Iran’s Population-Control Programs Are User-Friendly

TEHRAN —  Jalal Shahpasand, a tall, husky restaurateur, waited until after dinner and the chaperons had gone off to watch television. After courting “the lovely Jila” for a year, he was ready. So he took her hand and softly asked, “Will you marry me?” Jila nodded.

Javad Goudarzi, a handsome plastics worker with a thick mustache, chose the traditional route to marriage: family arrangement. When he met 19-year-old Theahereh the first time, he decided that she was the girl for him. A week later, the proposal was relayed from his parents to her aunt and then to Theahereh. Back through the same route, she accepted.

And so the two couples ended up in a whitewashed health clinic classroom last week, waiting for something even more important in Iran than a marriage license: a slip certifying that they had passed the nation’s family planning course.

No one gets married without it.

The course is just one aspect of an ambitious campaign to stop what had become one of the world’s biggest population surges--one that had almost doubled the number of Iranians since the 1979 Islamic Revolution, from 34 million to 63 million today.

The numbers shot up after the new religious government in the late ‘70s urged Iranian women to breed an Islamic generation. Aided by a lowering of the marriage age to 9, they more than complied.

By the early 1980s, the population growth rate had reached 3.2%, according to Iran’s Health Ministry. International agencies pegged the rate at up to 3.9%, among the world’s highest. The U.S. rate is 0.9%.

Either way, the government--aware of the costs of such a large population--is spending millions of dollars a generation later to reverse the trend.

It seems to be working. When the instructor asked how many children each couple plans to have, Jalal and Jila, who together have seven siblings, said, “One.” Javad and Theahereh, who have 13 siblings, said, “Two.”

Nationwide, the population growth rate is now down to 1.41%, Iran says. And the fertility rate has dropped to such a staggering degree that wary demographic experts are helping to expand the database and sampling techniques.

Country’s Campaign Wins Global Praise

Nonetheless, Iran’s campaign has won worldwide praise. Population groups cite it as a model for developing nations and the Islamic bloc. And Washington-based Population Action International bestowed its highest commendation on Iran’s program.

Its strength may be its imaginative initiatives.

Abbas Farsi, a diminutive truck driver with the first strands of silver in his hair, showed up early at the “No-Scalpel Vasectomy” clinic in south Tehran last week for the 10-minute procedure--and the 30-minute video showing a vasectomy and answering the most-asked questions, plus personal counseling.

“We have two children, and we want to give them a good education, so it was time to make sure we didn’t have any more,” he said.

Farsi’s procedure was one of about 3,500 annually at the facility, which in turn is one of dozens of permanent and mobile clinics in Iran. All are free.

In fact, from Norplant to condoms, IUDs to the pill, and including both male and female sterilization, birth-control products are free to all takers in another aspect of Iran’s program.

In the process, sex has come off the list of taboo subjects in the Islamic Republic.

In health rooms set up in all factories, in schoolrooms, in mosques during Population Week in July, in widespread media coverage and in a blanket advertising campaign that includes billboards and water towers, family planning is widely discussed.

The ruling clerics have even issued fatwas, or religious edicts, approving it.

Among them is one from Iran’s supreme leader, the Ayatollah Ali Khamenei.

“When wisdom dictates that you do not need more children,” he proclaimed, “a vasectomy is permissible.”

Theahereh’s father, who escorted the young couple to the class, volunteered that he had a vasectomy in 1996. At the clinic, where a green line was originally painted from the front door to the vasectomy counseling room so embarrassed men would not have to ask directions, several men discussed their sex lives without hesitation.

“Vasectomy is much better than withdrawal,” said Mohsen Rezaie, a 29-year-old bus company employee and father of two who had come in for a checkup. “And it’s improved rather than hurt our relations, as I feared.”

Chief surgeon Fereidoun Forouhary added: “It liberates sex life.

“We give each man the two tiny pieces . . . cut out [through a tiny abdominal puncture] and ask him to show them to his wife, who will be very happy and love him even more because he has done this for her health.”

Vasectomies a Hot Topic

About 40% of all vasectomies now are referrals from family members or friends who had the procedure, indicating that the subject is a hot topic, said Forouhary, who keeps a photo album of well-known patients who bring in referrals.

One is a turbaned Muslim cleric who escorts a couple of friends or colleagues weekly.

The other most effective way of pulling in patients is advertising the no-scalpel technique in big white letters on the blue water tower that rises high above the clinic.

