The structure of the healthcare system of each country requires the design of documented frameworks in the field of issues and problems that may affect the overall health outcomes of society; these policies can certainly be influenced by economic conditions, necessary infrastructure, and similar factors.

Usually, the goal of a country’s healthcare system is to design strategies for providing health services that can bring a healthier community for the future of the country as much as possible, increase the life expectancy of the society, and reduce the consequences such as infant mortality, children under five years old, pregnant mothers, and the spread of diseases.

In this regard, it is necessary for health system experts of each country to develop programs in the field of environmental health, prevention of communicable and non-communicable diseases, mental health, maternal and child care, and family planning, and based on indicators, monitor the progress of these programs for comprehensive monitoring of community health.

Although all aspects of health are extremely important and vital in the health sector, and no priority can be given to any of these activities over others, in fact these factors are intertwined in some way. However, the rate or percentage of population growth, along with the fertility rate, can affect other systems and policies of the country (although this is true for many other cases as well) and requires necessary predictions for the necessary infrastructure for the future population of the country, such as education, employment, clean water, housing, etc. It can be said that if a country changes its population policies but does not adjust its development infrastructure accordingly, whether intentionally or unintentionally, it will lead to serious problems in the future and this highlights the role of governments in regulating these policies accordingly.

Population growth in Iran.

In recent years, according to the statistics of the United Nations, the population growth rate in the world is approximately 1.17%, and according to the World Bank, it is around 1.16%. This is while the population growth rate in Iran, according to the United Nations, is 1.35% and according to the World Bank, it is 1.31%. According to the United Nations, Iran ranks 96th and according to the World Bank, it ranks 104th in terms of population growth rate among 230 and 210 countries respectively.

According to the latest report from the World Health Organization, in 2013, the population of Iran was over 77 million and 447 thousand people, with a fertility rate of 1.9% and 6.7% of the gross national income being spent on healthcare.

Looking at the history of population growth in Iran, we can see that the growth rate was 3.1% in 1966 AD, 2.7% in 1976 AD, and after the February 1979 revolution, it reached a sudden growth rate of 3.9% in 1986 AD. Due to the lack of necessary infrastructure, this sudden growth caused problems such as schools with multiple shifts. As a result, the policies for controlling population (or perhaps poverty of the people, or both factors) were readjusted and implemented, leading to a decrease in the growth rate to 2% in 1996 AD and 1.6% in 2006 AD.

The purpose of this writing is to examine human rights issues at both the societal and professional levels within the Ministry of Health, Treatment, and Medical Education, and to observe the implementation of new population policies regardless of potential issues and problems that may arise due to lack of necessary infrastructure. It will also assess to what extent these policies align with human rights evaluation indicators.

Respect for human rights among experts employed in the Ministry of Health.

Although examining the observance or non-observance of human rights in society is very important and crucial, due to the consequences of damaging the body of a country’s expertise from mandatory orders, it undermines society’s trust in the principles of expertise. Therefore, we will initially focus on this aspect.

Health activists remember that after the increase in population growth, the activities of the Ministry of Health in the form of health care networks have significantly increased in order to control this phenomenon. This was achieved by promoting incentive policies, distributing free preventive equipment, providing incentives to employees in this field, and providing free surgeries to applicants, along with extensive advertising in health homes and health care centers, and obtaining advertising permits from religious authorities. However, resistance and even physical confrontations and threats by health workers who were active in preventing pregnancy were seen in many provinces. Nevertheless, these activities, and of course the economic conditions of society, have led to the disproportionate growth of the population and the re-establishment of the slogan “less children, better life” in society. But it was not long before, in the government of Mahmoud Ahmadinejad, suddenly and without sufficient funding or, more importantly, without proper evaluation by relevant ministries, the society was encouraged to increase the population through a financial incentive package. Although at that

Exactly this sudden change in the system of a country’s education (without the necessary scientific and evidential documents) can be a small model of the level of freedom of thought and expression in the country; consider the individuals who until yesterday were encouraging patients to use methods of birth control and prevention of pregnancy, but in a short period of time are forced to promote and encourage pregnancy. The noteworthy point is that these individuals are humans, not robots who only operate based on a program, so this sudden change in the mindset of this population is not a result of the structure of a ministry or a miracle, but rather a result of force, which is closer to reality! It is not surprising that in countries where freedom is absent, there is a demand from experts to shape the desires of politicians, but such sudden changes in a country are relatively rare. As the head of the Office of Population, Family, and Schools stated: “The population policies of the Ministry of Health are completely based on the general population

