Contraception in the Middle East

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The rapid population growth in the Middle East is of Some women prefer not to use oral contraceptive pills particular importance in this politically unstable region because they believe that their use might be associated because of its serious effects on employment, access to with infertility. Furthermore, because the use of health-care services, and cost of government subsidies. hormonal contraceptive methods is usually associated The population of the Middle East tripled between 1970 with decreased menstrual bleeding, many women in the and 2010 to about 350 million. The growth rate in 2011 region prefer not to use them because they believe that varied from country to country, ranging from 0·24% in menstrual bleeding is necessary for health. Lebanon to 3·28% in the United Arab Emirates. Effective contraceptive methods are important in the In some countries, the government decided to control Middle East because cultural and religious reasons make the rapid growth through nationwide establishment of clinical terminations for unwanted pregnancies difficult. effective family planning programmes. In Iran, whose At least half of more than 45 million induced abortions population grew by 50% between 1976 and 1986, the done worldwide every year are done in unsafe conditions. population growth rate was 1·25% in 2011. In 2000, Most of these unsafe practices occur in countries with more than 70% of married Iranian women older than social and religious beliefs against abortion. Clandestine 15 years of age were using a contraceptive method—an unsafe abortions carry a high risk of maternal mortality For more on unsafe abortion impressively high rate that puts Iran in the upper ranks and morbidity, accounting for more than 80 000 maternal see Lancet 2012; 380: 149−56. http://dx.doi.org/10.1016/ worldwide for contraceptive use. deaths per year. Although information about the extent of S0140-6736(12)60609-6 The contraceptive methods used in the Middle East maternal mortality and morbidity associated with unsafe For more on family planning in Iran see East Mediterr Health J are different to those used in Europe and the USA. abortions in the region is scarce, an indirect estimate 2012; 18: 279−86. http:// According to Islam, the prevailing religion of the region, revealed that 5% of pregnancy-related maternal deaths in applications.emro.who.int/emhj/ v18/03/18_3_2012_0279_0286. one should be completely clean to perform the daily Iran were due to complications after abortion. pdf praying ritual, and menstruating women cannot do so In view of the high population growth rate, cultural For more on abortion in Iran see until menstruation is finished and they have bathed. As and religious bans against termination of unwanted Sex Reprod Health 2011; 37: 134−42. http://www. a result, some longacting contraceptives that are popular pregnancies, and the high risk of unsafe abortion, the guttmacher.org/pubs/ in other countries, such as depot medroxyprogesterone Middle East needs to improve education of young people journals/3713411.html acetate, are less welcome by Muslim women because about birth control and to establish more efficient family their use can be associated with some spotting. planning programmes. For cultural reasons, girls in many In many countries of the region, natural methods countries in the region marry at a young age, when are preferred to medical barrier methods, spermicidals, pregnancy carries a high risk of complications and fetal and hormonal contraceptives. For example, lactational and maternal mortality and morbidity. The education For more on lactational amenorrhoea is an important method for family planning of young girls about the use of effective contraceptive amenorrhoea see Contraception 2004; 69: 317−22. http://dx.doi. in Egypt; almost 80% of Egyptian women breastfed their methods would decrease this risk substantially. Free org/10.1016/j.contraception. children for at least 6 months and more than half of these access to contraception would also result in improved 2003.11.015 mothers used no additional contraceptive methods. family planning in the region. However, in Islam, sexual Coitus interruptus is another prevalent natural method. In relationships outside marriage are not acceptable a study of 2480 married Iranian women aged 15–49 years and legal distribution of contraception to unmarried For the study of contraceptive who were sexually active and not planning to conceive, individuals would be challenging. In some countries, methods used in Iran see Eur J Contracept Reprod Health Care 48% practised coitus interruptus, 11% used combined such as Iran, tubal ligation and vasectomy are done 2002; 7: 1−6. http://dx.doi. org/10.1016/j.contraception. oral contraceptive pills, 4% used condoms, and 5% used free of charge. Birth control in the Middle East could be 2003.11.015 intrauterine devices; 32% used no contraception. Many substantially improved if other countries in the region women do not use an intrauterine device because of its follow a similar policy of easy access to contraception. associated complications such as increased risk of pelvic inflammatory diseases and abdominal pain. Additionally, Farrokh Habibzadeh many women do not use condoms because many men The Lancet Middle East Edition, NIOC Medical Education and believe that they reduce sensation and sexual pleasure. Research Centre, Shiraz, Iran