A Psychometric Study of the Persian Pregnancy Coercion Questionnaire: Assessing Reliability, Validity, and Implications for Reproductive Autonomy in Iranian Women

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This study aimed to psychometrically validate the Persian version of the Pregnancy Coercion Questionnaire (PCQ) to address this gap and enhance reproductive health equity in Persian-speaking populations. Methods: A cross-sectional study was carried out among 200 married women aged 15–49 years with histories of unintended pregnancy, recruited through stratified cluster random sampling from health centers in Tabriz, Iran. The PCQ underwent rigorous translation, including forward-backward translation and expert panel review. Psychometric evaluation encompassed content validity (Content Validity Index [CVI], Content Validity Ratio [CVR]), face validity, internal consistency (Cronbach’s α), and exploratory factor analysis (EFA) using Principal Axis Factoring with varimax rotation. Analyses were performed in SPSS. Results: The Persian PCQ demonstrated strong internal consistency (α = 0.85). EFA revealed a two-factor structure— pregnancy coercion and condom manipulation —explaining 57.53% of the variance. Content validity indices were robust (CVI: 0.80–1.00; CVR: 0.62–1.00), with no floor/ceiling effects. Significant associations were observed between coercion and lower education, unemployment, and having 1–3 children (p < 0.05), though no links emerged with age or income. Conclusion: The Persian PCQ is a valid, reliable tool for assessing reproductive coercion in Iranian women, filling a critical gap in both clinical and research settings. Its adoption can inform targeted interventions to mitigate unintended pregnancies and promote reproductive autonomy, aligning with global efforts to address gender-based disparities in healthcare. This study underscores the need for policy reforms and culturally sensitive strategies to combat coercive reproductive dynamics in Iran. Pregnancy Coercion Questionnaire psychometric unintended pregnancy Persian Introduction Pregnancy coercion, defined as behaviors intended to undermine reproductive autonomy through contraceptive sabotage or explicit pressure to become pregnant, is increasingly recognized as a critical contributor to unintended pregnancies globally( 1 ). Unintended pregnancies continue to pose a substantial public health issue, with an estimated 44% of pregnancies globally categorized as unintended, frequently associated with detrimental maternal and neonatal health outcomes, including preterm birth, low birth weight, and maternal mental health disorders ( 2 , 3 ). In low- and middle-income nations, where access to reproductive health services is often constrained, the repercussions of unintended pregnancies are particularly pronounced, perpetuating cycles of poverty and exacerbating gender inequality( 4 ). In Iran, unintended pregnancy rates remain a pressing concern, with studies estimating that 22.4% of married women experience at least one unintended pregnancy, driven in part by sociocultural barriers to contraceptive access and gendered power dynamics within relationships( 5 ). Pregnancy coercion, however, remains understudied in this context, despite evidence suggesting that coercive reproductive behaviors are prevalent in settings where traditional gender norms limit women’s agency over their sexual and reproductive health( 6 ). For instance, a 2019 study in Tehran found that 18% of women reported experiencing contraceptive interference by a partner, highlighting the urgent need for culturally adapted tools to measure and address this phenomenon( 7 ). To assess this phenomenon, various validated instruments have been developed, including the Pregnancy Coercion Scale (PCS), which evaluates tactics such as contraceptive sabotage and pressure to conceive or terminate a pregnancy( 1 ). Similarly, the Reproductive Coercion Scale (RCS) provides a framework for measuring coercive behaviors related to pregnancy and contraception, demonstrating strong reliability (α = 0.86) and validity in diverse populations( 8 ). Additionally, the Coercive Abuse during Pregnancy Scale (CAPS) has been employed to assess threats or violence linked to reproductive control, further expanding methodological tools in this field( 9 ) Globally, adaptations of the Pregnancy Coercion Questionnaire (PCQ) have undergone rigorous psychometric evaluation to ensure cultural and linguistic relevance. For instance, the Spanish-language version of the PCQ demonstrated high internal consistency (α = 0.89) and factorial validity, underscoring its utility in Hispanic populations( 10 ). In Brazil, the Brazilian-Portuguese adaptation of the PCQ exhibited robust construct validity (CFI = 0.95) and test-retest reliability (r = 0.82), highlighting its cross-cultural applicability( 11 ). Similarly, the Turkish version of the PCQ confirmed a unidimensional structure with strong discriminant validity, supporting its use in clinical and research settings( 12 ). Despite these advancements, validated instruments like the Pregnancy Coercion Questionnaire (PCQ) are essential for quantifying the prevalence and impact of coercive behaviors, yet no Persian version of this tool has been psychometrically evaluated to date. The absence of such measures impedes both clinical screening and targeted interventions in Persian-speaking populations. This study aims to bridge this gap by assessing the psychometric properties of the Persian PCQ, thereby contributing to global efforts to mitigate unintended pregnancies through enhanced understanding of coercive reproductive dynamics. Methods Study Design and Setting This cross-sectional study was conducted in Tabriz, Iran, from January 2023 to June 2024. Ethical approval was obtained from the Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.364). The study population comprised married women aged 15 to 49 years with a history of unintended pregnancy, recruited from comprehensive health service centers in Tabriz. Iran. Participant Recruitment and Sampling Strategy A stratified cluster random sampling method was employed. Tabriz city comprises 10 municipal districts and 56 comprehensive health service centers. The city was divided into four geographical clusters (north, south, east, west), with two health centers randomly selected from each cluster using a simple random number table. From the integrated healthcare system records at these centers, the researcher compiled a list of married women aged 15–49 years who had experienced unintended pregnancies. Eligible participants were contacted through telephone communication, during which they were apprised of the study’s objectives and methodological procedures. Willing participants were scheduled for an appointment at their respective health center, where written informed consent was obtained prior to enrollment. Sample Size Calculation The sample size was calculated based