Celebrate Solutions: Iran’s Family Planning Success Story

By: Harshi Hettige, Women Deliver

Iran’s family planning program has been lauded as an ‘Iranian Miracle’ and modeled around the world, including here in the US. It holds the record for the largest and fastest decline in fertility ever. The total fertility rate (TFR) dropped from 6 children per woman in the mid-1980s to 2.1 children per woman in 2000. This greatly exceeded expectations; the TFR in 2000 was less than half of what had been planned for 2011. "It confounded all conventional wisdom that it could happen in one of the world's few Islamic republics," said Jalal Abbasi-Shavazi, a demographer at the University of Tehran.

The decline coincided with the development of a rural family planning program and health delivery services carried out through health houses (small community primary care centers.) The program aimed to 1) postpone first pregnancy, 2) increase birth spacings and 3) limit the family size to three.

The health house construction program began in the early 1970s and the family planning program officially launched in December 1989. In the late 1980s, Ayatollah Ruhollah Khomeini, Iran's supreme leader, made birth control widely available and acceptable to conservative Muslims. Public clinics in urban areas, as well as the rural health houses, provided married couples with the latest contraceptive methods for free.  By 2000, almost all villages were covered by the health house services.

They provided contraceptive services and devices and related training programs. Health workers recommended contraception as a way to leave more time between births and help reduce maternal and child mortality. Along with easily-accessible resources, in 1993, parliament passed a new family planning bill which removed all economic incentives for large families, such as tax deductions. The government and health care delivery system provided effective educational programs. Couples intending to marry were required to receive counseling in family planning. State-owned media also initiated an informative campaign encouraging smaller families.

“The birthrate plunged, helping to usher in social changes, particularly in the role of women,” described The Los Angeles Times.

A study by Salehi-Isfahani et al.(2009) evaluated the impact of the program by comparing villages who were exposed to the program and villages who were not. They contributed 7% of the change in fertility to the program. The success of the program could be attributed to many things: the expansion of contraceptive use, an increase in women’s education and their presence in the labor force, or perhaps just the passing of time.

Many governments and non-governmental organizations have responded to rapid population growth and its potentially negative socioeconomic effects with programs aimed at reducing birth rates. India implemented the first national family planning campaign in 1952. By 1990, 95% of the developing world's population lived in countries providing some type of family planning initiative.

However, family planning is not only important for population growth. The recent London Summit on Family Planning in July highlighted the significant impact it has. Prime Minister David Cameron spoke about the importance of family planning from a perspective of human rights as well as finances, saying that family planning can aid in unlocking “the golden thread of development,” by creating smaller, healthier, and wealthier families and societies, and more empowered women.

Women Deliver President Jill Sheffield said, “If women can't plan their fertility, they simply can't plan their lives. We also know that family planning is the quickest, least expensive way to save women's lives from dying in pregnancy and childbirth. It's as simple as that.”

However, currently, Iran’s President Mahmoud Ahmadinejad sees the country’s contraceptive program as "a prescription for extinction." The Huffington Post reports, "Authorities are now slashing its birth-control programs...The changes – announced in Iranian media last week – came after Supreme Leader Ayatollah Ali Khamenei described the country's wide-ranging contraceptive services as "wrong." The independent Shargh newspaper quoted Mohammad Esmail Motlaq, a Health Ministry official, as saying family planning programs have been cut from the budget for the current Iranian year, which began in March."

Efforts to reverse the small family trend have so far, been widely ignored. Young couples, soon to be wed, still flock to health centers for medical screenings required for marriage and classes on family planning. Government-trained midwives teach with the aim of avoiding an unwanted child.

Sussan Tahmasebi, an Iranian women's rights leader now living in the United States, stated, "Iranian women are not going back."

Flickr photograph via unicefiran.

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