Comparison of reproductive health literacy and related factors in urban and rural women of reproductive age in Iran 2023

Comparison of reproductive health literacy and related factors in urban and rural women of reproductive age in Iran 2023 | 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 Comparison of reproductive health literacy and related factors in urban and rural women of reproductive age in Iran 2023 zeinab hamzehgardeshi, maryam ahmadian, Maedeh Rezaei, Kosar Alizadeh, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5763987/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Reproductive health is a key area of health and an important indicator of the health status of societies . Improving reproductive health literacy is one of the most important strategies to achieve the goals of reproductive health in various groups of women . Methods: This study is a cross-sectional descriptive analytical study in eligible married women aged 18-49. The reproductive health literacy questionnaire and demographic-social- reproductive characteristics questionnaire were completed by 593 people in person, online and by phone. Simple random sampling with allocation proportional to the size of reproductive age women was done in each center. After collecting the data, it was analyzed by spss 23 software. Results: The health literacy score for urban and rural women was 118.54 ± 21.38 and 111.40 ± 24.21, respectively, indicating a significant difference (P<0.00). Besides, the percentage of women with favorable literacy in rural are as was higher than in urban areas (70.4% vs. 51.4%). In logistics regression, there was a significant relationship with women's reproductive health literacy score in the city only between breast self-examination (p= 0.009 and OR = 0.4) and in the village between breast examination by physician or midwife (p= 0.003 and OR=0.38), employment of a family member in the health care system (p= 0.000 and OR=0.25) and the number of pregnancies (p= 0.04 and OR= 55). Conclusion: The results of this study can help health planners and policymakers design and implement more appropriate training and health services by considering the differences in urban and rural areas. In addition, given the importance of behaviors related to reproductive health, encouraging preventive examinations and raising public awareness in this area can help improve reproductive health literacy in women. reproductive health literacy related factors reproductive age Background Reproductive health is a prerequisite for sustainable development in today's societies. Therefore, in recent years, the international community has paid special attention to reproductive health. Reproductive health is a key area of health and an important indicator of the health status of societies, which has been addressed as a priority by WHO and UNFPA since 1994 and is still at the center of global attention[1]. Women of reproductive age are a vulnerable group in every society due to special physiological conditions in this period such as pregnancy, childbirth and breast feeding[2]. Reproductive health literacy in women increases their awareness, ability to make decisions as well as upholding skills on reproductive health issues, increasing the use of reproductive health services, reducing unwanted fertility and empowering women to monitor their own health. Women's health is the foundation of family and community health, and they are of special importance in ensuring and maintaining the social and family health [3] .Efforts have always been made to improve the reproductive health status of people in different countries by implementing a variety of strategies. The note worthy issue is that the latest needs assessments and researches have shown that improving reproductive health literacy is one of the most important strategies to achieve the goals of reproductive health in various groups of women [4] [5]. The study of Vongxay et al. in Laos in 2019 showed that 65.5% of young people lacked sexual and reproductive health [6]. The results of a study by Dabiri et al. in Iran in 2019 indicated that 85% of the investigated couples lacked sufficient sexual health and reproductive literacy [7]. Kharazi et al.'s study showed that there is a significant relationship between maternal health literacy and care during pregnancy, pregnancy outcome and birth weight, indicating the need to pay more attention to maternal health literacy in health promotion programs [8]. Although significant progress has been made in several aspects of reproductive health, there are still many challenges in this regard, including unwanted pregnancy, high-risk behaviors, early detection of STD through screening for disease prevention (such as screening test for human papilloma virus), and negative effect of obesity on reproduction [9]. In a study conducted in 104 countries (2010-2014), the prevalence of unwanted pregnancies in the world was reported as 44% and in developed countries as 30% [10]. According to the report of US Center for Disease Control and Prevention (2017), condom failure is observed in 46% of people aged 15-24 in their last sexual intercourse; 21% of newly diagnosed AIDS cases were among these people and more than 50 % of new cases of other sexually transmitted infections were also seen in them [11]. In addition, in a meta-analysis conducted in Iran (2020), the prevalence of unwanted pregnancy in Iran was reported to be 52% [12]. In a study performed in Tehran (2011), the prevalence of weight gain according to BMI in women is 31.3% before their pregnancy [13]. In a qualitative research conducted on Tehrani women aged 25-65 years (2020), their knowledge about cervical cancer (CC) and screening was limited, with social and cultural barriers hindering proper communication between health providers and clients on issues related to CC and screening. The perceived risk of CC was low due to overestimation of the role of hereditary factors for CC, the difficulty in differentiating between cancer and STI, and absence of visible symptoms [14]. Age and marital status are among the factors related to reproductive health literacy in Iranian women. The average score of health literacy in women aged ≥25 years is higher than that of women >25 years, but this upward trend continues until 45 years of age, after which it has a downward trend. Progressive age along with facing more fertility-related issues can be a reason for higher reproductive health literacy scores in the age group of 25-45 years [15]. Other related factors include training, education, income, socioeconomic status[16, 17] , place of residence, participation in reproductive and sexual health training classes, and employment of a family member in health centers [6]. According to studies, the improvement of education index alone explains the level of reproductive health to a large extent, so that reproductive health improves in countries with an efficient education system that have invested in education. Moreover, the education index has explained only about 71% of the total changes in reproductive health [18]. Culture and ethnicity are also among the factors that affect health. Family, social and cultural influences are vitally important in shaping attitudes and beliefs, affecting the way people interact with the health system [19]. Awareness of the prevailing conditions appears to be necessary before implementing any targeted intervention to improve women's reproductive health literacy; therefore, the goal of the present study was to compare reproductive health literacy and its related factors among urban and rural women of reproductive age in Sari city. Methods Type of study: This is a cross-sectional, descriptive analytical study that was conducted in 2023. Participants: The participants of the study were married women aged 18-49 years from Sari and its nearby villages. Women living in Sari and its suburbs who were willing to participate in the study met the inclusion criteria. The only exclusion criterion was voluntary withdrawal from the study. The data was collected by an interviewer familiar with research methods and sampling principles. For this purpose, the interrogator identified the eligible people from the files in urban and rural health centers, and then the questionnaires were submitted to the samples using both online and face-to-face methods. The participants were assured that their information would remain confidential. If the participants had the ability to link in the group to complete the online questionnaire, they were enrolled in the online group list, and if such conditions were not provided for them, they were enrolled in the face-to-face group. The questionnaire link was subsequently presented to the research community online through WhatsApp Messenger. Questionnaires were also provided to the people in attendance at the health centers. For those who did not have the online and face-to-face conditions, the sampler asked the questions over the phone and completed the questionnaires. Sample size: Based on the study of Najimi et al. conducted on 2017 [3] and the average health literacy of 41.50 ± 9.23 at a confidence level of 0.95 and maximum error of 1, the sample size was estimated 327 using the following formula to determine sample size in an independent group: Considering that this study was conducted in urban and rural women of reproductive age, 327 samples were also selected as a comparison group in the village, that is, a total of 654 samples were recruited in the study. Simple random sampling with allocation proportional to the size of reproductive age women was done in each center. In this way, several health centers in different parts of Sari and villages around it were randomly selected. Through the list of families covered by selected urban and rural health care centers, women of reproductive age were randomly selected and the necessary arrangements were made with them by phone call. Instrument: The data collection tool consisted of two questionnaires. The first questionnaire was a reproductive health literacy questionnaire for women of reproductive age, which was developed in a study at University of Shiga, Japan, and its validity and reliability have also been examined [20]. In Iran, Kohan et al. (2018) evaluated the validity and reliability of the mentioned questionnaire. The content and face validity of the questionnaire was examined both qualitatively and quantitatively (CVI, CVR). By calculating the content validity ratio, all the items with a score >0.6 were kept in the questionnaire, and by calculating the content validity index, all the items in the questionnaire had a score >0.79. The reliability of this questionnaire was confirmed by test-retest, with alpha of 0.8 and correlation coefficient of 0.72.This instrument measures the level of women's reproductive health literacy in the form of 29 questions with a four-point Likert scale of very poor (score = 1), poor (score = 2), acceptable (score = 3), good (score = 4) and very good ( score = 5), and the total score range of this questionnaire is 29-145. In this instrument, reproductive health literacy scores above the average are defined as favorable and below average as unfavorable [15]. The second questionnaire created by the researcher includes the demographic-social-fertility characteristics. This questionnaire contains 29 items, including 9 questions about demographic-social characteristics, 4 about fertility status, and 16 regarding behaviors related to reproductive health, in which questions related to reproductive health behaviors and the recommended screening method for women according to their age were asked based on available texts [17, 21] Statistical analysis : After collection, the data was analyzed by SPSS software (version 23). Quantitative and qualitative variables were described with mean±SD and frequency distribution table (frequency-percentage), respectively. The reproductive health literacy score in both urban and rural areas was investigated using Smirnov-Kolmogorov test, which showed non-normality of the literacy score. Therefore, non-parametric tests were used to compare between two or more groups. Mann-Whitney and Kruskal-Wallis tests were utilized to compare the means between groups; Chi-square test and Fisher's exact test were used to compare variables. In addition, logistic regression analysis was performed to determine the correlated factors. There were many variables in the study, including age, education, job, economic status, duration of marriage, number of children, pregnancies, and abortions, unwanted pregnancies, the contraceptive method, as well as other variables indicating reproductive health related behaviors such as familiarization with screenings, Pap test, breast self-examination, breast examination by a physician or midwife, pelvic examination, presence and treatment of genital warts, mammography, hepatitis and HIV tests and screening mode according to age, method of obtaining information on reproductive health and relatives working in the healthcare system, which were considered independent variables whose relationship with reproductive health literacy