- Email: [email protected]
Infertility and patriarchy: the cultural politics of gender and family life in Egypt
Book Reviews Learning About Sexuality: A Practical l[h~nalag, edited by Sondra Zeidenstein and Kirsten Moore. The Population Council, New York, 1996. 404 pp., U.S. $20. This book is a collection of essays that grew out of a meeting of the National Council on International Health (NCIH). It is edited by Sondra Zeidenstein (an international women's health specialist) and Kirsten Moore (program manager at the Population Council). As the backgrounds of the editors suggest, the book is geared to practitioners and has an international focus. The book, Learning About Sexuality, is not, though, as the title might imply a primer on sex education for clients. The title instead refers to the learning that is needed by researchers and practitioners to understand and appreciate the impact of sexuality on programs in family planning, HIV/STD prevention and other reproductive health areas. The essays are largely in-depth qualitative examinations of sexuality within a particular culture. Many oftbe authors are from developing countries including Mexico, Thailand, Egypt and Zimbabwe. The practitioners and researchers who contributed to the book generally display extensive knowledge of and experience in the community they are describing. Their messages are more powerful by including material in the words of the individuals described such as reports by women in Romania who had illegal abortions and conversations between male college students in the U.S. about sexual experiences, fears and pressures. In addition, the authors contextualize their contributions by providing background information about themselves and their biases. The essays illustrate the ways in which learning about sexuality can contribute to reproductive health services, For example, Indonesian women's concern about the effect of hormonal contraception on sexual desire and functioning affects their family planning decisions. Also male street youth in Tanzania engage in different sexual behaviors with males and females, but only vaginal intercourse is considered "sex". A lack of this cultural knowledge will limit effectiveness of disease prevention efforts. Several themes emerge in the book. One is the importance of understanding cultural gender roles. When women's role is to please men sexually, for instance, they may not want to use contraceptive methods that interfere with male pleasure. Similarly, when men are considered "real men" only if they are sexually active, they will likely engage in early sexual intercourse. Several selections look at how sex roles affect the experience of sexual initiation for men and women. Others talk about special programs, such as separate services for boys and men, developed to address sex role expectations. Another theme is that sexuality is viewed as a forbidden topic in many cultures. Or else, as in a chapter on Indonesia,
Infertility and Patriarchy: the Cultural Politics of Gender and Fandly Life in Egypt, by Marcia C. lnhorn. University of Pennsylvania Press, Philadelphia, i 996. 296 pp., Cloth ISBN 0-8122-3235-6, US$36.95; Paper ISBN 0-8122-1424-2, US$16.95. It is curious that fertility is the focus of so much interest in medical and population circles, while infertility receives almost none. The thorough attempts which were made in recent years to give an itemised inventory of the global burden of disease for females,* exclude all mention of infertility, even though burden of disease was estimated for *In the World Development Report (World Bank 1993, Investing in Health), burden of disease is calculated in DALYs or disability adjusted life years.
1841
sex is presumed to be "natural" so does not need to be discussed by health professionals. The authors illustrate, however, the extent of ignorance about sexuality and the desire for this information. For example, women in Mexico and the U.S. enjoyed learning fertility awareness method of contraception, in large part because of the increased knowledge this gave them about their bodies and sexual functioning. A third theme is to question the presumption of consensual sex. One chapter reviews U.S. sexual behavior surveys, which they say tend to assume that sexual behavior is consensual. Other authors describe implications of non-consensual sex such as a discussion of IV drug-using women in the U.S., many of whom were sexually abused as children. The editors are concerned about sexual abuse to the extent that an appendix is included on screening and counseling abused women. The book is organized into three main sections. Part I is called, "Approaches to understanding the experience of sexuality" and consists of three essays on personal experiences with sexuality or sexuality programs and five essays from the perspective of sexuality researchers. Part II is about the links between sexuality, contraception and reproductive health and includes sub-sections on integrating sexuality into family planning services, reproductive health interventions and biomedical research related to sexuality. The third part contains five essays, under the heading "Challenging entrenched attitudes and behavior related to sexuality" and includes chapters on addressing violence against women in Zimbabwe and an interview with the founder of EMPOWER, a sex worker support organization, in Thailand. If I have any criticism of the book, it is that I found the organization somewhat confusing. Some chapters ostensibly about individual experiences included information about programs, and other chapters about programs told about it through the eyes of a single individual. Perhaps, this blurring of categories is also an asset, showing how well the book combines the experience of the clients and practitioners and its responsiveness to the needs of the community. A second criticism is that I found the section on biomedical research distracting. Although interesting in its own right, I felt that these chapters detracted from the powerful personalized accounts that make the book so memorable and useful to practitioners around the world.
