A lot can be said about a country’s infant mortality rate and birth to healthy infants. It’s a constant that can’t be manipulated or exaggerated. It is an affirmative indicator how well a country is doing overall and whether or not it is classified as a third world country, or one that is developing into one that is established and stable. Therefore, it is pertinent to observe the methods of how a country prevents unwanted births, plans their pregnancies, or terminates pregnancies.
Depending on location, rural or urban, the withdrawal method, or “pull out method”, has a sizable preference in Iran. According to a study in Tehran, Iran, 70% of rural women and 57% of urban women in Iran use the withdrawal method of contraception. Despite all of the modern conveniences and vast improvements made in Iran for women’s health, the old-fashion use of withdrawal is still preferred among the masses there.
This leads to the question of why. Why is it preferred to use the withdrawal method of contraception than the modern day oral contraception? Another study, also conducted in Tehran, Iran examined this inquiry. They found that married women between the ages of 15 and 49 years of age who didn’t desire pregnancy used the withdrawal method due to its conveniences, the lack of needing a pelvic exam, the fact that it didn’t cost anything, the husband’s desire to control pregnancy, and firmly established myths about the dangers of oral contraception.
Women explained in this aforementioned study that even though they feared getting pregnant, and knew there was a likelihood that the withdrawal method would fail, they trusted its natural use. It was convenient; it didn’t require medical intervention or doctor visits. As many know, medical centers are far and few between in Iran and in the Middle East. There are even less doctors to be had in Iran or anywhere in the Middle East. The war in the Middle East can be blamed for part of that occurrence. This is why rural women are more apt to use the withdrawal method of contraception than their urban counterparts.
Having a pelvic exam is humiliating to women in Iran and this part of the world. If the doctor is not a female, both women and their husbands have greatly protested to having a pelvic exam performed on the woman. (Since women are usually barred from getting their college education, doctors are typically male). Women find the pelvic exam, necessary throughout the reproductive years for reasons beyond gaining access to modern contraception, painful as well.
Often resources are tight. In a world where women are still seen as second-class citizens or a commodity, women depend on their husbands for everything. If the husband does not consider oral contraception, condoms, or any modern contraception as a necessity, than the woman simply does not get to choose her contraception method.
Men in Iran and customarily throughout the Middle East balk at modern institutions from making family planning decisions in their place. They feel this is a private matter and a decision for them solely to make. Therefore, men traditionally throughout the centuries in this area of the world, even in Africa and Asia, prefer the withdrawal method by which they have total control of pregnancy.
This is what this study revealed about Iranian women’s views about oral contraception:
“My husband said, I am easy with this method (withdrawal). Pill is unsafe for you. It
makes you infertile and obese. Possibly you will get pregnant, but I am completely in
control.” (36-year-old, secondary high school, housewife, 1 child)
“The pills are chemicals that go into our body. They are very harmful. I have not heard
any benefits for pills. Even, when I become ill, I wouldn’t like to take tablets! I prefer
to use withdrawal method instead of using the pill. Is it right?” (29 -old-year secondary
high school, housewife, 2 children)
The most fascinating revelation from this study is that women in Iran and in the Middle East see amenorrhea, a side affect of oral contraception, as a terrible thing. They believe that if they don’t get rid of all the dirty blood in their body during menstruation that they will fall ill, have fertility problems, or possibly die. Iranian women who have amenorrhea practice Hijamah (also Alhijama). This is a process by where the woman has blood and fluids suctioned from her vagina/uterus which is collected in a cup (Westerners call this practice “wet cupping” for this reason). The practice was started by the Prophet Mohammad (peace be upon him). Hijamah is still widely practiced by Muslims today.
The withdrawal method is imperfect. Accidents happened. This leads to a final concern, the most important one of all: unplanned pregnancies. There are 91 000 births worldwide that occur every day, 20% are unwanted (World Health Organization (WHO). Community Based Distribution of Contraceptives. Geneva, Switzerland: WHO, 1995; 1-100). According to statistics, 28.6% of pregnancies in Iran alone are unwanted. As one would surmise, this same source also confirms that there is a plethora of unsafe abortions and infant and maternal deaths in Iran. This study finds that 44% of couples that use withdrawal method have at least one abortion.
Yet another survey completed in Iran has discovered that the withdrawal method of contraception is highly correlated to the poor female literacy rate, infant mortality, and the human development index. The older the married couple is, the more likely they are to use the withdrawal method.
It is disheartening and sad that 73,000 unborn Iranian babies are aborted every year. Worse, about 16 million dollars are spent annually by women in Iran to obtain these abortions, which are mostly illegal and unsafe. This same source confirms that in 1988, Iranians were having at least 5 children. Now they are only having an average of two children per couple.
Consider the fact that the abortion rate is two times greater among urban and employed than among rural and unemployed women. Surveys previously mentioned in this article stated that the use of modern contraception (which more urban Iranian women use) would hopefully lower unwanted pregnancies, thus lowering abortion rates. This is obviously not true either because either urban women have the resources to get an abortion, or rural women hold more strongly to their Muslim beliefs that murder is wrong. It could be that as society evolves, having a family even in third world countries is less desirable than securing an education, a career, and personal autonomy. Either way, the world should take notice about how cultural beliefs affect family planning, abortion, infant and maternal mortality, female literacy rates, and human development. There are all strongly correlated and intertwined, and should be dealt with wholly, not separately if we want to improve humanity’s progress.