Health Consequences of an Ideological Perspective on Population Growth in Iran

The promise of “Independence, Freedom and an Islamic Republic” since 1979 when the Islamic Party come to power has been replaced with horrific human rights abuses. Religious and minorities are frequently abused, arrested for their beliefs and deprived of their political and civil rights. Students, human rights activists and journalists also face unwarranted arrests, personal violence and imprisonment. The legal, social, and political rights and roles of women since the abolishment of Iran’s “Family Protection Act” of 1974, that offered women a place in society and its replacement with Sharia law has restricted women’s rights. Iran is run by a patriarchal government led by the office of the Supreme Leader, who appoints the Council of Guardians, the Expediency Council and the judiciary. They collectively hold complete power and can veto whatever they dislike. They are solely made up of men who hold rigid views on women’s rights. Women, considered as sexual objects are meant to care and nurture and if not controlled are believed to be capable of inflicting chaos and confusion. With the establishment of the Islamic Republic of Iran in 1979, the country faced an explosive population growth, so that the population of Iran increased from 34 million people in 1976 to 50 million people in 1986. But, since the proper infrastructure was not available for this amount of population, the government of Iran, with the intervention of the clerics, by encouraging the people with the slogan “fewer children, better life” and implementing “Family Planning Programs” in universities and health centers, tried to prevent population growth, these actions were effective and the total fertility rate fell from 6.5 births in mid-1980 (Abbasi-Shavazi, McDonald, and Hosseini-Chavoshi 2009) to 2.01 in 2016 (Iran’s Population and Housing Census 2016), and 1.7 in 2021 (United Nations 2022).

In recent years, religious officials of the country suddenly became critical of the population control program and considered it a conspiracy of enemies (Aramesh 2024; Asadisarvestani and Sobotka 2023; Erfani 2017) to reduce the population of Muslims. Since Iran’s regime is an ideological regime based on the “Guardianship of the Islamic Jurist” many experts believe that the main concern of government officials is not the decline of the Muslim population or aging population, but the disruption of the Sunni-Shia demographic balance and the decrease in the number of Iranian Shiites in the coming years. Ideological governments gain their legitimacy from a belief system, duties are imposed on the people that everyone is obliged to do, and all the elements of the system are forced to defend it unconditionally, this also applies to Iran.

In this regard, the regime of Iran has approved a law entitle “The Rejuvenation of the Population and Protection of the Family” (RPPF) in order to increase the population, which has imposed many restrictions on couples and the general population, including: elimination of prenatal screening, criminalization and prohibiting physicians and health care providers from providing families with essential information about screening tests and encouraging screening, prohibition of sterilization procedures, such as male vasectomies and female tubal ligations, severe restrictions on access to contraceptives, cancelation of the “Family Planning Program” and “Therapeutic Abortion Act.” Iran’s Minister of Health, as the country’s highest health official, has threatened pregnant mothers that they will be prosecuted if they attempt to have an abortion (Independent Persian 2023), also the health care system is prohibited from providing any services to mothers seeking abortion. In the media, the government advertises early marriage and child marriage, the disadvantages of screening and even the benefits of having a disabled child, and by abusing people’s religious beliefs with slogans such as “child is a gift from God” in order to encourage couples to childbearing as an Islamic matter and divine. In addition to, the government is trying to childbearing and marriage with some incentive plans, including loans to buy or build housing, and some discriminatory plans, including priority in employment.

Despite the use of contraceptives by 80% of Iranian women (Erfani 2013), 25% of pregnancies are unwanted in Iran (Ebrahimzadeh et al. 2015) and unwanted births account for 20% of all children born in Iran (Hajian 2004) which shows most unwanted pregnancies in Iran lead to childbirth. On the other hand, only 1% of abortions in Iran are due to medical reasons and 99% are related to unwanted pregnancy (Fallah 2006). the RPPF can lead to increase in unwanted pregnancies and unsafe abortions, pushing pregnant mothers to get abortion drugs from the black market for a self-administered termination and resort to unqualified practitioners. Furthermore, the religious atmosphere of Iranian society and the public propaganda of the government media that abortion is illegitimate and sinful have also caused negative social judgment and aggravated the psychological consequences of abortion for mothers and exposed them to psychiatric disorders including: post-traumatic stress disorder, anxiety and depression. This situation applies more to female sex workers (FSWs), who are stigmatized and marginalized as criminals, sexual deviants and disease carriers and they are viewed as a threat to society’s values, and ultimately they have less access and desire to receive health, care and treatment services. Given the considerable burden of HIV among FSWs (Sajadi et al. 2013) and the intersection of HIV and reproductive health outcomes among FSWs through mother-to-child transmission of the virus, the RPPF makes their situation more fragile. Iranian health authorities have tried to prevent the spread of infectious diseases by sexual health education, HIV testing and counseling, distribution of free condoms and needles are available for FSWs, but the implementation of the RPPF can raise the alarm of the spread of infectious diseases in all sexually active members of society. Also it is estimated that there are up to 3 million thalassemia carriers in Iran (Madmoli et al. 2016) which can be controlled through screening, genetic counseling, prenatal diagnosis and termination of pregnancy (Modell 2020), but the RPPF will cause disruption in this field as well. The purpose of the government’s approval of Law the RPPF is to increase the fertility rate, but this law violates basic human rights and freedoms and interferes explicitly in the most private aspects of people’s lives, and is in complete contradiction to the principles of bioethics and weakens the foundation of the family. As a result, the RPPF destroys the efforts of the country’s health experts over the years and threatens the health of the entire society, and it leads to consequences such as: increase in the number of unwanted pregnancies and illegal and unsafe abortions, increase in the death rate of pregnant mothers, an explosive spread of infectious diseases including HIV, intensification in the birth of babies with genetic defects and congenital anomalies, especially in low-income families.

Iran is a country in a transition phase, where the lifestyle and ideals of the people, especially the young and women, are in conflict with the ideology of the government, that is governed by clerics and militarian who try to use women’s lives and bodies as a tool for political purposes, this contrast was well shown in the nationwide protests of 2022 year. The approval of the quasi-medieval laws has no other consequences for the people except health damage and creating a crisis. The approval of the RPPF continues the patriarchal view of the government toward the family, which considers the main duty of women to be housekeeping and motherhood, and has captured women’s bodies and wombs in the service of its ideology.

In conclusion, since the health and scientific bodies in the country are dependent and do not have the possibility to react independently and have continuously rushed to help the regime in stabilizing this ideology anti-health law, international health institutions, including the World Health Organization warn the policymakers about the health consequences of this law, so that they can stop this anti-health law before the health crisis engulfs the country.

Furthermore, since the health of women and members of the society is preferable to any ideological and political principle, the ideological view of health must be avoided due to its destructive consequences. Statesmen and religious authorities have to recognize the right of people to own their lives, bodies and health and services to prevent pregnancy and the spread of infectious diseases, prenatal screening, etc., should be provided in health care centers, and since the increase in population should occur in a safe and healthy setting from a health perspective, for this purpose, it is better to use evidence-based scientific approaches.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study received no specific grant from any funding agency, commercial or not-for-profit sectors.