Editorial Board: Editor: George H. Conklin, North Carolina Central University Board: Bob Davis, North Carolina Agricultural and Technical State University Richard Dixon, UNC-Wilmington Ken Land, Duke University Miles Simpson, North Carolina Central University Ron Wimberley, N.C. State University Robert Wortham, North Carolina Central University
Editorial Assistants Rob Tolliver, North Carolina Central University Shannon O'Connor, North Carolina Central University John W.M. Russell, Technical Consultant
Volume 5, Number 1
Fertility and Family Planning Among
Ali Asghar Moghadas
Starting in 1978, several wave of Afghans refugees arrived in Iran along the timing of military invasion, civil war, and the control of the country by the Taliban. In between these calamities economic opportunity especially in the construction and agriculture in Iran supported the increasing number of Afghan population and augmented the number of those who wanted to make home in Iran. According to the 1996 census, there were about 800 thousands Afghans counted in Iran (Statistical Center of Iran, 2000). The unofficial estimate of the Afghan population goes beyond one million. In 2000, an estimate of 1.4 million Afghan was reported to live in Iran under different status (UNCHR, 2006). In 2004, it was estimated that a little over one million documented Afghans (1009, 354 individuals) remained in Iran. About 90 percent of this population lived in households with 2 or more members. The province of Khorasan had the second largest number of the Afghan family households after Tehran province. Mashad is the largest and the capital city of Khoransan province, where a great majority of Afghan population live. Mashad has been the second most populous destination of Afghan families who moved to Iran. This paper provides a window to fertility and family planning of Afghan immigrant women in the city of Mashhad.
McGinn's (2000) extensive review of literature on reproductive health of war affected populations showed a mixed response to childbearing among those affected by war. The published and unpublished studies indicated that fertility may increase or decrease as a result of forced migration in different communities and with different circumstances.
Afghan migration stream to Iran during the last two decades of the 20th century was not always the result of war uprooting. Availability of economic opportunity in Iran played a very important role in motivating Afghans who were otherwise faced with distressed agricultural economy and afraid of Soviet army, to enter into Iran as refugee. Despite their status as refugee, they had a great freedom of movement across the country and from city to city to find the best economic opportunity they could put their hands on. They experienced very limited restriction and did not live in densely populated refugee camps. The immigrant Afghans living in Iran have lived integrated into Iranian communities, or in their own communities within Iran's cities and villages. Unlike Pakistan, only a small percentage of Afghans have lived within refugee camp restrictions. Hence their behavior in general and fertility behavior in particular, can be examined within the conventional framework of migration processes. Two aspects of immigration process are very important in understanding the consequences of migration. Selectivity and adaptation are integral parts of the immigration process. The extent to which immigrants are selective by such factors as age or education and other socioeconomic characteristics, the outcome of immigration would be different. Theoretically immigrants are expected to undergo a process of adaptation or adjustment to the new social environment including fertility norms and patterns in the host country (Weeks, 2005). Yet immigrants might keep their fertility level high despite the low fertility norm of their adopted country, to protect their population size as they feel the threat of being in minority. A third alternative behavior is that achieving immigrants rush to limit their fertility as way of accelerating their access to their higher economic objectives.
In the decade which coincided with the increasing number of Afghan refugees accumulation in major Iranian cities, the fertility level of Iranian women particularly those living in large urban centers such as Mashad decreased to a very low level (Ministry of Health and Medical Education, 2003). Contraceptive use increased to about 75 percent with very minimal differences between urban and rural women. Many currently married women had tubectomy and male sterilization became popular among all classes as a method of preventing more pregnancies. An important question for our research was the level of adjustment of Afghan immigrant women to the new fertility norms and patterns as they settled and stayed in Iran.
Data and Method
The data from this study are drawn from a survey of Afghan households in the city of Mashad in 2003. According to the Bureau of Alien and Foreign Immigrant Affairs (BAFI, 2003) a total of 52, 359 Afghan family households resided in Mashad. For the purpose of this study 503 households were selected through stratified random sampling. In the first stage neighborhoods with concentration of Afghan families were selected. Then in each selected neighborhood sample households were visited and an ever-married woman was interviewed. To have representation from less concentrated areas, a total of 30 households were included through quota sampling. A total of 533 households were visited and 508 ever-married women were interviewed. Trained female Afghan interviewers conducted the interviews. In addition to these data, we had access to tabulations from the 2000 Iran Demographic and Health Survey (Ministry of Health and Medical Education, 2003). We were able to use the latter data for comparison of immigrant women with urban native women from the Khorasan province of which the city of Mashad is the capital and the site of our immigrant data collection.
