Multi-level framework of push-pull entrepreneurship: comparing American and Lebanese women

In 1953, Lebanon became the first Arab nation-state to grant women suffrage. The story of that monumental moment begins in the 1910s with the rise of the Lebanese women’s movement. The Lebanese women’s movement has a long history of transformation and metamorphosis that responded to the needs of the state in power at the time. It began under the Ottoman Empire (1516–1918), bloomed in the Nahda Arab Renaissance of the late 1800s and early 1900s, was sustained through French colonial occupation (1920–1943), flourished with independence in 1943, and continues today (Kaedbey and Naber 2019).The early Lebanese women’s movement of the 1910s and 1920s primarily focused on women’s access to education and their role in charity organizations (Stephan 2014). The writers and readers of popular women’s magazines, and the leaders of women’s organizations, came from the middle and upper classes. Their focus on education and charity work for the poor reflected their bourgeois class position, but many in the Lebanese women’s movement sought to provide benefits for all women (Armstrong, pers. comm., September 24, 2019). In the years between World War I and World War II, during the French Mandate, the women’s movement gained a nationalist character. Women’s public support of an independent Lebanon was spurred by the Syrian revolt of 1925, and subsequent struggles for independence, as well as the changing political pressure of French occupation during World War II (Weber 2003: 91). Women leaders promoted nationalist curricula in schools, and increasingly addressed the French colonial state on social issues such as health, education, labor, and the reform of religious personal status laws concerning marriage, divorce, and inheritance (Weber 2003: 91).The movement leaders carried this agenda with them as they attended a series of conferences throughout the Middle East beginning with a conference in Beirut in 1928. The conference in Beirut was followed by additional “Arab” and “Eastern” women’s conferences in Jerusalem, Beirut, Damascus, Baghdad, Cairo, and Tehran between 1929–1938 (Robinson 2015: 21). Lebanese independence in 1943 and the creation of an independent state ushered in a period of transformation for Lebanon. Women’s rights activists viewed independence as a perfect opportunity to shift their work away from education, charity, and a maternalist agenda, toward formal political participation, long considered a prerogative of men. Pioneers of the women’s movement, Najla Saab, Labibtha Thabit, and Labiba Saab and her daughter, Laure Moughaizel, spearheaded this transition. Najla and Labiba were members of the two premier women’s advocacy organizations of the time—the Lebanese Women Union, founded in 1920 to bring together Arab nationalists and leftists, and the Christian Women’s Solidarity Association, founded in 1947 and composed of elite women representatives from twenty Christian organizations throughout Lebanon (Stephan 2010: 536).In 1952, the two organizations came together to form a permanent organization known as the Lebanese Council of Women. A coalition of this kind may seem implausible today, but during this period Muslim, Druze, and Christian women came together across the political spectrum to champion women’s rights within Lebanon and in the region. This collaboration included humanitarian aid to Palestinian women in 1948, and vocal support for Palestinian liberation (Latif, pers. comm., September 30, 2019). Although Christian women from elite class backgrounds usually headed formal organizations like the Council of Women, significant work was simultaneously occurring among working-class women labor activists. The unity built among Muslim and Christian women is particularly important given the large Christian presence in Lebanon in comparison to its Muslim-majority neighbors. This presence, which thrived under the French Mandate, is an ongoing legacy of its colonialism (Traboulsi 2012: 91).The Lebanese Council of Women spearheaded the fight for women’s suffrage, and still exists today as a group of over 170 women’s organizations in consultation with the Lebanese Parliament (Stephan 2010: 536). In the 1950s, council members traveled throughout the country and region of West Asia and North Africa attending conferences and meeting with heads of state and community leaders to build solidarity among women. They used formal channels, the press, public education, and direct action to advocate for the rights of women. After a decade of sustained and united campaigning, on February 18, 1953, they succeeded in pressuring the government to grant all Lebanese women voting rights.The following In the Archives document, written by Najla Saab, outlines the political rights she, Labiba, Laure, and an entire generation of Lebanese women pursued. These women built on the work before them—the magazines of the 1910s, the charity work of the 1920s, the conferences, lobbying, and direct action of the 1930s and 1940s—to once again transform the struggle for women’s rights in Lebanon. All documents are from the Ruth Frances Woodsmall Papers, Sophia Smith NajlaCollection, Smith College (Northampton, Massachusetts).

