Dadras Omid, Nakayama Takeo, Kihara Masahiro, Ono-Kihara Masako, Seyedalinaghi Seyedahmad, Dadras Fateme
Department of Health Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Global Health Interdisciplinary Unit, Center for Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.
PLoS One. 2021 Jan 15;16(1):e0245007. doi: 10.1371/journal.pone.0245007. eCollection 2021.
An estimated 2.5 million Afghans are living in the Iran and almost half of them are young women at the childbearing ages. Although the evidence indicates lower rates of antenatal care and higher incidence of pregnancy complications in Afghan compared to Iranian women, the underlying reasons are not well defined. Therefore, in the present study, we aimed to explore the prevalence and associated sociodemographic factors of adverse pregnancy outcomes and examine the impact of intimate partner violence, food insecurity, poor mental health, and housing issues on pregnancy outcome in Afghan women living in Iran.
In July 2019, we enrolled 424 Afghan women aged 18-44 years old using the time-location sampling at three community health centers in the south region of Tehran province. The data was collected through face to face interviews using the researcher-developed questionnaire. Using bivariate and multivariate analysis, the impact of poor antenatal care, intimate partner violence, food insecurity, and poor mental health was assessed on the incidence of adverse pregnancy outcome.
More than half (56.6%) of Afghan women reported at least one pregnancy complication in their recent pregnancy. The results showed that undocumented, illiterate, and unemployed Afghan women with lower socioeconomic status are more likely to experience adverse pregnancy outcomes. Furthermore, we observed lower prevalence of adverse pregnancy outcomes among documented immigrants with health insurance compared to those with no health insurance. It is also been found that the food insecurity [Adjusted OR = 3.35, 95% CI (1.34-8.36)], poor antenatal care [Adjusted OR = 10.50, 95% CI (5.40-20.39)], intimate partner violence [Adjusted OR = 2.72, 95% CI (1.10-6.77)], and poor mental health [Adjusted OR = 4.77, 95% CI (2.54-8.94)] could adversely impact the pregnancy outcome and we observed higher incidence of adverse outcomes among those suffering from these situations.
To our knowledge, this is the first study that explored the prevalence and associated factors of adverse pregnancy outcomes and the impact of intimate partner violence, food insecurity, poor mental health on pregnancy outcome among Afghan women in Iran. Enhancing the psychosocial support and empowering Afghan women through expanding the social network and safety net should be a priority for the central government and international parties. Psychological counseling should be incorporated into routine maternity care for Afghan refugees. Access to free antenatal care is a right for all Afghan women and it should be facilitated by universal health insurance for all Afghans regardless of their legal status.
据估计，有250万阿富汗人生活在伊朗，其中近一半是育龄期年轻女性。尽管有证据表明，与伊朗女性相比，阿富汗女性的产前护理率较低，妊娠并发症发生率较高，但其根本原因尚未明确。因此，在本研究中，我们旨在探讨阿富汗女性不良妊娠结局的患病率及相关社会人口学因素，并研究亲密伴侣暴力、粮食不安全、心理健康不佳和住房问题对生活在伊朗的阿富汗女性妊娠结局的影响。
2019年7月，我们在德黑兰省南部地区的三个社区卫生中心采用时间-地点抽样法，招募了424名年龄在18-44岁之间的阿富汗女性。通过使用研究人员编制的问卷进行面对面访谈收集数据。采用双变量和多变量分析，评估产前护理不足、亲密伴侣暴力、粮食不安全和心理健康不佳对不良妊娠结局发生率的影响。
超过一半（56.6%）的阿富汗女性报告在最近一次怀孕中至少出现一种妊娠并发症。结果表明，社会经济地位较低的无证件、文盲和失业的阿富汗女性更有可能经历不良妊娠结局。此外，我们观察到，有健康保险的有证件移民的不良妊娠结局患病率低于没有健康保险的移民。还发现，粮食不安全[调整后比值比=3.35，95%置信区间（1.34-8.36）]、产前护理不足[调整后比值比=10.50，95%置信区间（5.40-20.39）]、亲密伴侣暴力[调整后比值比=2.72，95%置信区间（1.10-6.77）]和心理健康不佳[调整后比值比=4.77，95%置信区间（2.54-8.94）]会对妊娠结局产生不利影响，我们观察到在遭受这些情况的人群中不良结局的发生率更高。
据我们所知，这是第一项探讨伊朗阿富汗女性不良妊娠结局的患病率及相关因素，以及亲密伴侣暴力、粮食不安全、心理健康不佳对妊娠结局影响的研究。加强心理社会支持，通过扩大社交网络和安全网增强阿富汗女性的权能，应成为中央政府和国际各方的优先事项。心理咨询应纳入阿富汗难民的常规孕产妇护理。获得免费产前护理是所有阿富汗女性的权利，应为所有阿富汗人提供全民健康保险，无论其法律地位如何，以便利她们获得免费产前护理。
