The study was led by Molouk Jaafarpour of Ilam University of Medical Sciences, together with colleagues at Tehran University of Medical Sciences, Baqiyatallah University of Medical Sciences, and Ayatollah Taleghani Hospital. The team chose Ilam deliberately. The province combines pronounced economic hardship, strong patriarchal traditions, and documented gaps in maternal healthcare access, making it what the researchers describe as a critical case: a setting where the forces that erode maternal dignity are concentrated and therefore easier to trace. Globally, the stakes of such research are high. The World Health Organization estimates that roughly one in three women worldwide experiences physical or sexual violence in her lifetime, most often from an intimate partner, and pooled estimates of intimate partner violence during pregnancy range from about 5 percent to more than 30 percent depending on the setting. In Iran, a recent national review estimated that approximately 59 percent of women experience domestic violence, a figure that rises to 61 percent during pregnancy, with psychological violence the most commonly reported form.

Methodologically, the study is a textbook example of rigorous qualitative inquiry. The researchers conducted in-depth, semi-structured interviews with 26 postpartum women aged 18 to 44, all of whom had given birth within the previous three years in an Ilam hospital, and with 6 key informants: spouses, mothers-in-law, a reproductive health specialist, and a sociologist specializing in gender studies. Recruitment combined purposive and snowball sampling through maternity wards and postpartum clinics, capturing voices from both urban and rural areas and diverse socioeconomic backgrounds. The interviews, which ran between 30 and 90 minutes with a mean of 55 minutes, were conducted from August to December 2019 in private settings chosen by the participants, and continued until three consecutive interviews produced no new themes, the standard marker of thematic saturation.

The analysis followed the conventional content analysis method of Graneheim and Lundman, supported by MAXQDA 18 software. The researchers generated 642 initial codes across the 32 interviews, refined these into 311 codes, clustered them into 18 preliminary subcategories, and finally distilled seven subcategories grouped into two overarching categories. Coding consistency was checked by having two authors independently code a subset of six transcripts, yielding 84 percent intercoder agreement, with discrepancies resolved through discussion. To guard against imposing theory onto the data, the team coded inductively first and applied the conceptual lenses of structural and symbolic violence only after stable patterns had emerged. Trustworthiness was reinforced through roughly eight months of prolonged engagement by the lead researcher in local clinics, iterative verbal member checking during interviews, peer debriefing, and a detailed audit trail. The study received ethical approval from Tehran University of Medical Sciences, and elaborate safeguards, including anonymized transcripts, encrypted storage, and post-interview referrals to psychological support, were used to protect participants in a conservative context where disclosure carries real risk.

The first overarching category, structural and symbolic violence at the systemic level, describes how institutions themselves inflict harm. Participants described weak legal and regulatory frameworks surrounding maternal care: complaint mechanisms that lead nowhere, and laws that, where they exist, tend to protect medical teams rather than pregnant women. One reproductive health specialist told the researchers that existing legal frameworks predominantly focus on protecting the care team rather than safeguarding the rights of pregnant women. A participant put the consequences more starkly, saying that even if someone dies under their care, no one does anything, and that complaints lead nowhere. Another participant’s remark that all the system wants is the baby was interpreted by the researchers as evidence of a systemic dehumanization in which the pregnant woman is reduced to a reproductive vessel, her well-being rendered secondary to the biomedical outcome of a live birth.

Economic neglect emerged as a second pillar of structural violence. Employed participants described workplaces that stopped their salaries during pregnancy, told them they should not have become pregnant, and offered no prenatal leave, forcing them to keep working through the physically demanding final months. Women in poverty described being unable to afford basic prenatal tests or adequate nutrition while society simultaneously expected them to produce healthy children, and many said financial constraints left them no choice but under-resourced public hospitals where care was poor. The sociologist among the key informants framed the pattern precisely: women are expected to bear children, yet none of the institutional foundations are provided for them. The researchers read these accounts as structural violence in the classic sense, harm produced and normalized by social, economic, and legal arrangements rather than by any single actor’s intent.