The important point to note is that in countries where the foundations of expertise are emphasized, experts in relevant fields usually set the overall framework for formulating specialized policies. In case of conflicts with other departments, they are integrated in coordination committees and are essentially the creators of population policies. Although, according to global foundations and conventions, this sudden change should be evaluated, we raise the question to prevent prolonging the discussion: In a country where expressing opinions on scientific and technical issues is not free, are the freedoms of expression and opinion (Articles 1, 2, 3, 7, 18, 19, and 21) stated in the Universal Declaration of Human Rights applicable?

Respecting the human rights of all members of society.

It may be possible to extend all of the above cases in the field of the right to life of individuals, and therefore it can be said that the above foundations can easily be extended in society as well. However, alongside the right to life of the general population, the right to access to health is another issue that can be considered as a subcategory of the right to life of individuals. To properly examine this right, five characteristics must be carefully considered, including “sexual and reproductive health”, “mortality rates and methods of caring for the health of children and infants”, “environmental and occupational health of individuals”, “methods of prevention, treatment, and control of diseases”, and “access to essential health facilities and medications”. It seems that the issue of family planning is also debatable under the section of sexual and reproductive health, as well as the methods of access to health facilities and essential medications.

In any case, there are various methods for evaluating the observance of human rights in the health sector, which examine the observance of individuals’ rights based on indicators and criteria within defined frameworks. The important point is that these evaluations are usually carried out in the form of examining processes, outputs, and structures. Below, we will briefly discuss the indicators for evaluating the observance of human rights in the field of family planning. Studying these indicators easily demonstrates the lack of compliance with the country’s new family planning policies. It is necessary to mention that the criteria raised are examined in various methods of evaluating human rights in health, and non-compliance or lack of attention to them indicates a lack of observance of human rights in this area.

Some of the cases related to the subject of family planning are mentioned in the following list:

Is the right to health among the fundamental laws of the country?

Has the government explicitly recognized the right to health, including sexual and reproductive health, as a fundamental right?

Number of reports submitted by governments based on the provisions of treaties: a) International Covenant on Economic, Social and Cultural Rights b) Convention on the Rights of the Child c) Convention on the Elimination of All Forms of Discrimination against Women d) International Convention on the Elimination of All Forms of Racial Discrimination

The number of national judicial decisions in the past five years that have considered sexual and reproductive health rights in the country.

Providing high-quality services for family planning.

Is there a need for a third party license to receive family planning services by women in the country’s laws? B) Is it only possible for married women to receive family planning services?

Are condoms and hormonal contraceptives included in the list of essential national drugs?

The percentage of primary healthcare facilities that provide counseling on protection against sexually transmitted infections (STIs), HIV, and unintended pregnancies simultaneously.

Percentage of individuals with access to comprehensive family planning services; disaggregated by minimum criteria: age, gender, race, ethnicity, social and economic status, and rural/urban.

Percentage of women at risk of pregnancy who themselves or their sexual partner use a method of pregnancy prevention or all, broken down by minimum: age, race, ethnicity, social and economic status, rural/urban.

Percentage of women at risk of pregnancy who want to prevent pregnancy, but either themselves or their sexual partner do not use contraceptive methods; broken down by minimum: race, age, ethnicity, social and economic status, and rural/urban.

Structural indicators related to sexual health and fertility.

“Time frame and coverage of national health policies in the field of sexual and reproductive health.”

“Time framework and coverage of national policies regarding abortion and determination of fetal gender.”

Indicators of trends (process) related to sexual health and fertility.

Appropriate coverage for prenatal care.

Investigating cases where the family needs of individuals have not been met.

Related indicators in the field of basic financial frameworks.

Does the government have laws to ensure universal access to sexual and reproductive health care?

The percentage of budgets allocated by the government to the health sector.

The percentage of the government’s health budget allocated to sexual and reproductive health sector.

Average per capita expenditure on sexual and reproductive health.

National Strategy and Operational Plan.

Does the government have a national strategy for reproductive and sexual health, as well as an operational plan for it?

Does the strategy/ operational plan have the following frameworks:

a) Has it explicitly recognized the rights of sexual and reproductive health?
b) Have the defined goals of the program been clearly stated through reporting methods?
c) Have the responsible individuals and their duties been specified?
d) Has a timeline been established for the program?
e) Does the program specifically include actions to benefit and cover vulnerable groups?

