Enormous gains in reproductive health and rights have been achieved in the Islamic Republic of Iran over the last decade, due in part to patience and persistence in dealing with culturally sensitive issues.
For several years after the Islamic Revolution in 1979, having large families was encouraged in the Islamic Republic of Iran. It was not long, however, before the Government realized that high population growth (3.9 per cent) was thwarting its efforts to reduce poverty and provide jobs and adequate housing for its citizens.
In the last decade, tremendous strides have been made. Fertility rates in the Islamic Republic of Iran have dropped by more than half, spurred by government support, concerted advocacy efforts and the establishment of one of the best primary health care systems in the region. The country has far exceeded the targets laid out at the 1994 International Conference on Population and Development in Cairo.
In the Third Country Programme (2000-2004), UNFPA is assisting the Government in its goals of empowering women and youth and decreasing the illnesses and deaths of mothers and children. It is working in disadvantaged, hard-to-reach areas, where health indicators are lower than the national average. These areas are also home to two important ethnic communities, the Baluchis and the Kurds, for whom issues related to family planning are extremely sensitive.
In response to enormous needs in both communities, a programme in reproductive health has been carefully designed using a combination of research, training, and information materials to promote the use of family planning services by men, women and adolescents. The programme is carried out at the community level by doctors at local health centres and Behvarzes (community health workers), who come from the same village as the families they visit. According to a partner in the programme, the least sensitive issues, which emphasize women's health, were addressed initially. Only gradually, and after infant mortality began to decline, did “people trust us and realize that our services are vital,” he says.
“The next step was bringing religious and community leaders together in meetings and seminars where reproductive health and family planning experts discussed the programme and asked for the leaders' help,” he adds. The dissemination of newly issued fatwas (edicts) by important religious leaders was also instrumental. “People realized that reproductive health and family planning were not against their religion.”
Another initiative, implemented by the Literacy Movement Organization and its network of 50,000 instructors, is spreading messages on population and reproductive health through basic literacy classes and continuing education for adults. Instructors who are native to an area and aware of local sensitivities have been ideal messengers for information on reproductive health.
Since it first began in 1992, the project has provided orientation and training for more than 17,000 instructors and achieved its goal of integrating reproductive health messages into the national literacy programme. More than 30 booklets have been produced on issues ranging from childcare and pregnancy to the preference for sons, and are being shared with neighbouring Islamic countries. On a pilot basis, HIV/AIDS education is now being introduced.
A third initiative, known as the “Women's Project”, is mobilizing support from religious leaders and other decision makers for quality reproductive health services and the promotion of women's rights. These goals are being pursued through research, public-awareness campaigns, capacity-building among institutions and organizations working in the social sector, and activities to empower women, including incomegenerating schemes.
Of all the projects supported by UNFPA in the Islamic Republic of Iran, the Women's Project is the most sensitive. After several years of effort with little progress, protective legislation and other measures are now being discussed, prompted by a more open environment. More than 35 statements have been issued by parliamentarians, policy makers and key religious and community leaders in favour of reproductive health issues, including gender equity and women's rights, as a result of persuasive advocacy efforts.
“Any step towards the project's goals has proved to be very time-consuming and, at times, tiresome,” says the national project director. “But my experience has shown what when you deal with culturally sensitive issues, you have no choice but to be as careful and patient as possible. Every concern should be addressed properly. Otherwise, greater problems emerge at later times, when nothing can be done.”
In fact, in none of these projects was progress achieved overnight. After the Islamic Revolution, both the Government and most Iranians were suspicious of foreigners, including foreign organizations. Establishing mutual trust was a painstaking process, which UNFPA addressed by consistently demonstrating transparency.
“The most important lesson,” says a professor at Tehran University, “is that through patience and cultural sensitivity an organization working within a culturally complex context, at a time when foreigners were regarded with suspicion, has been able to address sensitive issues among the most disadvantaged groups in the country and to implement projects now regarded as success stories. UNFPA is regarded as a trustworthy partner by both conservative and liberal partners in Iran.”
In an environment characterized by ethnic and religious diversity, it is important to assume the role of facilitator. This sends a clear message of neutrality.
Culturally sensitive issues are best addressed in the context of health: a technical or scientific perspective can make discussion of and acceptance of such issues easier.
At the beginning of a project, invest as much time as necessary to clarify issues and address any doubts that may arise. If doubts and questions remain, they will surface later and negatively affect project implementation.
Sensitization campaigns that emphasize the positive economic and social benefits of small families can be persuasive. Comparing the situations of families with similar backgrounds, social class and income, differing only in the number of children they have, brings home the value of family planning in a way people can relate to and understand.
Field-based evidence can be effectively used to convince religious leaders, policy makers and the public about the importance of reproductive health for individuals and communities as well as for the nation as a whole.
When attempting to reach grass-roots communities, engage a partner that has a thorough understanding of local sensitivities and can address them appropriately.
Letting your partners manage projects themselves instils a sense of ownership. Nevertheless, it is important to provide continuous support through technical backstopping, capacity-building and information.
Creating opportunities for women can help them to demonstrate their capabilities. In this way, false, culturebased beliefs are diminished.