Title: "Family and society empowerment": A content analysis of the needs of Iranian women
who experience domestic violence during pregnancy: A qualitative study
Version: 2 Date: 02 May 2023
Reviewer's report:
I find this manuscript to be on an important topic, especially in it’s geographical and cultural
context. And has important implications for care of pregnant women who are survivors/victims
of DV/IPV.  That said, I have a few suggestions for improvement upon it’s existing form.
Overall, the use of a grammar check will improve readability.
Introduction:
1. Line 75: This sentence: “Abused young pregnant women need education, economic
independence, and prohibiting identification of fetal gender during pregnancy, in addition to
treatment of alcohol use disorder, and improving spouse's consciousness about pregnancy”  is
confusing and should be better clarified, especially “prohibiting identification of fetal gender”
Why? Maybe expand for clarity.
2. Line 97: I would separate this sentence into two just to make a stronger impact of what you are
discussing: “Based on the Iranian civil law if divorce occur the full custody of children after a
certain age is being given to the father (23), and women prefer to stay in an abusive relationship
than to divorce for different reasons such as fear of losing children, lack of social and legal
support, and pressure of social judgment that stigmatize divorce (24)”
3. Line 101: I am not sure what this sentence is saying: “Similarly, pregnant women prefer to
stay in abusive behavior in Iran” do you mean to say in abusive environments/relationships?
4. I am aware that I am not an expert on IPV/DV in Iran and since I lack the knowledge of
cultural nuance when approaching this subject, please take this as you will: in IPV/DV studies,
when we acknowledge the inherent patriarchal power differential that has a strong relationship
to the proliferation of IPV/DV, we also dismantle such systems by using person-first language.
In this instance, I take issue with the use of “abused women” as an identifier. Using this identifier
attaches the abuse to the women’s identity and separates it from an act that is perpetrated upon
them by an abuser. Examples of person-first language in this case would be “women who have
been abused” “women who experience DV’ or even the now common identifier victim/survivor
(shortened by using V/S after the first mention). I would encourage the authors to explore, and
keep consistent, a person-first identifier for this population, especially as they work to dismantle
systems which perpetuate IPV/DV.
5. I think given the international reach of BMC, the introduction should include more on
the unique cultural factors relating to IPV/DV in Iran- that is, situate the problem more in a
geographical context so that the reader truly understands the findings later.
Method:
1. I am not understanding how content analysis was used here. It sounds like the analysis process
was much more in depth- much more aligned with phenomenology as the intent of the study
was to better understand the experiences of the victims/survivors. Content analysis is generally
more for quantifying of thematic content- how often does a similar concept arise in the data/to
better understand the meaning and relationship of words used. The method you are describing
here seems much more in-depth and richer. I think this section needs clarifying; either to ensure
that it is in fact content analysis that is happening (and if so, better clarify how the themes were
found using content analysis) or to better illustrate a different method that was used.
Results
1. I think the results would be enhanced by differentiating between key informants and victims/
survivors. Readers like to know who said what as V/S perspectives often differ than those of key
informants. Furthermore, the quotes are much better contextualized when it is differentiated what
type of participant they were. I honestly think organizing the quotes by V/S and key informants
would strengthen this study. For instance, “V/S had this to say about this” “Meanwhile, key
informants endorsed this theme saying..”
2. Another recommendation I have to strengthen the positionality of this manuscript is to use
pseudonyms. Especially when reporting research on previously silenced voices, it is important
to personalize the data. I would suggest, (again, up to the authors here) the use of pseudonyms
in reporting verbatim quotes as international readers would benefit from the personalization of
the data.
3. The results felt curt- I know that space is always limited in qualitative reporting, but if possible
even just a follow up line at the end of each theme/subtheme would tie the results together better
and lead to a more cohesive result section.
4. Line 292: I cannot understand what this sentence is trying to convey: “Strengthen inter
sectoral, legal and social supports included the provision and strengthen inter sectoral support,
reform the education system, reform and implementation of women’s protection laws, and
receive social support.” I would recommend clarifying this sentence and rewording for clarity
sake.
5. Further contextualization of quotes is needed. For example, on line 305, this quote:  The
following statements indicate it: “I come to forensic medicine because of my wife’s physical
violence, but I do not know what they will do here. I have been waiting for several hours and
I am very tired.” (Participant 8) doesn’t make sense within the subtheme. Perhaps a  clarifying
statement before the quote, such as “when asked x, this person explained the need for provision
of forensic services” or “ discussing x, they said..” I think many quotes need more information
in the lead into them.
Discussion
1. As with the intro, this is where Iran specific (the paper states “exclusive needs in Iran”)
information again should be tied into the interpretation of the results. Does this differ from
literature in other parts of the world? If so, how (this will illuminate unique facets of this study)?
2. I feel as though the discussion should have more focus on the importance of pregnancy in
the study- since that is the population being studied. Why IS it so important to address DV/IPV
in pregnancy? (we know it is a time of heightened violence and also a reflective  time for the
mother who may be more likely to want to make lasting changes). I feel just a few lines with
research on this can strengthen this (it is mentioned some but not explicitly).