Empowerment Status of Pregnant Women in an Iranian Setting: A Cross-Sectional Study

Empowerment Status of Pregnant Women in an Iranian Setting: A Cross-Sectional Study | 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 Empowerment Status of Pregnant Women in an Iranian Setting: A Cross-Sectional Study Mostafaee Fatemeh, Mashoufi Mehrnaz, Mardi Afrouz, Fathi Negin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7942116/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Introduction: Pregnancy is a crucial period in a woman's life, as the level of empowerment of pregnant women directly affects the health of mothers, children and families. The aim of this study was to determine the empowerment status of pregnant women in an Iranian setting. Methods: This analytic cross-sectional study was carried out on 200 eligible pregnant women attending Ardabil health centers in 2023, selected through random cluster sampling. Data was collected using a demographic questionnaire and a Persian version of the Kameda questionnaire on empowerment of pregnant women, which was completed through interviews. The overall empowerment score ranged from 27 to 108, and is classified as poor to excellent. Descriptive statistics, logistic regression, Pearson's correlation and t-tests were utilized for data analysis using SPSS version 17. Results: The mean age of the pregnant women was 26.8± 4.67 years, with the majority having a college education (60%) and being housewives (76%). The overall empowerment score of the pregnant women was 54.58, which indicates a moderate level of empowerment. Among the subscales of empowerment, the highest mean score (64) was related to the joy of adding a person to the family, and the lowest score (49) was related to the subscale of self-esteem. There was a significant inverse correlation between the age of pregnant women and their future image (P=0.019). Higher education and employment were linked to higher self-esteem. There were no statistically significant relationships between empowerment status in pregnant women and housing type, income, husband's education, gravida, parity, number of abortions or number of living children. Conclusion: The results of this study could be used in conducting effective interventions for maternal health and promoting the empowerment of pregnant women. Empowerment Pregnant Women Iran Background Pregnancy is one of the most important and sensitive periods in a woman's life( 1 , 2 ). Women's health during pregnancy and childbirth is considered as the cornerstone of population health at the international level. Improving maternal health and reducing infant mortality have been two crucial components of the third Millennium Development Goals ( 3 – 5 ) and remain among the 17 key goals of Sustainable Development, 2030( 6 ). Empowerment is one of the objectives of the World Health Organization aimed at improving health( 7 ). However, defining and understanding the concept of empowerment remains complicated( 8 ). Gibson (1991)stated that women’s empowerment is the process of recognizing and enhancing women’s ability to meet health needs, solve health problems, and take action to feel in control of their health and lives( 9 ). Kameda defined empowerment during pregnancy as a sense of satisfaction, happiness, self-actualization and increasing independence through interacting with the environment and other people. This ultimately leads to a spontaneous increase in psychological energy for pregnancy, successful childbirth, and better adaptation to physical and psychological changes in the perinatal period ( 10 ). In general, empowerment in pregnancy was redefined as the capability to make strategic life decisions( 11 ). Pregnant women must obtain the necessary knowledge and skills to navigate this period and play an active and effective role during their pregnancy and childbirth. They should be able to have a natural childbirth without fear or worry, and with increased self-confidence( 12 ). On the other hand, the transition to parenthood is a significant life change that necessitates adjustments in physical, psychological and social aspects. This transition can be accompanied by considerable distress( 13 ). In addition to the rapid physical changes, future mothers also experience the process of developing maternal identity ( 14 ). Therefore, the empowering pregnant women on issues during pregnancy, safe delivery and postpartum care is one of the key components of reproductive health. It can play an important role in maternal and child health, while also positively influencing the likelihood of reporting instances of pregnancy discrimination ( 12 , 15 – 17 ). WHO indicates that empowering pregnant mothers leads to increased use of contraceptive methods after childbirth, decreased Illegal abortions and infant mortality, improved of perinatal care, complete vaccination and overall maternal and child health ( 18 , 19 ). Considering the importance of empowerment during pregnancy and the lack of adequate research in Iran, conducting the present study to determine the empowerment status of pregnant women in an Iranian setting, was deemed necessary to implement appropriate interventions to enhance maternal and child health. Methods This analytic cross-sectional study was conducted on 200 pregnant women who were referred to Ardabil health centers to receive care, in 2023. Random cluster sampling was utilized in this study. The inclusion criteria were; being literate, having a health record in the integrated health system, not having high-risk pregnancy conditions, no history of chronic diseases, not taking any drugs, alcohol, narcotics, immune-suppressive drugs, or chemotherapy. Exclusion criteria included incomplete questionnaires and unwillingness to continue cooperation. Ardabil city has 34 health care centers in the five regions of the city (North, South, Center, East and West), two health centers were randomly selected from each of the regions, totaling 10 centers. Women were recruited into the study using convenience sampling. The number of pregnant women in each center was listed, and the ratio of the number of pregnant women in each center to the total number of pregnant women was determined. The sample from each center was then selected randomly. The data collection tool was a checklist containing demographic information and a standard questionnaire on empowerment in pregnant women (Kameda)( 10 ), which was completed through interviews by researcher. The questionnaire was translated and localized by Hajipour et al. (2016). They translated the questionnaire from English to Persian twice. Then, the final version was reviewed by a group of experts to determine content validity and very minor changes were made. Next, the questionnaire was distributed to 15 pregnant women to check their reading and comprehension ability and minor changes were made. In this way, the validity and reliability of the instrument were confirmed. By the way, the Cronbach's alpha coefficient for all questions in this study was 0.89 ( 20 ). This questionnaire consists of 27 items and five subscales, namely self-efficacy (six items), imagining the future (six items), self-esteem (seven items), understanding support from others (four items), and the joy of adding a person to the family (four items). Content validity and face validity were used to determine the scientific validity of the questionnaire. Participants answered the items using a four-point Likert scale, scoring from one to four points: strongly disagree ( 1 ), disagree ( 2 ), agree ( 3 ), strongly agree ( 4 ). The scores for each subscale ranged from 6 to 24 points for self-efficacy and imagining the future, 7 to 28 points for self-esteem, 4 to 16 points for understanding support from others and the joy of adding a person to the family. The empowerment score for pregnant women was calculated by summing the scores from each subscale, with a total score ranging from 27 to 108. Finally, this raw score is classified as poor (0–50), average or moderate (50.1–66), good (66.1–84) and excellent (84.1–100) on a scale of 0-100. Descriptive statistics (frequency, mean, and standard deviation) were used for demographic variables. The correlation between quantitative variables (age, Gravida, Parity, number of abortions, and number of live children) with the empowerment status of pregnant women were analyzed using the Pearson's correlation test, and the relationship between qualitative variables (Job, education, income, type of housing and spouse's education) were analyzed using the chi-square test in SPSS version 17. Ethical considerations The study was approved by the research ethics committee at IR.ARUMS.REC.1402.037. The study protocol adheres to the ethical guidelines outlined in the 1975 Declaration of Helsinki, including considerations such as voluntary participation and obtaining written informed consent. Women were assured of the privacy of their data and were informed that all data would be analyzed anonymously. Results According to the findings of this study, the mean age of pregnant women was 26.8 ± 4.67 years. 