09.11.2004Family Planning Muslim StyleTightrope Walk between Pragmatism and MoralityIn spite of the rigid morality of the ruling clerics, Iran has set up effective programmes for sexual education and family planning. But the programmes are entirely dependent on the state. Cyrus Schayegh reports
In Iran, the state wants to maintain its control over the social and moral development of the country Kamran Hashemi smiles as he points out that the way to success for him has been a stony one. He's referring to the beginnings of his condom factory, which he opened in Qazvin twelve years ago. It took five years for him to get a licence for what remains the only contraceptive factory in the Islamic Republic. And after that there were the staff problems.
"To start with people thought the factory must be a den of iniquity," says Hashemi's chief engineer Mohammed Tahmasab. "The men didn't want to let their wives and daughters work here. But the situation has become more normal with the years. People understand now that this is a perfectly ordinary factory. Nowaday there are a lot of young women who work here."
Sharp drop in population growth
The pragmatic attitude of the workers reflects a change in the population policy of the political and religious elite in the Islamic Republic which has led to a sharp drop in the rate of growth in the population, currently standing at around 70 million.
Between 1976 and 1986, the annual increase in population was 3.2%. In the year 2000 it had dropped to 1.2%. But the reduction is not only due to a new policy on the part of the authorities; the economic difficulties in which many families find themselves play an important part, as does the policy of the Islamic Revolution of encouraging women's education, which has led to a rapid increase in the number of women at work.
Iran's population has not always grown fast. The growth rate of 3.2% represents historically the peak level in a population explosion which, in fact, started rather late. In the nineteenth century, the population suffered from hunger and sickness and the population never reached more than ten million.
Decreasing the death-rate
At the beginning of the twentieth century improved hygiene and economic reforms led to a decrease in the death rate. But the birth rate remained high, and, as had already happened in Western Europe, the population exploded. Until about the middle of the century, the intellectual and political elite saw this development as positive.
More children meant more workers for a country which was trying to catch up economically with the industrial states.
In 1967 a family planning programme was introduced, but it had little effect. After the Islamic Revolution, the religiously motivated opposition to birth control of the new religious elite was reinforced by the war on Iraq. More children meant more soldiers for the state and more food coupons for families who were finding it hard to survive under the rationing of a war economy.
Follow the green line for vasectomies
A rethinking of this policy was beginning just as Hashemi applied to the Ministry for Industry for his licence. Under the influence of information from doctors and scientists, the religious leaders of the country became aware of the long-term consequences of the explosion in the birth rate. Ayatollah Khomeiny, the leader of the Islamic Revolution, issued his first fatwa on the subject in 1988.
A family planning programme was launched in 1989, and a pioneering law on family planning and birth control was passed in 1993. The United Nations Population Fund began to support programmes carried out by the state health system, which, since the Revolution, had been massively expanded into the countryside and the poorer parts of cities.
Reduction of the birth-rate
The political will was there, the necessary money was made available and doctors and officials were highly motivated. The programme still provides the main political and institutional backbone for the reduction in the birth-rate which began in 1986.
Mehdi Sedghazar, medical director of the state polyclinic Shahid-e Jaffary in eastern Teheran, is one of the earliest pioneers of birth control. The sign at the entrance to his clinic says "Centre for Family Planning." Beside it is a second sign in Persian and English: "Vasectomy and Tubal Ligation." The same notice is painted on a wooden tower which has been specially erected for the purpose and which can be seen from afar.
Dr Sedghazar remembers with a smile how he had trouble with the head teacher of the nearby girls' school when he opened the clinic. She was worried about the effect of the signs on the moral education of her girls. The men who came in the early years were so shy that the clinic had to paint a green line on the ground so that they could find the way from the entrance to the vasectomy clinic without having to ask anyone.
Now the paint is slowly wearing out. Dr Sedghazar says that persistent educational work, free contraception and free medical treatment have all had their effect.
2.7% of Iranian men were sterilised in the year 2000, a remarkably high figure in a society with such a strong patriarchal tradition as Iran. But it is low compared the 17.1% of Iranian women between fifteen and 49 who have had a tubal ligation.
Using more temporary forms of contraception
The use of more temporary forms of contraception reflects the same trend. In 2000, 5.9% of men used condoms, while 30.9% of women used the pill or other modern contraceptive methods. The fact that differences in gender roles are still strong, even if they are decreasing, can be seen from the legal situation. A woman must have the written approval of her husband before she can be sterilised.
In Dr Sedghazar's clinic, a man must have his wife's approval for a vasectomy, but that doesn't apply everywhere. His clinic is different in other ways too: anyone can be sterilised there; at other clinics, only couples with at least two children can have the operation.
Before they get married, all Iranian men and women have to attend two-hour sessions, divided by sex, in which they watch a video film and hear a lecture, mainly dealing with birth control methods. These sessions usually take place in one of the clinics which also provides family planning services.
In the Shahid-e-Nur-Saadat Clinic in the centre of Teheran a doctor explains to about twenty men how the pill works and how to use a condom properly, but also, what menstruation is, and how a man can help his wife with early testing for breast cancer.
His tone is neither overly chummy or exaggeratedly earnest, and he emphasises several times that a woman has sexual needs which mustn't be neglected, just like a man. When asked, the doctor says initially that this won't be news for most of the men sitting there, but he say later that, in his experience, there's a lot of ignorance, especially in the field of sex education.
Control is better
The fact that information on family planning and sexuality is so firmly in state hands in not just because the state has the necessary infrastructure.
Vasectomies and tubal ligations can be performed by private doctors, while contraceptive pills and condoms can be sold by doctors and chemists, usually without even questions being asked about marital status. However, advertisements for condoms are not allowed.
This doesn't matter much to Hashemi, who sells 80% of his annual production of 75 million condoms to the health ministry. But the ban on advertising shows that the state wants to keep control of family planning and birth control, not just because they are important for the long-term social and economic development of the country, but also because it wants to put over certain moral norms.
© NZZ 2004
This article was previously published by the Swiss daily Neue Nürcher Zeitung, 10 October 2004.
Cyrus Schayegh is a historian currently living in Teheran.