Authors: Shayda Swann, MD/PhD Candidate, University of British Columbia & Bahareh Azadi, Graduate Student, University of British Columbia
Editor: Negin (Events & Communications Specialist), Romina Garcia de leon (Blog Coordinator).
Publication date: Oct 7th, 2022
In light of the recent death of Mahsa Amini, a 22-year-old Iranian woman, while detained by Iran’s “morality police”, we sought to explore and expose the impacts of oppression in Iran on women’s health. While we could consider this issue from many vantages, we focus here on how systemic oppression impacts women’s reproductive and mental health.
Before delving into the topic, we felt it critical to declare our positionality. Shayda is an Iranian-White MD/PhD student whose research involves women’s sexual and reproductive health. Shayda has never lived in Iran but feels a deep attachment to the country where her family originated and escaped religious persecution as members of the Baha’i Faith.
Bahareh is an Iranian graduate student and health researcher who lived in Iran until the age of 14 before immigrating with her family to Canada in pursuit of a better future. Since immigrating, Bahareh has frequently visited Iran as a young woman where she has had several encounters with the “morality police” and has experienced first-hand the consequences of the oppressive norms of the regime.
Impact on women’s sexual and reproductive health
Sexual and reproductive health refers to upholding rights and freedoms concerning body autonomy, reproductive choice, prevention of sexually transmitted infections, menstrual hygiene, and various other aspects of women’s lives.
A 2015 report by Amnesty International points to numerous ways in which oppression in Iran limits women’s sexual/reproductive health. Before 2012, Iran’s Family and Population Planning program met several successes, including reducing the fertility rate from 6.5 to 1.6 births per woman between 1976-2012. This program was cut in 2012, accompanied by statements from high-ranking officials that contraception should only be used with consent from the husband, thus limiting women’s autonomy. These changes, unsurprisingly, were accompanied by an increase in sexually transmitted infections among women, with a 550% increase in the prevalence of HIV from 2007 to 2015.
In 2021, women’s reproductive choices were further restricted by the “rejuvenation of the population and support of family” bill, which severely limits women’s access to contraception. The bill further mandates the creation of materials that denounce contraception and abortion, while encouraging women to have more children. Policies such as this violate women’s body autonomy and reproductive rights, put them at higher risk for unsafe pregnancy and sexually transmitted infections, and limit their educational and occupational opportunities; therefore, these policies compound the socio-structural barriers faced by Iranian women.
Menstrual education is another important aspect of women’s reproductive health. A 2018 review found “weak knowledge” about reproductive physiology and menstrual health among Iranian girls, attributing this to sociocultural and political barriers that limit reproductive health education. Importantly, one study found that only 26% of adolescent girls report receiving adequate information about puberty.
Another study emphasized how shame and anxiety shape young women’s experience of menstruation in Iran. Shockingly, a study investigating knowledge about menstrual health among girls found that less than half (41.2%) of participants considered menstruation to be a normal physiological process, and only 1.6% had “good knowledge” about menstrual hygiene. These studies underscore a concerning lack of education and understanding of menstruation, which is likely perpetuated by culturally-rooted shame and lack of political will to incorporate this into public education, thus depriving young girls of the necessary information about their bodies.
Women’s reproductive health is further threatened by the country’s marriage laws. The legal age of marriage for girls in Iran is thirteen-years-old, or younger if allowed by the court, compared to age fifteen for boys. Child marriage is not only legal in Iran, but is tacitly encouraged through government loans, with rates of child marriage rising drastically since the introduction of these loans. In the first half of 2021, more than 16,000 Iranian girls between the ages of ten and fourteen were married. This unquestionably leads to younger pregnancy ages – which increases the risk for complications, fetal illness, and maternal mortality – along with violence and reduced educational/employment opportunities. We concur with statements by the United Nations that child marriage is a human rights violation and “can lead to a lifetime of suffering”. These are but a few examples of how oppressive and discriminatory policies threaten the health of Iranian women and girls.
Impact on women’s mental health
Mental health is defined as emotional, psychological, and social well-being. State of mind affects many aspects of life, including how people think, feel, act, deal with adversity, relate to others, and make decisions. Women living in countries affected by war and political instability have a higher risk of developing mental health disorders than men.
A 2014 study reported that more than 25% (as high as 36% in the capital, Tehran) of Iranian women suffer from mental disorders. Iranian women are particularly vulnerable to experiencing mental health disorders due to social and cultural factors, including being of lower overall social standing, having inferior rights, and being subject to strict laws that dictate their everyday lives. They are treated as ‘second-class’ citizens and live in a patriarchal society with male-dominated attitudes and discriminatory laws that impose restrictions on their rights and personal liberties, such as laws that require women to cover their body with loose-fitting clothing and cover their hair with hijab from the age of nine-years-old.
This law is enforced by the “morality police” and authorities have long detained, fined, and jailed thousands of women for “improper hijab.” Those who resist detention are brutally beaten. Iranian women are left to constantly assess their performance against gender norms and strict laws; being subject to this constant scrutiny renders them unable to attend to more important issues that affect their lives (Figure 1).
Figure 1: Persepolis by Marjane Satrapi.
Another factor that greatly contributes to the vulnerability of Iranian women to mental health disorders is related to discriminatory labor laws and regulations that limit the financial freedom of women and their participation in the job market.
The link between financial standing and mental health comes as no surprise. Financial instability is a major cause of stress and contributes to mental health challenges. Women who experience financial instability are at a higher risk for developing mental health disorders, such as anxiety and depression. According to a report released by the Statistical Center of Iran in 2015, although women make up over 50% of university graduates, their participation in the job market is as low as 17%.
This is a direct consequence of domestic laws that limit women’s access to employment, in addition to placing restrictions on the types of professions that women can participate in. Further, Iranian law grants men the authority to prevent their wives from obtaining employment, and some employers go as far as to require consent from a woman’s husband. Thus, it is not surprising that the chronic exposure of Iranian women to societal pressures and their continued struggle for basic rights places them at higher risk for developing mental health disorders.
Here, we chose to highlight only two of the many ways that women’s health is jeopardized by oppressive social and political circumstances in Iran. As Iranian women in health research, we felt compelled to highlight these issues, with the hopes of drawing greater awareness to these inequitable and unjust circumstances. We stand in solidarity with the women of Iran as they fight for freedom.