Intermediary Determinants of Health and Access to Reproductive Health Services among Afghan Migrant Women: A Scoping Review
Abstract
Background: This scoping review aimed to identify intermediary Social Determinants of Health (SDH) affecting access to reproductive health services among Afghan migrant women, emphasizing the challenges in achieving equitable health service access for this vulnerable population.
Methods: To ensure methodological rigor, the PRISMA checklist was followed. The inclusion criteria comprised quantitative studies addressing access to reproductive health services among Afghan migrants. Articles were retrieved from SCOPUS, Web of Science, and PubMed databases, as well as through manual reference checks, covering the period from Jan 2000 to Mar 2025. Data extraction was guided by the World Health Organization's SDH framework, with a specific focus on intermediary determinants such as healthcare quality, behavioral and psychosocial factors, and social networks.
Results: From an initial pool of 628 articles, 18 met the eligibility criteria. The most frequently reported intermediary SDH was the quality and condition of healthcare services. Other common factors included behavioral aspects, social capital and cohesion, and psychological well-being. These determinants were consistently linked to disparities in access to reproductive health services.
Conclusion: Effective access to reproductive health services among Afghan migrant women hinges on addressing both structural and intermediary SDH. The influence of these factors is context-specific, and tailored interventions are needed. Notably, the supportive role of non-governmental organizations and community-based social support systems should be prioritized to enhance reproductive health outcomes in migrant population.
1. World Health Organization (2021). Sexual and reproductive health and rights: A human rights-based approach. WHO, Geneva.
2. Commission on Social Determinants of Health (2020). Social determinants of health. WHO, Geneva.
3. World Health Organization (2021). Resolu-tion WHA74.16 on addressing the social determinants of health. WHO, Geneva.
4. Perry B, Teddlie C (2022). Social inequali-ties in health: A global perspective. Int J Public Health, 67 (2): 210-222.
5. Gonzalez F, Lopez M, Garcia R (2020). Global migration trends and the impact on health systems. Int Migr Rev, 54 (3): 422-438.
6. UNHCR (2023). UNHCR global trends: Forced displacement in 2023. UNHCR, Geneva.
7. United Nations (2023). The world’s mi-grants: 2023 update. United Nations Population Division, New York.
8. UNHCR (2023). Afghan refugees in Iran and Turkey: Regional update. UNHCR, Geneva.
9. Marmot M, Allen J, Bell R (2020). Social de-terminants of health: A review of the ev-idence. Lancet, 396 (10259): 1146-1156.
10. Dahlgren G, Whitehead M (2021). Policies and strategies to promote social equity in health. WHO, Geneva.
11. Egli-Gany E, Schmidt N, Lederer P (2021). Structural and intermediary determi-nants of sexual and reproductive health among migrants: A systematic review. Int J Public Health, 66 (5): 563-572.
12. American College of Obstetricians and Gynecologists (2022). Social determi-nants of health and their impact on re-productive health. Obstet Gynecol, 139 (4): 677-684.
13. Sadeghi S, Mohammadi A, Rezaei M (2024). Health behavior and socio-demographic factors affecting reproductive health among Afghan women in Tehran: A multi-phase study. J Migr Health, 5 (1): 42-58.
14. Rahimi-Tabar M, Hosseini S, Karimi A (2023). A systematic review of the health status and access to healthcare services for Afghan refugees in Germany and Iran. J Glob Health, 13 (2): 230-240.
15. Beiglari-Abhari Z (2022). Social determi-nants of reproductive health among women: A global perspective. Soc Sci Med, 292: 114436.
16. PRISMA (2020). Transparent reporting of systematic reviews and meta-analysis. Available from: http://www.prisma-statement.org
17. Badshah S, Mason L, McKelvie K, et al (2011). Maternal risk factors in Afghan-refugees compared to Pakistani mothers in Peshawar, NWFP Pakistan. J Pak Med Assoc, 61 (2): 161-164.
18. Shafiei T, Small R, McLachlan H (2012). Women's views and experiences of ma-ternity care: A study of immigrant Af-ghan women in Melbourne, Australia. Midwifery, 28 (2): 198-203.