75% of women were in the second trimester of pregnancy. Most of them had a college education (60%), 76% were housewives and 72% declared their family income to be at an average level (Table 1 ). Table 1 Demographic characteristics of pregnant women Variables N (%) Age Mean ± SD 18> 18–24 25–34 35–44 45≤ 26.8 ± 4.67 4( 2 ) 18( 9 ) 144(72) 33(16.5) 1(0.5) Education Diploma≥ College Bachelor≤ 26( 13 ) 120(60) 54( 27 ) Husband Education Diploma≥ College Bachelor≤ 9(4.5) 129(64.5) 62( 31 ) Occupation Employed Housewife 48( 24 ) 152(76 Housing Personal 47(23.5) Rental 53(26.5) Corporate 45(22.5) Parental home 55(27.5) Family income Low Average High 46( 23 ) 144(72) 10( 5 ) Gestational age(Trimestre) 1 2 3 30( 15 ) 150(75) 20( 10 ) Gravida 1 2 3≤ 160(80) 25(12.5) 15(7.5) Abortion 0 176(88) 1 5(2.5) 2 18( 9 ) 3 1(0.5) The overall score of the pregnant woman's empowerment was 54.58, which indicates a moderate level of empowerment. Among the subscales of empowerment, the highest mean score (64) was related to the joy of adding a person to the family, and the lowest score (49) was related to the subscale of self-esteem. The mean empowerment scores of pregnant women in support and assurance of others and future image subscales were 55, and the self-efficacy was 53.9 (Table 2 ). Table 2 The status of empowerment and its subscales in pregnant women under study Subscales of empowerment Mean score SD Minimum score obtained Maximum score obtained Range of earnable score on a scale of 0-100 Self-efficacy 15.7 2.27 8 21 24 − 6 53.9 future image 15.9 2.5 9 22 24 − 6 55 Self-esteem 17.3 2.4 12 23 28 − 7 49 Support and assurance of others 10.6 2.3 5 16 16 − 4 55 Joy of an addition to family 11.7 1.76 5 16 16 − 4 64 Overall empowerment 71.21 5.73 55 88 108 − 27 54.58 In Table 3 , Pearson's correlation test shows that there was a significant inverse correlation between the age of pregnant women and the future image. Therefore, as pregnant women get older, the future image is not good. Table 3 Correlation between some variables with empowerment and its subscales in pregnant women under study Subscales of empowerment Variables Self-efficacy r p-value future image r p-value Self-esteem r p-value Support and assurance of others r p-value Joy of an addition to family r p-value Overall empowerment r p-value Age 0.062 0.287 -0.136 0.019 -0.075 0.192 0.029 0.621 0.001 0.983 -0.054 0.347 Gravida -0.067 0.25 -0.012 0.834 0.032 0.583 -0.078 0.178 -0.024 0.677 -0.058 0.317 Parity 0.063- 0.277 0.022 0.703 0.038 0.508 -0.086 0.14 0.043 0.461 -0.021 0.713 Abortion 0.026- 0.648 -0.052 0.371 0.023 0.689 -0.04 0.491 -0.017 0.772 -0.045 0.436 Alive child -0.062 0.282 0.017 0.769 0.05 0.388 -0.102 0.077 0.027 0.64 -0.03 0.604 Analyzed by the Pearson's correlation test Another outcome of this study was that higher education is associated with higher self-esteem and working women have higher self-esteem compared to housewives (Table 4 ). Table 4 The relationship between empowerment and its subscales with some variables in pregnant women under study Subscales of empowerment Variables Self-efficacy \(\:{\text{χ}}^{\text{2}}\) p-value future image \(\:{\text{χ}}^{\text{2}}\) p-value Self-esteem \(\:{\text{χ}}^{\text{2}}\) p-value Support and assurance of others \(\:{\text{χ}}^{\text{2}}\) p-value Joy of an addition to family \(\:{\text{χ}}^{\text{2}}\) p-value Overall empowerment \(\:{\text{χ}}^{\text{2}}\) p-value Education 3.753 0.73 6.399 0.342 16.367 0.012 0.349 1.000 1.941 0.119 7.092 0.172 Job Housband Education 1.313 0.519 3.158 0.532 2.416 0.299 5.418 0.247 11.835 0.003 2.485 0.647 0.307 0.858 2.01 0.734 1.05 0.592 4.085 0.395 2.122 0.346 1.63 0.803 Income 0.985 0.912 6.947 0.139 4.138 0.388 5.537 0.236 2.381 0.666 1.362 0.851 Type of housing 2.759 0.838 3.404 0.757 6.503 0.369 2.342 0.886 6.987 0.322 1.553 0.956 Analyzed by the chi-square test There was no statistically significant relationship found in the scores of the five subscales (self-efficacy, future image, self-esteem, support and reassurance from others, joy of an addition to family) with type of housing, income, husband's education, gravida, parity, number of abortions and number of living children. Discussion The focus of this study was to determine the empowerment status of pregnant women. The results of the overall scores indicated a moderate level of empowerment in this study, which was consistent with the study of Hajipour et al.( 20 ), but lower than the study of Borghei et al( 21 ). Among the subscales of empowerment, the highest score was related to the subscale of the joy of adding a person to the family, and the lowest score was related to the subscale of self-esteem, in line with the results of Borghei et al. ( 21 ). The low score of support from others in our study indicates insufficient support from pregnant women's relatives, spouses, and even health-care providers, which should receive more attention in this field. Supporting pregnant women not only has a positive effect on the mental health and stress reduction of women, but can also improve mother-infant interactions and subsequently, a child's growth, leading to an increase in self-esteem and empowerment ( 22 – 24 ). Another finding of this study was the high score in relation to the joy of adding a new person to the family. This result could be interesting despite the decrease in mothers' desire to have more children and the increase in families' preference for having only one child in recent years. This result emphasizes the fact that one of the components of women's empowerment in Iranian society has always been the number of family members and children( 25 ). In Ardabil province, 24% of families have opted to have only one child( 26 ). This finding, in turn, may be the result of new efforts and incentives for childbearing, including economic and social support, etc. in the country. Regarding factors related to the empowerment of pregnant women, the results of our study showed that; there was no significant relationship between the overall level of empowerment and the age of pregnant women. However, there was a significant inverse correlation between the age of mothers and the image of the future. As pregnant women age, their image of the future tends to be less positive. As a woman's age increases, her rights and duties also change( 27 ). In this regard, Tavananezhad et al., reported that the empowerment of pregnant women weakens with ageing( 28 ), but this finding is inconsistent with other studies that suggest aging is associated with an increase in women's empowerment( 21 , 27 , 29 , 30 ) A common explanation offered by most of these researchers is that older women spend more time with their husbands and children, leading to better communication and understanding of family issues ultimately resulting in increased empowerment. Therefore, these differences may be due to cultural variations in other societies. The results of this study show a statistically significant relationship between a mother's education and empowerment, indicating that mothers with a university education have higher self-esteem. Education is directly correlated with learning and skills( 28 ). The importance of women's education in today's society is increasing, and the positive role of education in empowering women has been supported by numerous studies ( 31 – 34 ). Our study’s findings confirm these contents. Another finding of this study is that working women have higher self-esteem compared to housewives. Occupation plays a crucial role in one's beliefs, abilities and self-esteem( 35 ). Entrepreneurship and financial independence empower women( 36 , 37 ). Akter et al., in their study in Bangladesh, concluded that having a job and exposure to communication were positively correlated with women's empowerment ( 38 ). In the study by Aboagye et al(2024), the highest odds of adequate prenatal care and empowerment belonged to women with higher levels of education, employment, and wealth( 34 ). Hajipour et al., reported the mean empowerment score of working women was higher than that of housewives, although not statistically significant( 20 ). The employment of pregnant women may also be associated with risks, Burgers(2024) reported that 43% of pregnant employees in the Dutch labor market experienced pregnancy discrimination between 2007 and 2019( 15 ). However, in this study, being employed had a positive effect on the self-esteem of pregnant women, possibly due to socio-cultural issues or financial independence. In this study, no statistically significant relationship was found between the empowerment of pregnant women with housing type, income, spouse's education, Gravida, Parity, number of abortions, and number of living children. However, many studies have reported a significant relationship between them. Sabit et al. (2024), reported that most women who had spontaneous abortions had low levels of self-esteem( 39 ). Zare et al, revealed that infertile women had lower self-esteem than fertile women and there is a significant relationship between self-esteem and women’s income, and housing ( 40 ). Silva also reported that pregnant women’s empowerment is influenced in it’s subscales, by the previous experience of pregnancy and birth and by social support( 41 ). Samari investigated the impact of childbearing on women’s empowerment trajectories in Egypt. She discovered that, for a young woman, giving birth is associated with increased empowerment; the first birth and each subsequent birth predicted improvements in all measures of empowerment except the financial autonomy ( 42 ). Ndola Prata et al, has been found that group antenatal