School of Social Work University of Washington Seattle, WA U.S.A.
Diane Civic
other nonmedical categories such as war. Yet few conditions are more productive of human suffering. As this study amply illustrates, infertility can threaten a woman's social status, her relationships, and her very identity. If we wish to explore the importance of children for ordinary people, what better way than to ask what it is that is lacking in the lives of childless couples? Egypt has had a state-sponsored population control programme since the 1960s--the first Middle Eastern Muslim country to do so. Yet in Egypt, as in many parts of the world, efforts to control population growth have been judged as being of little value. The state publicly supports population programmes--despite an awareness of the need for plenty of young people to support the growing numbers of the elderly. The government has worked with Muslim family planning advocates to assure people of the legitimacy
1842
Book Reviews
of family planning within Islam. These efforts are however confounded by ordinary people who describe themselves as having great love for children. Within this strongly patriarchal society, children are essential for social reproduction. As Inhom tells us, the Arabic word used in Egypt to denote “family” usually means extended family; common usage of the term usra to denote “nuclear family” is relatively recent, coming from its adoption in family planning campaign material. An usra consists of husband, wife and children. A husband and wife are not an usra, and there is no word for couple. Those who marry and remain childless have no recognised existence; they are a social aberration. Inhom’s book makes fascinating reading, because it gets behind the superficiality of RAP surveys, and avoids sweeping assumptions about women’s and men’s attitudes to children and families. As the author points out, we know little about the lives and feelings of real women in Middle Eastern societies, especially in relation to the poor. There are few studies of family life. This work is based on conversations with 100 infertile women and 90 fertile women attending Alexandria’s large public teaching hospital which is attended primarily by lower class woman. Individual stories are followed by analysis. Although the organisation of the book leads to some repetitiveness, it is readable and brings together the author’s primary data with a much wider appreciation of the relevant literature. Notions of motherhood are, as the author points out, culturally constructed. In the case of Egypt, the key factors to consider are patriarchy, class, urbanism and religion-and these intertwine. In teasing out what is important, she paints a picture of social change. More women than ever are receiving education, and somewhat more are entering the workplace. With urbanisation, extended family systems are being eroded, though paradoxically the men may become more powerful in a situation where the husband is breadwinner and the wife consumer. In the countryside, women have access to crops, land and livestock; they can pursue crafts; they have access thus to income. In the town, the women are more dependent on their menfolk, while in turn the men, who have cash, who can buy a meal outside, are less dependent on them. Stripped of any productive role,
women are forced to focus more than ever on their reproductive role. Though patriarchy has always encouraged pronatalism, in today’s urban society the stakes have been raised. The author suggests that population control programmes, while worthy in their aims, have served in recent years to create contradictions for poor women, by appearing to devalue the role of motherhood. The recent rise of Islamism, itself to be seen as perhaps a reaction to the breakdown of the patriarchal extended family, exploits this situation, Islamists have mounted a public attack on family planning. They see it as a threat to the Islamic ideal of the beauty of motherhood; as contradictory to the will of God and casting doubt on his ability to provide for all his children; the road to promiscuity and moral depravity, and lastly as disloyal to the Prophet who urged that the faithful should marry and multiply. Not unconnected with Islamism is the increasingly important nationalistic dimension to pronatalism, which sees the family planning movement as a Western conspiracy. The focus of the book however, is on the plight of individuals who, in the face of this pronatalist trend, and with no organ&d support, have to live lonely lives with the disapproval of family and neighbours. Not all aspects of life are negative for every one; while mothers in law may give problems, the mothers of infertile women were found to be often a source of support and sympathy, as were, in some cases, husbands, sisters and neighbours. A sad picture emerges nevertheless, of women who embark on a search for children which takes them to quacks as well as reputable doctors, eats up all their savings and leads them to se.11 their jewellery, and ends only at menopause. One wonders whether this problem is taken seriously by the state health services, and what forms of community and health service support could be developed to help women through the difficult decisions they face in coping with their problems.
