Practicing preachers: reproductive behavior of rural health workers in Iran

Shirin Ahmadnia, Ministry of Science, Research & Technology, Iran
Amir-Houshang Mehryar, Ministry of Science, Research & Technology of Iran
Nahid Salehi, Center for Population Reseach & Studies in Asia and the Pacific

Having followed a pronatalist policy during the first decade of her life (1979-1989), the Islamic Republic of Iran adopted a birth control policy and revived the FP program in 1989. The program has been exceptionally successful in terms of raising contraceptive prevalence (to above 73%), reducing fertility (to a TFR of 2.1) and general improvement of maternal and child health situation. A major achievement of the program has been the enormous narrowing of the traditional gap between urban and rural areas with respect to contraceptive prevalence and other indicators of reproductive health. This is generally attributed to Iran’s innovative primary health network and the community based rural health workers known as “Behvarz”. A major reason for the success of the latter would seem to lie in their deep commitment to and absorption of the goals and objectives of reproductive health advocated by the PHC system. This paper presents data on the reproductive health behaviours and outcomes of a representative sample of behvarz (N = 2127) taken from all over Iran. Results indicate a high degree of conformity to reproductive health ideals advocated by the national program. Despite their rural background and relatively low level of education, the behvarz fall far above their rural and urban counterparts in terms of contraceptive prevalence rate (89.9%) and mix of methods used. Their pattern of contraceptive choice is urban in some respects (e.g., an exceptionally high rate of male sterilization) and rural in other (e.g., a very low rate of traditional method use, 3.2% as compared with 22.8% of all Iranian women).Proportion of Behvarz reporting use of modern methods (86.7%), vasectomy (4.6%) and injectables (8.1%) is much higher than national norms while a much smaller proportion depend on withdrawal (3.2%) and other traditional methods.