352 Studies in Family Planning According to the International Conference on Population and Development (ICPD) held in Cairo in 1994, reproduc- tive health “is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive sys- tem and to its functions and processes” (UN 1994). By this definition, reproductive health embraces a wide range of issues and programs addressing different aspects of human reproductive behavior, fertility, morbidity, and mortality. Before ICPD, reproductive health programs concentrated on the following four areas: prenatal care, safe delivery, and postnatal services; family planning information, counseling, and services; prevention and treatment of infertility; and abortion and postabortion care. Since ICPD, the coverage of reproductive health has been widened to include areas like prevention and treat- ment of reproductive tract infections (RTIs) and sexually transmitted infections (STIs), including HIV/AIDS; coun- seling on sexuality and treatment of sexual dysfunctions; treatment of cancers of the reproductive system; efforts to discourage the practice of female genital mutilation; pre- vention of gender-related violence and effective counsel- ing and treatment of its victims; and special attention to certain populations at higher risk or with special needs, such as adolescents, same-sex couples, refugees or dis- placed persons, disabled individuals, and commercial sex workers. This broadened definition has led to the emergence of new concepts such as reproductive rights and sexual health. Because of the central importance of reproductive health for women, a close link has also been established between reproductive health, women’s rights, and gender mainstreaming. However defined, reproductive health touches on highly sensitive issues and can thus give rise to serious ethical problems. It deals not only with the control of fer- Reproductive Health in Iran: Pragmatic Achievements, Unmet Needs, and Ethical Challenges in a Theocratic System Amir H. Mehryar, Shirin Ahmad-Nia, and Shahla Kazemipour Since its revival in 1989, the reproductive health and family planning program of Iran has made great strides in raising the contraceptive prevalence rate and reducing fertility. The majority of couples are using modern methods promoted and provided by the national program, although a sizable proportion of couples continue to depend on the traditional method of withdrawal. The longstanding urban–rural gap in contraceptive prevalence rates has been reduced to about 10 percent, which is mainly the result of better-educated urban couples’ continued practice of withdrawal. Despite its enormous success in meeting the needs of married couples, in narrowing the urban–rural gap in access to and use of modern contraceptives, and in reducing fertility, the Iranian family planning program is open to criticism for confining its target audience to married couples and failing to address the issue of abortion. The restrictive aspects of the program are often justified on the grounds of religious values and fear of encouraging sexual promiscuity. Because of the theocratic nature of the political system and the immense power enjoyed by Shiite ulama (religious leaders), no step can be taken to address these restrictions without their implicit support and approval. This study describes some of the ethical issues facing the reproductive health program of Iran and indicates how pragmatic approaches adopted by the ruling Shiite ulama to solve some of the social and medical challenges of a rapidly modernizing society may be extended to overcome ethical hurdles faced by the reproductive health program. (STUDIES IN FAMILY PLANNING 2007; 38[4]: 352–361) Amir H. Mehryar is Professor, Advanced Institute for Management and Planning Research & Training, No. 10, Mokhtar Asgari Str. Jamal Abad, Niavaran Avenue, Tehran 19-599, Iran. E-mail: ahmehryar@gmail.com. Shirin Ahmad-Nia is Assistant Professor, Sociology Department, Allameh-Tabatabaei University, Tehran. Shahla Kazemipour is Assistant Professor and Associate Director for Research, Center for Population Studies and Research, Ministry of Science, Research & Technology, Tehran.