BackgroundFemale breast cancer (FBC) is the most common type of cancer and is associated with a considerable disease burden as well as significant mortality rates. The present study aimed to provide an update on the incidence, mortality, and burden of FBC in 2019, based on the Global Burden of Disease (GBD) Study.MaterialsThe incidence, death rate, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), the age-standardized rates (ASR) of FBC in 204 countries, and a variety of classifications, were retrieved from the Global Burden of Disease Study. Data on tobacco use, alcohol consumption, and drug use were collected. The incidence, mortality, and burden of FBC were registered and compared between regions. Associations between age-standardized incidence rates and age-standardized mortality rates of FBC with smoking, drinking, and drug use were determined.ResultsThe highest incidence of FBC was observed in countries with a high socioeconomic status such as those of the European continent. Despite the lower incidence of FBC in countries with a low socio-demographic index (SDI), mortality rates secondary to FBC are higher in these countries than in high-income countries. The highest age-standardized mortality rate has been reported in the Eastern Mediterranean Region (EMRO), followed by the African Region (AFRO). The highest age-standardized rates of DALY and YLL per 100,000 population in 2019 were observed in lower-income countries, while the highest ASR of YLD per 100,000 population was reported in high-income countries.ConclusionThe present GBD-based study provides a comprehensive review of the incidence, mortality, and burden of FBC in 2019. The incidence of FBC is higher in regions with a higher socioeconomic status, whereas mortality rates and DALYs are higher in poorly developed regions. We suggest better screening measures and early detection programs for the latter regions.

Background The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. Objective To analyze the CS rates in the last 2 years using the Robson Classification System in Iran. Methods A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. Results Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. “Fetal Distress” and “Undefined Indications” were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. Conclusion The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.

Background Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions.

Background: Mistreatment of women during childbirth is a global health challenge. Maternity healthcare providers have key roles in influencing women’s birth experiences. This study aimed to assess knowledge, attitudes and practices of maternity healthcare providers about mistreatment during labour and childbirth in public hospitals in Tehran, Iran.Methods: This cross-sectional study was conducted from October to December 2021 in five public hospitals in Tehran. All maternity healthcare providers (obstetricians, midwives) and students were invited to the study. Data were collected using a questionnaire consisting of four sections: socio-demographic characteristics (11 items), knowledge (11 items), attitudes (13 items), and practices (14 items) about mistreatment. Knowledge, attitude, and practice levels were determined using Bloom’s cut off point. Data were analyzed using descriptive and analytical statistics at a significant level of p < 0.05.Results: A total of 255 individuals participated (response rate: 94.5%). Most participants (82.7%) had poor knowledge about physical abuse, verbal abuse, poor rapport between women and providers, and failure to meet professional standards of care. Most participants (69.4%) were alright with physical abuse, verbal abuse, and discrimination. Self-reported practices of different types of mistreatment were not common and only 3.1% of the participants were in moderate level. However, shouted at women, applied fundal pressure, and slapped the thighs during birth were categories used by providers. Age, profession, field of study, employment status, monthly income, work experience, numbers of night shifts, and training history were significantly related with the participants’ knowledge, attitudes, and practices about mistreatment.Conclusions: Knowledge, attitudes, and practices of our participants were poor about maternity mistreatment. Findings of our study have important implications for program planners and decision makers on development of effective interventions to reduce mistreatment during labour and childbirth in Iran. These interventions should include designing and implementing continuing education courses and revising the educational curriculums to increase knowledge, strengthen positive attitudes, and modify practice of maternity healthcare providers, overcoming staff shortages, paying staff fairly, establishing support culture for mother-centered and respectful care, and increasing quality of maternity care.

Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experience in the birth facilities. In this study, we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the consolidated framework for implementation research (CFIR). Methods: An exploratory qualitative study involving thirty in-depth and semi-structured interviews was conducted between July 2022 and February 2023. Participants include a purposive sample of key informants at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) Individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companion: e.g., patient needs and resources, structural characteristics, culture); (2) Healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) Hospital level (evaluating the performance of maternity healthcare providers: e.g., external policies and incentives, executing); and (4) National health system level (implementation of painless childbirth guidelines: e.g., networks and communications, knowledge and beliefs about the intervention, executing, reflecting and evaluating). Conclusions: This study shows a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise in the implementation of their current programs and policies regarding the quality of maternity care by focusing on identified challenges.

Background: This study was conducted to provide strategies for improving the quality of midwifery care and developing midwife-centered care in Iran. Methods: A qualitative study using the content analysis method was conducted. Data were collected from 121 participants, including midwifery board members, gynecologists, head of midwifery departments, midwifery students, in charge midwives in the hospitals, and midwives in the private sector in order to find the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran. Focused-group discussions were used for data gathering, and data were analyzed using content analysis method. Results: The main strategies that participants mentioned for improving the quality of midwifery care were as follow: education, manpower, incentive and support system, midwifery care and duties, equipment and facilities, policy making, monitoring and interdisciplinary activities. Conclusion: Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

Background The rise of Cesarean Section (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. Objective To analyze the CS rates in the last two years using the Robson Classification System in Iran. Methods A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. Results 2322500 women gave birth, 53.63% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.36%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.57% and 10.78%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.23% and 33.07%, respectively. “Fetal Distress” and “Undefined Indications” were the most common reasons for cesarean deliveries at CS rates of 13.6% and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. Conclusion The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity unit, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.