Midwives' Experiences of Implementing Iran's Pronatalist Population Policy: A Qualitative Study



S Kohan SHAHNAZ ; F Mokhtari FATEMEH ; Mg Goujani Marzieh GHASEMI ; K Saberi KIANA ; Zi Pour Zahra IZADI
Source: Journal of Mazandaran University of Medical Sciences Published:2025

Abstract

Background and purpose: In response to declining total fertility rates, concerns about population replacement, and the spread of low-fertility patterns, a pronatalist population policy was approved in Iran under the “Youthful Population and Protection of the Family” law in 2021. The implementation of most of its legal provisions was assigned to the Ministry of Health, and one of the key professions involved is midwifery. This qualitative study was conducted to explore midwives' experiences regarding the implementation of Iran's fertility encouragement policy. Materials and methods: This study was conducted using a qualitative content analysis approach. Midwives working in the health system were selected through purposeful sampling. Data were collected through semi-structured individual interviews. All interviews were transcribed and analyzed using qualitative content analysis. By categorizing similar codes, subcategories were developed, and through continued categorization, categories and overarching themes were extracted. Results: By analyzing the experiences of 15 midwives, four themes emerged: the harm of the pronatalist policy to maternal health and midwifery authority; the potential of midwives in the success of the pronatalist policy; sustainable encouragement of childbearing and promotion of reproductive health; and midwives’ concerns about addressing the shortcomings of the pronatalist policy. Conclusion: Data analysis revealed that midwives perceive themselves as having significant capabilities and roles in encouraging childbirth and maintaining maternal health. However, they expressed concerns about the consequences of the pronatalist policy on their professional status and the health of mothers and children. Utilizing the potential and expertise of midwives may contribute to the successful implementation of the pronatalist policy while safeguarding maternal and child health. © 2025 Elsevier B.V., All rights reserved.