Fertility Treatment in Iran

Here’s an interesting article by Elizabeth O’Donnell in Le Monde Diplomatique regarding the growth and development of fertility treatments in Iran. 

I’ve pasted some paragraphs that were of particular interest (for the full article follow the link below) regarding the flexibility of the Iranian legal system, the shattering of certain taboos vis-a-vis sperm and egg donation, and also the patriarchal instinct so deeply rooted in Iranian culture to hold women, rather than their male counterparts, responsibile for marriages which fail to bear children.  Is this evidence of the Iranian symbolic register’s propensity to associate barrenness with feminity?  If so, we need to try our best to undo this often unconscious and highly objectionable association.

“According to the World Health Organisation (WHO), infertility affects approximately 8-12% of couples of reproductive age (15-49 years) worldwide. A 2000 study suggests that in Tehran infertility is about 12%, in line with WHO calculations. Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It is also the inability to carry a baby to term or have a family – and the feeling of exclusion from the human experience that can bring. Although male and female factors contribute equally to infertility, the term has historically and unfairly been used to describe the reproductive status of women, since they become pregnant and give birth.”

“Until the mid-1960s reproductive freedom was essentially unchallenged in Iran. By 1967 this had changed based on census data that showed a population growth rate of 3%, and concerns for overpopulation led to a government-sponsored family planning initiative. Following the 1978 revolution fertility climbed and by 1986 population growth was 3.9%. Fear for Iran’s ability to sustain itself resurfaced and a public education campaign ensued. Family planning became an integral part of the healthcare mandate and by the end of the 1990s the birth rate per 1,000 had gone from 48 in 1978 to less than 30.

The commitment to family planning is a religious and political edict in Iran and part of a progressive initiative that has extended urbanisation, influenced healthcare and mortality rates, and educated the public on the cost of overpopulation to families and the planet. Islam does not forbid the use of contraception and no direct references to it not being permitted are found in the Qur’an. So a space has been made for the use of birth control in Muslim life.

Like birth control, infertility and its treatment comes under the auspices of Jurist rule in Iran, represented by the absolute guardianship of the Supreme Leader, Grand Ayatollah Ali Hussein Khamenei. Currently – and this may surprise people in the West – Iran has the most progressive stance toward infertility treatment and the use of the assisted reproductive technologies (ART) of any Muslim country.”

“The use of donor egg or sperm has tremendous significance for anyone contemplating infertility treatment. In most Muslim countries formal adoption is typically forbidden. (Iran has also begun to reconsider its position on adoption.) For couples who have no chance of conceiving via their own egg or sperm, using a donor presents a resurrection of hope, as well as the opportunity to experience pregnancy and birth. But Sunni Islam has categorically forbidden the use of third-party reproductive practices, comparing it to adultery (zina) as a violation of the marital commitment to fidelity.

Several Shia scholars are of the same opinion. However, Iran’s Supreme Leader has decreed it permissible – despite the “official” Iranian position that sperm or egg donation is not acceptable. Khamenei’s fatwa speaks to the intention of couples seeking treatment, which is to have a family. Rather than use a literal or reductive explanation, Khamenei has applied an enlightened and compassionate view of infertility. A view that not only stands in significant opposition to many other Muslim clerics (inside and outside of Iran) but also challenges the West’s view of Iran as an absolute and archaic society whose principles take no account of the dilemmas of modern life. Clearly there is dissonance between the theoretical and practical application of ART as it relates to the third-party parenting practices.”

“It is too soon for Firoz to imagine his wife pregnant with the sperm of another man. He has never told Salma that his father blames her for their lack of children; “Well, it’s not you,” he has said to Firoz many times, firm in his blame of Salma. Salma has slowly retreated from the world, preferring to sit at home reading books on natural cures and remedies rather than go to family dinners.

Resolving the problem of infertility by using donated gametes creates more than the abstract possibility that a couple could be accused of committing adultery. Using the sperm or egg provided by a third party changes the biological relationship between parents and offspring and has a profound impact on the transition of lineage, and preserving the integrity of lineage or kinship is important in both the Shia and Sunni traditions. One of the ways in which the issue of marriage has been addressed in third-party parenting arrangements in Shia Islam has been via the use of temporary marriage (mut’a) which does not exist in Sunni Islam.

However, Khamenei’s fatwa does not mandate the use of mut’a. In 2003 the Iranian parliament ratified the Embryo Donation to Infertile Spouses Act, which allows married couples to donate embryos (fertilised from the husband’s sperm and wife’s egg) to another married couple with a documented difficulty conceiving. Although the act does not specifically permit sperm and egg donation, that too is implied and, according to Soraya Tremayne, director of the Fertility and Reproduction Studies Group at Oxford University, “the likelihood of an ensuing fatwa allowing donation by strangers is high”.”

“Infertility treatment involves the consideration of biological, medical, social, psychological, religious, legal, ethical and cultural factors. Shia Islam has not attempted to shy away from or forbid treatment of infertility using advanced technology. Instead there has been a burgeoning interest in the application of hadith to manage all human dilemmas.

The attitude towards infertility treatment in Iran is symbolic of the complicated relationship that exists within Islam, and between Islam and the West. It is an attitude that reflects a willingness by many Iranians to push from the inside. When Shirin Ebadi won the Nobel Prize for Peace in 2003 she said that change in Iran had to come from within. Since the 1978 revolution many Iranian women have resisted discrimination, some paying with their lives. (Like human rights, infertility and its treatment have been an area of disenfranchisement for women all over the world.) But though Iran does not invite the opinion of outsiders, this does not mean that change isn’t happening.”


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