Women and Health

f Women's NGOs of the I.R.I

Introduction

The Constitution of the Islamic Republic of Iran

Article 29

To benefit from social security with respect to retirement, unemployment, old age,

disability, absence of a guardian, and benefits relating to being stranded, accidents,

health services, and medical care and treatment, provided through Insurance or

other means, is accepted as a universal right. The government must provide the foregoing

services and financial support for every individual citizen by drawing, in

accordance with the law, on the national revenues and funds obtained through public

contributions.

\Vision

The twenty years vision of the country:

A society enjoying health, welfare, food security, social security, equal opportunities,

proper distribution of income, strong family structure, far from poverty, corruption,

discrimination and benefiting an appropriate environment.

Charter of Women’s Rights and Responsibilities

1.In this Charter, “right” means ability, advantage and immunity and “responsibility”

means the obligations upon women towards others.

47. Right to enjoy physical and psychological health in the individual, family and

social life considering women’s characteristics at different stages of life and the

responsibility of securing it as well

49. Right of participation of women in policymaking, planning, management, execution

and supervision in the fields of health and treatment, particularly, that specified

to women

Current Situation and Achievements

Increased women’s access to appropriate, affordable and equality

health care

C.1 INCREASED WOMEN’S ACCESS THROUGHOUT THE LIFE CYCLE

TO APPROPRIATE, AFFORDABLE AND EQUALITY HEALTH CARE,

IFORMATION AND RELATED SERVICES

An indicator that represents gender discrimination is mortality rate of children since

they are the most vulnerable against diseases. Table 1 shows the rate of mortality

among children that during 1986 till 2001 it has mitigated to half and in all these

years the mortality rate of girl infants has been less than boy infants. In 1986, the

mortality rate of children, boys and girls accordingly was 81 and 75 per 1000 where

in 2001 it was 35 and 30 per 1000, which represents a significant decline.

Though, in the history of the country, baby boy preference existed, at this stage the

baby boy preference has decreased and it can only be traced in certain rural of

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deprived provinces of the country. According to a research conducted with barren

women, 53 to 51 percent of urban and rural women said that there is no difference

between baby boy or girl (Ministry of Health and Medical Education, Population

and Health, 2000, p. 80). 11 to 12 percent of urban and rural women were willing

to give birth to a baby boy and accordingly 14 to 11 percent were willing to have a

baby girl. This research shows that preference among children is to the benefit of

boys in urban areas and to the benefit of girls in rural areas. In general, baby preference

is to the favor of girls. In another research conducted with a target group of

pregnant women, 21 percent preferred baby boys and 18 percent preferred girls and

61 percent said that it doesn’t make any difference to them.

Increase of Life Expectancy

One of the main health indicators, which is also an indicator of development, is life

expectancy. This indicator shows the probable length of life of an individual from

birth. According to this indicator, table 2, the life expectancy has increased during

the last 15 years. It shows that this increase has been more in women than men so

that difference of one year of life expectancy between men and women in 1986 has

reached 3 years in 2001.

In 2001, the life expectancy of men has approximately been estimated as 68 that is

8 years more than 1986. Increase of life expectancy among men has been 10 years

since in 1986 it has been 60 while in 2001 it has reached over 70 years. Life

expectancy didn’t have much difference in 2004 in comparison to 2001.

Development of Health Services

Health centers have been active in different urban and rural areas of the country

conducting vaccination and delivering treatment services and they are expanding.

The clients of these health centers are mostly women who refer for vaccination of

their children or themselves, family planning and hygiene purposes. Number of

these health centers reached 7345 in 2003 which means that comparing to 1986 it

has been doubled and 5130 units of these centers are in urban and 1404 units are

active in rural areas (Center of Statistics of Iran, Annual Statistics of 2003, pare

624).

Family planning takes place in these centers and special health care is given to

mothers in case of emergency delivery in urban and rural health centers (see table

2). Moreover, in rural areas, there are smaller units called Health Houses where

each unit covers one or more villages of 1500 inhabitants.

Health house is the first unit that delivers primary health care services in rural areas.

These health houses started their activities in1996 with 14000 units covering 84 percent

of rural population. In 2003, this number reached 16000 and its coverage

reached over 93 percent. Similar to health centers, the services of health houses are

mostly for women. One of the main responsibilities of these health houses is to

complete the life diagram of the population. This diagram is a piece of paper of

50x70 cm, containing 7 tables and 5 concentric circles printed in four colors containing

different information such as demographic information according to age and

sex of children, delivery situation, maternal mortality rate and causes, utilization of

iodine salt and family planning. As far as it can be seen, the activities of health cen-

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ters not only are not less from women than men but it is more.

