Curbs to prenatal screenings and abortions in Iran’s 2021 Youth Population law have contributed to the doubling of Down syndrome births, according to a report by Shargh newspaper.
The current rate is about one in 700 births, compared to one in 1,000 in developed countries, it reported, and Down syndrome rates in Iran have risen from 1.2% to 2.9%.
The law, officially titled the Youthful Population and Family Support Act, was ratified in late 2021 and implemented in 2022. It seeks to raise fertility rates to 2.5 children per woman amid declining population growth, which currently stands at about 0.7%.
The law restricts abortions, prenatal screenings and contraceptives while offering incentives for marriage and childbearing.
Midwives in health centers are barred from requesting or discussing prenatal screenings, and legal obstacles have made voluntary pregnancy terminations nearly impossible, the report said.
Abortion now requires both a medical commission and judicial approval even in cases of confirmed fetal abnormalities under the justification of “intolerable hardship.”
These restrictions have pared back screening visits, with a 20–30% decline in Tehran and a 50% decline in less-privileged provinces, contributing to more chromosomal disorder births, according to Shargh.
“There are an estimated 120,000 individuals with Down syndrome currently living in Iran,” said Pourandokht Bonyadi, head of the Iran Down Syndrome Charity Foundation.
Underground abortion market
While the law has failed to significantly raise birth rates, it has fueled an underground abortion market.
Iran’s judiciary announced last week that a person in Hormozgan province had been sentenced to death for performing 140 illegal abortions. The case is under Supreme Court review.
“Out of 12,000 annual forensic medicine referrals for pregnancy termination, 8,000 involve fetal abnormalities, but 2,000 are rejected due to procedural issues or late referrals,” said Mohammad Akrami, president of the Iranian Medical Genetics Association.
Experts warn the law’s restrictive measures could have long-term social and healthcare consequences, urging policymakers to reconsider the legislation to curb rising disability rates and the spread of illegal abortions.
Incentives but limited results
Alongside restrictions, the law provides incentives to encourage fertility, including marriage loans, child allowances, housing loans for young couples, tax breaks for parents, employment priority for families and expanded health and transportation subsidies.
Despite these measures, the law has not produced the intended rise in fertility. According to official media, the rate of population decline has slowed by about 20% over the past seven years, but fertility has only stabilized at 1.6 children per woman, far below the 2.5 target.