“The numbers doubled almost immediately,” Forouhary said.

The family planning program, often referred to as Tehran’s “other revolution,” coincided with the end of the 1980-88 Iran-Iraq War and with broader societal openings as the revolution began to settle down. It also represented a new streak of pragmatism among the country’s Shiite Muslim clergy.

Aware that even with its oil wealth Iran would soon not be able to feed, clothe, house, educate and employ the burgeoning numbers, religious leaders, health experts, government officials and academics held a summit to figure out what to do. Simply providing birth control was not enough, they agreed.

By 1990, the Fertility Regulation Council was established. By 1993, new laws withdrew food coupons and subsidized health insurance after the third child. And then came the array of programs, which, unlike India’s sometimes coercive tactics, are user-friendly, outside experts say.

Prenuptial Class One of Early Steps

The two-hour prenuptial class was one of the first steps in 1994.

“At first we used the trick of requiring couples to take the course,” said Safieh Shahriari, a female gynecologist and senior family planning expert in the Health Ministry. “But after a year or two, we found most couples wanted to take the course. It’s a place to ask questions at exactly the time they need answers.”

In the clinic classroom, instructor Abol Faz Mohajeri offered no-nonsense guidance.

“What’s the goal of getting married?” he asked the betrothed couples.

The answers varied from having an independent life and completing the human experience to fulfilling the prophet Muhammad’s message.

“Yes,” said Mohajeri, adding what the others won’t say: “But it’s also about having regular sex.”

He then explained the various environmental consequences of overpopulation and did an explicit show-and-tell of birth-control devices.

“And what do you want from God?” he continued. Jila responded that she wants healthy children.

“Yes, that’s right. It’s not important whether boy or girl,” he offered.

Iran’s program has emphasized gender equality to prevent the problem of male preference found elsewhere in Asia.

Pregnancy Before 20 Not Recommended

Despite Iran’s marriage age, which family planning experts here want to return to 15, the program also stresses that pregnancy before age 20 is not recommended. An accompanying pamphlet shows caricatures of a young teenager and an old woman at full term.

Later, Mohajeri, who has a degree in family planning, surveyed the couples to find out what they know and the birth-control means they are considering.

Amid a lot of blushing and vague descriptions like “male things,” Mohajeri gently encouraged them. “Don’t be afraid to name these things. That’s why we’re here.”

To reach blue-collar workers, who have the lowest participation in family planning, the Islamic Republic has set up education workshops in factory health rooms, which are also distribution centers for free contraceptives.

Nationwide, Iran holds its annual Population Week, which coincides with the U.N.-designated Population Day on July 11. All segments of society are engaged.

“We ask religious leaders to tell people, when they are praying, about the effectiveness of population control in dealing with social and economic development,” Shahriari said. “Other Islamic countries are often surprised at how the religious leaders support us.”

During the week, elementary through high schools focus on population issues in environmental classes developed jointly by the Health and Education ministries. To encourage media coverage, Iran’s program offers free trips for the largely Tehran-based press to Isfahan and Shiraz, the historic centers of famed Iranian poetry, art and architecture, to cover family planning activities.

Female Volunteers Recruited as Advisors

Year-round, Iran also recruits female volunteers who act as neighborhood advisors about family health and planning techniques. The approach varies.

“If neighbors are just starting a new life, a volunteer tells them about nutrition, cancer screening and care. For a family with four children, she might tell them about vasectomy and the benefits of population control, Shahriari added.

The vast majority of the 35,000 volunteers are in urban areas. They, in turn, train friends to spread the word.

To reach remote mountain villages and rural tribal areas, Iran has 80 mobile teams, which have evolved from health workers who consulted on contraceptives to medical units--surgeons, anesthesiologists, lab technicians and nurses--that now travel by four-wheel-drive vehicles or helicopters to perform vasectomies or tubal ligation.

As a Muslim country, Iran has had some unusual problems to deal with along the way.

“Norplant, for example, can cause some bleeding, and Muslim women can’t pray when they’re bleeding. So people don’t like it,” Shahriari noted.

And the system still has serious glitches. Despite pervasive family planning options, about 33% of pregnancies are still unwanted by one or both partners, a recent government survey shows. And among unwanted pregnancies, 35% take oral contraceptives, indicating that they are misused or not understood.

But even success does not eliminate the dangers. Even if the government meets its objectives, Iran’s population is still projected to reach 90 million in less than 25 years.