Decreased maternal mortality rate and pre-delivery health care

Maternal mortality rate that represents deaths of mothers due to different events

during delivery per 100000 has significantly decreased in Iran so that from 150 per

100000 live births, it has reached approximately 40 per 100000 in the recent years.

Also, considering pre-natal care, 93 percent of mothers who have had delivery during1999

to 2000, have been under special care for at least once where this ratio in

urban areas has been 95 and in rural areas has been estimated to be 90 percent. Ratio

of individuals who have been taken care for at least twice is 91, 93, 88 percent and

mothers who have been taken care for at least six times during these years are estimated

to be 80, 82, and 75 percent (Ministry of Health and Medical Education,

Population and Health, 2000, p. 50).

Abortion

In the Islamic Republic of Iran, abortion is prohibited and illegal; but in case the

respective doctor diagnoses that continuation of pregnancy will be associated with

risks for the mother or the fetus suffers abnormalities threatening the life and health

of mother, with legal permission, abortion is possible.

There are cases of illegal abortion, which take place in unhygienic places by specialist

doctors of other individuals far from the access of law.

In Islamic Republic of Iran, abortion is not an acceptable way of family planning

and women undergoing abortion illegally, according to the articles 482, 622, 673,

and 624 of Islamic Penal Law, according to their involvement, are sentenced to 3 to

5 months of imprisonment and also paying blood money and retaliation. According

to most religious doctrines, if pregnancy threatens mother’s life, abortion is

allowed. Regarding abnormalities, there are different ideas but most of them accept

aborting in case of abnormality of life threatening situations before soul comes to

the fetus.

Decrease of Infant Mortality Rate

Infant mortality rate in our country, from 35 per 1000 in1996 has reached to 32 per

1000 in 2001. This rate has been 5 per 1000 more in boys in 2001 so that mortality

rate among boys has been 35 per 1000 and 30 per 1000 for girls. Tehran province

has had the minimum number of 29 per 1000 and Sistan and Baluchistan province

with 55 per 1000 have had the maximum rate. Since1996 to 2001, more than 10 per

1000 deaths have decreased in Sistan and Baluchistan province, while the decrease

rate in Tehran has been 3 per 1000. The infant mortality rate in Iran in1996 has been

even less than estimated rate of the Platform for Action of 2015 to be 35 per 1000.

Mortality rate of children under 5 in1996 was approximately 46 per 1000, which is

less than provisions of 2015. In the recent years this ratio has reached to less than

35 per 1000, which is significant.

Generally, the health indicators of Iran are much better than other developing countries

but they are still less than developed countries.

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Promotion of Breast feeding

Breast feeding provides sufficient food till 6 months of age and babies don’t need

any other kind of food even water; breast feeding promotion has been taking place

in Iran through posters and brochures rendered by health centers of the Ministry of

Health and Medical Education and by face to face advocacy of health workers to

mothers. According to the statistics only one percent of children under 2 have never

been breast-fed. 90 percent of children up to one year, 80 percent up to 1.5 year and

40 percent up to 2 years have been breast-fed (Ministry of Health and Medical

Education, Population and Health, 2000, p. 80).

Participation of Non-governmental Organizations

Different governmental departments such as the Ministry of Health and Medical

Education and the Welfare Organization have cooperated with different NGOs

involved in health issues at different levels. This cooperation consists of funding

NGOs’ health projects for women.

Many high rank managers of health departments have acknowledged establishment

of NGOs and implementing advocacy and capacity building projects in the field of

health for women in the last decade whereas the managers act of establishing NGOs

is contrary to the definition and function of a real NGO but this step has been efficient

in the sense of creating norms and implementing certain projects that can’t be

undertaken in the structure of governmental organizations.

NGOs have played a crucial role not only in implementing projects but also since

the last two years they have been actively involved in governmental meetings of

decision making and policy making.

Quality Promotion of Medicine

According to the National Drug Policy of Iran which was reviewed and approved

on 15 May 2004, all drugs available in drug market of Iran including those for family

planning should meet national and international standards.

According to this policy, auditors of the Ministry of Health and Medical Education

pay periodical visits to drug providers and observe different stages of production

regarding taking into account the rules of productions by the producers.

