Abortion in Iran

Abstract

Background:

Legal abortion has been permitted in the Islamic Republic of Iran since 2003 if there is serious and incurable disease that would cause the mother or the fetus suffering.

Aims:

This study evaluated the characteristics of women applying for a legal abortion licence to the Tehran Province General Office of Legal Medicine, and compared the findings with earlier studies to evaluate changes over time.

Methods:

All women visiting the office between August 2011 and 2012 to apply for a legal abortion licence were interviewed and sociodemographic data, reason for the application and outcome of the application were recorded.

Results:

A total of 1378 women applied for a licence, and 48% were issued. Most applications (80.6%) were for fetal rather than maternal indications and 90.2% of the licences issued were for fetal indications.
Most of the applications for fetal indications (53.7%) were granted a licence, while 75.7% for maternal indications were rejected. Neurological abnormalities in the fetus were the most common reason for the application (24.6%) and licences issued (30.7%). Neurological and psychological disorders were the most common maternal reason in all applications (25.7%) and in unsuccessful applications (28.6%).
Cardiac disease (23.1%) was the most common maternal reason in successful applications.

Conclusions:

Comparison of the results with those of earlier studies shows an increase in the number of women applying for a legal abortion licence and in the number of licences issued.
Similar studies are recommended to provide information on the effect of national abortion laws and help improve the legal abortion process in the Islamic Republic of Iran.

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abortion

Abortion refers to the termination of pregnancy before the 20th week of gestation or a fetus less than 500 g of weight, and may be spontaneous or induced (medically, non-medically or criminally) . Therapeutic or legal abortions are performed for medical reasons related to the mother or the fetus . In some countries there are legal restrictions on abortion. Given its integration with legal, judicial, moral and social issues, abortion is not just a medical problem . Before the 1979 Islamic Revolution in Iran, abortion was legal for the purposes of saving a mother’s life or her mental and physical health, or after diagnosis of fetal defects. After the revolution, however, abortion regulations were abolished, and abortion was allowed only in the few cases in which the pregnancy threatened the life of the mother .

The legal vacuum

on legal abortions was problematic in the Islamic Republic of Iran because many fetal anomalies and diseases existed.
This became a subject of discussion in 1997 following a fatwa by the Supreme Leader of the Islamic Revolution authorizing legal abortion for fetuses with major thalassemia.Based on Islamic law and guided by modern medicine, the medical abortion law was prepared in 2003, revised and ratified by the Islamic Parliament in 2005 (6,7), and approved by the Guardian Council on 15 June 2005.
The law states that:
legal abortion is allowed provided that three specialists make definite diagnoses about the fetus being malformed or retarded, thus causing the mother to suffer severely, or about the mother’s own life-threatening conditions, and given the general office of legal medicine’s final approval, provided the fetus is not yet four months old, the time at which spirit is breathed into it, and provided the mother’s consent, and the superintendent doctor has no responsibilities toward the matter and will not be punishable by law with regard to this action.
action. Based on this law, the Iranian Legal Medicine Organization has adopted procedures in recent years for authorizing legal abortion, which require at least one of a list of 51 conditions to be met for a licence to be issued; 22 relate to the health of the mother and 29 to the health of the fetus. These 51 conditions are serious and incurable diseases that will cause the mother, the fetus or the future child to suffer .
The Supreme Leader of Iran, Ayatollah Khamenei, issued a fatwa on this matter in 2003, stating that, “if the fetal condition can be definitively diagnosed, and if the survival of this fetus causes serious suffering, which is typically the case, performing an abortion is permitted before the spirit is breathed into the fetus. However, to take precaution, the blood money (dieh) for the fetus should be paid” .
To summarize, the therapeutic abortion law was approved by the Iranian parliament in 2003.
Before this law, abortion permissions were severely restricted in the Islamic Republic of Iran. At that time, a guideline on indications for abortion was presented by the Legal Medicine Organization of Iran. Parliament and the Islamic Consultative Assembly approved this in 2005 .

Methods

Study design and sample

This was a prospective study of all the women who visited the Tehran Province General Office of Legal Medicine to apply for a legal abortion licence between 23 August 2011 (1/6/1390 Iranian calendar) and 21 August 2012 (31/5/1391 Iranian calendar).

Data collection

In Tehran Province General Office of Legal Medicine, women applying for a legal abortion are referred to the Women’s Office. The outcome of the application is usually received after one or two visits and on the same day in the case of fetal indications for a legal abortion licence. For applications based on indications of the mother, the outcome takes three days to one week.
For data collection, the women were approached on their last visit when the outcome of their application for a legal abortion licence was confirmed.
Most of the women agreed to be interviewed and for their data to be reviewed; 11 women did not wish to be interviewed but some information was available for them, namely: reason for applying for an abortion licence, fetal or maternal indication for the abortion, fetal age, issuance of the abortion licence or not, if not, the reason for not issuing the licence. The data were collected by two of the researchers of this study (AJ and FS) who worked at the Women’s Office.
The researchers interviewed the women at the Women’s Office and data were also obtained from the women’s medical documents.
The data recorded for each women included: age, husband’s age, level of education, occupation, husband’s occupation, gravidity, parity, number of living children, history of abortion, number of abortions, reason for requesting an abortion, type of fetal or maternal indication for the abortion, history of using medications for every acute/chronic disease or exposure to radiation during pregnancy, fetal age, person or place referring the woman, issuance of the abortion licence or not, if not, the reason for not issuing the licence, and reason for any delays in applying for the licence.

Statistical analysis

The data obtained were analysed using descriptive statistics. Participants were divided into 2 groups – those who were issued the licence and those who were not. Differences between the 2 groups were compared according to socioeconomic and obstetric characteristics using the independent t-test (for continuous variables) and the chi-squared test (for categorical variables).
Mother’s medication use, her diagnosis of communicable diseases that could cause fetal anomalies and her exposure to radiation were considered fetal indications for an abortion in the analysis of the data as they could have adverse effects on the fetus.
Some fetal problems that did not require an abortion licence or that should have been followed up by a hospital were also taken to be fetal indications, including partial moles, intrauterine growth restriction, abnormal amniotic fluid, intrauterine fetal death and a blighted ovum.

Ethical considerations

The study was approved by the Ethics Committee of Tehran University of Medical Sciences.
A letter of introduction was provided by the authorities of Tehran University of Medical Sciences to the Tehran Province General Office of Legal Medicine.
The researchers explained the objectives of the study to the office authorities and obtained their consent before collecting data on the women.

Hysterotomy abortion

Hysterotomy abortion is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section. The procedure is generally used after the failure of another method, or when such a procedure would be medically inadvisable, such as in the case of placenta accreta.
In 2016, this method made up less than 0.01% of all abortions in the United States, with the CDC reporting only 51 having occurred due to the invasive and complex nature of the procedure, and the availability of much simpler and safer methods.