Egg freezing is a relatively new and controversial procedure in the Arab region, challenging traditional perceptions of fertility and motherhood. This study aims to assess Lebanese women's awareness and acceptance of egg freezing and how these attitudes differ according to vary with age, socio-demographic characteristics, and educational level. We conducted a cross-sectional survey targeting Lebanese females aged between 18 and 39, involving 402 Lebanese women from six different institutions representing diverse cultural backgrounds. 65% of the respondents had heard of egg freezing. Younger women (18-30 years old) were 2.09 times more likely to consider egg freezing than those aged 31-39. Single women were 4.31 times more likely to consider egg freezing than women in relationships, while childless women were 5.00 times more likely compared to women who already had children. Overall, medical egg freezing was more widely accepted than social egg freezing. The most supported indication for social egg freezing was to enable women who struggled to find the right partner during their peak fertile years to have children in the future (41.5%). The most common concern that affected women's decision to undergo egg freezing was whether the procedure would be proven safe for their future children and whether it would affect their future fertility. Interestingly, in a relatively conservative country, concerns about hymenal disruption were the least prevalent, (19%). The most common concern by far was limited information on the procedure (62%). In conclusion, the study reveals that awareness and acceptance of social egg freezing among Lebanese women were higher than expected. Limited information on the procedure's details was the main impediment to higher acceptance rates, highlighting the importance of physicians and primary healthcare providers in providing reproductive-aged women with the necessary information to safeguard their reproductive potential.

Imagining an Anti-Racist Cosmopolitanism:Localization, Imperialism and Transnational Women's Activism in Interwar Japan Noriko Ishii On 18 April 1934, Kobe College, one of the first women's colleges in Japan founded by the American Congregational women missionaries, celebrated the dedication of its new Okadayama campus, built in a beautiful Mediterranean style. This was a product of a thirty-year transnational collaboration of American Protestant women's networks across the Pacific. Japanese women of the Kobe College alumnae association provided the land and American women of Protestant churches provided the buildings for the one-million-dollar expansion. At the dedication ceremony, Mrs Hazel Thorne Wilson, representing the Kobe College Corporation in Chicago, declared that the corporation would continue promoting Kobe College as "a symbol of international friendship and goodwill."2 Hashimoto Hatsue, Class of 1926, speaking on behalf of the Japanese women alumnae, said the alumnae's success was due to "a burning love for the college" and "the loving kindness of many American friends,"3 inferring Japanese women's deference to American women's friendship. This case study of the Kobe College expansion campaign provides us a window to examine how the notions of internationalism, friendship and cosmopolitanism were imagined and used as we historicize the campaign against the backdrop of the shifting world order and the changing landscape of the American foreign missionary movement between 1905 and 1934. The thirty years of the expansion campaign coincided with the end of the Russo-Japanese War, the First World War, the 1924 US Immigration Act prohibiting Japanese immigration, the Great Depression of 1929 and the Manchurian Incident in 1931 and the emergence of uneasy tensions between the United States and Japan, each with their Pacific empires. Both Japanese and American missionaries were forced to face the controversial question of how to deal with the Japanese empire's religious policy of encouraging the three major religions, Shintoism, Buddhism and Christianity, to evangelize among the colonized in order to assimilate them into the Japanese empire. In addition, during the 1920s, women of the American foreign missionary movement faced an internal crisis in which most of the separate women's mission boards were merged with their male-led denominational parent boards. These mergers epitomized the decline of female autonomy in American Protestant foreign mission enterprises.4 Robert also points out that after the First World War, "'World Friendship' decisively replaced 'Woman's Work for Woman' as the missiology of the woman's missionary movement." Robert explained that "World Friendship assumed that western culture no longer had a monopoly on virtue" and that "what was needed of missions was not paternalism, but partnership and friendship: united work for peace and justice,"5 suggesting that such partnership entailed an equal relationship between the western missionaries and their Indigenous counterparts. This article argues that in the Japanese mission field, the transition was more complex. In the Kobe College expansion campaign, the nineteenth-century mission ideology of Woman's Work for Woman remained salient and coexisted with the ecumenical notions of internationalism, friendship and cosmopolitanism. David A. Hollinger links the concept of what he called "missionary cosmopolitanism" or liberal internationalism in the missionary movement to Wilsonian internationalism. He also called for more attention to study the role of missionary-connected individuals in postwar American diplomacy, including the so-called "mish kids" or the missionary children, because they served as the informants of prewar Asian history and culture, and became the key purveyors of liberal internationalism in the United States.6 This article argues that such was the case in the Kobe College expansion campaign, for both American and Japanese women often used the notions of Wilsonian internationalism and friendship and the concept of Christian internationalism interchangeably. Moreover, Kobe College was imagined to be an ecumenical space of aspirational cosmopolitanism and friendship by both American and Japanese women, especially under the leadership of missionary president Charlotte B. DeForest, herself a "mish kid" born in Japan. Drawing on the conceptual framework of "aspirational cosmopolitanism" defined as "the pursuit of conversations across lines of difference, between disparate socio-cultural, political and linguistic groups, that provisionally created shared public worlds,"7 this article examines how the Kobe College expansion campaign...

