When the number of caregivers is not proportional to the number of clients, the quality of care decreases: - A service provider with 28 years of experience said: "Sometimes, a woman's husband does not visit because he doesn't like to be trained by a woman or because the midwife doesn't give him proper training. The truth is that it is a bit difficult to communicate with a man; it requires skills, knowledge, the presence of a male healthcare worker in the center, and also enough time. All healthcare workers are women right now, and this makes it really difficult” (participant 18). - A healthcare worker with 18 years of experience believed, "I think all mothers who are apparently healthy should also be screened psychologically. Sometimes, we examined a mother based on the questions on the website, and the mother was evaluated as healthy, but later, the same mother committed suicide. We don't have any space for providing psychological counseling here. They've given this room to a doctor, who doesn't do anything at all really!" (participant 19). 4. Discussion The results of the present study showed that in the postpartum period, women often face many obstacles and are not content with their received support, care, and SRH. The results further suggest that women do not have a proper understanding or awareness of their SRH components and rights in the postpartum period, which can affect their low level of postpartum SRH and access to SRH care[ 2 , 21 , 39 ]. One of the most important problems reported by the studied women is marital dissatisfaction. Postpartum marital dissatisfaction can be caused by various factors, such as fear, distorted body image, fatigue, and worrying about the husband's extramarital affairs [ 40 , 41 ]. Fear is the most important cause of marital dissatisfaction as reported by the participants. Fear of engaging in sex due to vaginal dryness, prolonged bleeding after childbirth, damage to the genitals, and the resulting pain disrupts sex in the postpartum period [ 40 – 43 ]. A distorted body image was another reason that caused a reduction in marital satisfaction or led to marital dissatisfaction in women. Changes in body image, including weight gain [ 44 ], worrying about lost attractiveness for the husband [ 45 ], discoloration, loose and sagging breasts, and changes in the color and appearance of the genitals are associated with postpartum depression and hopelessness in women [ 46 – 49 ]. The mother's insomnia due to the infant's crying and restlessness in the first weeks postpartum and her loss of energy due to the long course of pregnancy and the stresses of childbirth cause fatigue and ultimately decrease sexual desire, lack of desire to engage in sex, and worrying about the husband's extramarital affairs [ 17 ]. In their review study, Wood et al. showed that women face many sexual and marital problems in the postpartum period due to the problems experienced during childbirth [ 17 ]. The results of another review study conducted by Hajimirzaie et al. also revealed that weight gain, changes in body image, fear, and fatigue are related to decreased sexual functioning in the postpartum period [ 22 ]. The second category extracted in this study was the husband’s and family’s supportive role in the postpartum period, which includes the dimensions of the lack of support from the husband, men’s lack of participation in counseling and training sessions, and having support from the family. Changes and increases in roles multiply the mother's responsibilities, require the expenditure of more energy on her part, reduce her quantity of sleep and cause changes in her lifestyle and reduced participation in social activities. All of these issues can affect the mother's SRH [ 22 ]. Most women believe that when they first become a mother, they need support from their parents and husband to accept their new conditions. In this study, mothers who received support reported a better SRH [ 50 ]. Nonetheless, some women, such as those in the marginalized families of Dar es Salaam, Tanzania, who have a low socioeconomic status, are deprived of the help of other family members and even their spouse for cultural reasons [ 39 ]. Some mothers do not receive adequate support during their postpartum period due to their husband’s job conditions, the cultural conditions governing their society, and the inability of their husband or families to provide them with any support. This problem leads to dissatisfaction and a decrease in the quality of physical, sexual, and reproductive health in the postpartum period [ 23 , 39 , 51 ]. Some mothers refrain from receiving support from their families for various reasons. These reasons include family interference in the child's care and feeding, restricting the mother from engaging in sexual relations with her husband for an extended period, and the family's tendency to prescribe traditional medicines for the child [ 39 ]. Ensuring that postpartum women and new parents receive ample support can improve the understanding about SRH and thus enhance the welfare of families [ 52 ]. Men's lack of participation in counseling and training sessions for cultural reasons and other issues, as mentioned in the Results section, leads to the husband’s decreased cooperation at home and limits the mother’s visits to healthcare centers for receiving services and causes the couple’s non-cooperation in using contraceptives [ 51 , 53 , 54 ]. Psychological conflicts were another factor related to women’s postpartum SRH, which emerged with four subcategories: Worrying about personal health, worrying about the child's health, worrying about the child's future, and ambivalence towards the child’s birth [ 25 ]. Most of the mothers reported that because of their new responsibilities, they had become anxious and worried about many things after giving birth. They thought that the birth of the child caused depression, decreased their energy, led to anemia, malaise, insomnia, and related problems, and decreased their psychological and physical health. They reported that the birth of their child had made them socially isolated. In their qualitative study, Alderdice et al. also reported that many aspects of mothers' health were compromised after having children, e.g., their vitality, self-esteem, and positive functioning. They felt lively and joyful only a few hours each day, and often reported fatigue and illness [ 52 ]. Women in the postpartum period face psychological conflicts such as feelings of inadequacy, postpartum depression, anxiety, guilt, and identity changes.. These psychological challenges can significantly affect women's mental well-being, interpersonal relationships, and postpartum sexual and reproductive health (SRH). Some believe that the occurrence of illness in women, especially postpartum depression, can cause depression in the husbands [ 39 ], which further highlights the importance of the physical and mental health of women and families and reveals the necessity of promoting this index for policy-makers. Due to the unstable economic conditions, some mothers reported that fear of their own illness or death, which could change their child's future, explained why they worried about the child's health and future. Aside from the self-worth and pleasurable feelings associated with the experience of motherhood, some of the participating mothers reported ambivalent feelings about not having the required self-confidence to care for their child[ 52 ]. Some working mothers argued that being away from their child for many hours each day was the reason for their worries and concerns. Receiving social support, having childcare facilities in the workplace, or getting support from friends and acquaintances are factors that can significantly reduce the concerns of mothers and families in this regard [ 55 ]. A defective healthcare system, with a lack of proper counseling by trained personnel, non-standard physical space, and an insufficient number of healthcare service providers, severely affects women's postpartum SRH. The broad range of midwives' responsibilities, the recruitment of staff who lack the expertise in SRH, midwives' lack of up-to-date information, the lack of timely presence of healthcare workers at the place of service, and the lack of respect for privacy are among the reasons for the service recipients' mistrust of the health system and its employees. All these factors cause dissatisfaction, reduce the motivation to visit and receive services, and ultimately reduce the SRH of those who visit these centers, especially mothers [ 39 , 56 ]. Most mothers and midwives emphasized that healthcare workers and midwives need to participate in retraining courses and learn new information [ 21 , 39 , 57 ]. In all service provision centers in the study setting, all healthcare providers are women. Considering the cultural conditions prevailing in the studied region, many men are reluctant to seek health services and SRH counseling from a caregiver of the opposite sex [ 57 ]. The insufficient number of personnel in proportion to the number of clients, long waiting times, not allocating the necessary time to providing high-quality services and counseling, and not having a suitable space for the husbands to wait contribute to men's reluctance to participate in counseling and training sessions [ 7 ]. Deficiencies in the health system concerning postpartum sexual and reproductive health (SRH) care include the lack of comprehensive care programs, insufficient training for healthcare providers, and limited access to specialized counseling services. Cultural barriers, inadequate integration of SRH services into postpartum care, and poor follow-up mechanisms further contribute to the neglect of women's SRH needs. Recent studies have also emphasized the need to address postpartum sexual health as part of routine maternal care [ 58 , 59 ]. These gaps highlight the need for policy reforms, provider education, and the development of accessible, integrated SRH services in postpartum care protocols. In Ilam, cultural taboos, traditional gender roles, and limited social support hinder women’s access to postpartum SRH care and open discussions. The findings of this study align with previous research on postpartum SRH, highlighting similar challenges across different cultural and healthcare contexts. However, unique sociocultural factors in Ilam further influence women's experiences, differentiating these results from those in other regions. Future studies should explore these contextual variations to develop more tailored interventions. 5. Limitations This study was conducted on postpartum women in Iran. One limitation of this study is that factors such as the lactational status and related hormonal influences were not specifically assessed, as the study focused solely on the inductively derived categories and subcategories emerging from participants' narratives through a conventional content analysis approach. The results of This study can be used for comparison purposes, but the findings may not be generalizable to other regions due to the unique cultural conditions and their impact on the subject. 