Knowledge and the Sd~olarly Me&al TradItiona, edited by Don S. Bates. Cambridge University Press, 1995. 360
Many intriguing quotes from ancient .~ literature appear, revealing unique aspects of ancient life. Dean-Jone’s chapter describes the Galenic separation of women’s from men’s health, and contrasts this with Chinese traditions in which no separation occurred. Chinese doctors, records show, were not allowed to physically examine female patients. Galenic physicians, however, recorded accurate antomical obervations, negative opinions of patients historia (what others told them), but showed deference to midwives and to women’s “innate consciousness of their own bodies”. Citing contributions by midwives and physicians to Hippocratic writings, Dean-Jones argues that men’s lack of innate “consciousness” of the female body made women’s testimony of their own bodies indispensable to medicine. Thus ancient Hippocratic physicians came to rely on both autopsia (their own observations) and historia. As universities became prevalent medicine gained intellectual respectability, says Garcia-Ballester in a chapter on health care in medieval Latin Galenism. He describes discrepancies faced by 13th century students; Schools of Arts (that were involved in medicine as in all things connected with human life) taught that philosophers investigate principles of health and illness, but doctors apply these principles to practice. Physicians of the 13th century
pp. US$64.95 (hardback, ISBN: 0 521 48071 X) and $24.95/UKE16.95 (paper, ISBN: 0 521 49975 5). The cover of Knowledge and the Scholarly Medical Traditions is royal blue, offset by a small red and white woodcut. The contents are as rich and commanding as the cover is inviting. Much of the prose, by 15 authors from around the world, is beautiful and insightful. The chapters are arranged in three parts dealing respectively with ancient Gale&, Chinese, and Ayurvedic medical traditions. The similarities and differences of each are highlighted. The editor says the book, which originated from a workshop, aims to compare the ways in which ancient physicians learned and knew. In Ayurvedic and Chinese traditions, he says, knowledge is conveyed from master to disciple. A true practitioner is perceived as semi-divine and. inseparable for true knowledge. Galenic (Western) tradition turns instead to experience as a basis for knowledge. It centers on what is known in terms of methodology and other knowns. All three traditions, however, encompass degrees of both epistemology and of gnosticism; all have structural systems, and revere the past. The book reflects the authors’ diverse styles and interests.
Nt&eld Institute for Health University of Leeds 71-75 Clarendon Road Lee& LS2 9PL
Carol Barker
U.K.
Infertility and Patriarchy: the Cultural Politics of Gender and Fandly Life in Egypt, by Marcia C. lnhorn. University of Pennsylvania Press, Philadelphia, i 996. 296 pp., Cloth ISBN 0-8122-3235-6, US$36.95; Paper ISBN 0-8122-1424-2, US$16.95. It is curious that fertility is the focus of so much interest in medical and population circles, while infertility receives almost none. The thorough attempts which were made in recent years to give an itemised inventory of the global burden of disease for females,* exclude all mention of infertility, even though burden of disease was estimated for *In the World Development Report (World Bank 1993, Investing in Health), burden of disease is calculated in DALYs or disability adjusted life years.
