Currently, over 75 percent of the rural population and 60 percent of the urban population of Iran are served by the established health network of the Ministry of Health and Medical Treatment and Education. According to the targets set in Iran’s Second five-year Development Plan (1994/95 – 1998/99), by 1999, the entire rural population will be served by the national heath network. The country’s basic policies in health include the following priorities and principles:

• Preventative measures are regarded as long-term investments
• Rural areas and remote corners have priority in the allocation of medical resources.
• Outpatient treatment is preferred to hospitalization.
• General health care services have priority over specialized services.

Contents:

1. Life Expectancy
2. Gender Ratio
3. Infant Mortality Rates
4. Maternal Mortality Rates
5. Sex Differentials in the Handicapped
6. Women and HIV
7. Specific Health Measures for Women
8. Population Policy and Family Planning
9. Health and Medical Care
10. Nutrition
11. Immunization
12. Existing Problems and Long-term Plans in the Implementation of Health Projects in Iran

As is the case with women in almost all parts of the world, Iranian women have a longer life expectancy than men do. Women’s life expectancy in Iran increased from 56.3 years in 1979 to 69 years in 1993. This trend is expected to continue because of expanding health and medical attention given to mothers and infants as a means of long-term planning and investment.

The population ratio between men and women in Iran has changed very little in the past fifteen years. Based on the latest census, the ratio was 106 men to 100 women in 1991.

Due to the extensive health measures and training in the past fifteen years, infant mortality rates have decreased significantly in Iran (Table 18).

4. Maternal Mortality Rates

Fifteen years ago, maternal mortality rates were very high, particularly in the rural community. The expansion of medical-care services in the past fifteen years has decreased maternal mortality rates significantly from the high figure of 245 per 100,000 live births in 1978 to the relatively low figure of 54 in 1993. Implementation of family planning programs for the control of population expansion has also done its part in decreasing the maternal mortality rate through lowering the number of births per woman during childbearing age.

In 1986, there were 285,339 handicapped males and 167,751 handicapped females in Iran. The higher sex differential for men is mainly attributable to injuries suffered during the imposed war, although men’s engagement in more hazardous jobs also contributes to this differential.

Fortunately, Iran is one of the safest countries in the world in regard to the scourge of AIDS. Religious beliefs and deep-rooted traditions have been the strongest safeguards against the spread of AIDS in Iran. Strict measures and screening of donated blood and blood products by Iran’s Blood Transfusion Organization, as well as training, the institution of precautionary measures and low incidence of addiction to illegal intravenous drugs can be cited as other factors which have prevented the spread of AIDS in Iran.

In 1989, the first HIV positive woman was identified in Iran. From that date until the end of December 1993, 272 HIV positive cases were identified in 1.4 million persons tested for the virus. Of the total 272 HIV positive cases, 33 were women. Eight of these infected women have been affected by the disease, of which, five have died. The first AIDS-related female death in Iran was recorded in 1990.

Until the establishment of the primary health care network in Iran, mortality rates for mothers and children were very high due to lack of coverage by medical care services. However, since the creation of the medical care network in 1985, the situation of mothers and of children under five, as major vulnerable groups, has improved significantly.

At present, according to existing data, the child mortality rate is much lower than the level that existed before the expansion of the medical-care network, mothers and children immunization rates have increased notably, the percentage of women using contraceptives has gone up, and prenatal care is on the increase. The population growth rate declined from 3.2 percent in 1984 to 2.3 percent in 1993, and further decreased to 1.8 percent in 1994, which is an indicator of the consistently improving condition of women and mothers in regard to fewer births. Meanwhile, women’s fertility rate, expressed in terms of number of births per woman, decreased from the high of 5.2 in 1984 to 4.6 in 1993 and to 3.6 in 1994.

Within a period of 90 years from 1904 to 1993, the population of Iran increased from about 10 million to over 60 million, which is reflective of the high population growth rates during this period. Nonetheless, the rates of population expansion were not constant during this time period. The highest growth rate was experienced between 1976 and 1986, when the annual growth rate reached 4 percent. Three major factors were responsible for this unprecedented growth rate:

• Noticeable decrease in infant mortality rates, brought about by improved health care services, particularly control of diarrhea diseases in villages and remote areas of the country.
• Laxity in family planning techniques and, at times, encouraging the birth of more children, factors that resulted in births per 1,000 to jump from 39 to 42.
• Arrival of immigrants and refugees from neighboring countries, particularly from Afghanistan.

