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Emerging Reproductive Health Technologies in the Middle East and North Africa: Misoprostol, Hymenoplasty, and Assisted Reproduction

Panel 052, 2010 Annual Meeting

On Friday, November 19 at 11:00 am

Panel Description
The way a society interprets and adopts (or rejects) a new technology reveals a great deal about the complex relationship between religion and medicine, bodies and the body politic. The development of new technologies is rapidly changing the global face of reproductive health. Yet work by anthropologists, sociologists, and political scientists have demonstrated that the way these global technologies are incorporated and accepted in different local environments reflect variations in religious, cultural, social, and legal contexts. Reproductive health technologies are often particularly controversial because of their potential to reconfigure kinship relationships, sexual mores, gender roles, and the way life is conceptualized. In this panel, panelists explore the use of misoprostol for pregnancy termination in Palestine, hymenoplasty in Egypt, and assisted reproductive technologies (ART) and infertility in Turkey and the United Arab Emirates. Grounded in original social science research in these countries, the panelists describe these technologies and discuss the relevant political, cultural, religious and economic issues shaping use of and debate over that technology. By including a variety of technologies in a range of country-specific contexts, this panel highlights both differences and similarities throughout the region. This panel promises to make an important contribution to the growing body of research dedicated to reproductive health in the Middle East and North Africa. Over the last several decades, family planning, and in particular contraceptive use within the marital relationship, has dominated the reproductive health research agenda. The needs of unmarried women and the complexities surrounding a woman's ability to terminate a pregnancy have received modest attention. Further, issues surrounding infertility and assisted reproductive technologies have often been separated from family planning and the broader reproductive health discourse. By focusing on infertility and abortion, as well as hymenoplasty, this panel departs from this tradition through the incorporation of both a wider array of reproductive health issues and a focus on the reproductive health needs of both married and unmarried populations. Finally, this panel offers reflections on the potential for reproductive health technologies to expand access to reproductive health services in the region.
Disciplines
Anthropology
Sociology
Participants
Presentations
  • Introduction: The creation of the wall in the West Bank, curfews, road closures, and enforcement of the Jerusalem identity card and permit system has severely disrupted Palestinian women's access to health facilities and family planning services. A growing body of evidence suggests that decreased access to health services combined with the worsening economic situation is contributing to increased rates of unintended pregnancy and influencing pregnancy intentions. Although abortion in the West Bank is restricted to cases of life or physical health endangerment, abortion through 14 weeks' gestation is legal and available in Jerusalem for a wide array of indications. However, in the absence of a Jerusalem identity card West Bank women must obtain a medical permit in order to enter the city to obtain an abortion. Since 2001, "abortion travel permits" have become more difficult to secure and the process is time consuming, expensive, and non-confidential. Decreased access to Jerusalem-based abortion care has coincided with increased reports of both quasi-legal abortion provision and self-induction practices. Our study aimed to examine the availability of misoprostol for early pregnancy termination in the West Bank. Methods: Representing approximately 15% of all retail pharmacies in the West Bank, we conducted interviews with pharmacists at 87 retail pharmacies in nine cities. Our interviews included questions on misoprostol knowledge, availability, and provision patterns. We asked pharmacists to reflect on community and clinician awareness of misoprostol and the need for misoprostol among specific groups. We coded and analyzed the interview content for key themes. We combine these results with findings from in-depth interviews with Palestinian women about their abortion experiences. Results: Pharmacists expressed concern about the high rates of contraceptive failure and unintended pregnancy. Over 75% reported that women come to the pharmacy seeking misoprostol for pregnancy termination and nearly 70% of these pharmacists reported that there has been a considerable increase in requests for misoprostol since the second Intifada. Pharmacists reported varied knowledge about the evidence-based regimens for using misoprostol. Our interviews with women suggest that women are engaging in a number of practices to terminate unwanted pregnancies but most are not aware of misoprostol. Conclusion: Access to abortion and reproductive health services cannot be separated from the broader context of occupation. However, our study points to several avenues for expanding access to safe(r) abortion services, including misoprostol-only education campaigns targeting pharmacists, clinicians, and women with unintended pregnancies.
  • Ms. Zeynep Gurtin-Broadbent