1841
sex is presumed to be "natural" so does not need to be discussed by health professionals. The authors illustrate, however, the extent of ignorance about sexuality and the desire for this information. For example, women in Mexico and the U.S. enjoyed learning fertility awareness method of contraception, in large part because of the increased knowledge this gave them about their bodies and sexual functioning. A third theme is to question the presumption of consensual sex. One chapter reviews U.S. sexual behavior surveys, which they say tend to assume that sexual behavior is consensual. Other authors describe implications of non-consensual sex such as a discussion of IV drug-using women in the U.S., many of whom were sexually abused as children. The editors are concerned about sexual abuse to the extent that an appendix is included on screening and counseling abused women. The book is organized into three main sections. Part I is called, "Approaches to understanding the experience of sexuality" and consists of three essays on personal experiences with sexuality or sexuality programs and five essays from the perspective of sexuality researchers. Part II is about the links between sexuality, contraception and reproductive health and includes sub-sections on integrating sexuality into family planning services, reproductive health interventions and biomedical research related to sexuality. The third part contains five essays, under the heading "Challenging entrenched attitudes and behavior related to sexuality" and includes chapters on addressing violence against women in Zimbabwe and an interview with the founder of EMPOWER, a sex worker support organization, in Thailand. If I have any criticism of the book, it is that I found the organization somewhat confusing. Some chapters ostensibly about individual experiences included information about programs, and other chapters about programs told about it through the eyes of a single individual. Perhaps, this blurring of categories is also an asset, showing how well the book combines the experience of the clients and practitioners and its responsiveness to the needs of the community. A second criticism is that I found the section on biomedical research distracting. Although interesting in its own right, I felt that these chapters detracted from the powerful personalized accounts that make the book so memorable and useful to practitioners around the world.
School of Social Work University of Washington Seattle, WA U.S.A.
Diane Civic
other nonmedical categories such as war. Yet few conditions are more productive of human suffering. As this study amply illustrates, infertility can threaten a woman's social status, her relationships, and her very identity. If we wish to explore the importance of children for ordinary people, what better way than to ask what it is that is lacking in the lives of childless couples? Egypt has had a state-sponsored population control programme since the 1960s--the first Middle Eastern Muslim country to do so. Yet in Egypt, as in many parts of the world, efforts to control population growth have been judged as being of little value. The state publicly supports population programmes--despite an awareness of the need for plenty of young people to support the growing numbers of the elderly. The government has worked with Muslim family planning advocates to assure people of the legitimacy
1842
Book Reviews
of family planning within Islam. These efforts are however confounded by ordinary people who describe themselves as having great love for children. Within this strongly patriarchal society, children are essential for social reproduction. As Inhom tells us, the Arabic word used in Egypt to denote “family” usually means extended family; common usage of the term usra to denote “nuclear family” is relatively recent, coming from its adoption in family planning campaign material. An usra consists of husband, wife and children. A husband and wife are not an usra, and there is no word for couple. Those who marry and remain childless have no recognised existence; they are a social aberration. Inhom’s book makes fascinating reading, because it gets behind the superficiality of RAP surveys, and avoids sweeping assumptions about women’s and men’s attitudes to children and families. As the author points out, we know little about the lives and feelings of real women in Middle Eastern societies, especially in relation to the poor. There are few studies of family life. This work is based on conversations with 100 infertile women and 90 fertile women attending Alexandria’s large public teaching hospital which is attended primarily by lower class woman. Individual stories are followed by analysis. Although the organisation of the book leads to some repetitiveness, it is readable and brings together the author’s primary data with a much wider appreciation of the relevant literature. Notions of motherhood are, as the author points out, culturally constructed. In the case of Egypt, the key factors to consider are patriarchy, class, urbanism and religion-and these intertwine. In teasing out what is important, she paints a picture of social change. More women than ever are receiving education, and somewhat more are entering the workplace. With urbanisation, extended family systems are being eroded, though paradoxically the men may become more powerful in a situation where the husband is breadwinner and the wife consumer. In the countryside, women have access to crops, land and livestock; they can pursue crafts; they have access thus to income. In the town, the women are more dependent on their menfolk, while in turn the men, who have cash, who can buy a meal outside, are less dependent on them. Stripped of any productive role,