ABSTRACTWaterpipe tobacco smoking (WTS) has become a serious public health threat in the Middle East and beyond. To estimate the prevalence rates of cigarette and WTS among Lebanese women and describe characteristics associated with each behavior. Secondary analysis of women’s health data obtained in a national survey in 2010. Of 2,255 selected women, 78 percent reported no or past long-term WTS. Among the 12 percent of regular waterpipe smokers, 40 percent were light users (mean three waterpipe heads weekly), while 60 percent were heavy users (mean of 11 heads per week). About 70 percent were never or past long-term cigarette smokers. Younger age, location within Greater Beirut (GB) and having professional employment were significantly associated with use of WTS. Older age, GB location, lower education, and ever-married were significantly associated with cigarette smoking. WTS is becoming a socially normative behavior among empowered professional women, who can spare the time and expense to engage in this behavior in easily accessible cafés, which prohibit cigarette smoking. Government, media, and NGO campaigns against smoking should target waterpipe use, not only in Lebanon but also across the Arab world and among Arab communities in the Diaspora with messages different from anti-cigarette campaigns.

Background: Previous studies in the Western world and some Arab countries have shown that women seeking healthcare consider a variety of factors such as physician bedside manner, hospital affiliation, experience, competency, gender, and recommendations from friends among others. The objective of this study is to evaluate factors that affect Lebanese women’s choice of their obstetrician and gynecologist (ob-gyn). Materials and Methods: Quantitative data were collected from 199 respondents after administering a self-completion questionnaire created on “LimeSurvey” and sent via email to a random sample (n=848) of female employees at the American University of Beirut (AUB). SPSS was used to code and analyze the data. Results: Lebanese women value consultation quality (median score (MS) = 92%), convenience (MS = 80%), physician’s educational background (MS = 73.34%) and reputation (MS = 52%), more than physical qualities (MS = 40%), and physician’s gender (MS = 20%). Multivariate analysis showed that younger females care more about consultation quality (p = 0.01), Muslim women and village residents prefer a female physician (p = 0.02 and p = 0.01, respectively), and the woman’s level of education directly relates to the physician’s educational background (p = 0.01). Conclusion: These findings will help medical graduates, program directors, current practitioners, and hospital human resources managers to better understand and cater to the needs of the population they are serving.

