Reproductive Health in Iran: International Conference on Population and Development Goals

   Katayon Vakilian,1 Khadijeh Mirzaii,2 Najm Abadi2  


  DOI 10.5001/omj.2011.36  
From the 1Department of Reproductive Health, Medical Sciences of Shahroud University, Shahroud, Iran; 2Medical Sciences of Shahroud University, Nursing Medwifery College, Shahroud, Iran.

Received: 25 Oct 2010
Accepted: 20 Dec 2010

Address corespondence and reprints request to: Dr. Katayon Vakilian, Department of Reproductive Health, Medical Sciences of Shahroud University, Shahroud, Iran.

How to cite this article

Vakilian K, Najm Abadi KM. eproductive Health in Iran: International Conference on Population and Development Goals. Oman Med J 2011 March; 26(2):143-147.

How to cite this URL

Vakilian K, Najm Abadi KM. eproductive Health in Iran: International Conference on Population and Development Goals. Oman Med J 2011 March; 26(2):143-147. Available from


The International Conference on Population and Development (ICPD) held in Cairo, 1994 by 184 countries to recognize the need of population issues in a different way. Previous discussions were emphasized on the effect of population growth with regards to failures of development  and poverty  along with its role in environmental deterioration.

The ICPD in 1994 established a "new paradigm" in population policy with a shift from focus on effect of population growth to human rights. Demand is growing in developing  countries for sexual and reproductive health programs for young women. They may face a different reproductive health risks such as sexually transmitted infections (STIs)  including HIV  infection, too- early pregnancy and  unintended pregnancy, often leading to unsafe abortion and its complications. Sexual and reproductive health is a human right and essential to human development to achieve the Millennium Development Goals, particularly those concerned with child and maternal health, HIV/AIDS and other communicable diseases, and gender.1-3

Five priority aspects of reproductive and sexual health targeted in the 57th World Health Assembly (WHA), targeted; improving antenatal, delivery, postpartum and newborn care; providing high- quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynecological morbidities; and promoting sexual health.However, little scientifically based evidence exists about which program approaches are most effective in shaping healthy behaviors. The Islamic Republic (IR) of Iran was  successful in some of the reproductive health domains which  are discussed in this report.

Evolution of Iran’s Reproductive Health

Family planning was considered on the international agenda in ICPD conference in 1984. The target for family planning in Iran is family health promotion, and specific  program followed up three goals; preventing  very early pregnancies, spacing between pregnancies by three-year intervals and encouraging women not to have more than three children. As a result, family planning programs  have given rise to increasing contraceptive prevalence.5 The statistics show that the Contraceptive use rate has increased from 49.9% in 1989 to 73.8% in 2000.6

Planning Studies and United Nations in Islamic Republic of Iran (2004) stated that family planning services established  by the Government provide a free of charge service for contraceptive methods (pills, IUD,  condoms, injections,  tubal  ligation, no scalpel vasectomy) throughout the Public Health Center (PHCs) network. In remote areas, these services are carried out through mobile clinics.

According to the Iranian ministry of health, the country’s total fertility rate declined from 5.6 births per woman in 1985 to 2.0 births in 2000. Iran’s fertility decline is particularly remarkable in rural areas. Between 1976 and 2000, the total fertility rate in rural areas declined from 8.1 births per woman to 2.4 births per woman. The fertility of urban women declined from 4.5 births to 1.8 births per woman during the same period.

Statistics show that the decline in fertility has mainly been due to the increased use of contraception among married women from 37% in 1976 to 74% in 2000. The change in marriage patterns has also affected fertility; women’s average age at first marriage has increased from 19.7 in 1976 to 22.4 in 1996.7,8 Although the family planning and safe motherhood programs have been successfully implemented in the past years, there still remain challenges. For instance, the unresolved need for family planning is estimated to be 8%.9 Using the traditional method is rather high. 