women are forced to focus more than ever on their reproductive role. Though patriarchy has always encouraged pronatalism, in today’s urban society the stakes have been raised. The author suggests that population control programmes, while worthy in their aims, have served in recent years to create contradictions for poor women, by appearing to devalue the role of motherhood. The recent rise of Islamism, itself to be seen as perhaps a reaction to the breakdown of the patriarchal extended family, exploits this situation, Islamists have mounted a public attack on family planning. They see it as a threat to the Islamic ideal of the beauty of motherhood; as contradictory to the will of God and casting doubt on his ability to provide for all his children; the road to promiscuity and moral depravity, and lastly as disloyal to the Prophet who urged that the faithful should marry and multiply. Not unconnected with Islamism is the increasingly important nationalistic dimension to pronatalism, which sees the family planning movement as a Western conspiracy. The focus of the book however, is on the plight of individuals who, in the face of this pronatalist trend, and with no organ&d support, have to live lonely lives with the disapproval of family and neighbours. Not all aspects of life are negative for every one; while mothers in law may give problems, the mothers of infertile women were found to be often a source of support and sympathy, as were, in some cases, husbands, sisters and neighbours. A sad picture emerges nevertheless, of women who embark on a search for children which takes them to quacks as well as reputable doctors, eats up all their savings and leads them to se.11 their jewellery, and ends only at menopause. One wonders whether this problem is taken seriously by the state health services, and what forms of community and health service support could be developed to help women through the difficult decisions they face in coping with their problems.
Knowledge and the Sd~olarly Me&al TradItiona, edited by Don S. Bates. Cambridge University Press, 1995. 360
Many intriguing quotes from ancient .~ literature appear, revealing unique aspects of ancient life. Dean-Jone’s chapter describes the Galenic separation of women’s from men’s health, and contrasts this with Chinese traditions in which no separation occurred. Chinese doctors, records show, were not allowed to physically examine female patients. Galenic physicians, however, recorded accurate antomical obervations, negative opinions of patients historia (what others told them), but showed deference to midwives and to women’s “innate consciousness of their own bodies”. Citing contributions by midwives and physicians to Hippocratic writings, Dean-Jones argues that men’s lack of innate “consciousness” of the female body made women’s testimony of their own bodies indispensable to medicine. Thus ancient Hippocratic physicians came to rely on both autopsia (their own observations) and historia. As universities became prevalent medicine gained intellectual respectability, says Garcia-Ballester in a chapter on health care in medieval Latin Galenism. He describes discrepancies faced by 13th century students; Schools of Arts (that were involved in medicine as in all things connected with human life) taught that philosophers investigate principles of health and illness, but doctors apply these principles to practice. Physicians of the 13th century
pp. US$64.95 (hardback, ISBN: 0 521 48071 X) and $24.95/UKE16.95 (paper, ISBN: 0 521 49975 5). The cover of Knowledge and the Scholarly Medical Traditions is royal blue, offset by a small red and white woodcut. The contents are as rich and commanding as the cover is inviting. Much of the prose, by 15 authors from around the world, is beautiful and insightful. The chapters are arranged in three parts dealing respectively with ancient Gale&, Chinese, and Ayurvedic medical traditions. The similarities and differences of each are highlighted. The editor says the book, which originated from a workshop, aims to compare the ways in which ancient physicians learned and knew. In Ayurvedic and Chinese traditions, he says, knowledge is conveyed from master to disciple. A true practitioner is perceived as semi-divine and. inseparable for true knowledge. Galenic (Western) tradition turns instead to experience as a basis for knowledge. It centers on what is known in terms of methodology and other knowns. All three traditions, however, encompass degrees of both epistemology and of gnosticism; all have structural systems, and revere the past. The book reflects the authors’ diverse styles and interests.
Nt&eld Institute for Health University of Leeds 71-75 Clarendon Road Lee& LS2 9PL
Carol Barker
U.K.