score as the dependent variable was examined. Variables with a significance level <0.21 were considered significant variables to enter the logistic regression model. The significance level was considered p<0.05. Results A total of 593 women participated in this study, including 294 women in the city and 299 women in the village. Table 1 shows demographic-social characteristics and some fertility-related behaviors in women of reproductive age in city and village. Table 1 Demographic-social and fertility characteristics of women of reproductive age in citiy and village. Variable Grouping city village frequency (percentage) frequency (percentage) Average age of samples (standard deviation) 34/09(8/1) 35/47( 7/94) Age groups ( year ) 15–24 40(13/6) 34(11/4) 25–34 123(41/8) 91(30/4) Above 35 131(44/6) 174(58/2) Education levels illiterate - 3(1) elementary 5(1/7) 23(7/7) middle school 16 (5/4) 48(16/1) high school 56(19) 138(46/2) university 215(73/1) 85(28/4) seminary 2(0/7) 2(0/7) job housewives 145(49/3) 239(79/9) employed 149(50/7) 60(20/1) Economic status enough 101(34/4) 92(30/8) less than enough 20(6/8) 22(7/4) More than enough 14(4/8) 14(4/7) average 159(54/1) 171(57/2) Time interval from marriage to- pregnancy ( month) 28/15(26/3) 35/47(7/9) Number of children 0–1 104(47/8) 67(26/1) 2–3 113(51/9) 160(62/2) Above 3 1(0/5) 30(11/7) Number of pregnancies 0–1 81(37/9) 67(22/4) 2–3 116(54/2) 160(53/5) Above 3 17(7/9) 30(10) How to get reproductive health -information midwife 83(28/2) 137(45/8) doctor 93(31/6) 93(31/1) Internet 61(20/7) 37(12/4) Other cases 57(19/4) 32(10/7) unwanted pregnancy yes 57(19/4) 47(15/7) no 236(80/3) 252(84/3) Contraception method yes 169(57/5) 154(51/5) no 125(42/5) 145(48/5) Pap smear test yes 183(62/2) 214(71/6) no 84(28/6) 40(13/4) Breast self-examination yes 163(55/4) 146(48/8) no 131(44/6) 153(51/2) Check for genital warts yes 46(15/6) 15(5) no 248(84/4) 284(95) Breast examination by doctor and- midwife yes 136(46/3) 126(42/1) no 158(53/7) 173(57/9) According to Table 1 , the average age of urban and rural women was 34.09 ± 8.1 and 35.47 ± 7.94 years, respectively. The most frequent age group in the city and village was > 35 years (44.6% in the city and 58.2% in the village). The highest level of education in urban and rural women was university degree (72.1%) and high school diploma (46.2%), respectively. Most urban women were employed (50.7%), and the majority of rural women were housewives (79.9%). About half of urban and rural women had a moderate economic status (54.1% in the city and 57.2% in the village). Table 2 shows the average score of reproductive health literacy as well as percentage and frequency of favorable and unfavorable literacy separately in the general population and urban and rural women. Table 2 The average score of reproductive health literacy in the city and village and the whole population. Favorable health literacy frequency (percentage) Unfavorable health literacy frequency (percentage) Health literacy score mean (standard deviation) (P- value) city 151(51/4) 143(48/6) 118/54(21/38) P < 0.00 village 210(70/4) 89(29/6) 111/40(24/21) whole- population 339(57/2) 254(42/8) 114/94(23/11) A significant difference was observed in the average score of fertility literacy in both urban and rural areas. According to Table 2 , the health literacy score in the total population of women is 114.94 ± 23.11, with 57.2% of women having favorable health literacy and 42.8% unfavorable health literacy. The health literacy score for urban and rural women was 118.54 ± 21.38 and 111.40 ± 24.21, respectively, indicating a significant difference (P < 0.00). Besides, the percentage of women with favorable literacy in rural areas was higher than in urban areas (70.4% vs. 51.4%). Tables 3 and 4 show the correlation of quantitative and qualitative variables with health literacy scores in urban and rural women with Mann-Whitney, Chi-square and Fisher's exact tests, respectively. Table 3 Investigating the quantitative variables related to reproductive health literacy score in urban and rural women of reproductive age. Variable Grouping Average reproductive health literacy score (standard deviation) (P- value) city (P- value) village mother's age 15–24 113/43(22/26) 0/00 0/75 25–34 119/05(20/17) 35≥ 112/43(24/85) Number of pregnancies 0–1 118/72(21/45) 0/04 0/06 2–3 113/73(22/82) 3≥ 103/13(30/01) Number of children 0–1 117/63(21/59) 0/07 0/00 2–3 112/76(24/23) 3≥ 82(19/82) According to the results of Table 3 , there was a significant relationship between the number of pregnancies and mother's age in urban women and the number of children in rural women with average score of women's reproductive health literacy. The variables of duration of marriage, the number of abortions in the city and the village had no significant relationship with reproductive health literacy score (not indicated in the table). Table 4 Investigating the qualitative variables related to reproductive health literacy score in urban and rural women of reproductive age. Variable city village Health literacy score mean (standard deviation) (P- value) Health literacy score mean (standard deviation) (P- value) being employed 118/54(21/38) 0/00 111/40(24/22) 0/00 education 118/54(21/38) 0/00 111/40(24/22) 0/00 Having a prevention method 118/54(21/38) 0/15 118/54(21/38) 0/03 unwanted pregnancy 118/54(21/38) 0/77 111/40(24/22) 0/39 Familiarity with screening 118/54(21/38) 0/00 111/40(24/22) 0/00 Going for a breast -examination by a doctor or- midwife 118/54(21/38) 0/00 111/40(24/22) 0/00 Breast self-examination 118/54(21/38) 0/00 111/40(24/22) 0/00 Referral for pelvic- examination 118/54(21/38) 0/02 111/40(24/22) 0/07 Mammography 118/54(21/38) 0/77 111(40) 0/01 Referral for HIV testing 118/54(21/38) 0/00 111(40) 0/00 Referral to check hepatitis 118/54(21/38) 0/00 111(40) 0/00 Working relatives in the- healthcare system 118/54(21/38) 0/00 111(40) 0/00 Based on Table 4 , there was a significant relationship between employment, education and employment of a relative at health center in urban and rural women with average health literacy score of women. There was also a significant difference between urban and rural women's reproductive health literacy score and the variables that indicate reproductive health behaviors, including familiarity with screening, visiting for breast examination, breast self-examination, hepatitis, and HIV. In general, based on the results of Tables 3 and 4 , a significant relationship was found between the variables of employment (0.00), education level (0.00), employment of a relative in a health center, acquaintance with screenings (0.00), visiting for hepatitis and HIV (0.00) with fertility literacy score among urban and rural women. Visiting for mammography (0.01) in rural women and referring for pelvic examination (0.02) in urban women had a significant difference with reproductive health literacy score. To perform logistics regression, the variables with a significance level < 0.21 in single variable test were considered significant for entering the logistics regression model In logistics regression, there was a significant relationship with women's reproductive health literacy score in the city only between breast self-examination (p = 0.009 and OR = 0.4) and in the village between breast examination by physician or midwife (p = 0.003 and OR = 0.38), employment of a family member in the health care system (p = 0.000 and OR = 0.25) and the number of pregnancies (p = 0.04 and OR = 55). The number of pregnancies was the most important predictor of health literacy in rural women, which increased by 55% with the increase in the number of pregnancies. Another predictor among the behaviors related to reproductive health in rural women was referring to a physician or midwife for breast examination. The likelihood of optimal literacy increased by 38% in rural women who referred for breast examination. Another predictor was employment of a family member in the health care system, which increased the likelihood of optimal health literacy by 25%. Another predicator of health literacy in urban women was breast self-examination, such that the likelihood of optimal health literacy increased by 24% among women who performed breast self-examination. Discussion The present study compared the factors related with reproductive health literacy among women of childbearing ages in city and village. The results showed that about half of the general population of women in childbearing age had favorable health literacy. In the study of Kohan et al. (2018), most women had a good reproductive health score. The health literacy score was favorable in 91% of women and unfavorable only in 9% of them[ 15 ]. In a national study of Iranian adult health literacy conducted by Tavoosi et al. (2015) in Iranian provincial capitals, 56% of the Iranian society had a favorable health literacy score [ 19 ], whereas in a systematic meta-analysis paper (2018), the health literacy in the Iranian population was borderline[ 22 ]. Moreover, in the study of Haqdoost and colleagues in Iran (2015) in nine provinces, a moderate level of health literacy score was reported [ 23 ]. The results of Tavoosi study are almost in line with those of the present study. These divergent results in different studies are a function of the characteristics of study population, cultural and social conditions, and different questionnaires. The statistical results of the present study showed that there was a significant difference in mean scores of reproductive health literacy between the city and the village, the mean score of fertility health literacy in urban women was higher than that of rural women, which could be a function of higher access to educational and health services in urban areas. Despite the high average fertility literacy score in urban women, the ratio of women with favorable literacy in the village was higher than in the city, indicating the impact of more powerful cultural factors and social communication in rural societies that could have a positive effect on improving health literacy. The finding shows that health literacy is not necessarily dependent on educational resources and that cultural factors can play an important role in this regard. In the studies conducted by Sayyadi et al. (2022) in Chabahar, the average score of fertility health literacy was lower in rural women than in urban women [ 24 ]. In contrast, the results of Haqdoost et al. [ 23 ]and Nowruzi et al. (2019) in Ahvaz showed that the rural population had higher health literacy due to easier access to the family physician and health workers at the time of study because at that time the family physician program was only implemented in the villages[ 25 ]. The high literacy score in urban women of the present study is probably because the percentage of women with university education in urban women is higher than that of rural areas (72.1% vs. 28.4%). Most urban women were also employed (50.7% vs. 19.9%). Educated and employed women have a greater opportunity for social and cultural interactions, so their fertility health literacy score is higher. It should be noted that living in village alone does not explain the difference because demographic and social factors are also involved in this difference. Single-variable investigation of the factors related to reproductive health literacy in the two groups of urban and rural populations revealed a significant difference between employment, education and employment of a relative in the health care system. However, education and employment variables were not significant in regression results due to interaction with demographic variables. In the village, the number of pregnancies and employment of a family member in the health care system were significant factors. The findings showed that factors such as education, employment, and employment of a family member in the health system are significantly related to fertility health literacy. Education is one of the most important predictors of health literacy, especially in urban are as where women have higher academic degrees. Employment of women in cities also had a positive impact on health literacy due to access to more information resources and interacting with wider social environments. In rural areas, the number of pregnancies was identified as one of the main predictors of health literacy. This may be because women with higher number of pregnancies have gained more experience in fertility and improved their health literacy. In the study of Ansari et al. (2018), participants had a high health literacy score and reported higher education, sampling area, information source and Internet as the factors related to high health score[ 26 ]. In the study of Haqdoost and colleagues, the level of education, age, female gender, residence in rural areas, and having a permanent job had a significant relationship with health literacy [ 23 ]. In the study of Sayyadi et al., the relationship between education and socioeconomic conditions with health literacy score was confirmed [ 24 ]. In the study of Kohan et al., there was a relationship between age and