Iran's revolutionary approach to family planning.

PIP: This article presents Iran's revolutionary approach to family planning. In 1967, the "Tehran Declaration" acknowledged family planning as a human right promoting the social and economic welfare of families and society; however, this program was dismantled after the Revolution. After the war with Iraq in 1988, the government realized that rapid population growth was a hindrance to development and subsequently called for the establishment of a national family planning program. In December 1989, the revived family planning program was inaugurated with three major goals: 1) encourage spacing of 3-4 years between pregnancies; 2) discourage pregnancies among women aged under 18 and over 35 years; and 3) limit family size to 3 children. In May 1993, a law was passed that included disincentive penalties for couples who had more than 3 children. According to the Ministry of Health and Medical Education (1989-97), there was an increased use of contraceptives among married women, and the total fertility rate (TFR) dropped from 5.2 to 2.6 children. Moreover, Iran's 1996 census showed a total population of 60.6 million with an average annual growth rate of 1.5% over the previous 5-year period. Iran's success in bringing about a decline in its TFR has been helped by the integration of family planning and primary health care and the involvement of various segments of society.^ieng

Spotlight: Oman.

PIP: Halfway through 1997, Oman had a population of 2.3 million growing via natural increase at a rate of 3.4% annually. Birth and death rates in the country are 38 and 4 per 1000 population, respectively. Oman encompasses 82,030 sq. miles. 27 infants die in Oman per 1000 live births, the average woman bears 6.2 children, and life expectancy is 69 and 73 years for men and women, respectively. 97% of ever-married women know of at least one contraceptive method, and the rate of contraceptive prevalence among married women increased from 9% in 1987 to 28% in 1995, 21% of which is modern methods. The oil boom of the 1970s brought wealth to Oman, driving per capita gross national product from $370 in 1973 to $6200 in 1982. The economy is based largely upon the government-controlled petroleum industry, which accounts for 80% of revenues. Two-thirds of the world's crude petroleum shipped by sea passes by Oman through the Strait of Hormuz, giving Oman disproportionately large geopolitical importance. Foreigners largely from India, Pakistan, and the Philippines comprise more than half of the country's labor force. More than 80% of primary school-age children are enrolled in school, with increasing numbers of Omani women also attending school.^ieng

Surprising decline in Iran's growth rates.

PIP: According to Iran's 1996 census, the country's population was 60 million, about 6-7 million people fewer than estimates used by the UN and other international organizations. These findings surprised Iranian demographers and have been examined with skepticism outside of the country. However, if Iran's 1986 and 1996 censuses are comparable and children were not undercounted, these results indicate a remarkable decline in fertility. The proportion of Iran's population under age 5 years fell from 18% in 1986 to 10% in 1996. An Institut National d'Etudes Demographiques, Paris, study published in 1996 estimated that Iran's total fertility rate (TFR) fell from an average of 6.2 children/woman in 1986 to 3.5 in 1993. However, based upon analyses of sample surveys, the Iranian government's health ministry reported that the TFR dropped from 5.0 in 1991 to 3.3 in 1995. Irrespective of questions over the magnitude of Iran's fertility decline, it is clear that the Iranian government is committed to limiting population growth. The UN Population Fund considers Iran's family planning program to be one of the world's best-functioning, with the Ministry of Health Care and Medical Education providing free contraceptives. A bill was passed in 1993 which penalizes couples who have more than 3 children and posters around the country encourage the one- or two-child family. Iran's family planning program is integrated into the national primary health care system and provides a broad range of reproductive health services to women. The program is also the only one in the region which promotes both male and female sterilization.^ieng

Men and family planning: focus on Egypt.

PIP: Approximately half of all Egyptian couples practice family planning. The 1992 Demographic and Health Survey for Egypt gathered detailed information about men's knowledge, attitudes, and practice of family planning. The survey found that 87% of men approved of the use of family planning, with the level of approval not varying much among men of different age groups or education levels, or between rural and urban residence. Few Egyptian men, however, were using a condom, male sterilization, withdrawal, or periodic abstinence. More than 18% of married men surveyed reported having used a male method of contraception in the past, but vasectomy is extremely rare even though 60% of the surveyed men indicated desiring to have no more children. The vast majority of the 50% of married couples practicing family planning used the IUD and the oral contraceptive pill. Men were more familiar with female family planning methods than male methods. These survey findings point to the need for better-targeted information on family planning and related issues.^ieng

Oil jobs have big impact on heavily populated Middle East.

PIP: Labor force interdependence creates a complex pattern among countries in the Middle East. Oil-rich countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) must import two-thirds of their labor force, including 80% of their professional and technical workers. These migrant workers come from Egypt (60%), Jordan, Yemen, Sudan, and South Asia, and the money they send home is a major factor in the economies of their native lands. Many Arabs who are considered foreign laborers have spent their entire lives, or have even been born, in the oil-rich countries; they have no hope of attaining citizenship. South Asians compete with Arabs for work in the Gulf States and tend to accept less-desirable jobs and lower wages. South Asian workers migrate from Bangladesh, India, Pakistan, Sri Lanka, Indonesia, Korea, the Philippines, and Thailand. Middle Eastern women have social constraints on labor force participation, and most of the women working n the Gulf States are Asian; they often work as domestics. The women of the Middle East are an untapped resource for this labor market.^ieng

The Middle East population puzzle.

PIP: An overview is provided of Middle Eastern countries on the following topics; population change, epidemiological transition theory and 4 patterns of transition in the middle East, transition in causes of death, infant mortality declines, war mortality, fertility, family planning, age and sex composition, ethnicity, educational status, urbanization, labor force, international labor migration, refugees, Jewish immigration, families, marriage patterns, and future growth. The Middle East is geographically defined as Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Gaza and the West Bank, Iran, Turkey, and Israel. The Middle East's population grew very little until 1990 when the population was 43 million. Population was about doubled in the mid-1950s at 80 million. Rapid growth occurred after 1950 with declines in mortality due to widespread disease control and sanitation efforts. Countries are grouped in the following ways: persistent high fertility and declining mortality with low to medium socioeconomic conditions (Jordan, Oman, Syria, Yemen, and the West Bank and Gaza), declining fertility and mortality in intermediate socioeconomic development (Egypt, Lebanon, Turkey, and Iran), high fertility and declining mortality in high socioeconomic conditions (Bahrain, Iraq, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates), and low fertility and mortality in average socioeconomic conditions (Israel). As birth and death rates decline, there is an accompanying shift from communicable diseases to degenerative diseases and increases in life expectancy; this pattern is reflected in the available data from Egypt, Kuwait, and Israel. High infant and child mortality tends to remain a problem throughout the Middle East, with the exception of Israel and the Gulf States. War casualties are undetermined, yet have not impeded the fastest growing population growth rate in the world. The average fertility is 5 births/woman by the age of 45. Muslim countries tend to have larger families. Contraceptive use is low in the region, with the exception of Turkey and Egypt and among urban and educated populations. More than 40% of the population is under 15 years of age. The region is about 50% Arabic (140 million). Educational status has increased, particularly for men; the lowest literacy rates for women are in Yemen and Egypt. The largest countries are Iran, Turkey, and Egypt.^ieng