Gender and Cultural Influences on Reproductive Decision-Making and Fertility Trends in ,

Thesis Submitted for the Degree of Doctor of Philosophy at the University of Cardiff Metropolitan

By

Engee A. Jamal-Hariri

2015

Gender and Cultural Influences on Reproductive Decision-Making and Fertility Trends in Jeddah, Saudi Arabia

Engee A. Jamal-Hariri

Abstract

This thesis presents a critical examination of dynamic fertility trends and reproductive behaviour in Jeddah, Saudi Arabia. This is established through the following four objectives: to establish a comprehensive understanding of the relationship between gender system and reproductive behaviour; to determine the role of cultural, religion and social networks in influencing family planning decisions; to analyse the changes that occurred in fertility trends in a period of 8 years (2005-2013); and to describe the function of using innovative methods in achieving such a sensitive study in a conservative society. This study applied a mixed methodology, including a repeated questionnaire survey over a period of 8 years, and in-depth interviews. It was found that an early age of marriage is common and regarded as advantageous to the future of women. Moreover, this study reveals that Saudis place great and high value on children, as children represent the flow of wealth from children to parents. Thus, the preferred family size is relatively large (4 children) and both parents have a preference for male children. Moreover, the study reveals that the traditional division of labour assigns women the responsibility of taking care of children. Also, it was found that even though many women found difficulties in discussing reproductive issues with their spouse, discussing fertility issues reduced family size. Men are predominantly in control of reproductive decision-making in the family, although when fertility decisions were mutual, family size declined. A higher socioeconomic status promoted shared fertility decisions. Further, this study shows that there is a high level of diffusion of contraceptive knowledge and practices among study respondents and their social networks. However, planning family size is not a very common practice among study respondents and having a large family is seen to be complying with a religious Islamic duty, and reflects pride toward kinship relationships. It was also found that the extended family provides a supporting motive for parents to have a large family. However, the latest survey, of 2013, revealed some positive changes in gender structure that could contribute to greater gender equality, such as a rise in the age of marriage for both genders, more involvement of males in household responsibility, an increase in mutual decision-making and practice of planning for family size.

ii

Acknowledgements

I give all the Glory and Honour to God. My faith in God and constant prayers have given me added strength and the determination needed to accomplish this work.

In accomplishing the task of researching and writing this thesis, I have received support, intellectual and personal encouragement from my supervisors. Initially, I would like to thank Professor Peter Abell for his unfailing support, encouragement and supervision of this project from beginning to end. I shall always remain grateful to him for his intellectual guidance, insight and persistent critical questioning, which, combined with his patience and personal support, gave me not only a strong intellectual foundation to pursue the themes of this thesis but also the courage and determination to continue during those trying periods of emotional discouragement.

I also express my gratitude to Professor Malcolm Bennison, who also took on the role of supervising my study. He was very sincere and his excellent guidance and above all his constant encouragement instilled in me the confidence which helped my progress. I am thankful to him for his valuable suggestions and close scrutiny of my work and also for his intellectual support and comments, which provided critical appraisal throughout this work.

I am extremely grateful to Professor Don Harper, who not only played a fundamental role in the initiation and setting up of the project, but who has also continuously supported me, and gave me comments and insights regarding

iii different aspects of my work. Further, I shall always remain grateful to Doctor Fouad Dahlawi for his intellectual guidance through the data analysis with SPSS, and his constant encouragement, patience and personal support, which helped my progress.

In addition, I am grateful to Doctor Ali Saqur, my local supervisor, for his unwavering encouragement and support. His kind-hearted intellect steered me through the most difficult times of my study. I also owe a deep sense of gratitude to Doctor Salha Abden, who initiated my interest in population studies as an undergraduate student and also supervised my Master’s degree. I shall always remain grateful to her for her intellectual guidance. Her continuous support and encouragement instilled into me the confidence which steered my progress towards an academic career. I am also thankful to Doctor Mohammad Al-Gamdi and Doctor Muhsen Mansory for their support and encouragement, and for providing me with many important references. Additionally, I am grateful to King Abdul Aziz University for the scholarship that enabled me to undertake my study in Britain. In particular I am grateful to the Supervisor General of the Joint Supervision Program, Professor Ammar Amin, for his support and encouragement. Also, special thanks to Omaima Olagi for her continued help and support.

I shall always remain grateful to the faculty of Arts and Humanity headed by Doctor Osama Jastania and the head of Sociology Department, for their consistent support. In addition, heartfelt thanks to my colleagues and friends in Saudi Arabia, for their support and words of encouragement.

I would like to thank the institutions (hospitals and business enterprises in Saudi Arabia) for their co-operation during the data collection for the survey. Heartfelt

iv thanks go to all interviewees and respondents in my study who took time to respond to my interviews, participate in the discussions or give practical support. Without their co-operation I would not have accomplished this task.

I finally owe deep gratitude to my family, who through their love, prayers and support gave me the encouragement to continue during those difficult periods. To my beloved children I owe a special debt of thanks for their love, and words of encouragement exhorting me to work hard. Most importantly, special thanks and admiration go to my husband, who through great sacrifice, love, patience and understanding has supported our children and me. His support and reassurance have been invaluable to me.

v Dedication

All love and honour to my parents, my mother in-law, my husband, and my daughters and sons, I will always remain grateful to them. It is hard to find words with which I can thank them for all the support they gave me and for their love and prayers which enabled me to accomplish this work. Therefore, I dedicate this work to them.

vi Table of Contents

Abstract ii Acknowledgements iii Dedication vi Table of Contents vii List of Tables xi List of Figures xiv List of Appendices xvi List of Words xvii Chapter One Introduction Of The Study 1 Statement of the Problem 1 Study Foci and Concerns ...... 1 Fertility Patterns in Saudi Arabia...... 2 The Gap in Knowledge and The Contribution of the Study ...... 4 Study Justification 11 Contribution to Global Concerns about Rapid Population Growth ...... 11 Helping to Address Society’s Needs ...... 15 Research Aim 16 Thesis Structure 17 Chapter Two The Social Context and Reproductive Behaviour 19 Introduction 19 Theoretical Approaches to Fertility Changes 19 The Demographic Transition Theory...... 20 The Wealth Flow Theory ...... 21 Economic Theories of Fertility ...... 22 The Microeconomic Model ...... 22 Easterlin’s Framework ...... 23 Ideational Theory ...... 24 Embeddedness Theory ...... 25 Social Structure and Fertility Behaviour 27 Fertility and Nuptial Regimes ...... 27 The Value of Children, Sex Preference and Fertility Behaviour ...... 30 Gender Structure Related to Fertility Behaviour 33 Women Status, Patriarchal Society and Fertility Decisions ...... 33 Women’s Education and Participation in Paid Work...... 38 Cultural Context and Reproductive Behaviour 41 Social Network and Fertility Behaviour ...... 41 Islam and Family Planning in the Saudi Arabian Culture ...... 44 Contraceptive Technologies: Islamic Ongoing Debate About Birth control ...... 44 Religion and Reproductive Behaviour ...... 45 State Discourses and Practices on Reproduction and Citizenship ...... 48 Conclusions 49

vii Chapter Three Methodology and Research Design 52 Introduction 52 Mixed Methodology as a Research Approach 52 The Debate about Mixed Methods ...... 52 Justification of Mixed Methodology...... 55 Study Site Selection 57 The Justification for Choosing Jeddah as the Study Site ...... 57 The Study Sample ...... 59 Data Collection Techniques 59 Questionnaire Sample ...... 59 Questionnaire Process ...... 62 Sample Selection for In-depth Interviews ...... 65 The Process of In-depth Interviews ...... 66 Data Organisation and Analysis 68 Statistical Techniques of Survey Data ...... 68 Interview Content Analysis ...... 69 Writing and Dissemination ...... 72 Study Ethics, Access, Reflexivity and Positionality 73 Research Ethics ...... 73 Access ...... 75 A Reflection on the Questionnaire Survey ...... 77 A Reflection on the In-depth Interviews ...... 79 Positionality ...... 81 Characteristics of the Surveys and In-depth Interview Samples ...... 83 Conclusions 92 Chapter Four Insight On Saudi Arabia and Jeddah’s Culture 94 Introduction 94 The 94 The Role of Islam 96 Saudi Culture and Women 98 Patriarchy and Gender System ...... 98 Beliefs about Women ...... 99 Women and Education ...... 101 Women and Politics ...... 103 Women and Paid Employment ...... 104 106 The Development Plans of Saudi Arabia 111 Education and Health Care Services 114 Reproductive Services and Attitudes towards Family Planning 115 Maternity Services ...... 115 Interviews Regarding Attitudes towards Family Planning Programmes ...... 116 Conclusions 118 Chapter Five The Continuity and Change in Fertility Trends, Over the Period of Eight Years 121 Introduction 121 Social Structure and Fertility Patterns 121 Introduction 121 Nuptial Regimes Concerning Age at Marriage in (2005) 122 The Change in Nuptial Regimes Concerning Age at Marriage in (2013) 123 viii The Value Placed on Children and Family in (2005) 125 The Change in the Value Placed on Children and Family in (2013) 130 Sex Preference in (2005) 132 The Importance of Having Male Children ...... 132 The Implications of Sex Preference ...... 134 The Change in Sex preference in (2013) 137 The Change in Importance of Having Male Children ...... 137 The Change in Implications of Sex Preference ...... 138 The Role of Gender in the Decision-Making Process Concerning Reproduction 140 Introduction 140 Dimensions of Women’s Status in (2005) 140 Gender-Based Roles ...... 140 Women’s Status and ‘Permission Issues’ ...... 144 The Change in Dimensions of Women’s Status in (2013) 145 The Change in Gender-Based roles ...... 145 The Change in Women’s Status and ‘Permission Issues’ ...... 148 Gender, Decision-making and Reproduction in (2005) 148 Discussing Reproductive Decisions ...... 148 Gender Power in Fertility Decisions ...... 151 The Change in Gender, Decision-Making and Reproduction in (2013) 154 The Change in Discussing Reproductive Decisions ...... 154 The Change in Gender Power in Fertility Decisions...... 156 The Influence Of Social Networks and Contraception Decisions, On Reproductive Behaviour 158 Introduction 158 Contraception Diffusion and the Role of Social Networks in (2005) 159 The Change in Contraception Diffusion and the Role of Social Networks in (2013) 162 The Mode of Contraceptive Practices in (2005) 165 The Change in the Mode of Contraceptive Practices in (2013) 169 Planning or Not Planning Family Size in (2005) 171 The Change in Planning or Not Planning Family Size in (2013) 175 Influence of the Extended Family in (2005) 178 The Change in the Influence of the Extended Family in (2013) 180 Conclusion 181 Chapter Six Discussion, Evidence from Qualitative Interviews and Theoretical Explanations of Fertility Trends 184 Introduction 184 Social Structure and Fertility Patterns 184 Nuptial Regimes Concerning Age at Marriage 184 Discussion of Nuptial Regimes Concerning Age at Marriage ...... 188 The Value Placed on Children and Family 190 Discussion of the Value Placed on Children ...... 192 Sex Preference 194 The Importance of Having Male Children ...... 194 Discussion of the Importance of Having Male Children ...... 196 The Implications of Sex Preference ...... 197 Discussion of the Implications of Sex Preference ...... 198 The Role of Gender in the Decision-Making Process Concerning Reproduction 200 Dimensions of Women’s Status 200 Gender-Based Roles ...... 200

ix Discussion of Gender-Based Roles ...... 204 Women’s Status and ‘Permission Issues’ ...... 205 Discussion of Women’s Status and ‘Permission Issues’ ...... 208 Gender, Decision-making and Reproduction 209 Discussing Reproductive Decisions ...... 210 Discussion of Discussing Reproductive Decisions ...... 214 Gender Power in Fertility Decisions ...... 217 Discussion on Gender Power in Fertility Decisions...... 221 The Influence of Social Networks and Contraception Decisions, on Reproductive Behaviour 225 Contraception Diffusion and the Role of Social Networks 227 Discussion on Contraception Diffusion and the Role of Social Networks...... 229 The Mode of Contraceptive Practices 231 Discussion on the Mode of Contraceptive Practices ...... 233 Planning or Not Planning Family Size 234 Discussion on Planning or Not Planning Family Size ...... 238 Influence of the Extended Family 242 Discussion on the Influence of the Extended Family ...... 245 Conclusions 247 Chapter Seven Concluding Remarks 250 Introduction 250 Summary of Study Outcomes 251 Importance of the Research 256 Implications for Sociological Literature and Theory ...... 256 Implications for Fertility Study Approaches ...... 259 Sensitivity to Cultural Context and Implications for Research Methodologies ...... 261 Policy Recommendations 261 Study Limitations 262 Suggestions for Future Research 264 Appendix-1: Survey Questionnaire (Female Version) 266 Gender and Fertility in Saudi Arabia 266 Survey for Women 267 Demographic Information 267 Gender and Fertility Behaviour 269 Social Interaction and Fertility Decisions 273 Appendix-2: In-depth Interview Questions (Female Version) 276 In-depth Interviews (for Women) 276 1- General Information: 276 2- Domestic Division of Labour in the Society 276 3- Gender and Social Networks in Relation to Reproduction 276 References: 278

x List of Tables

Table 1.1 Population of the World, 1950, 1975, 2005, 2012 and the Projection Variant of 2050 11 Table 1.2 Total Fertility Rates for the World, 1970-1975, 2000-2005, 2012 and the Projection Variants of 2045-2050 12 Table 3.1 Jeddah’s Population Growth 58 Table 3.2 Distribution of Population in Saudi Arabia Administrative Areas 58 Table 3.3 Examples of Qualitative Analysis According To Study Codes (from several respondents) 70 Table 3.4 Age Distribution by Gender of 2005 survey sample 84 Table 3.5 Age Distribution by Gender of 2013 survey sample 84 Table 3.6 Distribution of Genders by Different Income (SR per month) in 2005 85 Table 3.7 Distribution of Genders by Different Income (SR per month) in 2013 85 Table 3.8 Distribution of Gender Education Levels in 2005 86 Table 3.9 Distribution of Gender Education Levels in 2013 86 Table 3.10 Distribution of Male Occupational Status in 2005 86 Table 3.11 Distribution of Male Occupational Status in 2013 87 Table 3.12 Distribution of Female Occupational Status 87 Table 3.13 Distribution of Female Occupational Status 87 Table 3.14 Characteristics of the In-depth Interviews Sample 87 Table 4.1 Enrolment Ratio by Gender and Education Level (1975-2000) % 102 Table 4.2 Total Number of male and female students in Education Level (2007-2010) 103 Table 4.3 Percentage Distribution of Population at Working Age by Work Status and Gender % 104 Table 4.4 Employed Saudi Female Population (15 years and over) by Main Economic Activity in 2004 106 Table 4.5 Gross Domestic Product (GDP) by Economic Sectors at Constant Prices (Million Riyals) 109 Table 4.6 Structure of Actual Development Expenditure during the Development Plans (percent) 112 Table 4.7 Human Development Index of Saudi Arabia (Some Indicators) 113 Table 5.1 Gender Education and Median Age at Marriage 122 Table 5.2 Gender Occupational Status and Median Age at Marriage 123 Table 5.3 Family Income and Median Age at Marriage by Gender 123 Table 5.4 Gender Education and Median Age at Marriage 124 Table 5.5 Gender Occupational Status and Median Age at Marriage 124 Table 5.6 Family Income and Median Age at Marriage by Gender 124 Table 5.7 male preference and Median family size 133 Table 5.8 Male Preference and Median Family Size 138 Table 5.9 Male View on Caring for Children as Women’s Responsibility in Relation to Family Size 141

xi Table 5.10 Caring for Children as Men’s Responsibility in Relation to Family Size 142 Table 5.11 Male View on Caring for Children as Women’s Responsibility in Relation to Family Size 145 Table 5.12 Caring for Children as Men’s Responsibility in Relation to Family Size 146 Table 5.13 Discussing Reproductive Issues in Relation to Family Size 149 Table 5.14 Gender Education Related to Discussing Reproduction Issues 150 Table 5.15 Family Income Related to Discussing Reproduction Issues 150 Table 5.16 Gender Occupational Status (Recoded) by Discussing Reproduction Issues 151 Table 5.17 Gender Power in Fertility Decisions and Family Size 151 Table 5.18 Gender Education and Gender Power in Fertility Decisions 152 Table 5.19 Family Income and Gender Power in Fertility Decisions 153 Table 5.20 Gender Occupational Status and Gender Power in Fertility Decision-making 153 Table 5.21 Discussing Reproductive Issues in Relation to Family Size 154 Table 5.22 Gender Education Related to Discussing Reproduction Issues 154 Table 5.23 Family Income and Gender Power in Fertility Decisions 155 Table 5.24 Gender Occupational Status (Recoded) by Discussing Reproduction Issues 155 Table 5.25 Gender Power in Fertility Decisions and Family Size 156 Table 5.26 Gender Education and Gender Power in Fertility Decisions 157 Table 5.27 Gender Occupational Status and Gender Power in Fertility Decision-making 157 Table 5.28 Family Income and Gender Power in Fertility Decisions 158 Table 5.29 Knowledge of Contraceptive Methods by Gender 159 Table 5.30 Point of View Regarding Contraception in Relation to Family Size 162 Table 5.31 Knowledge of Contraceptive Methods by Gender 163 Table 5.32 Point of View Regarding Contraception in Relation to Family Size 164 Table 5.33 The Method of Contraception Used By Gender 166 Table 5.34 Reasons for Not Using Contraception Used By Gender 167 Table 5.35 Did Practice Birth Spacing in Relation to Family Size 168 Table 5.36 Ever Used Contraception in Relation to Family Size 168 Table 5.37 The Method of Contraception Used By Gender 169 Table 5.38 Reasons for Not Using Contraception Used By Gender 169 Table 5.39 Did Practice Birth Spacing in Relation to Family Size 170 Table 5.40 Ever Used Contraception in Relation to Family Size 170 Table 5.41 Planning Decisions and Reproductive Outcomes 171 Table 5.42 Gender Education and Planning Decisions 173 Table 5.43 Family Income (SR/month) and Planning Decisions 173 Table 5.44 Gender Occupation (Recoded) and Planning Decisions 174

xii Table 5.45 Planning Decisions and Reproductive Outcomes 175 Table 5.46 Gender Education and Planning Decisions 176 Table 5.47 Gender Occupation and Planning Decisions 176 Table 5.48 Family Income and Planning Decisions 177 Table 5.49 Extended Family Financial Support and Family Size 179 Table 5.50 Extended Family Effect on Reproduction Decisions 180 Table 5.51 Extended Family Financial Support and Family Size 180 Table 5.52 Extended Family Effect on Reproduction Decisions 181 Table 6.1 The Actual and Preferred Age at Marriage and Socioeconomic Status for the Interviewee Females 185 Table 6.2 Discussing Reproductive Issues (in-depth interview sample) 211 Table 6.3 Gender Power in Fertility Decisions (in-depth interviews sample) 218 Table 6.4 Planning or Not Planning Family Size (in-depth interviews sample) 234

xiii List of Figures

Figure 1.1 Fertility Rates in Arab World – 1985, 2007, and the projection of 2020 3 Figure 1.2 Contraceptive Prevalence (% of Women Aged 15-49) in 2011 4 Figure 3.1 Research Approach 55 Figure 3.2 Basic Map of Saudi Arabia 58 Figure 3.3 Framework of the 2005 Survey Sample 61 Figure 3.4 Framework of the 2013 Survey Sample 62 Figure 3.5 The Survey Questions Regarding United Nations Programmes 64 Figure 3.6 The Technique of Selecting a Respondent from a Snowball Sample 66 Figure 4.1 OPEC Shares of World Crude Oil Reserves in 2013 107 Figure 4.2 The Changes in Saudi Arabia Oil Prices From 1970-2006 108 Figure 4.3 The Changes in Saudi Arabia Oil Prices From 2003-2012 108 Figure 4.4 Gross Domestic Product (GDP) by Sectors (Million Riyals) 110 Figure 4.5 Trends of Actual Oil and Non-Oil Revenues by (Billion Riyals) 110 Figure 5.1 The Value of Children by Gender 125 Figure 5.2 What Is Regarded as Motivation for Having Many Children (Over Three) by Gender 128 Figure 5.3 The Value of Children by Gender 130 Figure 5.4 What is Regarded As Motivation For Having Many Children by Gender 131 Figure 5.5 Importance of Having Male Children by Gender 133 Figure 5.6 What Men would Do if They had Only Daughters 135 Figure 5.7 What Men Would Do if They Had Boys Only 136 Figure 5.8 Importance of Having Male Children by Gender 137 Figure 5.9 What Men Would Do if They had Only Daughters 138 Figure 5.10 What Men Would Do if They had Boys Only 139 Figure 5.11 The View of Caring for Children as Women’s Responsibility 141 Figure 5.12 Who is Financially Responsible for Children 142 Figure 5.13 The Kind of Help with Childcare Given by Husbands 143 Figure 5.14 The Requirement of Permission for Women to Buy Something for Themselves 144 Figure 5.15 The View of Caring for Children as Women’s Responsibility 145 Figure 5.16 Who is Financially Responsible for Children 146 Figure 5.17 The Kind of Help With Children Given by Husbands 147 Figure 5.18 The Requirement of Permission for Women to Buy Something for Themselves 148 Figure 5.19 From Which Source Does Each Gender Learn About Contraception 160 Figure 5.20 Family and Friends Used Contraception 161

xiv Figure 5.21 From Which Source Does Each Gender Learn About Contraception 163 Figure 5.22 Family and Friends Used Contraception 164 Figure 5.23 Ever Used Contraceptive by Gender 166 Figure 5.24 Ever Used Contraceptive by Gender 169 Figure 5.25 Reasons for Not Planning for Family Size 174 Figure 5.26 Reasons for Not Planning for Family Size 177

xv List of Appendices

Appendix-1: Survey Questionnaire (Female Version) 266 Gender and Fertility in Saudi Arabia 266 Survey for women 267 Demographic Information 267 Gender and Fertility Behaviour 269 Social interaction and fertility decisions 273

Appendix-2: In-depth Interview Questions (Female Version) 276 In-depth Interviews (for Women) 276 1- General Information: 276 2- Domestic Division of Labour in the Society 276 3- Gender and social Networks in relation to reproduction 276

xvi

List of Arabic Words

Abaya and burgha: The dress code in Islam for women. a’ila: The family, although it includes the close kinship related by blood or by marriage. Alqawama: A concept based on the Quran verse that men are the protectors and maintainers of women, because they are obliged to support women financially. However, many Muslim men misinterpret this verse of the Quran, believing that men are women’s guardians and that the husband rules over his wife because men are more capable than women. Al-Kahf, ; Al-Hadeed,; Al-Baqura; Al-alq; Al-Mugadila; Al-Anaam; Hood; Al-Kahf: the titles of chapters of the Holy Quran. Azl: Withdrawal. Fatwa: Rule based on Islamic doctrine. Hadeeth: Prophet’s Words. Hijaz: Now Makah and Medina Regions. Hajj: Muslims Pilgrimage, where the Muslims go in the month of Zo-Alhejah (Arabic and Muslims calendar) to visit the two holy cities of and Medina. Kuttab: The traditional or unofficial schools, which generally teach basic education (reading and writing), with a particular focus on teaching how to read the Quran. Khul: When the wife seeks divorce. Magless Shura: The State Consultative Council. Madh'hab: A term that refers to a school of thought or religious jurisprudence within Sunni Islam. Quran: The Holy Book of Muslims. Shia and Sunni: Major jurists or school of Islam. Shari’ah: Islamic law. Sunna: Prophet Mohammed’s sayings and actions. Surat: Chapter of the Holy Quran. Talaq: Divorce. Wakil: A male acting as power of attorney.

xvii Chapter One Introduction to the Study

Statement of the Problem

Study Foci and Concerns

This study is a critical examination of the dynamic of fertility patterns and reproductive behaviour in Jeddah, Saudi Arabia. This research seeks to present gendered insights into fertility determinants and examine the changes in fertility trends over an eight-year period by applying mixed methodologies.

