Iran ends free vasectomies with 'maximum-baby' push

A prominent green arrow painted on the ground once led the way to one of Iran’s largest family planning clinics so that men seeking free vasectomies could find their way without asking embarrassing questions. 

For most of the next two decades, thousands of men followed that arrow, taking advantage of a reproductive health policy so successful at curbing a soaring birth rate that the United Nations trumpeted Iran as a model for the Islamic world.  

Today it is a faint shadow. Free vasectomies ended two years ago and Iranian officials, anxious about the impact of a plummeting birthrate, are encouraging a new baby boom. 

In a shrinking population, the government sees not just economic decline, but national weakness. Last month former nuclear negotiator Saeed Jalili launched a poster campaign bearing the slogan, “Population decline equals decline in military power.”

And just days ago one cleric said on television that Iranians should start making babies immediately, aiming for numbers linked to the Shiite faith like the eighth Imam Reza, or the 12 holy imams, or the 14 “infallible figures.”

“We don’t accept less than five,” Ayatollah Mohammad Hosseini Ghazvini told Velayat TV. “So tonight...start the operation of having five, eight, 12, and 14 children, which, God willing, will be a big slap in the face…of this nasty one-child culture.” 

Out of step with the population

The strident declarations mask the far more nuanced debate underway in parliament and the health ministry, private vasectomy clinics, and even shared taxis, where riders blanche and joke at suggestions on the radio that a new "maximum-baby" policy will be a panacea for Iran’s problems. There is great skepticism about the wisdom of such a dramatic reversal after years of pridefully enjoying plaudits for population control policies that other nations took decades to achieve. 

This is a country, after all, where the breaking of taboos on this issue includes clerical approval for sex-change operations and the making of flavored condoms. Viagra was once sold in shops like individual pieces of wrapped bubble gum. 

Supreme Leader Ayatollah Ali Khamanei has said that Iran can handle a near-doubling of the population, to 150 million, and in 2012 he called previous population control efforts a “mistake.” In 2010, then-President Mahmoud Ahmadinejad said the marriage age for women was to be dropped to 16.

But today many Iranians are less willing to stretch limited resources to cover more children. They are already struggling in an economy damaged by sanctions and chronic mismanagement. Talk in parliament of banning vasectomies altogether – very unlikely, health officials say – is a sign to some that politicians are taking this too far.   

“When I go to different neighborhoods, even poor areas, people don’t like these [larger family] policies – they now plan for the future,” says an Iranian doctor who has performed 9,000 vasectomies in government facilities and now has a private practice.

"There are still many people who do not believe that more kids leads to a better life,” he says, adding that since vasectomies became costly, the number of illegal abortions has risen.

“People will not accept this. The government must first build the infrastructure, homes, economy, and then decide” on boosting the population, adds the doctor, who asked not to be named because of the sensitivity of the subject. “If this continues, we’re going to have another crisis.”  

Reproductive trailblazing 

Iran’s “family planning” policies have always been radical, one way or another. At the start of the 1979 Islamic Revolution, the Shah's birth control policies were discarded and Iranians were encouraged to create “soldiers for Islam." The birthrate surged to one of the highest in the world, peaking at 3.9 percent per year. The population doubled in less than a decade.

But when the ramifications of the baby bulge became clear in the late 1980s – as the Iran-Iraq war came to an end, the economy in ruins – Iran’s revolutionary father, Ayatollah Ruhollah Khomeini, approved discussion on how to reverse course.

Religious rulings and laws brought modern family planning and mandatory reproductive and family planning education to the most remote villages and the government cut incentives for large families. By 2001, a state-owned factory was producing 70 million condoms each year in a wide array of different sizes, colors, and flavors. They were provided virtually free of charge everywhere, as was birth control pills for women. 

Iran’s birthrate dropped to as low as 1.47 percent and today stands at roughly 1.8 percent – below the replacement level of 2.1 percent. Iranian individuals have received the annual United Nations Population Award three times since 1999.

“On reproductive health, this country has really great achievements,” says Mehmet Hulki Uz, the Iran representative of the UN Population Fund (UNFPA) in Tehran. There is no need to "rush" the changes, because even at the current birthrate, Iran’s population will expand to more than 91 million by 2030, he says.

Iran’s challenge will be to maintain its high reproductive health standards even as it raises the birthrate. Given its expertise in demographics and health, he says, Iran has the capacity to set an example. 

The U-turn

In the last two years, much government support for birth control has been cut and mandatory birth control education has turned into “marriage and family” classes that emphasize having more babies. Along with the end of vasectomy and other sterilization operations in government facilities, women say that foreign-made contraceptive pills have become almost impossible to find, and local production more expensive than before.  

But some steps have been corrective. The free vasectomies of the past meant that some men made the decision without thinking it through, and later returned, insisting that the procedure be reversed, says a government doctor who is not authorized to speak to the media.

Men who lined up for free vasectomies were eventually required to first attend two counseling sessions in government clinics. At one busy official clinic, before government-provided vasectomies were stopped, only 1 in 5 who took the counseling went ahead with the procedure, and none of them later asked for a reversal. 

The end to the free service has also forced men to think the decision through – vasectomies cost up to $200 in a private clinic, says another government doctor.

“There are many in the Ministry of Health who are against banning vasectomies – that would be extreme,” he says. “It’s not a finished issue.”

Small pocketbooks

Today family size more often depends on a family's resources, not any religious desire to have enough children to match the holy imams. 

One young banker shows pictures on his cell phone of his two infant children, the youngest just six months old. He had a vasectomy three weeks ago, at his wife's insistence after two Caesarian sections.

It was not easy to pay for, since he works two jobs to make ends meet – but it was cheaper than supporting more children. Both part of the post-revolution baby boom, they consider themselves a slice above middle class.

His wife is a homemaker with a mathematics degree; they both feel that two children is all they can afford. 

“The first reason is the high cost of living. Food, clothing, rent, inflation, all these impose a huge cost on families,” says the 32-year-old, who wears a carefully trimmed beard and large gold-style watch.

“There are people with certain ideas, they believe in this government and believe what they say…and will have more children,” says the father. “And there are others like me, for whom finances are the priority.”