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The
Strategic Implications of Iran's STD Epidemic
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Originally published under the title, "STD's and strategy
in Iran."
In the 5th Century BC, the "Persian disease" noted by
Hippocrates probably was bubonic plague; in 8th-century Japan, it meant
the measles. Today it well might mean chlamydia. Standout levels of
infertility among Iranian couples, a major cause of the country's falling
birth rate, coincide with epidemic levels of sexually transmitted
disease. Both reflect deep-seated social pathologies. Iran has become a
country radically different from the vision of its theocratic rulers,
with prevailing social pathologies quite at odds with the self-image of
radical Islam.
Iran's fertility decline from about seven children per female in 1979
to just 1.6
in 2012 remains a conundrum to demographers. Never before in recorded
history has the birth rate of a big country fallen so fast and so far.
Iran's population is aging faster than that of any other country in the
world. In 2050, 30% of its people will be over 60, the same ratio as in
the United States but with a tenth of America's per capita GDP. I see no
way to avoid a social catastrophe unique in human experience. Since I
first drew attention to Iran's demographic implosion a decade ago,
I have heard not one suggestion as to how Iran might avert this disaster,
despite some belated efforts to raise the birth rate.
Iran's fertility decline remains a
conundrum to demographers. Never before has the birth rate of a big
country fallen so fast and so far.
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Iran was the first Muslim country to achieve mass literacy, thanks in
large part to the Shah's Literacy Corps of the 1970s. Muslim total
fertility rates correlate closely with female literacy rates: As soon as
Muslim women have the means to make their own decisions, they reject
traditional society and the fertility behavior associated with it.
But another factor is at work. Iran has the highest incidence of
lifetime infertility of any country in the world, estimated at between
22% and 25% in separate Iranian
government surveys. Roughly a quarter of Iranian couples, that is,
are unable to bear children.
By comparison, lifetime infertility ranges from 11% in Europe and 15%
in India. The Iranian data are more extensive than in most other
countries because Iran's government has devoted enormous resources to
finding explanations and remedies for its uniquely high infertility rate.
The lifetime infertility in selected countries: Iran (year of survey
2004-2005) 24.9%; Australia(1991-1993) 18.4%; Denmark (1995) 15.7%;
Indian Kashmir (1997) 15.1%; UK (1988) 14.1%; France (1988) 12.2%; Europe
(1991-1993) 11.3%; Norway (1985-1995) 6.6%.
One explanation for Iran's strikingly infertility rate is the high
level of consanguineous (cousin) marriages, that is, inbreeding. Azadeh
Noaveni writes:
Iran, like other Middle Eastern
countries, has an extremely high infertility rate. More than 20 percent
of Iranian couples cannot conceive, according to a study conducted by one
of the country's leading fertility clinics, compared with the global rate
of between 8 and 12 percent. Experts believe this is due to the
prevalence of consanguineous marriages, or those between cousins. Male
infertility is "the hidden story of the Middle East," says
Marcia Inhorn, a Yale University medical anthropologist and a specialist
on assisted reproduction in the region.
This surmise probably is wrong. Iran's rate of cousin marriage is
about 25%, lower than most of the Middle East. We do not have permanent
infertility data for most Middle Eastern countries, but the fertility rate
in neighboring Iraq (at four children per female) is more than double
that of Iran. In fact, the proportion of cousin marriages is inversely
correlated with fertility, because women in the sort of traditional
society that fosters cousin marriage tend to bear more children.
A more probable cause of Iran's extremely high rate of infertility is
sexually transmitted disease, particularly chlamydia, the most common
bacterial STD and one likely to go undetected in countries with poor
public health systems. This may seem incongruous, for the Islamic
Republic of Iran represents itself as the guardian of social standards
against Western decadence. Nonetheless, the government's own data
strongly support this inference.
A 2013
paper by a team of Iranian researchers, "Effects of Chlamydia
trachomatis Infection on Fertility: A Case Control Study," observes:
The molecular prevalence of C.
trachomatis was 12.6% in woman in Tehran, the capital of Iran, and in
another study it was 21.25% in women attending Shahid Beheshti Hospital
in Isfahan, Iran. Considering the different prevalence rates of C.
trachomatis infection in Iran, it is vitally essential to assess the
impact of C. trachomatis on the reproductive health of women.
Iran appears to have the world's
highest rate of lifetime infertility because it also has the world's
highest rate of STD infections.
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By contrast, the US Center for Disease
Control reports a rate of 643 cases per 100,000 American women, or an
infection rate of only 0.6%. Among sexually active females aged 14-19
years, the American population segment most at risk, the infection rate
was 6.8%. Globally, the chlamydia infection rate was 4.3% in 2008,
according to the World Health Organization.
Iran appears to have the world's highest rate of lifetime infertility
because it also has the world's highest rate of STD infections. This is a
tentative conclusion, to be sure, because Iran's fairly primitive public
health system has produced only fragmentary evidence about STD infection
rates. It is nonetheless convincing.
