In Iran, where abortion is severely restricted by law, married women aged 15–49 have an estimated 73,000 abortions per year, according to a recent analysis of nationally representative data.¹ This translates to 0.26 lifetime abortions per woman. However, the abortion rate varies widely among Iran's provinces, depending largely on regional levels of religiosity and modern contraceptive use.

The data used to estimate abortion rates and levels come mainly from a subsample of 87,248 married women aged 15–49 who completed the 2000 Iran Demographic and Health Survey. The women provided information on social and demographic characteristics (including fertility), as well as on factors affecting their reproductive health. Because abortions are difficult to obtain in Iran and are often performed illegally, accurate data on the procedure's incidence were unavailable; thus, the researchers used the so-called residual method to estimate the abortion rate. In this approach, the abortion rate is calculated from a formula that incorporates women's theoretical maximum fertility rate (15.3 children per woman), the total fertility rate for Iran (2.0 children per woman), contraceptive use, postpartum infecundability, and seasonal and absolute spousal separation (due primarily to work-related migration). This rate was then applied to 1996 census data to generate an estimate of the incidence of abortion.

To examine the relationship between abortion and religiosity, the researchers merged data on the estimated abortion rates for Iran's provinces with information from the 1999– 2000 World Values Survey, a 60-country survey of religious attitudes and behavior. The Iranian sample consisted of 2,532 men and women aged 15 or older and represented 26 of the country's 28 provinces. Data on the importance of religion in respondents' lives and the frequency with which respondents attended religious services were used to construct a religiosity scale that ranged from –3 (weak religiosity) to 2 (strong religiosity).

The researchers estimated that among the measured factors that limit fertility, contraceptive use had the greatest effect in Iran, far outweighing the impact of postpartum infecundability and spousal separation. Abortion accounted for 4% of fertility inhibition. Extrapolating from the data, the researchers estimated the total abortion rate to be 0.26 lifetime abortions per woman, which corresponds to a national annual abortion rate of 7.5 per 1,000 married women aged 15–49. Overall, Iranian women have an estimated 73,000 abortions per year. The national rate, the researchers point out, obscures large regional differences: The estimated rate was essentially zero in 10 provinces, while it was more than 40 per 1,000 in Hormozgan (40.6) and Sistan-Baluchestan (46.3). In the remaining 16 provinces, estimated abortion rates ranged between 0.8 and 22.8.

A bivariate analysis of data from the 18 Iranian provinces with estimated abortion rates higher than zero revealed an inverse relationship between rates of abortion and contraceptive use, underscoring contraception's role in preventing the need for abortion. In an analysis that included all 28 provinces, the association between religiosity and abortion was generally negative: Highly religious provinces tended to have lower abortion rates than did areas that scored lower on the religiosity scale. Nonetheless, provinces with similar abortion rates often varied widely in religiosity. For instance, among provinces with an abortion rate of zero, religiosity scores ranged from around –1 (in Ardebil, which had the fourth lowest religiosity score) to 2 (in Semnan, the province with the highest score). In most cases, provinces that had low levels of both abortion and religiosity, such as Ardebil, had relatively high rates of modern contraceptive use.

In a multivariate analysis, the investigators found that together, contraceptive use and level of religiosity accounted for 87% of the variance in abortion rates among provinces. The analysis also confirmed that contraceptive use is negatively associated with abortion, even when the influence of religiosity is taken into account. Overall, the effect of contraceptive use on abortion rates was 51% greater than that of religiosity.

The researchers point out that the level of abortion in Iran, while relatively low—less than half that of neighboring Turkey—is nonetheless cause for concern, as "most [abortions] are performed in unsafe and hazardous circumstances because legal restrictions on the practice of abortion, although partially relaxed in recent years, remain strict." Given the strong negative association between contraceptive use and abortion rates, the authors advocate greater promotion of modern contraceptive use through Iran's family planning policies and programs. Their recommendations include increasing the availability of modern contraceptives in areas with high abortion rates, expanding contraceptive education efforts to reach couples, and increasing information about and access to emergency contraception.—H. Ball

REFERENCE

1. Erfani A and McQuillan K, Rates of induced abortion in Iran: the roles of contraceptive use and religiosity, Studies in Family Planning, 2008, 39(2): 111–122.