Iran - People
Iran's population of about 88 milllion as of 2023 was projected to peak at a bit over 101 milllion around the year 2060. According to Iranian government estimates, Muslims constitute 99.4 percent of the population, of whom 90 to 95 percent are Shia, and 5 to 10 percent are Sunni. Iran's population stood at 49.8 million in 1986, 1 1/2-2 million of which were Afghan refugees. The annual population growth rate was 4%. The infant mortality rate was 10/1000 and life expectancy was 54 years. 40% of the labor force is engaged in agriculture, 33% are employed in industry and commerce, and 27% work in services.
According to the report of 2011 census which was the seventh national population and housing census of the country, the total population of Iran was 75,149,669 (comprising 50.4 % male and 49.6% female) whom 71.4% were settled in urban areas. The population is concentrated in the north, northwest, and west, reflecting the position of the Zagros and Elburz Mountains; the vast dry areas in the center and eastern parts of the country, around the deserts of the Dasht-e Kavir and Dasht-e Lut, have a much lower population density.
Iran completed its demographic transition, reaching replacement fertility level of 2.1 children per woman around 2000. The 2016 Iranian Census revealed that 14 of the country’s 31 provinces have sub-replacement fertility. The province of Tehran, where a woman on average gives birth to 1.5 children during her reproductive period, has the lowest fertility in Iran. However, the ‘two-child’ norm prevails in the country and even a woman of young reproductive age still values having at least two children on average. In other words, there exists a gap between a woman’s actual and desired fertility. In societies in early-and mid-demographic transition, desired family size is usually lower than actual family size, whereas the reverse is often the case in post-transitional societies. Economic constraints have strongly been associated with fertility decline in Iran.
The Islamic Republic of Iran has had one of the most successful family planning programs among developing countries and experienced the fastest fertility decline which has not been widely recorded elsewhere. The first national family planning program in Iran was established in 1967 in order to improve and promote the physical, mental and socio-economic welfare of the family and to reduce the annual population growth rate in the country. Between 1966 and 1976, the total fertility rate in Iran decreased from around 7.7 to around 6.0.
Shortly after the Islamic revolution of 1979, the family planning program was undermined by the new government, and early marriage and large family formation were promoted as basic Islamic values. As a result of these changes and because of the underlying social, cultural, and political circumstances, fertility increased to around seven children per woman by 1986. The eight-year (1980–1988) war between Iran and Iraq gave further impetus to pronatalist population policies because a large population was considered advantageous for the nation. The results of the 1986 census revealed that despite the large losses during the war, Iran had attained the highest population growth rate of 3.9 percent per annum ever recorded, comprising 3.2 percent natural increase and 0.7 percent immigration.
However, after several campaigns in 1988 aimed at controlling the country’s rapid population growth, the government officially revived its voluntary family planning program in 1989. Thereafter, Iran’s total fertility rate (TFR) fell sharply from 5.5 in 1988 to 3.6 in 1993 and then to below 2.8 in 1996. The Iran Demographic and Health Survey of 2000 showed that the country’s TFR dropped further and reached near replacement level (2.26) during 1998–2000. Iran’s fertility rate continued to decline and reached 1.8 by 2006–2011. However, according to the Iranian Population Census of 2016, the country’s total fertility rate appears to have increased slightly to 2.01, but still hovers around replacement level fertility.
Average household size decreased from 4.03 in 2006 to 3.55 in 2011. Even though this change will definitely have positive impacts on family health and economy, the negative consequence of such a change will be reflected in the caregivers’ numbers for the old parents in the future. The comparison between population age pyramids shows the trend of ever increasing old population in Iran during recent years. Comparing Iran's population age pyramid in the past two decades illustrates that the structure of age pyramid is reversing. It shows that in the coming years the present young population will incline towards aging.
Increasing life expectancy is a valuable index that is considered an achievement for the health system in Iran because of raising public awareness about age-related disorders. Population growth will have adverse effects on socioeconomic advancement and the health of older people. The expansion of the number of aged individuals in the population will unavoidably be accompanied by an increasing number of age-related disorders.
One of the most significant indicators in social development is the literacy rate. Illiteracy is a crucial issue in demographic characteristics of elderly population because of its role as a known risk factor for developing AD on one side and lack of enough knowledge to prevent or control modifiable age-related disorders such as hypertension, diabetes, coronary artery disease, hypercholesterolemia, stroke, osteoporosis and depression on the other. Even though the rate of illiteracy among population with the age of 10 to 49 year has been decreased compared to the last census, there is still no available data about the level of education in the old segment and the only findings about this index is found in the last census in 2006.
Caregivers’ burden is higher in Iran - and societies with similar culture - as the strong emotional bonds between the family members and their elderly parents don’t let them leave their old parents in the institutional homes. In Iran's history and religion, taking care of the elderly has been one of the major commitments for the families, therefore, most families are seriously opposed to letting their old patients live in institutional homes. However, as a result of increasing urbanization, large-scale migration, employment of both men and women, smaller size of families, and longer life expectancy of old people in recent decades, a major change has been occurring in the public attitude toward this issue. This phenomenon is more apparent in metropolitan cities such as Tehran. In the cities with smaller population and more traditional and religious culture, there is still a negative attitude toward this issue.
Although Iran is a low and middle income country, in recent years effective changes has been made in health promotion which cause to shift disease pattern in the society from communicable diseases to non-communicable diseases, similar to developed countries.
Like other countries, cardiovascular diseases, motor vehicle accidents, cancers, intentional and unintentional injuries, lower respiratory tract infections, and stroke are the most important causes of mortality in Iran. The major causes of death and its burden have not been yet appropriately identified in Iran. Motor vehicle accidents are the major cause of death in ages younger than 45 years. The death rate due to motor vehicle accidents is higher than twice of the global average. While in older than 45 years, cardiovascular diseases are the main cause of death. Trauma and poisoning are in the second rank and traffic accident is in the third. The motor vehicle accidents deaths had the highest person years of life lost followed by cardiovascular disease, cancers, intentional and unintentional injuries, respectively.
Smoking, hypertension, alcohol consumption, weight gain, high blood cholesterol, lower consumption of fruits, and sodium rich foods are the most important risk factors of cardiovascular diseases which have a high prevalence in Iranian population. Smoking has a key role in developing cancers as the major risk factor. In addition, household air pollution from solid fuels, urban air pollution caused by fossil fuels, exposure to occupational pollutants, drug usage, and inappropriate diet are other risk factors of cancers. Today, such factors have been dramatically increased in urban areas.
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