Impact of Agency on Iranian Women's Access to and Utilisation of Reproductive Healthcare Services: A Qualitative Study

IntroductionAgency, as the ability to identify one's goals and act upon them, has been recognised as a prominent strategy to achieve universal access to sexual and reproductive healthcare services (SRHS). This study explored Iranian women's agency in accessing and using SRHS and how agency at various individual, relational, and collective levels, is constructed, constrained, and facilitated.MethodsA qualitative inductive thematic analysis using in-depth, semi-structured, individual face-to-face interviews was conducted with 52 participants across three categories: women of reproductive age (18-49 years), experts and healthcare providers, and policymakers in Iran in 2021.ResultsIranian women exercise their agency to uptake SRHS by relying on their individual capacities, financial autonomy, and social media as a source of sexual and reproductive knowledge in a culture that is largely silent on sexual and reproductive health matters. Women's agency at the familial level is limited because of the exclusion of men from SRHS and reproductive education. At the structural level, sociocultural norms and expectations, patriarchal gender norms, lack of political will and legal support, and lack of appropriate policies to meet the sexual and reproductive needs of all populations restrict access to SRHS. Marginalising people who act outside the traditional sociocultural norms and legal framework made accessing and using SRHS difficult because healthcare services and policies do not recognise these groups.ConclusionThis study provides unique insights into how Iranian women face limitations to exercise agency but can, at times, negotiate and enact agency to access and use SRHS.Policy ImplicationsEssential requirements to improve Iranian women's agency in accessing and using SRHS require a strong political commitment to evaluate and eliminate the social, legal, policy, administrative, and healthcare-level barriers.