OBJECTIVE: Access to family planning services is a human right that plays an essential role in society's health, particularly women's health. The COVID-19 pandemic has affected all aspects of human life including access to family planning services. Accordingly, the main goal of this study was to explore the experiences of women and service providers from the main challenges and obstacles of access to family planning services and abortion services in Bangladesh, Iran, and the Netherlands during the COVID-19 pandemic. METHODS: In this qualitative study, the data were collected through online, telephone, or in-person semi-structured interviews with key informants. Participants selected by purposive sampling method. The participants included women aged 15 to 49 (n = 63) and service providers (n = 54) in the 3 abovementioned countries. These individuals were included from October 2020 until December 2020. Conventional thematic analysis was employed to analyze the collected data. RESULTS: The main extracted themes were challenges (reduction of referral; disruption of access to services; insufficient knowledge; worries among staff; rising prices; and unavailability of some contraceptives), measures (time extension and visit scheduling; telephone, online, and door to door services; and support of the media) and recommendations (health facility improvements; free, online, and closer services; and ongoing trainings and awareness campaigns). CONCLUSION: The COVID-19 pandemic has affected family planning and reproductive health services in different ways and has uncovered existing inequalities in access to these services. However, in Iran, the reported challenges were also rooted in new population policies that have further limited access to family planning and abortion services.

• Keywords
• Abortion, COVID-19, Contraception, Family planning, Reproductive health, Sexual health,
• MeSH
• COVID-19 * epidemiology   MeSH
• Abortion, Induced * MeSH
• Humans MeSH
• Pandemics MeSH
• Family Planning Services methods   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Bangladesh epidemiology   MeSH
• Iran epidemiology   MeSH
• Netherlands MeSH

Iran has witnessed three major reversals of population policies since their inception in the 1960s. In response to a rapid decline in fertility to very low levels, the latest policy shift has led to the development of legislation that aims to encourage marriage and fertility, particularly the "Youthful Population and Protection of the Family" law approved in 2021. This study reviews the changes in population policy and their interrelations with fertility trends, focusing mainly on the shift towards pronatalist policies since 2005, and accompanying restriction of reproductive health and family planning services. Combining international and national sources, we position the new pronatalist drive in the country within the broader trend of government attempts to reverse fertility decline and promote conservative family values. Our study has three main aims. (1) We provide an overview of fertility trends, policy discourses and policy shifts in the context of the changes in the societal and political structures of Iran during the last half a century. (2) We highlight and discuss the most problematic features of the new Family Law, especially the legislation pertaining to maternal and reproductive health, access to abortion and contraception, and incentives supporting earlier marriage and higher fertility. (3) We discuss the likely consequences of the new legislation for maternal and child health and sexual and reproductive rights, for women in general, and the country's socio-economic disparities. As well as violating reproductive rights, the new policy is unlikely to achieve its aim of initiating a sustained rise in fertility in Iran.

L’Iran a connu trois revirements majeurs de ses politiques démographiques depuis leur apparition dans les années 1960. En réponse à une diminution rapide de la fécondité à des niveaux très bas, le dernier changement de politique a abouti à l’élaboration d’une législation qui vise à encourager le mariage et la fécondité, en particulier la loi « Jeunesse et protection de la famille », approuvée en 2021. Cette étude passe en revue les changements dans la politique démographique et leurs liens avec les tendances de la fécondité, en se concentrant principalement sur l’évolution vers des politiques pronatalistes depuis 2005, et la restriction des services de santé reproductive et de planification familiale qui va de pair avec cette évolution. En combinant les sources nationales et internationales, nous situons la nouvelle campagne pronataliste du pays dans la tendance plus large des mesures du gouvernement pour tenter d’enrayer la baisse de la fécondité et promouvoir des valeurs familiales conservatrices. Notre étude a trois principaux objectifs: (1) nous donnons un aperçu des tendances de la fécondité, des discours politiques et des changements de politique dans le contexte des évolutions dans les structures politiques et sociétales de l’Iran au cours du dernier demi-siècle; (2) nous mettons en évidence et examinons les caractéristiques les plus problématiques de la nouvelle loi sur la famille, en particulier la législation relative à la santé maternelle et reproductive, l’accès à l’avortement et à la contraception, et les mesures d’incitation en faveur de mariages précoces et d’une fécondité accrue; (3) nous discutons des conséquences probables de la nouvelle législation sur la santé maternelle et infantile et sur les droits sexuels et reproductifs, pour les femmes en général, et les disparités socioéconomiques du pays. En plus de violer les droits reproductifs, la nouvelle politique a peu de chances d’atteindre son objectif d’initier une hausse soutenue de la fécondité en Iran.

• Keywords
• Iran, contraception, family planning, family policy, fertility, health, population policy, pronatalism, reproductive health, reproductive rights,
• MeSH
• Child MeSH
• Fertility * MeSH
• Humans MeSH
• Reproductive Rights * MeSH
• Family Planning Services MeSH
• Pregnancy MeSH
• Public Policy MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Iran MeSH