On the other hand, quality of premarital consultation should be improved.  Another  aspect of family planning program is promotion of maternal health. Reports have shown a reduction of maternal mortality ratio by ¾ (three-quarters) between 1990 and 2015, which is the target of the MDG program. Maternal health was valuated by maternal mortality ratio.10

The Ministry of Health and Medical Education of Iran (2004) and WHO  (2005) pointed that the maternal mortality ratio per 100,000 live births has dropped sharply to 37.4 deaths in 1997 from 91 deaths in 1989 to 26 deaths in 2005 in Iran.11 Iran’s family planning program is one of the most successful throughout the world.6

Combating HIV/AIDS

The Board of the United Nations Development Program and the United Nations Population Fund (2004) showed that there were 700,000 reported cases of sexually transmitted infections (STIs) in 2003, and more than 30,000 people are estimated to be living with HIV/AIDS in Iran. The prevalence of HIV/AIDS in the general population is less than 0.1%, and the prevalence in the 15-24 age group estimated at less than 0.01%. On the other hand, the prevalence among high-risk groups such as intravenous drug users is much higher, over 1%.12

The office of the Deputy for Social Affairs of Iran (2004) pointed out that while the prevalence of HIV/AIDS among 15-24 year old pregnant women reported cases was zero in 2003, the prevalence of the condom use rate by married women (15-49) was9.3% in urban and 5.4% in rural areas in 2000. The total number of registered HIV/AIDS infected cases in Iran was calculated to be 7,510 by late September 2004, and reached 20,130 in 2009.13 Injecting  drug users accounted for 60.8%  of all HIV  cases reported to the Ministry of Health and Medical Education, and 94.8% of the reported cases were men.14 Injecting drug use (57.4%) is the most common way of transmission and responsible for the spread of HIV/AIDS in the country and the next common mode (6.8%) is sexual transmission. There three major factors that affect HIV/AIDS spread in the country are; human trafficking for sex in neighboring countries to the north of Iran, narcotics smuggling through  eastern countries  to  Iran,  and  extra-marital sexual behaviors.11

Adolescent Reproductive Health

The Population Action International (PAI) (2002) stated that Iran had implemented national governmental programs on young people's  sexual and  reproductive  health, such as compulsory premarital counseling programs for all couples wanting to marry.15 This  program also provides  a  useful model that  would be culturally acceptable in other countries of the region.16  Although this program was very good, but for adult people it was very late because studies show that sexual behavior initiates very soon and before marriage.17 In the past, there was no formal reproductive and sexual health in schools in Iran,  because such program for young people was a taboo in schools, health units, and even amongst families. Generally, people believed that such programs and discussions have negative effects on the youth and encourage sexual risk behavior. Therefore, the youth were at risk of STIs, HIV/AIDS, and unwanted pregnancies.

Fortunately, IR Iran agreed to teach adolescents health and even sexual health as a result of negotiation between academics and religious leaders in New York ICPD+5 1999, provided that its content is suitable on youth conditions is done with parental supervision. A number of  educational programs have  been developed  and  executed providing  information on  adolescent health, family planning, STD, HIV/AIDS, and even sex issues to girls and boys based on their age and understanding. These programs are welcomed by families and the authorities.18 Due to the sensitivity of adolescent reproductive health, efforts are being delegated to  formal and no formal education channels such as Parents/Teacher Associations. This channel seems to be appropriate and culturally accepted, though it should be further strengthened. Couples receive information on reproductive health, family planning, sexually transmitted infections, safe pregnancy and delivery, as well as referral procedures in case of any complications.9

Management   of  Unsafe   Abortion and  Sexually  Transmitted Infections

It is estimated that 100,000 young women resort to illegal or induced abortion every year worldwide.16 Another study stated an estimated 73,000 abortions per year, according to a recent analysis of nationally representative data. Because abortions are difficult to obtain in Iran and are often performed illegally, accurate data on the procedure's incidence are unavailable.19

The  Statistical  Center  of  Iran  (2000-001)  pointed  out that abortion is illegal in Iran, except to save the mother’s life,7 and termination pregnancy related to  fetus malformation or retardation, but post abortion care is provided as part of primary health care.20