6. Conclusion This study examined women's perception of the concept of postpartum SRH. This study emphasizes the need for educational programs, better counseling services, and supportive policies to improve postpartum SRH care. In most political and health plans, SRH only includes women's health during pregnancy and also family planning, while other aspects of health and women's postpartum SRH are ignored. As demonstrated by the study findings, SRH is critical in the postpartum period. The lack of sufficient attention to mothers’ health for various reasons, such as the lack of a standard protocol to examine mothers' postpartum SRH, a defective health system, the lack of sufficient supervision over service provision systems, men's lack of participation in counseling and training sessions, and the limited knowledge of service providers, husbands, and families all reduce women’s postpartum SRH. By resolving these deficiencies, health policy-makers and decision-makers should be able to improve the postpartum health of mothers, which is critical and guarantees the health of not only the mothers, but also the other family members. Improving postpartum SRH requires education, integration of services, healthcare provider training, psychological support, and policy reforms to ensure better access and equity. Future research can address gaps in postpartum SRH care through longitudinal studies, culturally tailored interventions, exploring family roles, and developing inclusive healthcare models. Additionally, qualitative methods can provide deeper insights into women's experiences. Abbreviations PTSD: Posttraumatic Stress Disorder SRH: Sexual and Reproductive Health NICU: Neonatal Intensive Care Unit Declarations Ethics approval and consent to participate This project was approved by the Research Council of the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, and a code of ethics was obtained for it too (IR.TUMS.FNM.REC.1401.072, date: 09/28/2022). The authors corresponded with Ilam University of Medical Sciences to obtain permission for sampling the health centers in Ilam. Eligible mothers provided written and verbal consent for participation in the study. Each research stage was carried out according to the ethical principles of the World Medical Association’s Declaration of Helsinki. Not applicable. Consent for publication This project was approved by the Research Council of the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, and a code of ethics was obtained for it too (IR.TUMS.FNM.REC.1401.072, date: 09/28/2022). The authors corresponded with Ilam University of Medical Sciences to obtain permission for sampling the health centers in Ilam. Eligible mothers provided written and verbal consent for participation in the study. Each research stage was carried out according to the ethical principles of the World Medical Association’s Declaration of Helsinki. Consent Not applicable. Availability of data and materials The data used in this study are included in the manuscript. The data collected in this study were included in this manuscript. The data have not been stored in a publicly accessible repository. The data sets used in the analysis that support the conclusions of this study can be obtained from the corresponding author upon a reasonable request. Of course, after obtaining permission from the Ethics Committee of Tehran University of Medical Sciences. Competing interests The authors declare that they have no conflicts of interest. Funding This manuscript is a part of the thesis which was registered in Tehran University of Medical Sciences and has no any supported grant. Author contribution statement ZBM: She is the corresponding author and also the supervisor of this study. She has played a key role in the conceptualization, supervision, data interpretation, and critical revision of the manuscript.Conceived and designed the experiments; Analyzed and interpreted the data; Project administration; Contributed reagents, materials, analysis tools or data. NR: Conceived and designed the experiments; Performed the experiments; Contributed reagents, materials, analysis tools or data; Wrote the paper. MN and AT: Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Software; Validation ; Wrote the paper; Review & editing. SM: Contributed reagents, materials, analysis tools or data; Wrote the paper, Review & editing. All authors They approved the manuscript draft, revised it, and approved the final version for publication and agreed to be accountable for all aspects of the research. All authors read and approved the final manuscript Acknowledgments This study is derived from a PhD dissertation in Reproductive Health, funded by the Vice-Chancellor of Research and Technology of Tehran University of Medical Sciences. We are grateful to the Iranian Ministry of Health and Medical Education, Tehran University of Medical Sciences, Faculty of Nursing and Midwifery, and all the mothers, healthcare workers, and midwives who participated in our research. Authors' information Authors' E-mails, City and country: NR : [email protected] Ilam, Iran Department of Midwifery, School of nursing and midwifery, Ilam University of Medical Sciences, Ilam, Iran Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran M N : [email protected] Tehran, Iran Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran A T : [email protected] [email protected] Ilam, Iran School of Medicine, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran SM: [email protected] Tehran, Iran Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Z BM : [email protected] Dr. Zahra Behboodi Moghadam is corresponded author Tehran, Iran Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran References Rezaei N, Azadi A, Zargousi R, Sadoughi Z, Tavalaee Z, Rezayati M. Maternal health-related quality of life and its predicting factors in the postpartum period in Iran. Scientifica . 7 (2016), DOI: 10.1155/2016/8542147. Alvarez-Nieto C, Pastor-Moreno G, Grande-Gascón ML, Linares-Abad M. Sexual and reproductive health beliefs and practices of female immigrants in Spain: A qualitative study. Reprod Health . 12(1) (2015) 1-10, DOI: 10.1186/s12978-015-0071-2 Rezaei N, Arman A, Kourosh S, Reza V. Postpartum sexual functioning and its predicting factors among Iranian women. Malays J Med Sci . 24(1) (2017) 94. Razurel C, Bruchon-Schweitzer M, Dupanloup A, Irion O, Epiney M. Stressful events, social support and coping strategies of primiparous women during the postpartum period: A qualitative study. Midwifery . 27(2) (2011) 237-42. Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol . 12(3) (2015) 173, https://doi.org/10.4274/tjod.2015.03.03 Sayer EP, et al. Depression, anxiety, and stress in pregnancy and postpartum: A longitudinal study during the COVID-19 pandemic. Midwifery . 108 (2023) 103655, doi:10.1016/j.midw.2023.103655. Balogun OO, Fagbamigbe AF. Timing of postnatal care and maternal health outcomes among women in Nigeria: Evidence from the Nigeria Demographic and Health Survey. Niger J Clin Pract. 24(1) (2021) 46-55. doi:10.4103/njcp.njcp_123_20. Kuo C. F, & Yang C. Y. The Relationship between Postnatal Care and Maternal Health Outcomes: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 16(13) (2019) 2285, doi:10.3390/ijerph16132285. Verreault N, Barlow M, Ritchie K, et al. Maternal mental health after childbirth: A systematic review of psychosocial interventions. Heliyon. 9(4) (2023) e12962, doi:10.1016/j.heliyon.2023.e12962. Acele EÖ, Karaçam Z. Sexual problems in women during the first postpartum year and related conditions. J Clin Nurs . 21(7-8) (2012) 929-37. https://doi.org/10.1111/j.1365-2702.2011.03882.x Morof D, Barrett G, Peacock J, Victor CR, Manyonda I. Postnatal depression and sexual health after childbirth. Obstet Gynecol . 102(6) (2003) 1318-25, https://doi.org/10.1016/j.obstetgynecol.2003.08.020 Yilmaz FA, Avci D, Aba YA, Ozdilek R, Dutucu N. Sexual dysfunction in postpartum Turkish women: Its relationship with depression and some risk factors. Afr J Reprod Health . 22(4) (2018) 54-63, doi:10.29063/ajrh2018/v22i4.6 George M, Johnson AR, Basil RC, Murthy SN, Agrawal T. Postpartum and newborn care: A qualitative study. Indian J Community Health . 30(2) (2018) 163-5, doi:10.47203/IJCH.2018.v30i02.012 Lomoro O, Ehiri J, Qian X, Tang S. Mothers’ perspectives on the quality of postpartum care in central Shanghai, China. Int J Qual Health Care . 14(5) (2002) 393-401, https://doi.org/10.1093/intqhc/14.5.393 Fuchs A, Czech I, Dulska A, Drosdzol-Cop A. The impact of motherhood on sexuality. Ginekol Pol . 92(1) (2021) 1-6, doi:10.5603/GP.a2020.0162 Krivats-Arba K, Aavik A. A woman with special needs in maternity care in cooperation with a midwife and an occupational therapist: Building up the subject in Tallinn Health Care College in curriculum of midwifery. Eur J Midwifery . 7(Suppl 1) (2023). Wood SN, Pigott A, Thomas HL, Wood C, Zimmerman LA. A scoping review on women’s sexual health in the postpartum period: Opportunities for research and practice within low- and middle-income countries. Reprod Health . 19(1) (2022) 1-34. doi:10.1186/s12978-022-01399-6 Rashidian A, Karimi-Shahanjarini A, Khosravi A, Elahi E, Beheshtian M, Shakibazadeh E, Khabiri R, Arab M, Zakeri MR. Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS-2010): Study protocol. Int J Prev Med . 5(5) (2014) 632-42, doi:10.4103/2008-7802.132775. Cheng C-Y, Fowles ER, Walker LO. Postpartum maternal health care in the United States: A critical review. J Perinat Educ . 15(3) (2006) 34, doi:10.1624/105812406X119002 DeJudicibus MA, McCabe MP. Psychological factors and the sexuality of pregnant and postpartum women. J Sex Res . 39(2) (2002) 94-103, doi:10.1080/00224490209552128 Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: A qualitative evidence synthesis. Cochrane Database Syst Rev . 11(11) (2018) CD011558, doi:10.1002/14651858.CD011558.pub2 Hajimirzaie SS, Tehranian N, Razavinia F, Khosravi A, Keramat A, Haseli A, Mirzaii M, Mousavi SA. Evaluation of couple's sexual function after childbirth with the biopsychosocial model: A systematic review of systematic reviews and meta-analysis. Iran J Nurs Midwifery Res . 26(6) (2021) 469-78, doi:10.4103/ijnmr.IJNMR_426_20 Ghanbari-Homaie S, Meedya S, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Mohammadi E, Mirghafourvand M. Recommendations for improving primiparous women's childbirth experience: Results from a multiphase study in Iran. Reprod Health . 18(1) (2021)146, doi:10.1186/s12978-021-01196-7 Brockington, I. F, & Kumar, R. Motherhood and mental health: A review of the literature. Psychological Medicine. 51(6) (2021) 985-993, doi:10.1017/S0033291720000322. Hamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: A scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Rev . 41 (2020) 1-24, doi:10.1186/s40985-020-00125-6 Maluka SO, Peneza AK. Perceptions on male involvement in pregnancy and childbirth in Masasi District, Tanzania: A qualitative study. Reprod Health . 15(1) (2018) 68, doi:10.1186/s12978-018-0512-9 Zhou Y, Sze S, & Smiley, A. The impact of socioeconomic status on maternal health outcomes: A systematic review. International Journal of Environmental Research and Public Health. 19(1) ( 2022 ) 321, doi:10.3390/ijerph190100321. Fathalla MF, Sinding SW, Rosenfield A, Fathalla MM. Sexual and reproductive health for all: A call for action. Lancet . 2006;368(9552):2095-100. Barker G, Moraes M, & Rios, T. Achieving SDG 3 and SDG 5: The Role of Gender Equality in Health. Global Health Action, 15(1) ( 2022 ) 2035401, doi:10.1080/16549716.2022.2035401. United Nations. Progress report on the sustainable development goals: Health and gender equality. United Nations Publications (2024), DOI: 10.18356/sdg2024-health-gender. Onah H, Iloabachie G, Obi S, Ezugwu F, Eze J. Nigerian male sexual activity during pregnancy. Int J Gynecol Obstet . 76(2) (2002) 219-23. Gruskin S, Yadav V, Castellanos-Usigli A, Khizanishvili G, Kismödi E. Sexual health, sexual rights and sexual pleasure: Meaningfully engaging the perfect triangle. Sex Reprod Health Matters . 27(1) (2019) 1593787, doi:10.1080/26410397.2019.1593787 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care . 19(6) (2007) 349-57. Guba E. G, & Lincoln Y. S. The Sage Handbook of Qualitative Research (5th ed.). SAGE Publications. 2018, doi:10.4135/9781071803868. Morse JM. Qualitative Health Research: Creating a New Discipline. Left Coast Press; 2016. Williams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. Australas J Paramed . 2010;8:1-13. Wildemuth BM. Applications of Social Research Methods to Questions in Information and Library Science. 2nd ed. Libraries Unlimited; 2016. Flick U.An Introduction to Qualitative Research (6th ed.). SAGE Publications. 2018, doi:10.4135/9781526415383. Mbekenga CK, Pembe AB, Christensson K, Darj E, Olsson P. Informal support to first-parents after childbirth: A qualitative study in low-income suburbs of Dar es Salaam, Tanzania. BMC Pregnancy Childbirth . 11 (2011) 98, doi:10.1186/1471-2393-11-98 Rathfisch G, Dikencik BK, Kizilkaya Beji N, Comert N, Tekirdag AI, Kadioglu A. Effects of perineal trauma on postpartum sexual function. J Adv Nurs . 66(12) (2010) 2640-9. Pardell-Dominguez L, Palmieri PA, Dominguez-Cancino KA, Camacho-Rodriguez DE, Edwards JE, Watson J, Leyva-Moral JM. The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry. BMC Pregnancy Childbirth . 21(1) (2021) 1-13. Zgliczynska M, Zasztowt-Sternicka M, Kosinska-Kaczynska K, Szymusik I, Pazdzior D, Durmaj A, Szlachta M, Bartnik P, Wielgos M. Impact of childbirth on women's sexuality in the first year after the delivery. J Obstet Gynaecol Res . 47(3) (2021) 882-92. Dominoni M, Gritti A, Bergante C, Pasquali MF, Scatigno AL, De Silvestri A, Gardella B. Genital perception and vulvar appearance after childbirth: A cohort analysis of genital body image and sexuality. Arch Gynecol Obstet . 307(3) (2023) 813-9, doi:10.1007/s00404-022-06826-4 Kerrigan D, McDonald S, McDonald S. Obesity and normal birth: A qualitative study of clinician’s management of obese women during labour. BMC Pregnancy Childbirth . 15 (2015) 212, doi:10.1186/s12884-015-0673-2 Rahmani A, Fallahi A, Allahqoli L, Grylka-Baeschlin S, Alkatout I. How do new mothers describe their postpartum sexual quality of life? A qualitative study. BMC Womens Health . 23 (2023) 477, doi:10.1186/s12905-023-02619-2 Yan J, Zhang Y, Zhang L. Gestational weight gain and risk of postpartum depression: A meta-analysis. Psychiatry Res . 310 (2022) 114448, doi:10.1016/j.psychres.2022.114448 Tavares IM, Nobre PJ, Heiman JR, Rosen NO. Longitudinal associations between mindfulness and changes to body image in first-time parent couples. Body Image . 44 (2023) 187-96. Brandão T, Brites R, Nunes O, Hipólito J. Posttraumatic growth after childbirth in women: A systematic review. J Clin Psychol Med Settings . 