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When I Ran Out of Birth Control in Iran

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BIRTH CONTROL
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I recently had to extend my trip to Iran and ran out of birth control. No biggie, I thought, contraceptive pills are easily found in pharmacies throughout the country and you don't even need a prescription. I walked into a pharmacy in Tehran two nights ago, showed the pharmacist my own birth control pills from the United States, and asked for something similar. "We don't have anything like this," he said. "Our choices of birth control have become extremely limited the past few months." With the same tired look he also responded to questions from other customers, repeatedly forced to say the same thing: "We no longer have that. You have to check on the black market."

I knew that Western sanctions against Iran had made it difficult, if not impossible, to procure many vital medicines. Cancer patients, sufferers of multiple sclerosis and those with numerous others serious conditions have turned to buying medicine on the black market for exorbitant prices, and at times not finding them at all. But I never thought there would be shortages of medicines as routine as birth control. Juggling requests and questions from an anxious crowd of other customers, the pharmacist barely looked back at me: "Ma'am, the only thing I can offer you is Yaz or Yasmin. That's the best we have in Iran right now."

I was deeply worried, as Yaz was bad news. I had taken it four years ago only to develop blood clots and extreme mood swings, and gained weight. Yaz and Yasmin are the same birth control brands that now face major lawsuits in the United States because they have been linked to heart attacks, strokes, pulmonary embolism, deep vein thrombosis, and blood clots in women. Distributed by Bayer Healthcare Pharmaceuticals, there are currently more than 9,000 pending lawsuits against these brands of pills.

I could not believe that the best birth control left in Iran -- an Iran whose pharmaceutical market has been decimated by sanctions -- were the same pills facing court action and considered a serious health threat in the United States. I visited several pharmacies that same day, and received the same answer from one beleaguered pharmacist after another, all of whom had grown tired of telling their customers they no longer had the medicine they needed.

For years, there has been a plethora of birth control pills and other contraceptives easily available and extremely affordable in Iran, a country that boosts one of the most successful family planning programs in the world. It is only in the aftermath of cumulative American-led sanctions against Iran's banking and financial sectors that most of these options have disappeared from pharmacies. Up until two months ago, pharmacists told me, there were simply no foreign-made birth control pills available at all. Many doctors are wary of prescribing the Iranian-made pills because sanctions have made access to the raw materials required to produce them nearly impossible, making many of these drugs unreliable.

"My face completely broke out and I vomited on a daily basis from the birth control pills I took," said Negin, a 33-year-old architect I spoke with. "I tried every pill on the market this past year, and each was worse than the other. It got so bad that I now have my aunt in Germany send me a packet of birth control pills every month."

Neda, a 28-year-old engineer, recounted a similar experience. "The month that I took birth control in the winter was the worst month of my life," she told me. "I have never experienced such extreme highs and lows in my mood. I thought I was going crazy." She said her gynecologist eventually advised her to stop taking the pills and to find alternative types of contraception.

I went to a gynecologist to see if she could prescribe something for me that was close enough to the pills I take back home. I told the doctor that I was not willing to take Yaz or Yasmin given my prior experience with them. "I know how horrible they are," she said, "but you only need to take them until you get back to the U.S. I don't prescribe anything else to my patients, because they're simply worse. This is the best we have in Iran now." And she proceeded to write me three other prescriptions: one in case I had nausea, one in case I experienced spotting, and the other in case I developed extreme headaches. "You'll have to put up with the potential weight gain and mood swings. But if you get a blood clot, come see me immediately." I walked out of her office with four prescriptions in hand.

Astonished that good birth control that would not make a woman sick had become so difficult to find, I traveled to pharmacies throughout Tehran and Karaj the next day. In Karaj, a burgeoning city 20 kilometers west of Tehran, a pharmacist told me that when it comes to such medicines specifically for women, most are no longer available. One pharmacist put the situation in perspective like this:

"Two months ago, we didn't even have access to foreign birth control -- at least we do now, even if it's Yaz or Yasmin. But go searching in all of Iran, and you won't find any vaginal creams or vaginal antibiotics. And for women who are undergoing IVF treatment, they have to search high and low to buy their medicines on the black market. There's nothing left in the pharmacies."

What all this means is that women suffering from yeast infections, urinary tract infections, and other vaginal infections have no recourse to modern medical treatment for extremely common, painful maladies. And for a woman undergoing IVF treatment and hoping for a child, well, the black market with it's back-breaking prices awaits, with no guarantee that the medicine she buys to inject into her body are actually the drugs she thinks she's paying for.

Some have suggested that Iran's birth control shortages may also be due to the Ahmadinejad government's push to reverse the country's family planning program in a bid to boost the national birth rate and increase family size (today, Iran has a population growth rate of 1.2 percent and a fertility rate of 1.6). I posed this specific question to pharmacists and manufacturers, who are working at the frontline of shortages.

They agreed that mismanagement and internal conflict over public health policy play a role in medicine shortages, but on the issue of birth control, they didn't think it was the government's doing. Foreign brands of birth control went missing for five months at precisely the same time that other foreign medicine became hard to find in the country. Nearly three months ago, Yaz and Yasmin returned to the market, but other foreign brands that used to be widely available did not.

Throughout this, however, Iranian-made birth control pills have remained on the market. Some raised the issue of IVF treatments, arguing that if decreased access to good birth control pills was government policy to increase the birth rate, then where were the necessary injections for IVF treatment? Women who were actively trying to get pregnant could not find the medicine they needed to ensure their pregnancy. And why have vaginal antibiotics and creams disappeared, which have nothing to do with increasing the population? "In short, what is going on is that medicine for women has become increasingly difficult to find -- all medicine for women, and no one talks about it," said a pharmacist in Tehran's Vanak Square.

Last week the U.S. Treasury Department, which oversees all American sanctions, announced that it was adding items to its general license for medicine export to Iran. The export of medicine has always been allowed under the current sanctions regime against Iran, yet there is still a severe shortage of medicine in the country. At this point, actions like this from the U.S. have become comical for those of us who travel to Iran frequently. Which bank is willing to make the transactions necessary for the medicine to reach Iran, given that sanctions have choked off Iranian banks from the world? Which company is willing to ship the medicine to Iran, given that almost all shipping routes have been sanctioned? The U.S. Department of Treasury can appear to be making a humanitarian gesture, but without making actual changes to banking and trade sanctions -- which have been and will continue to block the sale of medicines to Iran -- nothing will change.

And in the meantime, millions of women in Iran will continue to suffer the consequences of compromised U.S.-made birth control pills and the lack of any medications at all to treat the other gynecological problems they may have. American policy makers, who ironically invoked the plight of women in the Middle East to enact their wars in the region after Sept. 11, should know that their policies in Iran are quite literally making women sick.

Narges Bajoghli is a Ph.D student in anthropology at New York University, and director of the documentary film, The Skin That Burns (2012), about survivors of chemical warfare in Iran.

This post originally appeared on Iran Wire.

This story appears in Issue 62 of our weekly iPad magazine, Huffington, in the iTunes App store, available Friday, August 16.