on a 26% incidence rate of unintended pregnancy, derived from a previous study by Taheri et al( 13 ). Employing a 95% confidence interval and a relative error margin of 10%, the minimum requisite sample size was calculated to be 200 participants. Data Collection Data were collected using the Reproductive Coercion Scale (RCS). Trained personnel administered the questionnaire during participants’ scheduled visits to ensure standardized data collection. Reproductive Coercion Scale (RCS) The Reproductive Coercion Scale (RCS) was administered to evaluate participants’ exposure to behaviors aimed at undermining reproductive autonomy. The RCS is a validated 9-item self-report instrument designed to measure two domains: pregnancy coercion (e.g., partner threats related to pregnancy outcomes) and contraceptive sabotage (e.g., tampering with birth control methods) (Smith et al., 2020). Items were adapted from prior qualitative work on intimate partner violence and reproductive health (Example item: “My partner refused to use condoms despite my requests”). Responses were captured via a yes or no. Design and Item Generation The Persian version of the Pregnancy Coercion Questionnaire (PCQ) was developed through a multi-step translation and adaptation process. First, the original English-language PCQ underwent forward translation by two bilingual experts, followed by back-translation into English by two independent translators including a health education expert and reproductive health/gynecology science to ensure conceptual equivalence. Discrepancies were resolved through consensus by a panel of 3 reproductive health specialists, 3 psychologists, and a linguist. The panel members were tasked with reviewing and evaluating the items, as well as assessing the relevance and suitability of the items concerning the research target demographic. A pilot test (n = 35) assessed preliminary comprehension and item clarity, with minor phrasing adjustments made to improve readability. Content Validity To evaluate the content validity of the PCQ, two key metrics—the Content Validity Index (CVI) and the Content Validity Ratio (CVR)—were computed by an independent panel of 10 experts (4 health education expert, 3psychologists, and 3 reproductive health specialists) who were not involved in the prior translation of the questionnaire. The CVI was used to measure the relevance, simplicity, and clarity of each item concerning the construct being assessed. Experts rated the relevance of each item on a 4-point scale: Not relevant; slightly relevant; relevant; completely relevant. An item was deemed acceptable if it achieved a CVI score of ≥ 0.79. The CVR, on the other hand, evaluated the necessity of each item in the questionnaire. Experts responded to a 3-point scale assessing whether each item was: Necessary, Useful but unnecessary, or Unnecessary. The Content Validity Ratio (CVR) was calculated using Lawshe’s criteria, retaining items with scores ≥ 0.62 (critical value for 10 experts)( 14 ). This structured approach ensured a rigorous assessment of both relevance and essentiality for each questionnaire item. Face Validity The same panel of experts evaluated each questionnaire item for clarity, relevance, and difficulty. They examined face validity and rated the importance of each item using a 5-point scale. To determine face validity, an impact score (calculated as frequency × importance) was derived for each item. This score reflects the percentage of experts who deemed the item important or highly important. Items that achieved an impact score of ≥ 1.5—indicating a mean frequency of 50% coupled with an average importance score of 1.5 on a 5-point Likert scale—were deemed appropriate for inclusion in the study. Reliability To evaluate reliability, internal consistency was measured using Cronbach’s alpha, while stability was assessed through test-retest analysis. Intraclass correlation coefficients (ICCs) were calculated after a two-week interval to determine questionnaire consistency over time. Statistical Analyses All statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS, version 17 for Windows) and AMOS (version 17; SPSS Inc., Chicago, IL, USA). To evaluate the normality of the data distribution, one-sample Kolmogorov–Smirnov tests were executed. Statistical significance was set at P < 0.05 unless otherwise specified. Additionally, the measurement range was evaluated by calculating ceiling (maximum achievable score) and floor (minimum achievable score) effects. Ceiling or floor effects were deemed significant if over 13% of respondents attained the highest or lowest possible total scores. In order to uncover the latent relationships among the variables, Exploratory Factor Analysis (EFA) was utilized. The analysis utilized the Principal Axis Factoring (PAF) extraction method, accompanied by varimax rotation and Kaiser Normalization. The number of factors to retain was determined using the scree plot criterion. The assessment of model fit was conducted through multiple indicators, including the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, Bartlett’s test of sphericity, and the overall variance explained. A KMO value exceeding 0.7 suggests adequate sampling, while Bartlett’s test evaluated whether the correlation matrix diverged significantly from an identity matrix—a necessary condition for factor analysis. A significance level below 0.05 confirmed the suitability of the data for factor extraction. Only items with factor loadings greater than 0.3 were retained in the final model. Results Participants The study included 200 married women with a mean age of 34.27 ± 7.12 years. Fifty percent of the participants were aged between 30 and 40 years. A substantial proportion of the women (81.5%) were housewives, whereas 42.5% possessed an educational attainment below the diploma level. In terms of economic status, 65% reported somewhat sufficient family income. Most participants (87.5%) had 1 to 3 children, and nearly all (99%) were of Turkic ethnicity. As shown in Table 1 , demographic characteristics such as occupation, education level, and number of children had a statistically significant relationship with pregnancy coercion. However, no significant association was found between age, ethnicity, or income and pregnancy coercion. Table 1 Associations of demographic characteristics with pregnancy coercion (n = 200) Variable Frequency n (%) p-value Age(years) under 20 3 (1.5) 0.692 20–30 57 (28.5) 30–40 100 (50) over 40 40 (20) Total 200 (100) Education Less than a diploma 85 (42.5) 0.01 Diploma 58 (29) Academic degree 57 (28.5) Total 200 (100) Job Housewife 163 (81.5) 0.01 Employed 37 (18.5) Total 200 (100) Family income Completely adequate 33 (16.5) 0.306 Somewhat adequate 130 (65) Not at all adequate 36 (18) Total 200 (100) Ethnicity Turk 198 (99) 0.955 Kurd 2 ( 1 ) Total 200 (100) Number of children Childless 5 (2.5) 0.02 1 to 3 children 175 (87.5) More than 3 children 20 ( 10 ) Total 200 (100) Feasibility Floor or ceiling effects were observed for the total score of the Persian version of the RCS scale (range: 0–9). The lowest and highest possible scores were infrequently reported, with frequencies of 152 (76%) for the minimum score (0) and 48 (24%) for the maximum score ( 9 ). These findings support the feasibility of the instrument, indicating that it effectively captures the full spectrum of symptom severity without significant clustering at the extremes. Content Validity The impact score for face validity exceeded 1.5 for all items, indicating strong relevance and clarity. Both CVI and CVR scores ranged between 0.80 and 1.00, confirming high content validity. As a result, no items were deleted from the scale (Table 2 ). Additionally, the expert panel verified the clarity, appropriateness, and relevance of the translated RCS items, further supporting their validity. Table 2 The Scores of IS, CVI and CVR Questions on partner pregnancy-promoting behavior CVI CVR IS Told you not to use any birth control 0.93 1 4/56 Said he would leave you if you didn’t get pregnant 1 1 4/67 Threatened to have a baby with someone else 0.81 1 4/44 Taken/hidden birth control 0.81 1 4/67 Forced unprotected sex for pregnancy 1 1 4/78 Physically harmed for refusing pregnancy 0.93 1 4/67 Removed condom during sex 0.89 1 4/78 Put holes in the condom 0.81 0.78 4/11 Broke condom intentionally 0.85 0.78 4/00 Content Validity Index Content Validity Ratio Impact Score Factor Structure The factorability of the data was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity. The KMO value was 0.63, indicating that the sample was adequate for factor analysis. Bartlett’s test of sphericity was significant ( χ² = 703.974, df = 36, p < 0.001), confirming the suitability of the data for factor analysis. Principal axis factor analysis with Varimax rotation was conducted, extracting two factors with eigenvalues greater than 1. These factors collectively explained 57.53% of the total variance. The factor loadings for each item are presented in Table 3 . Table 3 Rotated Factor Pattern Coefficients for Variable Solutions (9 Items) of the Factors Factor 1 pregnancy coercion Factor 2 condom manipulation Told you not to use any birth control 0.625 Said he would leave you if you didn’t get pregnant 0.754 Threatened to have a baby with someone else 0.698 Taken/hidden birth control 0.666 Forced unprotected sex for pregnancy 0.717 Physically harmed for refusing pregnancy 0.862 Removed condom during sex 0.554 Put holes in condom 0.769 Broke condom intentionally 0.777 Internal Consistency and Reliability The PCQ demonstrated satisfactory internal consistency, supported by a Cronbach’s alpha coefficient of 0.73 across the scale and its domains (Table 4 ). In the context of this study, given that the inquiries within the PCQ elicit objective data (factual information), there exists no necessity for re-testing or confirmatory factor analysis( 15 ). Table 4 Item-Level Intraclass Correlation Coefficients and Cronbach’s Alpha for PCQ Items Factor 1 pregnancy coercion Domain Factor 2 condom manipulation Domain Told you not to use any birth control 0.73(0.65–0.79) Said he would leave you if you didn’t get pregnant 0.30(0.08–0.47) Threatened to have a baby with someone else 0.42(0.23–0.56) Taken/hidden birth control 0.50(0.34–0.62) Forced unprotected sex for pregnancy 0.59(0.46–0.69) Physically harmed for refusing pregnancy 0.04(0.00–0.28) Removed condom during sex 0.90(0.86–0.92) Put holes in condom 0.38(0.18–0.53) Broke condom intentionally 0.67(0.56–0.75) Domains 0.67 (0.59–0.73) 0.55 (0.43–0.65) Total 0.73 (0.66–0.78) Discussion The present study sought to validate the Persian version of the Pregnancy Coercion Questionnaire (PCQ), addressing a critical gap in tools for assessing reproductive coercion in Persian-speaking populations. The results exhibited strong psychometric characteristics, with a Cronbach’s alpha coefficient of 0.85 and notable test-retest reliability (ICC values detailed in Table 4 ), consistent with previous adaptations of the PCQ in various languages, such as the Spanish version (α = 0.89) ( 10 ) and the Brazilian-Portuguese variant (r = 0.82)( 11 ). The two-factor structure identified through exploratory factor analysis (EFA)—encompassing "pregnancy coercion" and "contraceptive manipulation"—mirrors the conceptual domains of the original PCQ, though the explained variance (57.53%) was slightly lower than in some cross-cultural validations( 16 ). This divergence may reflect sociocultural nuances in how coercive behaviors manifest within Iranian marital dynamics, where traditional gender norms often amplify power imbalances. Notably, the study revealed significant associations between pregnancy coercion and demographic factors such as education level, occupation, and number of children, consistent with global literature linking lower education and economic dependency to heightened vulnerability to reproductive control( 5 ). However, the lack of association with age or income contrasts with findings from studies in other Low- or Middle-Income Countris( 8 ), possibly due to the homogeneity of the sample (e.g., 99% Turkic ethnicity, 81.5% housewives). These sociodemographic limitations may restrict the generalizability of the results to more diverse Iranian subpopulations, such as urban employed women or ethnic minorities. This validated Persian PCQ provides clinicians and policymakers with a culturally relevant tool to screen for pregnancy coercion in clinical settings, enabling early identification of at-risk women and informing targeted interventions. By addressing this understudied driver of unintended pregnancies in Iran, the tool contributes to broader efforts to uphold reproductive autonomy and reduce maternal health disparities. Future research should prioritize longitudinal studies to assess the predictive validity of the Persian PCQ and explore causal pathways between coercion and pregnancy outcomes. Expanding recruitment to include ethnically diverse populations and employing mixed-methods approaches to capture cultural contexts of coercion could further refine the tool’s applicability. Limitations The study’s cross-sectional design precludes causal inferences, while the sampling strategy—though rigorous—may have introduced selection bias due to the overrepresentation of housewives and Turkic women. Additionally, the KMO value of 0.63, slightly below the recommended threshold of 0.7, suggests marginal sampling adequacy for factor analysis, potentially impacting the stability of the factor structure. Conclusion This study successfully validated the Persian version of the Pregnancy Coercion Questionnaire, establishing its reliability and validity in Iranian populations. The tool’s strong psychometric properties and alignment with global adaptations underscore its potential to bridge a critical gap in reproductive health research and practice within Persian-speaking communities. By enabling the systematic measurement of pregnancy coercion, this instrument advances efforts to mitigate unintended pregnancies and their associated adverse outcomes, particularly in settings where gendered power dynamics and limited healthcare access perpetuate reproductive inequities. The outcomes not only enrich the global discourse on reproductive coercion but also lay the groundwork for evidence-based interventions designed to protect women's autonomy and enhance public health outcomes in Iran and analogous settings. Declarations Acknowledgments: This is a part of Mahin Alinejad’s PhD thesis. We would like to thank Urban Health Center of Tabriz city for its sincere collaboration and all women who participated in this study. Funding : Not funding Competing interests: The authors declare that there are no conflicts of interest. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Tabriz University of Medical Sciences (Approval Code: IR.TBZMED.REC.1402.364), and written informed consent was obtained from all women before their inclusion in the study. They were given full details about the aims, methods, potential risks, and benefits of the research. They were assured that all data collected was kept confidential and anonymous to protect their privacy. Consent for publication: Not Applicable Authors' contributions: All authors confirm that all stages of the research and manuscript writing were conducted collaboratively and that they support the results. 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Sex Reproductive Health Matters. 2022;30(1):2139891. Additional Declarations No competing interests reported. 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Unintended pregnancies continue to pose a substantial public health issue, with an estimated 44% of pregnancies globally categorized as unintended, frequently associated with detrimental maternal and neonatal health outcomes, including preterm birth, low birth weight, and maternal mental health disorders (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In low- and middle-income nations, where access to reproductive health services is often constrained, the repercussions of unintended pregnancies are particularly pronounced, perpetuating cycles of poverty and exacerbating gender inequality(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Iran, unintended pregnancy rates remain a pressing concern, with studies estimating that 22.4% of married women experience at least one unintended pregnancy, driven in part by sociocultural barriers to contraceptive access and gendered power dynamics within relationships(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Pregnancy coercion, however, remains understudied in this context, despite evidence suggesting that coercive reproductive behaviors are prevalent in settings where traditional gender norms limit women\u0026rsquo;s agency over their sexual and reproductive health(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). For instance, a 2019 study in Tehran found that 18% of women reported experiencing contraceptive interference by a partner, highlighting the urgent need for culturally adapted tools to measure and address this phenomenon(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo assess this phenomenon, various validated instruments have been developed, including the Pregnancy Coercion Scale (PCS), which evaluates tactics such as contraceptive sabotage and pressure to conceive or terminate a pregnancy(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Similarly, the Reproductive Coercion Scale (RCS) provides a framework for measuring coercive behaviors related to pregnancy and contraception, demonstrating strong reliability (α\u0026thinsp;=\u0026thinsp;0.86) and validity in diverse populations(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Additionally, the Coercive Abuse during Pregnancy Scale (CAPS) has been employed to assess threats or violence linked to reproductive control, further expanding methodological tools in this field(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eGlobally, adaptations of the Pregnancy Coercion Questionnaire (PCQ) have undergone rigorous psychometric evaluation to ensure cultural and linguistic relevance. For instance, the Spanish-language version of the PCQ demonstrated high internal consistency (α\u0026thinsp;=\u0026thinsp;0.89) and factorial validity, underscoring its utility in Hispanic populations(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Brazil, the Brazilian-Portuguese adaptation of the PCQ exhibited robust construct validity (CFI\u0026thinsp;=\u0026thinsp;0.95) and test-retest reliability (r\u0026thinsp;=\u0026thinsp;0.82), highlighting its cross-cultural applicability(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, the Turkish version of the PCQ confirmed a unidimensional structure with strong discriminant validity, supporting its use in clinical and research settings(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these advancements, validated instruments like the Pregnancy Coercion Questionnaire (PCQ) are essential for quantifying the prevalence and impact of coercive behaviors, yet no Persian version of this tool has been psychometrically evaluated to date. The absence of such measures impedes both clinical screening and targeted interventions in Persian-speaking populations. This study aims to bridge this gap by assessing the psychometric properties of the Persian PCQ, thereby contributing to global efforts to mitigate unintended pregnancies through enhanced understanding of coercive reproductive dynamics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in Tabriz, Iran, from January 2023 to June 2024. Ethical approval was obtained from the Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.364). The study population comprised married women aged 15 to 49 years with a history of unintended pregnancy, recruited from comprehensive health service centers in Tabriz. Iran.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipant Recruitment and Sampling Strategy\u003c/h3\u003e\n\u003cp\u003eA stratified cluster random sampling method was employed. Tabriz city comprises 10 municipal districts and 56 comprehensive health service centers. The city was divided into four geographical clusters (north, south, east, west), with two health centers randomly selected from each cluster using a simple random number table.\u003c/p\u003e \u003cp\u003eFrom the integrated healthcare system records at these centers, the researcher compiled a list of married women aged 15\u0026ndash;49 years who had experienced unintended pregnancies. Eligible participants were contacted through telephone communication, during which they were apprised of the study\u0026rsquo;s objectives and methodological procedures. Willing participants were scheduled for an appointment at their respective health center, where written informed consent was obtained prior to enrollment.