27(2) (2020) 318-30, doi:10.1007/s10880-020-09720-w Kapa HM, Litteral JL, Keim SA, Jackson JL, Schofield KA, Crerand CE. Body image dissatisfaction, breastfeeding experiences, and self-efficacy in postpartum women with and without eating disorder symptoms. J Hum Lact . 38(4) (2022) 633-43. Hosseini Tabaghdehi M, Keramat A, Kolahdozan S, Shahhosseini Z, Moosazadeh M, Motaghi Z. Positive childbirth experience: A qualitative study. Nurs Open . 7(4) (2020) 1233-8, doi:10.1002/nop2.499 Davis J, Vyankandondera J, Luchters S, Simon D, Holmes W. Male involvement in reproductive, maternal and child health: A qualitative study of policymaker and practitioner perspectives in the Pacific. Reprod Health . 13(1) (2016) 1-11. Alderdice F, Gargan P. Exploring subjective wellbeing after birth: A qualitative deductive descriptive study. Eur J Midwifery . 3 (2019). van Vulpen M, Heideveld-Gerritsen M, van Dillen J, Oude Maatman S, Ockhuijsen H, van den Hoogen A. First-time fathers' experiences and needs during childbirth: A systematic review. Midwifery . 94 (2021) 102921, doi:10.1016/j.midw.2020.102921 Bunda B. S, & Amani, J. Factors influencing couples' decision-making on family planning in Tanzania: A qualitative study . Reproductive Health. 20(1) (2023) 50, doi:10.1186/s12978-023-00512-w. Bennetter KE, Richardsen KR, Vøllestad NK, Jenum AK, Robinson HS, Mdala I, Waage CW. Associations between social support and physical activity in postpartum: A Norwegian multi-ethnic cohort study. BMC Public Health . 23(1) (2023) 1-12. Gurung R, Ruysen H, Sunny AK, Day LT, Penn-Kekana L, Målqvist M, Ghimire B, Singh D, Basnet O, Sharma S. Respectful maternal and newborn care: Measurement in one EN-BIRTH study hospital in Nepal. BMC Pregnancy Childbirth . 21(1) (2021) 1-13. Yin R.K Y. Health and well-being in the 2030 agenda for sustainable development: A comprehensive approach. Global health action. 13(sup1) (2020) 1682265, doi: https://doi.org/10.1080/16549716.2020.1682265 Chen Y, N Patel, T Robinson. Advances in postpartum care: Integrating sexual health into routine follow-up. Journal of Women's Health Research. 29(1) (2025) 34-42, doi: https://doi.org/10.1097/JWR.0000000000000452 Khalil A, S Wernicke, A Langer. Addressing postpartum sexual health: A priority for maternal well-being. International Journal of Gynecology & Obstetrics. 167(2) (2024) 250-8, doi: https://doi.org/10.1002/ijgo.14789 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Dec, 2025 Read the published version in Reproductive Health → Version 1 posted Editorial decision: Revision requested 25 Sep, 2025 Reviews received at journal 24 Sep, 2025 Reviewers agreed at journal 19 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor assigned by journal 14 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 11 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7349600","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":520325583,"identity":"900466c7-d777-4e4a-af72-e623ba7045c9","order_by":0,"name":"Nazanin Rezaei","email":"","orcid":"","institution":"Ilam University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nazanin","middleName":"","lastName":"Rezaei","suffix":""},{"id":520325584,"identity":"997f6fc5-2f06-42e8-8c4c-7e40c8d9c149","order_by":1,"name":"Masoumeh Namazi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Masoumeh","middleName":"","lastName":"Namazi","suffix":""},{"id":520325585,"identity":"cbd7e259-acc8-4c86-b4d0-1d0926ca9601","order_by":2,"name":"Atbin Tahmasebi","email":"","orcid":"","institution":"Ilam University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Atbin","middleName":"","lastName":"Tahmasebi","suffix":""},{"id":520325586,"identity":"b780349f-4117-45b0-a72c-9a260b420d4b","order_by":3,"name":"Somayeh Moukhah","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Somayeh","middleName":"","lastName":"Moukhah","suffix":""},{"id":520325587,"identity":"281f1b50-d82e-4171-beae-d9ce20206bd6","order_by":4,"name":"Zahra Behboodi Moghadam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYBACAwYeNiDFzMMPF2ImVotkG6laGAyOEeswc/beYw8+VFjLGN/vMd34g8FOnoGd9wFeLZY959INZ5xJ5zE7xmN2m4ch2bCBmd0Av8Nu5JhJ87YdhmgBujCBgZmNgF/uv4FoMW7jMbv5g6GeCC03eCBaDNh4zG7wMBwmrMWyJ8cc7BeJY2llt3kMjhu2EdJizn7GDBRi9vzNh7fd/FFRLc/PT3RwQ9zJwEDAjlEwCkbBKBgFxAAATPw3MyL/E0MAAAAASUVORK5CYII=","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"Behboodi","lastName":"Moghadam","suffix":""}],"badges":[],"createdAt":"2025-08-11 21:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7349600/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7349600/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12978-025-02232-6","type":"published","date":"2025-12-16T15:57:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92444877,"identity":"9ace2256-3ac4-4fed-9c11-02913a996342","added_by":"auto","created_at":"2025-09-29 19:56:36","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":352256,"visible":true,"origin":"","legend":"","description":"","filename":"MainManuscriptfile.doc","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/9a1db0ad472babd394e0aef8.doc"},{"id":92444874,"identity":"f40104ac-2d25-41cd-8c7a-540caec13581","added_by":"auto","created_at":"2025-09-29 19:56:36","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8426,"visible":true,"origin":"","legend":"","description":"","filename":"0d4c24d9385d4662a45011df4607ae12.json","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/09487c463edee70ad4cb547a.json"},{"id":92444875,"identity":"5ea45e12-116f-4fe8-ad9d-12cf21ef754a","added_by":"auto","created_at":"2025-09-29 19:56:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16829,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/6df0ab0c01a23d421f897b07.docx"},{"id":92444876,"identity":"0a887494-450c-41dc-b214-a1fef34e6fbb","added_by":"auto","created_at":"2025-09-29 19:56:36","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":161863,"visible":true,"origin":"","legend":"","description":"","filename":"0d4c24d9385d4662a45011df4607ae121enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/34effb7be73fd5de2137a2ea.xml"},{"id":92445585,"identity":"d837b7c5-1078-4863-b2b7-5e1909b615ed","added_by":"auto","created_at":"2025-09-29 20:04:36","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":154866,"visible":true,"origin":"","legend":"","description":"","filename":"0d4c24d9385d4662a45011df4607ae121structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/151af3e4fc38b128017d8e12.xml"},{"id":92444878,"identity":"e6c898c1-05f8-48e5-9c83-679b58c2e60d","added_by":"auto","created_at":"2025-09-29 19:56:36","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":179372,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/5c78a9b4abda1dd185aeecf0.html"},{"id":98813858,"identity":"cdd9d799-88f5-4cfb-b2f4-076f4873cd52","added_by":"auto","created_at":"2025-12-22 16:05:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":917559,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7349600/v1/1d0bdc60-87e4-4f59-94d0-e4aad881e2fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Women's Postpartum Sexual and Reproductive Health: A Qualitative Study in an Iranian setting","fulltext":[{"header":"Plain language summary","content":"\u003cp\u003eThe postpartum period is associated with fundamental physical and mental changes in the mother.\u0026nbsp;Many mothers and even service providers do not have enough knowledge and information about the rights and needs of sexual and reproductive health of mothers in the postpartum period.\u0026nbsp;The present qualitative study examines the concept of reproductive and sexual health in the postpartum period among Iranian women.\u003c/p\u003e\n\u003cp\u003eThis study shows the low quality and quantity of sexual and reproductive health care during the postpartum period and calls for improving the quality and quantity of these cares.\u003c/p\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eThe postpartum period is a phase in which women undergo significant physiological and psychological changes after childbirth. This stage involves physical recovery, hormonal adjustments, and adaptation to the new role of motherhood. The significance of the postpartum period for mothers, newborns, parents of newborns, and their families [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] important that in some countries, the birth of a child is the ultimate goal of marriage and a symbol of femininity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] The postpartum period is a time when spouses adapt to their parenting roles and resume their sexual activities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Most mothers face many complications during pregnancy and childbirth, including vulnerability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], physical problems [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], psychological problems and suicidal ideations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and sexual problems [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; these factors eventually cause disruption in marital relations[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Physiological, psychological, social, and cultural changes occurring during this period all affect women's sexual health and reproductive behavior [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Potential stressors for the mother in the postpartum period cause sleep deprivation, interference in relationships (personal, sexual, and social), anxiety about parenting skills, lifestyle changes, and increased need for social support [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which eventually reduce the mother's quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDue to the impact of unequal decision-making and societal gender roles in relationships, women in the postpartum period face significant challenges in both developing and even developed countries [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Still, in many developed and developing countries, most women are deprived of the necessary postpartum health and care services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe lack of comprehensive perception among women regarding postpartum sexual and reproductive health (SRH) is often attributed to insufficient education, cultural taboos, and the overemphasis on neonatal care, which leaves postpartum women's SRH needs largely unaddressed. Women's sexual health is often defined only in relation to their reproductive capacity, and in most cases, women's sexual function or dysfunction is ignored [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Health systems tend to neglect \u003cem\u003epostpartum\u003c/em\u003e care services related to the mother\u0026rsquo;s sexual and reproductive health (SRH) when providing reproductive health care during or before pregnancy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; healthcare staff often focus on prenatal care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] or care related to the newborn or child [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Meanwhile, women in this period visit health centers to receive routine postpartum care for themselves and postnatal care for their child and can easily benefit from such care as well [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe differing and insufficient perceptions of midwives[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], mothers, or their families regarding the importance of mothers' postpartum SRH[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], men's lack of cooperation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and the low quality and quantity of care provided in health centers [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] are factors that affect mothers' postpartum SRH[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo achieve Sustainable Development Goals (SDGs), particularly Goal 3 (Ensure healthy lives and promote well-being for all at all ages) and Goal 5 (Achieve gender equality and empower all women and girls), it is essential to address postpartum health challenges and ensure equitable access to healthcare services for women [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Although SRH care has generally improved through measures such as increased access to healthcare services, implementation of maternal health programs, community-based education initiatives, and policy reforms aimed at reducing barriers to care. These efforts have enhanced awareness, accessibility, and quality of postpartum SRH services, we are still far from the initial target, especially with regard to women's SRH[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Collecting data related to mothers' physical, sexual, and psychological complications in the postpartum period can help promote their postpartum SRH [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, the present study was conducted to explain women's perceptions and experiences about their postpartum SRH.