Iran

OVERVIEW

Overall, Iran is an incredibly complex, and often paradoxical, country when it comes to issues related to sexual and reproductive health care. On the one hand, Iran is a conservative nation and an Islamic republic, which has often preached a pro-natalist policy. Politicians and clerics routinely promote larger families and decry immorality. Locals report that they often feel uncomfortable asking pharmacists for birth control or emergency contraception, and the subject of STI tests remains generally taboo. Meanwhile, abortion is only legal during the first four months of pregnancy, and only when the pregnancy either endangers the woman's life or when there is severe risk of fetal impairment. There are minimal legal protections related to sexual harassment or gender discrimination, and homosexuality is illegal.

Yet, on the other hand, Iran is a country with a long history and dynamic society. Before the Islamic Revolution, family planning was declared a human right under the Tehran Declaration of 1967. Despite challenges to family planning after the revolution, you actually can purchase birth control, such as pills and condoms, at pharmacies and supermarkets without a prescription. You can also purchase emergency contraception (the morning after pill) at pharmacies without a prescription. You can access HIV tests at most laboratories that do blood work or through gynecologists found at hospitals or clinics. Meanwhile, there is a rather large underground network of abortion providers and even a top Iranian health minister acknowledged the high abortion rates in 2014. It is common for Iranian newlyweds to want small families or no children at all, and the country has a high rate of educated, urbanized women who proactively make decisions about their bodies.

With all of this being said, it's very difficult to draw blanket statements or broad generalizations about Iran. It is a country known for both strong conservatism and deep-set liberalism, and like many countries, the subject of family planning is a sensitive issue that's not without controversy.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Iran, you can purchase various forms of birth control at pharmacies without a prescription. You can also purchase condoms at supermarkets without a prescription. However, some women feel uncomfortable purchasing contraceptives, such as condoms or birth control pills, in their local pharmacies or supermarkets, where they may be observed by neighbors or family members. Furthermore, pharmacists are known to sometimes question locals, asking why they are purchasing contraception and if they married. This type of questioning is done to both men and women, but women receive a greater amount of stigmatization and shaming, according to locals. For this reason, local women may they travel to other neighborhoods to purchase contraceptives, where they can escape the judgment of neighbors.

Generally speaking, birth control pills and withdrawal are the most common contraceptive methods in Iran. According to a 2015 report, 76.6% of Iranian women (who are of reproductive age and married/in unions) use some form of contraception. The most common forms of contraception are withdrawal/"the pull out method" (16.9%), birth control pills (15.6%), female sterilization (14.8%), male condoms (13.7%) and IUDs (8.4%). Overall, it is estimated that 6.5% of Iranian women (who are of reproductive age and married/in unions) have unmet family planning needs. This rate is lower than in many Western European countries, meaning that, despite their conservative government, many Iranian women are still accessing contraception.

From a historical perspective, Iran has frequently changed its family planning policies. In the 1960s, Iran recognized that it was experiencing rapid population growth, and national family planning policies were introduced. In fact, the Tehran Declaration of 1967 acknowledged family planning as a human right. Yet, following the Iranian Revolution (1979), the newly formed Iranian government, under Ayatollah Khomeini, focused on a traditional, pro-natalist approach. Family planning clinics were closed down, birth control policy was suspended and abortion was re-criminalized.

However, in 1989, the government's policies began to rapidly change. The war with Iraq had ended, Ayatollah Khomeini had died, and the new leaders, Supreme Leader Ali Khamenei and President Akbar Hashemi Rafsanjani, recognized that there was a population growth problem. The government launched a new campaign to encourage families to have a maximum of two children under the slogan, "One is good. Two is enough." Furthermore, Iran's Health Ministry began providing free contraceptives, including condoms, pills, implants, IUDs and sterilization, which could be obtained at urban clinics, rural clinics and mobile clinics. The government also required that college students, soldiers and engaged couples take classes on family planning. These changes helped to successfully bring a decline in population growth and fertility rates.

The last decade has seen further shifts in family planning policy. In 2006, President Ahmadinejad declared that he wanted the population to increase, and many Iranian leaders and clerics have stated that population control measures belong in the past or were mistakes to begin with. The government has cut its its budget for subsidized condoms and family planning services, increased paid maternity and paternity leave and tried to make female or male sterilization illegal. However, many Iranian married couples, particularly middle-class and educated couples, may not feel the desire to have large families or any children at all. This is partially due to the increase in education among women, as well young people's concerns regarding the political and financial instability of the country.

