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Researching Contraception in the Middle East

December 16, 2011

Angel Foster, a medical doctor and Middle East expert, spoke to an audience at the Watson Institute this semester about reproductive health in the Middle East, in a presentation entitled “Building the Case for Expanding Access to Emergency Contraception in the Arab World.”

Worldwide, about 40 percent of pregnancies are unintended, occurring because of an unmet need for contraception, Foster said. Half of pregnancies in developed countries, over a third of pregnancies in the developing world – and about one quarter of all pregnancies in the Arab world unintended, she said.

Foster went on to focus on the Arab world, saying: “When we look specifically at the 18 countries that comprise the Arab Middle East, there is a wide range of social policies grounded in different historical, political religious, cultural, and subcultural traditions.” She added: “There is no government in the Arab world that actively limits married couples’ access to family planning information or services.”

She said the “overwhelming majority” of Islamic jurists support the “use of modern, nonpermanent methods of contraception within marriage if the woman consents,” adding that throughout the region, intrauterine devices and oral contraceptives are widely available.

But she added that challenges and debates persist throughout the region, especially regarding more permanent forms of contraception, as well as access to contraception for unmarried individuals.

Foster also said that while every country in the Arab world has a national family planning program, the legal status of abortion varies dramatically across the region.

Foster explained that one of the main goals, therefore, is to improve pregnancy prevention strategies across the Arab world. She pointed to Tunisia as an example of a country with a “quite low” rate of unintended pregnancy – just one in 11 Tunisian pregnancies is electively terminated – and said this is a result of family planning being “very much integrated into the national health system.”

Foster went on to describe her other efforts and studies in the region, including a project designed to find an Arabic translation for emergency contraception. She told the audience at the Watson Institute that for many years, there was no term in Arabic for emergency contraception, and health care providers were using a literal and direct translation of the phrase “the morning after pill.” But Foster said this phrase was medically inaccurate, as emergency contraceptive has proven effective for 120 hours after sex and can be taken at any time of day. Foster also said there were concerns that the phrase “morning after” carried a negative connotation of shame and regret.

She said after nine months, a team of researchers was able to come up with a medically accurate phrase that is accessible to users, health service providers, and policymakers. The term now in use generally translates to “emergency prevention of pregnancy.”

Foster also talked about projects to enable access to emergency contraception for women in Jordan, including a recent influx of Iraqi refugees, as well as access to such contraceptive methods for women in the West Bank.

She said her ongoing research hopes to collect information about issues of service delivery, potential discrimination toward unmarried women, and regional differences among women’s experiences as they relate to emergency contraception.

Foster is the Echo Endowed Chair in Women’s Health Research and an associate professor at the University of Ottawa, as well as an affiliated scholar at Ibis Reproductive Health in Cambridge, Massachusetts. She has conducted both qualitative and quantitative research in the United States, Palestine, Lebanon, Jordan, Tunisia, and Egypt and has authored and co-authored over 30 articles, book chapters, and reports dedicated to reproductive health issues in both the Middle East and the United States.

The talk was part of the Institute’s Middle East Seminar Series.

By Watson Institute Student Rapporteur Lauren Fedor '12