The effect of virtual cognitive-behavioral sexual counseling on sexual function and sexual intimacy in pregnant women: a randomized controlled clinical trial.

BACKGROUND & AIM: Pregnancy is associated with numerous physical and psychological changes and affects the sexual function of couples. Since the root of many marital problems lies in the quality of the relationship and sexual function, the present study investigates the effect of virtual cognitive-behavioral sexual counseling on pregnant women's sexual function and intimacy. METHODS & MATERIALS: This study is a randomized clinical trial, and 80 pregnant women aged 18 to 35 years and in 16-24 weeks of pregnancy were assigned to two intervention and control groups based on randomized blocks from June 2021 to July 2021. The control group received routine prenatal care, but the intervention group, in addition to routine prenatal care, underwent virtual counseling with a cognitive-behavioral approach during eight sessions of 90 minutes. Data were collected using the Female Sexual Function Index (FSFI) and sexual intimacy questionnaire. SPSS software was used for statistical analysis. RESULTS: The comparison of mean scores of sexual function and intimacy in the two groups before the intervention was not statistically significant with each other. However, after the intervention, the mean scores of sexual function and intimacy in the intervention group were significantly increased compared to the control group (p < 0.001). The effect size of the intervention was 0.52 for sexual function and 0.272 for sexual intimacy. CONCLUSION: Virtual cognitive-behavioral counseling can be used as an effective treatment to promote sexual function and intimacy of women during pregnancy. TRIAL REGISTRATION: IRCT20161230031662N10. Registry date: 21/06/2021.

How Do Iranian Men Perceive Their Sexual and Reproductive Health Situation? A Qualitative Content Analysis.

Background: Males' viewpoint about sexual and reproductive health (SRH) and their situation are essential components of men's and women's health in the community. Men have been overlooked in reproduction health, especially with reproductive issues such as contraception, sexually transmitted infections (STIs), infertility, and sexual function. This study aimed to investigate the males' perceptions of their SRH situation in Iran. Methods: A qualitative study was conducted from May 2016 to April 2017 on data retrieved through semi-structured interviews with 19 adult males aged 18 to 59 years. The participants were purposefully recruited from among populations of health centers in Alborz province, Iran. Conventional content analysis in OneNote software version 2016 was used for data analysis. Results: Three main themes and nine categories emerged including 1) Perceived SRH needs, including "need to increase men's awareness about SRH", "need to have an accessibility to SRH services", and "need to have a high-quality sexual relationship"; 2) perceived SRH responsibilities, including "health-seeking behaviors", "sexual skills", "childbearing responsibilities", and "ethical commitment", and 3) Men' perception of trends of social and cultural norms, including "changing SRH priorities" and "changing marital prototype". Conclusion: In this study, men perceived SRH as an important issue due to the changes in social and cultural trends, and many of their SRH needs have not yet been addressed. Hence, along with socio-economic changes, the policymakers of the health system should develop strategies and interventions to meet these needs.

The effect of a tele-educational intervention on modifying dysfunctional sexual beliefs of pregnant women: a randomized controlled trial.

BACKGROUND & AIM: Some cultural scenarios in pregnancy and childbirth reinforce dysfunctional sexual beliefs that reverse changes in the couple's sexual life. The present study aimed to investigate the effect of education by sending text messages on modifying dysfunctional sexual beliefs in pregnant women. METHODS & MATERIALS: This study is a randomized clinical trial, and 82 eligible pregnant women referred to educational-medical centers to receive prenatal care were randomly assigned to intervention or control group. The intervention group received 24 text messages during eight weeks (three text messages per week), and the control group received only routine care. Data was collected through a demographic questionnaire, reproductive profile, Spinner's Dyadic Adjustment Scale (DAS), and dysfunctional sexual beliefs questionnaire. Both groups completed the questionnaires before and one week after the intervention. Independent t-test, paired t-test, and analysis of covariance was used to analyze the data. RESULTS: The findings revealed no statistically significant difference in the baseline Dyadic Adjustment mean scores of control (132.4 ± 11.01) and intervention (130.10 ± 10.66) groups. Paired t-test analysis showed that the mean score of dysfunctional sexual beliefs was significantly decreased from (29 ± 7.61) at baseline compared to one week after intervention (10.54 ± 6.97) (p < 0.001). Analysis of covariance test to compare the scores of dysfunctional sexual beliefs in the intervention group (10.54 ± 6.97) and control group (26.80 ± 7.80) showed a statistically significant difference (p < 0.01) with an effect size of 0.67. CONCLUSION: This study showed that sending text messages to mobile phones of pregnant women has corrected their dysfunctional sexual beliefs. Therefore, this approach can be used in pregnancy care to promote women's sexual health. TRIAL REGISTRATION: Clinical trial registry: IRCT20161230031662N9 .

Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial.

BACKGROUND: Fathers' involvement is crucial for promoting breastfeeding. There are a few studies on the effectiveness of fathers' educational programs to promote exclusive breastfeeding. This study aims to assess the effectiveness of a fathers' educational program on their support for breastfeeding, mothers' breastfeeding practice, and exclusive breastfeeding status. METHODS: This was a randomized controlled trial on 76 fathers who were randomly assigned to two groups of intervention and control, in a selected health center in Iran, 2018. The tools for data collection were: 1) a questionnaire for "Demographic and Maternal-Infant Information"; 2) a questionnaire to assess "Fathers' support for Breastfeeding", and 3) an observational checklist to assess "Mothers' Breastfeeding Practice"; and 4) a questionnaire to assess "Exclusive Breastfeeding Status". The questionnaires were filled up through an interview. The checklist was completed through observation by the researcher. The fathers (with the mothers) of the intervention group were educated using individual face-to-face education and counseling, in two sessions, with the duration of about 40 min and one-week interval, whereas, the fathers of the control group did not receive any education and only mothers were educated with the same instruction. The content of the education was: fathers' education about "benefits of breast milk" and "the supporting ways for breastfeeding including the women encouragement". Then, the scores of "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" were compared before and after 4 months of intervention in each group, and also between groups. Data were analyzed using SPPS-23, and t- and paired-tests, Chi-square, and Generalized-Estimating-Equations (GEE) tests. RESULTS: The results showed two groups were not significantly different regarding the demographic and any other possible confounding variables before the intervention (P < 0.05). The before and after comparisons also demonstrated significant improvements in the two variables including "father's support for breastfeeding", and "mothers' breastfeeding practice after 4 months, in the intervention group (Paired t-test: P<0.001 and P<0.0001, respectively) however, there was a significant decrease in "father's support for breastfeeding" and no improvement in "mothers' breastfeeding practice" after 4 months in the control group (Paired t-test: P < 0.001 and P = 0.07, respectively). Between groups comparison showed also significant higher scores for "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" in the intervention group comparing to the control group, after 4 months (T-test: P < 0.001 and P < 0.0001; Chi2: P < 0.001, respectively). The interaction effects of time and group were significant in the GEE test for the fathers' support for breastfeeding (B-group = 31.93, B-time = 22.15, p < 0.001) and mothers' breastfeeding practice (B-group = 26.32, B-time = 12.86, p < 0.0). CONCLUSION: The results showed that the father's education improves mothers' breastfeeding practice and increases the rate and continuity of exclusive breastfeeding. TRIAL REGISTRATION: IRCT201508248801N10. "31/08/2016".

Tele-counseling based on motivational interviewing to change sexual behavior of women living with HIV: a randomized controlled clinical trial.

