Main Actors in the New Population Policy With a Growing Trend in Iran: A Stakeholder Analysis

doi:10.21203/rs.3.rs-481260/v1

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Main Actors in the New Population Policy With a Growing Trend in Iran: A Stakeholder Analysis

https://doi.org/10.21203/rs.3.rs-481260/v1

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Total fertility rate in Iran has declined to below replacement level recently and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key-informants and identification of relevant documents. Main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring total fertility rate to the replacement level in Iran. Despite the importance of new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro level authorities alongside with evidenced based population policy making.

Health Economics & Outcomes Research

Policy analysis

stakeholder analysis

population policy

Total Fertility Rate

Islamic Republic of Iran

Population policy is highly complex and intensely political, and directly linked to a country’s socio-economic development (1). In recent years, particularly in the last decade of the twentieth century, most countries have experienced a decline in the Total Fertility Rate (TFR). Of course, there have been significant differences in the TFR decline between various countries (2). Developing countries, similar to other countries in the world, have experienced a quick decline in the TFR in recent decades (3).

Islamic Republic of Iran as a developing country is of a TFR = 2.01 live births per woman according to the last census of 2016 (4) is moving toward the growing of old population. Such a low population growth rate and demographic transition (total fertility rate of 1·92—less than the replacement fertility level), and their potential socioeconomic consequences have driven the shift in policies (5). It forced executives and policy-makers of Iran to review former population policy (that has been mainly focused on birth control via family planning) and develop a new policy to avoid the aging problem in future (6).

On the other hand, policy analysts are taken into account in terms of importance of interest groups or stakeholders and the need to identify and categorize levels of their interests and powers, which influence particular policies for a long time (7–9). Stakeholders include those individuals and groups with an attention in an issue or policy, those a policy might affect them and those who may take part in relation to making or implementing it (10).

Stakeholder Analysis (SHA) was adapted from the organizational and management literature in the 1970s and 1980s, drawing on the prior work of policy scientists who were concerned with the distribution of power and the role of stakeholders in the decision-making and policy process. To understand the roles, interests, and powers of the different stakeholders in the evolution of policy context and processes, SHA is a powerful tool (11). It provides a conceptualization, which assists in the analysis of interests and power in the light of policy science approaches, with a specific focus on policy stakeholders (10).

By carrying out this analysis, policy-makers and managers can detect and prevent possible misinterpretations or hostility to the implementation of the policy or program and consequently, a policy or program will more likely succeed if a stakeholder analysis was done (12). Therefore, the goal of SHA is to develop a strategic view of the human and institutional setting, and the relationships between the different stakeholders and the issues, which they most think about them (13). Using the information gathered from SHA can develop strategies for collaborating with stakeholders, facilitating the implementation of choices or organizational objectives, and then, understanding the future of policy directions (14).

In the current study, we used three key steps followed by Roberts’s et al. work (15) to analyze stakeholders of new population policy in Iran. Firstly, to identify the stakeholders relevant to the policy of interest, secondly, to determine the current stakeholders' position (in terms of support, opposition, or non-mobilized), thirdly, assess the relative power of each stakeholder (in terms of high, medium, or low). Thus, this study aimed to identify the involved stakeholders and their characteristics in terms of position and level of power in new population policy change of Iran.

Approach

The study is of a qualitative approach conducted at a national level during 2017, in the Islamic Republic of Iran.

Participants and recruitment of key-informants

Purposeful sampling method was used to identify key-informants. Individuals or organizations that have specific experience or the knowledge in the area of population, reproductive health and population policy-making and other high-level authoritative executives were recruited in study. In the following, we also employed network sampling (16) to recognize other Key-informants (KIs) until reaching saturation.

Selecting and validating the policy documents

Thirty related documents were collected in kinds of upstream documents (like issued policies by the supreme leader, five–year economic, social and cultural plans of development), acts and rules by parliament, plans and programs by government and national and international reports. It is noteworthy that the majority of documents had high value and acceptability.

Data collection

All semi-structured and face-to-face interviews, carried out by one member of the study team (HJ). The interviews lasted an average of 60 minutes. The interviews conducted in the interviewee’s office or any places where participant suggested. Recorded interviews were then transcribed verbatim. Data saturation had occurred after 18 interviews.

Data management and analysis

Framework analysis, which is a qualitative method and aptly suited for applied policy research, used to analyze the data. The step by step guide proposed by Braun and Clarke (17) including familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and producing the report were by the MAXQDA software, Version 12. Data analysis was performed simultaneously and in parallel of interviews. Additionally, we applied Policy Maker 4 software to identify all the stakeholders, the affected, involved and influential and assess position and level and power of the stakeholders regarding policy change.

