Fear of pregnancy and its associated factors in Iranian women and providing strategies to reduce pregnancy fear: a sequential explanatory mixed-methods study

BACKGROUND: Fear of pregnancy can affect women's mental health, reproductive decisions, and quality of life, and may overlap with tokophobia. This study aims to assess its prevalence and determinants among women in Tabriz, Iran, and to develop evidence-based strategies to reduce it. METHODS: This sequential explanatory mixed-methods study consists of three phases. First, a cross-sectional survey will be conducted among 450 married women aged 15-49 years (nulliparous or with one previous pregnancy) using validated instruments, including the Fear of Pregnancy Scale (FOPS), Satisfaction with Life Scale (SWLS), Social Support Appraisals Scale (SSA), Health-Promoting Lifestyle Profile-2 (HPLP-2), and Depression, Anxiety, and Stress Scale (DASS-21). The psychometric properties of the FOPS will also be assessed. Quantitative data will be analyzed with descriptive statistics, correlations, and multivariable models in SPSS-26. In the qualitative phase, women with the highest and lowest FOPS scores will be purposively selected to ensure diversity, and semi-structured interviews will be analyzed through conventional content analysis. In the final phase, results from both stages, supported by a literature review, will be integrated and refined using the Delphi method to develop culturally appropriate strategies for reducing pregnancy-related fear. DISCUSSION: This first mixed-methods study in Iran addresses a critical gap in understanding fear of pregnancy. Integrating quantitative and qualitative findings with expert input, it will inform evidence-based, culturally sensitive strategies and guide policies and clinical practice to support informed reproductive decisions.