Despite severe restrictions on abortion in Iran, many women with unwanted pregnancies undergo abortions, which in the vast majority of cases are clandestine, unsafe procedures. According to a new study, “Induced Abortion in Tehran, Iran: Estimated Rates and Correlates,” by Amir Erfani, released in the September issue of International Perspectives on Sexual and Reproductive Health, about one in six married women of reproductive age in Tehran will have an abortion in their lifetime. The study, based on data from the 2009 Tehran Survey of Fertility, found that approximately 9% of known pregnancies in Tehran end in abortion.

According to the study, the first of its kind to provide direct estimates of abortion levels in Tehran for selected subgroups as well as for all women, women in Tehran are most likely to obtain an abortion in their 30s—a contrast with the situation in most countries, where the incidence of abortion is highest among women in their 20s. Erfani found rates of 11.7 abortions per 1,000 women aged 30–34 and 9.8 per 1,000 women aged 35–39, more than double the overall rate of 5.5 abortions per 1,000 women aged 15–49. The abortion rate was higher among women who were employed, were more educated and had higher incomes, as well as among those who reported a low level of religiosity. The lowest rate was among young married women.

According to the study, the total abortion rate for women in Tehran is lower than rates in neighboring countries in Central Asia and Eastern Europe. Though abortion underreporting is one possible reason for this, high rates of contraceptive use are likely a contributing factor. At the time of the survey, 85% of married women reported using a contraceptive; 54% used a modern method and 31% used a traditional one.

The most common reasons given by women who reported having had an abortion were related to fertility (47%), including the desire to limit and space births, and socioeconomic circumstances (21%). Overall, 84% of abortions resulted from contraceptive failures; women who obtained the other 16% of abortions were not using a method when they became pregnant.

The author notes that the actual abortion rate in Tehran is likely higher than that estimated by the current study, as abortion underreporting in surveys has been well documented. Although little is known about the negative health consequences of unsafe abortions in Iran, it is estimated that 5% of pregnancy-related maternal deaths are due to postabortion complications. Erfani highlights the need for improved services and counseling to prevent unintended pregnancy among higher-risk women, and cautions that new population policies emerging from the Iranian government’s recommendation that the national population be doubled will likely increase the incidence of unsafe, clandestine abortion.

The study, “Induced Abortion in Tehran, Iran: Estimated Rates and Correlates,” is currently available online and appears in the September 2011 issue of International Perspectives on Sexual and Reproductive Health.