Does the government collect data to evaluate the performance of programs in line with the strategy/operational plan, especially in relation to vulnerable groups?

Participation

Has the government taken any action during the formulation, approval, implementation, and monitoring of the strategy/operational plan in the field of sexual and reproductive health to establish a method and structure for regular communication and consultation with a wide range of representatives from the following groups:

a) Non-governmental organizations
b) Specialized organizations active in the field of health
c) Local governments
d) Private sector
e) Vulnerable groups
f) Community leaders

Information.

Is the right to search, receive, and transfer information about sexual health and fertility protected in government laws?

Has a systematic approach been outlined in the government’s strategy/operational plan for the regular dissemination of information on sexual and reproductive health policies to the following foundations?

a) Non-governmental organizations
b) Specialized organizations active in the field of health
c) Local governments
d) Media accessible in rural areas

Is there a requirement for informed consent from the individual in accepting or rejecting treatment in the laws?

Percentage of individuals facing information related to: a) Mother and infant care b) Family planning services c) Abortion and post-abortion care d) Prevention and treatment of sexually transmitted infections e) Prevention and treatment of cervical cancer and other complications of women’s diseases.

Are there any laws to protect the confidentiality of personal health information?

A percentage of the health facilities are subject to protocols regarding the confidentiality of personal health information.

Percentage of active specialists in the field of health who have received necessary trainings in the following areas:

a) Confidentiality of personal health information
b) Need for informed consent to receive or refuse treatment.

Percentage of women who have information about methods of pregnancy prevention (traditional or modern); broken down by minimum age, race, ethnicity, socioeconomic status, and rural/urban status.

Percentage of individuals aged 15-24 who have necessary knowledge about how to prevent HIV virus; broken down by minimum gender, race, ethnicity, social and economic status, and rural/urban.

Percentage of individuals who believe that their personal information provided to health professionals remains confidential; broken down by minimum age, gender, race, ethnicity, social and economic status, and rural/urban status.

National human rights institutions.

Does the country have a national institution for human rights that works in the field of reproductive and sexual health rights?

What has been the level of activity of institutions or organizations working in the field of sexual and reproductive health in the past five years in relation to educational programs and public campaigns?

The number of complaints and investigations related to sexual and reproductive health rights based on laws in the past five years that have been reviewed.

International aid and relevant collaborations (this indicator is for donors).

Are the policies of donor countries regarding aid for the development of other countries (countries in need of aid) based on consideration of human rights?

Do development policies outside the country adhere to any specific framework and regulations for promoting and protecting reproductive and sexual health rights?

“The percentage of development aid provided outside the country for the purpose of sexual health and fertility.”

Are the reports published by the country to human rights institutions include an accurate report of international aid and cooperation provided, including in relation to sexual and reproductive health?

Does the donor country provide an annual report on its international aid and cooperation with the recipient country, including in regards to sexual and reproductive health?

Improving the Sexual Health of Adolescents.

Have the laws of the country explained the comprehensive mandatory education on health and necessary sexual education, methods of preventing pregnancy and reproductive health during school years?

Does the country have a strategy/operational plan to improve the level of sexual health and fertility in adolescents?

The percentage of individuals who have received comprehensive sexual health education in schools at the ages of 15-19, broken down by minimum gender, race, ethnicity, social and economic status, and rural/urban areas.

Percentage of individuals who know about methods of preventing HIV infection at ages 15-19.

The fertility rate at specific ages (15-19 and 20-24 years) is divided based on minimum: race, ethnicity, social and economic status, and rural/urban.

Number of condoms available for distribution throughout the country (in the past 12 months) in the population aged 15-49 years.

Have the laws of the country considered the need for full and voluntary consent of both parties in marriage?

Marriage age is divided based on minimum: gender, race, ethnicity, social and economic status, and rural/urban.

The points that should be emphasized at the end are whether there is a legal obligation to participate with other involved groups in the matter of health or, in other words, stakeholders in the development of the country’s health plan. In fact, the right to health for individuals in society requires the participation of all active stakeholders in the field of health in decision-making at various levels of society, including national and international levels. However, experience shows that there is a significant gap between the slogans of government participation and the actual implementation. Therefore, this indicator addresses the question of whether there is a legal obligation to participate in the development of the national health plan.