Some might be surprised that Iran’s family planning program has been pointed to as a success story over the last few decades. While it was by no means perfect, the national family planning program that took root in the 1990’s provided widespread access to contraceptives for married women. Under that program, university students were required to take a course on population and family planning and government-sponsored family planning classes were mandatory for obtaining a marriage license. Modern contraceptive methods were available free and on-demand at public health clinics.
During this time, the government family planning program actively worked to eliminate doubts about the acceptability of sterilization under Islamic law. In 1990, the High Judicial Council declared that the female and male sterilization were not against Islamic principles or laws.
In recent years, however, the government has rolled back its national family planning program in favor of financial incentives for more children. This week, the government decided to restrict access to sterilization as method of family planning and prohibit advertising family planning methods. With such a successful family planning program and pro-natalist policies already in place, why make such a drastic change now?
According the New York Times article, “Iran: Permanent Contraception Through Surgery is Outlawed,” the decision was prompted by concerns of the potential for population decline. In the mid-1970s, a woman in Iran would have 6.49 children on average. By 2006, that number had dropped to 1.89 children per woman. Countries need a total fertility rate of 2.1 children per woman to keep the population stable.
However, providing meaningful access to contraceptive information, services and supplies should never be driven solely by population considerations. Reproductive autonomy—the ability to decide if and when to have children—is a human right. And part of ensuring that right is allowing women to choose the contraceptive method that works best for them. Globally, female sterilization is the most popular method of family planning. As of 2002, it was the method chosen by approximately 15 percent of contraceptive users in Iran.
The ability to exercise reproductive rights contributes to other improvements in health and development. Between 1990 and 2010, Iran’s maternal mortality ratio fell from 120 to 21 maternal deaths per 100,000 live births. The infant mortality rate dropped from 44 to 17 infant deaths per 1,000 live births over the same period. Countries cannot rely on population decline as an acceptable rationale to restrict access to modern methods of contraception, while ignoring the other health gains to which family planning contributes.
As of 2013, 26 countries around the world had negative or zero population growth. To date, several of these countries have attempted incentive-based pro-natalist policies, typically to encourage couples to have more children. While Iran is not known as a global trendsetter, this decision raises concerns over future pro-natalist approaches.
Governments should not restrict reproductive choice as a result of arbitrary opinions about family and population size. Women and men who are happy with their family and want to limit future childbearing should be able to choose their contraceptive method, including sterilization, no matter where they live.