Sexual transmission accounts for the majority of new HIV infections in Iran. More than 80% of HIV-positive persons are sexually active, and nearly 68% reported never using a condom. The present RCT study was conducted on a group of HIV-positive women using internet-based motivational interviewing. The participants, including 100 HIV-positive women, were randomly assigned to an intervention or control group. The intervention group received five weekly internet-based group motivational interviewing sessions focused on reducing risky behaviors, and the control group received routine care. Follow-ups occurred one month and three months after the end of the intervention. The participants completed demographic information, sexual behaviors, HIV knowledge, condom negotiation skills, and HIV-specific perceived social support scales before, one month, and three months after the intervention. Motivational interviewing was effective in improving knowledge about HIV/AIDS, condom negotiation skills, and HIV-specific perceived social support in the intervention group compared to controls. The intervention significantly increased using condoms in vaginal or anal intercourse in the last three months. Still, it was not effective at consistent condom use in all vaginal and anal sex. Further investigation or a larger RCT needs to confirm the using tele-counseling for women living with HIV.

Effect of counselling on maternal-fetal attachment in unwanted pregnancy: a randomised controlled trial.

Purpose: The present study aimed to determine the effect of group counselling on Maternal-Fetal Attachment (MFA) in mothers with unwanted pregnancy.Methods: This study was a randomised clinical trial. The participants were 80 mothers with unwanted pregnancy during 28-34 weeks of pregnancy who referred to health centres of Karaj to receive prenatal care in 2018. The women were randomly assigned into intervention (N = 40) and control groups (N = 40). The intervention group received four weekly group counselling sessions to promote MFA and the control group received routine care. Cranley's Maternal-Fetal Attachment Scale was used to assess the attachment of mother to fetus at baseline and two weeks after counselling. An ANCOVA test was performed to evaluate the effect of intervention and the number of parity.Results: There was no significant difference between the two groups in terms of general health scores and attachment of mother to fetus at baseline, but after the intervention, the mean scores of MFA in the intervention group had a significant difference with the control group (p < 0.001); the ANCOVA test indicated that attachment scores were significant in terms of intervention and pregnancy group and attachment scores indicated further increase in the primipara group compared to the multipara group (p = 0.041).Conclusion: Considering the effectiveness of group counselling in improving MFA in unplanned pregnancy, it can be used in prenatal care.

The Effect of Sexual Counseling Using BETTER Model on Sexual Function of Women with Infertility: A Randomized Controlled Trial.

Objective: Infertility can have adverse effects on sexuality of women. This study aims to examine the effect of sexual counseling based on the BETTER Model on the sexual function of Iranian women with infertility. Method: Eighty women with infertility were randomly assigned to either intervention or control groups. Female Sexual Function Index and Enrich Marital Satisfaction Scale were completed by participants at baseline and two months after. Results: All domains of FSFI (except for pain) were significantly increased (p < 0.001) after the intervention. Conclusions: Results showed that two sessions of sexual counseling can be used to improve the sexual health of infertile women.

Effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives in community health centers: a randomized clinical trial in Iran.

INTRODUCTION: Compliance with ethical principles is regarded as one of the key components in providing services in midwifery profession. This study was to evaluate the effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives working in community health centers in the city of Karaj, Iran. METHODS: This randomized controlled trial (RCT) was conducted in 2018 on a total number of 84 eligible midwives in two intervention and control groups, selected through multistage sampling method. The intervention group took part in six counseling sessions but the control group only received a training manual. Both groups then completed the Self-Reporting Questionnaire of Ethical Codes of Reproductive Health Providers (including 95 items in 14 domains) at three time points (before, immediately, and four weeks after intervention). Finally, the data were analyzed using the IBM SPSS Statistics (version 22) software via descriptive and inferential statistics. RESULTS: The findings showed that level of compliance and applicability rate in all 14 domains of midwifery professional codes of ethics were higher in the intervention group (after intervention) than those in the control group and trend of time changes in mean level of compliance and applicability rate of codes of ethics during the three time points were significantly different between both groups (p < 0.001). CONCLUSION: Given the effectiveness of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among the midwives working in community health centers, designing and applying this counseling approach was recommended to improve quality of reproductive health care services.

Comparison of Massage and Prone Position on Heart Rate and Blood Oxygen Saturation Level in Preterm Neonates Hospitalized in Neonatal Intensive Care Unit: A Randomized Controlled Trial.

