تصمیم دشوار در فضایی متناقض: رویکردی کیفی به علل و زمینه های سقط جنین در شهر تهران (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
پدیده سقط جنین در ایران، یکی از موضوعات حساس و چالش برانگیز در حوزه سلامت و سیاست گذاری اجتماعی و جمعیتی است. هدف از مطالعه این است که نشان دهد چرا زنان در ایران باوجود محدودیت های مذهبی، قانونی و اجتماعی به سقط جنین روی می آورند. رویکرد مطالعه کیفی با روش نظریه داده بنیاد و ابزار جمع آوری اطلاعات مشاهده و مصاحبه عمیق بوده است. تعداد افراد نمونه 46 زن ازدواج کرده در شهر تهران است که به صورت هدفمند و گلوله برفی و مراجعه به پزشک و ماما شناسایی شدند. یافته ها نشان داد که تصمیم به تداوم یا خاتمه بارداری نمی تواند فقط با انتخاب شخصی افراد قابل توضیح باشد، بلکه پدیده ای چندعلیتی است و تصمیمات مرتبط با آن متأثر از محدودیت های ساختاری، قوانین، سیاست ها، شرایط و زمینه های فردی و خانوادگی است. روایت افراد از دلایل تصمیم به سقط جنین در هفت مقوله محوری شامل «مشکلات اقتصادی و معیشتی»، «مشکلات روانی و عاطفی»، «ریسک های پزشکی»، «عرف اجتماعی و فشارهای اجتماعی و فرهنگی»، « بی ثباتی و مشکلات شغلی »، «ناآگاهی، محدودیت و پیشگیری ناکارآمد»، «باورهای مذهبی و نگرش به سقط جنین» و «نظام سیاست گذاری ناهماهنگ با نیازهای خانواده»، نمود می یابد که حکایت از تقاطع یافتگی علل دارد. تحلیل داده های این پژوهش به شناسایی مقوله هسته با عنوان «تصمیم دشوار در فضایی متناقض» منجر شد که نشان دهنده وضعیت پیچیده ای از ابهام، ترس، تردید و عدم قطعیت است که زنان در مواجهه با بارداری ناخواسته یا چالش زا تجربه می کنند این تصمیم دشوار در فضایی رخ می دهد که در آن سقط جنین نه به مثابه انتخابی رضایت بخش بلکه به عنوان راهبرد انطباقی با تنگناهای ساختاری بازتعریف می شود. این پژوهش الگوی پویای تعامل عوامل مختلف را نشان می دهد که در آن نقش عواملی نظیر باورهای مذهبی یا فشارهای اقتصادی در گرو شدت و جهت گیری شرایط دیگری همچون ریسک پزشکی و برخورداری از حمایت اجتماعی و خانوادگی است.A Difficult Decision in a Contradictory Space: A Qualitative Approach to the Causes and Contexts of Abortion in Tehran, Iran
IntroductionThe phenomenon of abortion in Iran, despite stringent legal and religious limitations, presents a complex social issue within the realm of reproductive health. National laws permit this procedure only under specific circumstances (Research Center of the Islamic Consultative Assembly, Family Protection and Youth Population Law, Article 56), while religious decrees categorically deem intentional abortion as forbidden (harām). However, evidence suggests that these prohibitions do not fully deter women, who often turn to informal methods outside the healthcare system to terminate pregnancies (Razeghi Nasrabad & Sadeghi Fasaei, 2025). This paradox raises critical questions about the factors and contexts influencing women's decision-making in this area. Numerous studies exploring the reasons behind declining fertility in Iran (Abbasi Shavazi et al., 2020; Madiri & Tanha, 2023; Askari Nodoushan & Razeghi Nasrabad, 2023) identify economic considerations as the most significant factor. For many women, having more children incurs considerable costs and an unwanted pregnancy is not only against their wishes, but also is seen as a source of financial strain that threatens the family's economic stability. Additionally, social pressures and cultural norms play a crucial role. Research indicates that the desired number of children in Iran typically ranges from 2 to 2.5 (Razeghi Nasrabad & Abbasi Shavazi, 2020), prompting women to seek alignment between their childbearing choices and this societal expectation. In recent years, alongside policies promoting childbearing, access to contraceptive services has also undergone changes (Asadi Sarvestani & Sobotka, 2023). Given that nearly half of women obtain contraceptive methods from public health centers, any restrictions on these services can lead to an uptick in unwanted pregnancies and, consequently, unsafe abortions. These challenges highlight that understanding the causes of abortion cannot be achieved through a purely quantitative or descriptive lens; it necessitates a deeper qualitative investigation to uncover the intricate interplay of economic, social, cultural, and legal factors influencing this decision. This research employed a qualitative approach grounded in Grounded Theory to address the fundamental question of why women resort to abortion despite these extensive restrictions. Materials & MethodsGiven the sensitivity of the topic regarding individuals' experiences and decisions about continuing or terminating a pregnancy, this research adopted a qualitative approach that prioritized confidentiality and the nuances of personal decision-making. The aim was to identify and understand the decision-making process, focusing on the interactions and contextual conditions that influenced it. To achieve this, we employed the grounded theory method (Strauss & Corbin, 1997), which was inherently process-oriented and capable of deriving theoretical models from real-world data. The coding process was conducted in 3 stages. In the first stage, each interview was subjected