Age of despair or age of hope? Elderly Palestinian women's perspectives on health in midlife

Abstract

BackgroundFew studies exist of women's experiences and understanding of health in the transition from reproductive to post-reproductive age. Available data is from high-income settings, and most studies tend to focus on women of reproductive age. Little is known about women's perspectives in the Palestinian context. The aim of this study was to add to our understanding of Palestinian women's midlife experiences, looking beyond reproduction and childbearing, and how elderly Palestinian women understand, explain, and manage their midlife health. MethodsWe recruited women aged 40–55 years for an in-depth interview using a life-history approach. To maximise heterogeneity, we included women living in the north, south, and central West Bank and women living in rural, urban, and camp settings with diverse economic and social conditions (education, employment, marital status). We analysed women's verbatim narratives to identify key themes and subthemes. Ethical approval was obtained from Birzeit University and the London School of Economics. Findings35 women were interviewed between Feb 1 and Aug 31, 2015. Many women articulated a positive view about ageing and midlife as a natural process. Perspectives were often linked with their own mothers' experiences, which was the main source of knowledge about menopause. Women reported a combination of indigenous and biomedical knowledge and practice, often beginning with popularised medical practices and herbal remedies. Although most women recognised faith and tawakul (reliance on God) as ways of coping with ill health, they also emphasised the need for physical activity and nutritious baladi (locally grown, native, organic, chemical-free) food, often romanticised as part of a generational past. Good health was conceptualised as a combination of physical well being, indicated by effortless movement, and a relaxed psychological state of mind (raha nafsiyeh, hadat al-bal). In times of hardship, health issues were often connected to life events. Having children appeared to provide a protective effect for women in coping with health issues. Local idioms of health (hamm [worry, disquiet, upset, uneasy, grief, anxiety, sorrow, affliction], za'aal [a combination of feelings, including anger, distress, frustration, grief, incapacitation, worry, and sorrow], nakad [distemper, bitterness, disturbing, troubling, and somber], and istislam [resignation, giving in]) characterised women's descriptions of ill health. Exposure to political violence, living in fear, and economic hardship were widely understood as affecting mental and physical health. Discourses surrounding women's experience of this transition included age of despair, age of hope, and age of power. Some women referred to this period as literally the cessation of menstruation (the menstrual cycle as having split from her) or that ageing has entered (el-kabar 'abar). Although these words are value-laden, not all women feel as the words indicate. Age of despair was often ridiculed but still used by women for ease of reference. InterpretationDespite wide variation in circumstances (place of residence, marital, and socioeconomic status), women's narratives are underpinned by consistent perspectives as to what good health entails. Our analyses reveal the pluralistic approaches that elderly Palestinian women take towards health and the need to better understand women's health after their reproductive years. FundingThe Emirates Foundation (through the London School of Economics Middle East Centre).