care to be effective in improving the empowerment of pregnant women. Pregnant women who feel empowered through better coping skills before giving birth are less likely to suffer from postpartum depression ( 43 ). These differences can be due to differences in the environment or cultural differences. Empowerment should be understood within the socio-cultural-economic-political perspective of women( 44 ). Women's external and internal characteristics must be considered in the broader socio-cultural-economic-political perspective of each woman, along with a woman's belief in herself and her meaningful connection with her caregivers ( 45 ). This study is one of the few studies have been conducted on the empowerment status of pregnant women in an Iranian setting. One limitation of this study was the low participation desire of some women and their reluctance to answer questions, which was addressed through cooperation of health care providers who were trusted by the pregnant women. Another limitation was that it was self-reported, so not all answers may be correct. The other limitation was that only urban women were studied, who might have different socio-cultural conditions compared to rural women. Therefore, it is recommended to also study the empowerment status of rural women. Conclusion The results of this study examined the empowerment status of pregnant women in an Iranian setting and confirmed that; a high level of education and being employed; can increase the self-esteem of pregnant women. However, aging does not always result in women feeling more empowered and can be associated with a negative outlook on the future. Therefore, it is recommended that policymakers pay more attention to pregnant women’s empowerment and provide the necessary support facilities for them. Declarations Acknowledgments The authors are highly grateful to the pregnant women who participated in this study and would like to express their gratitude to Ardabil University of Medical Sciences for their support. Author’s Contribution : MF was the main investigator, responsible for writing the original paper. MM was responsible for data analysis. MA contributed to study design, and final paper writing. FN collected data. All authors reviewed and approved the final version of the paper, providing critical feedback that shaped the research, analysis, and manuscript. Conflict of interest: The authors declare no conflict of interest. Informed Consent Statement: All participants provided written consent and were informed of the study’s subject and method. They were guaranteed that their information would be kept secret and anonymous. Data availability: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding: This research received no external funding. Institutional Review Board Statement: This study is the result of a research project with ethics approval from the Ethics Committee of the Research Deputy in Ardabil University of Medical Science (IR.ARUMS.REC.1402.037). References Troiano NH. Physiologic and hemodynamic changes during pregnancy. AACN Adv Crit Care. 2018;29(3):273–83. Swales DA, Stout-Oswald SA, Glynn LM, Sandman C, Wing DA, Davis EP. Exposure to traumatic events in childhood predicts cortisol production among high risk pregnant women. Biol Psychol. 2018;139:186–92. Mohtaram M, Zohreh Z, Razieh R, Maryam M, Kourosh K. The Effect of Midwife-Oriented Group Counseling, Based on Orem’s Model on Self-Care and Empowerment, in Primiparous Women. A Clinical Trial; 2019. Goudarzi M, Gholamrezaei S, Amraei K. Developing a causal model of psychological empowering of pregnant women: the role of psychological distress and mediation of resilience, Mindfulness and Meta-emotion. Iran J Psychiatric Nurs (IJPN) Original Article. 2021;9(1). Zarei Salehabadi M, Kheirkhah M, Esmaeili N, Haghani S. Effects of Empowerment on the Attitudes toward Fertility and Childbearing in Women with Failed Pregnancies: A Clinical Trial. Iran J Nurs. 2020;33(125):55–69. Nations U, THE 17 GOALS | Sustainable Development Department of Economic and Social Affairs United Nations. 2025 [Available from: https://sdgs.un.org/goals Organization WH. Maternal mental health and child health and development in low and middle income countries: report of the meeting. Geneva, Switzerland; 2020. Hermansson E, Mårtensson L. Empowerment in the midwifery context—a concept analysis. Midwifery. 2011;27(6):811–6. Gibson CH. A concept analysis of empowerment. J Adv Nurs. 1991;16(3):354–61. Kameda Y, Shimada K. Development of an empowerment scale for pregnant women. Kanazawa University; 2008. Liu Y, Che CC, Hamdan M, Chong MC. Measuring empowerment in pregnant women: a scoping review of progress in instruments. Midwifery. 2024:104002. McAllister E. Transparency in maternity care: Empowering women to make educated choices. J Perinat Educ. 2008;17(4):8. Ghassami M, Amiri S, Kalantari M, Talebi H. Structural model of the relationship between maternal attachment and parenting stress: investigation of the mediating role of maternal mindfulness. 2020. Hwang WY, Choi SY, An HJ. Concept analysis of transition to motherhood: a methodological study. Korean J Women Health Nurs. 2022;28(1):8–17. Burgers M. Empowering pregnant employees: the effect of knowledge on reporting pregnancy discrimination 2024. Zare M, Mardi A, Gaffari-Moggadam M, Nezhad-Dadgar N, Abazari M, Shadman A, et al. Reproductive health status of adolescent mothers in an Iranian setting: a cross-sectional study. Reproductive health. 2022;19(1):89. Zandian H, Pourfarzi F, Mardi A, Zahirian T, Shadman A. The socio-economic status predicting women’s reproductive health: a prospective cohort study in Ardabil City, Iran, 2017–2020. J Res Health. 2023;13(1):19–26. Organization WH. Newborn Mortality. 2022 Accessed in 8 Mar 2022. Organization WH. from. New insights into quality of care for girls and women facing the complications of unsafe abortion. 2022 Accessed in 8 Mar 2022. HajiPour L, Hosseini Tabaghdehi M, TaghiZoghi Z, Behzadi Z. Empowerment of Pregnant Women. J Holist Nurs Midwifery. 2016;26(3):16–24. Borghei NS, Taghipour A, Roudsari RL, Nooghabi HJ. Investigating the Determinants of Maternal Empowerment During Pregnancy: A Strategy for Prenatal Healthcare Promotion. J Midwifery Reproductive Health. 2017;5(3). Unesi Z, Nakhaee S, Nasirizade M, Panah AI. Evaluation of the relationship between perceived nursing support and parental stress among mothers of hospitalized preterm infants in neonatal intensive care units. Mod Care J. 2017;14(4). Kurniawati, Rustina Y, Budiati T. Peer support increases maternal confidence, kangaroo mother care implementation and weight gain in LBW infants. Compr child Adolesc Nurs. 2019;42(sup1):252–60. Nilsson L, Thorsell T, Hertfelt Wahn E, Ekström A. Factors influencing positive birth experiences of first-time mothers. Nurs Res Pract. 2013;2013(1):349124. Shakouri ARJM, Jafari M. Components of Women's Empowerment and Explanation of Influential Factors on Them. Women Dev Politics. 2007;5(1):1–26. Agency TIRN. Fertility rate in Ardabil province decreased to 1.66%. 2023. Batool SS, Batool SA. Levels of Education, Age, Legal Awareness and Women's Empowerment. J Res Reflections Educ (JRRE). 2018;12(2). Tavananezhad N, Bolbanabad AM, Ghelichkhani F, Effati-Daryani F, Mirghafourvand M. The relationship between health literacy and empowerment in pregnant women: a cross-sectional study. BMC Pregnancy Childbirth. 2022;22(1):351. Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS ONE. 2010;5(6):e11190. Khan SU, Awan R. Contextual assessment of women empowerment and its determinants: Evidence from Pakistan. 2011. Aslam M. Empowering women: education and the pathways of change. 2013. Bharati V. Women Education: Empowering Status in the Society. BIJMRD. 2024;2. Bhuwania P, Mukherji A, Swaminathan H. Women’s education through empowerment: Evidence from a community-based program. World Dev Perspect. 2024;33:100568. Aboagye RG, Okyere J, Seidu A-A, Ahinkorah BO, Budu E, Yaya S. Does women's empowerment and socio-economic status predict adequacy of antenatal care in sub-Saharan. Africa? Int Health. 2024;16(2):165–73. Hajipour L, Montazeri A, Mohtasham Amiri Z, Hosseini Tabaghdehi M, Mohsenzadeh Ledari F. The empowerment of pregnant women in Tonekabon, Iran. Casp J Reproductive Med. 2016;2(1):8–12. Krishna U, Deepthi S, editors. Entrepreneurship empowers women. AIP Conference Proceedings; 2024: AIP Publishing. Gupta S, Wei M, Tzempelikos N, Shin MM. Women empowerment: challenges and opportunities for sustainable development goals. Qualitative Market Research: Int J. 2024;27(4):608–30. Akter A, Choudhury F, Bagum T, Islam M, Hasan R. Socio-economic impact of entrepreneurship activities for the empowerment of women in Bangladesh. Int J Acad Res Bus Social Sci. 2024;14(2):935–53. Sabit EH, Fadhil SN. Assessment of self-esteem level among women with spontaneous abortion. Pakistan J Med Health Sci. 2022;16(04):892. Zare E, Bahrami N, Soleimani MA. Comparison of self-esteem in fertile and infertile women. Iran J Nurs. 2014;27(90):14–21. Silva DN. Empowerment da grávida: Fatores de capacitação para a maternidade. Instituto Politecnico de Viseu (Portugal); 2014. Samari G. First birth and the trajectory of women’s empowerment in Egypt. BMC Pregnancy Childbirth. 2017;17(Suppl 2). Prata N, Tavrow P, Upadhyay U. Women’s empowerment related to pregnancy and childbirth: introduction to special issue. BMC Pregnancy Childbirth. 