The Office of the Deputy for Social Affairs of Iran (2004) stated that information on illegal abortion is inadequate. The Ministry of Health and Medical Education (MOHME)  believe that  high-quality counseling together  with  reliable, effective, modern contraceptive methods will reduce the number of unwanted pregnancies, and hence illegal abortions. On the other hand, there is a shortage of data on the prevalence of STIs due to a lack of reporting, especially from the private sector clinics. The Government supports free provision of condoms for unmarried clients and no charges should be imposed in STI clinics.9 But it seems that this service is very weak for adolescents and teenagers, because there are insufficient trained health workers to provide this service and the service delivery is usually a few hours when the pupils are at school. More programs should stress the importance of abstinence of sexual behavior pre-marriage. There is insufficient statistical data on pre-marital relationships  and it is better to focus on these issues because a significant portion of the Iranian populations are young.


Every year, an estimated 210 million women suffer from pregnancy complications, often leading to serious disability, and a further half a million women die as a result of pregnancies worldwide. Three million babies die in the first week of life and about 3.3 million infants are stillborn every year.21,22

More than 120 million couples have  an unresolved  issues concerning contraception,23  and 80 million women have unwanted or unintended pregnancies each year, 45 million of  which are terminated.24  WHO  (2000) reported that of these  45 million abortions, 19 million are unsafe, 40% of them are done on women aged under 25, and around 68,000 women die every year from complications of unsafe abortions.25 WHO (2000) also reported that an estimated 340 million new cases of four common sexually transmitted bacterial and protozoa infections are acquired each year, at least a third of which affect people under the age of 25.26 Such infections contribute to the global problem of infertility, which affects  more  than  180  million couples in  developing countries.27

Nearly five million new HIV infections and 257,000 deaths from cervical cancer are reported each year.26,28 The risk of physical and sexual violence is thought to be between one in six women, which is a risk factor for many of these sexual and reproductive health problems.29  The honor victory of the Islamic Revolution (1979)  particularly in the  last decade has  taken major steps in  health  status, especially reproductive  health. The  highest population rate (4% a year) occurred  between 1967 and 1986, when the government faced great demands for food, health care, education and employment. Therefore, they decided to implement the population and family planning program in the government's five-year development plan.30

Some of the well-known political and religious figures in the country advocated having more children, to increase the population of Muslims but, after the war in 1988, the Plan and Budget Organization alerted head government leaders that the nation’s resources could not  support the  high cost of reconstruction, hence the Population and Development congress held in Mashad September 1988 by the ministry of health and medical education emphasized the importance of family planning and long discussions with  religious leaders and  policy makers convinced  them  to implement family planning programs in IR Iran. The program was approved by Ayatollah Ruhollah Khamene'i,  which meant that there was agreement from both the top religious leaders and the policy makers. This also ensured acceptance of family planning by the people of Iran from the point of view of religion.30-33

Furthermore,  after  the  revolution,  public health  systems rapidly improved. In Iran, public health systems consist of three levels, namely;  District, Regional and National levels. Executive units such as health houses and Rural, Urban Health Centers, and District Hospital, as well as District Health Directorates are located at District levels. In the Regional  level, the chancellors of the Universities of Medical Sciences supervise the activities in the district level. While at the national level, the Ministry of health and Education is in charge of policy-making, planning, goal setting of health lead and supervise the activities of the lower levels. Nowadays,  in rural areas, the government has established
1500 health houses, and more than 4000 health centers in rural and urban areas,32,33  which offer PHC  services, family planning and reproductive health free of charge. Each health house serves around 1,500 people, usually covering the people of one central village and those of satellite villages, who are within an hour’s walk from the central village. Each health house is generally controlled by health providers, entitled as Behvarzes, who are trained for two years.34

The other successful program related to the health development program  is  curriculum of  population  and  family planning education at all levels for university students. In public education, couples who are planning to marry must participate in consultation of  family planning  classes before  receiving  their  marriage certificate. The program’s goal is to increase male involvement and responsibility in family planning.31 Empowerment of women such as promotion of education at all levels, women’s participation in all areas of social life, women’s active involvement in the health sector, are considered another important aspect of the overall policies of the Iranian Government,  which have contributed significantly to the success of the policy on family planning.34