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eThis qualitative study was designed based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study Design and Subjects\u003c/h2\u003e\n \u003cp\u003eThis is the qualitative part of a mixed-methods research conducted using conventional content analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Sample Recruitment\u003c/h2\u003e\n \u003cp\u003eThe study was conducted in five districts of Ilam: North, South, East, West, and Central\u003c/p\u003e\n \u003cp\u003eCluster sampling of health centers was performed in five different districts of Ilam city in Iran: North, South, East, West, and Central. The samples included 17 eligible mothers (service recipients) visiting the health centers and six midwives (service providers). Qualitative purposive sampling was performed from November 5, 2022, to March 16, 2023, and continued until data saturation. After ensuring participants\u0026apos; eligibility, explaining the purpose of the study to the participants, semi-structured, in-depth, face-to-face interviews were held with them in a private place by an interviewer of the same sex (researcher), with their coordination and consent, in health care centers and in a private place. All interviews were conducted in the local languages, Kurdish and Luri, to ensure participants\u0026rsquo; comfort and accurate data collection. (The researcher is a member of the Faculty of Nursing and Midwifery, one of the universities of medical sciences. The researcher has many years of experience working in maternity hospitals and health-treatment and educational centers).\u003c/p\u003e\n \u003cp\u003eThe inclusion criteria for the mothers were as follows: Being in the postpartum period (six weeks to 12 months after childbirth), being literate, having only one living healthy child, no experience of stressful events over the past six months, and no childbirth complications having led to the mother\u0026apos;s hospitalization.\u003c/p\u003e\n \u003cp\u003eThe credibility, dependability, confirmability, and transferability of data were checked using Lincoln and Guba\u0026apos;s criteria [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. To ensure dependability of the data, two research team members carefully read the interview transcripts and performed coding, categorization, and review. For credibility, the researcher engaged with the participants through semi-structured in-depth interviews and constant review of the interview notes and data. The confirmability of the data was checked by giving the extracted codes to the participants. To ensure data transferability, purposive interviews were held with maximum variation, and the research procedure and a sample of participants\u0026apos; statements were presented in full.\u003c/p\u003e\n \u003cp\u003eThe mean duration of each interview was 57.92 minutes. MAXQDA software (v. 20) was used to manage the data.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Data Collection Tool.\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAfter permission from the participant, their voice was recorded. The interviews began with general questions and continued with probing questions to obtain more detailed information. Some of the questions to the service recipients were:\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e- What changes do you feel in your sexual relationship with your husband and your feelings towards him in the postpartum period?\u003c/p\u003e\n \u003cp\u003e- What do you think about your husband\u0026apos;s and your families\u0026apos; cooperation and support in the postpartum period?\u003c/p\u003e\n \u003cp\u003e- How do you feel about the changes in your breasts, genitals, and body?\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSome of the questions to the service providers included:\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e- What are the postpartum SRH needs of women?\u003c/p\u003e\n \u003cp\u003e- Which postpartum SRH needs of women are not met in health centers?\u003c/p\u003e\n \u003cp\u003e- What skills do midwives need to acquire to train mothers about postpartum SRH?\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Data Analysis.\u003c/h2\u003e\n \u003cp\u003eThe interviews were carefully typed verbatim on the same day of the interview and then coded. In this type of study, themes do not exist in advance and are extracted from information. Each subsequent interview was conducted after the previous one was analyzed. Data analysis was performed by Zhang \u0026amp; Wildemuth\u0026apos;s method:\u003c/p\u003e\n \u003cp\u003e- Preparing the data for qualitative content analysis: The recorded interviews were converted into text format.\u003c/p\u003e\n \u003cp\u003e- Defining the unit of analysis: Each transcript was entered into the qualitative data analysis software as a unit of analysis; then, the transcripts were coded by identifying the meaningful units.\u003c/p\u003e\n \u003cp\u003e- Categorization and coding: Categories were extracted from the data inductively with constant comparison.\u003c/p\u003e\n \u003cp\u003e- Testing the coding plan in the text sample: Coding was performed in a sample of the text; then, to ensure the stability of the coding, the data were controlled by two other research team members.\u003c/p\u003e\n \u003cp\u003e- Coding the entire text: After the research team reached consensus regarding the stability of the coding, the coding process was applied to the entire text.\u003c/p\u003e\n \u003cp\u003e- Re-examining the codes regarding coding stability: The primary codes, sub-categories, and categories were rechecked by two research team members and those experienced in qualitative research to prevent human error.\u003c/p\u003e\n \u003cp\u003e- Drawing conclusions from the coded and categorized data: This step involved identifying the features and dimensions of the categories, the relationships between the categories, discovering the patterns, and testing the codes against the full range of the data.\u003c/p\u003e\n \u003cp\u003e- Finally, to ensure the study\u0026apos;s replicability, the categories were reported [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eIn the analysis of the transcripts, 14 subcategories and four categories emerged. The total number of interviews was 23 (six with midwives and 17 with mothers). All the mothers reported that their pregnancy was planned. Four of them reported that they had not received any support during their postpartum period. Six mothers had one source of support, and seven mothers had all three sources of support (husband, own family, and in-laws). Thirteen mothers were housewives and four were employed. The mean duration of each interview was 57.92 minutes. Additional demographic data pertinent to the study participants are summarized in (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of the participants of the individual interviews\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean age\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of childbirth\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTime elapsed since childbirth (months)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eService providers (midwives)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e44.\u003cstrong\u003e52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s degree, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eService recipients (mothers)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;30.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree or higher, n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u0026thinsp;=\u003c/strong\u003e\u0026thinsp;NVD\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e8 =\u003c/strong\u003e C/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u0026ndash;3 months: n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s degree, n\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;6 months: n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBelow high school diploma, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026ndash;9 months: n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;12 months: n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the conventional content analysis led to four categories and 14 subcategories. These categories are summarized in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe results of the conventional content analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ecategories\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003esubcategories\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital dissatisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFear\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistorted body image\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorrying about the husband\u0026apos;s extramarital affairs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eThe husband\u0026apos;s and family\u0026apos;s supportive role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of support from the husband\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u0026apos;s lack of participation in counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining sessions, and having the support of the family\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePsychological conflicts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorrying about the child\u0026apos;s health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorrying about the child\u0026apos;s future\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmbivalence towards the child\u0026apos;s birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorrying about personal health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eDefective health system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe lack of proper counseling by trained personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-standard physical space\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInadequate number of healthcare service providers.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.1. Marital dissatisfaction: This category has four subcategories: Fear, distorted body image, fatigue, and worrying about the husband\u0026apos;s extramarital affairs.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e3.1.1. Fear: Due to the physical and psychological changes occurring in women during pregnancy and after childbirth, some women are afraid of having sex at this time due to possible complications:\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother (nine months after childbirth) said: \u0026quot;My body felt dry. I was afraid because of this dry sensation in my body. I didn\u0026apos;t like to have sex before two months had passed since my childbirth because I was afraid the stitches would open up\u0026quot; (participant 5).\u003c/p\u003e\n\u003cp\u003e- Another mother (five months after childbirth) said: \u0026quot;I was afraid of intercourse because of my bleeding. I was afraid that if I had sex, my bleeding would get worse, or that my uterus would rupture due to bleeding and I\u0026apos;d get hurt\u0026quot; (participant 11).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.1.2. Distorted body image: Some changes occurring during pregnancy take a long time to return to their original state after childbirth, or they rarely do. These changes, which include skin discoloration (face, genitals, and breasts), weight gain, hair loss, or sagging breasts, cause worries for many mothers or reduce the quality of sex for many couples.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother who had a five-month-old infant said, \u0026quot;I feel that my body is not stitched up properly and its shape is distorted and looks all weird. I don\u0026apos;t like my vagina myself. My breasts are sagging, and I don\u0026apos;t like them either\u0026quot; (participant 15).\u003c/p\u003e\n\u003cp\u003e- Another mother (seven months after childbirth) said worriedly: \u0026quot;I\u0026rsquo;m very upset that my body has become dark and I\u0026apos;ve gotten fat. I don\u0026apos;t feel alright. I\u0026apos;m always browsing [social media] channels that discuss how you can lose weight. My husband tells me to do something for myself because I\u0026apos;m a mess\u0026quot; (participant 7).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.1.3. Fatigue: Having gone through pregnancy and childbirth as well as the restlessness and excessive crying of the infant in the first weeks cause excessive fatigue in the mother, which can reduce sexual desire and affect the sexual relationship of the couple:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother with a seven-month-old infant noted: \u0026quot;I distance myself a lot from my husband because I\u0026apos;m tired and have insomnia. I think everyone likes sex. It\u0026apos;s a lie to say I don\u0026apos;t like it. My husband wants it too, but I tell him I\u0026apos;m tired\u0026quot; (participant 7).\u003c/p\u003e\n\u003cp\u003e- Another mother with a five-month-old infant stated: \u0026quot;I don\u0026apos;t think a mother hates having sex, but what can she do? Fatigue makes people assign the least priority to these things. Sometimes my husband gets nervous and disappointed because we haven\u0026rsquo;t had sex for a while\u0026quot; (participant 17).