to open coding, where phrases, statements, and indicative codes were extracted individually. In the second stage, following open coding, initial concepts were identified. Through iterative examination and comparison of the data, these initial concepts and codes were merged and classified into broader categories referred to as axial categories. Finally, after aggregating these axial categories and their subcategories, we derived a main or core category that encapsulated all other categories and their interrelationships. Discussion of Results & ConclusionThe findings of this qualitative study conducted by using the grounded theory method (Strauss & Corbin, 1997) revealed that women's decision-making regarding abortion was influenced by a complex interplay of factors that could be categorized into 3 general groups: causal factors, contextual factors, and intervening factors. These factors culminated in the core category of "difficult decision in a contradictory space".Causal factors encompassed 3 primary elements: economic, medical, and occupational. Economic pressures, such as financial strain, an inability to afford living and child-rearing expenses, and a lack of sufficient support, led women to perceive significant financial hardship associated with the birth of a new child. This finding aligns with studies by Chae et al. (2017), Biggs, Gould, and Foster (2013), Abdoljabari et al. (2015), and Razeghi and Sanjari (2016) and can be framed within Becker's (1976) rational choice theory. Medical issues, including diagnosed fetal abnormalities and the mother's physical or mental health challenges, made pregnancy a daunting and unwanted experience for some women. Additionally, occupational pressures—such as fears of job loss, job insecurity, and the difficulty of balancing work and family—were significant factors, particularly for working women.Contextual factors provided the backdrop, against which the decision to terminate a pregnancy was made. These included social norms and fertility customs, which typically defined the ideal family size as around two children (Razeghi Nasrabad & Abbasi Shavazi, 2020). Pregnancies that fell outside this framework—such as those occurring shortly after the birth of a previous child or during engagement—often faced social judgment and pressure. This phenomenon could be analyzed through the lens of the theory of planned behavior, particularly the component of subjective norms (Ajzen & Klobas, 2013; Fishbein & Ajzen, 1975). Another contextual factor was the level of knowledge and awareness among individuals regarding contraceptive methods and the laws and religious rulings governing abortion. Insufficient knowledge and incomplete information as noted in studies by Makleff et al. (2019), Navis, Krishnamoorthy, and Dongre (2015), and White et al. (2016) contributed to unwanted pregnancies and subsequent abortions.Intervening factors were those that could either facilitate or hinder the decision-making process regarding abortion. Difficult past experiences related to pregnancy and childbirth—such as postpartum depression—or a lack of adequate family support often lead women toward the decision to terminate a pregnancy. Personal attitudes and religious beliefs also play a dual role: on the one hand, religious women may be less inclined to consider abortion (consistent with the findings of Barkan (2014) and Saraei and Roshan Shomal (2012), as well as Lesthaeghe's (2022) theory of the second demographic transition); on the other hand, some individuals may view abortion as permissible under certain circumstances, despite their religious and Sharia beliefs. The most significant intervening factor identified was policies and laws. Changes in government policies regarding the provision of free contraceptive methods (as noted by Asadi Sarvestani & Sobotka, 2023) and the absence of adequate supportive laws for childbearing placed many women in socio-economic hardships, prompting them to consider abortion as an adaptive strategy. This aligns with the institutional explanation approach to fertility (McNicoll, 2009), as well as risk avoidance theory (Fiori et al., 2013; Matysiak et al., 2021).Ultimately, these intertwined factors positioned women within a "difficult decision in a contradictory space". This space was characterized by population growth policies and restrictive laws, where many viewed abortion as a sin and were hesitant to consider it, while socio-economic structures failed to provide necessary support for motherhood. In this context, abortion emerged not as a simple personal choice, but as an adaptive and often unwanted response to structural constraints.This study concluded that a comprehensive understanding of this phenomenon necessitates a health-oriented approach, increased public awareness, implementation of supportive family policies, and further research to explore the hidden dimensions of this issue.
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