Oral contraceptive use and its sociocultural determinants in Iranian women: a secondary cross-sectional analysis from the PARS cohort study

This study addresses a gap in global research by exploring sociocultural factors and health outcomes related to oral contraceptive pill (OCP) use among middle-aged Iranian women, where non-prescription access is common. It aims to identify determinants of OCP use and its association with chronic diseases in this demographic. This study was a secondary cross-sectional analysis which was conducted using baseline data from the Pars Cohort Study, launched in 2012 and included a sample of 4,034 married middle-aged women aged 45–64 years residing in Fars Province, Iran. To evaluate the factors influencing the current use of OCPs as the preferred contraceptive method among married women aged 45–64 years old in our cohort, Poisson regression analysis was employed. This analysis was adjusted for various demographic, reproductive, medical, and behavioral variables. Overall, 60.5% of women were current OCP users. Usage declined with age and increased with socioeconomic status. Higher use was also linked to Fars ethnicity, obesity, and multiparity. Lower use was associated with literacy and stillbirth history. OCP users tended to marry younger and had fewer postmenopausal years. OCP use was linked to a reduced risk of liver disease. other comorbidities showed no significant associations. OCP use remains high among middle-aged Iranian women, influenced by age, SocioEconomic Status (SES), ethnicity, and reproductive history—unlike global trends post-menopause. Non-prescription availability and cultural norms may sustain misconceptions about contraceptive need, highlighting the need for targeted education and policy changes to support informed reproductive health decisions. OCP use, as a method of contraception remains high among middle-aged Iranian women, driven by sociocultural factors and non-prescription access. Unlike global trends, the use of OCPs persists post-menopause, indicating gaps in reproductive health literacy, education, and policy reforms are needed necessary support informed contraceptive choices and address disparities in similar low-resource settings. Additionally, efforts to improve reproductive health literacy should include culturally tailored educational campaigns, pharmacist training to ensure informed dispensing of OCPs, and expanded community-based counseling services—especially for peri- and post-menopausal women.