At times, Iran has experienced shortages of birth control pills in pharmacies, particularly due to Western embargoes. You can read a personal account of attempting to buy birth control pills in Tehran, during a period of embargoes, here.

More information:

• AP Archive Video on Iranian Family Planning History/Laws

What to Get & Where to Get It

• If you want condoms, you can buy them in drug stores and supermarkets in Iranian cities, according to official reports and local sources. Some of the brands you can expect to see are Kapoot, Good Life and Nach. You can also find special condom brands, like Fiesta, which are manufactured locally in Iran, come in nine different flavors/types and were launched by DKT Iran (an NGO). In the past, Iran even launched condom vending machines in Tehran, which were meant to help prevent the spread of HIV/AIDS, but they were later considered to be promoting "immoral acts" and were removed.
• If you want birth control pills, you can easily find them in pharmacies. It's most common to find pills from Iranian, German and Dutch pharmaceutical companies, such as Aboreihan or Abidi (produced by Iranian companies), Lynestrenol (produced by Organon, a Dutch company) or Yasmin and Yaz (produced by Bayer, a German company).
• If you want an IUD, you can find a variety of options in Iran, both locally-produced and from international manufacturers. For example, you may find the Pregna brand, which is a locally-produced IUDs that was launched launched by DKT Iran (an NGO). Furthermore, you may find internationally recognized IUD brands like Mirena.
• While locals believe that you can find the contraceptive patch, contraceptive injectable and contraceptive implant in Iran, we have not yet received any definitive information on these options. If you know where to access them in Iran, please add this information to the page.

Costs

• For a pack of birth control pills, you can expect to pay around 260,000 IRR-350,000 IRR. While some articles may claim that the Iranian government subsidizes birth control pills, locals have confirmed that this not the case, as of December 2017.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Iran, emergency contraception (morning after pill) is available without a prescription.

What to Get & Where to Get It

• In Iran, emergency contraception pills (the morning after pill) is available without a prescription at pharmacies. Some people may feel judged by the pharmacists or uncomfortable when purchasing emergency contraception. For this reason, while emergency contraception is technically available, it may not be sought out by all women, or some women may choose to purchase emergency contraception outside of their neighborhoods where they can find more anonymity and privacy.
• If you cannot access dedicated emergency contraception pills (ECPs), you can use regular birth control pills as replacement ECPs. But remember that, in 28-day packs, only the first 21 pills can be used. To do this, you can take Contraceptive H.D. (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). Alternatively, you can also take Contraceptive L.D. (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).
• If you cannot access dedicated emergency contraception pills (ECPs), you can use an intra-urine device (IUD) as a form of emergency contraception. It will need to be inserted into your body as soon as possible after unprotected sex to prevent pregnancy. Consult a physician for more details.

Costs

• The average cost of emergency contraceptive pills (ECPs) in Iranian pharmacies is around 50,000 IRR, as of 2017.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

Generally speaking, Iran is rather conservative when it comes to issues of STIs. First, there are laws related to foreigners and HIV status. If you are tourist or short-term visitor to Iran, you do not need to take an HIV test. However, if you plan to obtain a work or residence permit, or if you plan to stay in Iran for over three months, you will need to take an HIV test. If you are found to be HIV positive, your visa or permit will probably be denied. There are an estimated 73,000 people in Iran living with HIV, and 0.1% of the population is HIV positive.

Regarding Human Papillomavirus (HPV), it could certainly be a topic that the government invests more resources toward, but this isn't currently the case. Cervical cancer is the ninth most frequent cancer among women (ages 15-44) in Iran, and about 2.8% of Iranian women are estimated to have HPV-16/18. Meanwhile, nearly 60% of invasive cervical cancer cases are attributed to HPV. However, Iran does not have a nationwide HPV vaccination program, as of 2017.

In Iranian society, the discussion of STI testing remains generally taboo. When we spoke with Iranian locals, we were told by multiple sources that they did not feel comfortable discussing STI tests with their friends or close contacts, and sometimes they did not even feel comfortable discussing the possibility of STI tests with health care providers. Multiple sources said that they only felt comfortable discussing STI tests with their partners.

Testing Facilities

• Tip from a local: "You have to go to a doctor, which we call a 'women's doctor,' to give you a prescription for STD tests. And, of course, they are not free but pretty expensive."
• You should be able to find HIV and some other STI tests in most blood/urine testing labs in Iran.