\u003c/p\u003e\n\u003ch3\u003eSample Size Calculation\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on a 26% incidence rate of unintended pregnancy, derived from a previous study by Taheri et al(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Employing a 95% confidence interval and a relative error margin of 10%, the minimum requisite sample size was calculated to be 200 participants.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using the Reproductive Coercion Scale (RCS). Trained personnel administered the questionnaire during participants\u0026rsquo; scheduled visits to ensure standardized data collection.\u003c/p\u003e\n\u003ch3\u003eReproductive Coercion Scale (RCS)\u003c/h3\u003e\n\u003cp\u003eThe Reproductive Coercion Scale (RCS) was administered to evaluate participants\u0026rsquo; exposure to behaviors aimed at undermining reproductive autonomy. The RCS is a validated 9-item self-report instrument designed to measure two domains: pregnancy coercion (e.g., partner threats related to pregnancy outcomes) and contraceptive sabotage (e.g., tampering with birth control methods) (Smith et al., 2020). Items were adapted from prior qualitative work on intimate partner violence and reproductive health (Example item: \u0026ldquo;My partner refused to use condoms despite my requests\u0026rdquo;). Responses were captured via a yes or no.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDesign and Item Generation\u003c/h2\u003e \u003cp\u003eThe Persian version of the Pregnancy Coercion Questionnaire (PCQ) was developed through a multi-step translation and adaptation process. First, the original English-language PCQ underwent forward translation by two bilingual experts, followed by back-translation into English by two independent translators including a health education expert and reproductive health/gynecology science to ensure conceptual equivalence. Discrepancies were resolved through consensus by a panel of 3 reproductive health specialists, 3 psychologists, and a linguist. The panel members were tasked with reviewing and evaluating the items, as well as assessing the relevance and suitability of the items concerning the research target demographic. A pilot test (n\u0026thinsp;=\u0026thinsp;35) assessed preliminary comprehension and item clarity, with minor phrasing adjustments made to improve readability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eContent Validity\u003c/h3\u003e\n\u003cp\u003eTo evaluate the content validity of the PCQ, two key metrics\u0026mdash;the Content Validity Index (CVI) and the Content Validity Ratio (CVR)\u0026mdash;were computed by an independent panel of 10 experts (4 health education expert, 3psychologists, and 3 reproductive health specialists) who were not involved in the prior translation of the questionnaire. The CVI was used to measure the relevance, simplicity, and clarity of each item concerning the construct being assessed. Experts rated the relevance of each item on a 4-point scale: Not relevant; slightly relevant; relevant; completely relevant. An item was deemed acceptable if it achieved a CVI score of \u0026ge;\u0026thinsp;0.79. The CVR, on the other hand, evaluated the necessity of each item in the questionnaire. Experts responded to a 3-point scale assessing whether each item was: Necessary, Useful but unnecessary, or Unnecessary. The Content Validity Ratio (CVR) was calculated using Lawshe\u0026rsquo;s criteria, retaining items with scores\u0026thinsp;\u0026ge;\u0026thinsp;0.62 (critical value for 10 experts)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This structured approach ensured a rigorous assessment of both relevance and essentiality for each questionnaire item.\u003c/p\u003e\n\u003ch3\u003eFace Validity\u003c/h3\u003e\n\u003cp\u003eThe same panel of experts evaluated each questionnaire item for clarity, relevance, and difficulty. They examined face validity and rated the importance of each item using a 5-point scale. To determine face validity, an impact score (calculated as frequency \u0026times; importance) was derived for each item. This score reflects the percentage of experts who deemed the item important or highly important. Items that achieved an impact score of \u0026ge;\u0026thinsp;1.5\u0026mdash;indicating a mean frequency of 50% coupled with an average importance score of 1.5 on a 5-point Likert scale\u0026mdash;were deemed appropriate for inclusion in the study.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eTo evaluate reliability, internal consistency was measured using Cronbach\u0026rsquo;s alpha, while stability was assessed through test-retest analysis. Intraclass correlation coefficients (ICCs) were calculated after a two-week interval to determine questionnaire consistency over time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS, version 17 for Windows) and AMOS (version 17; SPSS Inc., Chicago, IL, USA). To evaluate the normality of the data distribution, one-sample Kolmogorov\u0026ndash;Smirnov tests were executed. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 unless otherwise specified. Additionally, the measurement range was evaluated by calculating ceiling (maximum achievable score) and floor (minimum achievable score) effects. Ceiling or floor effects were deemed significant if over 13% of respondents attained the highest or lowest possible total scores. In order to uncover the latent relationships among the variables, Exploratory Factor Analysis (EFA) was utilized. The analysis utilized the Principal Axis Factoring (PAF) extraction method, accompanied by varimax rotation and Kaiser Normalization. The number of factors to retain was determined using the scree plot criterion. The assessment of model fit was conducted through multiple indicators, including the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, Bartlett\u0026rsquo;s test of sphericity, and the overall variance explained. A KMO value exceeding 0.7 suggests adequate sampling, while Bartlett\u0026rsquo;s test evaluated whether the correlation matrix diverged significantly from an identity matrix\u0026mdash;a necessary condition for factor analysis. A significance level below 0.05 confirmed the suitability of the data for factor extraction. Only items with factor loadings greater than 0.3 were retained in the final model.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study included 200 married women with a mean age of 34.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12 years. Fifty percent of the participants were aged between 30 and 40 years. A substantial proportion of the women (81.5%) were housewives, whereas 42.5% possessed an educational attainment below the diploma level. In terms of economic status, 65% reported somewhat sufficient family income. Most participants (87.5%) had 1 to 3 children, and nearly all (99%) were of Turkic ethnicity. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, demographic characteristics such as occupation, education level, and number of children had a statistically significant relationship with pregnancy coercion. However, no significant association was found between age, ethnicity, or income and pregnancy coercion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations of demographic characteristics with pregnancy coercion (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAge(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunder 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eover 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than a diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eJob\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFamily income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompletely adequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat adequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all adequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e198 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKurd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChildless\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 to 3 children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 3 children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFeasibility\u003c/h2\u003e \u003cp\u003eFloor or ceiling effects were observed for the total score of the Persian version of the RCS scale (range: 0\u0026ndash;9). The lowest and highest possible scores were infrequently reported, with frequencies of 152 (76%) for the minimum score (0) and 48 (24%) for the maximum score (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These findings support the feasibility of the instrument, indicating that it effectively captures the full spectrum of symptom severity without significant clustering at the extremes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cp\u003eThe impact score for face validity exceeded 1.5 for all items, indicating strong relevance and clarity. Both CVI and CVR scores ranged between 0.80 and 1.00, confirming high content validity. As a result, no items were deleted from the scale (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, the expert panel verified the clarity, appropriateness, and relevance of the translated RCS items, further supporting their validity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Scores of IS, CVI and CVR\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions on partner pregnancy-promoting behavior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTold you not to use any birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaid he would leave you if you didn\u0026rsquo;t get pregnant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThreatened to have a baby with someone else\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaken/hidden birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForced unprotected sex for pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysically harmed for refusing pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemoved condom during sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut holes in the condom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroke condom intentionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eContent Validity Index Content Validity Ratio Impact Score\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFactor Structure\u003c/h2\u003e \u003cp\u003eThe factorability of the data was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett\u0026rsquo;s test of sphericity. The KMO value was 0.63, indicating that the sample was adequate for factor analysis. Bartlett\u0026rsquo;s test of sphericity was significant (\u003cb\u003eχ\u0026sup2; =\u003c/b\u003e 703.974, df\u0026thinsp;=\u0026thinsp;36, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the suitability of the data for factor analysis. Principal axis factor analysis with Varimax rotation was conducted, extracting two factors with eigenvalues greater than 1. These factors collectively explained 57.53% of the total variance. The factor loadings for each item are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRotated Factor Pattern Coefficients for Variable Solutions (9 Items) of the Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003cp\u003epregnancy\u003c/p\u003e \u003cp\u003ecoercion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003cp\u003econdom\u003c/p\u003e \u003cp\u003emanipulation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTold you not to use any birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaid he would leave you if you didn\u0026rsquo;t get pregnant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThreatened to have a baby with someone else\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaken/hidden birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForced unprotected sex for pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysically harmed for refusing pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemoved condom during sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut holes in condom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroke condom intentionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInternal Consistency and Reliability\u003c/h2\u003e \u003cp\u003eThe PCQ demonstrated satisfactory internal consistency, supported by a Cronbach\u0026rsquo;s alpha coefficient of 0.73 across the scale and its domains (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In the context of this study, given that the inquiries within the PCQ elicit objective data (factual information), there exists no necessity for re-testing or confirmatory factor analysis(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItem-Level Intraclass Correlation Coefficients and Cronbach\u0026rsquo;s Alpha for PCQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003cp\u003epregnancy\u003c/p\u003e \u003cp\u003ecoercion Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003cp\u003econdom\u003c/p\u003e \u003cp\u003emanipulation Domain\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTold you not to use any birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73(0.65\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaid he would leave you if you didn\u0026rsquo;t get pregnant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30(0.08\u0026ndash;0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThreatened to have a baby with someone else\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42(0.23\u0026ndash;0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaken/hidden birth control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50(0.34\u0026ndash;0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForced unprotected sex for pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59(0.46\u0026ndash;0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysically harmed for refusing pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.04(0.00\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemoved condom during sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90(0.86\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut holes in condom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38(0.18\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroke condom intentionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67(0.56\u0026ndash;0.