# HPV vaccination in Iran: expert perspectives on family dynamics and barriers

## TL;DR

This study explores why HPV vaccination rates are low in Iran, focusing on family dynamics, costs, and social stigma.

## Contribution

The study identifies unique cultural and economic barriers to HPV vaccination in Iran and proposes culturally tailored solutions.

## Key findings

- High economic costs and social stigma are major barriers to HPV vaccination in Iran.
- Moral misconceptions about the vaccine lead to family conflicts and psychosocial distress.
- Experts recommend affordable domestic vaccines and culturally tailored education to improve uptake.

## Abstract

Cervical cancer, primarily caused by Human Papillomavirus, remains a significant global health concern. Despite vaccine availability, uptake rates are low in many conservative settings, including Iran, where context-specific factors influencing vaccination are often overlooked. This qualitative study aimed to explore and articulate the perceptions, experiences, and actionable recommendations of health and social experts concerning the barriers, facilitators, and the perceived family implications of Human Papillomavirus vaccination in Iran.

This qualitative inquiry employed Conventional Content Analysis. Using Maximum Variation Purposive Sampling, 18 female experts and professionals (Obstetricians/Gynecologists, health educators, laboratory staff, and academic researchers) were recruited from major medical universities in Tehran (January 2025 to September 2025). Data were gathered through five Focus Group Discussions (FGDs) and seven semi-structured In-depth Individual Interviews. Methodological rigor was ensured via techniques like Member Checking. Data were analyzed using MAXQDA 2020 software.

Participants included 18 female experts (mean age 44 ± 10.7 years). Thematic analysis identified 13 sub-themes categorized into five domains: (1) family awareness and information sources; (2) family attitudes and beliefs; (3) family decision-making; (4) systemic and economic barriers; and (5) family wellbeing and policy. A central finding was the synergistic interplay between high economic costs and deep-seated social stigma. This linkage perpetuates low awareness and fuels moral misconceptions (e.g., vaccine as a “moral license”), which often lead to severe marital conflicts, infidelity accusations, and psychosocial distress within the family unit.

From the Iranian experts’ perspective, vaccination uptake is primarily hindered by high cost, limited access, and deeply rooted social stigma associated with sexually transmitted infections. Key actionable recommendations include full insurance coverage, introducing affordable domestic vaccines, and implementing culturally tailored public health education to address moral concerns. These findings provide crucial evidence for policymakers to design targeted interventions that improve Human Papillomavirus vaccine coverage and protect family health in Iran.