being married but not with education with health literacy score [ 15 ]. In the study of Bahravand et al. (2022) in Minab, age, education, maternal employment were not predictors of pregnant mothers' health literacy[ 27 ]. The present study was not in line with the study of Haqdoost and Sayyadi in some related factors such as education and employment, but was consistent with them in terms of lack of relationship between education with health literacy score. In justifying this phenomenon, education alone may not be enough to underst and health care because some educated women do not receive sufficient health care service. According to the Research Agency for Health Care Research and High Quality Research, despite the relationship between the level of literacy and education, there is no complete correlation between education level and reproductive health literacy [ 28 ].In the present study, there was a significant relationship between reproductive health literacy with the number of pregnancies, so that reproductive health literacy increased with the increase in the number of pregnancies. In the present study, more than half of women had 2–3 pregnancies. In the study of Rakhshai et al. (2024), there was a significant relationship between reproductive health literacy of infertile women with age, number of pregnancies and abortion [ 29 ].Mutiparous women are likely to have more familiarity with sex and fertility issues. These women also have a higher interaction with health care personnel. Moreover, in single variable examination, there was a significant relationship between urban and rural fertility health literacy scores with variables indicating fertility-related behaviors, so that women with high health literacy scores more frequently visited for screening and reproductive health checks, including familiarity with screening, breast examination, breast self-examination, hepatitis, and HIV. In the regression test, this relationship was only significant with breast self-examination and breast examination by a physician and midwife. The results showed that behaviors related to fertility health such as breast self-examination in urban women and referring to midwives or physicians for breast examination in rural women were related with reproductive literacy. These findings show that promoting health awareness and preventive behaviors can help improve health literacy in both groups. For example, breast examination by a midwife or physician in rural women can help increase health literacy because these women benefit from health services that provide them with more information and awareness of reproductive health. In the study of Sentel et al. (2015) among Asians and Caucasians of California, the low reproductive health literacy had a significant relationship with poor mammography and Pap test screening [ 30 ]. In the study of Ghanbari et al. (2017) to determine the health literacy level with cancer screening behaviors among the administrative staff of Gilan University of Medical Sciences, a significant relationship was observed between health literacy and Pap test but not with breast self-examination and mammography [ 31 ].This indicates the role of health literacy in the promotion of cancer-related behaviors. In the present study, the frequency of urban and rural women visits for Pap test were (62.2 vs. 6.6), breast examination (46.2 vs. 42.1), genital warts (15.6 vs. 5), and breast self-examination (55.4 vs. 48.8), respectively. Inadequate participation of urban and rural women for screening was evident in the present study. Urban and rural women have also cited midwives and physicians as the most reliable information sources (60% in the city and 77% in the village) to promote reproductive health literacy. Therefore, increasing educational resources for health officials is necessary to promote the health literacy of the population of reproductive age [ 7 , 32 ] Strengths and Limitations One of the strengths of the present study was its large sample size, which enhances the generality of the results. Other strong points of this study were the use of an indigenous health literacy questionnaire in line with cultural, social, and economic features of the target group that increases the likelihood of proper responding. On the other hand, sampling was done online, face-to-face and by phone, which increased the flexibility of sampling. Online sampling and telephone calls also provided the conditions to collect data without presence of participants. One of the limitations of this study was the absence of illiterate women in it, so that only three illiterate rural women participated in the study. Another limitation of the study was the reliance of data collected concerning fertility health behaviors such as Pap test, breast examination by a doctor, pelvic examination, mammography and so forth on self-reporting, which increases the possibility of low or high reporting. Conclusion This study examined and compared reproductive health literacy in urban and rural women from Sari. The results showed significant differences regarding reproductive health literacy and its related factors. The findings of this research can help better understand the status of reproductive health literacy in these two groups and provide solutions to improve it. The results showed that about half of the urban and rural population had good health literacy. In addition, women participating in this study, especially those with lower number of pregnancies, need more authentic information in some items related to fertility health such as breast self-examination, breast examination by a doctor and midwife, Pap test, and genital warts. Therefore, adopting and implementing a number of measures can play an important role in promoting the health literacy of women in the community. In general, this study showed that various factors such as education, employment, and access to health services significantly affect women's fertility health literacy. The results of this study can help health planners and policymakers design and implement more appropriate training and health services by considering the differences in urban and rural areas. In addition, given the importance of behaviors related to reproductive health, encouraging preventive examinations and raising public awareness in this area can help improve fertility health literacy in women. Abbreviations OR Odds Ratio WHO World Health Organization UNFPA United Nations Population Fund STD Sexual Transmitted Disease AIDS Acquired Immunodeficiency Syndrome BMI Body Mass Index C C Cervical Cancer CVI, CVR Content Validity Index, Content Validity Ratio. Declarations Ethics approval and consent to participate This study with the code ir.mazums. rec.1402.15041 was registered at the Ethics Committee of Mazandaran University of Medical Sciences. The consent form was completed by the participants at the beginning of answering the questionnaire . The research was conducted in accordance with the guidelines proposed on the declaration of Helsinki. Consent for publication All the authors of the manuscript consented for publication. Availability of data and material The datasets used and analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare no competing interests. Funding The research process was funded by the Deputy Director of Research and Technology of Mazandaran University of Medical Sciences in Iran.But no funding was allocated for publication. Authors' contributions NAH conceived of the study. NAH, ZH, ZSh, MA,MR, KA and LH participated in the study protocol design. NAH, ZH, ZSh, MR, KA and LH participated in the cross sectional study. MA participated in the design of the study and performed the statistical analysis. NAH, ZH, ,MR, KA and LH participated in data collection and study design. NAH and ZH wrote the draft of the manuscript. The final version of the manuscript was critically reviewed by NAH. All authors read and approved the final manuscript. Acknowledgements This article is derived from a research project conducted at Mazandaran University of Medical Sciences. Therefore, the authors of the article appreciate the Deputy Director of Research and Technology of Mazandaran University of Medical Sciences for approving this project as well as the urban and rural women of Sari in Iran. References Organization WH, including UNDP/UNFPA/WHO/World Bank Special Programme of Research Training in Human Reproduction (HRP). Annual technical report 2015: department of reproductive health and research,. In.: World Health Organization; 2016. https://iris.who.int/bitstream/handle/10665/246092/WHO-RHR-HRP-16.08-eng.pdf Colciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women’s vulnerability within the childbearing continuum: a scoping review. Eur J midwifery 2020, 4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7839125 Najimi A, Golshiri P, Amini S. Health literacy and self-care in reproductive age: The role of reading and numeracy skills. Health 2017, 6(5). https://jne.ir/article-1-822-en.pdf Ma X, Yang Y, Wei Q, Jiang H, Shi H. Development and validation of the reproductive health literacy questionnaire for Chinese unmarried youth. Reproductive health. 2021;18:1–11. 10.1186/s12978-021-01278-6 . https://link.springer.com/article/ . Shieh C, Halstead JA. Understanding the impact of health literacy on women's health. J Obstetric Gynecologic Neonatal Nurs. 2009;38(5):601–12. https://www.sciencedirect.com/science/article/abs/pii/S0884217515302197 . Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JE, Sychareun V, Essink DR. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS ONE. 2019;14(1):e0209675. https://pmc.ncbi.nlm.nih.gov/articles/PMC6334956/ . Dabiri F, Hajian S, Ebadi A, Zayeri F, Abedini S. Sexual and reproductive health literacy of the youth in Bandar Abbas. AIMS Med Sci. 2019;6(4):318–25. https://eprints.bmsu.ac.ir/2754/ . Kharazi S, Peyman N, Esmaily H. Association between maternal health literacy level with pregnancy care and its outcomes. 2016. https://www.cabidigitallibrary.org/doi/full/10.5555/20173204427 Maricic M, Stojanovic G, Pazun V, Stepović M, Djordjevic O, Macuzic IZ, Milicic V, Vucic V, Radevic S, Radovanovic S. Relationship between socio-demographic characteristics, reproductive health behaviors, and health literacy of women in Serbia. Front Public Health 2021, 9:629051. https://www.frontiersin.org/journals/public-health/articles/ 10.3389/fpubh.2021.629051/full Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health 2018, 6(4):e380-e389. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30029-9/fulltext Kann L. Youth risk behavior surveillance—United States, 2017. MMWR Surveillance Summaries 2018, 67. https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm?s_hy_yrbs2017_adu Esfahani P, Danshi Kohani Z, Arefi M. Prevalence of unwanted pregnancy among Iranian Women: systematic review and meta-analysis. Pajouhan Sci J. 2020;18(2):1–12. https://psj.umsha.ac.ir/article-1-553-en.html . Goshtasebi A, Banaem LM, Rodbary MA, Bakouei S. The Association Between Preconception Body Mass Index and Pregnancy Weight Gain on Birth Weight. J Mazandaran Univ Med Sci (JMUMS) 2011, 21(84). https://jmums.mazums.ac.ir/article-1-672-fa.html Taghizadeh Asl R, Van Osch L, De Vries N, Zendehdel K, Shams M, Zarei F, De Vries H. The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration. BMC Public Health. 2020;20:1–12. 10.1186/s12889-020-09701-6 . https://link.springer.com/article/ . Kohan S, Mohammadi F, Yazdi M, Dadkhah A. Evaluation of relationship between reproductive health literacy and demographic factors in women. J Health Lit. 2018;3(1):20–9. https://literacy.mums.ac.ir/article_10928.html . Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, Bertran-Noguer C, González-Mestre MA, Masachs-Fatjo E, Santaeugènia SJ, Magrinyà-Rull P, Saltó-Cerezuela E. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health. 2019;19:1–12. 10.1186/s12889-019-7381-1 . https://link.springer.com/article/ . Stallings E. Literacy and culture as determinants of health: Designing education for improved outcomes. Drew University; 2015. https://www.proquest.com/openview/84d26aaeb814b18764434a3ad20ba5fc . /1?pq-origsite=gscholar&cbl=18750. Madanipour A, Ahmadnia S, Rostami Z, Ahmadabadi Z. Reproductive Health; Importance of Income or Education? Comparative Analysis of World Countries, with Emphasize on The Middle East, North Africa and Central Asia . J Fam Res. 2009;4:441–59. https://jfr.sbu.ac.ir/article/view/10163/article_95256_28017a2e03bfba71ed3ba91cdd55735e.pdf . Toçi E, Burazeri G, Myftiu S, Sørensen K, Brand H. Health literacy in a population-based sample of adult men and women in a South Eastern European country. J Public Health. 2016;38(1):6–13. https://academic.oup.com/jpubhealth/article-abstract/38/1/6/2362631 . Kawata S, Hatashita H, Kinjo Y. Development of a health literacy scale for women of reproductive age: an examination of reliability and validity in a study of female workers. [Nihon Koshu Eisei Zasshi] Japanese J Public Health. 