Quality and rigor of the study

For more credibility, we tried to use the maximum diversity approach for selecting of participants from various governmental, legislative, non-governmental and international institutions. In addition, triangulation such as the methods of collection (interview, observation of writing, and observation of documents) was used to obtain better results. After each review, the original audio was transcribed verbatim and sent to the participant for commenting.

One member of the research team (HJ) conducted all of the interviews. This was as bias prevention strategy that increased a large extent the accuracy of work and greater coordination. Continual attendance of interviewer in all interviews and spending enough time for more accurate data, as well as clarity of methodology added the transform-ability.

Ethical consideration

The present study received ethical approval from the ethics committee of Tehran University of Medical Sciences (Research Ethics Committee Reference: 9021460003). The investigators obtained the participants’ permission to perform and audio tape the interviews. The confidentiality of information was guaranteed, as the name and personal information of the interviewees was not stated in the tapes or transcripts. All tapes, transcripts and information sheets were given special codes and kept distinctly to protect the participants' anonymity.

We included the results from the review of relevant documents and from the interviews with Key-Informants. These findings encompass identifying the stakeholders and their related sectors, positions and levels of powers of stakeholders for new population policy in Iran.

In total, 18 participants were included in the study from different organizations including: Health Commission of the Islamic Parliament [Majles-e-Shoray-e-Eslami]; Office of population, family and schools health at the Ministry of Health, Treatment and Medical Education (MoHME); National Organization for Civil Registration (NOCR); Institute for Research (IR); Statistical Center of Iran (SCR); United Nations Population Fund (UNFPA); Non Governmental Organizations (NGOs) in the field of population; and Academics (demography and population and reproductive health professors and researchers in the field) (Table 1).

Table 1

Characteristics of participants
Participant	Position	Organization	Sex	Academic degree
Participant 1	Top manager	MoHME	Male	MD
Participant 2	Senior expert	UNFPA	Female	MD
Participant 3	Top manager	IR	Female	PhD
Participant 4	Senior expert	NGO	Female	MD
Participant 5	Parliamentarian	Parliament	Male	MD
Participant 6	Associate professor	Academics	Male	PhD
Participant 7	Associate professor	Academics	Female	PhD
Participant 8	Top manager	NOCR	Male	MS
Participant 9	Senior expert	UNFPA	Male	MS
Participant 10	Senior expert	MoHME	Female	BSc
Participant 11	Expert	SCI	Female	BSc
Participant 12	Senior expert	MoHME	Male	MS
Participant 13	Assistant professor	Academics	Male	PhD
Participant 14	Assistant professor	Academics	Male	PhD
Participant 15	Professor	Academics	Male	PhD
Participant 16	Top manager	NGO	Male	PhD
Participant 17	Middle manager	SCI	Male	M.S
Participant 18	Expert	NOCR	Female	BSc

Based on the findings from analyses of this study, stakeholders of the new population policy in Iran were divided into seven key sectors of religious, political, governmental, professional, international, media, and (NGOs) (Table 2).

Table 2

Stakeholders and their positions and levels of powers for new population policy in Iran
Stakeholder	Sector	Position	Power
Supreme Leader	Religious	High Support	High
Islamic Seminaries	Religious	High Support	Medium
Judiciary system	Political	Non-Mobilized	Medium
Islamic Parliament	Political	Medium Support	High
Supreme Council of the Cultural Revolution	Political	High Support	Medium
Ministry of Health	Governmental	Medium Support	Medium
Ministry of Cooperatives and Labor	Governmental	Non-Mobilized	Medium
Ministry of Education	Governmental	Non-Mobilized	Medium
Ministry of Science, Research and Technology	Governmental	Low Support	Medium
Ministry of Sport and Youth	Governmental	Low Support	Medium
Statistical Research and Training Center	Governmental	Low Support	Low
National Organization for Civil Registration	Governmental	Medium Support	Medium
Women's Affairs and Family of Presidency	Governmental	Non-Mobilized	Medium
Population Departments	Professional	Low Support	Medium
Environmental Experts	Professional	Low Opposition	Low
Islamic Republic of Iran Broadcasting	Media	High Support	High
National Population Studies & Comprehensive Management	Non-Governmental	Low Support	Low
Family Health Association of Iran	Non-Governmental	Low Support	Low
United Nations Population Fund	International	Non-Mobilized	Medium

Participants reported that superior leader at the national level has remarkable role and repeatedly disseminate information on the policy change, along with rationales requiring this change and mobilized officials and public to take up the new policy. According participants’ perspective, the superior leader is high supportive and influential, because the adoption of new population approach and its subsequent implementation heavily depended on his.

