The estimated potential birth loss from female accidental mortality in Iran, 2011-2023

Road-traffic injuries remain an important cause of premature death among women of reproductive age in Iran. We quantified the number of potential births not realised that are attributable to female deaths from road-related accidents, to inform injury-prevention and fertility policy.

We conducted a retrospective, population-based counterfactual analysis for 2011-2023. Annual female deaths from road-traffic injuries by age (Global Burden of Disease 2023) were regarded "aged forward" to identify women who would have been 15-49 years in a given year had they survived. For each age-year cell, we multiplied the resulting count of "missing" women by the contemporaneous age-specific fertility rate (ASFR) from national sources, and summed across ages to estimate potential births not realised each year. Uncertainty was propagated using a deterministic bound approach based on lower/upper bounds of mortality and fertility inputs.

Female accidental mortality was associated with an estimated 121 929 (cumulative) potential births not realized from 2011 to 2023. Annual losses declined by 55%, from 12 889 (conservative uncertainty bounds 4 053-24 936) in 2011 to 5 829 (conservative uncertainty bounds 3 200-7 685) in 2023, indicating a significant downward trend. Although small relative to Iran's multi-decade decline in overall births, these counterfactual losses persist at non-trivial levels.

Further reductions in preventable road-traffic deaths among women of reproductive age could modestly increase realised births while delivering primary health gains. Priorities include safer speeds and infrastructure, seat-belts/helmets, safer vehicles, fair enforcement, and strengthened prehospital and trauma care, measures that complement existing fertility initiatives without coercion.