Most studies concerning fertility behaviour only examine women's perspectives, which leads to inadequate and weak understanding of fertility behaviour, and in particular the influence of the gender system on fertility behaviour (Mishra et al., 2014; Upadhyay and Karasek, 2012). Therefore, this study will investigate the reproductive experiences of both women and men.

This novel study focusses on the case study of Jeddah, Saudi Arabia. Very little is known about the dynamics of reproductive behaviour in Saudi Arabia, and in particular Jeddah. According to the United Nations report on fertility prospects in the Arab region (2011) the largest gaps in knowledge on the demography of the Arab region are about Saudi Arabia (p.2). Further, the majority of developing countries have executed several surveys through the Demographic Health Survey (DHS) and the World Fertility Survey (WFS), which provide unique and valuable information regarding fertility behaviour in those countries, but this is unfortunately unavailable in the case of Saudi Arabia (United Nations 2011, UNDP 2012, 2013). In addition, few studies have been undertaken in Saudi Arabia concerning the trends, and the determinants of fertility behaviour. Besides, the subject of gender is invisible in Saudi Arabia. Therefore, the contribution to knowledge made by this study is that it will try to fill this gap and present exhaustive insights to fertility behaviour in the cultural context of Saudi Arabian society. By doing so, the present study could make a significant contribution to understanding fertility change in developing countries, the Arab world and Muslim society, as well as supporting policy makers in developing countries with valuable information.

1 In order to fully understand dynamic fertility patterns and reproductive behaviour, we have to consider the whole context of society, which includes the socioeconomic structure in Saudi Arabia, as well as religion and culture. Thus, this research will explore the socioeconomic and demographic factors influencing fertility behaviour; the influence of the gender ideology in Saudi Arabia on reproduction decisions; and the influence of social networks on contraceptive practices. In so doing, this study will explore the role of cultural values and norms affecting reproductive behaviour. As the state religion is Islam and all Saudi Arabian citizens are Muslims, and the foundation of the Saudi Arabian constitution is based on Islamic principles, this study will also consider the influence of Islamic perspectives on both men’s and women’s viewpoints regarding reproduction, particularly with respect to contraception and the value of children. Through such research, this study will fulfil the need for more information and a better understanding of fertility patterns and reproductive behaviour in Jeddah, Saudi Arabia.

The present study will explore the following factors: age at marriage, the value of children, sex preference for children, education levels and occupation status, family income, women’s status (through different indicators such as women's education, women's participation in the labour force, gender roles, permission issues), reproductive decision making, social networks and contraception diffusion, the mode of contraceptive practices, the influence of extended family and finally the planning of family size.

Fertility Patterns in Saudi Arabia

Saudi Arabia currently has an annual population growth rate of 2.1 percent, and the highest total fertility rate (TFR) of all the Gulf States, as well as most of the Arab countries (See Figure 1.1). However, it can be seen from Figure 1.1 that a significant decline in the total fertility rate (TFR) occurred from around 6 children per woman in 1985 to 4 by 2007. Also, more recent data from the Population Reference Bureau 2012 shows that the TFR is 2.8, while another report from the United Nations (2011) revealed it as 3.2 for the period 2005-2010. The latter report demonstrates that the projections for fertility rate in the region will not fall to replacement level or below (2.1 children per woman) any time soon, and a two-child goal is far from universal (p.6). Despite the speculation about total TFR in the country, it seems that significant changes have occurred in TFR from 1985 to date, these changes in fertility rates

2 have been accompanied by changes in age at marriage, contraceptive prevalence, and infant mortality, which are discussed below.

Figure 1.1 Fertility Rates in the Arab World – 1985, 2007, and the projection to 2020

Source: RAND 2011, p.5.

Statistics from the 1992 Saudi Arabian census and the demographic survey of 2000 show a significant increase in the age at marriage of both males and females in less than a decade. In 1992, the percentage of married females was 20.7 in the age group 15-19, and 64.5 in the age group 20-24, but these percentages had changed by 2000 to 6.9 and 33.5 respectively. Similarly, the percentage of married males in 1992 was 21 in the age group 20-24, and 67.4 in the age group 25-29. However, these percentages had changed by 2000 to 9.57 and 45.6 respectively (Khari 2000; Al-Rbdi 2005). Also, the demographic survey of 2007 (which is the most up to date data available in the country) shows that 97.4 percent of Saudi females were married before the age of 30, and the mean age of females for the first marriage is 20.4 years and 25.2 for Saudi males (The Ministry of Economy & Planning of Kingdom of Saudi Arabia 2007). Thus, huge changes have been occurring in the age of marriage in Saudi Arabia in the last decade; therefore, this research is going to investigate such changes.

In relation to contraception, data from the World Bank (2001) showed that contraceptive prevalence in Saudi Arabia was 21 percent in 1996. However, data from the Population Reference Bureau (2003) and the World Bank (2007) show an increase in contraceptive use in Saudi Arabia to 32 percent. In contrast, more recent data from the Population Reference Bureau (2012) and also data from UNFPA (2012) revealed that contraceptive prevalence for

3 women aged 15-49 was 24 percent for all contraceptive methods (see Figure 1.2), although it appears that there is low contraception prevalence in Saudi Arabia in comparison to other countries. Contraceptive prevalence is an important factor in investigations of fertility patterns as ‘contraception offers women the benefits of healthier spacing of pregnancies and increased ability to plan the number of their children’ (World Bank 2007, p.15). Nevertheless, it seems that there is a scarcity of information about contraceptive prevalence in Saudi Arabia.

Figure 1.2 Contraceptive Prevalence (% of Women Aged 15-49) in 2011

Source: United Nations 2011, p.1.

Finally, the vast majority of studies support the ‘demographic hypothesis’ which suggests that a decline in infant mortality will influence fertility levels, as the corresponding increase in child survival will contribute to increased motivation for family planning (see for example Cleland 2001; Dribe et al. 2014; Montgomery 2000; Hogan 2010; Wang 2013). In Saudi Arabia, a marked reduction can be seen in the infant mortality rate (IMR) (infant deaths per 1000 live births) from 118 in 1970 to 21 in 2005, and further reduction to 17 in 2012. Also, a significant decline is noted in the under-five mortality rate (per 1,000 live births), from 185 in 1970 to 26 in 2005, and a declined to 19 in 2012 (World Bank 2007; Population Reference Bureau 2012; UNFPA 2012). These are all issues that require research, as this thesis addresses.

The Gap in Knowledge and the Contribution of the Study Understanding fertility patterns and reproductive behaviour in Saudi Arabia is important in making a contribution to the sociological literature which endeavours to understand

4 reproductive behaviour in developing countries. In particular, there have been few studies to date focusing on fertility in Saudi Arabia, which is a major gap in the knowledge concerning fertility behaviour.

A brief summary of the work that has been done in Saudi Arabia is presented below, but suffice to note it is mostly dated, quantitative and limited in nature.

A study undertaken by Al-Etabi (1994) explored the influence of certain socioeconomic factors on the number of children in the family. The study was undertaken in the late 1980s, in the city of Riyadh, Saudi Arabia (sample size 234 males who were heads of households). The study revealed (through Multiple Regression analysis) that husbands with high educational levels had fewer children than husbands with low educational levels. Also, families from rural or Bedouin backgrounds had more children than families from urban backgrounds. Also studying Riyadh, Al-Obaidy (1995) used data from the Residential Survey of 1987 (conducted by the Al-Riyadh Development Authority) to examine the influence of some socioeconomic and demographic factors on family size (sample size of 2780 families). He concluded using applied Multiple Regression analysis, that wives with higher education levels had smaller families than those with lower education levels. Further, Al-Obaidy (1995) found that the average age of marriage of the wives affected family size. Almost 70 percent of wives with an average age at marriage of 20 years or under had an average of four children or more, while almost 60 percent of wives with an average age at marriage over 20 years had an average of three children or fewer. Al- Obaidy (1995) did not find any influence of family income on family size, nor any differences in family size between extended and nuclear families.

Later, Khraif’s (2002) study on the determinants of fertility levels for the whole of Saudi Arabia looked at data from the demographic survey of 1999. This survey was carried out by the Ministry of Economy and Planning of the Kingdom of Saudi Arabia. The sample size comprised 23,000 families from all around the country and it included the following information: age, sex, educational status, marital status, number of children ever born, males and females, number of live or dead births during the 12 months preceding the census, deaths during the 12 months preceding the census by administrative area and age at death, and type of housing unit. Khraif (2002) used multiple regression analysis on a sample of 5388 married women aged 50 years and younger. The findings showed that wives who married before age 18

5 had a Total Fertility Rate (TFR) of 5.94, compared to wives who married after 24, who had a TFR of 3.21. Further, the study found that parents’ education had a significant influence on fertility levels. Hence, the TFR for illiterate parents was 6.6, but 5.7 for parents who could only read and write, 4.7 for parents with primary education level, 3.9 for parents with secondary levels of education, 3.2 for parents with a tertiary level of education, and 3.1 for parents with university education. Moreover, the study showed that the Total Fertility Rate (TFR) was 4.5 in families where no infant mortality occurred, but was 7.43 in families where one infant death had occurred, and 9.3 in families where two or more infants had died.

From these studies it is apparent that there is a gap in the knowledge and understanding of fertility in Saudi Arabia. The few studies carried out are now dated and used quantitative methods only. Also, to date, most research has focused on the city of Riyadh. No study has yet been undertaken using mixed methods (quantitative and qualitative) to examine people’s viewpoints regarding their own reproductive behaviours, beliefs and concepts. Moreover, no work exists which examines the differences or similarities in perspective between men and women. Therefore, such an in-depth qualitative approach would be an invaluable addition to the literature. Additionally, previous researchers who have studied fertility have been male, despite recommendations (by Al-Etabi 1994; Al-Obaidy 1995; Khraif 2002) that future studies should be undertaken by females. For example, in his studies, Khraif (2002) refers to the difficulty of gaining detailed information from women due to the extremely sensitive subject and the private nature and habits of Saudi society. Therefore, fertility research undertaken in Saudi Arabia by a woman is liable to produce some original and interesting results, because a female researcher can collect data through in-depth interviews directly with women on sensitive issues, which has not been done before. Hence, this study will contribute towards filling the gap in the sociological literature about fertility patterns and reproductive behaviour in Saudi Arabia through exploring the influence of the gender system, social networks and Islamic perspectives (as a major part of the social context in Saudi Arabia) on reproductive behaviour. No study undertaken so far in Saudi Arabia has covered these issues.

There is extensive literature in social science and demography which covers different angles concerning fertility behaviour in developed and developing countries, yet there is a need for further understanding of the dynamic of reproductive behaviour and fertility change in the developing world, and in particular Arab countries, with emphasis on the Muslim context

6 (however, a detailed review of the literature that covers different sociological thoughts and contexts and the gaps in the literature will be covered in Chapter Two).

Therefore, this study will try to make a contribution to the sociological and demographic literature, and fill that gap mainly with respect to the most influential variables that could affect fertility behaviours. In this study, three key variables have been identified and each is discussed below.

Firstly, it was important to investigate the relationship between socioeconomic and demographic factors and reproductive patterns. A huge body of literature supports the idea that differences in fertility patterns can be attributed to socioeconomic and demographic factors. First, the demographic transition theory emphasises the role of the socioeconomic development that accompanies modernisation and urbanisation on fertility patterns (Caldwell 1982; Goode 1963; McDonald 1985; Notestein 1953). Further, many studies in developing countries endorse the importance of socioeconomic and demographic factors in fertility research. For example, Bollen et al (2007) note that in most studies concerning fertility behaviour, socioeconomic and demographic factors are considered important key determinants of childbearing. Also, Ushie et al (2011) highlight the importance of socio-cultural factors and economics in determinants of fertility differences, although they focus on age of marriage, education status and contraceptive use (see also: Acharya 2010; Bongaarts 2006, 2010, 2012; Kravdal 2012; Nag and Singhal 2013). Regardless of the huge body of literature that relates socioeconomic and demographic factors to differences in fertility patterns, it seems that there is a gap in knowledge concerning the understanding of this relationship, as each researcher highlights certain aspects while excluding others. Also, most researchers implement only a quantitative approach, while very few apply qualitative approaches.

This study provides further support for this important relationship in different social and cultural contexts, and presents quantitative and qualitative information about the dynamics and insights of this relationship, which will fill this gap and offer interpretation and reasoning from society members. This study will investigate the influence of culture, gender, and religion on peoples’ behaviour.

7 Also, many researchers examine socioeconomic influence only through the following aspects: education levels, occupation status, and family income. In contrast, the present study investigates the preceding aspects along with the effect of age of marriage, value of children and family, and the preference for male children, in addition evaluating parents’ experiences, opinions and reasoning, and the implications of these regarding reproductive behaviour.

Second, to establish a comprehensive understanding of fertility patterns in Jeddah, Saudi Arabia, it was also important to draw attention to the influence of the gender context on reproductive decision-making. This focus was in response to a sizeable body of theoretical literature which stressed the interaction of gender equality, women’s status and fertility behaviour (Cain 1993; Caldwell 1983; Chafetz 1984; Folbre 1983). For example, in his article about gender equity in theories of fertility transition, McDonald (2000) argues that the demographic transition in the West has been related to augmentation in gender equality over time in family-oriented and individual-oriented institutions (p.435). The significance of the impact of the gender system on reproductive decision-making has been stressed elsewhere (Mason 1997, 2003; Malhotra 2012; Moghadam 2003, 2005; Upadhyay and Karasek 2012; Unterhalter and North 2011) and this thesis therefore contributes to the literature explaining gendered fertility patterns. For example, from their studies in many developing countries, Mason and Smith (2000), using personal interviews with married women and their husbands, found that women’s status influenced reproductive behaviour. In contrast, Lee-Rife et al (2010) undertook a study which used data from United Nations World Population Prospects from 30 low and middle income countries to reveal that fertility decline fosters shifts in the gender dynamic regarding women's education and participation in the labour force.

Reviewing the sociological and demographic literature concerning the relationship between gender and fertility behaviour revealed limited literature. More so, most of the literatures were examining this relationship, especially the feminist scholars, from the experience of fertility decline in the western countries. Even though some studies have been undertaken in developing countries regarding this issue, there still remains a dearth of literature which focuses on women’s status in the Arabic and Islamic world, and in particular, women’s role in reproductive decision-making there. Also, as most of these studies depended on women's education and participation in the labour force as a measurement for women's status, they offered very limited information about gender systems in the society. Very few studies used

8 several dimensions of women's status and most scholars agree that applying several dimensions is a challenging issue in fertility research. Also, few studies explore the influence of inter- relationship between gender, patriarchy and religion on reproductive behaviour (see Chapter Two for a detailed literature review).

Therefore, this study has tried to fill this important gap in the literature by examining women’s status in relation to their role in society, which is important in exploring reproductive decision- making. Similarly, the effects of patriarchy and religious beliefs, which underlie the gender context and greatly affect reproductive decision-making in Saudi Arabia, were considered. Also, this study explored women's status and gender relationship by using different indicators including: women's education, women's participation in the labour force, gender roles (division of domestic labour), permission issues (women seek their husband's permission to leave the house and make purchases), and reproductive decision making (discussing reproductive decisions and power in fertility decisions). By doing so, this study hopes to achieve comprehensive and thorough insights into the gender system in Saudi Arabia and its relationship with fertility behaviour. In addition, this information is intended to be valuable to the sociological literature concerning gender systems in the developing world in both an Arabic and Islamic context.

Thirdly, this study focuses on understanding the effects of social networks on reproductive behaviour, as these are considered vital in any study attempting to understand fertility patterns (Kohler 2001, 2013). This is because many studies, particularly in developing countries, have found that the reproductive decisions of couples are greatly influenced by other members of their social networks. Cleland et al (2011) observe that research about fertility change in developing countries has found that the diffusion of modern contraception through social networks significantly changes fertility behaviour and increases contraceptive use. Social networks are truly important, especially in traditional societies where women largely depend on their social networks for building up their knowledge and information about contraception. For example, Youm (2011,p.1) notes that couples need information about other couples’ fertility decisions for their own decisions and also normative pressures from other couples or friends are crucial in the dynamic process of fertility change. Social networks are a major conduit both for information and normative constraints (See also: Bongaarts and Watkints 1996; Gandhi 2013; Khan et al. 2012).

9 Moreover, the broader context of cultural factors, ideas, and attitudes could also influence childbearing decisions. This viewpoint has been supported by the ideational theory, which emphasises the role of cultural values in determining cross-national dissimilarity in fertility patterns (Cleland and Wilson 1987; Hirschman and Young 2000; Lesthaeghe 1983, 2010, 2014). Beekle and McCabe (2006, p.270) state that ‘social and cultural norms, values, people’s beliefs, behaviours, gender roles and social networks influence people’s choices about family planning’.

However, most of the studies which explore the association between social networks and contraceptive use depended on abundant and valuable information from surveys done by the Demographic Health Survey (DHS) and the World Fertility Survey (WFS). Further, many of these studies examined this relationship in societies where family planning programmes exist, which offer efficient support to contraceptive knowledge in the society (for example, Kohler 2001, 2013; Khatun 2011; Odwe and Khasakhala 2013).

There is scarce information regarding contraceptive use and family planning in the Gulf region. Also, few studies investigate the effect of religion on family planning and contraceptive use, in particular in the Islamic context (even the few available were mostly outdated, as for example, Hasna 2003; Omran 1992; Obermeyer 1992). Therefore, this study aspires to provide beneficial data in respect of contraceptive use and family planning in Saudi Arabia, which could supply important information for future research in other Gulf countries and in general in other countries with an Islamic context.

Also, the cultural context in which social networks developed in Saudi Arabia is considered an important focus of this research, as no study in Saudi Arabia has so far covered this issue. The influence of culture and social networks is essential in the Saudi context, as such a context is based on close and intimate relationships between the individual and their extended family, along with community social networks, which overshadow their perspective.

10 Study Justification

Contribution to Global Concerns about Rapid Population Growth

This study will contribute to debates about population growth. The overall global population has been witnessing a definitive trend of growth, which is putting huge pressure on the Earth’s resources. The rate of this growth, however, is not uniform across all regions. According to demographers, in mid-2005, the global population reached 6.5 billion, and became 7 billion in 2012 (see Table 1.1); eighty two percent of the world’s total population live in developing countries, while 17.8 percent live in developed countries (United Nations 2011). The World Population Prospects of United Nations (2005, 2012) has made various projections of World population in 2050, depending on whether and how the total fertility rate (TFR) changes. The medium variant assumes that the TFR will converge at 2 children by 2050, giving a 2050 world population of 9.8 billion and exceeding 10 billion in 2100.

If fertility were to remain about half a child above the levels projected in the medium variant, world population would reach 10.6 billion by 2050 and 15.8 billion by 2100. The high variant assumes that the TFR will be 0.5 higher than the medium variant and gives a 2050 world population of 10.6 billion. The low variant assumes the TFR will be 0.5 lower than the medium variant and gives a figure of 7.7 billion (United Nations 2012).

Table 1.1 Population of the World, 1950, 1975, 2005, 2012 and the Projection Variant of 2050

Population (millions) Population in 2050 (millions) Major Area 1950 1975 2005 2013 Low Medium High Constant World 2 519 4 074 6 465 7 162 7 680 9 076 10 646 11 658 More developed regions 813 1 047 1 211 1 253 1 057 1 236 1 440 1 195 Less developed regions 1707 3 027 5 253 5 909 6 622 7 840 9 206 10 463 Least developed countries 201 356 759 898 1 497 1 735 1 994 2 744

Africa 224 416 906 1 111 1 666 1 937 2 228 3 100 Asia 1 396 2 395 3 905 4 299 4 388 5 217 6 161 6 487 Europe 547 676 728 742 557 653 764 606 Latin America and the 167 322 561 617 653 783 930 957 Caribbean North America 172 243 331 355 375 438 509 454 Oceania 13 21 33 38 41 48 55 55 Source: United Nations, World Population Prospects 2005, p.1 and 2012, p.2.

Note: While the TFR is varied in these projections for 2050, the mortality assumption is fixed (to maintain reach to highest and lowest rate) as is that for international migration.

11 According to data from the United Nations Population Fund (UNFPA 2012), the average population growth rate is around 1.1 percent for the whole world, 0.3 percent in the more developed regions, 1.3 percent in the less developed regions, and 2.2 percent in the least developed countries. Therefore, population growth in the developing countries will continue at high levels (See Table 1.1). This rapid population growth will cause extra burdens and pressure on socioeconomic development and living standards in those developing countries.

As the fertility level is a major determinant of population growth, it is important to understand fertility levels in developed and developing countries. More than one billion people are expected to be in their peak reproductive ages of 15 to 29 years during the next two decades in developing countries (Office of Technology Assessment 2003, p.4). Based on information from the World Population Prospects (2005), the average global fertility rate was 2.65 children per woman in 2000 – 2005. This was 1.56 in the more developed regions, 2.90 in the less developed regions, and in the least developed regions it was 5.02 (See Table 1.2). More recently, reveal a slight decline in the TFR, the global fertility rate is 2.53 in 2005-2010. This is 1.66 in the more developed regions, 2.69 in the less developed regions, and in the least developed regions it is 4.53.

Table 1.2 Total Fertility Rates for the World, 1970-1975, 2000-2005, 2012 and the Projection Variants of 2045-2050 Total Fertility (children per women) Major Area 2045-2050 1970- 2000- 2005- Low Medium High Constant 1975 2005 2010 World 4.49 2.65 2.53 1.56 2.05 2.53 3.50 More developed regions 2.12 1.56 1.66 1.34 1.84 2.34 1.67 Less developed regions 5.44 2.90 2.69 1.59 2.07 2.56 3.69 Least developed countries 6.61 5.02 4.53 2.08 2.57 3.05 5.56

Africa 6.72 4.97 4.88 2.03 2.52 3.00 5.50 Asia 5.08 2.47 2.29 1.42 1.91 2.41 2.98 Europe 2.16 1.40 1.54 1.33 1.83 2.33 1.45 Latin America and the 5.05 2.55 2.30 1.36 1.86 2.36 2.69 Caribbean North America 2.01 1.99 2.02 1.35 1.85 2.35 1.99 Oceania 3.23 2.32 2.47 1.42 1.92 2.42 2.72 Source: United Nations World Population Prospects 2005, p.6 and 2012, p.12.

