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Family, Medicine, and the State

Panel 016, 2009 Annual Meeting

On Saturday, November 21 at 5:00 pm

Panel Description
N/A
Disciplines
N/A
Participants
  • Dr. Djavad Salehi-Isfahani -- Presenter
  • Dr. Angel M. Foster -- Presenter
  • Dr. Nukhet Varlik -- Presenter
  • Dr. Samir Ben-Layashi -- Presenter
  • Irene Maffi -- Presenter
Presentations
  • Dr. Djavad Salehi-Isfahani
    The objective of this paper is to evaluate the impact of Iran’s family planning program on rural fertility outcomes. The lessons from Iran’s program are considered valuable but we do not know what they are because there are a number of other simultaneous changes in health and education that are well-known correlates of fertility decline. During the first few years of the Islamic Revolution Iranian fertility was on the rise, in part because of the revolutionary government's pro-natal policies. In a policy reversal, in 1989 the government launched an ambitious and innovative family planning program specifically aimed at rural families. By 2005, the program had covered more than 90 percent of the rural population and the average number of births per rural woman had declined to near replacement level from about 8 birth in the mid 1980s. In this paper we ask to what extent this decline was the result of the family planning program. To identify the impact of the family program on fertility, we use the timing of establishment of Health Houses and fertility decline for a smaple of about 14,000 villages. Our results indicate only a moderate effect of the program on rural fertility. Fertility decline in villages that received health services earlier was only slightly greater than those that received it later. Our regression results indicate that other factors, such as initial literacy and availability of schools may have played a larger role in fertility decline than family planning.
  • Emergency contraception (EC), medications or devices used post-coitally to reduce the risk of pregnancy, represents a relatively new reproductive health technology in the Arab world. In 2001, Tunisia became the first country in the region to register an emergency contraceptive pill (ECP). In the subsequent eight years, EC has become fully integrated in both the public and private health systems and in 2005 ECPs were made available directly from pharmacists without a prescription. Distribution of EC has steadily increased in Tunisia and in 2008 approximately 30,000 units of ECPs were obtained by women through retail pharmacies. Although Algeria, Egypt, Lebanon, Libya, Morocco, and Yemen have also registered ECPs, outside of Tunisia regional access to this important method of contraception remains limited. This paper explores the political, medical, and socio-cultural discourses surrounding the introduction of EC in Tunisia. Unlike many countries that have introduced ECPs there appears to have been remarkably little controversy surrounding expanding access to EC in Tunisia. Through a combination of qualitative and quantitative methods, including a survey of retail pharmacists and focus group discussions with unmarried women, this paper chronicles the history of EC in Tunisia and argues that the lack of controversy is directly tied to Tunisia’s overall commitment to providing comprehensive reproductive health services. The lack of politicization of EC in Tunisia is, in part, the result of longstanding reproductive health policies and services that are explicitly linked to women’s political, economic and social status. By situating EC in the broader reproductive health and development agendas, the Tunisian experience highlights how country-specific political, public health, and socio-cultural contexts can support and facilitate the adoption of a global reproductive health technology. By presenting the Tunisian experience, this research can inform broader regional efforts to introduce ECPs and incorporate EC into reproductive health and family planning services.
  • Irene Maffi
    Immediately after the Second World War the new Independent Jordanian government instituted the Ministry of Health which was to provide medical services for the local civil population. One important plan of the newly created ministry which was to be implemented in the next decades was aimed at creating a network of Maternal and Child Health centres in the country. As a result a college for the training of midwives and nurses was founded in Amman at the beginning of the 1950s and the first Faculty of Medicine was inaugurated at the Jordan University in 1972. Several governmental hospitals were built in the Kingdom and important efforts were made in order to train and control the activities of local dayyas (traditional birth attendants). By the 1990s, the Jordanian women not only had stopped giving birth at home but had become almost completely integrated into the local medical system at least in the domain of procreation. Moreover, since the end of the 1970s some international organizations and local NGOs have started to introduce in Jordan the concept of family planning. Although until recently the local authorities did not implement any policy in order to control the Kingdom’s