Toward the end of the imposed war, the harmful effects of unchecked population growth on economic development were deeply felt by the government. The subsequent establishment of the High Council on Population Control and the activities of the Council in adopting measures against population expansion finally brought the annual population growth rate down to about 2.3 percent in 1993, and further down to 1.8 percent in 1994, as already indicated. A number of factors have contributed to the relative success of programs for population control in Iran among which are the serious consideration of the issue by government authorities, women’s willingness to use different methods of contraception and the availability of free government facilities and consulting services for all to pursue family planning.

In 1992, there were 22,000 general practitioners and medical specialists, 3,600 pharmacists and 4,500 dentists in Iran. Currently, there are 12,220 health houses and 4,000 health care centers in urban and rural areas. About 16,000 Behvarzes, stationed at the health houses, offer primary health services to the community. Approximately 50 percent of the Behvarzes are women. (A Behvarz is a selected young man or woman who is a native of the district. After receiving practical and theoretical training for two years, he or she is employed by the Ministry of Health and Medical Treatment and Education to serve at health houses established in his or her locality).

Planning for manpower development and training specialists are among the top priorities of the Ministry of Health and Medical Treatment and Education. The Ministry is giving particular attention to the training of women specialists in different medical fields, and as of 1993, not only are similar quotas being allocated to male and female students entering medical colleges, but also maximum quotas are considered for women specializing in the branches of medical sciences which deal with disease and medical problems of women, such as obstetrics and gynecology.

Another health scheme developed is the selection of volunteers among married women who, after completing special training courses, will be responsible for the establishment of contact between an urban health care and medical treatment center and 50 neighboring households. Among the specific responsibilities of these trained women volunteers are the supervision of the vaccination of the infants and children target groups and education on family planning, nutrition and environmental hygiene. The scheme has been successfully implemented in south Tehran and is now being expanded throughout Iran. One special feature of the scheme is the use of women for providing health services.

One specific indicator of improved nutrition of pregnant women is that at present, 92 percent of the infants born today weigh over 2,500 grams at birth. A further indicator of improved child nutrition is the percentage of infants who are breast-fed for a period of at least 12 months, which has increased from 65 percent in 1987 to 67 percent in 1993. Meanwhile, the percentage of children receiving supplemental food appropriate for their age has increased from 29 percent in 1987 to 56 percent at the present time.

There are a number of training, health and cultural programs to overcome women’s nutritional problems. Checking the population growth through family planning an important scheme which has met with considerable success in Iran is bound to enhance women’s nutrition directly and indirectly.

Increasingly the production of iodine-supplemented salt, administration of medicated iodine injections, and identification of hyper-endemic regions are some of the current measures being implemented to correct iodine deficiency in women. Other schemes being implemented to enhance women’s nutrition include training courses on nutrition, analysis of traditional and cultural practices in nutrition in different parts of the country and educational programs. In order to improve nutrition of school children, the Ministry of Education has recently started free nutrition programs in poverty-stricken areas.

Immunization against six diseases, which are controllable by vaccines, has expanded considerably and currently 85 percent of the population is immunized against vaccine-controlled diseases through routine vaccination. Details on immunization are presented in Table 17. Meanwhile, the successful campaign against polio, which began in April 1994, has paved the way for the eradication of the disease in the next years.

The following points outline the principal problems and the necessary long-term planning in areas of health and disease prevention:

• In spite of the existence of suitable investment and political support for national health and prevention of diseases, the successful accomplishment of such programs requires enhanced comprehensive support and assistance.
• Co-ordinated activities among different organizations and their focuses attention on health issues at all levels are necessary for the achievement of improved national health targets.
• Public support and people’s participation are necessary for the success of health programs and their implementation at the grass root level.
• More attention must be given to other important health issues such as nutrition.

Women should not be regarded as mere recipients of health services. It is absolutely necessary that women’s role is enhanced and they are regarded as the expediters in the provision of health priorities to their household in particular and to the society in general. Hence, more concerted efforts are required for the education of female children and adolescent girls as a long-term investment. In addition, participation of women at different levels of organizations that provide services up to important managerial positions will be of the utmost importance.