BACKGROUND: These days, most of the admitted infants in neonatal intensive care units (NICU) are premature infants. Infant massage and prone position has been recommended for several decades to have a positive effect on preterm and low birth weight infants. The objective of this study was to determine the effects of neonatal massage with prone positioning in preterm infants on Heart Rate (HR), and Oxygen Saturation (O2Sa) status. MATERIALS AND METHODS: This is a controlled randomized three-group clinical trial study conducted on hospitalized infants in selected hospitals of Alborz University of Medical Sciences in Karaj-Iran. There are about 75 preterm infants (33-37 weeks) who met inclusion criteria were randomly assigned to groups of position, massage as intervention groups, and a control group. Intervention (prone position and massage) was administrated for five straight days. The repeated measure ANOVA test was performed to evaluate and compare the effect of interventions. p value less than 0.05 was considered as statistical significance. RESULTS: The Repeated Measure two-way Analysis of Variance (RM-ANOVA) result showed a significant difference in HR and SaO2 in different time points among control, position and massage groups with RM-ANOVA (F 10,360 = 10.376, p < 0.001). HR values was reduced and SaO2 values was increased in intervention groups with RM-ANOVA (F 5,360 = 2.323, p < 0.001). CONCLUSIONS: Results showed that massage and prone position equally led to the reduction of HR and increase of SaO2, compared to control group.

The Need for A Training Software among Iranian Infertile Couples: A Qualitative Study.

BACKGROUND: Training needs are multidimensional requirements affected by social and cultural background, level of knowledge and personal and health conditions. This study was conducted to explain the needs for a training software among Iranian infertile couples. MATERIALS AND METHODS: In this qualitative study, we used content analysis to examine the need among ten infertile participants (four men and six women) and six health care professionals (including two gynecologists, two reproductive health specialists and two midwives). The present research was carried out from January 2017 to July 2018 at Rouyesh and Ibn Sina infertility treatment centers in Karaj, Iran. The participants were selected through purposive sampling with maximum variation. Four focus group discussions with the health care professionals and twelve semistructured, in-depth interviews with the infertile participants were held for data collection. Data were analyzed using conventional content analysis in MAXQDA-10. RESULTS: Data analysis led to the extraction of a central theme of "a multidimensional training application" and its four main categories, including "pre-treatment training", "diagnostic training", "mid- and post-treatment training" and "continuous psychological training". These main categories also had 20 subcategories. CONCLUSION: Based on the results of this study, infertile women and men have multidimensional training needs before and after treatment and during the process of diagnosis; psychological aspects should also be considered.The interviewed health care professionals helped to explain these training needs. A training software thus needs to be designed based on the real needs of the infertile community.

The Effect of Cognitive Behavioral Therapy on Sexual Function in Infertile Women: A Randomized Controlled Clinical Trial.

Infertility and its consequences can have effects on various aspects of a couple's life and also in their marital relationships. This study aimed to investigate the effect of cognitive behavioral therapy (CBT) on sexual function in infertile women. The participants included 52 infertile women randomly assigned to intervention and control groups. A group-based, six-session sexual counseling using a CBT approach was also performed for the intervention group. Sexual functions of the participants in both groups were then assessed via the Female Sexual Function Index (FSFI) at three points in time. The findings revealed no statistically significant difference in the baseline FSFI mean scores of both groups. A significant difference was also reported for FSFI mean scores in the intervention group (29.35 ± 2.71) in comparison with those in the control group (25.84 ± 2.52) (p < 0.001) one month after intervention, with an effect size of 0.32. The mean scores of all the sexual-function domains, including sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), orgasm (p < 0.001), satisfaction (p < 0.001), and pain (p < 0.001), among the participants in the intervention group had also significantly increased following CBT implementation. The results of this study could be used to promote sexual health in infertile women.

The evaluation of a virtual education system based on the DeLone and McLean model: A path analysis.

Background: The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods: This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results: The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (ß=0.52), service quality through the indirect path (ß=0.03) and user satisfaction through the direct path (ß=0.73). Conclusions: According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.

Desired Numbers of Children, Fertility Preferences and Related Factors among Couples Who Referred to Pre-Marriage Counseling in Alborz Province, Iran.