Background: Breast cancer is the most common malignancy in women in Lebanon and Arab countries with 50% of cases below age 50. The incidence of hereditary breast cancer in Lebanese and Arab women is unknown. Methods: 250 Lebanese women with breast cancer, of young age with or without family history, were recruited at the American University of Beirut Medical Center (AUBMC) between 2009 and 2012. Study was approved by IRB. All signed an informed consent. Risk assessment questionnaire, medical chart review, and whole blood were collected. Coding exons and intron-exon boundaries of BRCA1 and BRCA2 were sequenced. Full BRCA gene sequencing was performed at Institut Jean Perrin, France. Study was funded in part by an Ethnic Research Initiative (ERI) grant awarded by GSK. Results: 14 out of the 250 patients (5.6%) had a deleterious BRCA mutation (7 BRCA1, 7 BRCA2) and 31 (12.4%) had a variant of uncertain significance (VUS). Table 1 shows deleterious BRCA mutations based on age group and FH. Deleterious BRCA mutations based on age group and family history TotalAge ≤ 40 (with no FH)Age ≤ 40 (with positive FH)Age 41-50 (with positive FH)Age ≥ 51 (with positive FH)Number of patients25074747527Patients with deleterious mutations (%)14 (5.6%)1 (1.4%)8 (10.8%)4 (5.3%)1 (3.7%)BRCA 170610BRCA 271231 All 7 BRCA1 mutation carriers had a positive family history, were between 32 and 48 years of age, and had Grade 3 IDC with negative ER, PR, HER2 receptors (TNBC). Six BRCA2 mutation carriers had IDC with positive hormone receptors (HR) and 2 had HER2-positive disease. We found 31 VUS. One VUS (BRCA2) was seen in two sisters with breast cancer. One VUS (BRCA2) was seen in 4 patients and another in 2 patients, while 2 VUS (BRCA1) mutations were seen in 2 sets of 2 patients. The significance of these VUS cannot be ascertained at this time. Haplotype analysis is ongoing. Conclusions: This is the first large study of ethnic Lebanese Arab women with breast cancer. The prevalence of BRCA deleterious mutations in women with breast cancer who are considered high risk of carrying a BRCA mutation is 5.6% in our total cohort, while in patients ≤40 with positive FH it is 10.6%. Those numbers are lower than expected from US and European populations. Tumor grade and pathology characteristics in this patient population correlated with that previously documented for BRCA1 (TNBC) and BRCA2 (positive HR) associated breast cancers. Our data supports use of young age together with positive FH should be used to select patients for counseling and BRCA testing in Lebanon and Arab countries with resource-sensitive guidelines. Several VUS were found in patients and sisters with breast cancer. The finding that 94.4% of high risk patients had no deleterious BRCA mutations suggests the need to look for alternate gene mutations and other factors that may contribute to the development of breast cancer in these high risk patients. Conclusions regarding haplotypes and diversity will be reported at the meeting. Citation Format: Nagi El Saghir, Nancy Uhrhammer, Hussein Assi, Katia Khoury, Stephanie Decousous, Yannick Bidet, Sara Jaber, Raghid Charara, Rania Farhat, Ziad Salem, Ali Shamseddine, Arafat Tfayli, Jaber Abbas, Faek Jamali, Muhieddine Seoud, Deborah Armstrong, Yves-Jean Bignon, Nathalie Zgheib. BRCA1 and BRCA2 mutations in ethnic Lebanese Arab high risk women for hereditary breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-03-06.

Data from Arab world studies suggest that Arab women may experience a more aggressive breast cancer phenotype. To investigate this finding, we focused on one of the largest settlements of Arabs and Iraqi Christians (Chaldeans) in the US, metropolitan Detroit- a SEER reporting site since 1973. We identified a cohort of primary breast cancer cases diagnosed 1973-2003. Using a validated name algorithm, women were identified as being of Arab/Chaldean descent if they had an Arab last or maiden name. We compared characteristics at diagnosis (age, grade, histology, SEER stage, and marker status) and overall survival between Arab-, European-, and African-Americans. The cohort included 1,652 (2%) women of Arab descent, 13,855 (18%) African-American women, and 63,615 (80%) European-American women. There were statistically significant differences between the racial groups for all characteristics at diagnosis. Survival analyses overall and for each SEER stage showed that Arab-American women had the best survival, followed by European-American women. African-American women had the poorest overall survival and were 1.37 (95% confidence interval: 1.23-1.52) times more likely to be diagnosed with an aggressive tumor (adjusting for age, grade, marker status, and year of diagnosis). Overall, Arab-American women have a distribution of breast cancer histology similar to European-American women. In contrast, the stage, age, and hormone receptor status at diagnosis among Arab-Americans was more similar to African-American women. However, Arab-American women have a better overall survival than even European-American women.