2017;17(2):352. Nieuwenhuijze M, Leahy-Warren P. Women's empowerment in pregnancy and childbirth: A concept analysis. Midwifery. 2019;78:1–7. Marianne Nieuwenhuijze PL-W. Women's empowerment in pregnancy and childbirth: A concept analysis. Midwifery. 2019;78:1–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 31 Mar, 2026 Reviews received at journal 10 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviews received at journal 30 Nov, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviews received at journal 28 Nov, 2025 Reviewers agreed at journal 28 Nov, 2025 Reviews received at journal 25 Nov, 2025 Reviewers agreed at journal 24 Nov, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviewers invited by journal 21 Nov, 2025 Editor invited by journal 27 Oct, 2025 Editor assigned by journal 26 Oct, 2025 Submission checks completed at journal 26 Oct, 2025 First submitted to journal 24 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7942116","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550979184,"identity":"ab286f00-e9d0-40b1-97f1-526537577b3e","order_by":0,"name":"Mostafaee Fatemeh","email":"","orcid":"","institution":"Bachelor of Public Health, Ardabil University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Mostafaee","middleName":"","lastName":"Fatemeh","suffix":""},{"id":550979186,"identity":"6cf86ad1-9cb8-4749-bc11-e53b21e237b0","order_by":1,"name":"Mashoufi Mehrnaz","email":"","orcid":"","institution":"Ardabil University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Mashoufi","middleName":"","lastName":"Mehrnaz","suffix":""},{"id":550979187,"identity":"1220793a-a320-4c4f-8898-6739c7f077d8","order_by":2,"name":"Mardi Afrouz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYJACiQQDiXo29gYg08CCWC0FFgl8PAdAWiSI1MLwoSJBTiIBwiYIdNvPPrzxwEAij03y+dUNPwokGPjbuxPwajE7k25sAfRLMZt0TtnNHqDDJM6c3YBfy4E0NpD3Gdukc9Ju8AC1GEjkEtBy/hlUi+SZtJt/iNJyA2JLYpsE+7HbxNly4xkzyC/GbDw5bLdlDCR4CPvlfBrjzR9/6uTk248/u/nmj40cf3svfi1IgMcATBKrHATYH5CiehSMglEwCkYQAAAp7EMGn4OggAAAAABJRU5ErkJggg==","orcid":"","institution":"Ardabil University of Medical Science","correspondingAuthor":true,"prefix":"","firstName":"Mardi","middleName":"","lastName":"Afrouz","suffix":""},{"id":550979189,"identity":"177e6757-43c0-44b1-b992-35120dde93d0","order_by":3,"name":"Fathi Negin","email":"","orcid":"","institution":"Bachelor of Public Health, Ardabil University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Fathi","middleName":"","lastName":"Negin","suffix":""}],"badges":[],"createdAt":"2025-10-25 19:54:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7942116/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7942116/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96937392,"identity":"1a41dbb3-b475-4baf-a39a-a5fdd2b715c6","added_by":"auto","created_at":"2025-11-27 16:53:33","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":61043,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/ce9cc1b8fc6caffdbc0f39b0.docx"},{"id":96937393,"identity":"54db1e56-e61e-48fe-8895-220a1a65d179","added_by":"auto","created_at":"2025-11-27 16:53:34","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6319,"visible":true,"origin":"","legend":"","description":"","filename":"95dad0e99f3943adaa97192488ae2872.json","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/235253d2ff1f8d2aa339c837.json"},{"id":96937387,"identity":"2df6846f-3433-4c7d-8169-a43bf9901d6f","added_by":"auto","created_at":"2025-11-27 16:53:33","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99770,"visible":true,"origin":"","legend":"","description":"","filename":"95dad0e99f3943adaa97192488ae28721enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/1845297500f11b6e7e29a7cd.xml"},{"id":96937409,"identity":"5b890f90-a636-43a2-b314-f81d1e2e2d04","added_by":"auto","created_at":"2025-11-27 16:53:34","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97234,"visible":true,"origin":"","legend":"","description":"","filename":"95dad0e99f3943adaa97192488ae28721structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/e423d2111f5842b41b3a7ca1.xml"},{"id":96937377,"identity":"dbf77315-54ac-4404-a5d2-d2c73468a58c","added_by":"auto","created_at":"2025-11-27 16:53:33","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108668,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/ea4b3779a0b16b4546f06c14.html"},{"id":97137023,"identity":"cf13bdde-2edf-40a1-81b2-7415b93ab919","added_by":"auto","created_at":"2025-12-01 09:57:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":860550,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7942116/v1/d7ed5294-8c8d-410f-a839-2690ef7c939e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowerment Status of Pregnant Women in an Iranian Setting: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePregnancy is one of the most important and sensitive periods in a woman's life(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Women's health during pregnancy and childbirth is considered as the cornerstone of population health at the international level. Improving maternal health and reducing infant mortality have been two crucial components of the third Millennium Development Goals (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and remain among the 17 key goals of Sustainable Development, 2030(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmpowerment is one of the objectives of the World Health Organization aimed at improving health(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, defining and understanding the concept of empowerment remains complicated(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Gibson (1991)stated that women\u0026rsquo;s empowerment is the process of recognizing and enhancing women\u0026rsquo;s ability to meet health needs, solve health problems, and take action to feel in control of their health and lives(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Kameda defined empowerment during pregnancy as a sense of satisfaction, happiness, self-actualization and increasing independence through interacting with the environment and other people. This ultimately leads to a spontaneous increase in psychological energy for pregnancy, successful childbirth, and better adaptation to physical and psychological changes in the perinatal period (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In general, empowerment in pregnancy was redefined as the capability to make strategic life decisions(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePregnant women must obtain the necessary knowledge and skills to navigate this period and play an active and effective role during their pregnancy and childbirth. They should be able to have a natural childbirth without fear or worry, and with increased self-confidence(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). On the other hand, the transition to parenthood is a significant life change that necessitates adjustments in physical, psychological and social aspects. This transition can be accompanied by considerable distress(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In addition to the rapid physical changes, future mothers also experience the process of developing maternal identity (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, the empowering pregnant women on issues during pregnancy, safe delivery and postpartum care is one of the key components of reproductive health. It can play an important role in maternal and child health, while also positively influencing the likelihood of reporting instances of pregnancy discrimination (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWHO indicates that empowering pregnant mothers leads to increased use of contraceptive methods after childbirth, decreased Illegal abortions and infant mortality, improved of perinatal care, complete vaccination and overall maternal and child health (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConsidering the importance of empowerment during pregnancy and the lack of adequate research in Iran, conducting the present study to determine the empowerment status of pregnant women in an Iranian setting, was deemed necessary to implement appropriate interventions to enhance maternal and child health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This analytic cross-sectional study was conducted on 200 pregnant women who were referred to Ardabil health centers to receive care, in 2023. Random cluster sampling was utilized in this study. The inclusion criteria were; being literate, having a health record in the integrated health system, not having high-risk pregnancy conditions, no history of chronic diseases, not taking any drugs, alcohol, narcotics, immune-suppressive drugs, or chemotherapy. Exclusion criteria included incomplete questionnaires and unwillingness to continue cooperation. Ardabil city has 34 health care centers in the five regions of the city (North, South, Center, East and West), two health centers were randomly selected from each of the regions, totaling 10 centers. Women were recruited into the study using convenience sampling.\u003c/p\u003e\u003cp\u003eThe number of pregnant women in each center was listed, and the ratio of the number of pregnant women in each center to the total number of pregnant women was determined. The sample from each center was then selected randomly.