Journal of Epidemiology & Community Health
June 2016, Volume 70, Issue 6
http://jech.bmj.com/content/current

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Essay
Birth control policies in Iran: a public health and ethics perspective
Mehdi Aloosh1, Yashar Saghai2
Author Affiliations
1McGill University Health Centre, Montreal, Quebec, Canada
2Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA
Correspondence to Dr Mehdi Aloosh, McGill University, McGill University Health Centre, Montreal, Quebec, H4A 3J1, Canada; mehdi.aloosh@mail.mcgill.ca
Abstract
In less than one generation, a unique demographic transition has taken place in Iran. A population growth rate of 4.06% in 1984 fell to 1.15% in 1993 and a total fertility rate of 6.4 births per woman in 1984 declined to 1.9 in 2010. In 2012, Iranian policymakers shifted away from a birth control policy towards a pro-natalist policy. At first glance, this may seem reasonable since its goal is to avoid the consequences of an aging population. However, we argue that the policy package raises serious public health, socioeconomic, environmental and ethical concerns and is likely to fail on its own terms.

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The influence of refugee status and secondary migration on preterm birth
Susitha Wanigaratne1,2, Donald C Cole3, Kate Bassil3, Ilene Hyman3, Rahim Moineddin4,
Marcelo L Urquia1,2,3
Author Affiliations
1Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
4Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Correspondence to Dr Marcelo L Urquia, St. Michael’s Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada; marcelo.urquia@utoronto.ca
Abstract
Background It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants.
Methods We conducted a retrospective population-based cohort study. Ontario immigration (2002–2010) and hospitalisation data (2002–2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22–31, 32–36, 37–41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration.
Results Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants.
Conclusions Refugee status, jointly with secondary migration, influences PTB among migrants.