A comparison of the total fertility rate for the three periods (1970-1975), (2000-2005) and (2012) shows that while significant decline has taken place in developing countries (See Table

12 1.2), the less developed regions have almost double the fertility level of the more developed regions, and the least developed regions have almost treble the fertility level. Developing countries would not reach below replacement level until 2050 (this is close to 2.1 children per woman) thus the continuing high fertility levels in these countries will cause rapid population growth which will put pressure on resources in these countries.

However, despite these global concerns regarding population growth rates, some of the developing countries, and especially the Middle Eastern countries, consider issues other than population problems, such as economy, are restricting their socioeconomic development. For example, Olmsted (2003, p.73) notes that: ‘some governments in the Middle East and North Africa (MENA), have argued that higher fertility rates are important and necessary to ensure a large indigenous labour force for the future’.

Despite this opinion, it is clear that some developing countries do face socioeconomic difficulties as a result of rapid population growth, which encourages the governments of these countries to adopt population policies aimed at reducing the fertility rate (for example countries such as Turkey, Tunisia, Egypt, Morocco and Iran have adopted family planning programmes since 1965). The adoption of family planning programmes in those countries (and also in many other developing countries) may help to reduce fertility levels, which will then influence population growth (Casterline 2011; Gupta 2013; Mirkin 2010; Richards and Waterbury 1998; Shukri 1996). The adoption of population policies in these countries could also be a result of women’s movements that highlight the struggle for civil, political, and social rights (a struggle which is supported by global organisations, such as the United Nations, that are concerned about human rights and women’s rights). The Arab Human Development Report (2005), which looked at the role of the Arab women’s movements, stated:

The global discourse on women has been a significant influence on the Arab women’s movement and a driving force in the latter’s reformulation of its goals and perseverance in its struggle. It has also provided support and backing through networking, which has influenced the organisational structure of women’s movements in the Arab countries as elsewhere in the world. The efforts of these women’s movements are reinforced by several international conferences such as the World Conference on Human Rights of 1993 in Vienna, the

13 International Conference on Population and Development of 1994 in Cairo, and the Women’s World Conference in Beijing in 1995 (2005, p.131).

Furthermore, the annual report of UN women (2011-2012) noted that, through the partnership between the United Nations and women's movement and governments in different countries, their main focus will be to achieve significant progress in gender equality and empowerment of women in politics and economics, and reduce violence against women.

In the case of Gulf Arab states, Freedom House (2009) reports of women’s rights in the Middle East and North Africa (from 2004 through 2008), show that women in the Gulf Arab states are making some progress in their struggle to achieve fundamental rights (women in Kuwait were able to vote and run for office in the parliamentary elections in 2005. In Bahrain and the UAE, the first women judges were appointed in 2006 and 2008, respectively). However, the patriarchal social context makes it more difficult for these women’s movements to operate in such a conservative context.

Indeed, as one of the more patriarchal Arab states, Saudi Arabia has not implemented any family planning programmes to date. The United Nations Population Fund (UNFPA 2011) and World Population Prospect (2015) indicate that the total population of Saudi Arabia is 31.540 million, and the average population growth rate is around 2.1 percent (2010-2015). Thus, it is clear that Saudi Arabia has the highest total fertility rate (TFR) among the Gulf countries as well as most of the Arab countries. Statistics from the United Nations Population Fund (UNDP 2005) show that in 2004, the total fertility rate (TFR) in Saudi Arabia was 4.1, compared to Kuwait at 2.4, and Qatar at 3.0 (See Figure 1.1), while more recent data from the Population Reference Bureau (2012) shows that the TFR in Saudi Arabia is 2.8, while another report from the United Nations (2011) revealed that it was 3.2 for the period from 2005-2010.

Therefore, the government of Saudi Arabia now faces significant challenges in balancing efforts to hasten the development of socioeconomic resource infrastructures, as required by a burgeoning population, with efforts to raise the standards of efficiency of its economy to establish full global competition. In order to enhance Saudi Arabia’s position in the global economy, it needs to assign greater efforts to attain the Millennium Development Goals (MDGs); this then could support the progress of global development. According to the (2006)

14 United Nations report on Saudi Arabia, the government of Saudi Arabia is facing challenges in fulfilling its Millennium Development Goals (MDGs) with respect to population issues. Thus, this study will provide essential information which may aid future planning strategies with respect to the Millennium Development Goals in Saudi Arabia.

The latest report by the United Nations on the Arab world (2010) notes that the Gulf countries, along with the other Arab countries, as a consequence of rapid population growth, will be held back in their progress toward achieving the Millennium Development's Goals, which include these issues; poverty alleviation, job creation, social welfare provisions, investing in skills development, strengthening social protection mechanisms, supporting fundamental and labour rights, and promoting gender equality.

Helping to Address Society’s Needs

A second rationale for the study is that it will contribute to the overall development of social well-being in Saudi Arabia, and will aid in future planning strategies, particularly through providing qualitative information about reproductive behaviour, which is so far not covered in studies of Saudi Arabia. The Saudi Arabian government is becoming increasingly aware of the needs and the processes which will enable it to become a viable socioeconomic entity in the present and future global arena (The Human Development Report of Saudi Arabia 2003). For example, King Abdullah has stated that the government plans to encourage women’s participation in the development process, but that this participation will happen on the basis of cultural traditions and values of the Saudi Arabian society. The King noted ‘we will leave no door closed to women, but with the condition that doors will be opened only as long as it involves no violation of our religion and ethics’ (Doumato 2001, p.174).

Nonetheless, in Saudi Arabia there is a difference between established or traditional thinking (which is open to change if people deem it necessary) and religion (being sacrosanct and inviolable). It is also true that some who oppose change to tradition blur the line between the two by singularising certain aspects of religious (in this case, Islamic) tenets specifically to encourage a certain cultural mind-set. For instance, the interpretation of the Prophet’s encouragement to ‘go forth and multiply’ is focused upon to justify large family size, whilst the holistic Islamic context stating that it is incumbent on families to be realistic in deciding what

15 number of children they can adequately care and provide for is played down (for support of this viewpoint see for example, Hasna 2003; Obermeyer 1992, 1994; Omran 1992).

However, Saudi Arabian society must now focus on the quality of life for its citizens, especially women. This is important, particularly as the Human Development Index of Saudi Arabia (2007) shows that the gender empowerment level in the Kingdom is relatively low, with a Gender Empowerment Measure (GEM) rank of 92 and value of 0.254 compared to a 14 ranking and 0.783 value in the United Kingdom. Meanwhile, the GEM in Qatar ranks 84th and has a value of 0.374, while the United Arab Emirates rank 29th with a 0.652 GEM value, and Oman ranks 80th and has a value of 0.391 (there is no available data on GEM for other Gulf countries). More recent data from the Human Development Report (2011) revealed that for the Gender Inequality Index (GII), Saudi Arabia ranks at 135, and has a value of 0.646 (United Kingdom ranks 34 at 0.209). Meanwhile, the United Arab Emirates ranks 38th at 0.234, Qatar ranks 111th at 0.549, and Oman ranks 49th at 0.309. Thus, through providing vital information concerning women’s status and fertility patterns, this study could help future planning strategies with respect to broader socioeconomic development and more specifically, women’s needs in Saudi Arabia.

Research Aim

The overall aim of this study is to explain the dynamic of fertility trends and reproductive behaviour in Jeddah, Saudi Arabia. Also, this study seeks to present gendered insights into fertility determinants and examine changes in fertility behaviour.

This main aim is established through the following four objectives:

1- To establish a comprehensive understanding of the relationship between gender system and reproductive behaviour. 2- To determine the role of culture, religion and social networks in influencing family planning decisions. 3- To analyse the changes that occurred in fertility trends in a period of 8 years (2005- 2013). 4- To describe the function of using innovative methods in achieving such a sensitive study in a conservative society.

16 Thesis Structure

This thesis comprises seven chapters. Chapter One is the introduction to the thesis. This includes the statement of the problem and the provision of the study’s justification. The specific study aims are outlined as well as the thesis structure.

Chapter Two is the literature review. This includes a presentation of the sociological literature and theoretical perspectives that can assist in explaining reproductive behaviour and the factors that influence it. This review of the literature identifies key gaps and clarifies the need for more information and better understanding of fertility and reproductive behaviour in Saudi Arabia.

Chapter Three covers the methods used to collect the study data. This study used mixed methods. The chapter outlines the data collection methods of the questionnaire survey and in- depth interviews, and the sampling methods used for each. It also discusses methods of analysis and includes a reflection on ethics, positionality and representation. A justification of the choice of study site (Jeddah) is also provided.

Chapter Four introduces the Kingdom of Saudi Arabia and Jeddah city. This chapter provides a brief introduction to the social context and cultural background of Saudi Arabia and its political, economic and social development. This background will help the reader to contextualise the explanations and interpretations for reproductive behaviour examined later in this thesis.

Chapter Five is the first analytical chapter of this study and explores the continuity and changes in fertility trends within a span of eight years from 2005 to 2013. This is important, as it can help uncover differences in fertility trends, and observe the dynamics of the factors that direct parental choices towards preferred fertility behaviour.

Chapter Six is the second analytical chapter of this study. This chapter discuss the study results, providing explanations from participants’ perspectives from in-depth interviews and reflects on the theoretical background. Also, this chapter assists in building knowledge that could help to improve the explanation of reproductive behaviour and moves us towards establishing a comprehensive understanding of fertility patterns in Jeddah, Saudi Arabia. 17 Finally, Chapter Seven includes the concluding remarks. It identifies the important findings of this study and their contribution to knowledge about reproductive behaviour in Saudi Arabia in particular, and to the sociological literature more generally. It also presents some policy implications and makes suggestions for future research.

18 Chapter Two The Social Context and Reproductive Behaviour

Introduction

The previous chapter presented the introduction and the focus of the study, along with the justifications for this study. This chapter presents the sociological literature and theoretical perspectives which can assist in explaining reproductive behaviour patterns and the factors that influence them. It will first be important to review the theoretical approaches to changes in fertility behaviour, which include; Demographic Transition Theory, Caldwell’s Theory of Intergenerational Wealth Flows, Economic Theories of Fertility, and Ideational Theory. Next the literature concerning the relationship between the social structure and reproduction is reviewed, since the social structure determines the socioeconomic and demographic factors that are related to childbearing. It focuses particularly on the following socioeconomic and demographic factors: fertility and nuptial regimes; the value of children; and sex preference. Thirdly, it is also important to review the literature regarding the influence of the gender system on reproductive decision-making: in particular, given the effect of patriarchy, women’s status in relation to their role in reproductive decision-making, and the influence of women’s education and employment status on fertility behaviour. Fourthly, it is essential to review the literature concerning the effect of social networks and the broader cultural context on decisions regarding childbearing, as these are considered vital in any study attempting to understand fertility patterns. Finally, the link between Islam and family planning in the Saudi Arabian context will be explored.

Theoretical Approaches to Fertility Changes

Various theories and approaches have been provided to explain and interpret the changes in fertility trends. This understanding of changes in fertility behaviour comprises a major and important component in the field of demography. This study will utilise a broad theoretical framework that basically intends to illustrate and explain the change in fertility behaviour, and includes four major theories; the Demographic Transition Theory, the Intergenerational Wealth Flow Theory and the Economic Theories of Fertility, the Ideational Theory, and the Embeddedness Theory.

19 The Demographic Transition Theory led demographic research for many years, and many demographers believe it has room for almost every variable (Hirschman 1994; Kohler 2001). Then from the mid-70s to the beginning of the 80s two major theories were established: those are the Intergenerational Wealth Flow Theory and the Economic Theories of Fertility. Lastly, after the further attention that was given to the cultural influence on fertility differences, the Ideational Theory was founded.

However, many scholars believe that it is difficult to apply one theory or approach in order to explain fertility behaviour, as they think that all the present theories are insufficient on their own. In order to have a full sociological understanding of fertility behaviour, it is important to broaden the conceptual ground of the analysis (Greenhalgh 1995; Hirschman 1994; Mason 1997; McNicoll 1980). Therefore, all these theories will be drawn upon in the data analysis of this study, and contribute to the conceptual framework of the research.

The Demographic Transition Theory The principal notion of the Demographic Transition Theory is the modernisation process conceived as urban industrial society that led to a decline in fertility (the basis of this theory was developed by Warren Thompson in 1929, but it become apparent as the Demographic Transition Theory in the 1940s, mainly through the empirical work of Frank Notestein in 1945). The basic argument is that the socioeconomic development that accompanies modernisation facilitates significant improvements in the general health of the population, which then decreases mortality levels. According to Davis (1963) and Notestein (1953), this decline in mortality reduces incentives to have large families and eventually leads to low levels of fertility (Hirschman and Young 2000, p.13). Furthermore, there is an additional reason for fertility decline in the urban modern society, which is the rise in the cost of child rearing in such societies. This factor indeed ‘discourages most parents from having large families’ (Mason 1997, p.444). Notestein (1953) stresses several key factors that explain fertility decline in modern societies, which include: the extensive adoption of contraception by married couples, the decrease of child contribution to the family income, and the increase of women’s participation in the labour force, which enhances their economic independence and reduces their centralization on their domestic role (Hirschman 1994). Therefore, Notestein (1953, p.16) attributes the ‘emergence of a new ideal in matters of family size’ to the influence of modernization on producing changes in people’s way of thinking and attitudes as the influence

20 of traditional values and norms weaken.

The Demographic Transition Theory provides an explanation for shifts in developed countries (Western Europe and North America), from slow population growth (consisting of high fertility and high mortality), to rapid population growth (consisting of high fertility and low mortality), and then to slow population growth (consisting of low fertility and low mortality). Notestein (1953), points out that the demographic changes that took place in developed countries were a reflection of the structural transformation from traditional to modern societies.

While the Demographic Transition Theory is a major theory that stimulated much research in the field of demography, it has also faced criticism. One of the main criticisms is the inconsistent relationship between modernisation and fertility decline from the Princeton University-based European Fertility Project under the guidance of Ansley Coale (Cleland and Wilson 1987; Knodel and Van de Walle 1979). Indeed, the empirical research provides evidence of downward fertility transitions starting in many developing countries without significant improvement in socioeconomic development (Bongaarts and Watkins 1996; Amin and Lloyd 2002). Nonetheless, the Demographic Transition Theory remains important in demography. Mason (1997, p.444) states that, ‘Demographic Transition Theory has ideas that are hard to ignore and that live on despite the barrage of criticism to which the theory has been subjected. In its original form, however, the theory is incomplete’. Therefore, it is not enough to depend only on this theory in order to offer a full interpretation of fertility changes, and thus it could be better to consider other theories that explain fertility change.

The Intergenerational Wealth Flow Theory

Caldwell (1982) states that the flow of wealth between children and parents is a key determinant of the fertility level in the society. According to Caldwell (1982), the flow of wealth includes the resources and services that children provide for their parents, such as economic support, social status, care in old age and preservation of the family name. Caldwell (1982) argues that in traditional societies, the flow of wealth from children to parents is positive, but in modern societies, this flow of wealth becomes negative. In traditional societies, children represent a source of wealth to their parents, which then rationalises the high fertility

21 levels, while in modern societies this flow of wealth from children to parents becomes weakened, which then leads to a significant decline in fertility levels. The shift in the flow of wealth between parents and children occurs as a result of two major changes that take place in the process of socioeconomic development; mass education (which changes the function of children from producers of income to dependents on parents because they spend their childhood and early adulthood in schools) and the emotional nucleation of the family (this involves the diffusion of the centrality of the nuclear family model in which parents do not expect any economic return from their children).

Many sociologists (Hirschman 1994; Mason 1987) have noted that Caldwell’s theory may apply to sub-Saharan African societies, where the relationships between extended family members are strong and they benefit from each other (much of Caldwell’s fieldwork was conducted in Africa). However, Caldwell’s theory does not apply effectively to other developing countries. For example, in Taiwan, Freedman (1979, p.7) found that despite massive socioeconomic development and a rapid fall in fertility in 1973, over 80 percent of elderly parents lived with a married son if they had one. This means that modernisation did not weaken the flow of wealth from children to parents (See also, Lesthaeghe 1980; Thornton and Fricke 1987).

Economic Theories of Fertility The Microeconomic Model

The main focus of the microeconomic model of fertility is that the demand for children is determined by economic factors, as parents make fertility decisions based on two important factors: family income and time constraints (Becker 1960). According to this model, parents decide their fertility behaviour after considering the cost and benefits of children as well as the time spent on childbearing and rearing. There are two important concepts in this model that could explain the decline in fertility (or the preference for a low fertility regime): the trade-off between quantity/quality and the opportunity cost of the mother’s time. First, parents’ high aspirations for children might be related to a preference for low fertility, as the parents prefer to invest more in each child, so they exchange 'child quantity' for 'child quality'. Second, the socioeconomic development and modernisation of a society increases female education and

22 economic opportunity. In such a context, a mother’s time has economic costs related to the labour market (the income she could earn from paid work) and the number of children is negatively related to the income of the mother owing to the amount of time required in the caretaking of children (Donaldson 1991; Leibenstein 1974).

Mason (1997, p.444) criticises this theory as it ignores important factors such as ‘the environmental and institutional conditions that change costs, income, or preference and thereby trigger fertility decline.’ However, it can be said that the microeconomic model of fertility directs the demographer to give more attention to the influence of economic factors.

Easterlin’s Framework

Easterlin (1975, 1976) developed a broader and more distinctive framework than the microeconomic model. He explained fertility behaviour through three key determinants: first, the demand for children, which involves the number of surviving children that parents desire if birth control is low cost; second, the supply of children, which involves the number of surviving children that parents would have if they did not intentionally practise any restriction on their fertility; and third, the costs of fertility regulation, which involves the psychological, temporal and monetary costs to acquire knowledge of contraceptive methods and how to use them.

According to Easterlin (1975), the demand for children means that infant and child mortality rates might be connected to fertility behaviour. So, if the infant and child mortality rates are high in a society, fertility levels will also be high and if the infant and child mortality rates are low, fertility levels will be low (as seen in the Demographic Transition Theory). Additionally, modernisation in the society links fertility decisions to the substitution of quantity of children in favour of the quality of children. The supply of children depends on ‘natural fertility which is independent of voluntary control on coital frequency, fecundity, or foetal mortality, since it relates to the number of births a household would produce in the absence of intentional limitation of fertility. Natural fertility depends partly on physiological or biological factors and partly on cultural practices’ (Easterlin 1975, p.56). Lastly, the costs of fertility regulation depend on the attitudes towards contraceptive methods and the availability of these methods. If

23 birth control is high cost this might lead to a low level of practice of birth control in the society, which could increase unwanted pregnancies.

One of the criticisms that this theory faces is that it ignores different fertility patterns in the pre- transition period (by using the term natural fertility to describe fertility patterns in traditional societies before modernisation). Also, similar to criticisms of the Demographic Transition Theory, Easterlin’s framework does not clarify the socioeconomic factors that explain the demand for children (Hirschman 1994). However, despite this criticism, many scholars think that Easterlin’s Framework is important, as it improves the understanding of fertility decline (Bulatao and Lee 1983; Mason 1997).

Ideational Theory

This theory was developed as a reflection on the inability of the microeconomic approach to provide a full interpretation of the fertility decline that occurred in European countries between 1963 and 1970. Ideational Theory emphasises the relationship between culture and fertility behaviours; the main hypothesis in this theory is that cultural values can explain the variations in fertility behaviours among different groups or regions even if they have equivalent socioeconomic characteristics. Lesthaeghe (1980), through analysis of the (1963-1970) marital fertility decline in West Europe, states, ‘fertility transition in Western Europe followed linguistic and cultural boundaries and diversifications that emerged in the timing and format of marital fertility decline were closely associated with the development of differential and sometimes compartmentalised ideological codes,’(p.539). Furthermore, Lesthaeghe and Surkyn (1988), in their article about cultural dynamics and economic theories of fertility change note that differences in religious beliefs, individualism, and secularism are important cultural elements that help to explain historical variations in European fertility patterns.

Lesthaeghe (1980 and 1988) notes that fertility transition in Western European countries in the period from 1880 to 1910 happened in most areas that share similar western culture. Although there was some difference in the timing of that transition between these European areas, it seems that the onset of fertility decline was occurring at a similar time in European regions holding similar cultural backgrounds. The most famous example that Lesthaeghe provides to support his ideas is the case of Belgium, as it comprised two different regions and cultures,

24 Walloon and Flemish (French-speaking and Dutch-speaking respectively). The onset of fertility decline was earlier and faster in the Walloon area, even though both areas have similar socioeconomic characteristics.

Furthermore, in an addition to Ideational Theory, Cleland and Wilson (1987) developed the diffusion of innovation approach. This approach suggests that the diffusion of fertility control as an innovation is the basis of fertility decline in the developed world and many developing countries. Cleland and Wilson (1987, p.24) note, ‘evidence from developing countries such as Sri Lanka and Indonesia revealed changes across socioeconomic sectors, no doubt a reflection of a more egalitarian society or of effectiveness of government policies in promoting the ideas of smaller families or birth control’ (For Sri Lanka see Iqbal and Cleland 1981; for Indonesia, Budi and Hatmadji 1982; also for more support of the diffusion approach see Montgomery and Casterline 1993; Retherford and Palmore 1983).

Many scholars criticise ideational theory as it makes culture the prime factor that causes fertility decline and disregards the socioeconomic explanation of fertility changes (Davis et al. 1986; Hirschman 1994; Mason 1992). However, Kohler (2001, p.7) criticises the theory for its unclear model, stating that, ‘the mechanisms leading to these alterations in the Ideational Theory remain largely unexplained.’ However, this theory highlights the importance of cultural factors linked to fertility behaviour, which offer a complementary explanation of fertility behaviour.

Embeddedness Theory

This theory demonstrates the importance of the individual’s surrounding or social network in influencing his or her choices and the decisions he/she makes. Radil (2011, p.109) notes that ‘the term embeddedness has become popular in discussing social networks to illustrate the many situations that social actors create and must negotiate in their behaviour. Embeddedness is a recognition that relationships, distance, and place-specific social relations are intertwined to situate actors’. Also, Garland and Alestalo (2014, p.39) state, ‘embeddedness refers to how connected an individual is in the local network and how her/his actions might potentially impact others’.