\u003c/p\u003e\u003cp\u003eThe data collection tool was a checklist containing demographic information and a standard questionnaire on empowerment in pregnant women (Kameda)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), which was completed through interviews by researcher.\u003c/p\u003e\u003cp\u003eThe questionnaire was translated and localized by Hajipour et al. (2016). They translated the questionnaire from English to Persian twice. Then, the final version was reviewed by a group of experts to determine content validity and very minor changes were made. Next, the questionnaire was distributed to 15 pregnant women to check their reading and comprehension ability and minor changes were made. In this way, the validity and reliability of the instrument were confirmed. By the way, the Cronbach's alpha coefficient for all questions in this study was 0.89 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This questionnaire consists of 27 items and five subscales, namely self-efficacy (six items), imagining the future (six items), self-esteem (seven items), understanding support from others (four items), and the joy of adding a person to the family (four items). Content validity and face validity were used to determine the scientific validity of the questionnaire. Participants answered the items using a four-point Likert scale, scoring from one to four points: strongly disagree (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), disagree (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), agree (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), strongly agree (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The scores for each subscale ranged from 6 to 24 points for self-efficacy and imagining the future, 7 to 28 points for self-esteem, 4 to 16 points for understanding support from others and the joy of adding a person to the family. The empowerment score for pregnant women was calculated by summing the scores from each subscale, with a total score ranging from 27 to 108. Finally, this raw score is classified as poor (0\u0026ndash;50), average or moderate (50.1\u0026ndash;66), good (66.1\u0026ndash;84) and excellent (84.1\u0026ndash;100) on a scale of 0-100.\u003c/p\u003e\u003cp\u003eDescriptive statistics (frequency, mean, and standard deviation) were used for demographic variables. The correlation between quantitative variables (age, Gravida, Parity, number of abortions, and number of live children) with the empowerment status of pregnant women were analyzed using the Pearson's correlation test, and the relationship between qualitative variables (Job, education, income, type of housing and spouse's education) were analyzed using the chi-square test in SPSS version 17.\u003c/p\u003e\u003cp\u003eEthical considerations\u003c/p\u003e\u003cp\u003eThe study was approved by the research ethics committee at IR.ARUMS.REC.1402.037. The study protocol adheres to the ethical guidelines outlined in the 1975 Declaration of Helsinki, including considerations such as voluntary participation and obtaining written informed consent. Women were assured of the privacy of their data and were informed that all data would be analyzed anonymously.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAccording to the findings of this study, the mean age of pregnant women was 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67 years. 75% of women were in the second trimester of pregnancy. Most of them had a college education (60%), 76% were housewives and 72% declared their family income to be at an average level (Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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 characteristics of pregnant women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e18\u0026gt;\u003c/p\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003cp\u003e45\u0026le;\u003c/p\u003e\u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(16.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDiploma\u0026ge;\u003c/p\u003e\u003cp\u003eCollege\u003c/p\u003e\u003cp\u003eBachelor\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eHusband\u003c/p\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDiploma\u0026ge;\u003c/p\u003e\u003cp\u003eCollege\u003c/p\u003e\u003cp\u003eBachelor\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129(64.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e152(76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHousing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47(23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53(26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorporate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParental home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFamily income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eAverage\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGestational age(Trimestre)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150(75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160(80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAbortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e176(88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\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\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe overall score of the pregnant woman's empowerment was 54.58, which indicates a moderate level of empowerment. Among the subscales of empowerment, the highest mean score (64) was related to the joy of adding a person to the family, and the lowest score (49) was related to the subscale of self-esteem. The mean empowerment scores of pregnant women in support and assurance of others and future image subscales were 55, and the self-efficacy was 53.9 (Table\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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 status of empowerment and its subscales in pregnant women under study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales of empowerment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003cp\u003escore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMinimum score obtained\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003cp\u003escore\u003c/p\u003e\u003cp\u003eobtained\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRange of\u003c/p\u003e\u003cp\u003eearnable score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eon a\u003c/p\u003e\u003cp\u003escale of\u003c/p\u003e\u003cp\u003e0-100\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24\u0026thinsp;\u0026minus;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efuture image\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24\u0026thinsp;\u0026minus;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28\u0026thinsp;\u0026minus;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupport and assurance of others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16\u0026thinsp;\u0026minus;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJoy of an addition to family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16\u0026thinsp;\u0026minus;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e108\u0026thinsp;\u0026minus;\u0026thinsp;27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e54.58\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\u003eIn Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Pearson's correlation test shows that there was a significant inverse correlation between the age of pregnant women and the future image. Therefore, as pregnant women get older, the future image is not good.\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\u003eCorrelation between some variables with empowerment and its subscales in pregnant women under study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales of empowerment\u003c/p\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003efuture image\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-esteem\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSupport and assurance of others\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eJoy of an addition to family\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOverall empowerment\u003c/p\u003e\u003cp\u003er\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.136\u003c/p\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.075\u003c/p\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003cp\u003e0.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.054\u003c/p\u003e\u003cp\u003e0.347\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.067\u003c/p\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.012\u003c/p\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.078\u003c/p\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.024\u003c/p\u003e\u003cp\u003e0.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.058\u003c/p\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.063-\u003c/p\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003cp\u003e0.703\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.086\u003c/p\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.021\u003c/p\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.026-\u003c/p\u003e\u003cp\u003e0.648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.052\u003c/p\u003e\u003cp\u003e0.371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003cp\u003e0.689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003cp\u003e0.491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.017\u003c/p\u003e\u003cp\u003e0.