Islam, Gender, and Reproductive Health

Cover story from Centerpoint, May 2005

May 02, 2005

The Middle East Program and the Environmental Change & Security Project recently launched a series of six meetings on the sensitive yet critical topic of Islam, gender, and reproductive health. By April 2005, four of the six planned meetings have taken place in the series, which is supported by the U.S. Agency for International Development's Office of Population and Reproductive Health and the Interagency Gender Working Group. The final two meetings will examine gender-based violence and the role of men in promoting women's reproductive health, and HIV/AIDS in the region.

Reproductive Health Policy
Many Middle Eastern countries have experienced a decline in fertility rates in recent years, in part due to government campaigns aimed at reducing family size, said Nazy Roudi, project director for Middle East North Africa at the Population Reference Bureau, at the first meeting in the series. Roudi said the Iranian government promotes family planning by linking it to economic and political interests. One tenet of that campaign suggests having fewer children would lead to better educational opportunities for them.

Barbara Ibrahim, regional director for West Asia and North Africa at the Population Council in Cairo, said dignity is a core value for Muslims akin to freedom for Americans. She explained that raising awareness about reproductive health issues, such as HIV/AIDS and contraception, and the advantages of limited population growth, must be presented as indigenous programs in Muslim countries rather than as part of Western campaigns.

Contraception and Women's Health
While the countries of the Maghreb (Tunisia, Morocco, and Algeria) have taken different paths in developing family planning programs, former Wilson Center Fellow Lilia Labidi said they "all show a similar and significant reduction in birth rates." Current estimates place fertility rates at 2.5 children per woman in Morocco, 2.3 in Algeria, and 2 in Tunisia, down from rates well above 6 children per woman in the 1970s. The Maghreb "accomplished in 25 years what took almost 200 years in France," observed Labidi, an anthropologist and professor at the University of Tunis.

Although Tunisian women gained certain rights in the 1950s and 1960s, such as the right to vote and obtain judicial divorce, the government chose to promote contraceptive methods that "took the initiative away from women"—specifically IUDs and sterilization (sometimes coerced). However, Algeria and Morocco, where women's rights were less advanced, chose to promote the contraceptive pill, which gave women more control over their fertility. Labidi examined this apparent contradiction, tracing the impetus for Tunisia's sometimes coercive methods to the growing "secularization" of the state.

Karen Hardee, director of research at the Futures Group International in Washington, turned to Indonesia, home to the world's largest Muslim population. According to surveys conducted there by Family Health International, she said, Indonesia's strong, highly institutionalized family planning program has reduced the fertility rate from 5.9 children per woman to 2.6 over the past 30 years, employing educational campaigns and slogans such as "two is enough."

Although it faced initial resistance in the 1960s, the government engaged religious leaders in the policy dialogue to reach consensus. Because of this engagement, "religion does not play a big role in the decision to use family planning," said Hardee.

Infertility
In the world at any one time, approximately 80 million couples suffer from infertility, averaging around 10 percent. In addition, researchers have found an "infertility belt" in sub-Saharan Africa, where average infertility reaches about 30 percent, primarily due to trace infections in the reproductive system. In the developing world, many couples face secondary infertility, caused by sexually transmitted diseases, birth injuries, inadequate post-abortion care, and unsafe medical practices.

Marcia Inhorn, director of the Center for Middle Eastern and North African Studies and a professor at the University of Michigan, discussed the impact of Islamic teaching on the spread of infertility technologies in the Middle East. Due to enormous demand, Middle Eastern countries-—particularly Lebanon, Egypt, and Israel-—have the highest number of In Vitro Fertilization (IVF) clinics per capita.

Egypt issued the first Sunni fatwa regarding IVF in 1980, the tenets of which still influence the Muslim world. Among them: artificial insemination is permitted provided the husband's sperm is used; posthumous or post-divorce IVF is forbidden; surrogacy and sperm banks are forbidden. Another tenet outlawed third-party donation, considering it akin to adultery.

Although women generally are blamed for infertility, Inhorn said male-factor infertility accounts for more than half of all cases worldwide. One new technology is Intracystoplasmic Sperm (ICSI) Injection in which the doctor injects the husband's weak sperm directly into the ova. Inhorn said that such new technologies have entrenched traditional kinship practices and relations.

Harmful Practices
Ellen Gruenbaum, a professor at California State University-Fresno, who has studied the practice of female genital cutting (FGC) in Sudan since the 1970s, said many people still practice such pre-Islamic rites.

Surveys reveal that about 80 percent of girls in north and central Sudan are circumcised and its practice contributes significantly to a high maternal mortality rate. Sudanese custom follows an extreme form of FGC, and the girls who undergo this procedure can experience lifelong reproductive health problems including cysts, scarring, painful sexual intercourse, and difficulties with childbirth. Practitioners believe circumcision ensures propriety, virginity, and honor by reducing sexual urges in unmarried women, preventing pre-marital sex and maintaining the family honor. Although this ritual originated in pre-Islamic times, many mistakenly believe the Koran stipulates this practice.

Gruenbaum found that some Sudanese communities are trying to combat FGC by encouraging women's empowerment, training midwives to view FGC as harmful, and encouraging religious and community leaders to advocate against this practice. Some regional leaders have fostered discussion on FGC's harmful consequences and reinforce these ideas by using scripture from the Koran to demonstrate that this practice is neither required, nor condoned, by Islam. Many women however, excluded from these discussions, are hesitant to disapprove of FGC, despite their husband's new misgivings, because they worry that their daughters will be unmarriageable without circumcision.

Islam and Women's Health
Asma Barlas, a professor at Ithaca College, focused her remarks on interpretations of the Koran that explain Islam's position on such practices as polygamy and honor killings. She noted that the Koran's initial audience consisted of 7th-century Arab nomads, a patriarchal society that treated women as property. Subsequent interpretations of the Koran still are in a patriarchal context, though Barlas said many of the verses used to justify traditional customs are taken out of context. The Koran expressly forbids female infanticide. The Koran does condone, but does not require, young age at marriage and also condones polygamy, but only if the man has the resources to support multiple wives and their children.

"One cannot explain Muslim women's lives solely in the context of the Koran," said Barlas. She said many factors affect the status of women in any society, including the history of gender relationships, cultural trends, the economy, and class status.

Homa Hoodfar, a professor at Concordia University in Montreal, Quebec, said in the early 20th century, men and women led initiatives to reinterpret the Koran in a less patriarchal way, but such efforts failed. From her research of family law in 28 Muslim states, Hoodfar learned that Muslim women do have an evolving sense of rights and that women of all classes and levels of education speak of such rights. She attributed the success of Iran's family planning initiatives, in part, to the focus on educating men as well as women. Hoodfar is now working with national women's assemblies to provide them with the Koran's text on the treatment of women as well as more "women-friendly" interpretations of such teachings.

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