19. Åkerman E, Larsson EC, Essén B, et al (2019). A missed opportunity? Lack of knowledge about sexual and reproduc-tive health services among immigrant women in Sweden. Sex Reprod Healthc, 19: 64-70.
20. Raheel H, Karim MS, Saleem S, et al (2012). Knowledge, attitudes, and practices of contraception among Afghan refugee women in Pakistan: A cross-sectional study. PLoS One, 7 (11): e48760.
21. Cohen BE, Maguen S, Bertenthal D, et al (2012). Reproductive and other health outcomes in Iraq and Afghanistan wom-en veterans using VA health care: Asso-ciation with mental health diagnoses. Womens Health Issues, 22 (5): e461-e471.
22. Dadras O, Nakayama T, Kihara M, et al (2021). The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran: Findings from community-based survey. PLoS One, 16 (1): e0245007.
23. Purdin S, Khan T, Saucier R (2009). Reduc-ing maternal mortality among Afghan refugees in Pakistan. Int J Gynaecol Obstet, 105 (1): 82-85.
24. Sharifi M, Mousavi S, Rahimi F (2021). Sources of information and related fac-tors during pregnancy among Afghan migrant women in Iran. Nurs Open, 8 (2): 975-981.
25. Khan S, Riaz S, Ahmed N (2022). The re-productive health issues & practices among Afghan refugee women (with the special reference to Afghan Basti in Ka-rachi and Quetta). Pak J Int Aff, 5 (4): 1-15.
26. Roe JV, Webster P (2024). Health engage-ment sessions as a means of addressing reproductive health inequalities in a population of Afghan women during Operation Allied Solace. BMJ Mil Health, 170 (2): 186-187.
27. Inci MG, Schmidt A, Wagner K (2020). Unmet family planning needs among female refugees and asylum seekers in Germany – Is free access to family planning services enough? Reprod Health, 17: 115.
28. Dehghan M, Rahimi S, Mohammadi A (2020). Maternal–fetal attachment and domestic violence against Iranian and Afghan pregnant women: A cross-cultural study. Violence and Gender, 8 (4): 213-220.
29. Delkhosh M, Merghati Khoei E, Ardalan A (2019). Prevalence of intimate partner violence and reproductive health out-comes among Afghan refugee women in Iran. Health Care Women Int, 40 (2): 213-237.
30. Changizi N, Rezaei M, Shariati M (2023). Improving the health status of Afghan mothers living in the Islamic Republic of Iran. East Mediterr Health J, 26 (11): 861-869.
31. Kizilkaya MC, Akgun S, Yilmaz E (2022). Breast cancer awareness among Afghan refugee women in Turkey. EClinicalMedi-cine, 49: 101459.
32. Balsara ZP, Wu I, Archer L (2010). Repro-ductive tract disorders among Afghan refugee women attending health clinics in Haripur, Pakistan. J Health Popul Nutr, 28 (5): 501-508.
33. Korkut B, Sevinç N, Adahan D (2022). An evaluation of obstetric characteristics and contraceptive use among refugee women. Cureus, 14 (4): e24045.
34. Dadras O, Nakayama T, Kihara M, et al (2020). Barriers and associated factors for adequate antenatal care among Af-ghan women in Iran: Findings from a community-based survey. BMC Pregnancy Childbirth, 20: 427.
35. Mahmoodi Z, Dolatian M, Jalal M (2023). The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: A path analysis. BMC Psychia-try, 23 (1): 11.
36. Vu M, Azmat A, Radejko T (2022). System-level factors influencing refugee wom-en's access and utilization of sexual and reproductive health services: A qualita-tive study of providers' perspectives. Front Glob Womens Health, 3: 1048700.
37. Kuru Alici N, Arikan Donmez A, Oguncer A (2024). Knowledge, attitudes, and cul-tural beliefs of Afghan refugee women toward gynecological cancer: A qualita-tive study. Clin Nurs Res, 33 (8): 620-629.
38. Hossain M (2021). Healthcare access for migrant women: Challenges and oppor-tunities. J Migr Health, 12 (4): 241-258.