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.045\u003c/p\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlive child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.062\u003c/p\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003cp\u003e0.388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.102\u003c/p\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003cp\u003e0.604\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eAnalyzed by the Pearson's correlation test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother outcome of this study was that higher education is associated with higher self-esteem and working women have higher self-esteem compared to housewives (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe relationship between empowerment and its subscales with some variables in pregnant women under study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales of empowerment\u003c/p\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003efuture image\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-esteem\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSupport and assurance of others\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eJoy of an addition to family\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOverall empowerment\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026chi;}}^{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.753\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.399\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.342\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.367\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.349\u003c/p\u003e\u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.941\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.119\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.092\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.172\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob\u003c/p\u003e\u003cp\u003eHousband Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.313\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.519\u003c/b\u003e\u003c/p\u003e\u003cp\u003e3.158\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.532\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.416\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.299\u003c/b\u003e\u003c/p\u003e\u003cp\u003e5.418\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.247\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.835\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003cp\u003e2.485\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.647\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.858\u003c/b\u003e\u003c/p\u003e\u003cp\u003e2.01\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.734\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.592\u003c/b\u003e\u003c/p\u003e\u003cp\u003e4.085\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.395\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.122\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.346\u003c/b\u003e\u003c/p\u003e\u003cp\u003e1.63\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.803\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.985\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.912\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.947\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.139\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.138\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.388\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.537\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.236\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.381\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.666\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.362\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.851\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of housing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.759\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.838\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.404\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.757\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.503\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.369\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.342\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.886\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.987\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.322\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.553\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.956\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eAnalyzed by the chi-square test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere was no statistically significant relationship found in the scores of the five subscales (self-efficacy, future image, self-esteem, support and reassurance from others, joy of an addition to family) with type of housing, income, husband's education, gravida, parity, number of abortions and number of living children.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe focus of this study was to determine the empowerment status of pregnant women. The results of the overall scores indicated a moderate level of empowerment in this study, which was consistent with the study of Hajipour et al.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), but lower than the study of Borghei et al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Among the subscales of empowerment, the highest score was related to the subscale of the joy of adding a person to the family, and the lowest score was related to the subscale of self-esteem, in line with the results of Borghei et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The low score of support from others in our study indicates insufficient support from pregnant women's relatives, spouses, and even health-care providers, which should receive more attention in this field. Supporting pregnant women not only has a positive effect on the mental health and stress reduction of women, but can also improve mother-infant interactions and subsequently, a child's growth, leading to an increase in self-esteem and empowerment (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother finding of this study was the high score in relation to the joy of adding a new person to the family. This result could be interesting despite the decrease in mothers' desire to have more children and the increase in families' preference for having only one child in recent years. This result emphasizes the fact that one of the components of women's empowerment in Iranian society has always been the number of family members and children(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In Ardabil province, 24% of families have opted to have only one child(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This finding, in turn, may be the result of new efforts and incentives for childbearing, including economic and social support, etc. in the country.\u003c/p\u003e\u003cp\u003eRegarding factors related to the empowerment of pregnant women, the results of our study showed that; there was no significant relationship between the overall level of empowerment and the age of pregnant women. However, there was a significant inverse correlation between the age of mothers and the image of the future. As pregnant women age, their image of the future tends to be less positive. As a woman's age increases, her rights and duties also change(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In this regard, Tavananezhad et al., reported that the empowerment of pregnant women weakens with ageing(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), but this finding is inconsistent with other studies that suggest aging is associated with an increase in women's empowerment(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) A common explanation offered by most of these researchers is that older women spend more time with their husbands and children, leading to better communication and understanding of family issues ultimately resulting in increased empowerment. Therefore, these differences may be due to cultural variations in other societies.\u003c/p\u003e\u003cp\u003eThe results of this study show a statistically significant relationship between a mother's education and empowerment, indicating that mothers with a university education have higher self-esteem. Education is directly correlated with learning and skills(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The importance of women's education in today's society is increasing, and the positive role of education in empowering women has been supported by numerous studies (\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Our study\u0026rsquo;s findings confirm these contents.