2014;61(4):186–96. https://europepmc.org/article/med/24869995 . Sheikhizadeh S. Self-care activities among women referred to health care centers in Kerman. J Health Based Res. 2016;2(1):55–67. https://hbrj.kmu.ac.ir/article-1-77-en.html . Dadipoor S, Ramezankhani A, Aghamolaei T, Rakhshani F, Safari-Moradabadi A. Evaluation of health literacy in the Iranian population. Health scope 2018, 7(3). https://brieflands.com/articles/healthscope-62212.pdf Haghdoost AA, Karamouzian M, Jamshidi E, Sharifi H, Rakhshani F, Mashayekhi N, Rassafiani H, Harofteh F, Shiri M, Aligol M. Health literacy among Iranian adults: Findings from a nationwide population-based survey in 2015. East Mediterr Health J. 2019;25(11):828–36. https://www.researchgate.net/publication/332903827 . Sayadi Z, Ahmadipour H. Reproductive Health Literacy and its Related Factors in Women of Reproductive Age Referring to Comprehensive Healthcare Centers in Chabahar in 2021. Health Dev J. 2023;11(1):24–8. https://jhad.kmu.ac.ir/article_91161_7a0c52d9eb9b3fbfad5809f97937d38e.pdfhttps://jhad.kmu.ac.ir/article_92067.html . Noroozi M, Madmoli Y, Derikvand M, Saki M, Moradi Kalboland M. Investigating health literacy level and its relation with some factors in patients with type 2 diabetes in Ahvaz-2018. J Health Lit. 2019;4(1):43–52. https://literacy.mums.ac.ir/article_13192.html . Ansari M, Mohammad-Moradi F, Khaledian M, Shekofteh M. Assessment of health literacy level in 18–30 year-old adults, an Iranian experience. 2018. https://core.ac.uk/download/pdf/189480057.pdf Baharvand P, Anbari K, Abdolian M. Health Literacy and Its Predictors Among Pregnant Women: A Cross-sectional Study. ournal Educ Community Health 2022. http://eprints.lums.ac.ir/id/eprint/4008 Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E. Health literacy interventions and outcomes: an updated systematic review. Evid report/technology Assess 2011(199):1–941. https://europepmc.org/article/nbk/nbk82434 Rakhshaee Z, Kamranpour B. Study of Reproductive Health Literacy and Its Related Factors in Infertile Women. J Health. 2024;14(4):466–80. https://healthjournal.arums.ac.ir/browse.php?a_code=A-10-608- . 301&sid=1&slc_lang=en. Sentell T, Braun KL, Davis J, Davis T. Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. Springerplus. 2015;4:1–9. https://link.springer.com/content/pdf/10.1186/s40064-015-1225-y.pdf . Ghanbari A, Rahmatpour P, Khalili M, Mokhtari N. Health literacy and its relationship with cancer screening behaviors among the employees of Guilan University of Medical Sciences. J Health Care. 2017;18(4):306–15. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C . 5&q=Health+literacy+and+its+relationship+with+cancer+screening+behaviors+among+the+employees+of+Guilan+University+of+Medical+Sciences.+&btnG=. Hamzehgardeshi Z, Shahhosseini Z, Tonekaboni S, Yazdani F. Sexual and reproductive health education needs and its associated factors in couples participating in premarital counseling. J Nurs Midwifery Sci. 2019;6(1):38–43. https://scholar.google.com/scholar?hl=en& . as_sdt=0%2C5&q=+Sexual+and+reproductive+health+education+needs+and+its+associated+factors+in+couples+participating+in+premarital&btnG=. Additional Declarations No competing interests reported. Supplementary Files supplementaryfile.docx Cite Share Download PDF Status: Posted Version 1 posted 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-5763987","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":401848732,"identity":"6de05f66-a091-4afc-8193-c912fe57870c","order_by":0,"name":"zeinab hamzehgardeshi","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"zeinab","middleName":"","lastName":"hamzehgardeshi","suffix":""},{"id":401848733,"identity":"75ab2fad-11d6-47fc-b6d3-944e36bcd2ba","order_by":1,"name":"maryam ahmadian","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"maryam","middleName":"","lastName":"ahmadian","suffix":""},{"id":401848734,"identity":"93f16f95-1b94-4fbb-aa34-29d94bc30d29","order_by":2,"name":"Maedeh Rezaei","email":"","orcid":"","institution":"Islamic Azad University of Gorgan","correspondingAuthor":false,"prefix":"","firstName":"Maedeh","middleName":"","lastName":"Rezaei","suffix":""},{"id":401848735,"identity":"64817736-f9c7-4b11-b347-88527834937a","order_by":3,"name":"Kosar Alizadeh","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kosar","middleName":"","lastName":"Alizadeh","suffix":""},{"id":401848736,"identity":"659f1e8b-36d8-488b-a1ef-93dc0638ea38","order_by":4,"name":"Zohreh Shahhosseini","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zohreh","middleName":"","lastName":"Shahhosseini","suffix":""},{"id":401848741,"identity":"5ae413cf-eb66-4f21-8031-f8b577ea3f1c","order_by":5,"name":"Leila Hamzehgardeshi","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Leila","middleName":"","lastName":"Hamzehgardeshi","suffix":""},{"id":401848743,"identity":"09b04577-e75a-408b-a69a-9acba39a6a9d","order_by":6,"name":"Nayereh Azam Hajikhani Golchin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACAwaGhIONDQwMbOzNBxgYG0jSwnMsgWgtDIwgLQwSOQbEaTFnP/Dw4Mwddnl8DDnfJH7usJFjYD98dAM+LZY9CQkHN55JLmZjOLtNsvdMmjEDT1raDbwOOwDU8rCNObGNsXebBG/b4cQGCR4z/FrOPwBpqU9sY+Z5JvmXKC03QA4Dqmxj42GTJs6WG0BbZrYdT2zjYTO2lm1LM2Yj6JfzOckfe9uqE+fPf/zw5ts2Gzl+9sPH8GphYOBJgLFYJEAkG37lIMB+AMZi/kBY9SgYBaNgFIxEAAC8MlUAThuxmQAAAABJRU5ErkJggg==","orcid":"","institution":"Islamic Azad University of Gorgan","correspondingAuthor":true,"prefix":"","firstName":"Nayereh","middleName":"Azam Hajikhani","lastName":"Golchin","suffix":""}],"badges":[],"createdAt":"2025-01-04 14:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5763987/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5763987/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79334459,"identity":"eed95806-359c-4924-a76b-3079ae56d38e","added_by":"auto","created_at":"2025-03-27 07:32:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":879431,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5763987/v1/86bcbd9f-aa21-4b9f-9a57-af20de057a6d.pdf"},{"id":73852911,"identity":"533550ab-26a0-4e71-911a-c59db943d654","added_by":"auto","created_at":"2025-01-15 09:55:48","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17026,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-5763987/v1/47f14e9864eff6cacd4a1c45.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of reproductive health literacy and related factors in urban and rural women of reproductive age in Iran 2023","fulltext":[{"header":"Background","content":"\u003cp\u003eReproductive health is a prerequisite for sustainable development \u0026nbsp;in today\u0026apos;s societies. Therefore, in \u0026nbsp;recent years, the international community \u0026nbsp;has paid special attention to reproductive health. Reproductive health is a key area of health and \u0026nbsp;an \u0026nbsp;important indicator of the health status of societies, which has been addressed as a priority by WHO and UNFPA since 1994 and \u0026nbsp;is still at the center of global attention[1].\u003c/p\u003e\n\u003cp\u003eWomen of reproductive age are a vulnerable \u0026nbsp;group in every society due to special physiological conditions in this period such as pregnancy, childbirth and \u0026nbsp;breast feeding[2]. Reproductive health \u0026nbsp;literacy in women \u0026nbsp;increases their awareness, ability to make decisions as \u0026nbsp;well as upholding skills on reproductive health issues, increasing the use of \u0026nbsp;reproductive health services, reducing unwanted \u0026nbsp;fertility and empowering women to monitor their own health. Women\u0026apos;s health \u0026nbsp;is the foundation of \u0026nbsp;family and \u0026nbsp;community \u0026nbsp;health, and they are of special importance in ensuring and maintaining the social and family health [3] .Efforts have always been made to improve the reproductive health status of people in different countries by \u0026nbsp;implementing \u0026nbsp;a variety of strategies. The note worthy issue is that the latest \u0026nbsp;needs \u0026nbsp;assessments \u0026nbsp;and \u0026nbsp;researches \u0026nbsp;have shown that \u0026nbsp;improving \u0026nbsp;reproductive health literacy is one of the most important strategies to achieve the goals of reproductive health in various groups of women [4] [5]. The study of Vongxay \u0026nbsp;et al. in Laos in 2019 showed \u0026nbsp;that 65.5% of young \u0026nbsp;people \u0026nbsp;lacked \u0026nbsp;sexual and \u0026nbsp;reproductive health [6]. The results of a study by Dabiri et al. in Iran in 2019 indicated that 85% of the investigated couples lacked \u0026nbsp;sufficient sexual \u0026nbsp;health and reproductive literacy [7]. Kharazi et al.\u0026apos;s study showed that there is a significant relationship between maternal health literacy and care during pregnancy, pregnancy outcome and birth weight, indicating the need \u0026nbsp;to pay more attention to maternal health literacy in health promotion programs [8].\u003c/p\u003e\n\u003cp\u003eAlthough significant progress has been made in several aspects of reproductive health, there are still many challenges in this regard, including unwanted pregnancy, high-risk behaviors, early detection of STD through screening for disease prevention (such as screening test for human papilloma virus), and negative effect of obesity on reproduction [9]. \u0026nbsp;In a study conducted in 104 countries (2010-2014), the prevalence of unwanted \u0026nbsp;pregnancies in the world was reported as 44% and \u0026nbsp;in developed countries as \u0026nbsp;30% [10].\u003c/p\u003e\n\u003cp\u003eAccording to the report of US Center for Disease Control and \u0026nbsp;Prevention (2017), condom failure is observed in 46% of people aged 15-24 in their last \u0026nbsp;sexual \u0026nbsp;intercourse; 21% of newly diagnosed AIDS cases were among these people and \u0026nbsp;more than 50 % of new cases of other sexually transmitted \u0026nbsp;infections \u0026nbsp;were also seen in them [11]. In addition, in a meta-analysis conducted in Iran (2020), the prevalence of unwanted pregnancy in Iran was reported to be 52% [12]. In a study performed in Tehran (2011), the prevalence of weight gain according to BMI in women is 31.3% before their pregnancy [13]. In a qualitative research conducted on Tehrani women aged 25-65 years (2020), their knowledge about cervical cancer (CC) and screening was limited, with social and cultural barriers hindering proper communication between \u0026nbsp;health \u0026nbsp;providers and clients on issues related to CC and screening. The perceived risk of CC was low due to overestimation of the role of hereditary \u0026nbsp;factors \u0026nbsp;for CC, the difficulty in differentiating \u0026nbsp;between cancer and \u0026nbsp;STI, and absence of visible symptoms \u0026nbsp;[14].\u003c/p\u003e\n\u003cp\u003eAge and \u0026nbsp;marital \u0026nbsp;status are among the factors related to reproductive health literacy in Iranian women. The average score of health \u0026nbsp;literacy \u0026nbsp;in women \u0026nbsp;aged \u0026ge;25 years is higher than that of women \u0026gt;25 years, but this upward trend continues until 45 years of age, after which it has a downward trend. Progressive age along with facing more fertility-related issues can be a reason \u0026nbsp;for higher reproductive health \u0026nbsp;literacy \u0026nbsp;scores in the age group of 25-45 years [15]. Other related \u0026nbsp;factors \u0026nbsp;include training, education, income, socioeconomic status[16, 17] , place of residence, participation in reproductive and sexual health training classes, and employment of a family member in health centers [6].\u003c/p\u003e\n\u003cp\u003eAccording to studies, the improvement of education index alone explains the level of reproductive health to a large extent, so that reproductive health improves in countries with an efficient education system that have invested in education. Moreover, the education index has explained only about 71% of the total changes in reproductive health [18]. \u0026nbsp;Culture and ethnicity are also among \u0026nbsp;the factors \u0026nbsp;that affect health. Family, social and cultural \u0026nbsp;influences are vitally important in shaping attitudes and beliefs, affecting the way people interact with the health system [19]. Awareness of the prevailing conditions appears \u0026nbsp;to be necessary \u0026nbsp;before \u0026nbsp;implementing any \u0026nbsp;targeted \u0026nbsp;intervention to improve women\u0026apos;s reproductive health literacy; therefore, the goal of the present study was to compare reproductive health literacy and its related factors among \u0026nbsp;urban and rural women of reproductive age in Sari city.