A Phenomenological Inquiry into the Psychological Experiences of Incarcerated Pregnant Women.

OBJECTIVE: With the increasing number of incarcerated women worldwide, the rate of women who experience pregnancy in prison, has also increased in this population. Exploring the unique experience of pregnant prisoners can contribute to understanding the complex world of this vulnerable population and, as a result, tailoring programs to promote their health status. The objective of this study was to understand the psychological experience of pregnancy in prison based on the lived experiences of incarcerated women. METHODS: This was a qualitative inquiry using van Manen's approach to phenomenology. Seven pregnant and four early postpartum women, with experience of pregnancy during incarceration, were selected purposefully in a prison in Iran from 2019 to 2020. In-depth semi-structured interviews were used to collect data. To analyze data, six-step van Manen's descriptive-interpretive phenomenological approach was adopted using MAXQDA10 software. RESULTS: The main theme of "white torture", a term used to describe the psychological and emotional distress experienced by incarcerated pregnant women, emerged from the data analysis. This theme echoes the pressure and torment of pregnancy on incarcerated women and consists of two subthemes: "captive to bitter and harsh emotions" and "suffering from psychosomatic pain and injuries." CONCLUSION FOR PRACTICE: As an emotional trauma, pregnancy puts incarcerated women under psychological torture. Policies should be developed towards the acknowledgment and meeting of the unique psychological needs of pregnant women in prison. It is also crucial for healthcare providers to provide women in prison with training on coping strategies to address the psychological and emotional challenges of pregnancy.

Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis.

BACKGROUND: Despite emphasizing the importance and benefits of men's active engagement in reproductive health programs, their engagement in reproductive health care is low. Researchers have identified different barriers to men's avoidance of participation in various aspects of reproductive health in different parts of the world. This study provided an in-depth review of the hindrances to men's non-participation in reproductive health. METHODS: This meta-synthesis was conducted using keyword searches in databases including PubMed, Scopus, Web of Science, Cochrane, and ProQuest until January 2023. Qualitative English-language studies that investigated barriers to men's participation in reproductive health were included in the study. The critical appraisal skills program (CASP) checklist was used to assess the articles' quality. Data synthesis and thematic analysis were done using the standard method. RESULT: This synthesis led to the emergence of four main themes such as failure to access all inclusive and integrated quality services, economic issues, couples' personal preferences and attitudes, and sociocultural considerations to seek reproductive healthcare services. CONCLUSION: Healthcare system programs and policies, economic and sociocultural issues, and men's attitudes, knowledge, and preferences, influence men's participation in reproductive healthcare. Reproductive health initiatives should focus on eliminating challenges to men's supportive activities to increase practical men's involvement in reproductive healthcare.

Complementary and alternative medicine use in infertility: A review of infertile women's needs.

The use of complementary and alternative medicine (CAM) is common in infertile women in different countries. The purpose of the current study was to review the infertile women's needs in relation to CAM use. This narrative review was conducted through searching English databases including Scopus, PubMed, Embase, Web of Science, Cochrane library as well as Persian databases consisted of SID, and Magiran. The used keywords included "CAM/therapy, needs, and Infertility." All studies published in English peer-reviewed journals from conception to October 2020, which examined the infertile women's needs in the field of CAM use were included in the review. In the process of data extraction, two researchers screened the title, abstract, and full text of the articles. Out of the 2166 articles reviewed, 29 articles including six qualitative and mixed methods studies, four review, and 19 quantitative studies met the inclusion criteria. The results showed that infertile women have different needs in six domains consisted of educational and informational needs, the need for psychological counseling, supportive needs, the need for CAM use counseling, the need to treatment consistent with women's culture and demands, and the need to the integration of CAM with conventional medicine. Awareness of infertile women's needs toward CAM use can help health policymakers and planners in designing and implementing counseling services in accordance with the demands and culture of infertile couples. It also helps to develop a coherent program to integrate the use of CAM in the classical infertility treatment.

The effectiveness of "Women's Postpartum Sexual Health Program (WPSHP)" on Iranian women's postpartum sexual health: A randomized clinical trial.