25 The term “embeddedness” has a long past in the social sciences. However, the conceptual idea of this term traces back to the economic historian Karl Polanyi, who, in 1957, wrote that the human economy...is embedded and enmeshed in institutions, economic and non-economic (Bögenhold 2013; Koon et al. 2012; Power 2011). Nonetheless, this concept becomes more popular by the work of economic sociologist Mark Granovette. Granovette (1985) argued for the significance of understanding economic action in social context, as this context influences human behaviour, and thus, his emphasis is on the role of concrete personal relations and structures or networks. Further, Granovette (1985, p.487) adds that actors do not behave or take decisions as atoms outside a social context, and their attempts at purposive action are instead embedded in concrete, ongoing systems of social relations (Bernardi and Klärner 2014; Daoud and Larsson 2011; Garland and Alestalo 2014).

Chua et al (2010, p.87) said that ‘the most commonly invoked argument for the positive effect of embeddedness on information transfer is that embeddedness increases trust. When trust exists between two individuals, they are more willing to share information or knowledge with the other party’. Burt et al (2013) Kewell (2006) and Walther (2015) noted that high embeddedness between people in a social network provides trust, and this trust could decrease risks and increase opportunities which then allow exchange of knowledge, resources, and decision strategies.

Social embeddedness and social networks as concepts have been used by sociological scholars as instruments for explaining behaviour. Toumbeva (2012, p.8) notes that ‘expanding the concept of embeddedness to also encompass the family microsystem would provide a more complete picture of all forces that shape individual decisions, attitudes, perceptions, and behaviours’. However, Power (2011) and Kim and Benbasat (2012) wrote that individuals are embedded and integrated in enduring relations within their social networks that impact their behaviours and decisions. Further, Welter (2011) emphasises the emotional understanding, encouragement, and support that social networks can provide, which then links between social and societal contexts.

Embeddedness theory has been used in several areas of social science research, even though the most common use of it is in economic sociology (Bögenhold 2013; Chua 2010; Daoud and Larsson 2011; Kim and Benbasat 2012; Power 2011; Welter 2011; Walther 2015). However, it

26 has also been applied in explaining criminology (Radil 2011; Taniguchi et al. 2011; Tita and Radil 2010, 2011; Weisburd et al. 2009) and in demography (Bernardi and Klärner 2014; Findlay et al 2015; Koelet et al. 2014; Willekens 2014).

Social Structure and Fertility Behaviour

Fertility and Nuptial Regimes

The prevalence of marriage in society and the age at marriage, particularly for girls, are two important factors affecting fertility levels (particularly in countries where bearing children is restricted to marriage). Marriage at an early age tends to increase women’s exposure to conception. This relationship between nuptiality and fertility behaviour has been recognised since the important work of Davis and Blake (1956) as an intermediate fertility variable. Through their search for explanations in variations in fertility levels, Davis and Blake focused on the factors that directly determine the level of fertility. They believed that economic, social and cultural factors are operating through intermediate variables, which are marriage, coital frequency, contraceptive use, abortion, post-partum infecund ability, fecund ability, spontaneous intrauterine mortality, and permanent sterility. However, many researchers (Hobcraft and Little 1984; Menken 1987) deem the Davis and Blake model very complex and it is difficult to apply because of the lack of appropriate data. Bongaarts (1978) adapted the Davis and Blake framework by focusing on only four intermediate or proximate variables, which are marriage, contraception, post-partum infecund ability and induced abortion. Bongaarts tested his model in several studies (1999, 2003, 2006, 2010 and 2012) by using data from the World Fertility Surveys plus the Demographic and Health Surveys of many developing countries. He noted that a delay in age at marriage is associated with significant reduction in fertility levels in many developing countries. However, the intermediate variables are out of the scope of the current study, due to the absence of statistical data on these, although this framework emphasises the influence of nuptial regimes on fertility, which is one of the factors that this study will consider.

The link between age at marriage and fertility behaviour has also been established by several empirical studies in developing countries. For example, the study of Nag and Singhal (2013) in India, based on survey, included the husband and wife of 1000 families, the age range of 15 to

27 50 years. They revealed that the average number of children ever born per ever married woman was more when a girl married at a younger age: particularly below 18 years; and the average number of children born decreased as her age at marriage increased. The average number of children born was 3.58 when wives were married between the ages of 15.00 and 17.99 and decreased from 3.58 to 2.86 when married between the ages of 18.00 and 20.99 and 21.00 and 23.99 years respectively (p.227). Also, Belayihum’s (2011) study in Ethiopia, with a large survey sample of 635 women aged from 20 to 49 years and married for 5 years and above, found that women who had their children at 19 years old or younger were 64% more likely to have a large family compared to women who had their children at 19 years or older, with adjusted OR=0.36, 95% CI (0.18, 0.68). A further study, by Acharya (2010), in Western Teral of Nepal, collected primary data through surveying 500 households to identify the difference in fertility levels between rural and urban areas. The study concluded that early marriage in a rural area is a significant factor in explaining the high fertility there, that 85 wives’ in rural areas to 5 wives in urban areas had got married below 14 years old, and 284 rural to 35 urban wives had married between the ages of 15 and 19 (p.107). Most studies depend on quantitative analysis or use only quantitative methods, which gives little information about preference for early marriage: the studies did not focus on age of marriage itself or as a major factor though they focus on differences or determinants of fertility levels. Little is known about the determinants of changes in marriage timing.

The Demographic Transition Theory also stresses the indirect influence of the postponement of marriage. Through the process of urbanisation and modernisation many changes occur in society linked to changes in the family structure and gender relations, which cause lower fertility levels (Caldwell 1982; Goode 1963; McDonald 1985). The sociological literature highlights the role of urbanisation in the rise of age at marriage, as urban life opens up new ideas and attitudes, and provides women with varied opportunities outside the household through education and paid work (Caldwell 1982; Hirschman 1985; Thornton et al. 1984).

Many studies also emphasise the role of female education in changing attitudes towards early age of marriage. An example is Palamuleni’s (2011) study in Malawi, which used data from the 2000 and 2004 Demographic and Health surveys to examine the effect of education on the timing of marriage in Malawi. The total sample for this analysis comprised 10,600 and 9605 ever-married women aged 15-49 years old in 2000 and 2004 data sets respectively. Palamuleni (2011, p.231) found that women with no education were 97% less likely to marry after age 20

28 relative to the reference category; women with primary and secondary education were 97% and 85% less likely to 17 times and 3 times as likely to marry after age 20 relative to the reference category. Similarly, Kravdal’s (2012) study, based on the analysis of Demographic and Health Surveys of 28 countries in sub-Saharan Africa, found that a one year rise in the average education decreases the odds of first birth by 6.88 (1.0 – 0.932). Also, a study by Bbaale et al (2011) used the Demographic and Health Surveys of Uganda to reveal that for those women with no education, over 83% were married by age 20 compared to only 23% with post- secondary education (p.31).

Surveys by UNICEF (2001) have shown that families from the Middle East, North Africa and other parts of Asia generally marry their daughters at puberty or shortly after. However, with increasing urbanisation and the intervention of Human Rights Organisations (such as United for Human Rights and Amnesty International), some countries have made strenuous efforts to raise the age of females at marriage (for example, Sri Lanka, China, India, Kenya, Nepal, Uganda, Zimbabwe and Senegal, Eastern Europe and the Baltic States) (UNFPA 2003). Despite a shift towards later marriages in many parts of the world, 82 million girls in developing countries who are now aged 10 to 17 will be married before their 18th birthday (UNFPA 2003). A recent report from UNICEF shows that the median age at marriage has increased, depending on data from 47 developing countries. Nonetheless, early marriage is still so common that approximately a third of women aged 20-24 years old in the developing world were married at an early age (UNICEF 2010).

Most Gulf States do not specify a lower age limit for marriage. Historically, boys and girls entered marriage at an early age, and a minimum age for marriage has never been introduced in any Gulf State except for Kuwait, where it is set at 15 years for both sexes. In the remaining Gulf States, it is left to the father or the nearest male relative to decide when their child can sign the marriage contract (Fakhro 1996; Yamani 1996). With more recent data, through her important work that explores the demographic situation in Gulf regions, Mohammed (2003), presents information regarding the age at marriage in the Gulf area (based on data from the Council of Health Ministers of Gulf States in 2000). She notes that the median age at marriage is 17 years; 20 in Kuwait, 19 in Bahrain and Qatar, 16 in Saudi Arabia and the UAE, and 15 in Oman. Unfortunately, new data about the median age at marriage for the Gulf regions is scarce, although some reports show that the age of marriage is rising in many Arab countries, as the young generation spend a longer time in education (the Economist Intelligence Unit

29 2009). However, the most recent information revealed that less than 5 percent of women stayed single into their late 30s in the Arabian Peninsula (Roudi-Fohimi and Kent for Population Bulletin 2007, p.9).

A demographic and epidemiological analysis of Saudi Arabia by the World Bank (2001) showed that in the preceding decade (before 2000), the median age at first marriage for females was 15 years, which has now increased to 17 years. Also, the demographic survey of 2007 (which is the most current data that is available in the country) shows that 97.4 percent of Saudi females are married before the age of 30 years, and the mean age of females for the first marriage is 20.4 years and 25.2 for Saudi males (The Ministry of Economy & Planning of Kingdom of Saudi Arabia 2007). The above data shows that a significant change has occurred in the age of marriage in Saudi Arabia in the last decade, yet early marriage is still common in Saudi Arabia. Therefore, it will be very useful to examine the effect of age at marriage on fertility levels in order to better understand fertility behaviour in Saudi Arabia. Also, it will be useful to explore people’s attitudes towards early marriage through in-depth qualitative research. To date no research has been done on this topic.

The Value of Children, Sex Preference and Fertility Behaviour

Besides the influence of age at marriage on fertility behaviour, there are other significant factors that have an impact on fertility and at the same time are related to and influenced by social context and cultural values. These factors are the value of children and sex preference.

Considerable literature confirms that the change in the value of children was one of the most important factors that caused fertility decline in the developed world. For example, Lesthaeghe’s pioneering work (1980, 1983) argued that the spread of high value aspirations in which people encouraged the individual to achieve their personal goals caused fertility levels to decline in Western Europe. Additionally, Preston (1987) also argues that the spread of the value of ‘responsible parenthood’ influences fertility behaviour by making the parents believe they should provide children with a high quality lifestyle, causing a reduction in family size in developed countries. The Economic Theory of Fertility also highlights the influence of the value of children on fertility behaviour, although it focuses on the economic factor attached to

30 children. These models underline the cost and benefit of children and the trade-off from quantity to the quality of raising children during the process of modernisation.

Further literature focuses on changes in the value of children in developing countries. For example, Caldwell’s (1982) Theory of Intergenerational Wealth Flows notes that the value of having many children declines as the wealth from children to parents shifts from positive to negative, leading to a decline in TFR. Also, Mason emphasises the relationship between the value of children and women's status in affecting reproductive behaviour. Mason's (1987) important work on the impact of women’s social position on fertility in developing countries, suggests four values that are attached to children and related to fertility behaviour. Those values include, ‘the value of children as insurance against a divorce, their value as securers of women’s position in the family, their value for economic or political gain (as a source of loyalty, labour, wealth and household help), and their value as risk insurance (as a source of economic support in widowhood, old age, time of disaster)’ (p.728). Mason supported her proposition by providing other studies that were conducted in different developing countries.

More currently, a qualitative study was carried out by Ibisomi and Odimegwu (2011) in Nigeria which depended on focus group discussions (FGDs), including a total of eighty-nine men aged 35 to 59 years and eighty-five women aged 35 to 49 years, and which represented rural and urban communities. The findings revealed that fertility preference was related to the value that individuals placed on children, their costs and benefits. However, the majority of discussants regarded children as God’s gift, and provided several reasons which influenced their preference for having many children, such as religion, culture and customs, old age care and provision, family business need, death of children, and children supporting each other later in life. Conversely, some discussants mentioned two factors which had a negative impact on their fertility decisions: the economic status of the family; and worrying about the effective guidance and control of the children (p.101-102). This qualitative study provided good insights into behaviour but in a different culture and socioeconomic status compared to Saudi Arabia.

A subsequent study provides a different approach to looking for the influence of old age support and its relation to fertility decisions by giving evidence that good support from the government or a good social security programme could reduce the influence of the preceding factor. The study, conducted by Sen (2013) in India, analyses the data from the National

31 Sample Survey Organization’s 43rd to 64th Round of Household Consumer Expenditure in India (1986-2008) and the World Bank database on national level development indicators for India (1961-2010). The findings from this paper indicate that the provision of old age and financial security may allow people to become more independent and rely less on some form of economic gift from their offspring; hence young parents will have fewer children, as they are not their sole source of income after they grow old and retire from employment.

However, Westoff (2010, p.49) in a report on DHS of 60 developing countries, notes that the number of children desired is declining in most of the developing world, with the exception of some countries in western and middle sub-Saharan Africa, where, on the whole, an average of 6.0 children are still desired. In southern and eastern Africa, the mean number desired is 4.5. In contrast, in Asia and in North Africa the average is 2.9 and in Latin America and the Caribbean 3.0 children. Meanwhile, Lunani’s (2014) study in Kenya and a World Bank report on determinants and consequences of high fertility in developing countries (2010) revealed that the value placed on children and its influence on the demand for children reflects several factors such as culture, ethnicity, and religion.

Another important issue that links fertility levels to the value of children is the high value or preference for male children, where several studies argue that the preference for sons fundamentally affects reproductive decisions (Cain 1980, 1982; Stash 2001; and Williamson 1983). For example, Chaudhuri’s (2012) study, based on data from India's 2005-2006 National Family Health Survey, with a study sample including 33,245 women, was one such study. Chaudhuri (2012, p.178) found that women with more sons than daughters were generally less likely than those with more daughters than sons to continue childbearing; the last-born child of women who had stopped childbearing was more likely to be a son than a daughter (sex ratios 133-157). Also, women without any sons were more likely than women without any daughters to continue childbearing at parities 1-4 (odds ratios, 1.4-4.5).

A preference for sons over daughters has been found in a large number of countries, ranging from East Asia through South Asia to the Middle East and North Africa (Cleland, Verrall and Vasessen 1983; Lin and Adsera 2012; Fuse 2010; United Nations 1985, 2012). Recently, from a Basu and de Jong (2010) study which analysed data from the DHS of 70 developing countries, the empirical analysis shows that son targeting fertility behaviours are present in

32 several countries in Asia and North Africa, although they are absent in sub-Saharan countries. Also, families that target sons are more likely to have larger families. This trend is most pronounced in the patriarchal societies of East and South Asia (United Nations 1987; UNFPA 2012).

In the case of Saudi Arabia, children are highly valued and this reality overlaps with various issues. First, Muslim society regards children as gifts from God and a great pleasure, as mentioned in the Quran. Second, as a society with a tribal background and with significant values regarding kinship cohesiveness, reproduction is regarded as the essential duty of women in support of their social obligations. In Saudi Arabia, parents and the community view a girl’s future to be bright and successful if it involves marriage and childbearing. Finally, a woman’s status is related strongly to motherhood and she gains respect, honour and some degree of freedom by becoming a wife and even more by becoming a mother in particular of male children (Al-Safe 1997; Gazaz 1994; Yamani 1996, 2000). However, not enough is known about whether the valuing of children is changing alongside shifts such as urbanisation, greater formal education and economic development: a gap to which this research can contribute. An understanding of both male and female viewpoints on the value of children and their attitudes toward preference for sons will be essential in analysing fertility behaviour patterns in Saudi Arabia. Especially, the patriarchy in Saudi Arabia makes son preference more significant. This study will therefore seek explanations and reasoning in the participants’ perspectives.

Gender Structure Related to Fertility Behaviour

Women’s Status, Patriarchal Society and Fertility Decisions

Scholars in demography have spent considerable effort studying and investigating the relationships between women’s status and reproductive behaviour in order to provide a full explanation of the variation in fertility levels across cultures (Blumberg 1984; Chafetz 1984; Lee-Rife et al 2012; Mason 2000, 2001 and 2003; Malhotra 2012). Their findings highlight the important influence of women’s position on fertility behaviour. Also, they emphasise the link between women’s status and the system of patriarchy. It is important to first present an extensive description of both women’s status and patriarchy, and then explain the process by which women’s status and patriarchy might influence fertility behaviour.

33 Many sociologists have attempted to define women’s status. For example, Mason (1987, p.719) writes, ‘women’s status refers to women’s versus men’s average position across a variety of social, economic, and political hierarchies.’ Dixon (1978, p.6) earlier presented a more explicit definition by noting that women’s status refers to ‘the degree of women’s access to material resources (including food, income, land, and other forms of wealth) and to social resources (including knowledge, power, and prestige) within the family, in the community, and in the society at large.’ Also, following several studies concerning women, Mason (1984, 1986, 1987, 1997, 2000, 2001 and 2003) states that she uses the concept ‘gender system’ instead of other terms used by sociological researchers, such as ‘women’s status’, ‘women’s roles’, ‘women’s autonomy’, and ‘female empowerment’. She explains her choice by noting that, ‘gender system comprises the entire complex of roles, rights, and statuses that surround being male versus female in a given society or culture,’ (1997, p.159). Many scholars who investigate women’s status stress three important factors that relate to this; women’s prestige, women’s power and women’s control over resources. These three factors represent basic aspects of gender inequality, according to the theories of gender stratification established by Blumberg (1984) and Chafetz (1984). They believe that economic power is a key determinant of women’s access to the resources of society (material such as wealth and privilege or non-material such as freedom and honour), and that access or control over means of production determines women’s status. Also, Blumberg (1984) and Chafetz (1984) argue that the division of labour by sexes is strongly related to power and status in society as the different roles of each gender produce different levels of power and status.

Moreover, several approaches have been developed to measure women’s status. The traditional approaches specify an index for women’s status such as education, participation in the labour force, political participation, family relationships, and age at marriage (e.g. Chowdhury and Trovato 1994; Jejeebhoy 1991; Sathar et al. 1988). Some of the more recent approaches (e.g. Balk 1994; Govindasamy and Malhora 1994; Niraula and Morgan 1996) consider the influence of the cultural context on women’s status. For example, in some societies women could attain high educational levels or have an occupation, but still experience difficulties in their life caused by their low status in the family. However, both traditional and recent approaches agree on the significance of women’s status for their freedom of choice in affecting their reproductive behaviour (Hirschman and Young 2000; Mason 1997, 2001; Malhora and Mather 1997).

34 Feminists have provided many definitions of patriarchy (Butler 1999; Greenhalgh 1995; Walby 1990). However, they agree that patriarchy represents a social structure where males dominate and have authority over females. For example, Olmsted (2003, p.84) defines the patriarchal system as ‘a system where men dominate women, primarily through the enforcement of strict gender-role ideologies, one of which is that women are responsible for reproductive labour and are more limited in their access to the public sphere.’ Also, Walby (1990), a well-known feminist, in her important work titled Theorizing Patriarchy, defines patriarchy as ‘a system of social structures and practices in which men dominate, oppress and exploit women,’ (p.20). She also distinguishes between public and private patriarchy. The former is based upon household production and the exclusion of women from public arenas, while in the latter women have access to both public and private arenas, but nonetheless they are subordinated within them. Meanwhile, Moghadam (2003) discusses the trajectory of patriarchy, from classic patriarchy to neopatriarchy. He indicates that the first form of patriarchy is classic patriarchy, which usually occurs in traditional societies, and especially ones with an agrarian structure. In the classic patriarchal structure, the elder male in the family dominates the other members of the household. This structure also restricts and centres women’s role to domestic labour (see also Kandiyoti 1991). The second form of patriarchy, neopatriarchy, started in modern society. Moghadam (2003, p.129) explains neopatriarchy as ‘the product of the encounter between modernity and tradition in the context of dependent capitalism, so it is modernized patriarchy.’ In neopatriarchy, the state supports its power through laws and legislation that subordinate women and give authority to men, such as when the Iranian Islamist state developed laws concerning women’s dress in the 1980s, the penalty for honour killings in Jordan, and the fact that women cannot drive cars in Saudi Arabia.

The attention towards the role that women’s status may play in affecting fertility behaviour basically started in the beginning of the 1980s, and then became a sub-focus in many theories on fertility (Greenhalgh 1995). Mason provides the most prominent works that examine this relationship (1984, 1986, 1987, 1997 and 2000) and the further importance of Mason’s works to this study is that they focus on developing countries. In analysis of the 1980s (1987, p.737) Mason developed a model that hypothesises the process through which women’s position may influence fertility levels through child supply, child demand, and child costs. This model indicated five main hypotheses. First, low female autonomy is likely to increase the importance

35 of marriage for women, which could lead to early age at marriage and so increase the supply of children. Second, high female autonomy will reinforce the female role in fertility decision- making and increase the possibility of contraceptive use (particularly if women prefer a small family size). These innovative behaviours could reduce fertility levels by dropping the demand for children and decreasing the psychological cost of fertility regulation. Third, economic dependency for women strengthens the need for children as security resources, and in particular male children. This might increase or sustain high fertility levels. Fourth, high female autonomy leads to an increase in female education and economic opportunities, which then increase the costs of children and reduce the demand for children. Fifth and last, high women’s status leads to greater gender equality, which could enhance concern for a wife's well-being. This might cause fertility decline as a result of limiting or planning childbearing. Mason supported her model by presenting several studies in various developing countries (for example, Caldwell 1982 and Cain 1982 support the view that children represent potential resources; Dyson and Moore 1983 support the link between women’s autonomy in decision- making and fertility; Smith 1983 supports the link to age at marriage in developing countries; Williamson 1983 and Cain 1980 support the link to male preference; Blake 1965 and Caldwell 1982 support the link to the value of children). Also, more recently, Upadhyay’s and Karasek’s (2012) study analysing data from DHS surveys in four Sub-Saharan African countries established that better egalitarian gender relations and more authority to women in family decision-making could inversely influence family size preference: however, only in two countries, Guinea and Zambia (beta coefficients, –0.5 and –0.3, respectively). Also, Wado’s (2013) study in Ethiopia based on the Demographic and Health Survey of 2005, which comprised around 14,500 households and 14,070 women of reproductive age, concluded that when women have a say in decision-making within the family they are more likely to practise family planning with odds ratios (ORs) of 1.75 (1.58- 1.94). However, he found that only 44 percent of women in the sample shared decisions with their husband.

Some feminist scholars focus on patriarchy in their attempt to examine fertility behaviour and its link to women’s status. Folbre (1983, p.268, 272) has explained the pathway through which patriarchy might impact fertility decision-making as follows. As the patriarchal society limits female access to the public sphere (through the division of labour by sex) and restricts women’s ability to achieve economic independence, so they become dependent economically on

36 marriage and are responsible for childcare because they cannot earn money for the family, as males do. The economic dependence of women (lack of wealth or material resources) weakens their bargaining power in the family, minimizing women’s role and maximizing men’s role in reproductive decision-making. She adds that in such societies, women bear the majority of the responsibility of childrearing by devoting their time and effort to childcare, which then reduces this cost for the family, while adult men gain material benefits from children’s labour. The result is a high TFR. However, the transition to capitalism then reduced the economic benefits from children and increased the demand for women’s paid labour to increase family income. This situation resulted in a decline in fertility levels in many developed countries. Even though the social context in developing countries is somewhat different from that of developed countries, Folbre’s (1983) work could be useful in this study as it explains the link between the economic dependency of women and power in reproductive decision-making. Mason (1987) also stresses this factor in developing countries. By contrast, Lee-Rife et al (2012) and Malhotra (2012) examine the impact of fertility decline on promoting gender egalitarianism (in developed and developing countries). They both determine that reduction in fertility levels endorses numerous advantages to women’s life as it results in greater attainment in education, more participation in the labour force and better enhancement in their health and well‐being.