    In vitro fertilization (IVF) technology - or t p bebek (literally "tube-baby") as it is ubiquitously known - has become one of the most arresting hallmarks of contemporary Turkish society. Ever present in popular media coverage, from celebrity endorsements on daytime television shows, to cutting-edge news items on the front pages of daily broadsheets, tsp bebek stories regularly pique the national interest and have wide appeal for an emphatically "child-loving" population. The growth and expansion of IVF within Turkey, particularly since the introduction of funded treatment cycles in 2005, has had a profound impact on the personal experiences of involuntarily childless men and women, and on social attitudes towards (male and female) infertility. Promoted as an efficacious modern medical "cure" for the social and personal tragedy of childlessness, the allure of IVF is evident in reports that estimate up to two million couples currently on waiting lists. Engagement with the biomedical system transforms the social condition of involuntary childlessness, usually blamed on the woman and identified in this context with the absence of a pregnant belly, into the medical condition of infertility, which can be attributed to either male or female physiology (as blocked fallopian tubes, hormone malfunctions, or low egg or sperm quality).However, regardless of the infertility diagnosis, IVF is always enacted upon the woman's body, and is thus unique among therapeutically indicated biomedical interventions in "treating" couples rather than individuals, and its ability to "cure" by-proxy. Using data from ethnographic fieldwork in fertility clinics, as well as archival research of media and regulatory materials, this paper analyses the impact of IVF on the gendered conceptions of infertility - its causes, consequences, and cures - as expressed both at the level of popular media representations, and in the personal accounts of male and female infertility patients. Tracing the social practices and public discourses surrounding IVF in Turkey, I argue for and explain the paradoxical outcome whereby IVF has led simultaneously to an increased awareness of male infertility and a perpetuation of traditional preconceptions that blame involuntary childlessness on women rather than their husbands.
  • Ms. Shirin Karsan
    A recent study in the UAE indicates that culture and religion are strong factors that shape the attitudes of Sunni Muslims in the Emirates when it comes to the pursuit of creating a family. Their religion (Islam) is by no means a barrier to the use of modern technologies if and when required; in fact every family interviewed in this study felt confident based on guidance from their religious authorities that within the institution of marriage, their usage of ART was halaal (acceptable) in Islam as long as family lineage is kept intact during the process. The UAE is unique in that it's government provides significant financial support required for Emirati families wishing to access assisted reproduction technologies, albeit under strict adherence to the practices of Shari' a (Islamic Law). While this alleviates the family's economic burden of huge medical costs, cultural sensitivities and pressure make it extremely difficult for most families to access treatment with sufficient and appropriate medical knowledge and information, thus presenting us with a model requiring assessment of the potential for over and perhaps some inappropriate usage of ARTs.
  • In 1996, the Lancet reported that there was a lively trade of surgeons performing hymenoplasty to give women the illusion of virginity before marrying, despite the fact that Al-Azhar (the highest Islamic institution in Egypt) had condemned hymenoplasty and the Egyptian Medical Association had forbidden its members from performing the procedure. Ethnographic research in Egypt conducted during 2008-2009 showed that, like the Lancet, a majority of Egyptian doctors interviewed believe that hymenoplasty is both illegal and haram (i.e. religiously prohibited), and hymenoplasty is not taught in Egyptian medical schools. Yet a careful investigation during the same years that these doctors were interviewed revealed that there was no Egyptian law prohibiting hymenoplasty, it has never been condemned by the ethics committee of the Egyptian Medical Syndicate, a 2007 fatwa (ruling of religious jurisprudence) issued by the Grand Sheikh of Al-Azhar University pronounced hymenoplasty religiously permissible under certain circumstances, and a 2008 fatwa from a Dar al-Iftaa mufti (jurisprudist) declared that any doctor asked to perform hymenoplasty should do so. Why do Egyptian medical authorities refuse to teach or openly perform a procedure that has been approved by one of the highest Islamic authorities in the country, and why do many doctors believe it is illegal when it is not? This paper, which is based on archival and ethnographic research in Cairo, Egypt, explores these paradoxes. Using the case study of hymenoplasty, it examines how key institutions - in this case, Islamic schools of jurisprudence and fatwas, medical schools, and the media - shape interpretations of the moral implications of new medical technologies, as well as their availability. It also provides a window onto the role of religious authorities in deciding questions of moral behaviour in the everyday lives of Muslims. Finally, studying debates about hymenoplasty in Egypt reveals what kinds of sexualities are popularly imagined to emerge from (and create the need for) this reproductive health technology.