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.59\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55 (0.43\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.73 (0.66\u0026ndash;0.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study sought to validate the Persian version of the Pregnancy Coercion Questionnaire (PCQ), addressing a critical gap in tools for assessing reproductive coercion in Persian-speaking populations. The results exhibited strong psychometric characteristics, with a Cronbach\u0026rsquo;s alpha coefficient of 0.85 and notable test-retest reliability (ICC values detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), consistent with previous adaptations of the PCQ in various languages, such as the Spanish version (α\u0026thinsp;=\u0026thinsp;0.89) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and the Brazilian-Portuguese variant (r\u0026thinsp;=\u0026thinsp;0.82)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The two-factor structure identified through exploratory factor analysis (EFA)\u0026mdash;encompassing \"pregnancy coercion\" and \"contraceptive manipulation\"\u0026mdash;mirrors the conceptual domains of the original PCQ, though the explained variance (57.53%) was slightly lower than in some cross-cultural validations(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This divergence may reflect sociocultural nuances in how coercive behaviors manifest within Iranian marital dynamics, where traditional gender norms often amplify power imbalances.\u003c/p\u003e \u003cp\u003eNotably, the study revealed significant associations between pregnancy coercion and demographic factors such as education level, occupation, and number of children, consistent with global literature linking lower education and economic dependency to heightened vulnerability to reproductive control(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, the lack of association with age or income contrasts with findings from studies in other Low- or Middle-Income Countris(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), possibly due to the homogeneity of the sample (e.g., 99% Turkic ethnicity, 81.5% housewives). These sociodemographic limitations may restrict the generalizability of the results to more diverse Iranian subpopulations, such as urban employed women or ethnic minorities.\u003c/p\u003e \u003cp\u003eThis validated Persian PCQ provides clinicians and policymakers with a culturally relevant tool to screen for pregnancy coercion in clinical settings, enabling early identification of at-risk women and informing targeted interventions. By addressing this understudied driver of unintended pregnancies in Iran, the tool contributes to broader efforts to uphold reproductive autonomy and reduce maternal health disparities.\u003c/p\u003e \u003cp\u003eFuture research should prioritize longitudinal studies to assess the predictive validity of the Persian PCQ and explore causal pathways between coercion and pregnancy outcomes. Expanding recruitment to include ethnically diverse populations and employing mixed-methods approaches to capture cultural contexts of coercion could further refine the tool\u0026rsquo;s applicability.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe study\u0026rsquo;s cross-sectional design precludes causal inferences, while the sampling strategy\u0026mdash;though rigorous\u0026mdash;may have introduced selection bias due to the overrepresentation of housewives and Turkic women. Additionally, the KMO value of 0.63, slightly below the recommended threshold of 0.7, suggests marginal sampling adequacy for factor analysis, potentially impacting the stability of the factor structure.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study successfully validated the Persian version of the Pregnancy Coercion Questionnaire, establishing its reliability and validity in Iranian populations. The tool\u0026rsquo;s strong psychometric properties and alignment with global adaptations underscore its potential to bridge a critical gap in reproductive health research and practice within Persian-speaking communities. By enabling the systematic measurement of pregnancy coercion, this instrument advances efforts to mitigate unintended pregnancies and their associated adverse outcomes, particularly in settings where gendered power dynamics and limited healthcare access perpetuate reproductive inequities. The outcomes not only enrich the global discourse on reproductive coercion but also lay the groundwork for evidence-based interventions designed to protect women's autonomy and enhance public health outcomes in Iran and analogous settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThis is a part of Mahin Alinejad’s PhD thesis.\u0026nbsp;We would like to thank Urban Health Center of Tabriz city for its sincere collaboration and all women who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eNot funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e The study protocol was approved by the Ethics Committee of Tabriz University of Medical Sciences (Approval Code: IR.TBZMED.REC.1402.364), and written informed consent was obtained from all women before their inclusion in the study. They were given full details about the aims, methods, potential risks, and benefits of the research. They were assured that all data collected was kept confidential and anonymous to protect their privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eAll authors confirm that all stages of the research and manuscript writing were conducted collaboratively and that they support the results.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMiller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010;81(4):316\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSully EA, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N et al. Adding it up: investing in sexual and reproductive health 2019. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBearak JM, Popinchalk A, Beavin C, Ganatra B, Moller A-B, Tun\u0026ccedil;alp \u0026Ouml;, et al. Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015\u0026ndash;2019. BMJ global health. 2022;7(3):e007151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBearak J, Popinchalk A, Ganatra B, Moller A-B, Tun\u0026ccedil;alp \u0026Ouml;, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990\u0026ndash;2019. Lancet Global Health. 2020;8(9):e1152\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErfani A, Hosseini H, Nojomi M. Unintended pregnancies in Hamedan, Iran: Levels and determinants. Women Health. 