Exploring strategies for accepting and continuing unintended pregnancies in the context of Iran’s pro-natalist policies: a qualitative study

Background Unintended pregnancy is a major reproductive health challenge. Although it often ends in abortion, its consequences can persist for an extended period. On the other hand, continuation of these pregnancies can also have multiple complications for maternal and child health. The cultural, social, and legal context of each country influences both the outcomes and the process of accepting such pregnancies. Therefore, this qualitative study aimed to identify strategies for accepting and continuing unintended pregnancies in Iran, a country characterized by pro-natalist policies and legal-religious restrictions on abortion. Materials and methods This qualitative study employed a content analysis approach in 2025 in Isfahan, Iran, with participants including women who had experienced unintended pregnancy, their spouses, and health care providers and policymakers. Participants were selected through purposive sampling with maximum variation, and recruitment continued until data saturation was achieved. After obtaining informed consent, data were collected using in-depth, semi-structured individual interviews and field notes. Data analysis was conducted following the conventional content analysis method proposed by Graneheim and Lundman. All interviews were transcribed verbatim, meaningful units were identified and coded, and through constant comparison and categorization, subcategories and main categories were generated. Results A total of 17 mothers who had experienced unintended pregnancy, 5 spouses, and 7 healthcare providers, and 4 policymakers participated in this study. Analysis of the interviews generated 2,115 codes, which were inductively organized into 16 sub-subcategories, 7 subcategories, and 3 main categories. Strategies for accepting and continuing unintended pregnancies emerged under three main categories: “Preparing the family to support the continuation unintended pregnancies”, “Revising the social structure to support unintended pregnancies continuation”, and “Policymaking to protect women health against unintended pregnancy complications”. Each main category comprised several subcategories and sub-subcategories. Conclusion The findings indicate that promoting maternal and child health among women experiencing unintended pregnancies requires interventions at three levels: family, community, and the health system. At the family level, improving couple relationships, strengthening family foundations, supporting mothers’ social roles and activities, and engaging men can create a supportive environment for the continuation of unintended pregnancies. At the community level, revising laws, providing financial support, coordinating non-governmental organizations, and leveraging the potential of online networks are essential to support pregnant women. The health system can also contribute through policymaking to promote planned pregnancies and provide long-term, continuous counseling services for women who have experienced unintended pregnancies.