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ABSTRACT
Palestinian women have one of the highest fertility rates in the world, averaging 4.38 births per woman. However, Palestinian fertility patterns are distinct from those of other developing nations, in that high fertility rates coexist alongside high levels of education and low levels of infant mortality – both of which have been established elsewhere as predictors of low total fertility rates. This study explores the dimensions and context of the contradictions between fertility predictors and rates, isolating main factors that shape Palestinian reproductive behaviour. Furthermore, while this study addresses factors that influence the high fertility in the Palestinian Territories, it also addresses factors that contribute to the steady decline of this trend. In-depth interviews were conducted with Palestinian women in urban refugee communities and key informant interviews with experts on Palestinian reproductive health. The findings indicate that five factors shape women's reproductive behaviour: (1) the fear of losing one's children in the ongoing conflict; (2) socio-economic factors including poverty and density of space; (3) the marital relationship; (4) religious values; and (5) generational differences. These results highlight the influence of socio-political conditions on reproductive behaviour and the significance of women's agency in manoeuvring their fertility outcomes.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1 By structures, I refer both to a state of affairs, as well as systems of dispersed rules, practices, and dispositions which influence the actions and behaviours of social actors.
2 ‘Gender regime’ refers to the pattern of gender relations in a society, organisation, or institution, specifically continuing patterns which provide the structural context for individual practices. This includes ‘economic processes, authority, violence, discourses and ideologies, sexuality and emotional connections … all part of the picture of gender relations – no one of them determines all the others’ (Connell, Citation2005, p. 7).
3 A similar ‘fertility conundrum’ has been addressed in the larger Arab world, where fertility rates do not match up with their typical predictors. In 2000, the TFR for the larger Arab world was 3.4 children per woman, down from 6 to 8 children per woman in the previous generation (Fargues, Citation2005, p. 43). However, this dramatic drop in high fertility rates did not correspond to the expected rise in the status of women. A 2002 report written for the United Nations found that, ‘progress in the empowerment of Arab women was low’ (Fargues, Citation2005, p. 43; UNDP, Citation2002). Typically, a drop in fertility rates accompanies higher levels of respect and opportunity for that society's women, as well as for their children, but this has not been the case in the Arab world. Contrary to universal causes of fertility decline including the developing role of women, this decline did not result from nor produce status changes for women (Fargues, Citation2005, p. 43). This type of ‘conundrum’ is similar to that found in the West Bank and Gaza Strip.
4 Inhorn (Citation2006, p. 367) beautifully stated that,
a great deal about women's health can be learned by letting women talk – by effectively and compassionately listening to them narrate their own subjective experiences of sickness and health, pain and suffering, oppression and resistance, good health and occasional joy that are part and parcel of women's health experiences around the globe. That ethos underpinned this research.
5 This research has addressed the endurance of high fertility rates compared to other nation-states, but not the fact that in the West Bank and Gaza Strip, these rates have been steadily declining.
6 Gross and Ravitsky have stated that,
Israel's pronatalist policy is evident in every aspect of its legal and regulatory framework. Incremental social security benefits for each child encourage large families. State funded healthcare covers pregnancy and birth related expenses but not contraception. National health insurance also covers infertility treatment (including IVF) to enable couples without children from the current marriage to have a first and second child, and to treat childless women who wish to establish a single-parent family. This level of public funding is unparalleled in any other country in the world. Moreover, labor laws compensate working women for absences resulting from infertility treatment. As a result, Israel has the highest rate of consumption of IVF in the world. (p. 251)
7 For example, PLO Chairman Yasser Arafat repeatedly encouraged women to have no less than 12 children (Najjer, Citation1992).
8 This approach differs from formal demography, where relationships in reproduction are analysed through the lens of ‘life events', such as marriage and childbearing, and through ‘status', such as being married or divorced. These formal methods lead to a modelling of population processes that neglects to connect demographic events to social and economic events (Carter, Citation1995).
9 Connell also addresses the way in which feminist theory has traditionally critiqued the notion of metanarratives by explicitly calling for metanarratives that are dialectical, relational, and holistic (Giroux, Citation1991, p. 34).