\u003c/p\u003e\u003cp\u003eAnother finding of this study is that working women have higher self-esteem compared to housewives. Occupation plays a crucial role in one's beliefs, abilities and self-esteem(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Entrepreneurship and financial independence empower women(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Akter et al., in their study in Bangladesh, concluded that having a job and exposure to communication were positively correlated with women's empowerment (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In the study by Aboagye et al(2024), the highest odds of adequate prenatal care and empowerment belonged to women with higher levels of education, employment, and wealth(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Hajipour et al., reported the mean empowerment score of working women was higher than that of housewives, although not statistically significant(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The employment of pregnant women may also be associated with risks, Burgers(2024) reported that 43% of pregnant employees in the Dutch labor market experienced pregnancy discrimination between 2007 and 2019(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, in this study, being employed had a positive effect on the self-esteem of pregnant women, possibly due to socio-cultural issues or financial independence.\u003c/p\u003e\u003cp\u003eIn this study, no statistically significant relationship was found between the empowerment of pregnant women with housing type, income, spouse's education, Gravida, Parity, number of abortions, and number of living children. However, many studies have reported a significant relationship between them. Sabit et al. (2024), reported that most women who had spontaneous abortions had low levels of self-esteem(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Zare et al, revealed that infertile women had lower self-esteem than fertile women and there is a significant relationship between self-esteem and women\u0026rsquo;s income, and housing (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Silva also reported that pregnant women\u0026rsquo;s empowerment is influenced in it\u0026rsquo;s subscales, by the previous experience of pregnancy and birth and by social support(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Samari investigated the impact of childbearing on women\u0026rsquo;s empowerment trajectories in Egypt. She discovered that, for a young woman, giving birth is associated with increased empowerment; the first birth and each subsequent birth predicted improvements in all measures of empowerment except the financial autonomy (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Ndola Prata et al, has been found that group antenatal care to be effective in improving the empowerment of pregnant women. Pregnant women who feel empowered through better coping skills before giving birth are less likely to suffer from postpartum depression (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). These differences can be due to differences in the environment or cultural differences. Empowerment should be understood within the socio-cultural-economic-political perspective of women(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Women's external and internal characteristics must be considered in the broader socio-cultural-economic-political perspective of each woman, along with a woman's belief in herself and her meaningful connection with her caregivers (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study is one of the few studies have been conducted on the empowerment status of pregnant women in an Iranian setting. One limitation of this study was the low participation desire of some women and their reluctance to answer questions, which was addressed through cooperation of health care providers who were trusted by the pregnant women. Another limitation was that it was self-reported, so not all answers may be correct. The other limitation was that only urban women were studied, who might have different socio-cultural conditions compared to rural women. Therefore, it is recommended to also study the empowerment status of rural women.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study examined the empowerment status of pregnant women in an Iranian setting and confirmed that; a high level of education and being employed; can increase the self-esteem of pregnant women. However, aging does not always result in women feeling more empowered and can be associated with a negative outlook on the future. Therefore, it is recommended that policymakers pay more attention to pregnant women\u0026rsquo;s empowerment and provide the necessary support facilities for them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are highly grateful to the pregnant women who participated in this study and would like to express their gratitude to Ardabil University of Medical Sciences for their support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMF was the main investigator, responsible for writing the original paper. MM was responsible for data analysis. MA contributed to study design, and final paper writing. FN collected data. All authors reviewed and approved the final version of the paper, providing critical feedback that shaped the research, analysis, and manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e All participants provided written consent and were informed of the study\u0026rsquo;s subject and method. They were guaranteed that their information would be kept secret and anonymous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThis study is the result of a research project with ethics approval from the Ethics Committee of the Research Deputy in Ardabil University of Medical Science (IR.ARUMS.REC.1402.037).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTroiano NH. Physiologic and hemodynamic changes during pregnancy. AACN Adv Crit Care. 2018;29(3):273\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSwales DA, Stout-Oswald SA, Glynn LM, Sandman C, Wing DA, Davis EP. Exposure to traumatic events in childhood predicts cortisol production among high risk pregnant women. Biol Psychol. 2018;139:186\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohtaram M, Zohreh Z, Razieh R, Maryam M, Kourosh K. The Effect of Midwife-Oriented Group Counseling, Based on Orem\u0026rsquo;s Model on Self-Care and Empowerment, in Primiparous Women. A Clinical Trial; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoudarzi M, Gholamrezaei S, Amraei K. Developing a causal model of psychological empowering of pregnant women: the role of psychological distress and mediation of resilience, Mindfulness and Meta-emotion. Iran J Psychiatric Nurs (IJPN) Original Article. 2021;9(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZarei Salehabadi M, Kheirkhah M, Esmaeili N, Haghani S. Effects of Empowerment on the Attitudes toward Fertility and Childbearing in Women with Failed Pregnancies: A Clinical Trial. Iran J Nurs. 2020;33(125):55\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNations U, THE 17 GOALS | Sustainable Development Department of Economic and Social Affairs United Nations. 2025 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sdgs.un.org/goals\u003c/span\u003e\u003cspan address=\"https://sdgs.un.org/goals\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. Maternal mental health and child health and development in low and middle income countries: report of the meeting. Geneva, Switzerland; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHermansson E, M\u0026aring;rtensson L. Empowerment in the midwifery context\u0026mdash;a concept analysis. Midwifery. 2011;27(6):811\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGibson CH. A concept analysis of empowerment. J Adv Nurs. 1991;16(3):354\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKameda Y, Shimada K. Development of an empowerment scale for pregnant women. Kanazawa University; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Che CC, Hamdan M, Chong MC. Measuring empowerment in pregnant women: a scoping review of progress in instruments. Midwifery. 2024:104002.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcAllister E. Transparency in maternity care: Empowering women to make educated choices. J Perinat Educ. 2008;17(4):8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhassami M, Amiri S, Kalantari M, Talebi H. Structural model of the relationship between maternal attachment and parenting stress: investigation of the mediating role of maternal mindfulness. 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHwang WY, Choi SY, An HJ. Concept analysis of transition to motherhood: a methodological study. Korean J Women Health Nurs. 2022;28(1):8\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurgers M. Empowering pregnant employees: the effect of knowledge on reporting pregnancy discrimination 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZare M, Mardi A, Gaffari-Moggadam M, Nezhad-Dadgar N, Abazari M, Shadman A, et al. Reproductive health status of adolescent mothers in an Iranian setting: a cross-sectional study. Reproductive health. 2022;19(1):89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZandian H, Pourfarzi F, Mardi A, Zahirian T, Shadman A. The socio-economic status predicting women\u0026rsquo;s reproductive health: a prospective cohort study in Ardabil City, Iran, 2017\u0026ndash;2020. J Res Health. 2023;13(1):19\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. Newborn Mortality. 2022 Accessed in 8 Mar 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. from. New insights into quality of care for girls and women facing the complications of unsafe abortion. 