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.1.4. Worrying about the husband\u0026apos;s extramarital affairs: Due to the physical and psychological changes during pregnancy and after childbirth, the sexual relationship of the couple sometimes gets disturbed. This issue makes some men seek to satisfy their unfulfilled sexual needs during pregnancy and after childbirth through extramarital affairs. Although most women do not express this concern, they always feel its possibility:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A service provider with about 30 years of experience in service provision to mothers said: \u0026quot;I remember that a patient had come to the clinic once. According to her, her husband said that her body had become loose after childbirth and wasn\u0026apos;t like it was before, so he didn\u0026apos;t feel the way he used to about it. She said she was afraid he might sleep with someone else\u0026quot; (participant 23).\u003c/p\u003e\n\u003cp\u003e- Another employee of the health centers with 15 years of work experience believed that: \u0026quot;The conditions of a mother have changed a lot in the postpartum period compared to before pregnancy; one must understand when this woman can be mentally and physically ready to have sex. Sometimes, the husband doesn\u0026apos;t understand the mother well and goes after extramarital affairs\u0026quot; (participant 21).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.2. The husband\u0026apos;s and family\u0026apos;s supportive role: This category has three sub-categories: Lack of support from the husband, men\u0026apos;s lack of participation in counseling and training sessions, and having the support of the family.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e3.2.1. Lack of support from the husband: The mother becomes very fragile and irritable during this period due to experiencing problems related to the postpartum period, such as bleeding, pain, insomnia, fatigue, and worrying for the infant. Not having the support of the husband during this period can aggravate her problems. Nonetheless, mothers who benefit from the support of close people, especially their husband, during this period feel more capable of tolerating and adapting to the stress and hardships of this period:\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother with a three-month-old infant noted: \u0026quot;I was completely alone for about ten days. I had no one to take care of me. My husband was at work until the evening, slept in a separate room at night and closed the door so that the baby\u0026apos;s crying wouldn\u0026apos;t bother him\u0026quot; (participant 6).\u003c/p\u003e\n\u003cp\u003e- Another mother with an 11-month-old infant said: \u0026quot;My husband is a bank employee; he should focus all his attention on his job so that he makes no mistake. I have to do everything by myself. Sometimes, he says, \u0026apos;Well, you\u0026apos;re the mother; it\u0026apos;s the mother\u0026rsquo;s duty!\u0026apos;\u0026quot; (participant 8).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.2.2. Men\u0026apos;s lack of participation in counseling and training sessions: Men\u0026apos;s participation in various areas of SRH can strengthen relationships within the family and increase the sense of responsibility in men. Nonetheless, despite the importance of their participation, their place in important life events, including the postpartum period, is still not well discussed:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- An employee with 27 years of experience providing services in health centers believed: \u0026quot;The husband is abandoned during pregnancy and after childbirth and is not involved in any training anywhere. There\u0026apos;s no role mentioned for the husband in maintaining and improving the family\u0026apos;s reproductive health. Our main problem is the husband! Husbands either don\u0026apos;t visit or don\u0026apos;t believe in training\u0026quot; (participant 22).\u003c/p\u003e\n\u003cp\u003e- A mother whose child was three months old said: \u0026ldquo;When I visit the health center, I only go to get the baby vaccinated, not to get care for myself. Because my husband wants to go to work afterwards, he doesn\u0026apos;t let me ask any questions about myself. He insists that I hurry up, get the baby vaccinated and leave. When he gets angry, it gets out of control. So, I say, \u0026lsquo;OK, let\u0026apos;s go back\u0026rdquo; (participant 6).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.2.3. Having the support of the family: Having family support in the postpartum period can help the mother both physically and psychologically and also effectively reduce her physical and psychological illness:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- One of the service providers said: \u0026quot;The mother is supported by many family members when she is pregnant, but as soon as she gives birth, the family\u0026rsquo;s entire attention goes to the infant, and the mother gets abandoned\u0026quot; (participant 22).\u003c/p\u003e\n\u003cp\u003e- A mother whose infant was two months old and who complained about the lack of support during this time noted: \u0026quot;I had no support at all, neither from my family nor my in-laws. Because I don\u0026apos;t sleep well at night, I\u0026apos;m really suffering. I\u0026apos;m having a hard time \u0026ndash;a very hard time!\u0026quot; (participant 1).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.3. Psychological conflicts: This category emerged with four subcategories: Worrying about the child\u0026apos;s health, worrying about the child\u0026apos;s future, ambivalence towards the child\u0026apos;s birth, and worrying about personal health.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e3.3.1. Worrying about the child\u0026apos;s health: Worrying about the child\u0026apos;s health is the first subcategory of psychological conflicts. Mothers\u0026rsquo; worries are considered normal in some cases, but sometimes, they get abnormally frightened and anxious about their infant\u0026apos;s health:\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother who had a three-month-old infant said: \u0026quot;I heard that some infants get choked to death. I have sometimes breastfed the child and burped him too, but then, he threw up again and might have choked if I weren\u0026apos;t nearby\u0026quot; (participant 16).\u003c/p\u003e\n\u003cp\u003e- Another mother, who was a midwife and whose baby was 11 months old, said: \u0026quot;My biggest concern right now is that I\u0026apos;m not with the baby. Although I trust the nanny, I\u0026rsquo;m more worried about the baby; what if something gets stuck in his throat and the nanny can\u0026apos;t do anything about it?\u0026rdquo; (participant 8).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.3.2. Worrying about the child\u0026apos;s future: Since becoming a mother, women often consider their child and everything about them as the most important concern in their life. Some get worried about their child\u0026apos;s future due to unfavorable and unstable economic conditions or for other reasons:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother with a three-month-old infant noted: \u0026quot;Now I\u0026apos;m mostly concerned about my child. I don\u0026apos;t want my child to experience the hardships that I went through. God gave me this child, but now I\u0026apos;m responsible for him. This sense of responsibility towards the child is very consuming\u0026quot; (participant 6).\u003c/p\u003e\n\u003cp\u003e- A mother who had a four-month-old child said: \u0026quot;Sometimes, I worry a little. Sometimes, I wonder what happens if I\u0026apos;m not there, how will my child grow up?\u0026quot; (participant 2).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.3.3. Ambivalence towards the child\u0026rsquo;s birth: During the postpartum period, although the mother is experiencing the joy of motherhood, she might occasionally feel psychological conflicts and ambivalence, especially if it is her first experience of motherhood, and she might therefore develop concerns about the baby\u0026rsquo;s future in addition to the happiness she feels:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother who had given birth three months before said: \u0026quot;I worry sometimes. I think that becoming a mother is a positive emotion given by God. Before becoming a mother, I wasn\u0026apos;t ready to give up my sleep for anyone or anything, but now, when I\u0026apos;m woken up, I\u0026apos;m happy and not angry. You know, the arrival of the child has given my life a purpose. It\u0026apos;s like a dirt road that was messy, and now, there\u0026apos;s asphalt pavement with a clean and tidy end\u0026quot; (participant 14).\u003c/p\u003e\n\u003cp\u003e- Another mother whose infant was three months old said: \u0026quot;Becoming a mother is a very good feeling, a very special sense. You feel a big change has happened in your life. But at first, I was worried and saw the birth of our child as a bad thing. It was as if my freedom was taken away from me\u0026rdquo; (participant 6).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.3.4. Worrying about personal health: Physical and psychological changes during pregnancy and after childbirth lead to worries about personal health disorders in the mother. At this time, the mother is worried that she may not be able to regain her lost energy or that the problems created will be permanent:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother who had given birth nine months before and complained deeply about the poor quality of postpartum care said: \u0026quot;I don\u0026apos;t want to have children anymore because I\u0026apos;m afraid that the problems I faced after this delivery will happen again. When I was discharged after giving birth and came home, I had problems urinating, and I was in pain until the morning. I could\u0026apos;ve died, but no one believed me!\u0026quot; (participant 5).\u003c/p\u003e\n\u003cp\u003e- A mother who had a five-month-old infant said: \u0026quot;One of the midwives told me that you have varicose veins on your legs. This worried me a lot. I\u0026rsquo;m worried that something might happen to me. Overall, pregnancy, childbirth, and child care harm the body way too much. How should I put it? The body becomes weak and may suffer severe complications later!\u0026quot; (participant 5).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.4. Defective health system: This category has three sub-categories: The lack of proper counseling by trained personnel, non-standard physical space, and inadequate number of healthcare service providers.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e3.4.1 The lack of proper counseling by trained personnel: Due to the changes in the job title of midwives and other healthcare workers in the Ministry of Health and Medical Education, where all of them are now called \u003cem\u003ehealthcare workers\u003c/em\u003e, many caregivers who provide services to clients do not have sufficient information about the subject due to their having multiple professions or not having the time or required expertise about the services they provide:\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A mother whose child was eight months old said: \u0026quot;I\u0026apos;d like them to give me info about how to have sex or use methods of contraception or disease prevention. But no one provides such training. They don\u0026apos;t spend enough time with the mother during this period. Sometimes, they just ask a general question, like \u0026apos;Do you have any marital problems?\u0026apos; If I say no, the doctor or midwife won\u0026apos;t ask me anything else\u0026quot; (participant 13).\u003c/p\u003e\n\u003cp\u003e- A healthcare worker with 15 years of experience said, \u0026quot;I think it would be very good for us as midwives to get some training on communication with the clients, especially with regards to sexual problems and so on. We have issues with this subject. We don\u0026apos;t know what\u0026apos;s right and what\u0026apos;s wrong. Sometimes I don\u0026apos;t know the answer to a mother\u0026apos;s questions or don\u0026apos;t have the confidence to answer them\u0026quot; (participant 19).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.4.2. Non-standard physical space: In order to provide SRH-related care, it is necessary to have a suitable physical space so that mothers and families can easily use these services:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A service provider with 15 years of experience said: \u0026quot;Due to our culture and lack of ability to respect privacy, the mother or her husband can\u0026rsquo;t easily tell us about their sexual problems. For example, I had a client whose husband only had anal sex with her, and although the woman was upset about this, it took her a long time to tell me about it with great difficulty\u0026quot; (participant 22).