Overall, the evidence emphasises the important role of gender relations in influencing fertility behaviour patterns, and thus for this study it was important to examine women’s status regarding reproduction decision-making. This study will use several factors to examine women’s status. Indeed, a number of sociologists highlight the significance of employing several important elements or components for examining women’s status and autonomy, such as the household division of responsibilities, decision-making powers, control of material resources, and freedom of movement (Achary 2010; Jejeebhoy 2001; Malhotra 2012; Upadhyay et al. 2014; Wado 2013). These components provide a more valid measurement of women’s status than dependence purely on education levels and work. However, despite the presence of some literature on the Middle East, there is a complete dearth of information on women’s status regarding fertility patterns in Saudi Arabia. This study will therefore contribute by investigating such issues in addition to assisting in providing more adequate data about women’s status.

37 Additionally, Saudi Arabia is a patriarchal society where men have authority over women in different spheres of life. As Doumato (2003, 2010), Murphy (2011) Mohammed (2003), and Yamani (2000, 2010) have reported, the tribal identity of Saudi Arabian citizens greatly fosters patriarchy in Saudi Arabia since the tribal family is generally based on a hierarchical structure where elder males are at the top and men have authority over women. Therefore, this study will also investigate the impact of patriarchy on women’s status and their role in reproductive decision-making, as there are currently no studies that have examined this in the Saudi Arabian context. More so, it provides comprehensive understanding of the process of decision-making concerning reproductive behaviour and its relationship to gender structure.

Women’s Education and Participation in Paid Work

Another important factor that influences fertility patterns is that of women’s education. Education is important because it can broaden perceptions as well as provide opportunities in life. Also, women’s education opens up opportunities for them to join the labour force. A huge body of literature supports the idea that female education and participation in the market economy have been the most important factors in determining reproductive decision-making and fertility reduction globally (Bongaarts 2003; Caldwell 1980; Jejeebhoy 2001; Jeffery and Basu 1996). Thus, women’s education and participation in paid work represent practical importance in developing countries.

However, education itself cannot generate a decrease in fertility levels if there are other strong competing cultural influences. For example, Unterhalter and North (2011), through their work, Girls’ Schooling, Gender Equity, and the Global Education and Development Agenda, emphasise the role of social context and the cultural setting in examining the associations between gender equality and female education. Unterhalter and North (2011) state that there are some people who are keen to have girls go to school and stay in school so that they become better housewives, and there are others who want girls to go to school so that they can actually transform society (p.11). Thus, a direct correlation between improved education and reduction in fertility levels cannot always be assumed. Moreover, the International Centre for Research on Women (ICRW) reports that gains to women’s education alone will not reshape gender relations. But when education is accompanied by other changes that increase a woman’s ability to control her own destiny, it can indeed play an empowering and transformative role. By the

38 same token, women’s increasing participation in the labour market does not automatically imply that they will feel more empowered and their lives will improve. It may instead indicate that women are being stretched both in and out of the home: especially if gendered expectations at home do not shift (2014, p.3).

There are several frameworks which look at the link between female education and fertility behaviour in order to identify the mechanisms through which women’s education may influence fertility. Most of these frameworks emphasise the role of women’s education in enhancing their status and autonomy (Bbaale 2011; Bongaarts 2010; Jatrana and Pasupuleti 2013; Lee-Rife et al. 2012). These are economic autonomy, knowledge autonomy, physical autonomy, emotional autonomy, and decision-making autonomy. Economic autonomy includes access and control over resources; knowledge autonomy includes knowledge about contraception and general information about health; physical autonomy includes freedom of movement; emotional autonomy includes interaction between spouses; and decision-making autonomy includes her role in decision-making within the family.

Various scholars have identified different pathways through which women’s education may influence fertility behaviour patterns (Bongaarts 2010; Colleran et al. 2014; ICRW 2014; Jiang and Hardee 2014; Shapiro 2011; UrRehman et al. 2011; Vogl 2015), each pathway linked to the main theoretical approaches to fertility decline. These pathways are first that schooling increases the costs of childbearing through improving economic opportunities for women, which decreases the demand for children (this stems from economic theories, gender equality and women’s autonomy). Second, schooling increases the preference for planning family size (this relates to the decline in infant and child mortality, which reduces the uncertainty risk for achieving the desired number of children). Third is the ability to achieve the planned number of births (this relates to increases in knowledge and access to contraception). Fourth, education leads parents to become more concerned about their economic status, and an increased use of contraception (this stems from the Demographic Transition Theory and economic theories). Fifth, education spreads knowledge about contraceptive methods, reducing fertility regulation costs and increasing use of contraception to limit fertility (ideational theories and economic theories).

39 All the above frameworks examining the relationships between female education and fertility behaviour patterns emphasise the significant link between women’s education and increase in economic opportunities, which in turn increases the costs of childbearing for women and so reduces the demand for children. These frameworks suggest that women’s participation in paid work could potentially influence fertility behaviour, a relationship which was established early in economic theories (Becker 1960; Easterlin 1975). Moreover, Folbre (1983) and Mason (1987, 1997, 2001) suggest that reducing women’s economic dependency on men is a very significant factor in changing gender stratification and male dominance. Opening the public sphere to women and giving them the opportunity to participate in the labour market is a first step towards economic independence. This could then lead to a higher socioeconomic status for women that will strengthen their bargaining power in the family and increase their role in reproductive decision-making.

It is therefore will established that female education and women’s participation in paid work are significant elements in influencing fertility behaviour patterns and increasing the use of contraception (see also: Alvergne et al. 2011; Bbaale 2011; Bongaarts and Casterline 2013; Jatrana and Pasupuleti 2013; Khattak et al. 2014). For example, Fadeyi’s (2010 p. 261-264) study in Nigeria was based on a survey which included 1072 males and females in addition to a focus group discussion. The study determined that gender-equity in decision-making promoted low fertility among married couples. Results showed that women who had gone beyond secondary education tend to jointly take a decision with their spouses on the number of children to have 1.12 times more than those with no education. Also, professional women tend to jointly take decisions with their spouses on the number of children to have, 1.53 times more than those who are unemployed.

Additionally, Acharya’s (2010) research in Nepal utilised data from the DHS of 2006 and included 8257 married women. The study used four aspects to explore women’s autonomy in domestic decision-making; health care, main and everyday household purchases and going out to visit family or friends. The findings revealed that educated women (secondary education or beyond) have more possibility to contribute in decision making in all aspects, and the odds ratios (ORs) were respectively 1.85 (1.36, 2.52), 1.28 (0.92, 1.78), 1.11 (0.79, 1.57), and 1.32 (0.94, 1.84). Also, with similar outcomes for working women, the ORs were respectively 1.41 (1.22, 1.63), 1.72 (1.47, 2.01), 1.97 (1.67, 2.32), and 1.86 (1.59, 2.18). More recently, Islam et

40 al.’s (2013, p.198) work in Bangladesh based on a sample of 451 married men, found that couples who favoured spousal communication were 2.045 times more likely to use contraception. Further, women who work were 3.436 times more likely to use contraceptives compared to housewives, and couples who had high education levels were 5.093 times more likely to use contraception compared to uneducated pairs.

In the case of Saudi Arabia, female education has increased. For example, recent data from UNESCO shows that in 2011, the literacy rate for ages 15 and above is 81.3 percent for females and 90.4 percent for males (UNESCO 2013). Also, female illiteracy was reduced from 40% in 1992 to 21% in 2004 and 19% in 2013. But women’s participation in the labour market is still small (17.7% in 2013). Therefore, this study needs to explore the relationship between educational status, occupational status and fertility behaviour in the Saudi Arabian context in order to enhance understanding of fertility decision-making which could help in future policy- making or planning.

Cultural Context and Reproductive Behaviour

Social Network and Fertility Behaviour

A large body of literature supports the notion that in developing countries the social networks of the parents are usually involved in the reproductive decision-making of a couple. Kohler (1997, 2001, 2007, 2012 and 2013), through his several works on social networks, argues that understanding the influence of social networks on fertility behaviour is an important element that could assist in a comprehensive explanation of differences in fertility. Kohler (2013, p.1) note: ‘Theories of social interactions in demography rest on the insight that individuals do not make decisions about demographic and other social behaviours in isolation, but rather with others. Rather than being constituted merely by collections of individuals, populations consist of interconnected networks of persons who share information, resources and often a common understanding of norms. Understanding this interconnectedness is essential for understanding demographic behaviours and the dynamics of demographic processes’. 41 The influence of social networks on fertility behaviour patterns is related in its origin to the Ideational Theory and in particular to the diffusion approach. Ideational Theory emphasises the role of cultural values that can explain variations in fertility patterns, and in particular, religious beliefs (Lesthaeghe and Surkyn 1988; Lesthaeghe 2010, 2014). Also, the diffusion approach aids in recognizing the influence of the diffusion of certain cultural values (e.g. low fertility model) and the diffusion of fertility control on fertility behaviour patterns (Bongaart and Watkins 1996; Bongaarts and Casterline 2013; Cleland and Wilson 1987; Cleland et al. 2011; Montgomery and Casterline 1993; Montgomery 2009). Montgomery and Casterline (1993, p.458) defines the process of diffusion as ‘when the adoption of innovative ideas, and corresponding behaviour, by some individuals influences the likelihood of such adoption by others’.

The social networks approach proposes that if diffusion of contraceptive knowledge occurs and is approved by the members of social networks, contraceptive practice would certainly increase. Therefore, couples become more likely to use contraceptives when the practice of contraception increases among their social network. Also, couples will seek information and advice from their social networks (including family, friends, and neighbours) about effective types of contraception, the convenience of use and any side effects (Kohler 2001, 2011, 2013; Casterline 2001).

Kohler et al (2001, 2013) state two important processes that impact on contraceptive behaviour: social learning and social influence. Social learning emphasises that decisions about contraceptive adoption are subject to substantial uncertainty (e.g. health implications of contraception, other women’s experiences). Social influence emphasises normative influences on behaviour (e.g. preferences regarding contraceptive methods or family size which are related to attitudes and behaviour that are predominant in the social context).

Several studies support the idea that in developing countries, people construct and develop their knowledge regarding contraception based on their social networks. For example, Khan et al (2012) conducted a study that examined the individual and community barriers in the provision of family planning services in Pakistan. The study used a mixed model cross-sectional study which was conducted including: first 10 in-depth interviews and two focus group discussions; second, a structured questionnaire comprising 111 health workers. Khan et al (2012) found that

42 the majority of the respondents reported barriers at the community level: religious barriers for 69% (n=67); and sociocultural barriers for 58% (n=56). Also, Khatun’s (2011, p.34) research in Bangladesh was based on data from the DHS of 2007 that included 10,088 married women as well as five focus group discussions. The results established that media and Family Planning exposure in social networks increased women’s probability of reduced fertility desires by 10.5 and 2.9 percentage points. More recently, the study of Gandhi (2013) was based on data from a 2010 survey conducted in Nicaragua, and from the 224 participants (97% of the selected sample), the study focused on 170 women. Gandhi (2013, p.3) discovered that the number of methods known increased significantly with an increase in the number of social contacts with whom the respondent had talked about contraception (β=0.24, p<0.01), and having any social contact (aside from one’s own partner) using contraception (β=0.4, p<0.05). Further, the current use of a modern contraceptive method was associated with having social contacts with whom the respondent had talked about contraception (OR 1.5, 95% CI 0.7-3.4). The association strengthened when the exposure was restricted to network contacts whom the respondent trusted to provide reliable health information (OR 1.9, 95% CI 0.8, 4.4). In a separate model, current use of a modern contraceptive method was associated with having at least one social contact believed to be using contraception (OR 1.4, 95% CI 0.6, 3.7).

There is low use of contraception in Saudi Arabia in comparison to other MENA countries (see Figure 1.2 in Chapter One). Data from UNFPA (2004) shows that contraceptive use in Saudi Arabia was 32 percent in 2004, while a more recent information shows that contraceptive prevalence for women aged 15-49 was 24 percent in 2012 (Population Reference Bureau 2012; UNFPA 2012). An earlier study by Khraif (2001) which used the data from the 1999 Demographic Survey in Saudi Arabia, found that only 20 percent of women in the sample used contraception. Khraif's study shows that the decision to use contraception is influenced more by the husband than by the wife, and the use of contraception is primarily for birth spacing. This study will investigate male and female viewpoints regarding contraceptive use, and also asks if there are variations between people from different socioeconomic backgrounds, for at present, the research is not differentiated according to different social groups. It will also investigate the influence of social networks in Saudi Arabia on fertility decision-making and behaviour, and the society’s attitudes towards family planning. Moreover, as the available information about family planning practice is very small, also the influence of social network on family planning decisions is not found or has not yet been investigated, which is very important as the structure

43 of Saudi society gives great importance to social interaction, and relationships between society members are close and intimate. It will therefore be useful to explore its influence on fertility behaviour.

Islam and Family Planning in the Saudi Arabian Culture Contraceptive Technologies: Islamic Ongoing Debate About Birth control

Contraceptive methods include traditional methods and modern methods. Traditional methods include; withdrawal (in Islam called azl), periodic abstinence (rhythm), abstinence after a birth, and lactation amenorrhea. Modern methods consist of; oral contraceptives or the pill (containing the hormones estrogen or progestin or both, taken daily in monthly cycles), intrauterine devices or IUDs (placed in the uterus, depending on the type, a single IUD is approved for 5 to 10 years), hormonal injections or implants (the former given every two to three months, and the latter inserted under the skin which can remain in place from three to seven years), male and female condoms (if used consistently each time a couple has intercourse), barrier methods (diaphragms, cervical caps, and foams/jellies, which also require consistent use), and male vasectomy and female sterilization. All modern methods of contraception are temporary methods, except vasectomy for males and sterilization for females, which are permanent methods (Population Reference Bureau 2008, p.17).

In Saudi Arabia, the government and population follow Sunni Islam, although there are two prominent branches in Islam which are Sunni and Shia. Sunni Islam includes four schools of law (Madh'hab), which are Hanafi, Maliki, Shafi’i, and Hanbali. In Islam, Madh'hab is a term that refers to schools of thought or religious jurisprudence within Sunni Islam. These four schools of Islamic law agree on most of their rulings and only differ on minor topics. Sunni Muslims in general do not categorize themselves according to one of these schools of law as they believe that these schools originated from the main sources of Islam: the Holy Book (Quran) and the Prophet Mohammed’s sayings and actions (Sunna) (Al-Zuhayli 1984; Sabiq 1957).

The majority of jurists (religious leaders of Sunni and also Shia sects) consider the use of contraception as permissible within the teachings of the religion, in particular temporary methods of contraception. The basis of this law is that withdrawal (azl) was an acknowledged

44 method practised during the time of the Prophet Mohammed. Also, the Qur’an does not prohibit birth control. However there are some jurists who believe that all methods of contraception are impermissible or even forbidden in Islam, except withdrawal (azl). Also, the use of permanent contraceptive methods poses difficult debate among Islamic jurists. Some jurists believe that vasectomy for males and sterilization for females are prohibited as they involve changing human physiology and do permanent harm to the human body while the liberal jurists argue that vasectomy and sterilization are also reversible methods, which makes them permissible in Islam. Furthermore, some jurists believe that permanent methods of contraception are permitted in Islam for only medically valid reasons and recognized necessities as for example, if pregnancy would endanger the mother’s health or life (Al-Zuhayli 1997; Sabiq 1957).

Obermeyer (1992) provides detailed information regarding the Islamic viewpoint on the use of contraceptives, quoting Al-Ghazali, a famous liberal Islamic theologian. Al-Ghazali gave many situations where Islam allowed the use of contraception (he specified the temporary methods) such as: if the parents (or one of them) suffered from a serious disease that might affect their children, for birth spacing, because of the difficult economic situation of the family, concern for the mother’s health from too many pregnancies, or even concern about the wife’s beauty. Also, Al-Ghazali, agreed that permanent methods of contraception were permissible in Islam but only under serious situations, such as if one of the parents carried a genetic disease.

With respect to abortion, there is general agreement among Islamic leaders that abortion is only permitted under the most critical conditions (if a pregnancy endangers the mother’s life and even then, it is only allowed before life is breathed into the foetus). However there are differences regarding the time period during which it can be performed; some permit it within the first 120 days, and some permit it within the first 40 days.

Religion and Reproductive Behaviour

As mentioned in the previous sub-section, it can be concluded that using contraception for certain reasons is acceptable in Islam, although a number of studies have found that some parents gave religion (Islam) as a reason for not using contraceptive methods, believing that

45 using contraception was against Islamic doctrine. For example, in his study in Kuwait, Al- Gallaf (1995) used a questionnaire survey that included 300 currently married women aged 15- 49. The study found that permanent methods of contraception are unlikely to have a high demand, as one-quarter of the study respondents said that these methods are against Islamic teachings. Additionally, Obermeyer (1994), through her reports, examined the extent to which reproductive choice is compatible with Islamic principles. She noted that the social context of Middle Eastern countries influences reproductive behaviour through political perspectives, cultural values and most importantly, women’s status. Further, Findlay (1994, p.162) notes that ‘Islam has influenced virtually every aspect of Arab culture in terms of its influence on morals, law, customs, and social behaviour’.

Besides the Islamic perspective regarding contraception, there is another important issue that could assist in understanding the relationship between Islam and reproductive behaviour patterns: children are highly valued in Islam, as Muslims believe they are ‘gifts from God’. In many verses in the Quran children have been mentioned as ‘the ornament and the joy of life’ (Surah: Al-Oumran, 14; Al-Kahf, 46; Al-Hadeed, 20). For example, Hasna (2003) states in her study of the Islamic viewpoint towards family planning that many Muslims believe that the Quran places great value on children. Consequently, many Muslims think they should bear many children to increase the Muslim population. As Hasna (2003, p.184) notes, however, it is not so clear-cut:

‘Many Muslims believe that it is their religious duty to multiply and populate the earth, while ignoring the harms resulting from having a large progeny when resources are scarce. Islam has focused on parental responsibility for the quality of education and for the rearing of children and the ability to raise children correctly’.

In the Sunna there is one well-known Hadeeth (Prophet’s saying) that many Muslims consider as an invitation from Islam to produce many children, which is, ‘marry the one who is loving and fertile, for I will be proud of your great numbers before the nations.’ However, in several Quranic verses and Hadeeth, the Islamic doctrine emphasises the importance of providing good quality care for children. For example, the Surat Al-Baqara verses state: ‘Every father is

46 responsible for providing his children with their needs as best as he can.’ Also, Hadeeth states: ‘It is a sin for parents not to take care of their children.’

The Islamic inheritance law may also have an effect on reproductive decision-making because it specifies that if the father of a family dies and does not have sons (even if he has daughters), other relatives from his family (such as brothers) will be included in his inheritance. If the father has a son, the inheritance will go to wife and children only. Therefore, women may continue to have children until they have a son so they can secure the inheritance for their immediate family; this could influence their fertility behaviour.

Further, a recent report of the Pew Research Centre Forum on Religion & Public Life, by Grim and Karim (2011, p.25, 57) concerning the future global Muslim population notes that:

‘Fertility rates have fallen in most Muslim-majority countries in recent decades. Yet they remain, on average, higher than in the rest of the developing world and considerably higher than in more-developed countries. However, the impact of religion on fertility rates is difficult to assess and remains a subject of debate. Islamic edicts generally have supported the use of birth control. But many Muslims are either uneasy about contraceptives or do not have access to them, and women in Muslim-majority countries report using birth control at lower rates than women in other developing countries. Fewer than half of married women aged 15-49 in Muslim-majority countries (47.8%) use any method of birth control. By comparison, 63.3% of married women in the same age group who live in non-Muslim-majority, less- developed countries and 68.5% of those living in more developed countries use some form of birth control’.

By reviewing the literature concerning the relationship between Islam and reproductive behaviour patterns (see for example, Al-Gallaf 1995; Browne 2012; Dalmasso and Cavatorta 2010; Hasna 2003; Omran 1992; Obermeyer 1992), it is clear that there is uncertainty or confusion. This could be because there is a difference between the content of Islamic doctrines and the practices or behaviour of different Muslims. The content of Islamic doctrine is represented in the Holy Book the Quran and Sunna (Prophet Mohammed’s sayings and 47 actions), while the practices or behaviour of different Muslims reflect the various interpretations of Islamic doctrine either by individuals, Muslim groups or religious leaders. Because about one-fifth of the world’s population is Muslim, comprising 1.25 billion people and spread around the globe, it is misleading to think that there is one homogeneous Muslim World. Richards and Waterbury (1998) through their work on the Middle East suggest that variation in reproductive behaviour in different Muslim countries or between different Muslim groups is due to different social contexts. They (1998, p.85) state:

‘Islam is a flourishing religion with its own dynamic and content which in part is determined by how its adherents interpret it. There is much debate in the Muslim world over personal status issues, with Muslim scholars arguing that some of what Westerners construe as Islamic practices, are in fact derived from a society’s customary traditions and law’.

In Saudi Arabia the state religion is Islam; accordingly this study will investigate the influence of Islamic perspectives on both male and female viewpoints regarding reproduction, and particularly their viewpoints on using contraception, as no study has to date brought to light these issues. Also, religious influences are considered important in this study as it has already been argued that fertility behaviour is generally influenced by a society’s social structure through its traditions and values in particular religious beliefs. McQuillan (2004, p.27) notes that, ‘more than most other social institutions, religions have elaborate moral codes that are meant to guide human behaviour, and many of the great religious traditions have given special attention to issues of sexuality, the roles of men and women, and the place of the family in the society’.

State Discourses and Practices on Reproduction and Citizenship

Saudi Arabia is a very conservative society and it can be said that the cultural norms related to the family system are extremely important and not easily changed. Doumato (2001, p.169) notes that Saudi Arabia did not participate in the United Nations Conference on Population and Development (in Cairo 1994), or in the United Nations Fourth World Conference on Women (in Beijing 1995). The religious leaders in Saudi Arabia rejected the three schemes on the

48 Conference agenda: first, they rejected the call for ‘freedom and equality between men and women’; second they objected to the encouragement of the use of contraception; and third to the availability of abortion. Consequently, there is a general rejection of family planning programmes (especially by religious leaders) in Saudi Arabia. Thus, there is no formal policy existing with regard to family planning in Saudi Arabia.