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eType of study:\u003c/strong\u003e This is a cross-sectional, descriptive analytical study that was conducted in 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e The participants of the study were married women aged 18-49 years from Sari and its nearby villages. Women living in Sari and its suburbs who were willing to participate in the study met the inclusion criteria. The only exclusion criterion was voluntary withdrawal from the study. The data was collected by an interviewer familiar with research methods and sampling principles. For this purpose, the interrogator identified the eligible people from the files in urban and rural health centers, and then the questionnaires were submitted to the samples using both online and face-to-face methods. The participants were assured that their information would remain confidential. If the participants had the ability to link in the group to complete the online questionnaire, they \u0026nbsp;were enrolled in the online group list, and \u0026nbsp;if such conditions were not provided for them, they were enrolled in the face-to-face group. The questionnaire link was subsequently presented to the research community online through WhatsApp \u0026nbsp;Messenger. Questionnaires were also provided to the people in attendance at the health centers. For those who did not have the online and face-to-face conditions, the sampler asked the questions over the phone and completed the questionnaires.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size:\u003c/strong\u003e Based on the study of Najimi et al. conducted on 2017 [3] and the average \u0026nbsp;health \u0026nbsp;literacy of 41.50 \u0026plusmn; 9.23 at a confidence \u0026nbsp;level of 0.95 and maximum error of 1, the sample size was estimated 327 using the following formula to determine \u0026nbsp;sample size in an independent group:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1736934583.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eConsidering that this study was conducted in urban and \u0026nbsp;rural women \u0026nbsp;of \u0026nbsp;reproductive age, 327 samples were also selected as a comparison group in the village, that is, a total of 654 samples were recruited in the study. Simple random sampling with allocation proportional to the size of reproductive age women was done in each center. In this way, several health centers in different parts of \u0026nbsp;Sari and villages around it were randomly selected. Through the list of families covered by selected urban \u0026nbsp;and \u0026nbsp;rural health care centers, women of reproductive age were \u0026nbsp;randomly \u0026nbsp;selected \u0026nbsp;and \u0026nbsp;the necessary arrangements \u0026nbsp;were made \u0026nbsp;with them by phone call.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrument:\u003c/strong\u003e The data collection tool consisted of two questionnaires. The first questionnaire \u0026nbsp;was a reproductive health literacy questionnaire for women of reproductive age, which was developed in a study at University of Shiga, Japan, and \u0026nbsp;its \u0026nbsp;validity and \u0026nbsp;reliability have also been \u0026nbsp;examined [20]. In \u0026nbsp;Iran, Kohan et al. (2018) evaluated the validity and \u0026nbsp;reliability of the mentioned questionnaire. The content \u0026nbsp;and \u0026nbsp;face validity of the questionnaire was \u0026nbsp;examined \u0026nbsp;both qualitatively and quantitatively (CVI, CVR). By calculating \u0026nbsp;the content validity ratio, all the items with a score \u0026gt;0.6 were kept in the questionnaire, and by calculating the content validity index, all the items in the questionnaire had a score \u0026gt;0.79. The reliability of this questionnaire was confirmed by test-retest, with alpha of 0.8 and \u0026nbsp;correlation coefficient of 0.72.This instrument \u0026nbsp;measures \u0026nbsp;the level of women\u0026apos;s \u0026nbsp;reproductive health literacy in the form of 29 questions with a four-point Likert scale of very poor (score = 1), poor (score = 2), acceptable (score = 3), good (score = 4) and very good ( score = 5), and the total score range of this questionnaire is 29-145. In this instrument, reproductive health literacy scores above the average are defined as favorable \u0026nbsp;and \u0026nbsp;below average \u0026nbsp;as \u0026nbsp;unfavorable [15].\u003c/p\u003e\n\u003cp\u003eThe second questionnaire created by \u0026nbsp;the researcher \u0026nbsp;includes the demographic-social-fertility characteristics. This questionnaire contains 29 items, including 9 questions \u0026nbsp;about demographic-social characteristics, 4 about fertility status, and 16 regarding \u0026nbsp;behaviors \u0026nbsp;related to reproductive health, in which questions related to reproductive health \u0026nbsp;behaviors \u0026nbsp;and \u0026nbsp;the recommended \u0026nbsp;screening method for women according to their age were asked based on available texts \u0026nbsp;[17, 21]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e After collection, the data was analyzed by SPSS software (version 23). Quantitative and qualitative variables were described with mean\u0026plusmn;SD and frequency distribution table (frequency-percentage), respectively. The reproductive health literacy score in both urban and \u0026nbsp;rural areas \u0026nbsp;was \u0026nbsp;investigated using Smirnov-Kolmogorov test, which showed non-normality of the literacy score. Therefore, non-parametric tests were used to compare \u0026nbsp;between two or more groups.\u003c/p\u003e\n\u003cp\u003eMann-Whitney and Kruskal-Wallis tests were utilized to compare the means between groups; Chi-square test and Fisher\u0026apos;s exact test were used to compare variables. In addition, logistic regression analysis was performed to determine the correlated factors. There were many variables in the study, including age, education, job, economic status, duration of marriage, number of children, pregnancies, and abortions, unwanted pregnancies, the contraceptive method, as well as other variables indicating reproductive health related behaviors such as familiarization with screenings, Pap test, breast self-examination, breast examination by a physician or midwife, pelvic examination, presence and treatment of genital warts, mammography, hepatitis and HIV tests and screening mode according to age, method of obtaining information on reproductive health and relatives working in the healthcare system, which were considered independent variables whose relationship with reproductive health literacy score as the dependent variable was examined. Variables with a significance level \u0026lt;0.21 were considered significant variables to enter the logistic regression model. The significance level was considered p\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 593 women participated in this study, including 294 women in the city and 299 women in the village. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows demographic-social characteristics and some fertility-related behaviors in women of reproductive age in city and village.\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\u003eDemographic-social and fertility characteristics of women of reproductive age in citiy and village.\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003evillage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003efrequency (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003efrequency (percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage age of samples (standard deviation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34/09(8/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35/47( 7/94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge groups ( year )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(13/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34(11/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123(41/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91(30/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131(44/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174(58/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEducation levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eilliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eelementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(7/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (5/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(16/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138(46/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003euniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215(73/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85(28/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eseminary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(0/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(0/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ejob\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehousewives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145(49/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e239(79/9)\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\u003e149(50/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(20/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eenough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101(34/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92(30/8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than enough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(6/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(7/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than enough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(4/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(4/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159(54/1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(57/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime interval from marriage to- pregnancy ( month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/15(26/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35/47(7/9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(47/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(26/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113(51/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160(62/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(11/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81(37/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(22/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116(54/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160(53/5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(7/9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHow to get reproductive health -information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(28/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(45/8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93(31/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(31/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(20/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(12/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(19/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(10/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eunwanted pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(19/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47(15/7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236(80/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e252(84/3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eContraception method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169(57/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154(51/5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125(42/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(48/5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePap smear test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183(62/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e214(71/6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84(28/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(13/4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast self-examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163(55/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146(48/8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131(44/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153(51/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCheck for genital warts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(15/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248(84/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e284(95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast examination by doctor and- midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(46/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126(42/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(53/7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e173(57/9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the average age of urban and rural women was 34.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 and 35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.94 years, respectively. The most frequent age group in the city and village was \u0026gt;\u0026thinsp;35 years (44.6% in the city and 58.2% in the village). The highest level of education in urban and rural women was university degree (72.1%) and high school diploma (46.2%), respectively. Most urban women were employed (50.7%), and the majority of rural women were housewives (79.9%). About half of urban and rural women had a moderate economic status (54.1% in the city and 57.2% in the village).