population, during the last decades several Western concepts, technologies and practices related to reproduction have gradually penetrated into the Jordanian population. Today, the Jordanian Ministry of Health together with some local NGOs and charitable societies offers all Jordanian women free antenatal and postnatal care, counselling in sexual and reproductive health as well as free contraceptives. In this paper I will focus on the cultural and social implications of the diffusion of the biomedical model in the domain of reproduction. I will pay attention to ordinary childbirth practices and women’s attitudes towards biomedical institutions, concepts and technologies. In this framework I hope to show how Jordanian women, according to their social status and their education, accept, adjust to, refuse or resist the actual biomedical practices and the related ideas of procreation.
  • Dr. Samir Ben-Layashi
    In this dissertation I will investigate the colonial encounter between Morocco and France from 1880 until 1962 through a history of the (physical) body. The goal of this research is to place meanings and practices of "medicine", "hygiene" and "body" at the center of Moroccan experiences of modernity. Colonialism instrumentalized medicine and hygiene for colonial projects in various ways: curing, civilizing, controlling populations and declaring the "demise" of their ill bodies and their rebirth in modern and medicalized bodies. The national discourse, which contested colonial medical discourse, adopted the latter because it proved to be efficient in conquering the social body by achieving a monopoly over the physical human individual body. In this dissertation I will show how the meanings and praxis of "medicine", "hygiene", and body" shifted away from Moroccan cosmology and moved to compass sate power, scientific progress, national identity, class conscience; when the concept of cleanness and care of the body moved from the intimate and privy to political and national, when having a bath in the hammam or cleaning one's body under a modern shower became a political act . The present research will attempt to deconstruct the monolith of "Western medicine" and capture its transformation and multiple manifestations in the context of colonial modernity, in order to reveal moments of ambivalence of the national elite, who from one hand they challenged and reformulated what they perceived as the errors and limits of Western medicine, and on they other hand they adopted the colonial medical discourse and incorporated in the curriculum of the new Nation Medical School of the independent state while keeping distance from traditional modes of healing giving up by this act a colonial attempt to incorporate tractional Moroccan medical practises in colonial hospitals in treating not only the local people but also the Europeans who lived their. This research aims to show how the encounter of colonial medicine with local traditional medical healing practices (re)shaped the modern Moroccan (fleshy) body as we know it today.
  • Dr. Nukhet Varlik
    The current literature on Ottoman medicine seems to suffer from an underlying assumption that there was a monolithic Islamic medical tradition that was adopted by the Ottomans starting from the early fifteenth century and perpetuated in the following centuries. Such an approach not only reduces the Ottoman medicine to a mere continuation of medical traditions of classical Islamic medicine, but also fails to grasp the nuances of Ottoman medical knowledge and practice. In contrast to the current literature, this paper will argue that the emergence and growth of the Ottoman medical establishment began to take shape in the late sixteenth century. By looking at the emergence and development of Ottoman medical practice and institutions during the sixteenth century, this paper aims to analyze the Ottoman medicine within the context of the redefinition of the idea of “state” and its capabilities in the sixteenth century Ottoman Empire. By using works on Ottoman medical literature, court records, and archival documents, this paper will argue that the early modern Ottoman state gradually began to emerge as the standard-setter and regulator of the newly emerging medical system in the second half of the sixteenth century. The paper will show that this process brought an increased prestige and respect to medical practitioners, who were now closely associated with the state. The paper will examine the changing perception of medical practitioners, within the context of increasing professionalization, standardization, and the introduction of state-sponsored medical education in the sixteenth century. As another manifestation of this change, the paper will also look at the presence of medical professionals consulted in court hearings, in cases where expert knowledge was required. Although the function of the kad? as expert and advisor to the central administration in health-related issues seem to have continued, starting from the second half of the sixteenth century the resort to expert knowledge of medical professionals in court cases will be analyzed within the context of growing prestige of the Ottoman medical establishment.