In this study, we examined the effectiveness of Women's Postpartum Sexual Health Program (WPSHP) on Iranian women's sexual health in the postpartum period. A single-blinded randomized clinical trial was conducted in 2016 on 80 postnatal women in Iran. We used the Female Sexual Function Index, Sexual Quality of Life - Female questionnaire and Female Sexual Distress Scale. The intervention group received counseling based on WPSHP. After 28 weeks, the mean score of the Female Sexual Function Index and Female Sexual Quality of Life significantly increased in the WPSH group (p < 0.001, p < 0.001), while the mean score of the Female Sexual Distress significantly decreased in the WPSH group (p < 0.001). We concluded that Women's Postpartum Sexual Health Program could promote postnatal women's sexual function and female sexual quality of life and reduces female sexual distress in women suffering from sexual problems in the postpartum period.

Menstrual and Reproductive Factors and Risk of Breast Cancer in Iranian Female Population: A Systematic Review and Meta-Analysis.

Background: Breast cancer (BC) is the most frequent cancer in Iranian females. Due to the changes in lifestyle and reproductive risk factors, the BC incidence rate has been rapidly increasing. Knowing risk factors of BC could significantly contribute to improve preventive behaviors. To investigate the relationship between menstrual and reproductive factors and BC in Iranian female population. Methods: Web of Science, PubMed, Scopus, and SID as well as references of included studies were searched. Among relevant published observational studies, 27 studies met the inclusion criteria. Pooled risk estimates for the risk factors were determined using random-effects models due to the presence of substantial heterogeneity (P < 0.05). Results: All of the selected studies had case-control design. There was a positive relationship between maternal age at first pregnancy and risk of BC (OR = 1.79 95% CI: 1.36-2.35). Also, menopausal status was associated with higher risk of BC (OR = 1.60 95% CI: 1.18-2.17), whereas, there was no association between menarche age and increased risk of BC (OR = 0.55 95% CI: 0.29-1.03). History of abortion (OR = 1.21 95% CI: 0.97-1.5), nulliparity (OR = 1.43 95% CI: 0.89-2.31), and breastfeeding history (OR = 0.68 95% CI: 0.42-1.09) were not associated with BC risk. Conclusions: Our findings suggest that age at the first pregnancy and menopausal status were significantly associated with BC risk among Iranian women, whereas menarche age, nulliparity, and history of breastfeeding were not. In regard to the history of abortion, our findings revealed no association with BC, but in high-quality studies, this relationship was significant.

The factors affecting male infertility: A systematic review.

BACKGROUND: In recent years, the incidence of male infertility has increased worldwide. It is necessary to study the factors that influence male infertility in each area/region for better management. OBJECTIVE: To determine the factors affecting male infertility in the Iranian male population. MATERIALS AND METHODS: An online search was conducted in electronic databases including PubMed, Google Scholar, SID, and Scopus to identify articles on the factors associated with male infertility, published in English and Persian. The keywords used to perform the search included "factor", "epidemiology", "causes of infertility", and "male infertility". The search was conducted without a time restriction, up to April 2020. RESULTS: The search resulted in a total number of 691 studies. After an assessment of the articles, finally 14 studies were included in this study with a total number of 26,324 infertile males. The factors associated with male infertility included semen abnormalities, varicocele and testis disorder, smoking, exposure to heat, obesity, anabolic steroids, vascular abnormalities, anti-spermatogenesis factors, antidepressants, taking ranitidine and cimetidine, penile discharge and genital ulcers, painful micturition, occupational factors, alcohol, chronic disease, sexual disorder, Surgical and urological diseases, genetic factors and herpes infection. Among these, the semen and varicocele disorders were common in most studies. CONCLUSION: The present review suggests that the factors affecting male infertility in Iran are similar to those reported from other countries. The results of this study can be used in adopting appropriate strategies for infertility management in Iran.

Comparing the Effectiveness of Sexual Counseling Based on PLISSITand BETTER Models on Sexual Selfdisclosure in Women with Sexual Problems after Childbirth: A Randomized Trial.