For example, he emphasizes the importance of population issues:

"One of the dangers which are frightening us by deep thinking about it, is population issue. Take it serious. Young population of country is reducing. If several years have passed, then there are no longer curable "(2014, December 20)

In addition, the overall population policies announced by superior leader on 20/5/2014, gave a lot of political legitimacy to population growth policies, as a road map, which is considered as a comprehensive document and it can somewhat determine the role of each of stakeholders including the executive, legislative and judiciary institutions, NGOs, private sector and the public.

"This document in present situation is a excellent and comprehensive policy and administrative offices on the basis of this policy should come to carry a lot of research to identify the reasons and write a detailed action plan”(Participant 9).

Parliament was another stakeholder who was reportedly very influential because it was highly respected, with a high supportive and high power on the issue. Parliamentarians proposed plans like comprehensive plan of population and family excellence or preventing the decline of population growth as the solutions and defendes them in the mass media to raise public awareness.

At the time of our analysis, most political stakeholders were essentially non-mobilized or had low support with regard to the population reform policy in Iran.

For instance, participants stated that researchers and population scholars’ roles have not been considered notably, because they were not engaged in policy dialogues to clarify the possible causes and direct selection of the best choice.

"Sometimes, hasty and unscientific decisions were made in population area without the use of expert opinions of demographics (for example, in Atiyeh plan) that result in failure” (Participant 7).

In this work, environmental experts were known as a low opposition with a low power stakeholder. They have serious concerns about the issue.

“The capacity of several disadvantaged provinces is low for more population. They do not have more water, land and infrastructural capacity to accommodate more population” (Participant 6).

It might be altered opposition of them by involvement in policy-making meetings and using their comments on the appropriation of the resources like water and land capacity of each region for increasing the TFR and not prescribing a unit prescription for all of regions. Therefore, by adding desired goals or mechanisms to the policy, it might be persuaded this stakeholder to weak its opposition. In addition, meeting with opponents such as environmental experts helps to seek common goals or policies, and thereby, reduce the intensity of their oppositions.

Our key informants mentioned that the role of ordinary people in policymaking is weak and largely they do not voice in governmental authorities. Namely, most of decisions made behind the closed doors with a non-participatory approach.

Strategies and solutions for changing the position and power of stakeholders in order to increase TFR is indicated in Table 3.

Table 3

Solutions for changing position and power of stakeholders
Stakeholders	Strategies
Islamic Seminaries, Supreme Council of the Cultural Revolution, Islamic Parliament, Judiciary system, Broadcasting, Ministry of Education, Ministry of Science, Research and Technology	Using media to increase the generality of the problem and change the perception of the problem
Islamic Seminaries, Ministry of Cooperatives and Labor, Ministry of Science, Research and Technology, Islamic Republic of Iran Broadcasting	Providing evidence such as technical and political information
Supreme Leader, Islamic Seminaries, Islamic Parliament, Supreme Council of the Cultural Revolution, Ministry of Health, Ministry of Cooperatives and Labor, Ministry of Science, Research and Technology, Statistical Research and Training Center, National Organization for Civil Registration, Population Departments, Family Health Association of Iran, Islamic Republic of Iran Broadcasting	Building a coalition with a specific identity with sufficient resources
Supreme Council of the Cultural Revolution, Ministry of Health, Ministry of Cooperatives and Labor, Statistical Research and Training Center, National Organization for Civil Registration, Family Health Association of Iran, Judiciary system, Ministry of Education, Ministry of Sport and Youth, Islamic Republic of Iran Broadcasting	Increasing stakeholder organizational power by providing more funding or experienced personnel
Judiciary system, Ministry of Education, Ministry of Sport and Youth, Women's Affairs and Family of Presidency, Environmental Experts, United Nations Population Fund	Encouraging stakeholders to reinforce their position by adding benefits as an incentive
Ministry of Health, Population Departments, Family Health Association of Iran, Ministry of Education, Environmental Experts, United Nations Population Fund	Encouraging stakeholders to reinforce their position by adding goals and mechanisms to policies
Ministry of Cooperatives and Labor, Ministry of Science, Research and Technology, Statistical Research and Training Center, Population Departments, Family Health Association of Iran, Judiciary system, Ministry of Education, Ministry of Sport and Youth, Women's Affairs and Family of Presidency, Environmental Experts, United Nations Population Fund	Increase access to policymakers and sources of power by forming a supportive campaign

In this study, the stakeholder analysis showed diverse stakeholders with different powers and positions are working in population policies in Iran. Of course, most of them are non-mobilized or had low support with regard to the population reform policy. Additionally, there is no centralized, clear and comprehensive mechanism to guide the activities of governmental, NGOs and private organizations and institutions to coordinate and bring TFR to replacement level.