2022 Accessed in 8 Mar 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHajiPour L, Hosseini Tabaghdehi M, TaghiZoghi Z, Behzadi Z. Empowerment of Pregnant Women. J Holist Nurs Midwifery. 2016;26(3):16\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBorghei NS, Taghipour A, Roudsari RL, Nooghabi HJ. Investigating the Determinants of Maternal Empowerment During Pregnancy: A Strategy for Prenatal Healthcare Promotion. J Midwifery Reproductive Health. 2017;5(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnesi Z, Nakhaee S, Nasirizade M, Panah AI. Evaluation of the relationship between perceived nursing support and parental stress among mothers of hospitalized preterm infants in neonatal intensive care units. Mod Care J. 2017;14(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKurniawati, Rustina Y, Budiati T. Peer support increases maternal confidence, kangaroo mother care implementation and weight gain in LBW infants. Compr child Adolesc Nurs. 2019;42(sup1):252\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNilsson L, Thorsell T, Hertfelt Wahn E, Ekstr\u0026ouml;m A. Factors influencing positive birth experiences of first-time mothers. Nurs Res Pract. 2013;2013(1):349124.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShakouri ARJM, Jafari M. Components of Women's Empowerment and Explanation of Influential Factors on Them. Women Dev Politics. 2007;5(1):1\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgency TIRN. Fertility rate in Ardabil province decreased to 1.66%. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBatool SS, Batool SA. Levels of Education, Age, Legal Awareness and Women's Empowerment. J Res Reflections Educ (JRRE). 2018;12(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTavananezhad N, Bolbanabad AM, Ghelichkhani F, Effati-Daryani F, Mirghafourvand M. The relationship between health literacy and empowerment in pregnant women: a cross-sectional study. BMC Pregnancy Childbirth. 2022;22(1):351.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS ONE. 2010;5(6):e11190.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan SU, Awan R. Contextual assessment of women empowerment and its determinants: Evidence from Pakistan. 2011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAslam M. Empowering women: education and the pathways of change. 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBharati V. Women Education: Empowering Status in the Society. BIJMRD. 2024;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhuwania P, Mukherji A, Swaminathan H. Women\u0026rsquo;s education through empowerment: Evidence from a community-based program. World Dev Perspect. 2024;33:100568.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAboagye RG, Okyere J, Seidu A-A, Ahinkorah BO, Budu E, Yaya S. Does women's empowerment and socio-economic status predict adequacy of antenatal care in sub-Saharan. Africa? Int Health. 2024;16(2):165\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHajipour L, Montazeri A, Mohtasham Amiri Z, Hosseini Tabaghdehi M, Mohsenzadeh Ledari F. The empowerment of pregnant women in Tonekabon, Iran. Casp J Reproductive Med. 2016;2(1):8\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrishna U, Deepthi S, editors. Entrepreneurship empowers women. AIP Conference Proceedings; 2024: AIP Publishing.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGupta S, Wei M, Tzempelikos N, Shin MM. Women empowerment: challenges and opportunities for sustainable development goals. Qualitative Market Research: Int J. 2024;27(4):608\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkter A, Choudhury F, Bagum T, Islam M, Hasan R. Socio-economic impact of entrepreneurship activities for the empowerment of women in Bangladesh. Int J Acad Res Bus Social Sci. 2024;14(2):935\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabit EH, Fadhil SN. Assessment of self-esteem level among women with spontaneous abortion. Pakistan J Med Health Sci. 2022;16(04):892.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZare E, Bahrami N, Soleimani MA. Comparison of self-esteem in fertile and infertile women. Iran J Nurs. 2014;27(90):14\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilva DN. Empowerment da gr\u0026aacute;vida: Fatores de capacita\u0026ccedil;\u0026atilde;o para a maternidade. Instituto Politecnico de Viseu (Portugal); 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamari G. First birth and the trajectory of women\u0026rsquo;s empowerment in Egypt. BMC Pregnancy Childbirth. 2017;17(Suppl 2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrata N, Tavrow P, Upadhyay U. Women\u0026rsquo;s empowerment related to pregnancy and childbirth: introduction to special issue. BMC Pregnancy Childbirth. 2017;17(2):352.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNieuwenhuijze M, Leahy-Warren P. Women's empowerment in pregnancy and childbirth: A concept analysis. Midwifery. 2019;78:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarianne Nieuwenhuijze PL-W. Women's empowerment in pregnancy and childbirth: A concept analysis. Midwifery. 2019;78:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Empowerment, Pregnant Women, Iran","lastPublishedDoi":"10.21203/rs.3.rs-7942116/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7942116/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Pregnancy is a crucial period in a woman's life, as the level of empowerment of pregnant women directly affects the health of mothers, children and families. The aim of this study was to determine the empowerment status of pregnant women in an Iranian setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This analytic cross-sectional study was carried out on 200 eligible pregnant women attending Ardabil health centers in 2023, selected through random cluster sampling. Data was collected using a demographic questionnaire and a Persian version of the Kameda questionnaire on empowerment of pregnant women, which was completed through interviews. The overall empowerment score ranged from 27 to 108, and is classified as poor to excellent. Descriptive statistics, logistic regression, Pearson's correlation and t-tests were utilized for data analysis using SPSS version 17.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean age of the pregnant women was 26.8± 4.67 years, with the majority having a college education (60%) and being housewives (76%). The overall empowerment score of the pregnant women was 54.58, which indicates a moderate level of empowerment. Among the subscales of empowerment, the highest mean score (64) was related to the joy of adding a person to the family, and the lowest score (49) was related to the subscale of self-esteem. There was a significant inverse correlation between the age of pregnant women and their future image (P=0.019). Higher education and employment were linked to higher self-esteem. There were no statistically significant relationships between empowerment status in pregnant women and housing type, income, husband's education, gravida, parity, number of abortions or number of living children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The results of this study could be used in conducting effective interventions for maternal health and promoting the empowerment of pregnant women.\u003c/p\u003e","manuscriptTitle":"Empowerment Status of Pregnant Women in an Iranian Setting: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-27 16:53:16","doi":"10.21203/rs.3.rs-7942116/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-31T17:07:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-10T05:44:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T07:01:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299183995299961043208687315290306459509","date":"2025-12-01T06:04:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T19:39:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14493917395258115247635246492915687244","date":"2025-11-29T14:05:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200020591573867680928493450945286234391","date":"2025-11-29T06:25:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T14:27:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11160293692855599795942433057636365339","date":"2025-11-28T12:14:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T05:57:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250727825892929951400890635441634197928","date":"2025-11-25T04:59:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76438531272185666947644640503331912291","date":"2025-11-23T13:23:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-21T07:02:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-27T12:18:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-27T03:40:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-27T03:39:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-24T16:05:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"054ff2bd-b08d-4c21-aaf7-9c7380204e18","owner":[],"postedDate":"November 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T18:38:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-27 16:53:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7942116","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7942116","identity":"rs-7942116","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}