Furthermore, in Saudi Arabia, there are no specific services for contraception either in the public or the private health sectors. However, women or mothers who require advice concerning contraception can request this from their doctors in the Obstetrics and Gynaecology clinics. If they want to buy any method of contraception it is then available from any pharmacy (there is however no free contraceptive service in the public health sector). Mohammed (2003), through her important work that explores the demographic situation in the Gulf regions noted that the policy there could be considered pronatalist. She also added, ‘There is limited (if any) family planning counselling or support facilities in the Gulf regions, and the only Family Planning Association is in Bahrain. The major activity of this association is educating mothers about nutrition, rather than fertility regulation’ (p.74). She noted that none of these states specify a minimum legal age for marriage. Also in general the governments there provide various services that could encourage the pronatalist policy, such as soft loans, free education and health services. However, despite the absence of a formal family planning policy in Saudi Arabia TFR has dropped (see Figure 1.1), and this needs accounting for.

Conclusions

The broader framework of this study is the overall development of social well-being, and a stronger and in-depth understanding of fertility in Saudi Arabia to aid in planning future strategies. Therefore, this study focuses on the socioeconomic and demographic factors influencing fertility behaviour patterns. Sizable literature emphasises the role of age at marriage, particularly for girls, in affecting fertility levels in any society. Data from UNICEF (2001, 2003) show that generally early marriage is common in the Middle East, North Africa and other parts of Asia. Therefore, it is pertinent for this study to explore people’s attitudes towards early marriage and its influence on fertility behaviour patterns in Jeddah, Saudi Arabia. Moreover, the value of children to parents should be understood in the context of social and cultural values. The costs and benefits of children need to be investigated more, since this 49 relationship appears not to have been fully understood, as it differs in each society according to its cultural and socioeconomic situation. A preference for sons over daughters has been found in a large number of developing countries, ranging from East Asia through South Asia to the Middle East and North Africa, and it is more pronounced in the patriarchal societies of East and South Asia (United Nations 1985, 1987). However, at the time of writing, no research had been conducted in Saudi Arabia on these topics. Thus, this study seeks to explore both male and female attitudes toward the value of children, sex preference and their influence on fertility decision-making.

Much of the sociological literature highlights the importance of patriarchy on fertility behaviour. The patriarchal form of society is prevalent in some developing countries, although there are some differences in the extent of the practices of masculine power in different types of patriarchy. However, there is agreement that a patriarchal society restricts women’s role to the private household, and centres it on childbearing. Also, in such societies women gain greater status through their children, which could influence fertility levels. Moreover, much of the literature emphasizes the essential role that women’s status plays in affecting fertility behaviour. Several approaches have been developed to measure women’s status. The traditional approaches measure women’s status through their education and work status, political participation, family relationships, and age at marriage, while more recent approaches consider the cultural context through which the previous elements are activated. However, many studies agree on the significance of women’s status on their freedom of choice and that this affects their reproductive behaviour. As there is a complete absence of information on women’s status regarding fertility in Saudi Arabia, this study will therefore contribute by providing more adequate and in-depth data about women’s status in Jeddah. Furthermore, much relevant literature supports the idea that female education and women’s participation in the labour market are very significant elements in reducing fertility levels.

Significant research has been found which supports the view that reproductive decision-making in developing countries involves more than just the parents, usually involving the social networks of their parents as well. Therefore, in order to establish a better understanding of the determinants of fertility behaviour, social networks must be considered. However, there are no studies in Saudi Arabia so far that cover this issue. Therefore, this study will investigate the

50 influence of social networks in Saudi Arabia on fertility decision-making and behaviour patterns, and the society’s attitudes towards family planning. It is realized the world over that developing an awareness of contraceptive choice is vital for achieving fertility decline. More importantly, developing societies need greater attention in this respect. Several studies highlight the significant influence of social networks on reproductive behaviour, especially as the diffusion of knowledge among social network members concerning contraceptive innovations could promote changes in fertility behaviour. Moreover, as there is low use of contraception in Saudi Arabia (Figure 1.2), a deeper investigation is indicated to explore this issue and also the differences between genders, as no study has been carried out in Saudi Arabia on these topics. Furthermore, considerable research shows that the influence of Islam on reproduction is important in understanding the reproductive behaviour patterns of Muslims, although there are different views on this topic. Accordingly, as in Saudi Arabia the state religion is Islam and, as all Saudis are Muslims, the influence of religion on fertility behaviour patterns will be investigated.

The few studies by Saudi academic researchers have hitherto elicited little information on reproduction issues in Saudi. Therefore, this study will fill this gap and fulfil the need for more information and better understanding of fertility and reproduction in Saudi Arabia.

51 Chapter Three Methodology and Research Design

Introduction

This study represents the first of its kind in Saudi Arabia, with its focus on mixed methods (quantitative including repeated cross sectional survey to explore changes and trends over a period of 8 years and also qualitative in-depth interviews for further interpretive profound information), and as such there were significant practical difficulties to be overcome. Having no precursor in this field of study is not surprising, owing to a deeply embedded reluctance by the Saudi population to disclose highly sensitive issues within a closed, close-knit and more or less tribal-based society and culture. However, need for research aimed at obtaining meaningful and comprehensive information regarding fertility issues in Saudi Arabia is reaching a critical phase, in that although fertility has fallen it remains high, and the population is growing at a rate which will see it double within the next twenty years if current trends continue (United Nations 2011). This study will endeavour to present a complex, gendered understanding of fertility behaviour in Saudi Arabia.

This chapter presents descriptions of the research design, and the approach to data collection and analysis. Accordingly, it is divided into six main sections: mixed methods as a research approach, study site selection, data collection techniques, data organization and analysis, ethics, access, reflexivity and positionality, and finally characteristics of the surveys and in-depth interview samples.

Mixed Methodology as a Research Approach

The Debate about Mixed Methods

Hakim (2000, p.36) indicates that in social research there is no single appropriate approach for all research questions. Accordingly, quantitative surveys offer a “bird’s eye view” and qualitative research offers a “worm’s eye view”. In addition, Cameron (2011) and Johnson (2012) outline many case studies that show how a fusion of quantitative and qualitative research lends considerable, albeit uneven, weight to both research approaches. Thus, 52 according to Frels and Onwuegbuzie (2013), mixing methods allows individual strategies to be applied with more confidence, as more holistic observation facilitates the emergence of contextual nuances and the inherent flexibility enables local issues to come to the fore.

Proponents who have developed the use of mixed methodological research practices concede that quantitative and qualitative research methodologies have traditionally been regarded as totally incompatible (for example, by purist scholars such as Howe 1988 and Smith and Heshusius 1986, who oppose mixed methods as they believe that the methods cannot be mixed). In their opinion, this polarized view has galvanized purists into positing that qualitative and quantitative research methods hold dissimilar ontological and epistemological propositions about the nature of research (Tashakkori and Teddlie, 2003; 2010), and as such, they are diametrically opposed. However, more recently there has been a move to integrate both methodologies, using the qualitative to inform the quantitative aspects of research and vice versa, resulting in the opportunity to combine macro and micro levels of a study (Cameron 2011; Frels and Onwuegbuzie 2013; Hossain 2012).

Consequently, it has been recognized ‘that epistemological purity doesn’t get research done’ (Miles and Huberman, 1984, p.21). Caruth (2013, p.112) adds that ‘mixed methods research has become a valid alternative to either quantitative or qualitative research designs. It offers richer insights into the phenomenon being studied and allows the capture of information that might be missed by utilizing only one research design’. While Hossain (2012) considers that quantitative and qualitative methods are related to each other rather than detached from each other. Indeed, it is quite possible for a single study to use both methods; quantitative methods to search for meaningful patterns and trends, and qualitative methods to aid in the understanding of those trends. More to the point, Cameron (2011), for example, emphasises that combining methods promises attractive rewards as a consequence of bringing together a range of perspectives that separately and together offer unique insight into the complex process of learning in a subject domain. Leech et al (2010) and Heyvaert, et al (2013) also support this view as they believe that combining quantitative and qualitative data enhances research validity and improves research inferences.

Above and beyond all the recognized benefits of combining both methodologies in one research project, this study is interested in highlighting two important advantages of using

53 mixed methods. These are, first, the ability to obtain complementary information regarding fertility behaviour, and secondly, the generation of a better understanding of gender roles, relationships and power differentials and their impact on fertility behaviour. Accordingly, these two benefits could provide this study with more strength and effective outcomes.

Firstly, the mixed methods approach allows the researcher to obtain a broad range of information. These differences between quantitative and qualitative research have been discussed by Caruth (2013), Alise and Teddlie (2010) and Fielding (2010). Here, it is worth quoting Ronkainen (2015), who notes that ‘the sociology of science and pragmatist philosophy and feminist epistemologies argue – even though their arguments vary – that the questions of research methodology and what is taken as knowledge cannot be answered by only using logical thinking and theories from the philosophy of science’. Further, Yeasmin and Rahman (2012) state that ‘social realities are inherently complex to be grasped in [their] entirety with one method of investigation, also the enquiry to unearth social phenomena and the various elements that influence and change it, most of the time, those cannot be measured- microscopically’. Thereby, through the implementation of mixed methods, this study aims to use the various forms of insights associated with each methodology along with promoting the validity of this research. Secondly, mixed methods can enable a better understanding of gender roles, relationships and power differentials. Many feminist researchers support the idea of combining quantitative and qualitative methods, and through their research work they manifest the benefits of this integration. For example, Hesse-Biber (2012) notes that using mixed methods would develop knowledge about gender equality to enable deep insight on gender issues. Also, Lehrner (2011) and Jackson (2011) believe that mixed methods would improve knowledge about gender issues, through producing literature able to capture gendered differences, sensitivity to gender, power and context.

Further, through applying a repeated cross sectional survey, the study will benefit from gathering information over time to discover and detect changes in population attitudes, behaviours and trends. Also, many scholars suggest that such an approach is significant in investigating the dynamics of demographic change (Almond and Sinharay 2012; Fairbrother 2011; Giganti et al. 2010; Minton et al. 2012; Stidham et al. 2014; Zirkel et al. 2015). For example, Stidham et al (2014, p.1105) note that ‘although analysis of cross sectional data can provide insight into dynamic social constructs, it ultimately has a limited ability to understand

54 ongoing processes. Whereas, longitudinal research could address this weakness by collecting data over two or more points in time, by enabling a more direct analysis of change within a population’. Also, Fairbrother (2011, p.3) states that ‘studies seeking to understand social change often employ longitudinal survey which help to answer big questions about why and how societies change, and why some change faster than others’.

It is hoped that by employing a mixed methodology, this study can establish a deep understanding of gender relations and roles in the family, as well as society, and how these influence fertility decision-making.

Justification of Mixed Methodology In order to meet these research objectives it was decided to apply both quantitative and qualitative methods, as shown in Figure 3.1. There are several reasons for adopting this mixed methodological approach in this research.

Figure 3.1 Research Approach

Methodology (Research Approach)

Mixed Methodology

Quantitative Qualitative Methodology Methodology

2 Survey Questionnaires; one In-depth Interviews in 2005 and the other in 2013 (16 married couples) each one included 100 Males In 2008 and 100 Females

Data Analysis

Writing-up and Dissemination

55 First, Saudi Arabia is a conservative society in the sense of its entrenched patriarchal system and strict gender segregation. In addition, its social structure adheres to the Islamic faith and its traditional value system. This study examines a very sensitive subject, reproduction, which is considered a private matter. This study also explores gender relationships, an issue that has rarely been studied in Saudi Arabia. It was therefore decided that using quantitative methods was the most appropriate way to establish general patterns of, and attitudes towards, fertility in Jeddah, Saudi Arabia. In contrast, qualitative methods were considered most suited to collect in-depth data to understand those patterns and to gain sensitive information on those topics.

Second, the quantitative method that this study used was a repeated cross sectional survey, through conducting two questionnaire surveys with a space of eight years apart in order to discover the changes that could occur in fertility trends. By doing that, this could promote more validation and endorsement for this study’s outcomes and explore societal change over time. Moreover, this approach offers a unique potential to investigate trends over time, which assists in the development of descriptive accounts of fertility change. These quantitative surveys were used to collect basic information about attitudes and behaviour through the use of standardized questions. Overall, the survey assisted in giving reliable and valid information on large-scale fertility patterns in Jeddah, Saudi Arabia, and identified the important relationships between fertility behaviour and socioeconomic and demographic factors. Thus, the quantitative method was a useful approach to address many important factors that influence fertility behaviour in Saudi Arabia, and offer explanations as to the nature of the phenomena.

The in-depth interview may provide access to the meanings which people attribute to their experiences and social worlds. Moreover, Sarantakos (2005, p.42) indicates that qualitative methods generally aim to interpret and understand social life and discover the meanings attached to people’s events and behaviour. Thus, with the aim of understanding and documenting intrinsic behaviours, qualitative interviewing was chosen in this research because it provided a means of exploring the points of view of the research subjects, and the viewpoints of people as to the interpretation of their reproductive behaviour. To do so, the qualitative methods that this research used were in-depth interviews of married couples (interviewed separately). Broadly speaking, the qualitative approach was used to explore people’s interpretations, perceptions, meanings and reasoning processes, and to explain people’s behaviour in Jeddah society; this has been called the ‘insider-view’ of human behaviour

56 (Mason 2002; Blaikie 2000) or a ‘subject-centred approach which describes life-worlds from inside out, from the view of the subjects’ (Sarantakos 2005, p.45). Thus, having given a detailed justification for the use of the mixed method approach, the chapter now goes on to justify Jeddah as the site selected for detailed study.

Study Site Selection

The Justification for Choosing Jeddah as the Study Site

Jeddah was selected as the site of detailed study for the following reasons. First, I am resident in Jeddah and was brought up in this city; this has provided me with extra insight into the cultural background and social interactions in the city. This also enabled me to conduct this research, despite its sensitivity in such a conservative context, using the social networks of my extended family, which provided me with important credibility and appropriate access to the study respondents (in both survey and in-depth interviews). Second, Jeddah is an ancient city. It was founded as a fishing village over 2,500 years ago and was for centuries the main city of the historic Hijaz province and historic port for Muslim pilgrims arriving by sea on their pilgrimage or hajj to the two holy cities of Mecca and Medina. The opening of the Suez Canal in 1869 effectively made Jeddah one of the major port cities of the Middle East, and Jeddah is thus a thriving port-of-call for all manner of traders from all over the Northern Hemisphere, importing various goods. Today, popular Saudi opinion regards Jeddah as the most liberal and cosmopolitan of Saudi Arabian cities, partly because of its shifting population. Jeddah is thus fondly regarded as ‘The Bride of the Sea’, as it serves as a gateway for the millions of pilgrims who arrive by air or, more traditionally still, by sea. As such, its liberal and cosmopolitan nature makes it easier to conduct a study of such a sensitive nature than elsewhere in Saudi Arabia.

Lastly, Jeddah is located in the west of Saudi Arabia (Figure 3.2) and is undergoing substantial population growth (Table 3.1). Jeddah is the second largest city in Saudi Arabia after the capital Riyadh, but to date most research about fertility has focused on Riyadh. Further, Jeddah is in the Makkah administrative area, which is the largest administrative area in the Kingdom (see Table 3.2), with a population of 7 million (Ministry of Planning 2014). Also, as Jeddah is the second largest city in Saudi Arabia, it contains or comprises a large number of government

57 and private business enterprises and organizations, schools, colleges, factories, and various shopping markets. Thus, due to its rapid population growth it is a prime location within which to study fertility change.

Table 3.1 Jeddah’s Population Growth Year Population size 1970 1 million 1986 1.4 million 1993 2.3 million 2004 2.8 million 2014 3.4 million

Source: Adapted from Ministry of Planning 2003, the Population Census of 2004 and Jeddah Municipality 2014.

Table 3.2 Distribution of Population in Saudi Arabia Administrative Areas The administrative Percent of The administrative Percent of areas population areas population Al-Riyadh 25 Asir 7 Makkah 25.5 Tabuk 2.9 Al-madinah 6.6 Hail 2.2 Al-qasim 4.5 Northern frontier 1.2 Eastern province 15.1 Jazan 5 1.9 Al-jauf 1.6 Al-baha 1.5 Source: Ministry of Planning 2010

Figure 3.2 Basic Map of Saudi Arabia

Source: Google.com

58 The Study Sample

The study sample was selected in the city of Jeddah and was restricted to Saudi citizens, as non-Saudi citizens are from many different backgrounds (Asian, African, European, American and Arab) and incorporate many different non-Saudi cultures. The percentage of non-Saudi citizens comprises approximately 30 percent of the total Saudi population. As this study focuses on understanding reproduction issues which relate strongly to people’s culture, beliefs, values and traditions, it would not be possible to establish a deep understanding of such different cultural backgrounds in one study. Therefore, it was decided to focus on Saudi citizens only and the Saudi Arabian culture; details of the sampling process for each research method follow in the next section.

Data Collection Techniques

Questionnaire Sample

In order to produce valuable insights concerning fertility change this study applied repeated cross-sectional questionnaire surveys, which aids in clarifying these changes in population trends depending on their social contexts. Each survey sample, from 2005 and 2013, included 200 respondents, which included 100 males and 100 females, so the total sample of both questionnaires was 400 respondents. However, in Saudi culture, it is uncommon and unacceptable culturally for researchers, whether male or female, to conduct data collection for a survey of any kind or purpose from both males and females, whether in a street or shopping centre, or house to house, not to mention collecting data on such a sensitive issue as reproduction. Therefore, the best possible sample in the Saudi social context was a multi-stage cluster sample. Several places were chosen to collect the sample, including major hospitals in Jeddah for the female sample and various major business enterprises in Jeddah for the male sample. Next, a systematic technique was applied to select samples from those places (see Figure 3.3 for 2005 survey, and Figure 3.4 for 2013 survey). It should be noted that social research should consider the social context of the society in which the research is based. Consequently, as a social researcher, I found myself in the position of having to make adaptations to my sampling strategy according to the Saudi Islamic social context as described below.

59 Accordingly, the women’s sample was collected from the Obstetrics and Gynaecology clinics of several hospitals (hospitals run by the Ministry of Health) for the reason that Obstetrics and Gynaecology clinics are the most adequate locale to ensure collection of a female sample of sufficient scale which will be representative of women from different socioeconomic backgrounds. However, collecting the female sample from hospitals excluded the women who do not go to hospitals; these women could be illiterate or very poor. They could also be women who did not have permission or approval from their husband to visit hospital. This may possibly influence the small representation of illiterate women, the very low income group, and women who are facing very strict gender relationships (these women might also have very high fertility levels). The female sample could not be collected from different business enterprises and organizations (as the male sample) because women’s participation in the labour market in Saudi Arabia is very small. The questionnaire was filled by the researcher to assist the illiterate respondents or those with minimal education. It has also been argued that it is much more productive to interview women alone in order to get a valid and truthful response (see Berik 1996; Heaphy and Einarsdottir 2012; Taylor and de Vocht 2011), thus the survey normally took place in hospital waiting-rooms, which are separated into male and female sections. Generally most women attended alone, due to their husband’s business or work commitments. In some cases, however, they were accompanied by immediate male relatives, such as a father or brother. All respondents complied with the request to participate in the survey. Consequently the response rate was around 70 percent in 2005 and was 72 percent in 2013 (those respondents who agreed to participate in the study and completed the questionnaire).

The male sample was collected from various business enterprises and organizations (both government and private), through a male assistant researcher (a postgraduate student in the sociology department), as Saudis live in a truly segregated society and cultural traditions disapprove of men and women mixing, particularly when dealing with sensitive issues. It should be noted that collecting the male sample from business enterprises excluded unemployed men, and also may have reduced the representation of unskilled labour. Those excluded unemployed men and unskilled labourers could be illiterate or with low educational levels; also they could be from the very low income group. This may possibly influence the small representation of illiterate men, or with low educational levels, and the very low income group (these men might also have very high fertility levels). Nonetheless, the sample did

60 include men of different socioeconomic backgrounds (see Figures 3.3 and 3.4). The response rate here was around 65 percent in 2005 and 76 in 2013 (those respondents who agreed to participate in the study and completed the questionnaire).

Figure 3.3 and Figure 3.4 summarize these sampling strategies and then details of the questionnaire survey process are given for 2005 and 2013.

Figure 3.3 Framework of the 2005 Survey Sample Multi-stage cluster sample City: Jeddah Areas: Hospitals, clinics and business enterprises It was decided to collect 200 respondents (100 males, and 100 females) Places for female sample: hospitals; response rate 70 percent.

King Abdul Aziz hospital: public and private sections (42 respondents were asked to participate in the survey and 29 responded). Maternity and Children’s hospital (32 respondents were asked to

participate in the survey and 23 responded). Dr. Abdul Rahman Bakish hospital (31 respondents were asked to participate in the survey and 21 responded).

Dr. Suleiman Fakeh hospital (38 respondents were asked to participate in the survey and 27 responded).

Places for male sample: business enterprises: response rate 65 percent. Electricity Company (29 respondents were asked to participate in the survey and 16 responded).

Saudi Airlines (32 respondents were asked to participate in the survey

and 18 responded). Ministry of Civil Service (35 respondents were asked to participate in the survey and 22 responded).

Ministry of Health (21 respondents were asked to participate in the survey and 15 responded). General Organization of Social Insurance (37 respondents were asked

to participate in the survey and 29 responded).

Individuals within those clusters: in each section there was a system to

organize the data collection. For example, in hospitals, every fifth patient was approached, while in business enterprises the lists of employees were used to enable a selection from each section of the institutions which allowed choice from different socioeconomic backgrounds (the selection of the employees in each institution depended on the Personnel Department, and generally was every tenth employee).

61 Figure 3.4 Framework of the 2013 Survey Sample Multi-stage cluster sample City: Jeddah Areas: Hospitals, clinics and business enterprises It was decided to collect 200 respondents (100 males, and 100 females) Places for female sample: hospitals: response rate 72 percent. King Abdul Aziz hospital: public and private sections (40 respondents were asked to participate in the survey and 30 responded). Maternity and Children’s hospital (33 respondents were asked to participate in the survey and 22 responded). International Medical Centre (IMC) (32 respondents were asked to participate in the survey and 24 responded). Dr. Suleiman Fakeh hospital (34 respondents were asked to participate in the survey and 24 responded).

Places for male sample: business enterprises: response rate 76 percent. Electricity Company (23 respondents were asked to participate in the survey and 17 responded). Saudi Airlines (30 respondents were asked to participate in the survey and 19 responded). Ministry of Civil Service (29 respondents were asked to participate in the survey and 23 responded). Ministry of Health (18 respondents were asked to participate in the survey and 13 responded). General Organization of Social Insurance (31 respondents were asked to participate in the survey and 28 responded).

Individuals within those clusters: in each section there was a system to organize the data collection. For example, in hospitals every fifth patient was approached, while in business enterprises the lists of employees were used to enable a selection from each section of the institutions which allowed choosing from different socioeconomic backgrounds (The selection of the employees in each institution depended on the Personnel department, and generally was every tenth employee).