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the average score of reproductive health literacy as well as percentage and frequency of favorable and unfavorable literacy separately in the general population and urban and rural women.\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 average score of reproductive health literacy in the city and village and the whole population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eFavorable\u003c/p\u003e \u003cp\u003ehealth literacy frequency (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnfavorable\u003c/p\u003e \u003cp\u003ehealth literacy frequency (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth literacy score\u003c/p\u003e \u003cp\u003emean (standard deviation)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(P- value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151(51/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143(48/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210(70/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89(29/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewhole- population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e339(57/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254(42/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114/94(23/11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA significant difference was observed in the average score of fertility literacy in both urban and rural areas.\u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the health literacy score in the total population of women is 114.94\u0026thinsp;\u0026plusmn;\u0026thinsp;23.11, with 57.2% of women having favorable health literacy and 42.8% unfavorable health literacy. The health literacy score for urban and rural women was 118.54\u0026thinsp;\u0026plusmn;\u0026thinsp;21.38 and 111.40\u0026thinsp;\u0026plusmn;\u0026thinsp;24.21, respectively, indicating a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Besides, the percentage of women with favorable literacy in rural areas was higher than in urban areas (70.4% vs. 51.4%).\u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show the correlation of quantitative and qualitative variables with health literacy scores in urban and rural women with Mann-Whitney, Chi-square and Fisher's exact tests, respectively.\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\u003eInvestigating the quantitative variables related to reproductive health literacy score in urban and rural women of reproductive age.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage reproductive health literacy score (standard deviation)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(P- value)\u003c/p\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(P- value)\u003c/p\u003e \u003cp\u003evillage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003emother's age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113/43(22/26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119/05(20/17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ge;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112/43(24/85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118/72(21/45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113/73(22/82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ge;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103/13(30/01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117/63(21/59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112/76(24/23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ge;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82(19/82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, there was a significant relationship between the number of pregnancies and mother's age in urban women and the number of children in rural women with average score of women's reproductive health literacy. The variables of duration of marriage, the number of abortions in the city and the village had no significant relationship with reproductive health literacy score (not indicated in the table).\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\u003eInvestigating the qualitative variables related to reproductive health literacy score in urban and rural women of reproductive age.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003evillage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth literacy score\u003c/p\u003e \u003cp\u003emean (standard deviation)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(P- value)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth literacy score\u003c/p\u003e \u003cp\u003emean (standard deviation)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(P- value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebeing employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving a prevention method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eunwanted pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamiliarity with screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoing for a breast -examination by a doctor or- midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast self-examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral for pelvic- examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111/40(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMammography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral for HIV testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral to check hepatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking relatives in the- healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118/54(21/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there was a significant relationship between employment, education and employment of a relative at health center in urban and rural women with average health literacy score of women. There was also a significant difference between urban and rural women's reproductive health literacy score and the variables that indicate reproductive health behaviors, including familiarity with screening, visiting for breast examination, breast self-examination, hepatitis, and HIV.\u003c/p\u003e \u003cp\u003eIn general, based on the results of Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, a significant relationship was found between the variables of employment (0.00), education level (0.00), employment of a relative in a health center, acquaintance with screenings (0.00), visiting for hepatitis and HIV (0.00) with fertility literacy score among urban and rural women. Visiting for mammography (0.01) in rural women and referring for pelvic examination (0.02) in urban women had a significant difference with reproductive health literacy score.\u003c/p\u003e \u003cp\u003eTo perform logistics regression, the variables with a significance level\u0026thinsp;\u0026lt;\u0026thinsp;0.21 in single variable test were considered significant for entering the logistics regression model In logistics regression, there was a significant relationship with women's reproductive health literacy score in the city only between breast self-examination (p\u0026thinsp;=\u0026thinsp;0.009 and OR\u0026thinsp;=\u0026thinsp;0.4) and in the village between breast examination by physician or midwife (p\u0026thinsp;=\u0026thinsp;0.003 and OR\u0026thinsp;=\u0026thinsp;0.38), employment of a family member in the health care system (p\u0026thinsp;=\u0026thinsp;0.000 and OR\u0026thinsp;=\u0026thinsp;0.25) and the number of pregnancies (p\u0026thinsp;=\u0026thinsp;0.04 and OR\u0026thinsp;=\u0026thinsp;55). The number of pregnancies was the most important predictor of health literacy in rural women, which increased by 55% with the increase in the number of pregnancies. Another predictor among the behaviors related to reproductive health in rural women was referring to a physician or midwife for breast examination. The likelihood of optimal literacy increased by 38% in rural women who referred for breast examination. Another predictor was employment of a family member in the health care system, which increased the likelihood of optimal health literacy by 25%. Another predicator of health literacy in urban women was breast self-examination, such that the likelihood of optimal health literacy increased by 24% among women who performed breast self-examination.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study compared the factors related with reproductive health literacy among women of childbearing ages in city and village. The results showed that about half of the general population of women in childbearing age had favorable health literacy. In the study of Kohan et al. (2018), most women had a good reproductive health score. The health literacy score was favorable in 91% of women and unfavorable only in 9% of them[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a national study of Iranian adult health literacy conducted by Tavoosi et al. (2015) in Iranian provincial capitals, 56% of the Iranian society had a favorable health literacy score [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], whereas in a systematic meta-analysis paper (2018), the health literacy in the Iranian population was borderline[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, in the study of Haqdoost and colleagues in Iran (2015) in nine provinces, a moderate level of health literacy score was reported [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of Tavoosi study are almost in line with those of the present study. These divergent results in different studies are a function of the characteristics of study population, cultural and social conditions, and different questionnaires.\u003c/p\u003e \u003cp\u003eThe statistical results of the present study showed that there was a significant difference in mean scores of reproductive health literacy between the city and the village, the mean score of fertility health literacy in urban women was higher than that of rural women, which could be a function of higher access to educational and health services in urban areas. Despite the high average fertility literacy score in urban women, the ratio of women with favorable literacy in the village was higher than in the city, indicating the impact of more powerful cultural factors and social communication in rural societies that could have a positive effect on improving health literacy. The finding shows that health literacy is not necessarily dependent on educational resources and that cultural factors can play an important role in this regard.\u003c/p\u003e \u003cp\u003eIn the studies conducted by Sayyadi et al. (2022) in Chabahar, the average score of fertility health literacy was lower in rural women than in urban women [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In contrast, the results of Haqdoost et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]and Nowruzi et al. (2019) in Ahvaz showed that the rural population had higher health literacy due to easier access to the family physician and health workers at the time of study because at that time the family physician program was only implemented in the villages[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The high literacy score in urban women of the present study is probably because the percentage of women with university education in urban women is higher than that of rural areas (72.1% vs. 28.4%). Most urban women were also employed (50.7% vs. 19.9%). Educated and employed women have a greater opportunity for social and cultural interactions, so their fertility health literacy score is higher. It should be noted that living in village alone does not explain the difference because demographic and social factors are also involved in this difference.\u003c/p\u003e \u003cp\u003eSingle-variable investigation of the factors related to reproductive health literacy in the two groups of urban and rural populations revealed a significant difference between employment, education and employment of a relative in the health care system. However, education and employment variables were not significant in regression results due to interaction with demographic variables. In the village, the number of pregnancies and employment of a family member in the health care system were significant factors. The findings showed that factors such as education, employment, and employment of a family member in the health system are significantly related to fertility health literacy. Education is one of the most important predictors of health literacy, especially in urban are as where women have higher academic degrees. Employment of women in cities also had a positive impact on health literacy due to access to more information resources and interacting with wider social environments. In rural areas, the number of pregnancies was identified as one of the main predictors of health literacy. This may be because women with higher number of pregnancies have gained more experience in fertility and improved their health literacy.