Promotion of Nutrition

A national surveillance over the micro nutrients of iron, zinc, vitamin A and E in

different age groups in 11 geographical areas shows that 38 percent of children

between 15 to 23 months suffer anemia (Sheykh- ol Islam, Robabeh, Director of

Nutrition Promotion Department of the Ministry of Health and Medical Education).

In other areas, anemia reaches 60 percent.

In 1995, anemia among girls of 14 to 20 years of age in the country has been 31 percent

and due to the provisions in 2001, this rate has decreased to 18 percent which

represents a proper growth.

According to the Beijing Platform for Action; from 1990 to 2000, anemia should

decline to one-third. Considering the estimate made, anemia decreased for 70 per-

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cent during 6 years. Anemia is a significant problem among pregnant women

though health network has not been very successful in its supplementary iron project.

In the Ministry of Health provisions have been made to deal with anemia, including:

nutrition education, promotion of sanitation including: water supply, dealing

with parasitical diseases, sanitary disposal of wastes and increased access to health

services.

Considering poverty, and malnutrition, in first, second and third Economic, Social,

and Cultural National Development Plans, eliminating poverty has been one of the

main objectives of the government since it has a direct impact over malnutrition.

In the chapter of Health Promotion and Improving Quality of Life (chapter 7) of

health development, human security, and social justice (third chapter) in the rules

and regulations of the fourth five-year Economic, Social and Cultural National

Development Plan of the Islamic Republic of Iran, it has been stated that “It is the

responsibility of the government has to take the following actions to change the

approaches and massive promotion of health and quality of life of Iranian citizens,

observing comprehensiveness and effectiveness, adopting proper expedients, policies

and strategies for promoting health and quality of life of people in all aspects

and also institutionalizing of management, policy making, evaluation and coordination

in the territory and also food security and nutrition in the country and preparing

appropriate food basket and decreasing diseases caused by malnutrition and

expansion of public health in the country:

Establishing “Health and Food Security Supreme Council” by integrating the Food

and Nutrition Council with the Health Supreme Council.

Provisions for training to promote culture and raise awareness regarding malnutrition.

Allocating funds, credit, banking facilities and subsides for production, support,

distribution and consumption of food items to achieve appropriate food basket and

providing resources for advocating healthy food among meals of students and also

supplementary feeding for deprived populations.

Provisions of general plan of decreasing food items.

Provisions of general plans for food security.

These goals and objectives have also been referred to not only in the fourth plan but

also in the first, second and third development plans.

Access to potable water

Access to pipe water which is one of the health indicators is in good conditions so

that almost 100 percent of urban families enjoy pipe water. This ratio has been 100

percent in 2002 for urban families in Ilam, Charmahal and Bakhtiary, Khorassan,

Semnan, and Mazandaran provinces. In Sistan and Baluchistan province in the same

year, 88 percent of urban families have had access to pipe water.

In rural areas in 2000 almost 83 percent of the families had access to pipe water

whereas in 2002 this ratio increased to 87 percent. This percentage for Tehran

province has been 99.9 and for Sistan and Baluchistan it has been 50 percent.

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Strengthen Preventive Programs

C.2 STRENGTHEN PREVENTIVE PROGRAMMES THAT PROMOTE

WOMEN’S HEALTH

The Islamic Republic of Iran approved the Family Planning and Population Law in

1993 and following to this law:

The Ministry of Education will be responsible to accommodate modules of population

and mother and child care effectively in related curricula.

The Ministry of Culture and Higher Education and the Ministry of Health and

Medical Education will be responsible to create a training session covering population

and family planning in all majors.

The Ministry of Culture and Islamic Guidance will be responsible to provide opportunities

for active participation of journalists, directors and other artists cooperating

with that organization to prepare programs regarding population and family planning

to promote general awareness.

The Islamic Republic of Iran Broadcasting Organization is responsible to provide

programs to be broadcasted through radio and TV to promote level of public awareness

to provide mother and child health and population.

Government’s Actions

Promotion of life expectancy among women through: increasing literacy level of

women, promoting reproductive health through educating pregnant women,

increased attended delivery, benefiting of insurance facilities by pregnant women,

advocating breast-feeding, cultural development regarding women and girls’ nutrition,

supplementary iron provisions for girl students at school, labor laws and mandates

for working pregnant and lactating women, implementing pilot projects of

integrated health care for mothers, providing contraception, encouraging and

empowering men to support their wife in raising children and family planning, preventive,

curative and rehabilitation provisions and promotion of women and girls’

psychological health status, screening breast cancer, advocating food security for

women, reinforcement and development of sport for women, providing training

material and films.