BACKGROUND: Sexual self-disclosure is one of the factors that affect sexual satisfaction. The aim of this study was to assess the efficacy of individual therapy using the Bring up, Explain, Tell, Timing, Educate, and Record (BETTER model) in comparison to individual therapy using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT model) in terms of increasing sexual self-disclosure in women with sexual problems after childbirth. MATERIALS AND METHODS: This randomized trial was conducted in 2017 in Mashhad, Iran. 80 women with sexual problems within 4 weeks to 6 months after childbirth were randomized into two equal groups and received the interventions in 2 sessions of 60-90 minutes. The research instruments included a demographic questionnaire, the Female Sexual Function Index (FSFI) and Hulbert sexual self-disclosure index. Changes in mean (SD) scores of sexual self-disclosures between groups were assessed before and 4 weeks after the intervention and the results (mean changes) were compared between groups. The data analysis was conducted using independent t-test, paired t-test, Chi-square, analysis of covariance (ANOVA), and Mann-Whitney U test in SPSS (p < 0.05). RESULTS: In the PLISSIT group, the mean (SD) sexual self-disclosure score at baseline was 43.80 (9.50) and after 4 weeks was 51.60 (8.30). In the BETTER group, at baseline and after 4 weeks the mean (SD) sexual self-disclosure score was, respectively, 44.10 (10.30) and 55.60 (8.20) (Z = -2.5, p = 0.013). CONCLUSIONS: The findings confirm the effectiveness of the BETTER counseling model in increasing sexual self-disclosure after childbirth.

Social Recovery: A Neglected Dimension of Caring for Women with Perineal Trauma in Iran.

BACKGROUND: Social recovery during the postnatal period in women with perineal trauma is a little-known concept. Therefore, this study was designed to explore the experiences of social recovery in women with childbirth-related perineal trauma. MATERIALS AND METHODS: A qualitative approach using content analysis was adopted to study a purposive sample of 22 postnatal women with perineal trauma during birth at Omol-banin Hospital, Mashhad, Iran from April 20th to December 25th, 2017. The participants were selected between 10 days to one year after childbirth. Data were collected through semi-structured interviews. Conventional content analysis approach was performed, concurrently, with data collection. To organize data, the MAXQDA 10 was used. RESULTS: Social recovery after perineal trauma was conceptualized as 'shifting from personal ill-health to interactional empowerment'. Two generic categories emerged from data analysis including 1) impaired individual and social function, which was recognized by social isolation and lack of ability to manage daily life and 2) empowering social interactions, which was characterized by rebuilding social partnerships and returning to an interactive lifestyle. CONCLUSIONS: Social isolation as the result of neglecting social recovery of women with severe perineal trauma endangers the mental health of mothers. Understanding the concept of social recovery for women with perineal trauma, especially in severe cases, will help health professionals to provide quality postpartum care for women with perineal trauma in a longer period after childbirth.

Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis.

BACKGROUND: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. OBJECTIVE: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. MATERIALS AND METHODS: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein-A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. RESULTS: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44-5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). CONCLUSION: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required.

Promoting Health Care for Pregnant Women in Prison: A Review of International Guidelines.

BACKGROUND: There are standard guidelines for the provision of health care for pregnant women in prisons. There is no single guide to meet all the specific needs of imprisoned women. In this study, the related international guidelines were reviewed to reveal the existing gaps. MATERIALS AND METHODS: In this narrative review, studies published from May 2010 to January 2019 were reviewed through investigating databases including PubMed, Scopus, the Cochrane Library database as well as Science Direct Google Scholar using keywords: Guideline AND Prison AND Pregnancy AND Prenatal Care. The contents of the guidelines were subjected to analogy comparison. RESULTS: 13 guidelines were included in the study. Of these, 10 guidelines were related to the organizations deployed in the USA, two guidelines to the United Nations and the World Health Organization, and one guideline to the United Kingdom. The most comprehensive care coverage of pregnant women was suggested, at the first level, by Birth Champion and in the second level by the Federal Bureau of Prisons. The care recommended in the guidelines was classified into four general categories of health care, safety and security, education and counseling, as well as miscellaneous issues. Most of the care items mentioned in the guidelines were related to the issue of safety and security of pregnant women. CONCLUSIONS: There are currently gaps in the guidelines in many aspects including maternal and fetal health assessments, mental health care, and also ethical and communication issues. It is essential to upgrade the guidelines provided for imprisoned women to promote their health.

Pregnant Women's Experiences of Social Roles: An Ethnophenomenological Study.

