Emergency contraception (EC) refers to a family of medications or devices used post-coitally to reduce, but not eliminate, the risk of pregnancy. Pills containing higher doses of the hormones found in oral contraceptive pills (OCPs) and the post-coital insertion of the copper-T IUD constitute the two primary methods of EC used worldwide. In the last fifteen years, dedicated emergency contraceptive pills (ECPs), progestin-only pills that are dosed, packaged, and marketed specifically for post-coital use, have been registered in more than 100 counties and are available without a prescription in nearly half of these settings. In 2001, Tunisia became the first country in the Arab world to register a dedicated levonorgestrel ECP (Norlevo®, HRA Pharma). Over the last decade ECPs have been subsequently registered in Algeria, Egypt, Lebanon, Libya, Morocco, and Yemen and registration efforts are now underway in Kuwait and Jordan. However, product registration does not guarantee availability, accessibility, or affordability and outside of Tunisia and parts of Lebanon, access to a dedicated post-coital method of pregnancy prevention is limited. Yet even in the absence of a dedicated ECP, the ubiquitous availability of OCPs through clinics and pharmacies means that throughout the region there is considerable access to medications that could be used post-coitally to reduce the risk of pregnancy. Drawing from original research conducted in Tunisia, Palestine, and Jordan, this paper explores the journey of EC in the region. Through an examination of the successes and challenges associated with the introduction of this relatively new reproductive health technology and the integration of ECPs into national family planning programs, standards of care protocols, and service delivery guidelines, this research offers insights into the ways in which EC has been locally appropriated. This paper showcases efforts that have been undertaken to expand information about EC to both clinicians and individual women and to engage with a variety of stakeholders to increase acceptability and awareness of the method. With the 10 year anniversary of dedicated product registration upon us, this paper critically examines the debates that have been generated by ECPs and argues that these debates center on broader issues of sexual and reproductive autonomy. In a region in which nearly one fourth of all pregnancies are unintended, EC continues to hold considerable promise for addressing women’s pregnancy prevention and reproductive health needs. This paper concludes by offering some reflections on the lessons learned and priorities for expanding EC access.

A cycle of in-vitro fertilization (IVF), locally valorized as a “modern cure” for infertility, is nevertheless more likely to result in failure than success. Based on ethnographic fieldwork in a Turkish IVF clinic and qualitative interviews with patients and practitioners, this paper explores the practical and discursive strategies used to negotiate this potential dichotomy, as well as the range of causal inferences made to understand and explain treatment outcomes. These strategies not only reveal particular local formulations between science and religion, or accountability and fate, but also, consequently, facilitate particular types of relationships between doctors and their patients. For example, both patients and practitioners place great emphasis on close adherence to doctors’ orders during the IVF cycle, not just on matters regarding the dosage of medication and timing of clinical visits, but also on less “medical” matters, such as which foods or activities to abstain from. Yet, doctors’ actions, knowledge, and powers on their own are recognized as insufficient to guarantee a pregnancy. Scientific and medical explanations fail to provide clear answers, and cannot satisfactorily elucidate why, despite exact replication, IVF will sometimes “work” but often will not. Thus, both patients and practitioners reference a range of other factors – including patients’ “psychology” or “energy” – as also influential to the treatment outcome, and will speculate regarding potential contributing reasons to the success and failure of particular cases. Most importantly, however, the outcome of IVF is seen as determined by the will of Allah, with the concept of “hay?r” (which can only loosely be translated as “auspiciousness” or “beneficence”) forming a central theme in both religious and secular narratives. This fatalistic attitude is reflexively assessed by both patients and practitioners as beneficial, both for enabling a more relaxed attitude during the treatment process and for providing a coping strategy for those faced with disappointments.

In this paper we examine the implications of prenatal diagnostic (PND) technologies on the pregnancy experiences of Haredi women in Israel. While a wide range of PND technologies are offered to all Israeli citizens as part of routine prenatal care and subsidized by the state of Israel, Ultra-orthodox Jewish women use them selectively. Israeli doctors and lay persons view compliance with PND and termination of affected pregnancies as responsible maternal behavior, and often misinterpret Haredi women's selective use of prenatal testing as irresponsible. These criticisms eclipse the different way maternal responsibility is conceptualized in Haredi communities; it is not framed in terms of exercising choice but of being chosen. Namely, Haredi women spend much of their married lives pregnant and view childbearing as a gendered route of devotion. Pregnancy signifies for them a divine mission. Bearing a child with a disability is taken as a test of faith and God's decree to be accepted. Yet, any indication of fetal anomaly creates anxiety about the women’s ability to fulfill their God-given task and about their position in an unwritten hierarchy of gendered righteousness. Becoming terrified following an indication of fetal anomaly signals falling spiritually short of God’s challenge. Thus, PND harbors a specific kind of risk for Haredi women, as it makes them “terrified of becoming frightened,” subjecting each and every pregnancy to inevitable struggles. Unlike the American women described by Rayna Rapp, who were left alone to engage in "moral pioneering," Haredi couples often assign challenging reproductive decisions to rabbis, or "expert moral pioneers." Rabbis may advise to pursue further testing (scans or amniocentesis), or prohibit it because any further medical information might impede God from performing an explicit miracle. A rabbi could prohibit or allow termination; sometimes he might even put enormous pressure on a particular woman to terminate the pregnancy if he felt that her physical and emotional health was seriously compromised. Yet rabbinical involvement does not exempt women from viewing themselves as inadequate in their religious devotion. All our interviewees had attended prenatal care checkups, but had rejected the maternal serum screening test, and were opposed to amniocentesis. Nearly all accepted ultrasound scans, but their number and timing varied among women and from one pregnancy to another. Ultimately, our study contributes evidence that refusing PND is not equivalent to resisting the medicalization of pregnancy.

Women in Afghanistan suffer the second highest maternal mortality ratio in the world. The physical causes of maternal death include post-partum hemorrhage, infection, obstructed labor and pregnancy induced hypertension; however in parts of the world where women have access to appropriate health care, these causes do not result in death, but are treated with rather basic medical technology. Unfortunately, most women in Afghanistan who die in childbirth do so without ever seeing a skilled health care provider. Challenges to accessing care include inadequate numbers of female nurses and doctors spread across mountainous and disparate communities, poor transportation infrastructure and political insecurity. Recently, the Afghan Ministry of Public Health partnered with several local and international NGOs address the shortage of providers by designing a fast-tracked program that trains young women in only the medical management of normal pregnancy and childbirth. In order to make the program work within local notions of gender and community, village leaders were made responsible for selecting the woman who will leave her home to attend the 18 month training in the provincial capital. These "community midwives" must sign contracts that stipulate they return to their villages following graduation and serve the women of their communities for at least three years. Using ethnographic data collected in three provinces in Afghanistan, this paper examines the reproductive health impact and social implications of community midwives as the first female professionals in many villages. A detailed examination of this emergent and unprecedented role offers insight into local meanings of community, gender and health in Afghanistan that are often mistaken as entrenched and misogynistic. Generational differences in women's perceptions and behaviors surrounding maternal risk also reflect more subtle changes in household expectations of family and gender. This article will demonstrate how the visibility of women in the public sphere creates resources and networks which ultimately reduce maternal risk.