The relationship between Social Determinants of Health and Access to Reproductive Health Services among Afghan Migrant Women based on the World Health Organization Model in Iran: path analysis

Introduction Despite global commitments to universal reproductive health coverage, migrant women face profound structural barriers in low- and middle-income host countries. This study aimed to investigate the relationship between social determinants of health and access to reproductive health services. Methods A cross-sectional study was conducted in Tehran, Iran, involving 350 Afghan migrant women recruited through purposive convenience sampling. Data were collected using a researcher-developed questionnaire that included demographic and obstetric characteristics, as well as social determinants of health. Statistical analyses were performed using SPSS version 27, and the hypothesized model was examined through path analysis using LISREL version 8.8. Results The mean age of participants was 31.4 ± 7.8 years. Path analysis revealed that non-governmental organizations (NGOs) had the strongest positive direct effect on access to services (B = 0.15), while social capital exerted the strongest negative direct effect (B = -0.12). Indirectly, education showed a positive causal effect (0.015) on access through improved living conditions and health-seeking behaviors. Governance regulations (B = 0.25) and social class (B = 0.14) demonstrated the strongest positive relationships with access across both direct and indirect paths. Conclusion Governance regulations emerged as the strongest predictor of access to reproductive health services. Without upstream reforms in legal structures and residency protocols, superficial interventions will not yield sustainable improvements. NGOs play a vital role in bridging governmental gaps, whereas the negative impact of social capital highlights structural isolation as a barrier to health-seeking behaviors. Key recommendations include revising residency policies, rebuilding social trust, and strengthening civil society organizations to mitigate structural discrimination.