In a small room in South Tehran's Shahre-Rey district, 12 women of all ages are gathered around a long table, listening intently and taking notes while their health trainer talks animatedly to them about the thyroid. The women will leave this class today and knock on as many as 50 doors to tell the families under their care about the necessity of using iodized salt to prevent developmental problems in children--an especially important lesson in these poorer parts, where seafood is rarely eaten.
These health workers are part of Women Health Volunteers (WHV), a network of 100,000 women who help the government with health and hygiene in urban areas like Tehran, one of the Middle East's biggest metropolises. Rapid urbanization as well as galloping population growth have swelled the city's citizenry from about 1.5 million in 1956 to close to 8 million in the city proper and pushed out its boundaries into a vast metropolitan area that's home to an additional 6 million.
For a city its size, Tehran offers exemplary primary health care and sanitation. The vaccination rate stands at 100%, there is close to universal access to clean water, and 80% of pregnant women are examined three times during their pregnancy. "That is why, despite the occurrence of polio in neighboring countries like Iraq, Afghanistan and Pakistan and frequent traffic between our countries, there hasn't been a single case of polio in Iran over the last eight years," says Dr. Hossein Malek-Afzali, the main founder of the program who won the U.N. Population Award in 2007.
WHV arose out of a mix of necessity and pragmatism as well as a fundamental belief, expressed by Malek-Afzali, that "women are the axis of health development and health is the axis of sustainable development." By working in grass-roots structures, WHV has been free of the usual bureaucratic baggage, not to mention that these volunteers are saving the government millions of dollars. "We took women from the neighborhoods, trained them once a week in our health centers and sent them out to educate the 50 families under their care, mostly their own families and neighbors," he explains. The government rewards the volunteers by giving them and their families free secondary health care.
Perhaps the program's most crucial success was to introduce family-planning to revolutionary Tehran, an effort that has brought down the birthrate per female, from six children to two, with the full support of religious leaders. They at first urged Iranians to boost the ranks of the "soldiers of Islam" but then promoted contraception to stop the alarming growth in population. The lower birthrate is critical to a nation like Iran as its economy evolves. About 7,000 women went door-to-door in Tehran and talked to mothers about the benefits of smaller families, informed them of the different types of birth control and handed out condoms and pills. "I must give credit to Iran's religious leaders for a pragmatic and creative approach to family-planning," says Dr. Mohamed Abdel-Ahad, an Egyptian who is head of the United Nations Population Fund in Iran.