Gendered bodies and reproduction in the Arab countries and Turkey

The Middle East has been a hub of geopolitics since the end of the Cold War and the site of near-constant interand intra-state conflicts. Despite the growing interest in the region as a result of these conflicts, reporting – whether academic or journalistic – has often focused on political authoritarianism and radical religious movements. Given these preoccupations, discourses on health, well-being and gender relations have too often been framed in macro-level terms with insufficient attention to context. Moreover, these trends have combined with the enduring influence of Orientalism to produce a depiction of Middle Eastern women as lacking in agency and in need of defence by Western actors. At the same time, their health and wellbeing have been too often assessed in terms of decontextualised aggregate indicators employed by international and other agencies. Such reports have singled out the Middle East, for example, for its seemingly belated decline in fertility; the low uptake of essential health services; the high prevalence of obesity and non-communicable diseases among women; or the exceptionally low levels of female labour force participation despite rising educational access. Yet, nowhere in these macro-level descriptions are the perspectives of Middle Eastern women taken into account, including their perceptions of their own health, of the health care offered to them, and of how they manage the everyday challenges of maintaining their own or their households’ well-being in the context of growing poverty and inequality, and above all, regional turmoil. This supplement is the first collective product of the work of members of a research network encompassing the Arab region and Turkey, the Reproductive Health Working Group (RHWG), that has been active for nearly three decades. Since its founding in 1988 as a small, multidisciplinary research group, it has provided a platform for the voices of researchers living in or working in the region addressing gender, well-being and the health of women, men and young people from multiple geographic, disciplinary and other perspectives. They have done so despite multiple practical, bureaucratic and political constraints and often amidst political conflict and instability. The idea for this supplement grew out of a conversation among the network’s regional governing committee over lunch in the mountains of Lebanon, as the group struggled with the fact that the interesting and timely research presented at the network’s annual meetings does not always get published in international, peerreviewed journals. This supplement aims to provide a dissemination forum for research presented at these meetings and to highlight complementarities among the individual studies. Recognising that several of the authors are students or recent graduates who are relatively new to publication, authors of each paper were assigned a mentor from the network who could provide support and constructive comments before submission. Papers particularly relevant to RHM were selected from among many presented over the network’s 30-year history. Thus, papers included in this supplement have been presented at RHWG annual meetings, or, in some cases, have been supported by RHWG “seed grants” and all have been supported by a mentor from the network. The articles that are included in this supplement can be broadly organised into themes that have also been recurrent at the RHWG’s regular network meetings. The history of the network since its inception is presented in the paper authored by EDITORIAL

The Middle East has been a hub of geopolitics since the end of the Cold War and the site of near-constant inter-and intra-state conflicts. Despite the growing interest in the region as a result of these conflicts, reportingwhether academic or journalistichas often focused on political authoritarianism and radical religious movements. Given these preoccupations, discourses on health, well-being and gender relations have too often been framed in macro-level terms with insufficient attention to context. Moreover, these trends have combined with the enduring influence of Orientalism 1 to produce a depiction of Middle Eastern women as lacking in agency and in need of defence by Western actors. 2 At the same time, their health and wellbeing have been too often assessed in terms of decontextualised aggregate indicators employed by international and other agencies. Such reports have singled out the Middle East, for example, for its seemingly belated decline in fertility; 3 the low uptake of essential health services; 4 the high prevalence of obesity and non-communicable diseases among women; 5 or the exceptionally low levels of female labour force participation despite rising educational access. 6 Yet, nowhere in these macro-level descriptions are the perspectives of Middle Eastern women taken into account, including their perceptions of their own health, of the health care offered to them, and of how they manage the everyday challenges of maintaining their own or their households' well-being in the context of growing poverty and inequality, and above all, regional turmoil.
This supplement is the first collective product of the work of members of a research network encompassing the Arab region and Turkey, the Reproductive Health Working Group (RHWG), that has been active for nearly three decades. Since its founding in 1988 as a small, multidisciplinary research group, it has provided a platform for the voices of researchers living in or working in the region addressing gender, well-being and the health of women, men and young people from multiple geographic, disciplinary and other perspectives. They have done so despite multiple practical, bureaucratic and political constraints and often amidst political conflict and instability.
The idea for this supplement grew out of a conversation among the network's regional governing committee over lunch in the mountains of Lebanon, as the group struggled with the fact that the interesting and timely research presented at the network's annual meetings does not always get published in international, peerreviewed journals. This supplement aims to provide a dissemination forum for research presented at these meetings and to highlight complementarities among the individual studies. Recognising that several of the authors are students or recent graduates who are relatively new to publication, authors of each paper were assigned a mentor from the network who could provide support and constructive comments before submission. Papers particularly relevant to RHM were selected from among many presented over the network's 30-year history. Thus, papers included in this supplement have been presented at RHWG annual meetings, or, in some cases, have been supported by RHWG "seed grants" and all have been supported by a mentor from the network.
The articles that are included in this supplement can be broadly organised into themes that have also been recurrent at the RHWG's regular network meetings. The history of the network since its inception is presented in the paper authored by EDITORIAL S1 DeJong et al. Through exploring why the RHWG has persisted, it analyses its governance trajectory and the approach to mentorship and capacity building with lessons relevant to similar research networks elsewhere. The paper also singles out three particular lines of multidisciplinary and comparative research by its members that have both resonated with regional needs and at the same time spoken to global debates on health.
Following this historical reflection, the remaining papers address three key themes.
Theme 1: Women's perceptions of their health and health care The first paper, by Kabakian-Khasolian and colleagues, focuses on the extent to which women delivering in a Lebanese maternity hospital are satisfied with the birth process, building on a long tradition of research on childbirth in the region that has been presented yearly at RHWG meetings. With the region following a global trend towards increased institutional births, such research raises important questions about the quality of care women receive, and to what extent their own preferences in relation to the process are taken into account.
Similarly, Wick, an anthropologist, in her paper follows the same theme, but goes out of the hospital to interview women in their homes, often in remote areas of Lebanon, after their baby had experienced a life-threatening neonatal complication. This paper focuses on how lines of social inequality affect both access to and experience of health care and underlines the economic barriers to care that have been relatively under-researched in the region.
The paper by Terziog˘lu and Hammoudeh is on the quality of life of women diagnosed with breast cancer and showcases the unusual opportunity for comparison between the Arab world and Turkey made possible through the network. With support from seed grants from the RHWG, a Palestinian and a Turkish researcher found common ground in their qualitative research with women in those two settings. Breast cancer is a growing health problem and its prevalence in the region has increased in recent years. 7 Breast cancer screening has been encouraged in the region often by civil society groups. However, following a diagnosis, approaches typically focus on the medical aspects of the breast cancer, and fail to support women in coping with and managing their illness.

