Abstract
Women's health is a key indicator of development. Among various factors, reproductive health poses significant challenges to women's well-being. Identifying these issues is the crucial first step in the policymaking process. This study aims to identify the challenges in women's reproductive health. The research was conducted using the scoping review method. All studies related to women's reproductive health and its challenges were searched in databases such as "SID," "Magiran," "Web of Science," "Scopus," "PubMed," and the "Google Scholar" search engine using appropriate keywords. Ultimately, 25 studies were selected and analyzed using MAXQDA software and the framework analysis method. In this review, 15 significant challenges in the field of women's reproductive health were identified and categorized into structural, social, individual, and legal dimensions. The most critical challenges included inadequate understanding of needs, insufficient household income and awareness, lack of proper inter-sectoral coordination for intervention implementation, a lack of coherence and focus in planning and policies related to reproductive health, ignoring the impact of stakeholders and actors in policymaking and planning, inefficiency in providing reproductive health services, shortage of necessary financial resources, inadequate insurance coverage, and the absence of a strategic plan or roadmap aligned with the goals in the field of reproductive health. A road map for improving women's reproductive health and its continuous evaluation to ensure optimal outcomes, identifying the real needs of society, especially vulnerable groups, strengthening the system of providing reproductive health services, and increasing timely access to these services can help reduce the challenges and allow more women to benefit from reproductive health promotion services.
Extended Abstract
Background
Reproductive health is a crucial and significant issue for women's health. The World Health Organization defines reproductive health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system at all stages of life." In other words, reproductive health, in its broad and global application, refers to a series of behaviors aimed at ensuring safe sexual relations and healthy reproduction. However, women's greater vulnerability to diseases compared to men, the increase in female-headed households, and the increasing social participation and presence of women and its impact on their physical, mental, or social health can pose significant challenges to reproductive health services. Therefore, it is necessary to identify the factors and challenges affecting women's reproductive health, respond appropriately within health policymaking, and plan to meet their health needs by improving reproductive care quality.
Methods
This study used a scoping review method to identify challenges related to women's reproductive health. A scoping review is a type of secondary study that synthesizes research evidence from primary research studies. It aimed to identify the nature, characteristics, volume, and scope of the research literature, categorize them, and identify knowledge gaps in the existing literature. This type of review is suitable for answering "what" and "why" questions within a specific subject area. The scoping review followed the Arksey & O’Malley protocol, which includes six stages: identifying the research questions, identifying relevant studies using reputable databases, reviewing texts, theses, review articles, and study references in the research area, selecting relevant studies for review from primary studies, charting the data in diagrams and tables, collecting, summarizing, and reporting the findings, and optionally consulting experts about the findings. This study utilized electronic English databases such as Scopus, PubMed, and Web of Science, and Persian databases including Magiran and SID, as well as search engine Google Scholar. The keywords used in this search included Reproductive Health, Women's Health, Sexual and Reproductive Health, Reproductive Health Policy, Reproductive Health Challenges, and Reproductive Health Services. Additionally, manual searches of references, lists of obtained articles, and grey literature in the field of reproductive health were conducted. The retrieved studies were imported into EndNote software. Inclusion criteria based on time (between 2015 and 2023) and language (Persian and English) were applied. Overall, 523 articles were retrieved from the database searches after removing duplicates and articles lacking full texts. In the final step, 12 articles were excluded due to incomplete data, resulting in 25 articles selected for final review (Chart 1).
Chart 1.The process of checking databases and collecting articles
Results
According to the findings of this study, 25 research studies (12 Iranian and 14 international) conducted between 2007 and 2023 examined women's reproductive health and its related challenges. Most of these studies were carried out between 2016 and 2019. This review identified 15 major challenges in the field of women's reproductive health, which can be categorized into structural, social, individual, and legal dimensions (Chart 2). Social challenges related to women's reproductive health include the failure to consider women's essential health needs a lack of adequate understanding of these needs, insufficient health literacy and awareness among men concerning women's and reproductive health, inadequate household income and awareness affecting decisions related to reproductive health, the prevailing cultural and social structures, a lack of sufficient community support for women's reproductive health, and disbelief in the importance and impact of public participation in reproductive health matters. Structural challenges identified in the studies include poor coordination and intersectoral communication in implementing interventions, a lack of cohesion and focus in reproductive health planning and policymaking, limited participation from vulnerable groups in reproductive and sexual health decision-making and policies, neglecting the role and influence of stakeholders in reproductive health policymaking and planning, inefficiencies in delivering reproductive health services, which do not consider the financial burdens on households and the health system, and inadequate communication between policymakers and researchers. Insufficient recognition of needs, low income levels, and lack of household involvement in reproductive health decision-making are significant individual challenges in women's reproductive health. Legal challenges encompass insufficient financial resources, inadequate insurance coverage, lack of effective financial support in the reproductive health sector, and the absence of a strategic plan or roadmap aligned with reproductive health goals.
Chart 2. Challenges related to women's reproductive health (statistics from studies)
Conclusion
This study emphasizes the importance of women's health and aims to improve health levels within this group. It identifies several challenges in women's reproductive health across various studies. These challenges include the neglect or lack of understanding of women's essential needs, insufficient household income and awareness, inability to make informed decisions regarding reproductive health, lack of stakeholder participation in policymaking and decision-making, unequal distribution of human resources and facilities, inadequate financial resources, poor insurance coverage, prevailing cultural and social structures, and the absence of strategic programs aligned with objectives. These issues often prevent women from accessing adequate reproductive health services and improving their health levels. Therefore, it is essential to focus on the following:
· Developing a strategic plan and roadmap to enhance reproductive health while continuously evaluating progress to ensure desired outcomes.
· Identifying the real needs of the community, especially vulnerable groups, and improving their participation and awareness in decision-making and self-care.
· Strengthening the reproductive health service delivery system and increasing timely access to these services.
Addressing these actions can significantly strengthen policymaking and decision-making in this field, reduce challenges, and enhance women's access to reproductive health services.
Practical Implications of Research
It is necessary to develop policies and plans related to women's reproductive health by recognizing the most significant and effective challenges in this field. Taking these actions can significantly strengthen policymaking and decision-making, reduce challenges, and enhance women's access to reproductive health services.