On the other hand, the Islamic Republic of Iran has created a program for HIV  prevention, care and support for injecting drug users, such as clinics for HIV prevention. A large number of triangular clinics providing services deal with drug users, sexually transmitted  infection services,   and  care/support  for  people living with HIV/AIDS.  Needle syringe programs, Methadone maintenance treatment in order to reduce the harm related to injecting drug use and education to prevent the spread of HIV/ AIDS have been implemented in triangular clinics.14

The Islamic Republic of Iran  has successfully met many of its commitments under the program of action of the International Conference of Population and  Development.35,36 However,  a national strategy is needed to reach reproductive health-care goals.7,8  Since 50%  benign young age-group  (<17) in Iran's population pyramid, supplying reproductive health is a fundamental strategy for the Iranian people, which is a point of consideration also mentioned by United Population Fund.37,38

It seems that advocating policy such as distributing modern contraception free of charge for couples, information/education/ communication programs (IEC), and empowering women are important  factors for the  accomplishment of positive  quality of family planning in Iran.10  In terms of maternal health,  five major reasons directly affect the decline in maternal  mortality including; decreased fertility rate, an increase in late marriages and childbirths, improved rural women’s  literacy,  better access to emergency health (especially obstetric)  services,  and a broad availability of maternal and childbirth care due to expanded health networks and centers.

For instance, the contraceptive prevalence rate jumped from 49.6% in 1989 to 73.8% in 2000. Moreover, the adolescent (15-19) fertility rate almost halved from 54 children per 1000 women in 1996 to 26.8 children per 1000 women in 2000. Furthermore, increasing literacy of women plays an important role in improving maternal health because liberate women postpone childbearing and increase the gap between children.

Another  cause which reduced maternal mortality is  the accessibility of network service through the establishment of nearly 12,000 (15000 or 12000) health houses and 4,000 health centers. At the present time, health care networks cover 75%  of rural villages and most of the urban areas.39  The office of the Deputy for Social Affairs of Iran (2004) reported that to further create a comprehensive national system to prevent maternal death requires an appropriate establishment or system to monitor maternal care programs, which is an important matter. Also, the proportion of births assisted by skilled attendants has increased from 70% in 1989 to around 90% in 2000.

HIV  programs, combating narcotics smuggling, education attainment and  accessibility to  knowledge around  HIV  also have an important role in HIV prevention. On the other hand, international development cooperation to face the challenges are equally important.9 Iran will consolidate its efforts to  promote culturally sensitive training on gender and reproductive health in  schools, particularly with  regard to reproductive   rights. Regarding adolescent reproductive health access to information and educational programs in schools, universities and premarital classes also play a pivotal role in achieving adolescent health goals.


While the country has gained significant achievements  towards ICPD targets, it still faces notable challenges which need systematic efforts in order to attain the recommended targets by 2015. Some of the recommendations include:

  1. Improving the role of NGOs in service provision  particularly when there is insufficient supportive policy on reproductive health.
  2. Improving  community-based programs and participation of all people would be effective. Male involvement in reproductive programs is vital.
  3. Developing  teenage-friendly and  male-friendly services   is recommended to help accomplish reproductive health as earlier as possible.
  4. The need to combat AIDs is an important priority and consists of; (a)  Introducing new methods of  identifying HIV-positive people, (b) Establishing a comprehensive  data bank on HIV/ AIDS Surveillance, (c) Modifying cultural and legal approaches that adversely influence the spread of HIV/AIDS, (d) Establishing regional cooperation with the aim of preventing drug trafficking, and (e) Providing high quality Anti Retro-Viral medicines (ARVs) and Rapid Diagnostic Kits at a low price to those who need it.
  5. Establishing surveillance   systems  for  sexual transmission (Diagnosis, counseling and treatment) and promoting prevention of sexually transmitted infections.
  6. Quality assurance systems for assessing comprehensive quality public health centers.
  7. Eliminating unsafe abortions and providing comprehensive care for women who seek abortions; safe abortion services where legal and post-abortion  care everywhere, including counseling on family planning to help avoid repeat abortion.


The authors reported no conflict of interest and no funding was received on this work.


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