BACKGROUND: The role of women and men is changing across the world, and women, including pregnant women, are adopting newer roles in traditional societies like Iran. This study aimed to explore the meaning of pregnant women's experiences regarding their social roles in the sociocultural context of Iran. MATERIALS AND METHODS: This study was carried out using an ethnophenomenological approach. Participants included 16 pregnant women who attended health centers, hospitals, and private obstetric clinics in Mashhad, Iran, between 2016 and 2017 and were selected based on purposive sampling. In-depth semistructured interviews, vignette interviews, participant observations, and field notes were used to collect data. To analyze data, six-step van Manen's (1997) descriptive-interpretive phenomenological approach was used. RESULTS: Through data analysis, the overarching theme of "selection, management, and adjustment of various roles to play social roles" was emerged. This was consisted of four themes: "Mother's perspective regarding out-of-home employment, incompatibility between pregnancy and social roles, mother's management strategies to play different roles, and husband's authority regarding mother's employment." CONCLUSIONS: The consequence of reciprocal endeavors of pregnant women along with their husbands as well as their work environment expectations tends to selection, management, and adjustment of feminine roles. Since the employment of pregnant women leads to their more physical and psychological involvement, not only the problems of working women but also the expectations and rules of the workplaces as well as the requests of their husbands should be taken into account.

Compliance of Published Randomized Controlled Trials on the Effect of Physical Activity on Primary Dysmenorrhea with the Consortium's Integrated Report on Clinical Trials Statement: A Critical Appraisal of the Literature.

BACKGROUND: Randomized Controlled Trials (RCTs) are reliable methods for the evaluation of treatment effectiveness, which should be rigorous and must report with clarity. This study aimed to assess the compliance of published RCTs about the effect of physical activity on primary dysmenorrhea with the CONSORT 2017 statement. MATERIALS AND METHODS: In this study, the review of literature was carried out based on Consolidated Standards Of Reporting Trials (CONSORT). All the clinical trials focused on the effect of the physical activity on primary dysmenorrhea indexed in Web of Science, Pubmed, Scopus, Google Scholar, Science Direct, Embase, Magiran and Scientific Information Database (SID) were searched using keywords of dysmenorrhea, randomized clinical trial, physical activity and exercise from 2000 to 2019. Out of 1423 articles, 30 RCTs were critically appraised using CONSORT 2017 checklist. The reporting quality score of articles was identified between zero and 43. RESULTS: The compliance rate with the CONSORT checklist was 55.58%. The mean (SD) score of the reporting quality was 23.37 (-5.15) with a minimum of 16 and a maximum of 37. The maximum weakness was in reporting the sample size and full trial protocol 23.33% and 6.67% respectively. Regarding new items of the consort 2017, if the blinding was not possible, the description of any attempts to limit bias was not described in 70% of articles. CONCLUSIONS: Reporting sample size, trial protocol, method of blinding, and control of bias are issues that require more attention in reporting of RCT studies. We recommend that the authors use the CONSORT 2017 statement for conducting and reporting the clinical trials.

Erratum to: Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications.

[This corrects the article on p. 41 in vol. 24, PMID: 29765926.].

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications.

OBJECTIVES: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. METHODS: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. RESULTS: Through data analysis "sexual disharmony" emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. CONCLUSIONS: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women.

A historical review of the concept of labor support in technocratic, humanistic and holistic paradigms of childbirth.

BACKGROUND: In the past century, maternal support during childbirth has been changed according to the different approaches suggested by various health care paradigms. OBJECTIVE: The aim of this review was to argue the maternity supportive care paradigms of the past century and to closely analyze each paradigm. METHODS: This is a historical review, in which published articles were retrieved from databases including Scopus, Science Direct, PubMed and Google Scholar. Sage Journals and Springer's publications were also searched due to the high citation rate of their articles. The keywords entered were "Labor support", "Normal delivery", "Birth attendance", "Supportive approaches", "Health care paradigms", and "Midwifery models of care". They were entered alone or in combinations using "AND". Also, Persian articles were searched in local databases including Irandoc, SID, IranMedex, and Magiran using the above-mentioned keywords in Persian. Sixty articles met inclusion criteria. RESULTS: The review revealed four main themes including the definitions of continuous labor support, the technocratic paradigm, the humanistic paradigm and the naturalistic paradigm as models of labor support. According to the evidence, labor support has changed from technocratic to humanistic and holistic approaches, which in turn, caused some changes in midwifery models of care used by midwives in the practice. CONCLUSION: Labor support based on the holistic approaches and the naturalistic paradigms could bring about remarkable outcomes, the most important being satisfied with the birth experience, increased mother's self-confidence, enhanced mother's ability in childbirth and better completion of the childbirth process.

