A relationship model of health literacy, self-rated health, and pregnancy- newborn outcomes among Afghan immigrant women

Iran hosts the second-largest population of Afghan immigrants in the world. The present study aimed to determine the relationship model of health literacy, self-rated health (SRH), and pregnancy and newborn outcomes among Afghan immigrant women in Alborz Province, Iran. This analytical cross-sectional study was conducted in 2024 on 270 Afghan immigrant women. Data were collected using the Afghan maternal health literacy questionnaire, the socioeconomic status questionnaire, and a maternal-newborn demographic checklist. The data were analyzed using SPSS 21 and LISREL 8.8. According to the path analysis, among the variables significantly related to pregnancy outcomes, the frequency of prenatal care visits (B = 0.22) and gestational age (B = 0.17) had the strongest effects in the direct path. In the indirect path, SRH (B = 0.04) was positively associated with the pregnancy outcome score. Health literacy (B = 0.51) was positively associated with pregnancy outcomes through both direct and indirect paths. The results showed that, regarding birth weight, gestational age (B = 0.58) and maternal weight gain (B = 0.16) were significantly associated with it in the direct path, whereas health literacy (B = 0.028) was significantly associated with it in the indirect path. In other words, birth weight increased with increasing gestational age and maternal weight gain (B = 0.58 and 0.16, respectively). In the indirect path, health literacy was associated with increased birth weight through maternal weight gain (B = 0.028). For newborn head circumference, gestational age (B = 0.46) had a significant positive effect, and SRH (B = -0.12) a significant negative effect. For the 1-minute Apgar score, gestational age (B = 0.34) showed the strongest significant positive association; that is, the 1-minute Apgar score increased with increasing gestational age. These findings highlight the importance of paying attention to this vulnerable group, strengthening their health literacy, and improving their access to culturally appropriate prenatal care.