Menopause is a complex biopsychosocial transition influenced by cultural factors. However, research on the psychological experiences of menopausal women in the Arab world remains limited. This study investigates how Lebanese women experience menopause, with a focus on the impact of marital status, motherhood, education, employment, and religious affiliation on self-esteem, anxiety, and body image. A cross-sectional survey was conducted with 260 Lebanese women aged 48 to 65 from three major regions. Participants completed standardized instruments: the Coopersmith Self-Esteem Inventory, the Spielberger State-Trait Anxiety Inventory, and the Body Image Questionnaire. Results showed that most participants reported high self-esteem (83.8%) and positive body image (75.4%), yet a significant proportion experienced elevated anxiety (68.5%). Married women exhibited significantly lower anxiety than single women. Parenthood was the most influential factor across psychological dimensions, with childless women reporting higher self-esteem, lower anxiety, and better body image than mothers. Christian women reported significantly higher self-esteem than Muslim women. Employment was associated with anxiety and body image outcomes, while educational attainment showed no significant effects. These findings reveal a paradoxical psychological profile marked by strength in self-perception but vulnerability to anxiety. They challenge assumptions about motherhood’s protective role and underscore the need for culturally adapted interventions.

This research explores women entrepreneurs' critical role in advancing gender equality and driving social change. By adopting a multifaceted approach, this study delves into the complex interplay between women's entrepreneurship, gender norms, and social structures. This investigation uses a mixed-methods research design to uncover the factors that enable and inhibit women entrepreneurs' agency in promoting gender equality and social change. This research is stranded in the theoretical framework of feminist entrepreneurship, which recognises women's unique challenges and opportunities in starting and running their own businesses. Through an intersectional lens, this study examines how social identities, including race, class, and sexuality, interact with gender in shaping women entrepreneurs' experiences. Drawing on qualitative interviews with women entrepreneurs, as well as surveys and secondary data analysis, this study seeks to identify the strategies that women entrepreneurs use to challenge gender norms and promote social change. This research investigates the impact of women-owned businesses on local economies, communities, and social structures. The findings of this study have substantial implications for policymakers, practitioners, and scholars interested in promoting gender equality and social change through entrepreneurship. By illuminating the critical role of women entrepreneurs in driving social change, this research can inform the design of policies and programs that support and enable women's entrepreneurship. Ultimately, this study seeks to contribute to a more comprehensive understanding of how women entrepreneurs can advance gender equality and promote social change.

Lebanese women’s active and impressive participation in the revolution has led to the wide use of “the revolution is female” as a new slogan. This article will try to explain why and how women have been able to appropriate the revolution, and whether men and women are asking for the same rights. The article will analyze gender in the revolution through insights from a piece of street art painted by two young artists. It will demonstrate that the revolution per se is not female; rather, it is the characteristics of Lebanon’s revolution that have put women’s faces at the fore.

Nisa’ wa jami’yat:Lubnaniyat beyn Insaf al-dhati wa khidmat al-gheyrBy Azza Sharara Baydoun, (Beirut: Dar al-Nahar, 2002)