This study led to the recommendations and strategies to change position and power of stakeholders about population policy in Iran. It was recommended that coalition of supporting groups or stakeholders, with a recognizable name and sufficient resources should be created. A steward under the supervision of the supreme leader or among all politicians including the judiciary and parliament and presidency system should work along with NGOs to achieve the aims of overall policy issued by supreme leader and other politicians. For instance, the population supreme council, which proposed by the majority of key informants, as a stewardship of the country's population policies should, been established to develop population policies, coordinate different authorities and prioritize TFR decline issue. Civic coalitions including stakeholders are shown to be effective in making positive changes in health outcomes. When politicians build a team with different influencers and expand their partnership, these coalitions become more effective (18).

Another strategy was adding desired goals and mechanisms to the policy based on stakeholders' ideas and suggestions (Engaging all stakeholders in policymaking process). Interventions should be founded on actuality and evidence, not on political and security perspectives. In this case, can be participated all stakeholders. As one individual stakeholder does not have all the needed skills and knowledge about the issue, cross-disciplinary collaboration of stakeholders is essential. However, capacity building of this engagement should be done first (19). When decisions and policies are determined without stakeholders' participation, programs couldn’t be getting translated to action (20). Despite benefits of stakeholder engagement in policymaking process, policymaker should be aware of different interests of stakeholders, which may change policy positions in a way that is not based on evidence (21).

Increasing availability to political leaders, through a lobbying campaign was the next recommendation of this research to change stakeholders position and power. Some experts believe that the fertility decline problem is more complex and needs a high structure, not only government, but also all officials to develop and adopt policies. Donors, NGOs and private sector have potentials to participate in financing as well as service delivery where government does not have enough resources (20). Research bodies also play important role in informing policymakers and stakeholders (22).

Another strategy to change stakeholders power and position is using the media to increase public awareness and change their perception about population issues. Of course, the above approach should be regarded as a necessary but not sufficient option along with other activities, not just that much remains conferences. Media provide information to the public at the national level and act as policy implementer; however media are a part of political communication at the regional level (23).

Providing information and evidence to stakeholders, including technical and political information is a strategy introduced by this study that can change position and power of stakeholders. Although the majority of respondents believed on necessity to change the population policy, there was no consensus regarding the best alternative. Some presented evidence showing that cultural practices could be effective, while others had evidence showing the effectiveness of economic affairs. However, it seems that participation of all stakeholders, including socio-economic and cultural bodies is necessary and by carrying out above strategy, the importance of issue and its policies become higher especially among senior authorities.

Finally, we suggest increasing the organizational strength of supporters, by providing increased material resources or experienced staff or by fostering political skills. For example, increased funding of MoHME along with other institutions by enhancing the strength of these organizations could cover the costs of infertility treatment. Technical and financial support of stakeholders has been shown to plays an important role in implementing such policies in the countries (24).

This study found that different stakeholders with different powers and positions are working in population policies in Iran. Of course, most of them are non-mobilized or had low support with regard to the population reform policy. Despite the importance of new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro level authorities alongside with evidenced based population policy making.

Information produced by a stakeholder analysis is always to some extent subjective and identifying stakeholders who are, or might become, involved in a particular policy process, requires the judgment of the analyst (12). Any analysis depends only as good as the analyst’s attention, creativity and access to the information. In addition, Key-Informants may not have enough time for an interview or may simply provide official positions (25) or what people say and how they say it, as opposed to what they actually do or think (11). For example, a minister may publicly defend a policy to win favor with voters or specific interest groups but may be actively working against it from within government. Hence, recognition and understanding these limitations, especially in population policies might boost the value of such studies and guide future researchers.

Ethical approval and consent to participate: The present study received ethical approval from the ethics committee of Tehran University of Medical Sciences (Research Ethics Committee Reference: 9021460003). The investigators obtained the participants’ permission to perform and audio tape the interviews.

Consent for publication: N/A

Availability of data and material: N/A

Competing interest: Authors declared no competing interests.

Funding: This work was financially supported by Tehran University of Medical Sciences.

Authors’ contribution: HJ designed the study. AP, RK, and NK gathered the data and analyzed the data. RK drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgement: This work was supported financially by Tehran University of Medical Sciences. (Research Ethics Committee Reference: 9021460003).

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You are reading this latest preprint version

Main Actors in the New Population Policy With a Growing Trend in Iran: A Stakeholder Analysis

Status:

Version 1

Abstract

Introduction

Methods

Approach

Participants and recruitment of key-informants

Selecting and validating the policy documents

Data collection

Data management and analysis

Quality and rigor of the study

Ethical consideration

Results

Discussion

Conclusion

Limitations Of The Study

Declarations

References

Status:

Version 1