Prevention of HIV/AIDS through trainings of recognizing AIDS and its preventive

measures to students at pre- high school and high school levels. Implementing

“Healthy Family Project” through training of sexual behavior, psychological needs,

addiction and HIV, measures to care of HIV suffering people through establishing

centers and institutions, educating people through mass media and holding specialized

seminars.

Advocating and rendering health services through volunteer forces: employing volunteer

forces in form of NGOs, Bassij, health workers, young cooperation forces for

development.

Health of the elderly: implementing special projects for elderly, training them on

healthy living methods after aging.

Expansion of research and surveillance by holding scientific seminars and training

for women and young girls and reserving credit for research projects at provincial

levels.

Increasing the number of rural health houses, urban health centers and mobilized

health units for families, implementing the project of healthy family.

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Establishing pre-marriage consultation centers, sexual hygiene, holding consultation

and training sessions in cultural and social centers for women, creating psychotherapy

and psychological health centers.

Consulting private sectors for general health services delivery.

Changing attitudes of health authorities of the country towards rights (health is a

public right) and participatory methods (moving from “Health for everybody” to

“Everybody for Health”).

Women’s NGOs Activities

“Sustainability” is the main characteristic of most Women’s NGO activities in

the field of health. A sum of 235 activities has been undertaken by women’s

NGOs in this field. Most of these activities have been training focused and massive

measures have been taken for sharing information and promoting

women’s awareness. Variety and innovation of these activities deserves appreciation.

Holding scientific, training and empowerment seminars on different issues of

women’s health concerns including reproductive health, women and obstetrics, preventing

addiction, family planning, supporting disabled people and analyzing gender

issues.

Holding training workshops on different topics of health such as reproductive

health, nutrition for women, psychological health, preventing special addictions of

women, family planning, breast-feeding and cancer.

Taking action to inform and raise awareness in women prisons through training and

consultations on narcotics and addiction.

Delivering consultation services and holding consultation sessions for women and

girls in need (including legal, family and psychological consultations) to promote

women’s health status.

Cooperating with governmental organizations such as health centers and secretariat

of Anti-Narcotic Department and the Ministry of Health and Medical Education

in implementing different projects for women.

Agreement with hospitals and clinics to render free services to patients suffering

special diseases.

Conducting research about women’s psychological health, productivity models in

Iran, family abnormalities and prevention of smoking among women.

Providing brochures and training materials regarding food security and other health

issues for women.

Preparing scientific articles on women’s role in preventing addiction in family.

Submitting proposals on women’s health from puberty to adulthood to government

organizations.

Rendering curative services to disadvantaged women, especially in deprived areas.

Communication with specialized medical institutions to render services through

them.

Covering the medical costs of those seeking assistance, especially women in need

of these services.

Establishing medical clinics, committees of prevention of AIDS at local level, constructing

public baths and health institutes and networks to distribute information

on women’s health issues.

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Women NGOs have been active in the field of capacity building and training, which

have been reinforcing measures of these organizations during the recent decade.

The main point is that the training models and workshop management methods have

made them practical and useful for governmental organization or private sectors

having similar missions. So, we can claim that these NGOs, considering their

approach to women’s health, have been able to create a new and successful wave of

training in the country and government organizations and private sectors owe it to

civil society.

These organizations have had innovations in rendering services and advocacy activities

and they have been able to cover most of the topics that were out of governmental

programming structure.

CNWN Activities

Holding puberty health workshops for young girls in two phases by the support of

UNESCO.

Holding consultative- training workshop on reproductive health in cooperation with

the Ministry of Health and Medical Education to promote NGOs’ cooperation in

rendering services to the population.

Establishing a consultation center and responding to the needs of women referring

to solve different family, education, professional problems and to advocating living

skills.

Fourth National Development Plan

Related parts in the Fourth National Development Plan to health and women’s

issues are as follows:

Programming and planning training courses to promote health and healthy living

methods (fourth chapter, Section T, Article 5).

For increased efficiency of health services system in the country and reinforcing

and developing medical services insurance system the following steps will be taken:

B- Up to the end of the Fourth Development Plan, Supreme Council of Medical

Services Insurance will establish facilities for health insurance focusing on family

medicine and referral system (Chapter 7, Section B, Article 91).

