More than numbers: An analysis of ‘political fertility’ in the occupied Palestinian territory

Description

Abstract

Background
Fertility rates in the occupied Palestinian territories have recently declined. Yet, at 4.5 births per woman, the rate remains among the world’s highest, despite improvements in child mortality and in women’s educational level. The high fertility has often been explained by the importance of population numbers in the political conflict of Israel-Palestine and the term ‘political fertility’ has been coined, a term mostly discussed in its numerical value and related to high-level politics. This study aims to understand qualitative dimensions of ‘political fertility’ as it is given meaning by refugee mothers and policy-planners in the West Bank.

Methods
This abstract is based on a qualitative empirical inquiry triangulating eight semi-structured interviews with mothers in Qalandia refugee camp in the centre of the West Bank, four semi-structured interviews with health policy-planners and 40 hours of participant observations conducted in the UNRWA health clinic within Qalandia camp. Fieldwork was conducted by LNH and MB in September-October 2011. Qalandia was chosen due to proximity to the Separation Wall and the Israeli military check-point separating Ramallah and Jerusalem. Policy-planners were sampled through stakeholder analysis, while mothers were purposefully sampled based on their use of reproductive health services, residence in the camp, number of children and imprisoned family members to obtain nuanced material. Informed consents were obtained orally. The empirical material was analysed by content analysis, where analytical condensation rounds were conducted to thematically group the material.

Findings
Almost all the mothers ascribe political meanings to childbearing, as several refer to the conflict and Israeli occupation in their explanations of fertility decisions. Most mothers fear teenage mortality or imprisonment by the Israeli military. For the majority, these fears prompt mothers to have more children to counter such losses, though the opposite was also noted, as few mothers have had fewer children due to fears of losing them. However, having many children is not merely framed as statements of political struggle, as several non-political factors also are present. There is a deep concern of infertility amongst the majority of mothers, and they perceive infertility as caused by the conflict and experience considerable difference in availability of infertility treatment due to the political situation. In addition, some mothers and some policy-planners perform a calculus of an ideal number of children with reference to the political conflict and to nation and kin, yet they want to refrain from explicit references to rates and concrete numbers.

Interpretation
We find talking of specific numbers and control of pregnancies is politically sensitive in Palestine and thus generally avoided. Globally, high fertility rates are often associated with high child mortality rates (“child survival hypothesis”), but this study shows that in Palestine, teenage imprisonment and mortality also influence fertility decisions. We conclude that fertility in the West Bank is ascribed political meaning, yet ‘political fertility’ is understood as involving more than merely a number of children. This entails opportunity to tailor health services accordingly and provides understanding of the complexity of motivations present in daily-life in occupied Palestine.