Iran's Successful Family Planning Program
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POPULATION REFERENCE BUREAU IRAN’S FAMILY PLANNING PROGRAM: RESPONDING TO A NATION’S NEEDS by Farzaneh Roudi-Fahimi ran has experienced dramatic demographic change in the last decade. Levels of childbear- Figure 1 ing have declined faster than in any other Trends in Total Fertility Rates for I Selected Countries country, and maternal and child health have great- ly improved. These changes have coincided with Births per woman the revival of the national family planning pro- 5.6 gram, which is delivered through a nationwide 4.8 network of primary health care facilities. Many 4.4 observers have wondered how such a dramatic 3.5 3.2 3.0 increase in contraceptive use could have occurred 2.6 in a traditional society ruled by Islamic law. 2.0 Demographic Trends Iran’s population increased from 34 million in 1976 to nearly 50 million in 1986, with an aver- 1985 20001988 2000 1987 1997 1988 1998 age growth rate of 3.9 percent per year (3.2 per- IranEgypt Morocco Turkey cent from natural increase and 0.7 percent from NOTE: Rates for Iran are based on data from the ministry of health and immigration); a decade earlier, the average annual medical education. The Statistical Center of Iran has reported that fertility growth rate had been 2.7 percent. But the rise in fell from 7.1 births per woman in 1986 to 2.5 births per woman in 2001. the population growth rate that occurred during SOURCE: Population Reference Bureau database, based on selected and after the 1979 Islamic revolution in Iran was national surveys. followed by a sharp decline. Between 1986 and 1996, the population growth rate dropped to 2.0 percent per year.1 Currently, Iran’s population is woman. The fertility of urban women declined estimated to be growing by 1.2 percent a year. from 4.5 births to 1.8 births per woman during The population growth rate has been declin- the same period.2 Figure 2 (page 2) shows how ing because of the dramatic change in Iranian fertility rates in Iran vary by province. women’s fertility: According to the Iranian min- The decline in fertility has mainly been due istry of health, the country’s total fertility rate to the increase in contraceptive use among mar- declined from 5.6 births per woman in 1985 to ried women: In 2000, 74 percent of married 2.0 births in 2000 (Figure 1). Iran’s fertility women practiced family planning, up from 37 decline is particularly remarkable in how quickly percent in 1976. The change in marriage patterns it occurred in rural areas. Between 1976 and has also affected fertility: Women’s average age at 2000, the total fertility rate in rural areas declined first marriage increased from 19.7 in 1976 to from 8.1 births per woman to 2.4 births per 22.4 in 1996. This overview of Iran’s family planning efforts and the role of the Islamic government and civil society in the revival of the national family planning program is the second in a series of policy briefs from the Population Reference Bureau. This series analyzes population, environment, reproductive health, and development linkages within the framework of the Cairo Programme of Action and the cultural contexts of population groups in the Middle East and North Africa (MENA). Future briefs on MENA will cover specific population-related topics or country case studies. Figure 2 health and its critical role in improving the well- Total Fertility Rate by Province, Iran, 2000 being of women and children. Family planning became an integral part of A ARDEBIL Z AZARBAIJAN E. maternal and child health services nationwide. By A R B the mid-1970s, 37 percent of married women A IJ were practicing family planning, with 24 percent A N W GILAN using modern methods. The total fertility rate, . ZANJAN although declining, remained high, at more than MAZANDARAN GOLESTAN KURDISTAN GHAZVIN six births per woman. TEHRAN HAMADAN SEMNAN KERMANSHAH QOM The Islamic Revolution and Pronatalism MARKAZY The family planning program was dismantled soon ILAM LORISTAN KHORASAN ESFAHAN after the 1979 Iranian Revolution, because the program was associated with the Iranian royal CHAHARMAHAL family and was viewed as a Western innovation. KHUZISTAN YAZD The new government advocated population KOHGILUYEH growth, and adopted new social policies, including B benefits such as allowances and food subsidies for O O FARS KERMAN S larger families. In an attempt to ensure continued H E H government support for family planning, a num- R ber of committed health professionals approached the government with information about the health Births per woman HORMOZGAN benefits of family planning. They even obtained 1.4–2.2 (Below or at replacement) SISTAN-BALUCHISTAN 2.3–2.9 fatwas (religious edicts concerning daily life) from 3.0 and up Imam Khomeini and other top-ranking clerics to the effect that “contraceptive use was not inconsis- SOURCE: Iranian