Symbolic violence, a concept borrowed from the sociologist Pierre Bourdieu, refers to the internalized legitimization of inequality through dominant cultural norms, language, and everyday practices. In the Ilam narratives it appeared most vividly in the stigmatization of mothers who bear daughters and the blaming of women for adverse fetal outcomes. One participant recalled her mother-in-law mockingly comparing her to her sister for giving birth to girls, and asked why only women should be blamed for a child’s sex. Another described the haunting fear that if anything went wrong with the baby, her husband and his family would hold her responsible, a belief she called toxic and completely irrational yet pervasive. Participants also described the idealization of maternal sacrifice as itself a form of devaluation: everyone praises how amazing mothers are, one woman observed, while mothers are forgotten, even by themselves. Notably, one of the mothers-in-law interviewed acknowledged the pattern herself, saying that women are oppressed and have no choice but to endure it, an illustration of how symbolic violence is reproduced even by those it harms.

The second overarching category, interpersonal and familial neglect, shows how these macro-level forces are enacted inside the home. Several women reported psychological abuse explicitly tied to fetal sex: husbands who withdrew affection upon learning the baby was a girl, pressured them to terminate the pregnancy, or whose families stopped interacting with them entirely, while lavishing attention on a sister-in-law who bore a son. Beyond active abuse, participants described a damaging vacuum of support, husbands and relatives who dismissed their exhaustion, failed to grasp their emotional vulnerability, and left them to labor without companionship, sometimes while their other children waited alone at home. The gendered expectation of uninterrupted domestic work emerged as a concrete mechanism of harm: women in their final month of pregnancy, and even during labor and postpartum recovery, were told that cooking and cleaning were simply women’s work. A smaller number of accounts included direct physical aggression, such as slaps for talking back or being shoved toward the kitchen when too tired to cook, which the researchers interpret not as isolated outbursts but as tools for enforcing obedience within gendered hierarchies.

One of the study’s most analytically important contributions is its insistence that these forms of violence do not operate in isolation. Weak legal protections and economic precarity restrict women’s choices about healthcare, employment, and childbirth settings; cultural norms of son preference and maternal sacrifice then lead many women to internalize blame and remain silent. Women’s agency, the authors argue, was not absent but constrained and negotiated: some resisted by refusing abortion demands, seeking informal support from their own families, or asserting moral and religious reasoning, while others adapted by minimizing conflict to protect their unborn child. The inclusion of male and in-law perspectives revealed that men, too, were shaped by the same forces, often framing control over women’s bodies and decisions as familial duty or economic necessity rather than violence. Crucially, the authors caution against reading poverty itself as the cause of violence; the root, they argue, lies in patriarchal gender norms and institutionalized inequality, with economic hardship intensifying vulnerability by increasing dependence and limiting access to protection.

The study’s conclusions point toward coordinated, multi-level reform. At the policy level, the authors call for strengthened enforcement of maternal protection laws, transparent supervisory and complaint mechanisms in public maternity hospitals, and actively monitored workplace guarantees of maternity leave and freedom from pregnancy discrimination. Within healthcare, they recommend structured training for midwives and obstetric providers on structural and symbolic violence, alongside routine psychosocial screening during antenatal visits to identify women in relational or economic distress. At the community level, they propose culturally sensitive interventions engaging local leaders and families to challenge son preference, redistribute domestic responsibilities, and dismantle the normalization of maternal sacrifice. The authors acknowledge that their findings are specific to Ilam and may not generalize across Iran, and they call for longitudinal research in other provinces. But their central message travels well beyond one border province: without embedding maternal dignity as a measurable and enforceable standard in policy and clinical practice, the quiet violence of neglect and devaluation will continue to shape women’s most vulnerable months, invisible precisely because everyone has agreed to call it normal.

Subject of Research: Structural and symbolic violence experienced by pregnant women in Ilam, Iran

Article Title: Structural and symbolic violence among pregnant women in Iran shaped by gender inequality and familial neglect

Article References: Jaafarpour, M., Taghizadeh, Z., Ebadi, A., & Direkvand-Moghadam, A. (2026). Structural and symbolic violence among pregnant women in Iran shaped by gender inequality and familial neglect. Discover Social Science and Health, 6(1), Article 104. https://doi.org/10.1007/s44155-026-00440-4

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00440-4

Keywords: structural violence, symbolic violence, pregnancy, gender inequality, Iran, maternal health, domestic violence, son preference, qualitative research, Ilam Province, intimate partner violence, health policy