Country of Origin and Country of Destination
Both at the beginning of the wave of immigration in late 1970s and 25 year later at the turn of century, the country of origin and the country of destination for Afghan immigrants to Iran, were widely apart socially and economically, despite being neighbors. The two countries share the religion of Islam. But Afghanistan has had a large population practicing Sunni sect of Islam while Iran has a great majority of Shia sect. Iran has been a rich oil producing country while Afghanistan population has been dependent on agriculture and opium as the main crop.
There are marked difference in the social-demographic characteristics of the two countries according to the data available from 2005 (Population Reference Bureau, 2006). With a birth rate of 48 and a death rate of 22, Afghanistan is among very few countries in Asia which is in the pre-transitional stage with respect to population dynamics (Table 1). On the other hand the Iranian population has moved to a low fertility and mortality stage. Total fertility rate or life time birth per woman has dropped to 2.1 as compared to the rate of 6.8 for Afghanistan. Infant mortality rate has declined to 32 per thousand live births and it is five times lower than the rate observed in Afghanistan. In Iran 75 percent of married women in reproductive ages use contraceptive as compared to 5 percent in Afghanistan. Hence Afghan Immigrants in general and Afghan women immigrant in particular have been exposed to a relatively different social, economic, and demographic environment in the Iranian cities such as Mashad.
Demographic and Household Characteristics
The majority of Afghan immigrant women reported they have been in Iran 10 years or more, with 50 percent of them reporting 15 years or more. The women in the sample reported a slightly higher average number of years of stay for their husbands. The age distribution of ever-married Afghan women in Mashah was very young. About 50 percent of them were 29 years old and younger. The mean age of women was 27 years. Only about 5 percent of women had married more than one time. Afghan immigrant women in Mashad reported very low age of marriage. About 43 percent of them reported to be married by age 16. The consequence of such a young age of marriage for older women was very early age at first birth and large number of pregnancies during their young adulthood. A great proportion of the Afghan immigrant women reported living in extended households. Three groups of non-nuclear members were reported. The major group (76 percent) was relative of husband. The second largest group of extended family members was relatives of wife. Overall the level of education reported by women was very low. A large portion of women were illiterate (32 percent). Among the literate women many had only a few years of elementary education. Some women had middle school education and only 9 percent had 8 years or more education.
Cumulative fertility level reported by Afghan immigrant women was relatively low for young women and very high for older women using the standard of the urban areas of Iran. On the average Afghan immigrant women reported 3.9 children ever born as compared to 3.6 children ever born for local urban women in Khoransan province. Despite this higher overall fertility level, Afghan immigrant women who were 25 years and younger showed almost the same level of fertility as local urban women (Table 2) The difference in fertility of Afghan women and Iranian women was related to the differences among older women. Older Afghan immigrant women have a much higher cumulative fertility than older local urban women. However, the share of older women among all Afghan immigrant women is much less than the share of older women among local urban women. Hence the overall fertility outcome of the Afghan immigrant will be based on the level of fertility of the current young women. These women seem to be adopting the fertility pattern of women in their host community.
Source: For Khorsan women, numbers are calculated from the province data in 2000 Iran Demographic and Health Survey, (MHME, 2003).
Table 3 shows the distribution of Afghan immigrant women by age and rate of contraceptive use. When asked about contraceptive use about 55 percent of them said they have used at least one of the four modern contraceptives including pill, IUD, condom, and tubectomy or vasectomy. It should be noticed that women reported “ever used contraceptive”, which does not capture the length of contraceptive use or continuity. Based on this information the rate of contraceptive use is in fact slightly higher than the rate for local urban women. The high rate of contraception among Afghan immigrant women reflects their access to free contraceptives which have been available through primary health care units in urban health centers in Iran. Except for the oldest age group, the rate of contraceptive use remains above 50 percent for all other age groups.
Source: For Khorasan women, the number is from province data (MHME, 2003).
Differentials in Fertility and Contraceptive Use
To examine the
determinants of fertility among Afghan immigrant women we used multiple
classification analysis which is a version of ordinary least square regression.
This method is useful for independent variables which are categorical.
The results of the analysis are shown in Table 4. Predicted average number
of children ever born is shown for each category of each independent variable.
The unadjusted means show the results of bivariate analysis. The adjusted
means show the results of multivariate analysis.