Ministry of Health and Medical Education et al., Demographic and Health Survey, Iran 2000, Preliminary Draft Report (2002). tent with Islamic tenets as long as it did not jeop- ardize the health of the couple and was used with the informed consent of the husband.”5 In 1980, Iran was attacked by Iraq. During Evolution of Iran’s Family the eight-year conflict that followed, having a large Planning Program population was considered an advantage, and There are three distinct periods in the history of population growth became a major propaganda Iran’s family planning program, each marked by issue. Many Iranian officials were pleased when the major changes in the government’s policy.3 1986 census showed that Iran’s population of close to 50 million was growing by more than 3 percent Family Planning Before the 1979 Islamic per year, one of the highest rates in the world.6 Revolution At the same time, the Plan and Budget Iran was one of the first countries to establish a Organization, which is the main government family planning program as part of its develop- agency responsible for monitoring government ment plan. The Imperial Government of Iran revenues and expenditures, and other ministries, adopted a national family planning policy in such as health, education, and agriculture, were 1966, and launched an active family planning aware of the economy’s vulnerability and the program in the ministry of health in 1967. The added difficulties caused by a rapidly growing 1967 Tehran Declaration acknowledged family young population. To assess the economic dam- planning as a human right and emphasized its ages of the war and prepare for a national devel- social and economic benefits for families and soci- opment plan, the Plan and Budget Organization ety.4 The program recruited and trained a cadre of collected data on issues such as employment and professional staff, and taught many young doctors demand for basic services. The assessment painted about family planning’s implications for public a grim picture of the country’s economy. 2 PRB MENA Policy Brief 2002 After the war with Iraq ended in 1988, as the Despite these efforts, some influential clergy government began to prepare its first national were not convinced about the potential effects of development plan, the Plan and Budget Organiza- rapid population growth or that public investment tion alerted top government leaders that the in family planning was consistent with the basic nation’s dwindling resources could not both sup- tenets of Islam.9 To overcome these objections, the port the high cost of reconstruction and provide government took the issue to the Expediency the social and welfare services stipulated by the Discernment Council of the System, which resolves new constitution. In response, the prime minister disputes between parliament and the Guardian asked all government departments to review the Council. The Expediency Council confirmed that population growth rate’s impact and implications family planning and population policies were legiti- for the first development plan (which would mate areas for government involvement, paving the take effect in 1989). Later, he declared that the way for the reintroduction of a national population government was “reconsidering the issue of policy and the family planning program. population growth.”7 The Revitalized Family Restoring the Family Planning Program Planning Program Having convinced many top policymakers of the The family planning program, officially inaugu- importance of family planning, the Plan and rated in December 1989, has three major goals: to Budget Organization and the ministry of health encourage families to delay the first pregnancy and medical education decided to launch a publici- and to space out subsequent births; to discourage ty campaign to convince other members of the pol- pregnancy for women younger than 18 and older icy elite and the general public about the need for a than 35; and to limit family size to three children. national population policy. The much-publicized The ministry of health and medical education has three-day Seminar on Population and Development been given almost unlimited resources to provide was held in Mashad in September 1988. free family planning services to all married cou- The Iranian media helped disseminate the ples, promote small families as the norm, and help seminar’s main message: Iran’s population growth couples prevent unplanned pregnancies. All mod- rate was too high and, if left unchecked, would ern contraceptive methods are available to married have serious negative effects on the national econo- couples, free of charge, at public clinics. In 1990, my and the welfare of the people. Participants at to remove continuing doubts about the accept- the seminar strongly urged the government to con- ability of sterilization as a method of family plan- sider population issues during policymaking.