In Iran, gender segregation becoming a fact of medical life

The gradual segregation of the sexes in Iran means there are more opportunities for women to pursue medical careers, but that appears to be one of the few advantages.

Figure. Women's Day in Iran: one-third of medical students are now women, but training is segregated Photo by: Canapress

A prime objective of Iran's Islamic revolution in 1979, which ended the trend toward secularization introduced by Reza Shah Pahlavi, was to separate men and women in almost every aspect of their lives and to minimize their physical contact. In the early 1980s, Ayatollah Khomeini, the supreme leader (Imam) of Iran, said the physical examination of female patients by male gynecologists violated religious rules. Although it was not possible to suspend the licences of all male gynecologists, no new male residents were accepted into the specialty from that time, and the number of male gynecologists is dwindling. The country has also begun introducing female-only hospitals that men are not permitted to enter.

This gender revolution has had a major effect on medical education. To ensure that there are enough female physicians to treat the country's 35 million women and girls, Iran will be training thousands of new female doctors over the next 2 decades. Ten years ago only 12.5% of Iranian medical students were women, and the government responded by setting a goal that half of new students would be female. Today, one-third of the 22 326 students in Iran's 38 medical schools are women.

To ensure that there are enough female specialists, another filter was added at the residency-selection stage. All the residency positions in obstetrics/gynecology are reserved for women, as are half of the positions in internal medicine, general surgery and cardiology. In many other specialties, including orthopedic surgery, urology, neurosurgery, ophthalmology and psychiatry, women must fill at least 25% of the residency positions.

These trends will guarantee the training of an adequate number of female physicians, but they are raising many questions about the impact on medical education. Today, male medical students in Iran are not receiving sufficient training in obstetrics. This means that male physicians in rural areas, where female physicians may be unavailable, may have trouble handling difficult deliveries. Likewise, female medical students are being deprived of education and training in male hospital wards. Last year, students at the Fatimieh Female Medical School in Qom, one of Iran's most religious cities, held a sit-in protest in Tehran.

The changes in medical education in Iran raise several issues. There are concerns that they may rob Iranian women of their right to choose a male or female physician. For now, female patients have this right, but there are fears that eventually they will be obliged to seek physicians of the same sex. Whether or not this happens will depend on the existence of extremist governors and the response from physicians and their patients. (Additional information about the segregation of medical education in Iran is available at www.zan.org/news25.html.)