\u003c/p\u003e\n\u003cp\u003e- A service provider noted: \u0026quot;To be honest, we don\u0026apos;t ask in detail about the mother\u0026apos;s problems. We share the hallway in which we work, and everyone\u0026apos;s listening. Even if we ask, the mother won\u0026apos;t tell the truth in this situation\u0026quot; (participant 18).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.4.3. Inadequate number of service providers: Another crucial factor in providing quality SRH services is having an adequate number of service providers for the family and clients. When the number of caregivers is not proportional to the number of clients, the quality of care decreases:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e- A service provider with 28 years of experience said: \u0026quot;Sometimes, a woman\u0026apos;s husband does not visit because he doesn\u0026apos;t like to be trained by a woman or because the midwife doesn\u0026apos;t give him proper training. The truth is that it is a bit difficult to communicate with a man; it requires skills, knowledge, the presence of a male healthcare worker in the center, and also enough time. All healthcare workers are women right now, and this makes it really difficult\u0026rdquo; (participant 18).\u003c/p\u003e\n\u003cp\u003e- A healthcare worker with 18 years of experience believed, \u0026quot;I think all mothers who are apparently healthy should also be screened psychologically. Sometimes, we examined a mother based on the questions on the website, and the mother was evaluated as healthy, but later, the same mother committed suicide. We don\u0026apos;t have any space for providing psychological counseling here. They\u0026apos;ve given this room to a doctor, who doesn\u0026apos;t do anything at all really!\u0026quot; (participant 19).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe results of the present study showed that in the postpartum period, women often face many obstacles and are not content with their received support, care, and SRH. The results further suggest that women do not have a proper understanding or awareness of their SRH components and rights in the postpartum period, which can affect their low level of postpartum SRH and access to SRH care[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the most important problems reported by the studied women is marital dissatisfaction. Postpartum marital dissatisfaction can be caused by various factors, such as fear, distorted body image, fatigue, and worrying about the husband's extramarital affairs [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Fear is the most important cause of marital dissatisfaction as reported by the participants. Fear of engaging in sex due to vaginal dryness, prolonged bleeding after childbirth, damage to the genitals, and the resulting pain disrupts sex in the postpartum period [\u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA distorted body image was another reason that caused a reduction in marital satisfaction or led to marital dissatisfaction in women. Changes in body image, including weight gain [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], worrying about lost attractiveness for the husband [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], discoloration, loose and sagging breasts, and changes in the color and appearance of the genitals are associated with postpartum depression and hopelessness in women [\u003cspan additionalcitationids=\"CR47 CR48\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe mother's insomnia due to the infant's crying and restlessness in the first weeks postpartum and her loss of energy due to the long course of pregnancy and the stresses of childbirth cause fatigue and ultimately decrease sexual desire, lack of desire to engage in sex, and worrying about the husband's extramarital affairs [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In their review study, Wood et al. showed that women face many sexual and marital problems in the postpartum period due to the problems experienced during childbirth [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The results of another review study conducted by Hajimirzaie et al. also revealed that weight gain, changes in body image, fear, and fatigue are related to decreased sexual functioning in the postpartum period [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe second category extracted in this study was the husband\u0026rsquo;s and family\u0026rsquo;s supportive role in the postpartum period, which includes the dimensions of the lack of support from the husband, men\u0026rsquo;s lack of participation in counseling and training sessions, and having support from the family. Changes and increases in roles multiply the mother's responsibilities, require the expenditure of more energy on her part, reduce her quantity of sleep and cause changes in her lifestyle and reduced participation in social activities. All of these issues can affect the mother's SRH [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost women believe that when they first become a mother, they need support from their parents and husband to accept their new conditions. In this study, mothers who received support reported a better SRH [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Nonetheless, some women, such as those in the marginalized families of Dar es Salaam, Tanzania, who have a low socioeconomic status, are deprived of the help of other family members and even their spouse for cultural reasons [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Some mothers do not receive adequate support during their postpartum period due to their husband\u0026rsquo;s job conditions, the cultural conditions governing their society, and the inability of their husband or families to provide them with any support. This problem leads to dissatisfaction and a decrease in the quality of physical, sexual, and reproductive health in the postpartum period [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSome mothers refrain from receiving support from their families for various reasons. These reasons include family interference in the child's care and feeding, restricting the mother from engaging in sexual relations with her husband for an extended period, and the family's tendency to prescribe traditional medicines for the child [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Ensuring that postpartum women and new parents receive ample support can improve the understanding about SRH and thus enhance the welfare of families [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMen's lack of participation in counseling and training sessions for cultural reasons and other issues, as mentioned in the Results section, leads to the husband\u0026rsquo;s decreased cooperation at home and limits the mother\u0026rsquo;s visits to healthcare centers for receiving services and causes the couple\u0026rsquo;s non-cooperation in using contraceptives [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePsychological conflicts were another factor related to women\u0026rsquo;s postpartum SRH, which emerged with four subcategories: Worrying about personal health, worrying about the child's health, worrying about the child's future, and ambivalence towards the child\u0026rsquo;s birth [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Most of the mothers reported that because of their new responsibilities, they had become anxious and worried about many things after giving birth. They thought that the birth of the child caused depression, decreased their energy, led to anemia, malaise, insomnia, and related problems, and decreased their psychological and physical health. They reported that the birth of their child had made them socially isolated. In their qualitative study, Alderdice et al. also reported that many aspects of mothers' health were compromised after having children, e.g., their vitality, self-esteem, and positive functioning. They felt lively and joyful only a few hours each day, and often reported fatigue and illness [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Women in the postpartum period face psychological conflicts such as feelings of inadequacy, postpartum depression, anxiety, guilt, and identity changes.. These psychological challenges can significantly affect women's mental well-being, interpersonal relationships, and postpartum sexual and reproductive health (SRH). Some believe that the occurrence of illness in women, especially postpartum depression, can cause depression in the husbands [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], which further highlights the importance of the physical and mental health of women and families and reveals the necessity of promoting this index for policy-makers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDue to the unstable economic conditions, some mothers reported that fear of their own illness or death, which could change their child's future, explained why they worried about the child's health and future. Aside from the self-worth and pleasurable feelings associated with the experience of motherhood, some of the participating mothers reported ambivalent feelings about not having the required self-confidence to care for their child[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Some working mothers argued that being away from their child for many hours each day was the reason for their worries and concerns. Receiving social support, having childcare facilities in the workplace, or getting support from friends and acquaintances are factors that can significantly reduce the concerns of mothers and families in this regard [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA defective healthcare system, with a lack of proper counseling by trained personnel, non-standard physical space, and an insufficient number of healthcare service providers, severely affects women's postpartum SRH. The broad range of midwives' responsibilities, the recruitment of staff who lack the expertise in SRH, midwives' lack of up-to-date information, the lack of timely presence of healthcare workers at the place of service, and the lack of respect for privacy are among the reasons for the service recipients' mistrust of the health system and its employees. All these factors cause dissatisfaction, reduce the motivation to visit and receive services, and ultimately reduce the SRH of those who visit these centers, especially mothers [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Most mothers and midwives emphasized that healthcare workers and midwives need to participate in retraining courses and learn new information [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. In all service provision centers in the study setting, all healthcare providers are women. Considering the cultural conditions prevailing in the studied region, many men are reluctant to seek health services and SRH counseling from a caregiver of the opposite sex [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. The insufficient number of personnel in proportion to the number of clients, long waiting times, not allocating the necessary time to providing high-quality services and counseling, and not having a suitable space for the husbands to wait contribute to men's reluctance to participate in counseling and training sessions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Deficiencies in the health system concerning postpartum sexual and reproductive health (SRH) care include the lack of comprehensive care programs, insufficient training for healthcare providers, and limited access to specialized counseling services. Cultural barriers, inadequate integration of SRH services into postpartum care, and poor follow-up mechanisms further contribute to the neglect of women's SRH needs. Recent studies have also emphasized the need to address postpartum sexual health as part of routine maternal care [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese gaps highlight the need for policy reforms, provider education, and the development of accessible, integrated SRH services in postpartum care protocols.\u003c/p\u003e\u003cp\u003eIn Ilam, cultural taboos, traditional gender roles, and limited social support hinder women\u0026rsquo;s access to postpartum SRH care and open discussions.\u003c/p\u003e\u003cp\u003eThe findings of this study align with previous research on postpartum SRH, highlighting similar challenges across different cultural and healthcare contexts. However, unique sociocultural factors in Ilam further influence women's experiences, differentiating these results from those in other regions. Future studies should explore these contextual variations to develop more tailored interventions.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThis study was conducted on postpartum women in Iran. One limitation of this study is that factors such as the lactational status and related hormonal influences were not specifically assessed, as the study focused solely on the inductively derived categories and subcategories emerging from participants' narratives through a conventional content analysis approach.