Women's perceptions and experiences of the challenges in the process of male infertility treatment: A qualitative study.

BACKGROUND: Despite the fact that both men and women are equally subject to infertility, it is usually women who bear the burden of treatment and its consequences, even in cases of male infertility. Therefore, it is more necessary to recognize their health problems in order to help them. AIM: To explore women's perceptions and experiences of the challenges they face in the process of male infertility treatment. METHODS: This qualitative study was conducted during 2014-2015 using content analysis. Thirty semi-structured interviews were conducted with women whose husbands suffered from male infertility. Purposive sampling was conducted until data saturation was achieved. All interviews were recorded, transcribed and analyzed using conventional content analysis adopted by Graneheim and Lundman. RESULTS: From data analysis, the major category of "treatment-related stresses" and four subcategories of "high treatment expenses", "inefficiency of healthcare system", "being captive in the infertility treatment" and "treatment failure" emerged. CONCLUSION: Experiences of women who face male infertility indicate their various concerns in the process of treatment. Therefore, it is required to develop emotional and financial support for the clients and to promote their quality of healthcare services. In addition, awareness of treatment challenges of these women can assist proper planning to promote the quality of services they need.

Predictors of Prenatal Empowerment Among Iranian Pregnant Women.

INTRODUCTION: Considering that empowering expectant mothers is an important issue to maintain a healthy pregnancy, this study was conducted to evaluate the predictors of empowerment among Iranian pregnant women. METHODS: This cross sectional study was conducted in Golestan, North of Iran in 2015. A total number of 161 pregnant women were selected through random cluster sampling from urban health centers, using PASS software. The socio-political, educational, and mental-financial predictors of empowerment were measured using a self-structured questionnaire during pregnancy and was analyzed by a linear regression model using SPSS version 16. RESULTS: The findings of linear regression showed that educational dimension of empowerment had the highest coefficient in the regression model, on total empowerment (ßeta standardized coefficient [ß]=0.696 with DW=1.830 and means error=0). The total empowerment score of pregnant women was controlled by individual factors such as the age of marriage (ß-0.228), employment (ß-0.210), and educational factors such as participation in prenatal education classes (ß-0.246), and moral issues such as sense of spiritual support (ß-0.217). CONCLUSION: By recognizing and observing predictors of empowerment during pregnancy, health care providers can increase women's power over their pregnancy. Educational predictors of empowerment were the most important factors to empower women during pregnancy. The objective of childbirth education classes, therefore, should shift from simply giving information to women, towards giving them appropriate knowledge in order to provide them with empowerment during pregnancy.

Experiences of women regarding gaps in preconception care services in the Iranian reproductive health care system: A qualitative study.

INTRODUCTION: Despite the beginnings of preconception care (PCC) delivery around a decade ago in Iran, there are still significant gaps in its service delivery. The purpose of this study was to explore the perceptions and experiences of women as well as midwives toward gaps in PCC delivery in the Iranian reproductive health care system. METHODS: In this exploratory qualitative study, 27 married women and 13 midwives were recruited using purposive sampling from five health centers in Mashhad, Northeast of Iran. Respondents participated in semi-structured, in-depth, individual and focus-group interviews to express their perceptions and experiences about gaps in PCC. Data were analyzed using conventional content analysis adopted by of Graneheim and Lundman (2004) with MAXQDA software. RESULTS: Analysis of data revealed four themes: 1) missing men and adolescents from PCC; 2) insufficient PCC package; 3) inadequate PCC strategies; and 4) health care providers' incompetency. CONCLUSION: It is recommended to deliver gender-sensitive PCC through addressing couples' instead of just women's PCC and to take into account the adolescent girls' health in order to improve their preconception health. Standardization of protocols and attention of health professionals toward occupational-environmental hazards and sexual and reproductive issues as well as enhancing professional capability of health care providers could improve PCC service delivery.