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Background: Infants are regarded as the most vulnerable group with special needs in natural disasters. Since midwives are responsible for providing reproductive health services for infants in natural disasters, this study was performed to assess their professional competencies. Methods: This cross-sectional study was conducted in Tehran, Iran. A total of 361 midwives were selected by cluster sampling method. After giving them informed consents, they participated in the study and completed the researcher-made questionnaire on providing health services for infants in natural disasters. Their professional competence was investigated through self-assessment in terms of their perceived importance, knowledge, and skill. Midwives inclusion criteria were as follows: having a degree in midwifery, having at least 6 months of experience in one of the public hospitals in the city, and a desire to participate in the study. Those who did not complete about 15% of the questionnaire items were decided to be excluded from the study.The Questionnaire included 10 items about infant care designed based on literature review of the resources and associated with the goals of MISP (Minimum package of the reproductive health services in natural disasters). To evaluate the instruments` validity, the questionnaire was given to 15 faculty members of the Nursing and Midwifery School of Tehran University of Medical Sciences. Five midwives were members of Tehran Red Crescent. After receiving comments from midwives and faculty members, the questionnaire items were reviewed. For analyzing the questionnaire reliability, the Cronbach coefficient α was calculated with 0.8. The data were analyzed by using SPSS, version 17. The analyses included descriptive and analytical statistics such as ANOVA, t-test at a significance level P<0.05. Results: Mean (SD) total score of professional competency of midwives in providing services for infants in natural disasters was 91.95(20.2) obtained from 3 subcategories: perceived importance, 39.83(9.55); knowledge, 22.5(5.06); and skill 30.16(6.86). There were significant relationships between the scores of professional competency of midwives with age (P=0.053), degree of education (P=0.028), workplace (P=0.053), and experience in natural disaster (P=0.047). About 49.86% of midwives demonstrated middle level of professional competency. The lowest knowledge and skill score were reported in managing common neonatal problems e.g. asphyxia, sepsis, physical trauma, which require referral and stability. Conclusions: The average scores of professional competencies of midwives to deliver Reproductive health service to infants in natural disasters show the necessity of related and integrated education. It is recommended that by holding emergency maneuvers and natural disaster simulations, midwives be educated with regard to natural disasters in order to know how to respond in these challenging situations. 

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Background: reproductive health is having physical, mental and social health not being sick or disable, in all related systems of reproduction, function and its process. This study aims to investigate the effective factors on using reproductive health services and their outcomes.
Methods: this was a narrative review and the keywords, including reproductive health, family health, services, health promotion, barriers and effective factors outcome, were determined basing on Mesh and searching the papers in Google, PubMed, Science Direct, SID and Scholar, published since 1990 to 2019. The criteria to participate in this study included the papers examined the effective barriers on using  reproductive health services and their outcomes; the criteria of putting unrelated papers aside were basing on the subject. Finally 39 papers were chosen from 85 ones (26 English and 13 Persian papers) to write the review.
Results: our findings in this paper were related to the effective barriers on using reproductive health services and their outcomes and divided into four groups. the effective barriers on using reproductive health services included poverty, violence, migration, injustice , inequality and their outcomes as the outcomes of poverty (access to modern family planning services, difference between fertility in urban and rural population due to in equality in access to contraception methods , differences in level of women’s knowledge about reproduction issues in poor and rich communities , increasing infertility, unsafe abortion and increasing  sexually transmitted diseases ), violence including some scopes like mental health (depression, sleep disorder, Posttraumatic Stress Disorder and suicide), reproductive health (unintended pregnancy, unsafe abortion, Complications of pregnancy, sexual disorders and   sexually transmitted diseases like HIV), risky behaviors (unprotected sex, multiple sex partners and sexual violence ), tragic outcomes (death caused by pregnancy complications, rape, unsafe apportion, killing newborn infant and suicide) and social outcomes (unintended pregnancy, leaving school, losing relationships and rejection by family and friends ), migration (increasing undesirable outcomes of pregnancy like low birth weight, sexually transmitted diseases, induced abortion and decreasing access to health services ) , injustice and inequality (reduced access to family planning services by poor communities comparing to rich ones and increasing fertility, increasing unintended pregnancy, short intervals between pregnancies and increasing family members ).
 Conclusions: according to the important role of reproductive health in human and communities, training people is necessary, not only for medical reasons but also as a basis in strength of marital life. Lack of information or incorrect data can increase family and marital problems so the effective factors and barriers should be determined and met.

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