\u003c/p\u003e\u003cp\u003eThe results of This study can be used for comparison purposes, but the findings may not be generalizable to other regions due to the unique cultural conditions and their impact on the subject.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study examined women's perception of the concept of postpartum SRH. This study emphasizes the need for educational programs, better counseling services, and supportive policies to improve postpartum SRH care. In most political and health plans, SRH only includes women's health during pregnancy and also family planning, while other aspects of health and women's postpartum SRH are ignored. As demonstrated by the study findings, SRH is critical in the postpartum period.\u003c/p\u003e\u003cp\u003eThe lack of sufficient attention to mothers\u0026rsquo; health for various reasons, such as the lack of a standard protocol to examine mothers' postpartum SRH, a defective health system, the lack of sufficient supervision over service provision systems, men's lack of participation in counseling and training sessions, and the limited knowledge of service providers, husbands, and families all reduce women\u0026rsquo;s postpartum SRH. By resolving these deficiencies, health policy-makers and decision-makers should be able to improve the postpartum health of mothers, which is critical and guarantees the health of not only the mothers, but also the other family members. Improving postpartum SRH requires education, integration of services, healthcare provider training, psychological support, and policy reforms to ensure better access and equity.\u003c/p\u003e\u003cp\u003eFuture research can address gaps in postpartum SRH care through longitudinal studies, culturally tailored interventions, exploring family roles, and developing inclusive healthcare models. Additionally, qualitative methods can provide deeper insights into women's experiences.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePTSD: Posttraumatic Stress Disorder\u003c/p\u003e\n\u003cp\u003eSRH: Sexual and Reproductive Health \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNICU:\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eNeonatal Intensive Care Unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was approved by the Research Council of the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, and a code of ethics was obtained for it too (IR.TUMS.FNM.REC.1401.072, date: 09/28/2022). The authors corresponded with Ilam University of Medical Sciences to obtain permission for sampling the health centers in Ilam. Eligible mothers provided written and verbal consent for participation in the study. Each research stage was carried out according to the ethical principles of the World Medical Association\u0026rsquo;s Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was approved by the Research Council of the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, and a code of ethics was obtained for it too (IR.TUMS.FNM.REC.1401.072, date: 09/28/2022). The authors corresponded with Ilam University of Medical Sciences to obtain permission for sampling the health centers in Ilam. Eligible mothers provided written and verbal consent for participation in the study. Each research stage was carried out according to the ethical principles of the World Medical Association\u0026rsquo;s Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are included in the manuscript.\u003c/p\u003e\n\u003cp\u003eThe data collected in this study were included in this manuscript. The data have not been stored in a publicly accessible repository. The data sets used in the analysis that support the conclusions of this study can be obtained from the corresponding author upon a reasonable request. Of course, after obtaining permission from the Ethics Committee of Tehran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript is a part of the thesis which was registered in Tehran University of Medical Sciences and has no any supported grant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZBM: She is the corresponding author and also the supervisor of this study. She has played a key role in the conceptualization, supervision, data interpretation, and critical revision of the manuscript.Conceived and designed the experiments; Analyzed and interpreted the data; Project administration; Contributed reagents, materials, analysis tools or data.\u003c/p\u003e\n\u003cp\u003eNR: Conceived and designed the experiments; Performed the experiments; Contributed reagents, materials, analysis tools or data; Wrote the paper.\u003c/p\u003e\n\u003cp\u003eMN and AT: Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Software; Validation ; Wrote the paper; Review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eSM: Contributed reagents, materials, analysis tools or data; Wrote the paper, Review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eAll authors They approved the manuscript draft, revised it, and approved the final version for publication and agreed to be accountable for all aspects of the research. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is derived from a PhD dissertation in Reproductive Health, funded by the Vice-Chancellor of Research and Technology of Tehran University of Medical Sciences. We are grateful to the Iranian Ministry of Health and Medical Education, Tehran University of Medical Sciences, Faculty of Nursing and Midwifery, and all the mothers, healthcare workers, and midwives who participated in our research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; E-mails, City and country:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eNR\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: [email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIlam, Iran\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Midwifery, School of nursing and midwifery, Ilam University of Medical Sciences, Ilam, Iran\u003c/p\u003e\n\u003cp\u003eDepartment of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eM N\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: [email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTehran, Iran\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eA T\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: [email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\[email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIlam, Iran\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSchool of Medicine, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSM: [email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTehran, Iran\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eZ BM\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: [email protected]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Zahra Behboodi Moghadam is corresponded author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTehran, Iran\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRezaei N, Azadi A, Zargousi R, Sadoughi Z, Tavalaee Z, Rezayati M. Maternal health-related quality of life and its predicting factors in the postpartum period in Iran. \u003cem\u003eScientifica\u003c/em\u003e. 7 (2016), DOI: 10.1155/2016/8542147.\u003c/li\u003e\n\u003cli\u003eAlvarez-Nieto C, Pastor-Moreno G, Grande-Gasc\u0026oacute;n ML, Linares-Abad M. Sexual and reproductive health beliefs and practices of female immigrants in Spain: A qualitative study. \u003cem\u003eReprod Health\u003c/em\u003e. 12(1) (2015) 1-10, DOI: 10.1186/s12978-015-0071-2\u003c/li\u003e\n\u003cli\u003eRezaei N, Arman A, Kourosh S, Reza V. Postpartum sexual functioning and its predicting factors among Iranian women. \u003cem\u003eMalays J Med Sci\u003c/em\u003e. 24(1) (2017) 94.\u003c/li\u003e\n\u003cli\u003eRazurel C, Bruchon-Schweitzer M, Dupanloup A, Irion O, Epiney M. Stressful events, social support and coping strategies of primiparous women during the postpartum period: A qualitative study. \u003cem\u003eMidwifery\u003c/em\u003e. 27(2) (2011) 237-42.\u003c/li\u003e\n\u003cli\u003eApi O, Breyman C, \u0026Ccedil;etiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. \u003cem\u003eTurk J Obstet Gynecol\u003c/em\u003e. 12(3) (2015) 173, https://doi.org/10.4274/tjod.2015.03.03\u003c/li\u003e\n\u003cli\u003eSayer EP, et al. Depression, anxiety, and stress in pregnancy and postpartum: A longitudinal study during the COVID-19 pandemic. \u003cem\u003eMidwifery\u003c/em\u003e. 108 (2023) 103655, doi:10.1016/j.midw.2023.103655.\u003c/li\u003e\n\u003cli\u003eBalogun OO, Fagbamigbe AF. Timing of postnatal care and maternal health outcomes among women in Nigeria: Evidence from the Nigeria Demographic and Health Survey. Niger J Clin Pract. 24(1) (2021) 46-55. doi:10.4103/njcp.njcp_123_20.\u003c/li\u003e\n\u003cli\u003eKuo C. F, \u0026amp; Yang C. Y. The Relationship between Postnatal Care and Maternal Health Outcomes: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 16(13) (2019) 2285, doi:10.3390/ijerph16132285.\u003c/li\u003e\n\u003cli\u003eVerreault N, Barlow M, Ritchie K, et al. Maternal mental health after childbirth: A systematic review of psychosocial interventions. Heliyon. 9(4) (2023) e12962, doi:10.1016/j.heliyon.2023.e12962.\u003c/li\u003e\n\u003cli\u003eAcele E\u0026Ouml;, Kara\u0026ccedil;am Z. Sexual problems in women during the first postpartum year and related conditions. \u003cem\u003eJ Clin Nurs\u003c/em\u003e. 21(7-8) (2012) 929-37. https://doi.org/10.1111/j.1365-2702.2011.03882.x\u003c/li\u003e\n\u003cli\u003eMorof D, Barrett G, Peacock J, Victor CR, Manyonda I. Postnatal depression and sexual health after childbirth. \u003cem\u003eObstet \u003c/em\u003e\u003cem\u003eGynecol\u003c/em\u003e. 102(6) (2003) 1318-25, https://doi.org/10.1016/j.obstetgynecol.2003.08.020\u003c/li\u003e\n\u003cli\u003eYilmaz FA, Avci D, Aba YA, Ozdilek R, Dutucu N. Sexual dysfunction in postpartum Turkish women: Its relationship with depression and some risk factors. \u003cem\u003eAfr J Reprod Health\u003c/em\u003e. 22(4) (2018) 54-63, doi:10.29063/ajrh2018/v22i4.6\u003c/li\u003e\n\u003cli\u003eGeorge M, Johnson AR, Basil RC, Murthy SN, Agrawal T. Postpartum and newborn care: A qualitative study. \u003cem\u003eIndian J Community Health\u003c/em\u003e. 30(2) (2018) 163-5, doi:10.47203/IJCH.2018.v30i02.012\u003c/li\u003e\n\u003cli\u003eLomoro O, Ehiri J, Qian X, Tang S. Mothers\u0026rsquo; perspectives on the quality of postpartum care in central Shanghai, China. \u003cem\u003eInt J Qual Health Care\u003c/em\u003e. 14(5) (2002) 393-401, https://doi.org/10.1093/intqhc/14.5.393\u003c/li\u003e\n\u003cli\u003eFuchs A, Czech I, Dulska A, Drosdzol-Cop A. The impact of motherhood on sexuality. \u003cem\u003eGinekol Pol\u003c/em\u003e. 92(1) (2021) 1-6, doi:10.5603/GP.a2020.0162\u003c/li\u003e\n\u003cli\u003eKrivats-Arba K, Aavik A. A woman with special needs in maternity care in cooperation with a midwife and an occupational therapist: Building up the subject in Tallinn Health Care College in curriculum of midwifery. \u003cem\u003eEur J Midwifery\u003c/em\u003e. 7(Suppl 1) (2023).\u003c/li\u003e\n\u003cli\u003eWood SN, Pigott A, Thomas HL, Wood C, Zimmerman LA. A scoping review on women\u0026rsquo;s sexual health in the postpartum period: Opportunities for research and practice within low- and middle-income countries. \u003cem\u003eReprod Health\u003c/em\u003e. 19(1) (2022) 1-34. doi:10.1186/s12978-022-01399-6\u003c/li\u003e\n\u003cli\u003eRashidian A, Karimi-Shahanjarini A, Khosravi A, Elahi E, Beheshtian M, Shakibazadeh E, Khabiri R, Arab M, Zakeri MR. Iran\u0026apos;s Multiple Indicator Demographic and Health Survey (IrMIDHS-2010): Study protocol. \u003cem\u003eInt J Prev Med\u003c/em\u003e. 5(5) (2014) 632-42, doi:10.4103/2008-7802.132775.\u003c/li\u003e\n\u003cli\u003eCheng C-Y, Fowles ER, Walker LO. Postpartum maternal health care in the United States: A critical review. \u003cem\u003eJ Perinat Educ\u003c/em\u003e. 15(3) (2006) 34, doi:10.1624/105812406X119002\u003c/li\u003e\n\u003cli\u003eDeJudicibus MA, McCabe MP. Psychological factors and the sexuality of pregnant and postpartum women. \u003cem\u003eJ Sex Res\u003c/em\u003e. 39(2) (2002) 94-103, doi:10.1080/00224490209552128\u003c/li\u003e\n\u003cli\u003eMunabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: A qualitative evidence synthesis. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e. 11(11) (2018) CD011558, doi:10.1002/14651858.CD011558.pub2\u003c/li\u003e\n\u003cli\u003eHajimirzaie SS, Tehranian N, Razavinia F, Khosravi A, Keramat A, Haseli A, Mirzaii M, Mousavi SA. Evaluation of couple\u0026apos;s sexual function after childbirth with the biopsychosocial model: A systematic review of systematic reviews and meta-analysis. \u003cem\u003eIran J Nurs Midwifery Res\u003c/em\u003e. 26(6) (2021) 469-78, doi:10.4103/ijnmr.IJNMR_426_20\u003c/li\u003e\n\u003cli\u003eGhanbari-Homaie S, Meedya S, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Mohammadi E, Mirghafourvand M. Recommendations for improving primiparous women\u0026apos;s childbirth experience: Results from a multiphase study in Iran. \u003cem\u003eReprod Health\u003c/em\u003e. 18(1) (2021)146, doi:10.1186/s12978-021-01196-7\u003c/li\u003e\n\u003cli\u003eBrockington, I. F, \u0026amp; Kumar, R. Motherhood and mental health: A review of the literature. Psychological Medicine. 