Jarahi et al. BMC Public Health 2011, 11:281 http://www.biomedcentral.com/1471-2458/11/281 R E S E A R C H A R T I C L E Open Access Parental willingness to pay for child safety seats in Mashad, Iran Lida Jarahi1,2, Mojgan Karbakhsh2,3* and Arash Rashidian4 Abstract Background: Iran has one of the highest rates of road traffic crash death rates throughout the world and road traffic injuries are the leading cause of years of life lost in the country. Using child car safety seats is not mandatory by law in Iran. The purpose of this research was to determine the parental willingness to pay (WTP) for child restraints in Mashad, the second most populated city in Iran with one of the highest rates of road traffic-related deaths. Methods: We surveyed 590 car-owner parents of kindergarten children who were willing to participate in the study in the year 2009. We asked them about the maximum amount of money they were willing to pay for car safety seats using contingent valuation method. Results: The mean age of children was 33.5 months. The median parental WTP for CSS was about $15. Considering the real price of CSSs in Iran, only 12 percent of responders could be categorized as being willing to pay for it. Family income level was the main predictor of being willing to pay. Conclusions: The median parental WTP was much lower than the actual price of the safety seats, and those who were of lower socio-economic class were less willing to pay. Interventions to increase low-income families’ access to child safety seats such as providing free of charge or subsidized seats, renting or health insurance coverage should be considered. Background Iran has one of the highest death rates of road traffic crashes (RTCs) throughout the world (44 per 100,000) [1,2]. Iran’s burden of disease study in 2002 identified injuries as the first cause of years of life lost in all ages and both genders (28% of the total) [3]. In 2000, around 423 under five children per 100,000 lost their lives due to RTCs [4]. RTC injury rate in Iran increased from 110 to 401 per 100,000 population during 1997-2005 due to rapid motorization and lack of strict car safety standards with a slight but significant decrease in 2006[5,1]. Child car safety seats (CSS) are effective in protecting children aged 0-4 years, if correctly used, and can reduce the risk of death by approximately 70% for infants and by half for toddlers [6,7]. While several countries have regulations for CSS use, its use is not necessitated by law in Iran. Thus, child safety seat * Correspondence: mkarbakh@tums.ac.ir 2Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article utilization in Iran depends on the parents’ decision mak- ing and choices. This is one of the reasons that high- lights the importance of studying willingness to pay for child safety seat in Iran. Determining the value that parents place on child injury prevention interventions can facilitate decisions for policy makers [8]. One approach is to study willing- ness to pay (WTP). In this approach, the maximum amount of money a person is willing to pay for a service is used for estimating the value of that intervention from the person’s perspective [9]. One method for elicit- ing WTP is contingent valuation method in which a sce- nario on a specific commodity in a hypothetical market is used. It is a valid method for estimating the value placed by people on health care interventions [10,11]. Example of its used include assessing WTP for improved quality of care [12], in vitro fertilization [13] and reduction of mortality after myocardial infarction [14]. WTP has also been used in the areas of health pro- motion like fortification of foodstuffs [15], and disease prevention like prevention of cancer [16] and SARS © 2011 Jarahi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.