Providing especial insurance (in form of support programs) to support women as the

head of the family and individuals with no support with the priority of orphan children

(Chapter 8, Section G, Article 96).

Promotion of psychological health, expansion of social assistance, reinforcing family

structure and empowering individuals and groups at risk (Chapter 8, Section A,

Article 98).

Government, six months after approval of this law, should take measures to prepare

and implement strategic documents of rendering services, promoting social, medical

and living level of people (Chapter 8, Article 99).

Challenges and Constraints

Imbalance of indicators in different provinces of the country and lack of contingent

plans for all provinces

Significant increase of medical and paramedical graduates and their lack of involve-

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ment in health centers though there is a great need.

Population growth in areas where health indicators are low

Lack of statistical information on issues such as illegal abortion, patients suffering

HIV and plans for solving problems

Increasing number of newborn and population growth due to increasing number of

women at marriage and reproductive age (due to population growth at the first

decade after the Revolution)

Malnutrition among low-income families.

Existing norm constraints in promoting advocating and preventive measures in

AIDS and women’s addiction and research on violence against women.

Recommendation to the Government

Necessity of diversified education fields at university level regarding women’s

health and expanding research on social damages related to women’s health especially

violation against women, street women, AIDS and etc.

Enhancing inter organizational innovations through drawing semi-governmental

organizations such as Red Crescent and Medical Workers Organization toward

independent and autonomous organizations.

Supporting private sector and providing special facilities and encouraging them to

work for women.

Reviving health network and preserving its quality and involving NGOs in health

network.

Creating norms in sexual health and AIDS using norm creating tools such as religious

leaders and media: enhancing TV programs regarding women’s health and

focusing on issues such as AIDS, violence against women and sexual health.

Comprehensive information distribution among ministries that have common mission

in the field of women’s health such as ministry of health and welfare organization.

Increasing synergy in improving and promoting women’s health through attracting

men’s participation and family members in relative programs.

Enhancing the level of health from an illness-free level to complete physical, psychological,

and social health.

Reinforcing women NGO participation with a women’s health approach in high

rank decision making levels such as Supreme Council of Health and involving them

in monitoring and evaluation of health projects for women.

Recommendation to Women NGOs

Informing networks focusing on women’s health in different specialized and

defined topics such as AIDS.

Preventing duplications and repeating or copying previously done activities by

other governmental organizations and NGOs and paying special attention to the

existing gaps on women’s health and organizing the activities according to the

needs.

Reinforcing regional and international cooperation in dealing with AIDS, addiction,

prostitution and enhancing activities fields to transnational levels.

Focusing on specialized activities and special organization mandates.

Interrelation of health and women’s health issues, necessity of contingency in training

materials, while focusing on one topic and ignoring other health issues declines

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impact on target group.

Paying special attention to research and increasing activities in media on health,

women’s health and providing written literature in this field.

Conclusion

Mortality rate of children is an indicator of health and also is used as an indicator

for development. The mortality rate of children in developing countries is 50 per

1000 while this indicator in Islamic Republic of Iran is 32 per 1000 and in developed

countries is less than 10 per 1000.

The mortality rate of girl child in 1986 was approximately 75 per 1000 while in

2001, during 15 years; it reached to 30 per 1000, which is almost half.

It is worth mentioning that most of medical and health indicators of the country for

women have better status compared to men and in the recent years there have been

significant changes. As an example, the life expectancy is another indicator of

development; in 1986 it has been one year more among women compared to men

whereas in 2001 this difference reached to 3 years (in 2001 life expectancy of

women was 70.4 and life expectancy of men was 67.6).

At the moment, the health development indicators for women and children in the

country are more developed than the indicators stated in the Beijing Platform of

Action.

Advocacy regarding breast-feeding by governmental and private centers has promoted

breast-feeding in the first year to 80 percent that is more than the rate in

developing and developed countries.

In Islamic Republic of Iran, abortion is not accepted as method of family planning

and prevention of abortion except in case of necessity has saved innocent children’s

life.

The health centers in 2004 reached to 7345 units and compared to 1987 it has doubled

and service rendered in health centers to women is more than those given to

men. Maternal mortality rate shows the incident of mothers’ death at the time of

delivery is among 100 thousand births; in Iran this rate has significantly decreased

so that from 150 per 100 thousand live births it has reached to 40 per 100 thousand

in the recent years.

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Tables and Graphs

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