Iranian authorities have made dire warnings about epidemic rates of
STD infection. As Muftah.org
reported in late 2013:
On World AIDS Day (December 1st),
Iran's Health Minister Hassan Hashemi, announced that Iran is facing a
dramatic increase in HIV diagnoses. Speaking at an AIDS-awareness conference
at the Ministry of Health, Hashemi noted that over the past eleven years,
AIDS cases have increased nine-fold. He further warned that the lack of
sexual education and persistent social taboos surrounding sexually
transmitted diseases (STDs) in Iranian society were factors in this
alarming trend.
Just weeks later on December 18th, news
about increases in Iran's STD infection rates again made national
headlines. Mostafa Aqlyma, the President of the Association of Social
Workers told the Iranian Labor News Agency (ILNA) that the country was
experiencing an outbreak of genital warts and that "nearly one
million people have been affected" by the virus. Aqlyma described
the epidemic as "more dangerous than HIV," and noted that he
had treated almost ten times the number of male patients this year as
compared to last.
That is at odds with the Islamic Republic's image in the West, but it
is quite consistent with the complaints of Iranian officials about the
widespread increase in casual sexual relationships. Premarital sex is
illegal in Iran, but the peculiar Shi'ite institution of Sigha, or
temporary marriage, allows Iranians to engage casual sex with official as
well as clerical sanction. Iran's Sharzad
news service reported in 2014:
Figures released by the Iranian
National Statistics Office indicate that Sigha - temporary
partnership - is on the rise, while fewer and fewer people are marrying
in the conventional way. According to the deputy justice minister, Sigha
rose by 28% in 2012 and by a further 10% in the first half of this year.
Sociologist Mustafa Aghlima told the ISNA news agency: "The increase
in Sigha at the cost of fewer proper marriages means the collapse of
family life and its cultural values."
I have been unable to find statistics on the total number of Sigha
liaisons in Iran, but anecdotal evidence suggests that they are very
common. The Azerbaijani website Trend reports:
Some 84.5 percent of Iranians aged 18
to 29 years are in favor of temporary marriage, Iranian Shargh
newspaper reported citing Iran's Youth Affairs and Sports Ministry's
study. According to the study which has conducted tests among 3,000 young
people of Iran's 14 cities, about 62.9 percent of Iranian youth avoid
temporary marriage due to fear of bad reputation. During the last several
years, number of websites which offer temporary marriage services to
Iranians has increased.
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Former
President Mahmoud Ahmadinejad once said that Iranian women who decline
to bear children are guilty of "genocide" against their
nation.
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The survey seems to conclude that the vast majority of young Iranians
the support the idea of temporary marriage and can arrange one online,
while 63% decline to do so - which suggests that 37% do.
Prostitution also is quite common in Iran, although I have been unable
to find an official estimate later than a 1994 International Labor
Organization estimate of 300,000 working prostitutes. Estimates vary
widely, but the Iranian authorities acknowledge that it is a serious
social problem.
Iran's leaders are well aware of the consequences of the sudden aging
of its population; former President Mahmoud Ahmadinejad said that Iranian
women who decline to bear children were guilty of "genocide"
against their country:
'Two children' is a formula for the
extinction of a nation, not the survival of a nation … The most recent
data showing that there are only 18 children for every 10 Iranian couples
should raise an alarm among the present generation … This is what is
wrong with the West. Negative population growth will cause the extinction
of our identity and culture. The fact that we have accepted this places
us on the wrong path. To want to consume more rather than having children
is an act of genocide.
Iran promotes In Vitrio Fertilization (IVF) as a solution to infertility,
as Ms Moaveni reported at Foreign Policy:
Women chat openly about IVF on state
television, couples recommend specialists and trade stories on Internet
message boards, and practitioners have begun pushing insurance companies
to cover treatment. And the state runs subsidized clinics, so the cost
for treatment is lower than almost anywhere else in the world: A full
course of IVF, including drugs, runs the equivalent of just $1,500.
IVF is a godsend for couples who wish to have children but cannot
conceive otherwise, but it is unlikely to have much of an impact on
Iran's overall numbers.
Iran's economy will be crushed
under an avalanche of elderly dependents a generation from now.
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Directly or indirectly, Iran's childlessness stems from a deep and
intractable national anomie, a loss of personal sense of purpose in a
country whose theocratic elite has no more support at the grass roots
than did the Communist Party of the Soviet Union in the 1980s.
We know how this will end: Iran's economy will be crushed under an
avalanche of elderly dependents a generation from now. What we do not
know is what will happen en route to the end. The sad task of Iran's
neighbors is to manage its inevitable decline and prevent its own sense
of national tragedy from turning into tragedies for other peoples as
well. Iran's position is without precedent among the nations of the
world. It knows as a matter of arithmetic that it has no future. Its
leadership feels that it has nothing to lose in strategic adventures,
which means that the rest of the world should take no chances with Iran.
David P Goldman is a Senior Fellow
at the London Center for Policy Research and the Wax Family Fellow at the
Middle East Forum. His book How Civilizations Die (and why Islam is Dying, Too)
was published by Regnery Press in September 2011. A volume of his
essays on culture, religion and economics, It's Not the End of the World - It's Just the End
of You, also appeared that fall, from Van Praag Press.
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