Related factors of violence against women with infertility: A systematic review study based on an ecological approach.

Background and aim: Infertility as a global problem, affects the different aspects of women's health. Also, violence against infertile women affects their psychological wellbeing and treatment consequence. This study aimed at reviewing related factors to violence against infertile women, based on an ecological approach.

Methods: In this systematic review, the researchers conducted their search in electronic databases such as Google Scholar, and then in more specialized ones such as Medline via PubMed, Science Direct, Up-to-date, Springer, SID, Magiran, Iranmedex and Irandoc with the key words violence, infertility, women, risk factors, social environment, and individuality, from 1988 to 2016. The selection of papers was undertaken from 20-27 January 2017. The articles were selected based on the following criteria: 1), the articles focused on the research question 2), infertility and violence were included in the title of the articles, and 3) articles were published in online journals. Exclusion criteria were articles which focused on violence against the general population, pregnant women and female sex workers and articles that were not available in full text form or written in other languages (Not Persian or English). The quality of selected studies was appraised using a 16-item checklist adapted from Tao. This checklist consisted of 16 items which used a 0 or 1 scoring system (not eligible or eligible). If an article received a score of 75% (12-16 points), it was of high quality. A score of 50% to 74% (8-12 points) indicated moderate quality, and less than 50% (8 points) indicated low quality. The process of titles, abstracts and full-texts' appraisal led to the selection of 16 articles, which were used to write this article.

Results: Two of the articles based on 16-items of the check list had high quality score, 8 of them had moderate and the remaining articles had low quality score. Our findings were classified under three categories corresponding with the ecological approach: (1) Microsystem level "individual sociodemographic and infertility characteristics", (2) Mesosystem level "interpersonal' and husband sociodemographic characteristics" and (3) Macro system level considered ethnicity and cultural factors.

Conclusion: Violence against infertile women and the stress caused by it, would affect the consequences of infertility treatment. It is noted that various cultural-contextual factors cause violence in different societies. There is a need for the development of screening tools and applying counselors to identify infertile women at the risk of violence, and provide clinical services, counseling and social support.