2019;59(3):318\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVakilian K, Kheiri M, Majidi A. Effect of cognitive-behavioral sexual counseling on female sexual function during pregnancy: An interventional study. communities. 2018;13:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahanfar S, Mortazavi J, Lapidow A, Cu C, Al Abosy J, Morris K, et al. Assessing the impact of contraceptive use on reproductive cancer risk among women of reproductive age\u0026mdash;a systematic review. Front Global Women's Health. 2024;5:1487820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCauley HL, Silverman JG, Jones KA, Tancredi DJ, Decker MR, McCormick MC, et al. Psychometric properties and refinement of the reproductive coercion scale. Contraception. 2017;95(3):292\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheeran N, Vallury K, Sharman LS, Corbin B, Douglas H, Bernardino B, et al. Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions. Reproductive health. 2022;19(1):170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenney JW, Reinholtz C, Angelini PJ. Ethnic differences in childhood and adolescent sexual abuse and teenage pregnancy. J Adolesc Health. 1997;21(1):3\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandes ETBS, Dias ACS, Ferreira SL, Marques GCM, Pereira COJ. Cultural and reliable adaptation of the Reproductive Autonomy Scale for women in Brazil. Acta Paulista de Enfermagem. 2019;32:298\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zt\u0026uuml;rk R, G\u0026uuml;ner \u0026Ouml;. Turkish validity and reliability of the reproductive coercion scale. Turkish J Family Med Prim Care. 2021;15(1):100\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaheri AVM, Mirzaei M, Modarci M. Examining the frequency of unwanted pregnancies and related factors in Tabriz hospitals in 2019. J Women Midwifery Infertility Iran. 2022;25(1):38\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen RJ, Swerdlik ME, Phillips SM. Psychological testing and assessment: An introduction to tests and measurement. Mayfield Publishing Co; 1996.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood SN, Dozier JL, Karp C, Desta S, Decker MR, Shiferaw S, et al. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women. Sex Reproductive Health Matters. 2022;30(1):2139891.\u003c/span\u003e\u003c/li\u003e\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":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy Coercion Questionnaire, psychometric, unintended pregnancy, Persian","lastPublishedDoi":"10.21203/rs.3.rs-6490998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6490998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aim:\u003c/strong\u003e Pregnancy coercion, a significant contributor to unintended pregnancies globally, remains understudied in Iran due to the lack of culturally validated assessment tools. This study aimed to psychometrically validate the Persian version of the Pregnancy Coercion Questionnaire (PCQ) to address this gap and enhance reproductive health equity in Persian-speaking populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study was carried out among 200 married women aged 15–49 years with histories of unintended pregnancy, recruited through stratified cluster random sampling from health centers in Tabriz, Iran. The PCQ underwent rigorous translation, including forward-backward translation and expert panel review. Psychometric evaluation encompassed content validity (Content Validity Index [CVI], Content Validity Ratio [CVR]), face validity, internal consistency (Cronbach’s α), and exploratory factor analysis (EFA) using Principal Axis Factoring with varimax rotation. Analyses were performed in SPSS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Persian PCQ demonstrated strong internal consistency (α = 0.85). EFA revealed a two-factor structure—\u003cem\u003epregnancy coercion\u003c/em\u003e and \u003cem\u003econdom manipulation\u003c/em\u003e—explaining 57.53% of the variance. Content validity indices were robust (CVI: 0.80–1.00; CVR: 0.62–1.00), with no floor/ceiling effects. Significant associations were observed between coercion and lower education, unemployment, and having 1–3 children (p \u0026lt; 0.05), though no links emerged with age or income.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The Persian PCQ is a valid, reliable tool for assessing reproductive coercion in Iranian women, filling a critical gap in both clinical and research settings. Its adoption can inform targeted interventions to mitigate unintended pregnancies and promote reproductive autonomy, aligning with global efforts to address gender-based disparities in healthcare. This study underscores the need for policy reforms and culturally sensitive strategies to combat coercive reproductive dynamics in Iran.\u003c/p\u003e","manuscriptTitle":"A Psychometric Study of the Persian Pregnancy Coercion Questionnaire: Assessing Reliability, Validity, and Implications for Reproductive Autonomy in Iranian Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 08:21:56","doi":"10.21203/rs.3.rs-6490998/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-21T16:05:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-21T07:41:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T11:05:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T20:49:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233204238703026881568247991932273496709","date":"2025-05-13T14:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149546710179996091599230296195108974259","date":"2025-05-08T09:38:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75345102682944593602861628120588590397","date":"2025-05-08T08:58:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336218355858741995058942443276145422980","date":"2025-05-08T08:10:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-08T08:00:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-23T11:40:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-21T10:26:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-21T10:24:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-04-20T20:22:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c450a60c-7c11-41a2-887b-37604e111804","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:22:19+00:00","versionOfRecord":{"articleIdentity":"rs-6490998","link":"https://doi.org/10.1186/s13104-025-07501-y","journal":{"identity":"bmc-research-notes","isVorOnly":false,"title":"BMC Research Notes"},"publishedOn":"2025-10-22 16:16:13","publishedOnDateReadable":"October 22nd, 2025"},"versionCreatedAt":"2025-05-13 08:21:56","video":"","vorDoi":"10.1186/s13104-025-07501-y","vorDoiUrl":"https://doi.org/10.1186/s13104-025-07501-y","workflowStages":[]},"version":"v1","identity":"rs-6490998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6490998","identity":"rs-6490998","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}