BACKGROUND:
Reproductive health policies in Iran have created documented disparities in healthcare access and outcomes, particularly affecting rural, lower socioeconomic status Persian and Afghan women. Clinical data suggest persistent inequities in contraceptive access and care quality despite policy transitions, with minority populations experiencing suboptimal outcomes and potential medical ethics violations.

OBJECTIVES:
This study examines how healthcare delivery systems contribute to reproductive health disparities in Iran, analyzing the relationship between clinical practice patterns and patient outcomes, with specific focus on how socioeconomic factors and ethnicity influence contraceptive counseling, informed consent processes, and reproductive autonomy.

METHODS:
This clinical ethnography employed systematic observation in three clinical sites in Yazd province from 2017-2022: a public maternity ward, private gynecological clinic, and midwifery practice. Data collection included clinical observation of patient-provider interactions (n=215), interviews with healthcare providers (n=42) including midwives and obstetrician-gynecologists, and structured interviews with undocumented Afghan women patients (n=37). Clinical documentation review supplemented observational data.

RESULTS:
Findings reveal significant disparities in contraceptive method allocation and informed consent processes based on patient socioeconomic status and ethnicity. Documentation analysis showed healthcare professionals provided reduced contraceptive education to patients from minority and lower socioeconomic backgrounds. Review confirmed cases of inadequately documented consent for sterilization procedures among marginalized populations, particularly affecting rural working-class and Afghan women.

CONCLUSIONS:
This study identifies clinical pathways through which reproductive healthcare delivery contributes to health disparities and medical ethics breaches. These findings have immediate implications for clinical practice reform, provider education, and health policy modifications to ensure equitable reproductive healthcare delivery.

KEY MESSAGE:
Clinical practices in Iran contribute to reproductive health disparities, with Afghan and low-income Persian women receiving inadequate contraceptive counseling and informed consent, revealing urgent ethical and policy gaps. French - equity & breastfeeding (including three-minute presentation competition)