Study | Iranians Have Abortions, Too

[ dispatch ] New analysis published in the journal International Perspectives on Sexual and Reproductive reveals that despite severe legal restrictions, abortion is common in Tehran. This should come as no surprise to anyone, as evidence shows that abortion is common worldwide, even where outlawed. Mere incidence does not equate to news.

What is interesting about these new numbers for Tehran, however, is how the city's abortion rate compares to those of nearby countries. Amir Erfani, the sociologist at Nipissing University in Ontario, Canada, who conducted the study, compared Tehran to selected Central Asian and Eastern European countries and found the city's rate of about nine in 100 pregnancies ending in abortion to be lower.

Why? One answer is Iran's high rates of contraceptive use. Erfani estimated Tehran's abortion rate by looking at responses from nearly 3,000 women who completed the Tehran Survey of Fertility. A full 85 percent of those women reported using a method of contraception. Fifty-four percent used modern methods, like condoms and birth control pills and male and female sterilization; the remaining 31 percent relied on traditional methods, like withdrawal.

Erfani estimates that 11,500 abortions take place in Tehran annually. Of these, more than two-thirds were pregnancies terminated by women who were using withdrawal, the pill or condoms. The policy implications, Erfani writes, are clear. Behind every abortion is an unintended pregnancy. Better access to modern methods of contraception and better knowledge of how to use them consistently and correctly would result in fewer abortions.

Again, none of this is really news so much as evidence confirming what public health experts around the world have been saying for decades. What Erfani provides that is brand new are breakdowns. The study offers the first ever comparison rates for different groups of women. The findings again differentiate Iran from neighboring counties. Unlike Central Asia and Eastern Europe where abortion rates are highest among younger women, in Tehran women in their early 30s had the highest abortion rate. Rates were also higher among more educated women, those who identified as less religious, women who already had two children and women who said they did not want to have any more children.

What these findings show is that abortion in Tehran is not the picture of desperate unwed schoolgirls that fulfills international stereotypes of who has abortions. It is an issue faced by adult married women motivated by the desire to plan their families, space their births and take care of the children they already have. Seven in ten women surveyed who had sought an abortion cited fertility-related or socioeconomic reasons for doing so.

Abortion is legal in Iran only in cases where they life of the mother is in danger or when the country's Legal Medical Organization diagnoses the fetus with one of several legally recognized diseases or defects. Such severe restrictions drive women seeking abortions who do not meet these requirements to seek clandestine and often unsafe procedures. The stakes, Erfani points out, are high. Five percent of maternal deaths in Iran are estimated to result from complications of unsafe abortion; unknown numbers of women suffer permanent injury and disability.

Previous work by Erfani and colleagues has shown abortion to be common not just in the capital, but throughout Iran. Though breakdowns for more rural regions don't exist, neither does any evidence that women living in remote parts of the country have access to quality care in the event of complications from an unsafe abortion.

Studies like this one provide a roadmap for those in positions of power to address public health problems and better direct resources. Though better off than some neighboring countries, this evidence reveals women in Tehran's need for better access to contraception.

Legal experts tracking abortion policies note a worldwide trend toward liberalization. And evidence shows that abortion and complications from unsafe abortion are lowest in countries, like many in Western Europe, where abortion is widely available and there is strong government support for access to modern methods of contraception.

On the other hand, as Erfani notes, the government of Iran views the country's low fertility rate as a threat and has called for a doubling of the population. How this recommendation plays out in new laws and policies remains to be seen. The evidence clearly shows the dangerous consequences of limiting women's access to methods of controlling their own fertility.

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