This transnational history of Syrian women’s activism argues that Syrian women’s identities were shaped by activism at home and abroad at the League of Nations. In the early twentieth century, women in Ottoman Syria—later divided by the French into Syria and Lebanon—forged regional as well as diasporic and activist connections to lobby for rights as Arabs and as women. Drawing from research in over twenty archives in Lebanon, Egypt, Switzerland, France, Italy, the Netherlands, and the United States, this project provides new historical evidence about how a pan-Arab women’s identity developed and how it was used in relation to domestic and international audiences. In the 1910s, Syrian women focused on providing basic social services to women and the poor. In the 1920s, when the League of Nations imposed the French Mandate for Syria and the British Mandates for Palestine and Iraq, a regional women’s network desirous of Arab independence was born. Women’s rights, which initially meant the right to citizenship, became an international issue during the League of Nations era, 1920-1945. Syrian women seized upon this transformation and channeled the regional Arab women’s network toward the League in the name of Arab independence and women’s rights in the 1930s. Arab women’s activism directed toward the League of Nations decentered the West as the only model for women’s rights. A gendered history of Syrian women’s pan-Arab activism problematizes the existing narrative that the UN Decade for Women, 1975-1985, was the moment when women’s rights first galvanized transnational activism in the global south. The existing history of the international women’s movement erases alternative definitions of women’s rights that circulated in the early twentieth century. In demonstrating the early global engagement of Syrian women on behalf of women’s rights and Arab independence, this history changes the narrative of the origins of transnational women’s activism and internationalizes the study of Arab women’s history. The project uses the lives and activism of Alice Kandaleft Cosma, Julia Tu’mi Dimashqiyya, ‘Afifa Karam, Anbara Salam Khalidi, Nour Hamada, and Ibtihaj Qaddura to challenge the pervasive stereotypes about Arab women’s passivity, which still have currency today.

Lebanon has historically been one of the most liberal and progressive countries in the Arab world, with a relatively free media climate and a culture and legal environment largely conducive to gender equality. Censorship in Lebanon remains nowhere near as stringent as in most of its regional counterparts, although journalists and bloggers self-censor for personal safety (Alabaster 2011). The country has a long tradition of press freedom, but nearly all media have ties to political groups (Al-Najjar 2011). Women have legal access to virtually all occupations and professions and enjoy equal constitutional rights with men, despite the persistence of some discriminatory laws and practices. In addition, Lebanese women in most professions face a national trend of underrepresentation in positions of power, especially within the news industry. As was learned in the Global Report on the Status of Women in the News Media (Global Report) study, Lebanese news companies employ twice as many men as women, and the disparity further increases as we go up the corporate ladder (Byerly 2011).

BackgroundThe Breastfeeding Behavior Questionnaire (BBQ) assesses women’s perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months.MethodsThe internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women’s BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery.ResultsThe BBQ-A had a good internal consistency reliability (Cronbach’s alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between − 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months.ConclusionsThe BBQ-A is a reliable and valid instrument to assess women’s perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.

Background:Breast cancer is the leading cause of cancer death among females in Lebanon. This study aimed at analyzing its epidemiology in the country over time.Methods:Data were extracted from the Lebanese National Cancer Registry (NCR) for the years 2004 through 2010. Age-standardized and age-specific incidence rates for cancers per 100,000 population were calculated.Results:Breast cancer ranked first, accounting for an average of 37.6% of all new female cancer cases in Lebanon during the period of 2004-2010. Breast cancer was found to have been increasing faster than other hormone-related women’s cancers (i.e. of the ovaries and corpus uteri). The breast cancer age-standardized incidence rates (world population) (ASRw) increased steadily from 2004 (71.0) to 2010 (105.9), making the burden comparable to that in developed countries, reflecting the influence of sociological and reproductive patterns transitioning from regional norms to global trends. The age-specific incidence rates for breast cancer rose steeply from around age 35-39 years, to reach a first peak in the age group 45-49 years, and then dropped slightly between 50 and 64 years to rise again thereafter and reach a second peak in the 75+ age group. Five-year age-specific rates among Lebanese women between 35 and 49 years were among the highest observed worldwide in 2008.Conclusion:Breast cancer is continuously on the rise in Lebanon. The findings of this study support the national screening recommendation of starting breast cancer screening at the age of 40 years. It is mandatory to conduct an in-depth analysis of contributing factors and develop consequently a comprehensive National Breast Cancer Control strategy.