Questionnaire Process

This study applied one of the main methods of administering questionnaires, which was the face-to-face questionnaire, mostly using closed questions. The male questionnaires were conducted through a male assistant researcher (both in 2005 and 2013), and the female questionnaire was conducted by myself (both in 2005 and 2013). The questionnaire was divided into four main parts: demographic information, socioeconomic status, gender and fertility behaviour, and social networks and fertility decisions (see Appendix 1 for a copy of the survey questionnaire). 62 The questionnaire was developed through several processes. The first was to check that the questionnaire covered all the study aims. However, the study concerned sensitive issues and it was also conducted in an extremely traditional and conservative society and culture where such matters are rarely discussed outside the medical arena. Consequently the questionnaire was revised in order to ensure that all data needed would be obtained in a sensitive and culturally appropriate manner. Furthermore, because the study has a significant focus on gender comparisons, it was important that both male and female questionnaires reflected the same format and ordering of questions to aid later comparative analysis. Further, the questions were framed to format the responses or data according to three categories: interval level, ordinal level, and nominal level. Also, in developing the question responses (the study followed the steps of Vaus (2002, p.100), the questionnaire was revised to ensure the following were adhered to: exhaustiveness (to ensure providing a range of alternative responses), exclusiveness (to ensure that each question had one answer, except for the questions that required multiple responses, then coding to create a separate variable for each category, as for example the question about the value of children), and balancing categories (to ensure providing some alternatives either side of the response, though the study used Likert scales, as for example the question about the responsibility of children).

Secondly, the questionnaire went through a coding procedure in preparation for later statistical analysis. The most important coding steps, as Vaus (2002, p.147) has suggested, were first, classifying responses that were based on the main issues in the study (such as the issues related to research aims). Next, codes were allocated to each variable, then a codebook was produced and finally coding errors were checked when entering the data. These steps have ensured accurate results when analysing the research data.

Thirdly, the questionnaire was piloted using a small sample size of 60 respondents, both males and females, to identify any weak spots and make any required adjustments as well as to determine if all the appropriate cultural conventions were met. The strategy for collecting the pilot sample was the same strategy that was used later in the actual sample. However, it was only applied for females in two hospitals and for males it was also only applied in two business enterprises. Thus the questionnaire was pre-tested through investigating the following major principles: variation, meaning, redundancy, scalability, non-response, and lastly acquiescent response set. Variation means making sure different responses for research questions are

63 available, while meaning means guaranteeing that respondents understand what the researcher is asking. Redundancy looks for no repetition of questions, while scalability refers to checking the format of the scales used. Non-response refers to deleting any question unanswered by several people and lastly acquiescent response set refers to double checking the questions measuring attitudes because some people choose the positive attitudes, so it is better to format those questions in a non-judgmental way (Blaikie 2000; Sarantakos 2005; Vaus 2002).

After the pilot questionnaire had been tested, some changes were needed, including grammatical adjustments. However, the pilot questionnaire showed that two questions needed to be deleted from the questionnaire, as there was complete non-response and ignorance from the survey samples towards those questions. Those questions were about knowledge regarding United Nations programmes concerning maternal and child health (see Figure 3.4). This non- response could reflect the fact that in Saudi Arabia there is no policy concerning family planning, and many people think that United Nations programmes are essentially family planning programmes. Also, it may be that people believe that reproduction is essentially a private matter and they do not agree with interference in such a private issue from an outsider (it may also be that many people in my culture believe that western institutions such as the United Nations are representing a non-Islamic perspective, which is unacceptable). Those questions were therefore cut because they could give respondents the impression that this study was being undertaken for western institutions, which would affect the study negatively, as many would refuse to participate. Next, the sample process used to select interviewees is outlined.

Figure 3.5 The Survey Questions Regarding United Nations Programmes

54- Do you know anything about the (UN or WB) programmes regarding reproduction issues (such as reproductive rights or safe motherhood)? A. No B. Yes

55- What you think of those programmes?

64 Sample Selection for in-depth Interviews

In-depth interviews were conducted using 16 females and 16 males (as 16 married couples). The researcher applied a snowball sample technique, dependent on the researcher’s social and family acquaintance networks. Berg (2004, p.36) affirms that the use of the snowball sampling technique is sometimes the best way to locate subjects with certain necessary characteristics, and that such a sampling technique is particularly popular among researchers interested in studying various classes of deviance, sensitive topics, or difficult-to-reach populations. Other researchers (Johnstona and Sabin 2010; Lukka and James 2013; Voicu and Babonea 2011) have also recommended the use of a snowball sampling technique in their studies owing to difficulties they faced through accessing their respondents, while Dragan and Isaic-Maniu (2013) noted that the technique was helpful in collecting samples from similar social networks. In this case, sensitivity of data meant that a snowball technique was deemed most appropriate to collect in-depth information on reproductive decision-making in a Saudi Arabian context. Figure 3.5 is a representation of the snowballing technique employed to find couples to participate in this study. Family and social networks were initially contacted and they then referred to other couples they were acquainted with, to build up the interviewee base.

In-depth interviews were conducted with both male and female citizens from the city of Jeddah. The researcher required the approval and consent of the respondents, and a determined effort was made to build a good relationship with the respondents, in order to get as much explicit and honest information from them as possible. This research used in-depth interviews with married couples, as reproductive issues and experiences are related to marital and gender relationships. For example, Mishra et al (2014) and also Upadhyay and Karasek (2012) note the importance of including both men and women in reproductive research, which helps to capture a complete understanding of reproductive decision-making within the family as both husband and wife are included in this process. Also, excluding men from such research could lead the study to ignore or miss the influence of power relationships between husband and wife on fertility decisions, and only provide the reality for one point of view (the wife’s). Thus a selection of male and female respondents was considered vital in this research.

65 Figure 3.6 The Technique of Selecting a Respondent from a Snowball Sample

A colleague Father’s Acquaintance Cousin From work

Acquaintance My Family’s Networks Wife’s Acquaintance Friend Neighbour

Acquaintance’s Employee Neighbour My Husband’s Networks The Friend Researcher’s Friend Networks Business (me) Associate A colleague Friend of Acquaintance’s Cousin Acquaintance Cousin Neighbour

Source: Fieldwork, 2005

The Process of in-depth Interviews

The researcher made every effort to establish, as far as possible, good close relationships with the respondents to gain their trust, so that they were comfortable and had confidence discussing such a sensitive subject. Briggs (2002) has highlighted the importance of giving study participants the opportunity to provide accurate information by letting them choose the interview site. Therefore, all interviews took place in the married couples’ homes, based on the desire of the interviewees; this went a long way to gaining respondents’ assurance and confidence and encouraged friendly interaction during the interviews, as well as ensuring a more comfortable and friendly environment for the respondents. Haahr et al (2014), Taylor and de Vocht (2011) argue that the interview site provides a material space for enactment and constitution of power relations, and interviews conducted in participants’ homes have important potential as a strategy for disrupting power hierarchies between researchers and participants.

66 Therefore, conducting the interviews in the respondents’ homes would make them more comfortable and secure from any pressure from the researcher, as respondents feel they are in charge in their own home.

Other researchers, such as Blichfeldt and Heldbjerg (2011) and Hämäläinen and Rautio (2013), have also noted that interviews dealing with highly emotional, sensitive or private issues are best conducted in the home of the participant (especially in the case of females) since such a setting offers a sense of intimacy and friendliness. Thus in this research the home proved to be the appropriate interview site.

Generally the interviews conducted with a married couple took approximately five hours: over two hours for the wife and the same for the husband. The interviews were therefore inevitably detailed and highlighted the complexity of the issues discussed. The interviews were tape- recorded and then transcribed by the researcher. By taping all the interviews the researcher was able to refer back to exactly what the respondent had said during the interview. This procedure is recommended by Bryman (2001), as the interviewer cannot effectively write and maintain a close interaction with the respondent at the same time. For example, it can be disruptive if the researcher asks the respondent to “hold on” because of the need to write down exactly what is being said.

The interviews with the wife were conducted first, separately from her husband, to maximise the obtaining of truthful and frank information from the woman, so she would not be influenced by her husband’s opinions. Heaphy and Einarsdottir (2012) and also Taylor and de Vocht (2011) have highlighted the advantage of separate interviews in that they give participants more freedom to express their own individual views; they also allow more privacy for discussing other household members (including the power dynamics between them), relationship secrets and so on. However, wives’ interviews were much easier to handle than husbands’ interviews, since I am a female. Berik (1996) reported that being a woman gave her the advantage of having frank and open conversations with female participants in her study in rural Turkey, and I also found this to be the case. On the other hand, interviews with the husbands were more difficult and embarrassing for me than the interviews with women, particularly as the interviews covered very private and sensitive issues, and I did not know how they would react or respond to my questions. Nonetheless, what made the men’s interviews

67 more tolerable was that fortunately I conducted the first two interviews with men who were very interested and curious about the study subject, so they were cooperative during their interview. Truthfully, these interviews gave me more confidence and prepared me for the rest of the interviews (where the husbands were less enthusiastic about the process).

The in-depth interviews were structured in the following order: first, general information; second, domestic division of labour in the society, and finally gender and social networks in relation to reproduction (see Appendix 2 for in-depth interview questions). The questions were organized in the question sheet with each question representing a main topic which then included several issues (questions) to cover other important elements that related to the main topic. However, the procedure in the interviews was to ask the respondent each question separately so he/she would not be confused by having multiple questions asked at the same time. Also, asking the respondent each question separately gave them the space and the appropriate time to answer the question without pressure. Furthermore, there was an important consideration in understanding the interview questions, and that was the matter of translation (all interviews were conducted in Arabic), which may make the interview appear ‘less open’. For example, in some questions (e.g. about income) I had to justify why I needed to ask about family income. I therefore had to show that the information concerning income is very important in order to understand the reproductive behaviour in relation to the socioeconomic status of the family (income is a very private matter in my culture, as is taxation, and even the government faces difficulty gathering this information during the census). In the next section, details of data organization and analysis are outlined.

Data Organisation and Analysis

Statistical Techniques of Survey Data

The quantitative data were subjected to statistical analysis in order to measure the nature and degree of the relationship between the many variables under investigation. In the case of this study, quantitative data from the survey questionnaire involved male and female respondents. Therefore, the questionnaire was coded in advance in order to enable the systematic classification of data and also to make the male and female questionnaires equivalent, so that data could be entered in a single table-sheet in the SPSS programme for comparison purposes.

68 As Rose and Sullivan (1996, p.38) note, ‘the way in which we allocate a numeric code to each category of a variable is the first step in preparing data for computer analysis and constitutes the first step in mapping our observations into data’.

The survey data were subjected to statistical analysis through the following techniques. First, descriptive analysis was applied to offer a general description of the data. These statistical techniques differed depending on the data types i.e. if the data were nominal or ordinal (Sarantakos, 2005, p.373 and Vaus, 2002, p.204). However, some data required a further coding process to enable accurate analysis, such as the combination of some categories, recoding these new categories, then re-entering them in the SPSS programme. For example, income classification was recoded into three categories instead of four (as it was in the questionnaire) because there was a very small number in one category; the same was done to educational levels. Also, occupational status for both genders was recoded into two main categories for the same reason. The main statistical analyses that were applied in this research included descriptive statistics, comparing means, and cross-tabulation.

Interview Content Analysis

The qualitative data from the in-depth interviews were analysed manually, as respondents’ information and data was in the Arabic language, and most of the computer software programs are in English. However, it is recognized that translation of the data could somewhat weaken its meaning, especially in the qualitative study. Moreover, Weitzman (2003) indicates that whilst QDA (qualitative data analysis) software provides tools that assist researchers with (physical) analysis - sorting, linking and further organizing data - it does not do the actual (intellectual) qualitative analysis. He also advises that using this software must not detract from the researcher’s ‘closeness’ to the data. Further, Crowley, et al (2002, p.195) note that such software provides facilities for data management, but that the researcher must not become a hostage to qualitative software. For these reasons, a manual process of analysis was employed, and as Dey (1993) suggests, this involves three main procedures. These are the description of data, the classification of data, and recognition of how concepts interconnect. Analysing the qualitative data for this research thus required a great deal of work. First the recording tapes were transferred into written transcripts; these transcripts were reviewed several times to gain

69 close familiarity with the data. Secondly, classifications of the data were applied according to the study codes which comprised the main issues of this research (see Table 3.3). Also, further classifications or groupings were employed in order to make a distinction between the different meanings of respondents’ answers. Finally, a further revision was undertaken in order to select the representative responses for research questions (the more detailed response), and a translation of these selected responses was made from Arabic to English, as all interviews were conducted in the Arabic language.

Table 3.3 Examples of Qualitative Analysis According To Study Codes (from several respondents) Examples of in-depth interviews coding Codes  Can you tell me the whole story of when and how you got married? ‘Women have no place other than their husband’s house, so even though Viewpoint I might have wanted to finish my education, if I did so before marriage, concerning I would lose or waste good opportunities to marry a good and suitable early man. So I married when I was 16 years old, and then I did finish my marriage. education’ (female 41 years, 5 children, university education, and professional occupation).  How much value do you, your husband and extended family place on children? ‘I know that my husband want s many children. Our family has also Gendered encouraged and also urged us to produce many children so they will be relations and proud of us, but after having had 12 children I have become so tired, so women’s exhausted, so I have decided I do not want to have any more children. autonomy. But my husband has told me that he will take another wife because he wants more children’ (female age 46, 12 children, illiterate, and housewife).  Do you think that at the present time there is conflict between desiring many Economic children and affording them (in light of economic constraints)? status, family size ‘There are some people who limit the number of children because of preference and economic constraints; I do not think this is right. As for me, I depend on religious ‘God’s Will’ and what He decides for me’ (male age 56, 6 children, influence. university education, and professional occupation).  What concerns do you and your husband have if you give birth to boys or girls Sex only? preference and gender issues. ‘I felt relieved when my first baby was a boy as you know there is preference for males in our culture’ (female 23 years, 1 son, university education, and housewife).  What do you now think of men’s and women’s roles, responsibilities and Domestic duties? division of labour. ‘Domestic responsibility is women’s duty, so my wife is responsible for everything regarding children and house necessities and our extended families help her’ (male age 35, 4 children, general education, and business occupation).

70  What did you plan or think at the beginning of your marriage about the number of children you wished to have (ideal family size)? Why?

‘Children are the natural outcome or product of marriage, I leave it to Planning God’s Will and I don’t have any problem if God decides that my children were few or many, especially if God decides that I have many issue. children then I will attain God’s law, as God asks his believers to bring many children’ (male age 56, with 6 children, university education, and professional occupation).

 Do you and your husband discuss fertility issues? What do you discuss and do you agree with your husband about reproduction decisions?

‘My husband wants everything to go his way, and he refused to discuss Discussing anything with me. A lot of problems take place in our life, and I always issues and told him I have the right to share my opinions with him. My husband gendered wants a lot of children, but as I now have two, I know and feel it is a big relationships. responsibility, so perhaps we will discuss this matter later to reduce that number, but I don’t know if my husband will concur with that or not’ (Female 26 years, 2 children, university education, and professional occupation).  What is the role or extent of influence of extended family (on either side), on an individual man's / woman’s life, regarding reproductive decisions?

‘My and my wife’s extended families constantly encourage us to have a Extended large family as they think children are a gift from God. So children bring family God’s blessing and well-being to the family. Thus I have a big family as influence. I believe the same thing as my extended family’ (Male, 45 years old, 12 children, literate, unskilled occupation).

There is much literature discussing how translation can affect research results: for instance, the loss of the direct connection between the researcher and the respondent through the employment of a translator who could miss the cultural significance and nuances of the language. However, in my case, as I am an ‘inside’ researcher, I did not encounter these problems. As Kerstetter (2012, p.99) notes, being an insider ‘dissolves the traditional boundaries between “researcher” and “subject” and involves community members fully in the research process. So that researchers and community members are broken down, the issue of trust emerges as critical to creating and sustaining successful partnerships’. Also, Inhetveen (2012) suggests that if the researcher is speaking the native language it will offer him/her significant opportunities for intimate awareness of participants’ perspective and the cross- cultural meanings, which will offer a unique outcome.

71 Baumgartner (2012) explains that if the researcher is not the translator or a non-mother tongue speaker, he/she may miss a significant way of understanding people as social actors and lack emotional depth, which could influence his/her ability to interpret those data. Further, Mafukata (2014) indicates that if the researcher shares the same language with the study respondents, this will enable reliable translation because she/he will understand the meanings that append to those words which are interrelated with the society and culture. Fortunately, being both the researcher and the translator, I was very close to my qualitative data and so for that reason did not need to use the software. However, this closeness brought with it dual responsibilities: first, as the researcher, the need to obtain a deep understanding in order to analyse the data; second, to represent my culture faithfully in terms of the meanings that had been provided and meant by research respondents. This also involved unpicking the meaning of the words that the respondents had used, not just an exact translation of the language, as this could indicate a further meaning, including issues relating to identity, gender and culture.

Writing and Dissemination

After analysing the data, a detailed and conclusive summary (relating to the study’s aim and objectives point by point) was produced; this integrated both qualitative as well as quantitative data, with the aim of describing and explaining clearly what the data and results meant. The latter was presented, as Cloke et al. (2004, p.338) suggest, in ‘an expository style which seeks to analyse, understand, explain and argue research findings’. This summary was used as a basis for writing up this thesis.

It is important to note here that the dissemination of this study in two languages requires double the amount of work. The thesis was first written in English and it will be retranslated from English into Arabic for publication, and also to benefit Arabic-only readers: especially the numerous respondents and fellow Arabic sociologists who have expressed a high degree of interest in the results of this study, and as such I have an obligation to ensure its availability. Also, prior to Arabic publication, the study will be further reviewed and revised to ensure political and social appropriateness regarding Saudi Arabian sensibilities. The final section discusses issues relating to ethics, access, reflexivity and positionality.

72 Study Ethics, Access, Reflexivity and Positionality

In the social sciences, there are some important issues that can have a major impact on research findings. These concern research ethics, access, reflexivity and representation.

Research Ethics

Hammersley and Atkinson (1995) provide guidelines for research ethics, which include informed consent, privacy, avoiding harm and exploitation. More recently, Resnik (2011) adds some general ethical principles such as honesty, objectivity, integrity, openness, respect for intellectual property, and social responsibility. Furthermore McCormick (2013) adds that feminist research ethics include to do good, which means to study important subjects that could improve women‘s status and enhance society’s well-being. Also, Cloke et al. (2004) note the importance of sensitivity to cultural differences and gender.

At the beginning of the data collection (survey and interviews) I gave the respondents general information about my identity, as well as my full name and my occupation, to make them feel safe with me, as I felt that if they knew my identity then they would be assured of the appropriate use of their information. I also informed the respondents of the aim of my research so they could understand why I needed such private and sensitive information, which would then encourage them to participate freely as much as possible. By giving the respondents information such as my full name and that I work at a university as a lecturer, I hoped this would make them less concerned that I might use their private information in unethical way (as they know my name and occupation, they can complain if their information is used wrongly, and this could then destroy and ruin my reputation).

In applying these ethics to my research (during the course of data collection in both the questionnaire and the in-depth interviews), and pertaining to informed consent in particular, I had to obtain two types of consent before conducting my study. The first consent was needed from the following hospitals in Jeddah; King Abdul Aziz Hospital, Maternity and Children’s Hospital, Doctor Bakish Hospital, and Doctor Fakeeh Hospital, and from the following business enterprises and organizations; Electricity Company, Saudi Airlines, Ministry of Civil Service, Ministry of Health, and General Organization of Social Insurance. To get consent from

73 these hospitals, business enterprises and organizations I used a written permission from King Abdul Aziz University to identify my position as a researcher and also used familial and social networks and connections (particularly as my study involved discussing a private and sensitive subject). The second consent required an initial verbal consent from the survey respondents and they were then asked to sign a consent form (to obtain this verbal and written consent, I fully informed the respondents about my research aims and all its aspects; also a letter of introduction was provided to the survey respondents at the front of the questionnaire form, which included information about the study subject, my name and also my position as a lecturer in King Abdul Aziz University).

The interview respondents were only required to give verbal consent, and this was obtained by telephone or pre-interview in a social setting (this issue is discussed in further detail in the section titled, ‘A Reflection on the In-depth Interviews’). I felt that the written form could give them an impression of formality which would be at odds with the close and friendly environment that I wanted to obtain during the interviews. A further issue is that I accessed the interview respondents through social networks, so it would be inappropriate in my culture to ask for their written consent after they had voluntarily agreed to share their private and sensitive information with me (all interviews were tape-recorded and respondents willingly agreed to this).

Furthermore, regarding the matter of privacy, I assured my respondents that I neither needed, nor would use, their names in the data, so unless they volunteered their names, I did not request this information. Regarding harm, my studies concerned adult perceptions and opinions among consenting men and women under no duress whatsoever, and while the nature of my study material is sensitive, it is definitely non-threatening in any capacity. The above can equally be applied to exploitation: there has been no unfair or covert treatment of any individual, or misuse of their information and opinions, as it has been freely volunteered and remains anonymous (particularly as in the case of in-depth interviews I never pressured any respondents to pursue any issues they did not want to give any information about; as for example, the details concerning their contraceptive practices).

Additionally, if ‘to do good’ is also to be seen as the appropriate use and development of information to benefit societal understanding and well-being, then this research sincerely hopes

74 to contribute to such a benefit. In this latter regard then it can be seen that the ethic ‘to do good’ is paramount as an ethical objective in this research. Furthermore, given the cultural and gender differences inherent in Saudi society (as previously outlined), sensitive and delicate handling of the respondents and the information they offered has been a great accomplishment. Being a female sociologist it was necessary for me to obtain a trustworthy male assistant to help me to collect data for the survey from Saudi men, as it would have been inappropriate for a woman in this society to be in the company of a man other than her husband or close male relative (also in Saudi Arabia it is not permissible for women to enter business premises, either government- based or private). More importantly, this could have compromised male respondents’ sensibilities. However, for the in-depth interviews, I was able to manage the interviews myself, as it was only a small sample of 16 married men who were selected from family networks. Also, the in-depth interviews were conducted in the privacy of their own homes, which was not the case in the survey sample, as these were conducted in public places.

Access

Access to the study setting is an important procedure in fieldwork studies, and study settings naturally differ according to the study subject and the target population. Sometimes tremendous effort is required by the researcher to obtain study setting access. For example, Cons’ (2014) work was with a researcher–assistant who was addicted to heroin, but this enabled him to access a dangerous area during his research at the India-Bangladesh border. Reeves (2010) faced numerous challenges when undertaking ethnographic fieldwork within a Probation Approved Premises, and the researcher went through difficult negotiations with gatekeepers in order to access the study site. Also, Newnham et al (2013) notes that being female and by establishing a mutual appreciation and communication with her participants before the study started, she was able to gain access in her ethnographic research to a childbirth setting in South Australia. Further, Johl and Renganathan (2010, p.42) state that gaining access to the research field is crucial and should not be taken lightly, that social skills are greatly required, and that it is important for one to gain the trust and acceptance of the participants in order to conduct one’s research.