10 In-depth interviews were chosen, as opposed to focus groups given the interviewees reluctance to leave their homes.
11 For example, data collected from the West Bank and Gaza in 2000 indicated that the percentage of women living in refugee camps who wanted to have more children was 43.5%, higher than in urban and rural areas, which stood equally at 40.6%. Additionally, these data indicated that the percentage of women who wanted to stop having more children was lower in refugee camps (48.9%) than in rural areas (53.7%) and urban areas (51.7%) (PCBS, Citation2006, p. 82).
12 Key informant interviews were conducted in interviewees' places of work.
13 As always with translation, meaning is lost and gained in ways that are difficult to track and parse: one set of meanings never quite makes the transition and others intrude from the secondary language domain.
14 Wick (Citation2008) has pointed out,
The term closure in Palestinian public discourse, and also in military practice, encompasses a graded set of measures. Historically, they began with the placing of Jerusalem and Israel out of bounds, and thus closures of destinations. As we have seen, they became by stages, closures of places or residence, towns or even houses (when curfews were in force). Checkpoints (and in the case of curfews, mobile military patrols) were the means whereby these policies were carried out. (p. 330)
15 In the West Bank, as of February 2014, there were 99 checkpoints in the West Bank, restricting Palestinian movement and access the health care. Additionally, the military constructs surprise ‘flying checkpoints’ along various West Bank roads. As of December 2013, the UN Office for Coordination of Humanitarian Affairs (OCHA) counted 256 such checkpoints. Furthermore, the Israeli military
has blocked the access roads to some of the main traffic arteries in the West Bank by means of hundreds of physical obstructions, such as dirt embankments, concrete blocks, iron gates and trenches. The number of obstructions fluctuates often, depending on political and security circumstances. At the close of 2012, OCHA counted approximately 532 physical obstructions a month. (B'Tselem Citation2008)
16 Between the beginning of the Intifada in 2000 and 26 December 2008, 316 children have been killed in the West Bank and 636 in the Gaza strip (B'Tselem, Citation2008).
17 Similar to the 2006 survey, the 2004 PCBS survey also noted that the percentage of women who wish to stop having children was positively linked with the number of living children each woman had (PCBS, Citation2006, p. 96).
18 It should be noted that another interesting demographic feature of Palestinian society is that, despite the strong valuation of marriage, there is a high proportion of young never-married women (Khawaja et al., Citation2009).
19 The economic situation in the Palestinian Territories has consistently declined since the second Intifada (popular uprising) in 2000, and poverty rose sharply after January 2006, when the political party Hamas took control of the Palestinian Legislative Council. This election triggered an international political boycott, reducing the amount of economic and humanitarian aid received by the Palestinian Territories (Abdul-Rahim et al., Citation2009, p. 967).
20 Fargues (Citation2000) asserts that Islamic fundamentalist values would explain why Palestinian fertility rates are the highest in Gaza, where fundamentalist Islamic groups are the strongest. However, he challenges this notion with three arguments: (1) Palestinians do not seem to have a greater allegiance to fundamentalist Islamic values than other Arab states with lower TFRs; (2) there is no association between adherence to fundamentalist Islam and fertility, and in fact, countries ruled by Islamic fundamentalists have seen some of the most rapid fertility declines ever recorded; and (3) Secular nationalism was the leading political force in Palestinian resistance when fertility rates were at their highest (Fargues, Citation2000, p. 470).
21 Citation from the Qu'ran (Ali, Citation1988, 2, p. 233).
22 Citation from the Qu'ran (Ali, Citation1988, 25, p. 74).
23 It should be noted that recollection of life events has the potential for bias, reconstruction, and reinterpretation (Grbich, Citation1999).
24 Local knowledge has been defined as ‘information pertaining to local contexts or settings, including knowledge of specific characteristics, circumstances, events, and relationships’ (Corburn, Citation2005, p. 47). This knowledge is produced outside of professional domains (Lindblom & Cohen, Citation1979), fluid, and changes through time (Corburn, Citation2005, p. 49).