By Julie R. S. Fogarty
Julie R. S. Fogarty ’08, a Government concentrator from Dunster House, graduates from Harvard College this year.
The Greater Middle East has one of the highest population growth rates in the world, lower only than that in sub-Saharan Africa.  The regional rate has continued to accelerate over the past 60 years, from 2.64 percent per year in the 1950s to 3.1 percent per year between 1980 and 1992, the highest in the world at the time. Although the rate had dropped slightly to 2.79% by 2007, many people remain concerned.  Population growth has had enormous economic consequences, including extreme pressure on educational and health services and unattainably high demand for new jobs. In an attempt to alleviate these social pressures, which could in turn prompt political upheaval, Egypt and Iran have sought to curb population growth directly through family planning programs. Although both countries have committed vast resources through sustained programs, Egypt and Iran have exhibited “stop and go” family planning policies.  Although Egyptian programs have been supported by international aid organizations, Iran has seen a more dramatic decrease in fertility rates (and a corresponding rise in birth control usage) due primarily to its own, government-sanctioned family planning initiatives of the past 15 years.
Iranian Family Planning
Iranian family planning has gone through two dramatic transformations. First, in 1965, the government of Mohammed Reza Shah instituted a family planning program that stressed the “supply side” of fertility rates: the availability of contraception.  For the first time, the government created educational and promotional campaigns endorsing contraception as a means to stem population overgrowth and improve the standard of living of Iranian families. Likewise, the Shah’s government encouraged women’s participation outside the home, granted women the right to vote, and reformed the Family Protection Law. The results were dramatic and immediate. In the ten years following the new policies, the Iranian average growth rate fell from 3.1 percent to 2.7 percent and hundreds of thousands more women began to use contraception.
However, the 1979 Islamic Revolution, led by the Ayatollah Khomeini, fundamentally changed the nature of Iranian society. Khomeini established an Islamic state, reversing many of the gains made in the area of women’s rights under the Shah and dismantling the family planning program.  In stark contrast to the previous policies, Khomeini nurtured a pro-natalist policy as a result of his religious outlook and his desire to usehigh birth rates as a strategic threat in the Iran-Iraq War (which began in 1980) and other conflicts. Islamic leaders publicly proclaimed that a woman’s first priority should be marriage and children. Subsequently, the government reduced the availability of contraceptives, lowered the legal age of marriage, dissolved the Family Planning Council, and provided subsidies for larger families.  These changes raised the growth rate to 3.4% and created a growing demand for food, health care, education, and employment. 
Changes within the Islamic Republic of Iran during the late 1980s altered the previously stringent pro-natalist policy. The 1986 national census served as a “wake up call” to family policy planners, underscoring the growing economic and social crisis. The end of the war with Iraq in 1988 and Khomeini’s death in 1989 provided the impetus for further change.  In 1989, the Ministry of Health announced plans for a new family planning program with three major goals: encouraging women to space their pregnancies, discouraging pregnancy for women not between the ages of 18 and 35, and limiting family size to three children.  Furthermore, sterilization for both sexes was legalized in 1990.  The program was endorsed by the country’s High Judicial Council, which declared that “Islam does not pose any barrier to family planning.”  In 1993, the government went a step further by restricting maternity leave and compelling the Ministries of Education, Health and Medical Education, and Culture and Education to incorporate information on family planning. 
The Iranian government has promoted these family planning initiatives through the state-run television and media, emphasizing the link between overpopulation and poverty, illiteracy, and unemployment.  The media encouraged the use of contraceptives, which were provided free of charge on demand, and legal reforms were made in favor of women.  Interestingly, religious leaders endorsed the program, directing all religious authorities to support family planning because it was initiated by the Islamic government.  Religious leaders now describe smaller families as a social responsibility.  In addition, the majlis, the Iranian parliament, voted to support the program. As a result, the number of women using contraceptives has nearly doubled from 37 percent in the 1970s to 65 percent now, although urban women are more likely to use them than rural women are. 
Moreover, the population growth rate sharply declined to 2.5 percent between 1986 and 1991 then to only 1.2 percent in 2001, one of the fastest declines on record.  In only 15 years (from 1985 to 2001), Iran’s total fertility rate dropped from more than births per woman to fewer than 3.  From 2000 to 2005, Iran’s average fertility rate was 2.53 births per woman,  and the United Nations predicts that it will drop to 2 births per woman (replacement level) by 2010.
Egyptian Family Planning
Egypt’s family planning programs have followed a similarly unsteady course. Debated by Egyptian social scientists since the 1930s, Egypt’s high population growth became widely viewed as an acute problem in the 1960s, when the government acknowledged the serious economic and social problems associated with it. The government soon established the National Family Planning Program as one response to the economic problems.  Yet, the program languished in the 1970s as President Anwar Sadat adopted the slogan “Development is the best contraceptive,” and focused on economic development. He also yielded to Islamists’ pro-natalist views in an attempt to gain their political support against the pro-Soviet left. 