Following the assimilation hypothesis, we examined the effect of number of years of immigration on fertility level controlling for other variables affecting fertility. Other things being equal there is some indication that women, who have stayed longer, have slightly lower fertility. But the difference is not statistically meaningful. On the other hand, we find a strong negative relationship between age of marriage and fertility, which is consistent with a large number of previous studies of differential fertility. Afghan immigrant women who have married at age 21 and more have only 2.1 children ever borne, almost half of the number of children ever borne by women who have married at age 18 or less.
One of the very important differentiating variables in fertility in high fertility communities is education (Hirschman 2004). While the overall level of education of the Afghan immigrant women was low, the multivariate analysis indicated a significant negative relationship between education and fertility level. The difference between illiterate women and women with some elementary education is about half a child. Once some middle school or high school education is attained, the difference increases to one child less, other things being equal.
The rural-urban background of women did not show any difference in fertility. In fact women born in towns had more children ever born. But the place of birth for husband influenced fertility in the expected direction. Other things being equal women married to husbands borne in towns had on the average about half a child less. The relationship between age and fertility was consistent.
The rate of ever used modern contraceptive was relatively high among Afghan Immigrant women even comparing them to the urban women in Khorasan the province where the city of Mashad is located. There was no significant age variation in use of contraceptive observed in the bivariate analysis reported in Table 3. We extended the analysis to multivariate logistic regression examining the effect of the independent variables on the probability of ever used contraceptives. The estimated logistic regression model was not significant as none of the independent variables showed any impact on the probability of contraceptive use.
Discussion and Conclusion
Recent estimates of fertility level of women in Afghanistan suggest that Afghan women have a very high fertility level as they marry young and continue to have children through the end of reproductive period. Except for a small portion of women, cultural and social barriers are the only instrumentation for preventing pregnancies. For example many women continue to breast feed their children up to 24 months of age and during this period of time the probability of pregnancy are very low. Afghanistan has one of the highest levels of infant and child mortality which contributes to the high motivation for higher fertility.
Relatively speaking, Afghan immigrant women in Iran have been exposed to a much lower fertility regime and have had access to a public primary health care system with strong reproductive health component. They have been able to engage in economic opportunity either through household production or provision of domestic services. On the average the Afghan immigrant women had born three children less than the average number of children ever born to women in Afghanistan—based on an estimated total fertility rate of 6.8 (Population Reference Bureau, 2006). With respect to contraceptives they reported a much higher rate of ever used contraceptive compared to the 5 percent rate estimated for women in Afghanistan (Table 1).
Young Afghan immigrant women seem to be following the pattern of fertility behavior similar to Iranian women in urban areas. Their cumulative fertility is low and they have a high rate of contraceptive use. Significant fertility difference is observed by age of marriage and literacy. Despite the high rate of contraceptive use reported by middle age women, their fertility is very high. One explanation might be error in contraceptive usage and failure rate especially for the pill which has the highest share in the contraceptive mix reported by Afghan immigrant women. While some Afghan immigrants have returned to Afghanistan since the collapse of Taliban and establishment of the new government, the Afghan immigrant population will continue to be the new minority population in large Iranian cities. The number of this new minority will be increasing due to the high fertility and continued stream of migration. There are already a growing number of first generation immigrants who need access to educational resources, job opportunities, and housing. These are in fact, three areas that the young Iranian population is struggling with. Most of the early immigrant males who entered in Iran were absorbed in the construction sector where they were not faced with any competition. In fact, their arrival was very important to the construction sector as the engine of Iranian economic growth. The immigrant women stayed home and participated in the informal sector through home production. It would be very difficult to expect the same level of participation in the economy and society of Iran for the new generation of Afghans who are born and raised in Iran as they want to compete with the Iranian youth for all the scarce resources. An important policy issue for the Iranian government is the status of these first generation immigrants and their integration into the Iranian society. For now the most important task for the Iranian government is to increase the access of Afghan women to reproductive health services and supporting them for more effective use of contraceptives.
Bureau of Alien and Foreign Immigrant Affairs (BAFIA). (2003). The First Official Registration of Alien and Foreign Immigrant. Tehran, Iran
Hirschman, C. (1994). “Why Fertility Changes,” Annual Review of Sociology 20: 203-233.
McGinn, T. (2000). "Reproductive Health of War-Affected Populations: What Do We Know?" International Family Planning Perspectives 26(4)174-180.
Ministry of Health and Medical Education (2003). Report of Iran 2000 Demographic and Health Survey. Tehran, Iran: Ministry of Health and Medical Education.
Statistical Center of Iran (1999). Report of the 1996 Census of Population and Housing. Tehran, Iran.
Weeks, J. R. (2005) Population
UNCHR: The UN Refugee Agency (2006).
©2007 by the North Carolina Sociological Association