Iranian Aging Tsunami from the Perspective of Sexual and Reproductive Health: Challenges and Strategies for Childbearing

Childbearing is an important component of reproductive and sexual health. The total fertility rate in Iran has reached below the replacement level of 2.1, which has the lowest rate in the Middle East. Based on World Health Organization, Iran will soon face the phenomenon of "aging tsunami”. This study aimed to review the challenges and strategies of childbearing from the perspective of sexual and reproductive health in Iran.

A narrative review was conducted based on the Scale for the Assessment of Narrative Review Articles (SANRA), without time limitation until September 2022. Literature search was performed through the English databases of PubMed, Web of Science, Scopus, as well as Persian databases of Magiran and SID. A qualitative synthesis was carried out on the 69 eligible articles out of 166 retrieved documents. 

The most important challenges of childbearing included socio-economic issues, individual preferences, medicalization of fertility, and effects of the COVID-19 pandemic. Strategies to overcome these challenges comprised identifying appropriate target groups for childbearing, modifying fertility control methods and providing them to high-risk groups, establishing laws that support women and family, allocation of infertility treatment facilities, empowerment and skills training of youth and family, and appropriate cultural interventions in lifestyle.

Iran has the best time for childbearing due to being in an open demographic window. This opportunity could be used to identify the target groups eligible for childbearing and to do appropriate interventions. However, it appears that certain childbearing policies need to be reevaluated.