BACKGROUND: The Islamic Republic of Iran has experienced a dramatic decrease in fertility rates in the past three decades. One of the main issues in the field of fertility is the couple's preferences and the desire to bear children. This study aimed to determine desired number of children, fertility preference, and related factors among people referring pre-marriage counseling to clarify their presumed behavior in case of fertility. MATERIALS AND METHODS: This study was a descriptive analytic cross-sectional survey, conducted during 8 months. The participants were 300 couples came to pre-marriage counseling centers of two health centers of Karaj and asked to complete a 22 items questionnaire about of demographic characteristics, participants' interest, preference about fertility, and economic situation. RESULTS: Majority of the males were between the ages of 20-30 years (66.6%) while majority of the females were below 25 years of age (57%). About 17 percent of men and 22.3 percent of women stated that they want to have 1 child and equally 52.7 percent of men and 52.7 percent of women wanted to have 2 children. The only factor that contributed to the female participant's decision for a desirable number of children was the number of siblings that they have. In male participants with an increasing age at marriage and aspiration for higher educational level, the time interval between marriage and the birth of the first child has increased. There was a convergence in desired number of children in male and female participants. CONCLUSION: Majority of the participants express their desire to have only one or two children in future but in considering the fact that what one desires does not always come into reality, the risk of reduced fertility is generally present in the community. Appropriate policies should be implemented in order to create a favorable environment for children.

The examination of quality of pregnancy care based on the World Health Organization's "Responsiveness" model of selected pregnant women in Tehran.

INTRODUCTION: The World Health Organization (WHO) Responsiveness model showing the ability of health systems in fulfilling people's expectations in connection with nonclinical aspects is an appropriate pattern to assess healthcare. The purpose of this study was to determine the status of pregnancy care provisions based on the responsiveness model. METHODS: This was a cross-sectional study conducted by randomly sampling 130 women visiting selected hospitals in Tehran in 2015. A researcher-made questionnaire based on the responsiveness model of WHO was used to collect data. We determined the face validity and content validity of the questionnaire, and its reliability was confirmed by Cronbach's alpha coefficient (0.94) and test-retest analysis (0.96). The obtained data were analyzed by SPSS version 20 descriptive statistics, t-test, one-way ANOVA, Pearson product-moment correlation coefficient, and Spearman correlation. RESULTS: Total responsiveness from the perspective of service recipients was 69.46±14.65 from 100. The obtained scores showed that, in the range of 0 to 100, 73.02 were about basic amenities (the most score), 72.93 about dignity, 70.91 about communication, 70.76 about confidentiality, 66.30 about provision social needs, 65.96 about choice of provider, 65.92 about autonomy, and 52.65 about prompt attention (the lowest score), which are representing the average level of service quality. There were significant relationships between participating in preparation class of labor and dignity (p<0.001), autonomy (p=0.01), provision social needs (p=0.01), and overall responsiveness (p=0.03). It was obtained that there is a significant linear relationship between scores given to hospitals and dimensions of responsiveness (p=0.05). Findings indicated a significant relationship between insurance type and dimensions of choice of provider (p=0.03) and communication (p=0.03). CONCLUSION: The mean score of service quality in the present investigation illustrated that nonclinical dimensions have been disregarded and it has potential to be better. So some grand plans are needed.

Maternal near miss approach to evaluate quality of care in Alborz province, Iran.