51(6) (2021) 985-993, doi:10.1017/S0033291720000322.\u003c/li\u003e\n\u003cli\u003eHamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: A scoping review of factors influencing maternal mortality and maternal health service use in India. \u003cem\u003ePublic Health Rev\u003c/em\u003e. 41 (2020) 1-24, doi:10.1186/s40985-020-00125-6\u003c/li\u003e\n\u003cli\u003eMaluka SO, Peneza AK. Perceptions on male involvement in pregnancy and childbirth in Masasi District, Tanzania: A qualitative study. \u003cem\u003eReprod Health\u003c/em\u003e. 15(1) (2018) 68, doi:10.1186/s12978-018-0512-9\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZhou Y, Sze S, \u0026amp; Smiley, A. The impact of socioeconomic status on maternal health outcomes: A systematic review. \u003c/strong\u003eInternational Journal of Environmental Research and Public Health. 19(1) (\u003cstrong\u003e2022\u003c/strong\u003e) 321, doi:10.3390/ijerph190100321. \u003c/li\u003e\n\u003cli\u003eFathalla MF, Sinding SW, Rosenfield A, Fathalla MM. Sexual and reproductive health for all: A call for action. \u003cem\u003eLancet\u003c/em\u003e. 2006;368(9552):2095-100.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBarker G, Moraes M, \u0026amp; Rios, T. Achieving SDG 3 and SDG 5: The Role of Gender Equality in Health. \u003c/strong\u003eGlobal Health Action, 15(1) (\u003cstrong\u003e2022\u003c/strong\u003e) 2035401, doi:10.1080/16549716.2022.2035401.\u003c/li\u003e\n\u003cli\u003eUnited Nations. Progress report on the sustainable development goals: Health and gender equality. United Nations Publications (2024), DOI: 10.18356/sdg2024-health-gender.\u003c/li\u003e\n\u003cli\u003eOnah H, Iloabachie G, Obi S, Ezugwu F, Eze J. Nigerian male sexual activity during pregnancy. \u003cem\u003eInt J Gynecol Obstet\u003c/em\u003e. 76(2) (2002) 219-23.\u003c/li\u003e\n\u003cli\u003eGruskin S, Yadav V, Castellanos-Usigli A, Khizanishvili G, Kism\u0026ouml;di E. Sexual health, sexual rights and sexual pleasure: Meaningfully engaging the perfect triangle. \u003cem\u003eSex Reprod Health Matters\u003c/em\u003e. 27(1) (2019) 1593787, doi:10.1080/26410397.2019.1593787\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. \u003cem\u003eInt J Qual Health Care\u003c/em\u003e. 19(6) (2007) 349-57.\u003c/li\u003e\n\u003cli\u003eGuba E. G, \u0026amp; Lincoln Y. S. The Sage Handbook of Qualitative Research (5th ed.). SAGE Publications. 2018, doi:10.4135/9781071803868.\u003c/li\u003e\n\u003cli\u003eMorse JM. Qualitative Health Research: Creating a New Discipline. Left Coast Press; 2016.\u003c/li\u003e\n\u003cli\u003eWilliams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. \u003cem\u003eAustralas J Paramed\u003c/em\u003e. 2010;8:1-13.\u003c/li\u003e\n\u003cli\u003eWildemuth BM. Applications of Social Research Methods to Questions in Information and Library Science. 2nd ed. Libraries Unlimited; 2016.\u003c/li\u003e\n\u003cli\u003eFlick U.An Introduction to Qualitative Research (6th ed.). SAGE Publications. 2018, doi:10.4135/9781526415383.\u003c/li\u003e\n\u003cli\u003eMbekenga CK, Pembe AB, Christensson K, Darj E, Olsson P. Informal support to first-parents after childbirth: A qualitative study in low-income suburbs of Dar es Salaam, Tanzania. \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e. 11 (2011) 98, doi:10.1186/1471-2393-11-98\u003c/li\u003e\n\u003cli\u003eRathfisch G, Dikencik BK, Kizilkaya Beji N, Comert N, Tekirdag AI, Kadioglu A. Effects of perineal trauma on postpartum sexual function. \u003cem\u003eJ Adv Nurs\u003c/em\u003e. 66(12) (2010) 2640-9.\u003c/li\u003e\n\u003cli\u003ePardell-Dominguez L, Palmieri PA, Dominguez-Cancino KA, Camacho-Rodriguez DE, Edwards JE, Watson J, Leyva-Moral JM. The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry. \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e. 21(1) (2021) 1-13.\u003c/li\u003e\n\u003cli\u003eZgliczynska M, Zasztowt-Sternicka M, Kosinska-Kaczynska K, Szymusik I, Pazdzior D, Durmaj A, Szlachta M, Bartnik P, Wielgos M. Impact of childbirth on women\u0026apos;s sexuality in the first year after the delivery. \u003cem\u003eJ Obstet Gynaecol Res\u003c/em\u003e. 47(3) (2021) 882-92.\u003c/li\u003e\n\u003cli\u003eDominoni M, Gritti A, Bergante C, Pasquali MF, Scatigno AL, De Silvestri A, Gardella B. Genital perception and vulvar appearance after childbirth: A cohort analysis of genital body image and sexuality. \u003cem\u003eArch Gynecol Obstet\u003c/em\u003e. 307(3) (2023) 813-9, doi:10.1007/s00404-022-06826-4\u003c/li\u003e\n\u003cli\u003eKerrigan D, McDonald S, McDonald S. Obesity and normal birth: A qualitative study of clinician\u0026rsquo;s management of obese women during labour. \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e. 15 (2015) 212, doi:10.1186/s12884-015-0673-2\u003c/li\u003e\n\u003cli\u003eRahmani A, Fallahi A, Allahqoli L, Grylka-Baeschlin S, Alkatout I. How do new mothers describe their postpartum sexual quality of life? A qualitative study. \u003cem\u003eBMC Womens Health\u003c/em\u003e. 23 (2023) 477, doi:10.1186/s12905-023-02619-2\u003c/li\u003e\n\u003cli\u003eYan J, Zhang Y, Zhang L. Gestational weight gain and risk of postpartum depression: A meta-analysis. \u003cem\u003ePsychiatry Res\u003c/em\u003e. 310 (2022) 114448, doi:10.1016/j.psychres.2022.114448\u003c/li\u003e\n\u003cli\u003eTavares IM, Nobre PJ, Heiman JR, Rosen NO. Longitudinal associations between mindfulness and changes to body image in first-time parent couples. \u003cem\u003eBody Image\u003c/em\u003e. 44 (2023) 187-96.\u003c/li\u003e\n\u003cli\u003eBrand\u0026atilde;o T, Brites R, Nunes O, Hip\u0026oacute;lito J. Posttraumatic growth after childbirth in women: A systematic review. \u003cem\u003eJ Clin Psychol Med Settings\u003c/em\u003e. 27(2) (2020) 318-30, doi:10.1007/s10880-020-09720-w\u003c/li\u003e\n\u003cli\u003eKapa HM, Litteral JL, Keim SA, Jackson JL, Schofield KA, Crerand CE. Body image dissatisfaction, breastfeeding experiences, and self-efficacy in postpartum women with and without eating disorder symptoms. \u003cem\u003eJ Hum Lact\u003c/em\u003e. 38(4) (2022) 633-43.\u003c/li\u003e\n\u003cli\u003eHosseini Tabaghdehi M, Keramat A, Kolahdozan S, Shahhosseini Z, Moosazadeh M, Motaghi Z. Positive childbirth experience: A qualitative study. \u003cem\u003eNurs Open\u003c/em\u003e. 7(4) (2020) 1233-8, doi:10.1002/nop2.499\u003c/li\u003e\n\u003cli\u003eDavis J, Vyankandondera J, Luchters S, Simon D, Holmes W. Male involvement in reproductive, maternal and child health: A qualitative study of policymaker and practitioner perspectives in the Pacific. \u003cem\u003eReprod Health\u003c/em\u003e. 13(1) (2016) 1-11.\u003c/li\u003e\n\u003cli\u003eAlderdice F, Gargan P. Exploring subjective wellbeing after birth: A qualitative deductive descriptive study. \u003cem\u003eEur J Midwifery\u003c/em\u003e. 3 (2019).\u003c/li\u003e\n\u003cli\u003evan Vulpen M, Heideveld-Gerritsen M, van Dillen J, Oude Maatman S, Ockhuijsen H, van den Hoogen A. First-time fathers\u0026apos; experiences and needs during childbirth: A systematic review. \u003cem\u003eMidwifery\u003c/em\u003e. 94 (2021) 102921, doi:10.1016/j.midw.2020.102921\u003c/li\u003e\n\u003cli\u003eBunda B. S, \u0026amp; Amani, J. Factors influencing couples\u0026apos; decision-making on family planning in Tanzania: A qualitative study\u003cstrong\u003e. \u003c/strong\u003eReproductive Health. 20(1) (2023) 50, doi:10.1186/s12978-023-00512-w.\u003c/li\u003e\n\u003cli\u003eBennetter KE, Richardsen KR, V\u0026oslash;llestad NK, Jenum AK, Robinson HS, Mdala I, Waage CW. Associations between social support and physical activity in postpartum: A Norwegian multi-ethnic cohort study. \u003cem\u003eBMC \u003c/em\u003e\u003cem\u003ePublic Health\u003c/em\u003e. 23(1) (2023) 1-12.\u003c/li\u003e\n\u003cli\u003eGurung R, Ruysen H, Sunny AK, Day LT, Penn-Kekana L, M\u0026aring;lqvist M, Ghimire B, Singh D, Basnet O, Sharma S. Respectful maternal and newborn care: Measurement in one EN-BIRTH study hospital in Nepal. \u003cem\u003eBMC \u003c/em\u003e\u003cem\u003ePregnancy Childbirth\u003c/em\u003e. 21(1) (2021) 1-13.\u003c/li\u003e\n\u003cli\u003eYin R.K Y. Health and well-being in the 2030 agenda for sustainable development: A comprehensive approach. Global health action. 13(sup1) (2020) 1682265, doi:\u003cu\u003ehttps://doi.org/10.1080/16549716.2020.1682265\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eChen Y, N Patel, T Robinson. Advances in postpartum care: Integrating sexual health into routine follow-up. Journal of Women\u0026apos;s Health Research. 29(1) (2025) 34-42, doi:\u003cu\u003ehttps://doi.org/10.1097/JWR.0000000000000452\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eKhalil A, S Wernicke, A Langer. Addressing postpartum sexual health: A priority for maternal well-being. International Journal of Gynecology \u0026amp; Obstetrics. 167(2) (2024) 250-8, doi:\u003cu\u003ehttps://doi.org/10.1002/ijgo.14789\u003c/u\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Females, Women's, qualitative study, Postpartum, Sexual Health, Reproductive Health","lastPublishedDoi":"10.21203/rs.3.rs-7349600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7349600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDespite the significance of the postpartum period, women's postpartum sexual and reproductive health (SRH) has been neglected. This study examines women's perceptions and experiences of SRH in the postpartum period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis qualitative study utilized conventional content analysis. The research was conducted in health centers in Ilam, Iran. The target population comprised parous women (six weeks to one year after childbirth). Sampling took place from November 5, 2022, to March 16, 2023. In-depth, semi-structured, face-to-face interviews were conducted with 17 women in the first postpartum year and six service providers. Sampling continued purposively until data saturation. All interviews were audio-recorded and then transcribed. The transcripts were analyzed based on the steps proposed by Zhang and Wildemuth\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwenty-three women participated in the study (six midwives and 17 mothers). The analysis of the interviews led to the emergence of four categories: marital dissatisfaction, husband's and family's supportive role, psychological conflicts, and a defective health system, with 14 subcategories. These findings highlight the complex interplay of emotional, social, and systemic factors that influence women's postpartum sexual and reproductive health, emphasizing the need for comprehensive support and targeted interventions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study results indicate that women's postpartum SRH has been neglected for various reasons, and women themselves do not have a comprehensive and correct perception of this period. Multifaceted interventions are needed in the postpartum period to improve women's SRH.\u003c/p\u003e","manuscriptTitle":"Women's Postpartum Sexual and Reproductive Health: A Qualitative Study in an Iranian setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-29 19:56:32","doi":"10.21203/rs.3.rs-7349600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-25T05:37:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T17:49:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320339794951044172967358982545275665258","date":"2025-09-19T07:50:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T08:41:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334932339210251777349746308377332462284","date":"2025-09-18T08:17:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237813307010580752513426206250832212394","date":"2025-09-18T07:24:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T05:22:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T04:58:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T04:57:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-08-11T20:57:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1004d065-514d-4e29-95db-6e76b4f6cc62","owner":[],"postedDate":"September 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:00:03+00:00","versionOfRecord":{"articleIdentity":"rs-7349600","link":"https://doi.org/10.1186/s12978-025-02232-6","journal":{"identity":"reproductive-health","isVorOnly":false,"title":"Reproductive Health"},"publishedOn":"2025-12-16 15:57:22","publishedOnDateReadable":"December 16th, 2025"},"versionCreatedAt":"2025-09-29 19:56:32","video":"","vorDoi":"10.1186/s12978-025-02232-6","vorDoiUrl":"https://doi.org/10.1186/s12978-025-02232-6","workflowStages":[]},"version":"v1","identity":"rs-7349600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7349600","identity":"rs-7349600","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}