39. Li M, Fong B (2025). Impacts of housing and environment on the community. In: Handbook of Community Health. Eds, Fong B, Law V. 1st ed, Springer, Cham, pp. 451-469.
40. Gerritsen AA, Bramsen I, Devillé W, et al (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Neth-erlands. Soc Psychiatry Psychiatr Epidemiol, 41 (1): 18-26.
41. Slewa-Younan S, Uribe Guajardo MG, Heriseanu A, Hasan T (2017). The men-tal health and help-seeking behaviour of resettled Afghan refugees in Australia. Int J Ment Health Syst, 11: 49.
2. Commission on Social Determinants of Health (2020). Social determinants of health. WHO, Geneva.
3. World Health Organization (2021). Resolu-tion WHA74.16 on addressing the social determinants of health. WHO, Geneva.
4. Perry B, Teddlie C (2022). Social inequali-ties in health: A global perspective. Int J Public Health, 67 (2): 210-222.
5. Gonzalez F, Lopez M, Garcia R (2020). Global migration trends and the impact on health systems. Int Migr Rev, 54 (3): 422-438.
6. UNHCR (2023). UNHCR global trends: Forced displacement in 2023. UNHCR, Geneva.
7. United Nations (2023). The world’s mi-grants: 2023 update. United Nations Population Division, New York.
8. UNHCR (2023). Afghan refugees in Iran and Turkey: Regional update. UNHCR, Geneva.
9. Marmot M, Allen J, Bell R (2020). Social de-terminants of health: A review of the ev-idence. Lancet, 396 (10259): 1146-1156.
10. Dahlgren G, Whitehead M (2021). Policies and strategies to promote social equity in health. WHO, Geneva.
11. Egli-Gany E, Schmidt N, Lederer P (2021). Structural and intermediary determi-nants of sexual and reproductive health among migrants: A systematic review. Int J Public Health, 66 (5): 563-572.
12. American College of Obstetricians and Gynecologists (2022). Social determi-nants of health and their impact on re-productive health. Obstet Gynecol, 139 (4): 677-684.
13. Sadeghi S, Mohammadi A, Rezaei M (2024). Health behavior and socio-demographic factors affecting reproductive health among Afghan women in Tehran: A multi-phase study. J Migr Health, 5 (1): 42-58.
14. Rahimi-Tabar M, Hosseini S, Karimi A (2023). A systematic review of the health status and access to healthcare services for Afghan refugees in Germany and Iran. J Glob Health, 13 (2): 230-240.
15. Beiglari-Abhari Z (2022). Social determi-nants of reproductive health among women: A global perspective. Soc Sci Med, 292: 114436.
16. PRISMA (2020). Transparent reporting of systematic reviews and meta-analysis. Available from: http://www.prisma-statement.org
17. Badshah S, Mason L, McKelvie K, et al (2011). Maternal risk factors in Afghan-refugees compared to Pakistani mothers in Peshawar, NWFP Pakistan. J Pak Med Assoc, 61 (2): 161-164.
18. Shafiei T, Small R, McLachlan H (2012). Women's views and experiences of ma-ternity care: A study of immigrant Af-ghan women in Melbourne, Australia. Midwifery, 28 (2): 198-203.
19. Åkerman E, Larsson EC, Essén B, et al (2019). A missed opportunity? Lack of knowledge about sexual and reproduc-tive health services among immigrant women in Sweden. Sex Reprod Healthc, 19: 64-70.
20. Raheel H, Karim MS, Saleem S, et al (2012). Knowledge, attitudes, and practices of contraception among Afghan refugee women in Pakistan: A cross-sectional study. PLoS One, 7 (11): e48760.
21. Cohen BE, Maguen S, Bertenthal D, et al (2012). Reproductive and other health outcomes in Iraq and Afghanistan wom-en veterans using VA health care: Asso-ciation with mental health diagnoses. Womens Health Issues, 22 (5): e461-e471.
22. Dadras O, Nakayama T, Kihara M, et al (2021). The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran: Findings from community-based survey. PLoS One, 16 (1): e0245007.
23. Purdin S, Khan T, Saucier R (2009). Reduc-ing maternal mortality among Afghan refugees in Pakistan. Int J Gynaecol Obstet, 105 (1): 82-85.