OBJECTIVE: the maternal near miss approach has been developed by World Health Organization for assessing and improving the quality of care. This study aimed to examine the incidence, characteristics, and features of the care provided for maternal near-miss cases in public and private hospitals in Alborz province, Iran. METHODS: a cross sectional, facility-based study was conducted in all 13 public and private hospitals of Alborz province between April 2012 and December 2012. The World Health Organization near miss criteria were applied to gather and analyse the data, and indicators related to maternal near miss, access to and quality of maternal care. FINDINGS: 38,715 deliveries were assessed. There were 38,663 live births, 419 (1.08%) had potentially life-threatening conditions and 199 had severe maternal outcomes (SMO) (192 near miss cases and 7 maternal deaths). The maternal near-miss ratio was 4.97 cases per 1000 live births. The incidence of severe maternal outcome was 5.15 cases per 1000 live births. Severe mortality outcomes index within 12 hours of hospital stay from admission (SMO12) was 3.52%. The proportion of SMO12 cases from the total SMO cases was 99.5%. The Intensive Care Unit (ICU) admission rate among women with SMO was 72.7%, while the overall admission rate was 0.7%. Overall, hypertensive disorder was the most frequent condition among women with potentially life-threatening conditions and maternal near-miss cases. Cardiovascular dysfunction and respiratory dysfunction were the most prevalent dysfunctions among maternal near miss (MNM) cases and maternal death cases respectively. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the WHO maternal near miss criteria help to identify issues that may lead to life threatening conditions and can be used to monitor and improve the quality of care in maternity settings. Hypertensive disorders related to near miss conditions need more attention to prevent maternal severe outcomes in Alborz province. Most of the process indicators were not satisfactory. The WHO tool enables health managers to improve maternal health care.

Predictors of Condom Use Among Iranian Women at Risk of HIV.

Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.

Developing a valid and reliable instrument to predict the protective sexual behaviors in women at risk of human immunodeficiency virus.

BACKGROUND: One much needed tool to assist with the monitoring and evaluation of Human Immunodeficiency Virus (HIV) prevention programs is to provide a valid instrument to measure protective sexual behavior and related factors. OBJECTIVES: The current study aimed to design a valid and reliable instrument to predict the protective sexual behaviors of women at risk of HIV in Iran. PATIENTS AND METHODS: The current study was a sequential mixed cross-sectional and methodological research. Initially, via a qualitative research, constructs and factors associated with sexual protective behavior of women at risk were identified through 25 in-depth interviews. The questionnaire on predictors of protective sexual behaviors in women at risk of HIV (PSPB) was designed based on a qualitative study, and then its qualitative validity, content, and construct validity were evaluated. Exploratory factor analysis was performed and 200 women at risk participated. RESULTS: Seven concepts emerged after exploratory factor analysis of the 48 items. The content validity ratio (CVR) of the questionnaire constructs were 0.55 to 0.76, and content validity index (CVI) structure was 0.86 to 0.95. Cronbach's alpha coefficient for the entire questionnaire was 0.78, and correlation coefficient of the test-retest reliability for the constructs was from 0.73 to 0.89. CONCLUSIONS: The current study proved the capability of the predictors of sexual protective behavior in women at risk for HIV questionnaire as a valid and reliable instrument for the Iranian community.

Development of strategies to reduce cesarean delivery rates in iran 2012-2014: a mixed methods study.

BACKGROUND: With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. METHODS: A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. RESULTS: Qualitative data analysis showed four concept related to increased cesarean delivery rates including; "standardization", "education", "amending regulations", and "performance supervision". Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. CONCLUSIONS: Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved strategies that in the context of Iran could work.

How do women at risk of HIV/AIDS in Iran perceive gender norms and gendered power relations in the context of safe sex negotiations?

Sexual transmission of HIV/AIDS among women is growing in the Middle East region. Despite the fact that there are numerous gender-related sociocultural factors influencing HIV/AIDS protective behaviors, little gender-specificity is carried out in HIV prevention in Iran. In order to close this gap, we aimed to provide preliminary work that explored the perceptions that women at risk of HIV had about gender norms and gendered power and their ability to protect themselves against HIV/AIDS. Twenty-five semi-structured in-depth interviews were conducted with women at risk of HIV/AIDS, aged 21-49 years, at Voluntary Counseling and Testing Centers or Drop in Centers in Tehran, Iran. Results showed that perceived gender norms were essential barriers of protective behavior through sexual socialization, male control over condom use and sexual decision-making, male pleasure predominating in sexual encounters and sexual double standards, and economic dependencies. In the conclusions, we consider how HIV/AIDS preventive programs can be structured to be gender-sensitive and empowering in Iran.