Support

• Dr. Mohraz: Provides HIV treatment. Address: Sanaie Place no 49, Teheran/Iran, Phone: +98 21 646 3728.
• UNAIDS Iran: Fardad Doroudi, Telephone: +98 21 22 85 89 50. Email: DOROUDIF@UNAIDS.ORG

Medications & Vaccines

What to Get & Where to Get It

• There is no nationwide HPV vaccination program in Iran. However, you may be able to access HPV vaccine, like Gardasil, in some Iranian clinics or hospitals.
• We cannot find evidence of PrEP (pre-exposure prophylaxis) being available in Iran. If anyone has information on this topic, please add info.
• We cannot find evidence of PEP (post-exposure prophylaxis) being available in Iran. If anyone has information on this topic, please add info.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

In Iran, pads are widely available. You should also be able to find tampons in supermarkets in cities. There have been some reports of a declining level of tampons, but this is not confirmed so we'll need someone to update this section with more info. Generally speaking, menstrual cups are extremely uncommon and it's unlikely that you will find them sold in Iranian markets.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Iran, abortion is only legal during the first four months of pregnancy, and only when the pregnancy endangers the woman's life or when there is risk of a fetal impairment that is recognized by the Legal Medical Organization. Three medical specialists must confirm that the pregnant woman's life is endangered or that there's risk of fetal impairment before an abortion can be legally performed.

In all other cases, abortion is illegal. This means that abortion is not available upon request, and it's not available when the pregnancy is the result of rape or incest, or when the woman has serious physical, mental or social reasons for seeking out an abortion. If someone pursues an abortion for any of these reasons, they may be made punished. According to Penal Code of 1991, which is based on Islamic law, an illegal abortion is considered a crime of bodily harm (also known as "oisas"). This is punishable and the involved parties must pay blood money or compensation (also known as "diyah") to the victim's relatives.

Despite strict abortion laws, abortion is apparently rather common in Iran, especially in larger cities like Tehran. In fact, the Iranian government has even begun to acknowledge the abortion rate. In 2014, Dr. Mohammad Esmaeel Motlagh, the director of the Health and Population Bureau of Iran’s Ministry of Health, presented statistics that showed about 250,000 abortions were performed in Iran each year. This was complemented by a 2011 report from the Guttmacher Institute, which estimated that 11,500 were performed on married women in Tehran each year and that "one of every six women of reproductive age will have an abortion in their lifetime if current age-specific abortion rates remain unchanged." In the report, it was found that two thirds of such abortions were performed on women who had used some form of contraception, such as condoms, pills or the withdrawal method. Furthermore, women were most likely to request abortions when they were in their early 30s, educated, less religious, already had children and when they felt that they did not want more children. This was a very different profile than in Central Asia or Eastern Europe, where young girls were the most likely to request abortions. According to a PBS news article, "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."

More Information:

• Guttmacher Institute Report: Induced Abortion in Tehran, Iran: Estimated Rates and Correlates
• Abortion in Iran: What Do We Know?, Amir Erfani - University of Western Ontario

What to Get & Where to Get It

• Since abortion is generally illegal in Iran, we cannot recommend any general providers in Iran. However, according to a 2014 Al-Monitor report, "Shahid Kamali Hospital is also one of the hospitals with the most traffic for abortions."
• There is a black market of abortion providers in Iran. In certain place, people may sell pills, such as Misoprostol, to induce abortion. Click here for more information. There are also certain midwives or clinics who perform clandestine abortion services. However, these methods can be extremely risky since they are on the black market and unregulated.
• If you are considering leaving the country for an abortion, you can get a legal abortion in India, Turkey, Greece, Georgia or Azerbaijan. If you are interested in traveling to Europe, there are also many countries where abortion is legal.

Costs

• Sources state that clandestine abortions in Iran are more expensive for unmarried women.
• If you are pregnant and considering getting an abortion outside Iran, you will need to consider the following costs: visa processing and procedures, transportation to the country where you will be obtaining an abortion, hotel or accommodation costs in that country, cost of the abortion in the country and the total amount of days you may need to be in the country both before and after the abortion.

List of Additional Resources

• Click here to learn about LGBTQ rights in Iran.
• Omid Foundation: "OMID is committed to strengthening the social, emotional and economic opportunities of disadvantaged young women in Iran. We provide them with a sense of self worth and life and opportunities in three key areas: self-empowerment, education and training." Email: info@omidfoundation.com
• IKWRO (Iranian and Kurdish Women’s Rights Organization): This London-based organization works on women's issues in the Middle East with a focus on Iran. "IKWRO’s mission is to protect Middle Eastern and Afghan women and girls who are at risk of ‘honour’ based violence, forced marriage, child marriage, female genital mutilation and domestic violence and to promote their rights." Address: IKWRO, PO Box 65840, London, EC2P 2FS