24. Sharifi M, Mousavi S, Rahimi F (2021). Sources of information and related fac-tors during pregnancy among Afghan migrant women in Iran. Nurs Open, 8 (2): 975-981.
25. Khan S, Riaz S, Ahmed N (2022). The re-productive health issues & practices among Afghan refugee women (with the special reference to Afghan Basti in Ka-rachi and Quetta). Pak J Int Aff, 5 (4): 1-15.
26. Roe JV, Webster P (2024). Health engage-ment sessions as a means of addressing reproductive health inequalities in a population of Afghan women during Operation Allied Solace. BMJ Mil Health, 170 (2): 186-187.
27. Inci MG, Schmidt A, Wagner K (2020). Unmet family planning needs among female refugees and asylum seekers in Germany – Is free access to family planning services enough? Reprod Health, 17: 115.
28. Dehghan M, Rahimi S, Mohammadi A (2020). Maternal–fetal attachment and domestic violence against Iranian and Afghan pregnant women: A cross-cultural study. Violence and Gender, 8 (4): 213-220.
29. Delkhosh M, Merghati Khoei E, Ardalan A (2019). Prevalence of intimate partner violence and reproductive health out-comes among Afghan refugee women in Iran. Health Care Women Int, 40 (2): 213-237.
30. Changizi N, Rezaei M, Shariati M (2023). Improving the health status of Afghan mothers living in the Islamic Republic of Iran. East Mediterr Health J, 26 (11): 861-869.
31. Kizilkaya MC, Akgun S, Yilmaz E (2022). Breast cancer awareness among Afghan refugee women in Turkey. EClinicalMedi-cine, 49: 101459.
32. Balsara ZP, Wu I, Archer L (2010). Repro-ductive tract disorders among Afghan refugee women attending health clinics in Haripur, Pakistan. J Health Popul Nutr, 28 (5): 501-508.
33. Korkut B, Sevinç N, Adahan D (2022). An evaluation of obstetric characteristics and contraceptive use among refugee women. Cureus, 14 (4): e24045.
34. Dadras O, Nakayama T, Kihara M, et al (2020). Barriers and associated factors for adequate antenatal care among Af-ghan women in Iran: Findings from a community-based survey. BMC Pregnancy Childbirth, 20: 427.
35. Mahmoodi Z, Dolatian M, Jalal M (2023). The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: A path analysis. BMC Psychia-try, 23 (1): 11.
36. Vu M, Azmat A, Radejko T (2022). System-level factors influencing refugee wom-en's access and utilization of sexual and reproductive health services: A qualita-tive study of providers' perspectives. Front Glob Womens Health, 3: 1048700.
37. Kuru Alici N, Arikan Donmez A, Oguncer A (2024). Knowledge, attitudes, and cul-tural beliefs of Afghan refugee women toward gynecological cancer: A qualita-tive study. Clin Nurs Res, 33 (8): 620-629.
38. Hossain M (2021). Healthcare access for migrant women: Challenges and oppor-tunities. J Migr Health, 12 (4): 241-258.
39. Li M, Fong B (2025). Impacts of housing and environment on the community. In: Handbook of Community Health. Eds, Fong B, Law V. 1st ed, Springer, Cham, pp. 451-469.
40. Gerritsen AA, Bramsen I, Devillé W, et al (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Neth-erlands. Soc Psychiatry Psychiatr Epidemiol, 41 (1): 18-26.
41. Slewa-Younan S, Uribe Guajardo MG, Heriseanu A, Hasan T (2017). The men-tal health and help-seeking behaviour of resettled Afghan refugees in Australia. Int J Ment Health Syst, 11: 49.
| Files | ||
| Issue | Vol 54 No 9 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19851 | |
| Keywords | ||
| Social determinants Health services Afghan Scoping review | ||
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How to Cite
1.
Bayat Jozani Z, Mahmoodi Z, Takian A, Mirmolaei ST. Intermediary Determinants of Health and Access to Reproductive Health Services among Afghan Migrant Women: A Scoping Review. Iran J Public Health. 2025;54(9):1820-1830.
