Aiming for quality in Iran's national family planning program - two decades of sustained efforts

The Iranian family planning program was relaunched in 1989 to improve maternal and child health. As coverage was extended throughout the country, it had the challenge to achieve harmonization and improve and maintain quality of care. Five strategies were put in place: (1) expand the method mix, (2) standardize provider training through the adoption of national norms and guidelines, (3) facilitate and harmonize service provision, (4) improve integration of family planning in family health services and (5) address myths and misconceptions surrounding contraception in the general population. This was supported by regular monitoring and evaluation. To date, this program is regarded as one of the most successful programs worldwide. While the direct impact of these quality improvements is difficult to evaluate, it is believed to have built the trust that family planning clients place in the program. Challenges remain, particularly facing a total fertility rate below replacement level nationally and providing quality services to an ever-growing peri-urban population.