Explaining the Reasons for Intentional Abortion in Iran: A Qualitative Content Analysis Study

In many parts of the world, the decision to end a pregnancy is not just a medical event but a complex web of personal, economic, and social forces. It is a choice shaped by whether a family can afford another child, whether a partner offers support, and whether a society allows a woman to speak openly about her struggles without fear. In Iran, where laws strictly limit abortion to cases of severe health risks or fetal abnormalities, the reality on the ground often diverges from the official rules. When a pregnancy is unwanted and the legal path is closed, women must navigate a landscape of silence and secrecy. Understanding why these decisions happen, and what happens to the women who make them, requires looking beyond statistics to the human stories behind the numbers. It is a question of how poverty, isolation, and the lack of safe options drive people toward dangerous paths, and what kind of care they receive when they finally seek help.

A team of researchers set out to uncover these hidden stories in Fasa County, a region in southern Iran that includes both towns and rural villages. Between March 2024 and March 2026, they conducted a deep dive into the lives of women who had ended a pregnancy intentionally, as well as the doctors and midwives who care for them. Instead of asking simple yes-or-no questions, the researchers held long, private conversations, allowing participants to share their experiences in their own words. They spoke with seven women who had undergone the procedure and six healthcare providers, selecting a diverse mix of people from different ages, backgrounds, and economic situations. The goal was not to count how many abortions occurred, but to understand the chain of events that led a woman to that point and the aftermath she faced.

The researchers found that for these women, the decision to terminate a pregnancy was rarely a single, clear choice. Instead, it was often a desperate response to a situation that felt impossible to escape. One major theme that emerged was what the researchers called the "inexorability of non-existence." This phrase describes a feeling of being trapped by circumstances where having another child seemed like a luxury that could destroy the family's ability to survive. Women spoke of daily struggles with debt and inflation, where the cost of groceries was already a threat. For many, the decision was not about avoiding responsibility, but about preserving the bare minimum for themselves and the children they already had. This economic pressure was often compounded by a profound sense of loneliness. Many women described feeling "alone in the crowd," lacking emotional support from their spouses. In some cases, the home environment was not a place of safety but a source of daily turmoil, marked by domestic violence or addiction, making the prospect of continuing a pregnancy feel like a sentence to further suffering.

Because the legal system offered no help and the fear of social judgment was so intense, women were forced onto "secret paths" to end their pregnancies. The internet became a primary source of information, with women turning to search engines like Google for advice they were too afraid to ask a doctor about. They also relied on neighbors, friends, and local herbalists, following instructions from people with no medical training. Some turned to underground clinics or medical supply shops that sold medications without prescriptions. These were dangerous routes, often involving cash payments and a strict pact of silence. The fear of being judged by family or community was a powerful force, pushing women away from formal healthcare and toward these risky alternatives. The researchers noted that this fear was not just about temporary shame; it was a deep, internalized worry that could haunt a woman for years.

The consequences of these hidden procedures were severe and long-lasting. The study highlighted "enduring harms" that affected both the body and the mind. Physically, women suffered from complications like severe bleeding, infections, and anemia, with some facing long-term issues like infertility. These physical problems were often made worse because the procedures were done in unsafe conditions without proper medical follow-up. Psychologically, the impact was equally heavy. Many women described a "restless soul," struggling with depression, guilt, and a deep sense of emptiness that lingered long after the procedure. A common feeling was one of profound regret, often tied to financial desperation. Some women realized too late that the abortion did not solve their economic problems, leaving them trapped in a cycle of suffering where the decision they made to escape one crisis only created another.

The researchers also uncovered a significant gap in knowledge and prevention. Many women felt they had missed opportunities to avoid the situation entirely due to a lack of education on contraception. In a society where religious beliefs are strong, some women admitted that in moments of extreme crisis, their faith did not stop them from making the decision, though they later felt a spiritual regret that added to their pain. This revealed a complex reality where religious prohibitions were present but often overpowered by immediate survival needs. However, the study also found a glimmer of hope in the way some healthcare providers treated these women. The theme of "the art of preserving dignity" emerged from interviews where women described feeling respected and heard, even when the medical staff could not legally perform the procedure. When providers offered a non-judgmental space and treated women with kindness, it helped build trust. Women noted that even if they were discouraged from the procedure, knowing they would be treated with respect made a difference. This suggested that the most effective way to protect women's health might not be through punishment or judgment, but through compassionate care that acknowledges their humanity.

The study concludes that the issue of intentional abortion in this region is driven by a mix of economic despair, social isolation, and a healthcare system that often fails to provide safe, accessible options. The hidden nature of these procedures exposes women to serious physical and psychological risks that can last for years. The researchers suggest that to address this, society needs to move beyond simple prohibition and focus on comprehensive education, better family support systems, and a healthcare approach that prioritizes dignity and non-judgmental counseling. By understanding the real reasons women turn to unsafe methods, policymakers and health officials can work to reduce the vulnerabilities that force them into these dangerous situations. The findings paint a picture of a community where women are making impossible choices in the shadows, and where the path forward requires not just stricter laws, but a deeper commitment to understanding and supporting the people living through these crises.