\u003c/p\u003e \u003cp\u003eIn the study of Ansari et al. (2018), participants had a high health literacy score and reported higher education, sampling area, information source and Internet as the factors related to high health score[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In the study of Haqdoost and colleagues, the level of education, age, female gender, residence in rural areas, and having a permanent job had a significant relationship with health literacy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the study of Sayyadi et al., the relationship between education and socioeconomic conditions with health literacy score was confirmed [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the study of Kohan et al., there was a relationship between age and being married but not with education with health literacy score [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the study of Bahravand et al. (2022) in Minab, age, education, maternal employment were not predictors of pregnant mothers' health literacy[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The present study was not in line with the study of Haqdoost and Sayyadi in some related factors such as education and employment, but was consistent with them in terms of lack of relationship between education with health literacy score. In justifying this phenomenon, education alone may not be enough to underst and health care because some educated women do not receive sufficient health care service. According to the Research Agency for Health Care Research and High Quality Research, despite the relationship between the level of literacy and education, there is no complete correlation between education level and reproductive health literacy [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].In the present study, there was a significant relationship between reproductive health literacy with the number of pregnancies, so that reproductive health literacy increased with the increase in the number of pregnancies. In the present study, more than half of women had 2–3 pregnancies. In the study of Rakhshai et al. (2024), there was a significant relationship between reproductive health literacy of infertile women with age, number of pregnancies and abortion [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Mutiparous women are likely to have more familiarity with sex and fertility issues. These women also have a higher interaction with health care personnel.\u003c/p\u003e \u003cp\u003eMoreover, in single variable examination, there was a significant relationship between urban and rural fertility health literacy scores with variables indicating fertility-related behaviors, so that women with high health literacy scores more frequently visited for screening and reproductive health checks, including familiarity with screening, breast examination, breast self-examination, hepatitis, and HIV. In the regression test, this relationship was only significant with breast self-examination and breast examination by a physician and midwife.\u003c/p\u003e \u003cp\u003eThe results showed that behaviors related to fertility health such as breast self-examination in urban women and referring to midwives or physicians for breast examination in rural women were related with reproductive literacy. These findings show that promoting health awareness and preventive behaviors can help improve health literacy in both groups. For example, breast examination by a midwife or physician in rural women can help increase health literacy because these women benefit from health services that provide them with more information and awareness of reproductive health.\u003c/p\u003e \u003cp\u003eIn the study of Sentel et al. (2015) among Asians and Caucasians of California, the low reproductive health literacy had a significant relationship with poor mammography and Pap test screening [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In the study of Ghanbari et al. (2017) to determine the health literacy level with cancer screening behaviors among the administrative staff of Gilan University of Medical Sciences, a significant relationship was observed between health literacy and Pap test but not with breast self-examination and mammography [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].This indicates the role of health literacy in the promotion of cancer-related behaviors. In the present study, the frequency of urban and rural women visits for Pap test were (62.2 vs. 6.6), breast examination (46.2 vs. 42.1), genital warts (15.6 vs. 5), and breast self-examination (55.4 vs. 48.8), respectively. Inadequate participation of urban and rural women for screening was evident in the present study. Urban and rural women have also cited midwives and physicians as the most reliable information sources (60% in the city and 77% in the village) to promote reproductive health literacy. Therefore, increasing educational resources for health officials is necessary to promote the health literacy of the population of reproductive age [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eOne of the strengths of the present study was its large sample size, which enhances the generality of the results. Other strong points of this study were the use of an indigenous health literacy questionnaire in line with cultural, social, and economic features of the target group that increases the likelihood of proper responding. On the other hand, sampling was done online, face-to-face and by phone, which increased the flexibility of sampling. Online sampling and telephone calls also provided the conditions to collect data without presence of participants. One of the limitations of this study was the absence of illiterate women in it, so that only three illiterate rural women participated in the study. Another limitation of the study was the reliance of data collected concerning fertility health behaviors such as Pap test, breast examination by a doctor, pelvic examination, mammography and so forth on self-reporting, which increases the possibility of low or high reporting.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined and compared reproductive health literacy in urban and rural women from Sari. The results showed significant differences regarding reproductive health literacy and its related factors. The findings of this research can help better understand the status of reproductive health literacy in these two groups and provide solutions to improve it. The results showed that about half of the urban and rural population had good health literacy. In addition, women participating in this study, especially those with lower number of pregnancies, need more authentic information in some items related to fertility health such as breast self-examination, breast examination by a doctor and midwife, Pap test, and genital warts. Therefore, adopting and implementing a number of measures can play an important role in promoting the health literacy of women in the community.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn general, this study showed that various factors such as education, employment, and access to health services significantly affect women's fertility health literacy. The results of this study can help health planners and policymakers design and implement more appropriate training and health services by considering the differences in urban and rural areas. In addition, given the importance of behaviors related to reproductive health, encouraging preventive examinations and raising public awareness in this area can help improve fertility health literacy in women.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eOR Odds Ratio\u003c/p\u003e \u003cp\u003eWHO World Health Organization\u003c/p\u003e \u003cp\u003eUNFPA United Nations Population Fund\u003c/p\u003e \u003cp\u003eSTD Sexual Transmitted Disease\u003c/p\u003e \u003cp\u003eAIDS Acquired Immunodeficiency Syndrome\u003c/p\u003e \u003cp\u003eBMI Body Mass Index\u003c/p\u003e \u003cp\u003eC C Cervical Cancer\u003c/p\u003e \u003cp\u003eCVI, CVR Content Validity Index, Content Validity Ratio.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval \u0026nbsp;and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study with the code\u0026nbsp;ir.mazums. rec.1402.15041\u0026nbsp;was \u0026nbsp;registered at the Ethics Committee of Mazandaran University of Medical Sciences.\u0026nbsp;The consent form was completed by the participants at the beginning of answering the questionnaire\u003cstrong\u003e.\u003c/strong\u003e The research was conducted in accordance with the guidelines proposed on the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors of the manuscript consented for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research \u0026nbsp;process \u0026nbsp;was \u0026nbsp; funded by the Deputy Director of \u0026nbsp;Research \u0026nbsp;and \u0026nbsp; Technology \u0026nbsp;of Mazandaran \u0026nbsp;University of Medical \u0026nbsp;Sciences in Iran.But \u0026nbsp;no funding \u0026nbsp; was \u0026nbsp;allocated \u0026nbsp;for \u0026nbsp; publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNAH conceived of the study. NAH, ZH, ZSh, MA,MR, KA and LH participated in the study protocol design. NAH, ZH, ZSh, MR, KA and LH participated in the cross sectional study. MA participated in the design of the study and performed the statistical analysis. NAH, ZH, ,MR, KA and \u0026nbsp;LH participated in data collection and study design. NAH and ZH wrote the draft of the manuscript. The final version of the manuscript was critically reviewed by NAH. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is derived from a research project conducted at Mazandaran University of Medical Sciences. Therefore, the authors of the article appreciate the Deputy Director of Research and Technology of Mazandaran University of Medical Sciences for approving this project as well as the urban and rural women of Sari in Iran.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH, including UNDP/UNFPA/WHO/World Bank Special Programme of Research Training in Human Reproduction (HRP). Annual technical report 2015: department of reproductive health and research,. In.: World Health Organization; 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/246092/WHO-RHR-HRP-16.08-eng.pdf\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/246092/WHO-RHR-HRP-16.08-eng.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women\u0026rsquo;s vulnerability within the childbearing continuum: a scoping review. Eur J midwifery 2020, 4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC7839125\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC7839125\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNajimi A, Golshiri P, Amini S. Health literacy and self-care in reproductive age: The role of reading and numeracy skills. Health 2017, 6(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jne.ir/article-1-822-en.pdf\u003c/span\u003e\u003cspan address=\"https://jne.ir/article-1-822-en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa X, Yang Y, Wei Q, Jiang H, Shi H. Development and validation of the reproductive health literacy questionnaire for Chinese unmarried youth. Reproductive health. 2021;18:1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12978-021-01278-6\u003c/span\u003e\u003cspan address=\"10.1186/s12978-021-01278-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShieh C, Halstead JA. Understanding the impact of health literacy on women's health. J Obstetric Gynecologic Neonatal Nurs. 2009;38(5):601\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/S0884217515302197\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/S0884217515302197\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JE, Sychareun V, Essink DR. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS ONE. 2019;14(1):e0209675. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC6334956/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC6334956/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDabiri F, Hajian S, Ebadi A, Zayeri F, Abedini S. Sexual and reproductive health literacy of the youth in Bandar Abbas. AIMS Med Sci. 2019;6(4):318\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://eprints.bmsu.ac.ir/2754/\u003c/span\u003e\u003cspan address=\"https://eprints.bmsu.ac.ir/2754/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKharazi S, Peyman N, Esmaily H. Association between maternal health literacy level with pregnancy care and its outcomes. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cabidigitallibrary.org/doi/full/10.5555/20173204427\u003c/span\u003e\u003cspan address=\"https://www.cabidigitallibrary.org/doi/full/10.5555/20173204427\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaricic M, Stojanovic G, Pazun V, Stepović M, Djordjevic O, Macuzic IZ, Milicic V, Vucic V, Radevic S, Radovanovic S. Relationship between socio-demographic characteristics, reproductive health behaviors, and health literacy of women in Serbia. Front Public Health 2021, 9:629051. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/journals/public-health/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/journals/public-health/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2021.629051/full\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.629051/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. \u003cem\u003eThe Lancet Global Health\u003c/em\u003e 2018, 6(4):e380-e389. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30029-9/fulltext\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30029-9/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKann L. Youth risk behavior surveillance\u0026mdash;United States, 2017. \u003cem\u003eMMWR Surveillance Summaries\u003c/em\u003e 2018, 67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm?s_hy_yrbs2017_adu\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm?s_hy_yrbs2017_adu\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsfahani P, Danshi Kohani Z, Arefi M. Prevalence of unwanted pregnancy among Iranian Women: systematic review and meta-analysis. Pajouhan Sci J. 2020;18(2):1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://psj.umsha.ac.ir/article-1-553-en.html\u003c/span\u003e\u003cspan address=\"https://psj.umsha.ac.ir/article-1-553-en.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoshtasebi A, Banaem LM, Rodbary MA, Bakouei S. The Association Between Preconception Body Mass Index and Pregnancy Weight Gain on Birth Weight. J Mazandaran Univ Med Sci (JMUMS) 2011, 21(84). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jmums.mazums.ac.ir/article-1-672-fa.html\u003c/span\u003e\u003cspan address=\"https://jmums.mazums.ac.ir/article-1-672-fa.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaghizadeh Asl R, Van Osch L, De Vries N, Zendehdel K, Shams M, Zarei F, De Vries H. The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration. BMC Public Health. 2020;20:1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-09701-6\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-09701-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohan S, Mohammadi F, Yazdi M, Dadkhah A. Evaluation of relationship between reproductive health literacy and demographic factors in women. J Health Lit. 2018;3(1):20\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://literacy.mums.ac.ir/article_10928.html\u003c/span\u003e\u003cspan address=\"https://literacy.mums.ac.ir/article_10928.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia-Codina O, Juviny\u0026agrave;-Canal D, Amil-Bujan P, Bertran-Noguer C, Gonz\u0026aacute;lez-Mestre MA, Masachs-Fatjo E, Santaeug\u0026egrave;nia SJ, Magriny\u0026agrave;-Rull P, Salt\u0026oacute;-Cerezuela E. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health. 2019;19:1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-019-7381-1\u003c/span\u003e\u003cspan address=\"10.1186/s12889-019-7381-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStallings E. Literacy and culture as determinants of health: Designing education for improved outcomes. Drew University; 2015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.proquest.com/openview/84d26aaeb814b18764434a3ad20ba5fc\u003c/span\u003e\u003cspan address=\"https://www.proquest.com/openview/84d26aaeb814b18764434a3ad20ba5fc\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. /1?pq-origsite=gscholar\u0026amp;cbl=18750.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadanipour A, Ahmadnia S, Rostami Z, Ahmadabadi Z. Reproductive Health; Importance of Income or Education? \u003cem\u003eComparative Analysis of World Countries, with Emphasize on The Middle East, North Africa and Central Asia\u003c/em\u003e. J Fam Res. 2009;4:441\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jfr.sbu.ac.ir/article/view/10163/article_95256_28017a2e03bfba71ed3ba91cdd55735e.pdf\u003c/span\u003e\u003cspan address=\"https://jfr.sbu.ac.ir/article/view/10163/article_95256_28017a2e03bfba71ed3ba91cdd55735e.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTo\u0026ccedil;i E, Burazeri G, Myftiu S, S\u0026oslash;rensen K, Brand H. Health literacy in a population-based sample of adult men and women in a South Eastern European country. J Public Health. 2016;38(1):6\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://academic.oup.com/jpubhealth/article-abstract/38/1/6/2362631\u003c/span\u003e\u003cspan address=\"https://academic.oup.com/jpubhealth/article-abstract/38/1/6/2362631\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawata S, Hatashita H, Kinjo Y. Development of a health literacy scale for women of reproductive age: an examination of reliability and validity in a study of female workers. [Nihon Koshu Eisei Zasshi] Japanese J Public Health. 2014;61(4):186\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://europepmc.org/article/med/24869995\u003c/span\u003e\u003cspan address=\"https://europepmc.org/article/med/24869995\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikhizadeh S. Self-care activities among women referred to health care centers in Kerman. J Health Based Res. 2016;2(1):55\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hbrj.kmu.ac.ir/article-1-77-en.html\u003c/span\u003e\u003cspan address=\"https://hbrj.kmu.ac.ir/article-1-77-en.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDadipoor S, Ramezankhani A, Aghamolaei T, Rakhshani F, Safari-Moradabadi A. Evaluation of health literacy in the Iranian population. Health scope 2018, 7(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://brieflands.com/articles/healthscope-62212.pdf\u003c/span\u003e\u003cspan address=\"https://brieflands.com/articles/healthscope-62212.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaghdoost AA, Karamouzian M, Jamshidi E, Sharifi H, Rakhshani F, Mashayekhi N, Rassafiani H, Harofteh F, Shiri M, Aligol M. Health literacy among Iranian adults: Findings from a nationwide population-based survey in 2015. East Mediterr Health J. 2019;25(11):828\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/332903827\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/332903827\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSayadi Z, Ahmadipour H. Reproductive Health Literacy and its Related Factors in Women of Reproductive Age Referring to Comprehensive Healthcare Centers in Chabahar in 2021. Health Dev J. 2023;11(1):24\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jhad.kmu.ac.ir/article_91161_7a0c52d9eb9b3fbfad5809f97937d38e.pdfhttps://jhad.kmu.ac.ir/article_92067.html\u003c/span\u003e\u003cspan address=\"https://jhad.kmu.ac.ir/article_91161_7a0c52d9eb9b3fbfad5809f97937d38e.pdfhttps://jhad.kmu.ac.ir/article_92067.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoroozi M, Madmoli Y, Derikvand M, Saki M, Moradi Kalboland M. Investigating health literacy level and its relation with some factors in patients with type 2 diabetes in Ahvaz-2018. J Health Lit. 2019;4(1):43\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://literacy.mums.ac.ir/article_13192.html\u003c/span\u003e\u003cspan address=\"https://literacy.mums.ac.ir/article_13192.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsari M, Mohammad-Moradi F, Khaledian M, Shekofteh M. Assessment of health literacy level in 18\u0026ndash;30 year-old adults, an Iranian experience. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://core.ac.uk/download/pdf/189480057.pdf\u003c/span\u003e\u003cspan address=\"https://core.ac.uk/download/pdf/189480057.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaharvand P, Anbari K, Abdolian M. Health Literacy and Its Predictors Among Pregnant Women: A Cross-sectional Study. ournal Educ Community Health 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://eprints.lums.ac.ir/id/eprint/4008\u003c/span\u003e\u003cspan address=\"http://eprints.lums.ac.ir/id/eprint/4008\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E. Health literacy interventions and outcomes: an updated systematic review. Evid report/technology Assess 2011(199):1\u0026ndash;941. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://europepmc.org/article/nbk/nbk82434\u003c/span\u003e\u003cspan address=\"https://europepmc.org/article/nbk/nbk82434\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRakhshaee Z, Kamranpour B. Study of Reproductive Health Literacy and Its Related Factors in Infertile Women. J Health. 2024;14(4):466\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://healthjournal.arums.ac.ir/browse.php?a_code=A-10-608-\u003c/span\u003e\u003cspan address=\"https://healthjournal.arums.ac.ir/browse.php?a_code=A-10-608-\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 301\u0026amp;sid=1\u0026amp;slc_lang=en.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSentell T, Braun KL, Davis J, Davis T. Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. Springerplus. 2015;4:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/content/pdf/10.1186/s40064-015-1225-y.pdf\u003c/span\u003e\u003cspan address=\"https://link.springer.com/content/pdf/10.1186/s40064-015-1225-y.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhanbari A, Rahmatpour P, Khalili M, Mokhtari N. Health literacy and its relationship with cancer screening behaviors among the employees of Guilan University of Medical Sciences. J Health Care. 2017;18(4):306\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scholar.google.com/scholar?hl=en\u0026amp;as_sdt=0%2C\u003c/span\u003e\u003cspan address=\"https://scholar.google.com/scholar?hl=en\u0026amp;as_sdt=0%2C\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 5\u0026amp;q=Health+literacy+and+its+relationship+with+cancer+screening+behaviors+among+the+employees+of+Guilan+University+of+Medical+Sciences.+\u0026amp;btnG=.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamzehgardeshi Z, Shahhosseini Z, Tonekaboni S, Yazdani F. Sexual and reproductive health education needs and its associated factors in couples participating in premarital counseling. J Nurs Midwifery Sci. 2019;6(1):38\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scholar.google.com/scholar?hl=en\u0026amp;\u003c/span\u003e\u003cspan address=\"https://scholar.google.com/scholar?hl=en\u0026amp;\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. as_sdt=0%2C5\u0026amp;q=+Sexual+and+reproductive+health+education+needs+and+its+associated+factors+in+couples+participating+in+premarital\u0026amp;btnG=.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"reproductive health literacy, related factors, reproductive age","lastPublishedDoi":"10.21203/rs.3.rs-5763987/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5763987/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eReproductive health is a key area of health and an important indicator of the health status of societies\u003cstrong\u003e.\u003c/strong\u003e Improving \u0026nbsp;reproductive health literacy is one of the \u0026nbsp;most \u0026nbsp;important \u0026nbsp;strategies \u0026nbsp;to \u0026nbsp;achieve \u0026nbsp;the goals of reproductive health \u0026nbsp;in various \u0026nbsp;groups of women\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study is a cross-sectional descriptive analytical study in eligible married women aged 18-49. The reproductive health literacy questionnaire and demographic-social- reproductive characteristics questionnaire were completed by 593 people in person, online and by phone. Simple random sampling with allocation proportional to the size of reproductive age women was done in each center. After collecting the data, it was analyzed by spss 23 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The health literacy score for urban and \u0026nbsp;rural women was 118.54 ± 21.38 and 111.40 ± 24.21, respectively, indicating a significant difference (P\u0026lt;0.00). Besides, the percentage of women \u0026nbsp;with favorable \u0026nbsp;literacy in rural are as was higher than \u0026nbsp;in urban areas (70.4% vs. 51.4%). In \u0026nbsp;logistics regression, there was a significant relationship with women's reproductive health literacy score in the city only between breast self-examination (p= 0.009 and OR = 0.4) and in the village between breast examination by physician or midwife (p= 0.003 and OR=0.38), employment of a family \u0026nbsp;member in the health care system (p= 0.000 and OR=0.25) and \u0026nbsp;the number of pregnancies (p= 0.04 and OR= 55).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The results of this study can help health planners and policymakers design and implement more appropriate \u0026nbsp;training \u0026nbsp;and \u0026nbsp;health services by considering the differences in urban and \u0026nbsp;rural areas. In addition, given the importance of behaviors related to reproductive \u0026nbsp;health, encouraging \u0026nbsp;preventive examinations and raising public awareness in this area can \u0026nbsp;help improve \u0026nbsp;reproductive health \u0026nbsp;literacy in women.\u003c/p\u003e","manuscriptTitle":"Comparison of reproductive health literacy and related factors in urban and rural women of reproductive age in Iran 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-15 09:55:43","doi":"10.21203/rs.3.rs-5763987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80d40466-39e6-4f12-abd2-41cda64a84bd","owner":[],"postedDate":"January 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-27T07:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-15 09:55:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5763987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5763987","identity":"rs-5763987","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}