Iran's parliament has recently voted to pass legislation banning permanent forms of birth control, such as vasectomy and tubal ligation (when women get their "tubes tied"), in an attempt to improve the country's declining birth rate. Other forms of birth control that are not permanent are not banned under the proposed bill.
Under the legislation, which has to be approved by another council before being enacted, health care providers who perform permanent contraception surgeries would first receive a warning, then a fine and could ultimately have their offices closed. Such procedures would be legal only if there were a medical need for them — for example, if a patient's health were threatened by an unintended pregnancy.
Iran's birth-control policy in recent decades, which encouraged all forms of contraception, has been dramatically effective in controlling population growth. But now, the declining fertility rates are starting to concern some members of the country's conservative government and the Supreme Leader Ayatollah Khamenei, who recently called Iran's former population control plan a "mistake."
Vinod Mishra, the United Nations' chief of population policy, said in an interview with the Middle East news organization Al-Monitor that, currently, Iran's fertility rate is about 1.7, which is well below the level of 2.1 that is the replacement-level fertility rate needed to maintain the current population numbers.
However, experts say there are better ways, other than banning vasectomies, to encourage childbearing and raise fertility rates. Moreover, banning access to some methods of contraception could be unethical, they say. [The History and Future of Birth Control]
"It is striking that 2014 marks the 20th anniversary of the Programme of Action of the International Conference on Population and Development," said Ann Biddlecom, the United Nations' chief of fertility and family planning. "One of the key principles of the Programme of Action is that all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children, and to have the information, education and means to do so," Biddlecom told Live Science.
What are vasectomies, and why are they done?
A vasectomy is a minor surgical procedure that works by blocking the tube, called the vas deferens, through which sperm pass. The female version of permanent sterilization is called tubal ligation or tubectomy, and involves sealing a woman's fallopian tubes to prevent eggs from reaching the uterus. Because tubectomy is a major surgical procedure, it is done less commonly than vasectomy.
"In Iran, a vasectomy is mostly suggested in the cases of couples who have had two to three children, or even five to six, and have been in marriage for a long time," said Dr. Mehdi Aghdaee, a neuroscientist at Harvard Univeristy in Cambridge, Massachusetts, who has previously worked as a primary care physician in Iran.
Although the new law will not prohibit Iranians from using other methods of contraception, for some couples who do not want more children, vasectomy is a good option that has very few side effects compared to other methods, and doesn't put a burden on a woman's body, Aghdaee told Live Science.
Vasectomy is not irreversible; it is possible to perform another surgery to try to reconnect the cut portions of the vas deferens. However, success is not guaranteed, and the procedure is costly.
How to ethically raise fertility rates?
Limiting people's choices about their reproductive health is generally unethical, said Arthur Caplan, a bioethicist at the New York University School of Medicine.
"When governments ask individual citizens to promote a common good by trying to manipulate medical procedures related to reproduction, it also raises a slippery-slope problem," Caplan said. "Pretty soon, birth-control pills become a problem, and then condoms."
"I think social goals are better achieved by incentives than they are by restrictions," he told Live Science.
Policies that use incentives to raise fertility rates include providing direct subsidies for childbearing, or making it easier for women and men to balance work and family, Biddlecom said. Many countries that face aging populations have implemented a wide range of such policies without limiting people's access to family planning methods, she said.
In the Iranian media, critics of the proposed law have pointed out that economic factors, and not the family planning policies, are contributing to the country's aging population. A difficult economy, a decline in marriages and an increase in divorce may be factors keeping people from having more children.
Using incentives targeted at younger couples would likely be more successful in raising fertility rates than banning a procedure that is used only by people who don't want any more children, Caplan said.