Essay by Deena Ayesh
Edited by Kaylie Harley
The social determinants of adverse health for women in the Middle Eastern and North African (MENA) region are largely understudied by global health scholarship, and as a result, inhibits the advancement of regional healthcare systems in addition to the overall progress of each individual woman’s health status. Despite the immense academic debates that exist for determining what constitutes the principal “solution” for improving women’s health in the Middle East, the majority of research in this area chooses to attribute the “low social status” (Roudi-Fahimi) and “lack of education and literacy” (Naveed) of women as the root cause underlying their poor health. These studies generally emphasize an absence or refusal of family planning, early marriages and pregnancies, and a higher tolerance for pain and injury—due to women refraining from communicating their health ailments—as the biggest contributing factors (Roudi-Fahimi). Often utilizing an oriental framework, Western research and media sources attribute patriarchal ideologies and conservative religious beliefs as additional factors for the lack of preventative measures in women’s health, thereby pushing for reforms and the restructuring of belief systems when, truthfully, this is not the core issue. The analysis and observation of regional gender norms, religious discourses, institutional poverty, and political climates establishes a complex perspective of what factors harm women’s health in Middle Eastern territories. However, the general consensus of international research outlets attributes it to the domestication of women, and questions the foundation of services, rights, and institutions (or lack thereof) around this philosophy. This realm of academia centers upon a narrative of oppression and victimization of Middle Eastern women, with little-to-no regard for the other factors that have contributed to the formation of such hardship and enabled its expansion.
As is common practice in the public health community, disparity research is oriented in a framework of “problem” and “solution.” While usually effective for illustrating other health issues, this methodology is inadequate for regions that are already understudied and improperly contextualized. The Middle East is plagued with underdeveloped infrastructure that inhibits its research representation and progression (Katoue), therefore becoming a target for criticism and selective portrayal by any external entity. A problem/solution health framework for a region that has little precursory research could thus foster the biases of these external entities. Research about the Middle East is dominated by a postcolonial perspective: “The idea that other men, men in colonized societies or societies beyond the borders of the civilized West, oppressed women were to be used, in the rhetoric of colonialism, to render morally justifiable its project of undermining or eradicating the cultures of colonized peoples” (Ahmed). Thus, instead of focusing on the principal solution for identifying health issues for women with respect to their gender role in the Middle East—or the most effective means of female advancement in the region—one should question who holds the appropriate authority to make such questions, conclusions, and decisions or if this authority can be rightfully granted altogether. Understanding these elements and their application will transform the implementation of transnational health intervention programs, as well as the legislations that redefine the standards of women’s rights by organizations with multiple outlets of representation.
An alternative perspective to consider—which should be of much more consideration, but instead acts as a background theme for many health analyses of the Middle East—is the contribution (or lack thereof) of political authorities in each respective nations’ systems of health education, their efficacy as well as the efficacy of foreign systems, and the accessibility of preventative care facilities. The reality of analyzing the relation between health and social roles of women in the greater Middle East is that other factors must be considered, including a society’s distribution of income, access to education, the source of educational instruction, and accessibility—as well as the normalized utilization of mental health services. An analysis through these lens will show that the Middle East suffers from similar issues experienced by other developing nations which are still recovering from post-colonial rule and its resulting structural violences (Farmer). Taking such factors into account, it can be seen that the Middle East is not exclusively misogynistic as studies prefer to imply; the trends of a woman’s lifestyle mirror those of women within another developing region with different cultural and religious upbringing when contextualizing from an equivalent lens.
Studies performed in the Middle East continuously criticize the absence of the glorified amenities found in industrialized nations and cite personal ideologies as the core issue when, in reality, the Middle East faces many of the same issues other developing nations suffer from socioeconomically—conditions that are beyond individual control. The inaccessibility of education and unequal distribution of wealth has had many repercussions, but within the health realm, it has notably damaged the reproductive health of women. This is elaborately detailed in Farzaneh Roudi-Fahimi’s work, Women’s Reproductive Health in the MENA: “Due to a lack of education and literacy, some women may not be aware of their health problems and/or not seek medical help. Furthermore, many women may not feel comfortable discussing these conditions publicly.” The failure of the healthcare and education system has limited the potential for open conversation and preventative measures, increasing unwanted and early pregnancies, lack of family planning, and poor diet. Because of the lack of public awareness about the importance of medical care during pregnancy, there is also a high trend of women in the MENA region that do not seek antenatal and postnatal care. Additionally, there is a shortage of resources and health practitioners who can accommodate the preferences of patients, making women less willing to seek care. Many women in the Middle East prefer to see female healthcare providers due to their cultural values of modesty, but as Roudi-Fahimi notes, “few such providers are available in many parts of the region.” In cases where male practitioners treat women, they willingly consent to having their husband or another male guardian oversee their care, ensuring that their safety and modesty are preserved. This is often cited in academia as an emphasis on patriarchy, inhibiting a woman’s agency and personal decision-making. While this perspective is incomplete, the argument remains that education should not only be placed onto the responsibility of women, but a responsibility for “husbands and other family members [to learn] about reproductive health issues” (Roudi-Fahimi). This way, better planning can be made for the health of a woman and decisions can be jointly made. Essentially, Roudi-Fahimi’s argument holds the notion that health “problems are compounded by social and economic conditions as well as gender roles,” and the only means by which they can be addressed is by reorienting policies and programs at the national governmental level in respective communities.