Theme 2: Gender, sexuality and daily life
The paper by Can in this issue explores the gendered nature of the workplace underpinning Turkey's export-oriented growth success. As noted above, the Middle East region is often portrayed as an outlier in terms of its low and stagnant female labour force participation despite its significant progress in educational enrolment for women. Yet, there have been relatively few studies that have explored the experiences of women who do enter the workforce. This paper explores the actual experiences of women in textile workshops wherein, in seeming contradiction, both a sexualised image of women and the use of a familial idiom simultaneously prevail.
Two papers in this issue focus more explicitly on sexuality and bring men into the picture, both as individuals with their own concerns about sexuality and as potential consumers of sexual services. Ghannam, who has based her paper on long-term ethnographic research in a quarter of Cairo, 8 shows concretely how the social construction of sexuality shapes both individual men's sexual "performance" and perceptions of it. It draws a connection between the social preoccupation with female virginity in Egypt with the less public, but nonetheless significant, pressures on men to perform sexually, and the ensuing crisis when they cannot (rabt, in Arabic).
The paper by Beňová offers a brave and unusual perspective from bars in Amman, Jordan, where Eastern European female hostesses have been drawn in as migrant labourers. The paper sensitively portrays the perceptions of some of these women, as well as their motivations, expectations and disappointments in their host country and work setting, as well as the constraints that both men as patrons and women as clients face in this highly gendered environment.

Theme 3: Conflict and displacement
Given the unprecedented scale of conflict and forced displacement in the region, it is not surprising that these recur throughout the papers and the specific topic of their effects on health and wellbeing occupies a special share of papers in this special issue.
The impetus for the paper by Kabakian-Khasolian and colleagues from Lebanon and Syria was a discourse of both economic and political concern J DeJong, S Heidari. Reproductive Health Matters 2017;25(S1):S1-S3 S2 in Lebanon over the seemingly high fertility rate of the Syrian refugees who have flowed into Lebanon since 2011. This paper explores Syrian women's perceptions of childbearing and fertility, providing a welcome contrast to that macro-level perspective offered in the media.
Hamayel et al in their paper take us to the occupied Palestinian territories, where new lines of political occupation have affected maternal health and even divided communities. They focus on Kafr 'Aqab, where Palestinian residents experience ever-growing constraints on their mobility, including for childbirth, which affect family formation and individual futures. This work began from a seed grant from the RHWG, and later the researchers succeeded in obtaining additional funding from other sources, and it now forms the basis of a doctoral dissertation.
The final paper by Knox on early marriage among Palestinian refugees in post-conflict Nahr Al Bared refugee camp in Lebanon challenges the conventional view of early marriage as always "forced" by bringing a much-needed perspective of the young women involved in the debate. The paper concludes that while these young women are married too young, they report having been involved in the decision-making process, even within the context of a patriarchal society. The important message that this paper conveys is that while the harmful consequences of early marriage have been repeatedly reported, little is published on the perspectives and alternative life trajectories of young girls in conflict and post-conflict settings. It concludes with the poignant argument that these young women, like their whole generation, should not have had to grow up under conflict.
To conclude, amidst regional turmoil, researchers of the RHWG network have found creative channels to articulate their perspective on the problems being faced by women, men and young people in the region. Their individual perspectives are strengthened and refined by discussions within the network with other scholars working on the same regional context, but also by sharing the diversity of experiences across the Arab countries and Turkey. This supplement is one opportunity to share those voices with a wider international audience and hopefully to present another view of a widely misrepresented region.

Funding
This work was carried out with the aid of a grant [grant number 106981-001] from the International Development Research Centre, Ottawa, Canada.