Impact of Family Planning Program on Related Drug Consumption in Iran: A Ten-Year Trend Analysis (2014 - 2023)

Abstract

Background: Global demographic patterns have shifted substantially over the past century, with declining fertility and accelerated population aging emerging as dominant trends. Iran exemplifies this transition, with an anticipated population peak around 2050 followed by sustained decline. In response, the Family Support and Population Rejuvenation Law (2021) reversed earlier fertility-limiting policies by expanding insurance coverage for infertility therapies while restricting access to subsidized contraceptives and abortifacients, thereby positioning the pharmaceutical sector as a key policy instrument. Objectives: This study aimed to evaluate the impact of the 2021 law on national consumption patterns of reproductive health-related medicines in Iran from 2014 to 2023, including fertility agents, contraceptives, abortifacients, and neonatal treatments. Methods: A retrospective time-series drug-utilization study was conducted using national wholesale data for 52 reproductive medicines, standardized according to the World Health Organization Anatomical Therapeutic Chemical and Defined Daily Dose methodology. Monthly and annual utilization was expressed as defined daily doses per 1000 inhabitants per day. Segmented linear regression and paired t tests were used to compare consumption trends before and after implementation of the law. Results: Of the 52 products examined, 19 dosage forms (37%) across 5 Anatomical Therapeutic Chemical codes showed significant level or slope changes after the law (P < 0.05). Use of infertility treatments, particularly recombinant follitropins, menotropins, and chorionic gonadotropins, increased markedly (+48%, P = 0.01). Despite legal restrictions, use of prostaglandin abortifacients, such as misoprostol and carboprost, also increased (+19%, P = 0.047). Total contraceptive use remained stable; however, market share shifted toward newer low-dose combinations, suggesting substitution rather than reduction. Neonatal surfactant use more than doubled after the law (P < 0.001), raising concerns about increased premature births amid limited prenatal screening. Conclusions: Although the Family Support and Population Rejuvenation Law expanded access to infertility medicines, it did not reduce contraceptive or abortifacient use. Shifts in consumption patterns suggest that regulatory restrictions alone may result in unintended consequences, including clandestine abortion and neonatal complications. A more balanced, evidence-based policy approach is essential to align demographic goals with maternal and newborn health.