Midwives' perspectives on preventing unsafe abortion: a qualitative study

Unsafe abortion poses severe risks to women's health and well-being worldwide. In Iran, implementation of restrictive abortion rules in 2022 has intensified concerns about a potential rise in unsafe practices. This shift is likely to introduce new challenges for midwives, who are often the first point of contact in healthcare. Midwives are frequently the first healthcare professionals women consult when seeking abortion or post-abortion care, whether the services are legal or illegal. Thus, this study was conducted to explore midwives' views on unsafe abortion.

This qualitative study was conducted in Yasuj, Iran, from 23 December 2024 to 29 April 2025. The participants were 14 midwives with practical experience in the region. Data were gathered from in-depth, semi-structured individual interviews with participants selected through purposive sampling. Data analysis involved conventional content analysis approach. Overall, 14 interviews with 14 midwives were done. Data were analyzed by MAXQDA. The trustworthiness was established.

The interview analysis revealed 4 main categories and 11 sub-categories: 1."policy development" including subcategories: implementing a policy for caregivers and clients," "re-orientation in legal abortion policies," "implementing policy for clients", and "re-orientation of the Family Planning Program, 2."risk communication strategies" including subcategories like "providing risk education to clients and caregivers", 3."media education on parenting" including subcategories like "responsibility of couples and adherence to values", and 4. "supportive approach" including sub-categories like "economic and social support".

Midwives in this study advocated for revising restrictive abortion laws, expanding family planning programs, and creating clear clinical guidelines. They emphasized educating women about the dangers of unsafe procedures and the media's role in disseminating accurate reproductive health information. In Iran's sociocultural context, these themes guide strategies for preventing unsafe abortion and enhancing reproductive healthpromotion. The study calls for a holistic, rights-based, and woman-centered approach to reproductive health, positioning midwives as essential contributors to policy and program development. Only with such integrated strategies can we achieve sustainable improvements in women's health and broader public health outcomes.