Table 1 Interventions that are currently implemented in Iran’s healthcare system at individual, healthcare provider, hospital, and national health system level

Individual level

 Training of pregnant women

In Iran, childbirth preparation classes are currently implemented with the aim of empowering pregnant women in public hospitals (2008) and health centers (2014) as one of the strategies for promoting vaginal childbirth. However, evidence shows that women still generally have limited knowledge about labour and childbirth processes [11, 38], which can provide grounds for mistreatment [11, 39, 40].

 Presence of birth companions

The possibility of presence of birth companions was provided by redesigning maternity wards to promote vaginal childbirth. However, most birth facilities do not provide birth companions [11, 25].

Healthcare provider level

 Integrating RMC into in-service training of maternity staff

In Iran, the first “congress on ethics in midwifery and reproductive health” with a focus on maternal dignity and the aim of increasing the knowledge, attitude, and behavioral intention of maternity hospital supervisors, was implemented at an online national workshop by the Ministry of Health and Medical Education (MOHME) in August 2022.

Hospital level

 Evaluating the performance of MHCPs about mistreatment and/or RMC

Iran’s Department of Midwifery (MOHME) developed a 27-item questionnaire to assess women's satisfaction with maternity services. This questionnaire was provided to the hospitals to be completed by the parturient women.

National health system level

 Implementation of pain relief during childbirth guidelines

The provision of childbirth pain relief methods is another strategy for promoting vaginal childbirth in Iran, which was implemented to make childbirth pleasant and to increase women's satisfaction. However, evidence shows that in public hospitals, pregnant women do not have access to pain relief options (mostly non-pharmacological) during labour [11, 41].