Following Sadat’s assassination, new Egyptian President Hosni Mubarak rejuvenated the family planning program and established the “National Strategy Framework of Population, Human Resource Development, and the Family Planning Program,” which promoted contraceptive use by married women.  From 1980 to 1992, the government, pressured by donor agencies like USAID, began to focus on expanding and strengthening family planning service delivery in both public and private sectors. These efforts doubled contraceptive use from 24 percent in 1980 to 50 percent in 2000, and reduced the total fertility rate from 5.3 births per woman to 3.5 births per woman in the same time period. 
Yet, the total fertility rate has remained at around 3.5 since 1995, a curious fact that one researcher attributes to upper and middle class Egyptian women. Although these groups drove the decline at the beginning, their fertility rates have since leveled off because of an increase in the level of fertility within marriage (which is offset by a higher age of first marriage).  Interestingly, while total fertility has remained stagnant at 3.5 among upper classes in the last decade, it has continued to decline among poorer women, moving from 5.02 children in 1988 to 4.03 children in 1995, and further to 3.62 children in 2000. Thus, while wealthier women still have lower total fertility rates than poorer women, the gap is steadily narrowing.
Although they took different paths, by the end of the 1980s both countries had made strong commitments to curb rapid population growth with family planning programs. The dire economic crises experienced by both Egypt and Iran in the late 1980s made both countries increasingly willing to support the distribution of contraceptives and economic conditions played a crucial role in the reintroduction of family planning programs later on.  Despite these similarities, the programs also exhibit several important differences.
First, the Egyptian program received significant aid from international donor organizations such as USAID. USAID pressured the Egyptian government to introduce family planning programs throughout the late 1970s and early 1980s, and providing millions of dollars ($87 million from 1977 to 1983) in funding to Egyptian organizations that supported USAID’s emphasis on training personnel and promoting the use of intrauterine devices (IUDs).  IUDs and permanent devices such as Norplant (a birth control device implanted in the upper arm that lasts for five years) rank as the most popular methods of birth control in Egypt. These contraceptives are distributed in Ministry of Health facilities by trained professionals and were widely encouraged by USAID members who were concerned that women would not use birth control pills correctly. 
In contrast, Iran developed its family planning program independently. As one of the world’s largest oil exporters, it had the financial security to avoid dependence on international aid organizations.  Thus, the Iranian government has funded the creation of a comprehensive health network throughout the country, in which “health houses” include family planning as an aspect of primary care (thus removing the stigma).  Furthermore, the government covers 80 percent of family planning costs and provides various contraceptives (including condoms, pills, and sterilization) free. The country is the only one in the region with a government-sanctioned condom factory. Consequently, Iranians tend to use oral contraceptives like “the Pill” and condoms rather than IUDs. Additionally, men have an increasingly active role in family planning. Iran is the only country in the Greater Middle East that requires a couple to complete a class on contraception before receiving a marriage license, and vasectomies are becoming more common.
Despite the aid and influence of international organizations like USAID and the International Monetary Fund, the use of contraceptives in Egypt is less widespread than in Iran. In 1995, only 48 percent of married Egyptian women were using contraceptives, compared to 70 percent of Iranian women.  In both countries, urban women use contraceptives at a far higher rate than rural women (most likely because of higher education levels and employment rates).  In Egypt, the divide between the rural fertility rate of 4.2 children per woman and the urban fertility rate of 3 children per women can be largely attributed to the fact that rural women must travel to receive IUDs from trained professionals or pay for expensive private services.  Although Iran also exhibits a divide between rural and urban contraceptive use, the gap is narrowing because of the country’s extensive network of health clinics in rural areas, and presumably, the easy and free access to contraceptives. 
Finally, the religious views of the predominantly Muslim population of both these countries influence women’s decisions about contraception. Contrary to popular belief, Islam does not forbid contraception.  Yet, because Islam teaches that a woman’s sphere is the home, and that children are the major source of her value, Islamic women are often pressured to forgo contraception.  Because of these potentially restrictive social norms, the Iranian religious leadership’s support of contraception was an important element to that country’s campaign. On the other hand, the Egyptian Muslim Brotherhood, a banned Islamist organization, condemned family planning initiatives as “a Western conspiracy to limit the number of Muslims,” and Islamic media sources have also criticized the program. 
In addition to encouraging the use of contraceptives, both Iran and Egypt have supplemented their family planning programs with female education initiatives and improvements in health care, which are also likely causes of a decrease in fertility. As Iran and Egypt demonstrate, a comprehensive family planning program backed by the government, media, and religious leaders can lead to dramatic decreases in population growth and fertility rates, which are widely understood to relieve pressure on the economy. Although Egypt and Iran have made large gains since the 1980s, many issues, such as the discrepancy between urban and rural contraceptive use, remain. Furthermore, the growing influence of Islamic fundamentalist groups in Egypt and the resurgence of religious fundamentalists in Iran may the trend of the past two decades.
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