In order to analyze the writings on women and public health, it is necessary to note that there exists a wide limitation in understanding the extent to which current societal constructs in the Middle East adversely affect women. The oppression of women is a global phenomenon, where women are subject to maltreatment and constraints in various forms. Yet, despite the international occurrence of women experiencing injustice, there is a continuous emphasis that Middle Eastern women are suffering, and the supposed reason is because of their country’s cultural and religious values. Generally, this is the case because the victimization of Muslim and Arab women is a popular narrative to magnify, and often organizations will use it to obtain sympathy from others that lack awareness in order to receive donations from them, as well as receive funding for their research projects that claim to aid these “victims.”
In “Saving Egypt’s Village Girls” by Rania Kassab, Kassab observes that there is an overwhelming number of international philanthropic projects intended to aid village girls from Muslim nations—mainly due to its palatability to Western audiences that have resonated with and championed “discourses of patriarchal oppression and marginalization for centuries,” but also due to the “age status and rural Otherness” of girls in the Middle East region. While the initiatives of non-governmental organizations (NGOs) that aim to serve this demographic appear well-intended at first glance, Kassab argues that they actually overshadow the political-economic factors responsible and perpetuate the minimization of poverty as an actual, systemic issue in the region. Additionally, these organizations increase the gap between Third and First World populations, inherently upholding global classist norms. Rather than addressing the issues of global poverty and underdevelopment that impact the Middle East, most NGOs prioritize educating girls whom they believe are victims of dehumanizing and “uncivilized” social constructs. The proper way to represent the health and well-being of village girls in developing nations “must be situated within broader discourses of global development, and the racialized and classed politics structuring the governance of poor populations through aid programs following neoliberal reforms and the dismantling of welfare states,” (Kassab).
The role of women in the Middle East is greatly affected by the political governing bodies of their homes. It is worth referencing the observation of Rhoda Kanaaneh in Birthing the Nation: Strategies of Palestinian Women in Israel, where she discusses the role of over-fertility as not solely a result of a patriarchal emphasis on the gender role of women to become mothers. Rather, it is observed that, in regions of political chaos—such as the Occupied Palestinian Territory (OPT) undergoing Israeli occupation—over-fertility is shown as a consented mechanism of nationalism for women, a response of rebellion against their colonial regime. Due to the political turmoil of the region, the role of women, both Jewish and Arab, is then used as an advantageous political weapon: “family planning is now part of the social processes in which these concepts are daily defined, changed, and redefined in people’s lives; in which gender is configured, communities are imagined, and boundaries of the modern are drawn” (Kanaaneh). As a result, laws are imposed to either promote, survey, or control their fertility and reproductive lives, with “citizens and their bodies, particularly female, nonwhite, and poor bodies, seen as vessels of population growth that must be controlled” (Kanaaneh). Kanaaneh further notes that fertility clinics grew widespread in Arab neighborhoods to educate the importance of the effects of population growth on the planet and promote birth control. Yet contrastingly, as a method of improving the efficiency of Israeli colonization, Israeli families were incentivized to have more kids by receiving child allowances and pronatalist awards, showing that the Arab fertility clinics were not as well-intended as portrayed.
Conclusively, it can be shown that the social determinants of adverse health for women in the Middle East and North Africa region are complex and cannot be directly attributed to social or educational status. Instead, it is necessary to consider the contribution of political authorities in each respective nations’ health education systems, and accessibility of preventative care facilities. The Middle East suffers from similar issues experienced by other developing nations which are still recovering from post-colonial rule and its resulting structural violences. The healthcare and education systems in place have limited the potential for open conversation and public awareness regarding serious health conditions for both patients and their family members. Without a just portrayal and perception of a demographic that is at least half of the population in the Middle East, a proper solution to public health issues is further impeded beyond the factors that adversely affect their implementation.
Works Cited
Farmer, Paul, On Suffering and Structural Violence: A View from Below, Vol. 3 2009 Jan 01, doi: 10.1353/rac.0.0025
Kassab, Rania. Saving Egypt’s Village Girls: Humanity, Rights, and Gendered Vulnerability in a Global Youth Initiative. Syracuse University Press, 2018.
Katoue MG, Cerda AA, García LY, Jakovljevic M. Healthcare system development in the Middle East and North Africa region: Challenges, endeavors and prospective opportunities. Front Public Health. 2022 Dec 22;10:1045739. doi: 10.3389/fpubh.2022.1045739. PMID: 36620278; PMCID: PMC9815436.
Kanaaneh, Rhoda. Birthing the Nation: Strategies of Palestinian Women in Israel. University of California Press, 2002.
Roudi-Fahimi, Farzaneh. Women’s Reproductive Health in the MENA: Empowering Women, Building Nations. Population Reference Bureau, 2013.