Knowledge, opportunities, challenges, and the way forward for reproductive health rights: a qualitative study of women in the Bethlehem area of the West Bank

Abstract

BackgroundReproductive health rights were declared as fundamental human rights at the International Conference on Population and Development in Cairo in 1994, and at the Fourth World Conference on Women in Beijing in 1995. Acknowledgment of the importance of these rights was a momentous event for reproductive health. In the Palestinian context, reproductive health rights are severely affected by the political system and cultural context. There has been growing interest in efforts to strengthen women's knowledge and opportunities to promote their reproductive health rights in Palestine. This study aimed to identify the multiple political, demographic, and cultural factors that influence Palestinian women's reproductive health rights as well as their knowledge, awareness, opportunities, and challenges regarding these rights. MethodsThe study was designed with two parts. First, a thorough review of previous literature was carried out using key terms and definitions to search for papers, to gain an overview of reproductive health rights in Palestine, focusing on the long-standing conflict, the Palestinian cultural context, and Palestinian law. Second, an empirical qualitative study was carried out using semi-structured interviews that were carried out via Skype. A purposive sample of ten Palestinian women aged 18–55 years, and living in the Bethlehem Area of the West Bank, were chosen. The sample was selected to include Islamic and Christian women, refugee and non-refugee women, and housewives and working wives. Interviews formed the basis of the analysis. The theory of intersectionality was used to guide the various discussions and debates within the interviews. All interviews were conducted in Arabic, recorded on a portable device, and translated into English. They were then analysed using the Six-Phase Thematic Analysis. Ethics approval was obtained from the Queen Margaret University Ethics Committee. Informed written consent was obtained from participants. FindingsThe literature from approximately the past 20 years confirms that women's health has had a place in Palestinian health regulations and policies. Many Palestinian organisations and institutions have launched procedures to promote reproductive health for women and their families, through maternal and child health services. Despite the focus on women's health and reproduction, access to knowledge or education regarding reproductive health rights in Palestine is limited. Access has been hampered by the combination of the political situation and traditional cultural norms existing in Palestinian society. Interviews were considered in the context of several themes and sub-themes: knowledge, information, and education (knowledge levels and access to information and knowledge); services and resources (accessibility and distribution of services); Palestinian context and norms (patriarchal society and loss of privacy and decision making); conflict and occupation (restriction of movement, and discrimination and humiliation); and violence against women. These themes shaped women's knowledge of reproductive health rights, highlighting factors that influence the existing opportunities and challenges for women to access reproductive health care and services, health-seeking behaviours, and overall wellbeing. Reproductive health rights in Palestinian society are perceived and acknowledged differently by different group of individuals (eg, between those living in cities and those in villages), but such differences are rarely mentioned in laws, policies, or programmes relating to reproductive health. Moreover, there is often a gap between laws and policies that are set, and what is implemented. InterpretationThis research emphasises the great importance of women's reproductive health rights in Palestine. Two significant limitations were the unavailability and scarcity of literature on Palestinian women's reproductive health rights, and the sensitive nature of the political conflict. It is recommended that governments demonstrate commitment to prioritising initiatives to promote reproductive health rights. Further research regarding reproductive health rights should be conducted in other areas of Palestine. FundingNone.