75 Another major issue in gaining access is that the researcher understands the respondents’ language and culture, as it could strongly influence the study results if there were any misunderstanding or misinterpretation (Kerstetter 2012; Thuo 2013; Unluer 2012). In Saudi Arabia, the sensitivity and the privacy of subjects and topics in a conservative society make issues such as reproduction very difficult to investigate. Additionally, as a woman, and given that my study includes liaising with both men and women, discussions of such sensitive subjects with men could be very complicated and difficult. This is especially so as Saudis live in a truly segregated society and cultural traditions strongly disapprove of men and women mixing, particularly when dealing with sensitive fertility issues. Because the quantitative method (each survey) comprised a large-scale sample (100 males and 100 females), and because of conservatism and segregation, the only way to obtain the male sample was by using a male proxy-assistant (who was a postgraduate student in a university sociology department) to support my research, to distribute the questionnaire and to assist male respondents in completing it. Owing to the social situation here, it was necessary for the assistant to be fully aware of and consenting with the research in order to collaborate (through numerous meetings with the researcher) with the collection of such information.

Furthermore, as a researcher in Saudi society, access to the places where I needed to meet with respondents for the quantitative survey (that is, hospitals and business enterprises), required much more than the University’s authorization documentation to enable access to respondents. As the researcher, I had to call into play my extended family’s status and social networks in order to guarantee full cooperation from institutions and individuals alike and to secure private, confidential and credible understanding and endorsement. To exemplify, for instance, during the 2003 census, family and friends revealed that census officers were faced with stern rejections from many Saudi citizens when they visited people’s homes to collect data. Many people refused to cooperate with the census officers and give any information about themselves as they believed that this procedure was not permissible, as it meant giving a stranger private information about their lives. So despite lavish advertising campaigns and government encouragement as to the benefits of such census information, the government faced great difficulty in completing a survey census. This is but one example of the difficulty of conducting research in Saudi Arabia.

76 Thus, breaking down the wall between respondent and researcher in Saudi Arabia involves removing certain obstacles, and it was only by using familial and social networks and connections (wasta), that I was able to overcome such obstacles in order to obtain bona fide and valid data.

To gain access to interviewees for the qualitative interviews, I again used my character along with family social interactions and connections, but this time on a more personal basis with the family unit (of husband and wife). Initially I used my family social networks in order to make a list of possible couples who would accept such an in-depth interview involving sensitive issues. Then I had to gather general characteristics about the couples in my list (probable respondents), such as their socioeconomic and demographic status (for example, education levels, economic status, occupation status, number of children, and current age of the couple). Further, after gaining general information about the possible respondent, I selected 16 couples from the list, which enabled a sample of different socioeconomic and demographic characteristics. Lastly, I contacted the couples on my final list in order to gain their acceptance and permission to participate in this research, which they gave after a detailed explanation regarding the nature of research and the way the information from the interviews would be used.

In addition, in what I thought to be the most important element that would help me to accomplish this study, I utilized cultural and cognitive embeddedness, which allowed me inclusive access to study respondents. Cultural and cognitive embeddedness refers to the similarity between the researcher and the researched, as they both share similar frames of mind, tradition, habits, principles, rules, ethics, values and the religious system of that society (Bögenhold 2013; Daoud and Larsson 2011; Toumbeva 2012). Further, this social embeddedness increased the intensity of relationships between the researcher and study respondents, provided beneficial trust and reduced the risks among them, particularly as this study is dealing with very sensitive and private matters (Radil 2011; Chua et al. 2010; Walther 2015).

A Reflection on the Questionnaire Survey

In order to understand some of the difficulties relating to the questionnaire survey, it is useful to understand the context within which the research was conducted. First, although I had

77 obtained written permission to identify my position as a researcher from the King Abdul Aziz University and to enable me to access the study setting (contact affiliation), unfortunately the University notification letter, which was signed by a high authority in the University (King Abdul Aziz), did not actually assist in gaining appropriate access to interview places. Therefore I decided to try a different approach and use social connections instead. First I contacted the Dean of King Abdul Aziz University Medical School, and through him made contact with the Medical Manager in King Abdul Aziz Hospital, and also the manager of the private section in the same hospital. Furthermore, to gain access to the government Maternity and Children’s Hospital, I contacted the general manager, and through him we contacted the manager of the hospital and also the medical manager. For private hospitals, we contacted the owners, who were close friends of my father, and through them we contacted the medical managers in those hospitals. Thus, my contacts were also able to ensure that I could conduct my research in an appropriate interview setting, which significantly enhanced the comfort and security of the respondents. Without these social familial links, undertaking a research project of this nature would have proved very difficult in Saudi Arabia. However, having repeated those efforts twice, for the 2005 survey and again for the 2013 survey which caused a great deal of pressure and stress, what gave me satisfaction was the outcome, which was valuable and insightful information that enriched the research.

During methodological considerations for my study, I felt a need to have more interaction with the study respondents rather than just giving people the task of filling in questionnaires. Increasingly, numerous researchers are applying a qualitative research approach to quantitative research (Kriel and Risenga 2014; Thuo 2013; Tracy and Robles 2010). The survey is a major tool in quantitative methodology, and this usually involves minimal interaction with respondents, as researchers are restricted to pre-formulated and structured questions. However, as my study investigated personal and socially sensitive issues within a culture unfamiliar in dealing with and discussing probing questions of this nature, I felt obliged to employ further skills and sensibilities.

Having more interaction with survey respondents required considerably more time and effort and permitted a more emotional or intimate contact with respondents. For instance, during the course of face-to-face questionnaires with female respondents (along with survey-filling), some of the educated women asked questions or required further information, while women from

78 across the educational spectrum also wished to discuss matters further, especially after questions regarding gender relations. On the other hand, women with minimal education levels (for example, elementary level only), were asking me to give them advice that would benefit them and their daughters and specifically on how to improve gender relationships with their husbands. As a result of the inquiries arising from the more intimate interactions, I felt more responsible for, and challenged by, the work undertaken.

As far as I could, during the survey I gave the respondents as much time as possible, explaining what I was doing, what my study aimed to do and hoped to achieve: an in-depth and insightful view of reproductive issues. Interestingly, most of the female respondents expressed a desire to see the results of my study’s findings. Even though I did not directly interview the men during the questionnaire survey, the male assistant (accompanied by a male relative) was reporting daily to me with further inquiries and explanations needed for male respondents’ concerns. For instance, they asked whether the results of the survey might deliver a negative impact (according to their perceptions) by changing our society’s traditions and values. Second, those who were more liberal and progressive were interested to know more about the study and also expressed a desire to view the results or outcomes. It can be seen then that responses to these inquiries required yet more effort on my part in arranging times for meetings with my male assistant to clarify and provide answers to male respondents’ pertinent queries.

A Reflection on the In-depth Interviews

Reflecting on the interview process and focusing on the difficulties and implications that confronted me through it illustrates the complexity of undertaking such a research topic in Saudi Arabia. From the beginning, a major issue was the nature of my culture and the inherent difficulties in finding willing spouses as respondents. It was also challenging to obtain a good cross-section or variety of family types across the spectrum of social characteristics relative to age, education, income and occupational status. For example, I used my family’s social networks, and also my husband’s social networks as well as my personal social networks. All this took tremendous effort to organize, along with careful thinking as to how to choose a variety of socioeconomic statuses.

79 The actual length of time for each interview, including the preamble and post-interview discussions varied, but on average took around five hours (approximately divided into two each for the husband and wife). Before each couple’s interview I spent a great deal of time organizing appointment times suitable for the three of us. My initial contact with respondents was by telephone or pre-interview (which sometimes occurred in social settings where I would bring the subject up in conversation with other women), and then I had to explain the purpose of requiring in-depth and face-to-face interviews (as opposed to a questionnaire), as this is such an uncommon occurrence in this culture. After agreement had been reached, a further lengthy process of dialogue was undertaken to ensure optimum honesty and truthful responses, and also to instil confidence in the respondents by explaining how the information would be used, and to assure their anonymity. In particular I had to ensure that the interview data would not be put forward as individual cases - in other words would not be presented as a life profile.

Moreover, I confronted individual situations during the interview process. For example, one couple of low socioeconomic status tended to treat me like a social worker who worked for a charity organisation and (because I was in their home) they tried to explain to me and show me the nature of the difficulties in their living circumstances. So I tried my best to respond directly to them and assure them of more permanent types of assistance, for instance either by registering them with specific charitable organisations or privately funded groups, all of which required a lot of time and effort to follow up to put in place. Also, some couples who were in my own social network or extended family, even though they were not very close to me, still felt confronted and had concerns and worries about telling me some aspects of their private lives, such as problems with their husbands or extended family relatives. This prompted me to constantly reassure them of the confidentiality of the information they were giving to me. Also with some couples, the husband did not feel comfortable, or had some suspicions, about my request to interview the wives alone. Sometimes, when I started an interview with the husband, I felt there was some tenseness in the responses which required me to react immediately to show that I was completely impartial to all the information passed on to me, by giving him my full attention and lightening the mood by sharing pleasantries and anecdotes.

I found myself using participant observation techniques, for instance examining body language, to elicit in-depth and insightful responses. Kriel and Risenga (2014) and Tracy and Robles (2010) have stressed that the interview is also an opportunity for participant observation which

80 can generate new information, providing the researcher with clearer understanding of what is discussed explicitly in the interview, rather than just asking questions and conversing with respondents. Moreover, Hämäläinen and Rautio (2013) have noted that interviews are a specific type of dialogue, torn out of the enduring context of social life: the very type of context which the study of people in places is best equipped to make sense of. Thus it is suggested that researchers would derive better results if they interviewed people and observed physical and emotional contexts. For example, in my research during the interviews there were some female respondents who clearly reported that they did not plan for a specific number of children and they agreed with their husband on this issue. But I noticed (through body language signals such as dropping the voice, unhappy facial expressions, or hand signs to show less autonomy), that some wives were not pleased about this lack of planning, but they did not want to express this directly as they did not want to appear to go against religious convention, nor to illustrate a disagreement within their family or indeed to manifest their lack of autonomy with respect to reproductive decision-making. In support of this issue, Berthin (2011) has given suggestions about dealing with silence issues. They state that there are many topics which people will refrain from speaking about because they cannot or do not want to speak, and these silences have to be interpreted using triangulation from other sources. In my case, I had to interpret such silences to question the expressed extent of agreement between husbands and wives, for clearly women were under pressure from the male domain in Saudi Arabian culture.

I thus increasingly found myself emotionally as well as intellectually involved in these couples’ lives and think that this was reflected in the way in which some of the interviewees requested my opinions or advice. Towards the end of the interview process, the utterly intense process of in-depth interactions with respondents was extremely exhausting, and it would take considerable time for me to de-brief in preparation for the next round of interviews.

Positionality

Day (2012), Greene (2014) and Muhammad et al (2014) highlight many important issues related to researchers’ positionality (which involves age, sex, ethnicity, cultural background and religion) and how it will affect our knowledge and influence the interaction between the researcher and the people under study. For example, Greene (2014) and Holmes (2014) note that our identity is structured by our age, religion, gender, ethnicity, cultural background, and

81 that this positionality will reflect our thoughts about what we determine is important and worth studying, which will be displayed in the gathered data and how it is analysed. In addition, Muhammad et al (2014) have stated that the process of conducting research is significantly influenced by how our identities are shaped and that our positionality will govern our relations to others. Also, Day (2012, P.72) indicates that ‘the researcher’s biography with regard to race, class, and gender is already formed prior to the research experience rather than being an emergent feature of the research process itself. A reflexive understanding of identity as a dilemma differs from this approach in trying to make explicit the ways in which identity is formed through the interactions between the researcher and the people under study’.

Further, Unluer (2012) notes that in the quest for a shared ground between the researcher and the study participants, harbouring mutually rewarding relationships, and acting on a deeper understanding of the role of emotions, social structures and communities in knowing and knowledge production, can help make fieldwork a worthwhile and rewarding venture. This has certainly been the case in my research.

Furthermore, Kerstetter (2012) notes that field researchers need to be aware of the diverse and profound interactions that are affected by gender and cultural background. Moreover, Mohammad (2001), a Pakistani female researcher, was given advice from her careers officer to do research on Pakistani society, as she was a member of that society. This advice revealed to her the ‘notion of positionality’ which meant that she would be seen as an insider and that would be very useful to her as a researcher with authentic knowledge.

In my case as a Saudi Arabian researcher, being married and a mother of a large family (five children) enabled me to share common ground with the research respondents (both men and women), especially as my research study focused on sensitive issues of reproductive behaviours and how reproductive decisions are reached. Thus, my personal status (as a married woman and a mother) encouraged the respondents to discuss these issues more openly and with more confidence once they became aware of my marital and maternal status. Saudi society bestows high status on married women with children, and as such, respondents were more likely to be trusting in providing information of a private and sensitive nature.

82 My positionality in the survey was affected by my cultural and religious background. However, for the in-depth interviews, a small-scale male sample of 16 married men, I was able to manage the interviews myself, through my careful selection of couples through family networks, and conduct them in the privacy of interviewees’ own homes (which was not the case with the survey sample, which was in public places, where segregation is applied). Moreover, in this instance there had to be strict adherence to dress codes (for interviews with males only) owing to religious and cultural norms and values. For instance, I dressed in the traditional abaya and burgha, which is total head to toe coverage, leaving only the eyes uncovered.

A final issue regarding representation and positionality is with respect to my presenting my study in the UK. This called for two considerations. Firstly, I had to put in extra effort and felt greatly responsible to present and clarify my society’s cultural background with valid and appropriate information to the non-Saudi readers of my thesis. Secondly, this gave me more intellectual licence to explore gender relations issues: a subject which is rarely discussed in Saudi Arabia. So, as a Saudi citizen, this allowed me an insider’s perspective on my research topic, as my culture is an intrinsic part of me, affording me a ‘grassroots’ perspective of my society and culture. But as a global student, it also allowed me an outsider’s perspective and afforded me the opportunity of making acquaintance with other students, enabling a closer connection to many diverse cultures. Both these simultaneous perspectives, as insider and outsider, thus enabled me to traverse the nuances of both cultures, which significantly enhanced my ability to analyse and present my study results.

Characteristics of the Surveys and in-depth Interview Samples

A discussion of the general characteristics of both survey samples will be presented here with respect to age, income, education and occupation, which will also allow the verification of the changes that have taken place between the basic characteristics of the societal changes in the survey respondents between 2005 and 2013.

First, regarding age, Tables 3.4 and 3.5 (representing the distribution of the survey sample by age groups, which only includes the age group from 15-60 years), shows that for survey respondents, on average, females get married younger than males (as the survey sample includes only married people). Also, it can be seen that the majority of the female sample were

83 in the age group 26-35, which could be a reflection of the fact that the female sample was collected from Obstetrics and Gynaecology clinics (Saudi Arabian females in this age group are most probably at the height of their reproductive period, which means that they need to visit Obstetrics and Gynaecology clinics more frequently than the women in other age groups). For the in-depth interview sample the age range for the interviewee husbands was from 27-56 years and for the interviewee wives from 23-49 years. This illustrates that the interviewee husbands are older than their wives (in my sample, the wife was older by 1-2 years in only two families).

Table 3.4 Age Distribution by Gender for 2005 survey sample Age Groups (years) Male % Female % 15-25 4 26 26-35 30 43 36-45 43 20 46-60 23 11 Total 100 100 Source: Fieldwork, 2005

Table 3.5 Age Distribution by Gender for 2013 survey sample Age Groups (years) Male % Female % 15-25 1 17 26-35 31 48 36-45 44 28 46-60 24 7 Total 100 100 Source: Fieldwork, 2013

Secondly, Table 3.6 represents the distribution of the survey sample by different income groups, and shows that the majority of respondents of the 2005 survey (60 percent) were in two income groups (from 2000-5000 and 5001-10000 SR) for family income (per month). Meanwhile, Table 3.7 shows an increase in income of survey respondents and the majority of respondents for the 2013 survey (78 percent) were in two income groups (from 5000-10000 and 10001-20000 SR) for family income (per month). This increase in income was due to a government decision to raise all employee wages. The income per month for the in-depth interview sample (comprising 16 families) was distributed as follows: 6.25 percent had an income of 3000 SR, 37.5 percent had an income of 10000-15000 SR, 37.5 percent had an income of 20000-30000 SR, and lastly 18.75 percent had an income of 40000-60000 SR.

84 Table 3.6 Distribution of Genders by Different Income (SR per month) in 2005 <2000 SR 2000-5000 SR 5001-10000 SR >10000 SR Total <533 $ 533- 1333 $ 1334-2667 $ > 2667 $ Male 0 19 35 46 100 Female 2 28 39 31 100 Total 2 47 74 77 200 Total % 1 23.5 37 38.5 Source: Fieldwork, 2005

Table 3.7 Distribution of Genders by Different Income (SR per month) in 2013 5000-10000 SR 10001-20000 SR >20000 SR Total 1334-2667 $ 2667-5333 $ > 5333 $ Male 33 46 21 100 Female 43 34 23 100 Total 76 80 44 200 Total % 38 40 22 Source: Fieldwork, 2013

Thirdly, Tables 3.8 and 3.9 represent the distribution of the survey sample at different educational levels (this table includes the education levels of the 100 male respondents and their wives, 100 female respondents and their husbands, in the age group from 15-60). Table 3.10 demonstrates that the illiteracy level in the survey sample (male and female) was only 1 percent. The rest of the survey respondents (male and female) were distributed in respect of education levels as follows: 48.5 percent have general education and 50.5 percent have university education. However, Table 3.9 did not include any illiterate respondents, and revealed an increase in respondents with a university education at 69.5 percent (both male and female). This could reflect the relatively young age of the respondents who have benefitted from the expansion of the education system in Saudi Arabia (see Table 4.7 in Chapter Four). Another reason is that the survey sample is from Jeddah and Jeddah is a cosmopolitan urban city. For the in-depth interview sample, only one wife and her husband have elementary education (family number 8). In three families, the husband’s education level was lower than the wife’s (the husband had a high school qualification or diploma and the wife had a university education). In five families, the husband’s education level was higher than the wife’s (the husband had a university education and the wife had a secondary level or high school qualification). For the rest of the interview sample, which comprised seven families (almost half the sample), both spouses were university educated. This means that interviewees had fairly high education levels. This might reflect the same reasons as the survey sample, although

85 the interview sample has the further reason that this sample represents a higher income level than the survey sample.

Table 3.8 Distribution of Gender Education Levels in 2005 Illiterate General Education University Total Male 1 84 115 200 Female 3 110 87 200 Total 4 194 202 400 Total % 1 48.5 50.5 Source: Fieldwork, 2005

Table 3.9 Distribution of Gender Education Levels in 2013 General Education University Total Male 57 143 200 Female 65 135 200 Total 122 278 400 Total % 30.5 69.5 Source: Fieldwork, 2013

Fourthly, regarding occupation, Tables 3.10 and 3.11 (representing the distribution of male respondents in the survey sample in different occupations, which only includes the age group from 15-60) shows that a low percentage of survey respondents work in low occupational status roles as skilled and unskilled labour (only in the 2005 survey), which could reflect the slightly high educational level in the survey sample. Table 3.12 and 3.13 (representing the distribution of occupational status among female respondents in the survey sample, which only includes the age group from 15-60) demonstrates that the majority of female respondents (74 percent in 2005 and 58.5 in 2013) were housewives, which could reflect the limited opportunities for Saudi Arabian women in paid employment (see Table 4.2 in Chapter Four). For the in-depth interview sample, only two interviewee husbands had unskilled labour occupations, whereas the rest of the interviewee husbands were distributed among the following occupations; five professionals, six administrative workers and three businessmen, which matched with rather high income and education levels. Regarding the interviewee wives, only five were working, which reflects the low percentage of working women in Saudi Arabian society. Table 3.10 Distribution of Male Occupational Status in 2005 Professional BusinessAdmin Skilled Unskilled Total Male 41 27 93 32 7 200 Total % 20.5 13.5 46.5 16 3.5 Source: Fieldwork, 2005

86 Table 3.11 Distribution of Male Occupational Status in 2013 Professional BusinessAdmin Skilled Total Male 60 19 108 13 200 Total % 30 9.5 54 6.5 Source: Fieldwork, 2013

Table 3.12 Distribution of Female Occupational Status Professional BusinessAdmin Housewife Total Female 36 4 12 148 200 Total % 18 2 6 74 Source: Fieldwork, 2005

Table 3.13 Distribution of Female Occupational Status Professional BusinessAdmin Housewife Total Female 37 2 44 117 200 Total % 18.5 1 22 58.5 Source: Fieldwork, 2013

Finally, the extent of in the 2005 survey sample was very low; from the male respondents, only eight reported that they had two wives, and from the female respondents only five reported that they were in a polygamous marriage (two wives), whereas no one from 2013 survey sample is in a polygamous marriage. This also was the case in the in-depth interviews; unfortunately there is no available data about the national level of polygamy in Saudi Arabia.

Table 3.14 Characteristics of the In-depth Interview Sample Case Number Family Characteristics Respondents’ Data Family number 1 Husband’s current age 27 Wife’s current age 23 Number of children 1 child Number of boys 1 boy Numbers of girls No girl (The age of their first child and last child) (3) Age of marriage; husband 23 Age of marriage; wife 19 Husband’s educational level University/ doctor Wife’s educational level University/ doctor Husband’s occupational status Professional Wife’s occupational status Professional Family income (per month) Around 11000 SR Years of marriage 4 years Family number 2 Husband current age 30 Wife’s current age 26 Number of children 2 children 87 Case Number Family Characteristics Respondents’ Data Numbers of boys 1 boy Numbers of girls 1 girl (The age of their first child and last child) (3-1) Age of marriage; husband 26 Age of marriage; wife 22 Husband’s educational level University Wife’s educational level University Husband’s occupational status Administrative Wife’s occupational status Professional/doctor Family income (per month) Around 15000SR Years of marriage 4 years Family number 3 Husband’s current age 35 Wife’s current age 31 Number of children 3 children Numbers of boys 1 boy Numbers of girls 2 girls (The age of their first child and last child) (11-2) Age of marriage; husband 23 Age of marriage; wife 19 Husband’s educational level University Wife’s educational level University Husband’s occupational status Administrative Wife’s occupational status Housewife Family income (per month) Around 13000 SR Years of marriage 12 years Family number 4 Husband’s current age 35 Wife’s current age 38 Number of children 4 children Numbers of boys 2 boys Numbers of girls 2 girls (The age of their first child and last child) (7-1) Age of marriage; husband 27 Age of marriage; wife 30 Husband’s educational level High school Wife’s educational level University Husband’s occupational status Businessman Wife’s occupational status Professional/teacher Family income (per month) Around 12000 SR Years of marriage 8 years Family number 5 Husband’s current age 41 Wife’s current age 35 Number of children 2 children Numbers of boys 1 boy Numbers of girls 1 girl (The age of their first child and last child) (8-3) Age of marriage; husband 28 Age of marriage; wife 22 Husband’s educational level University 88 Case Number Family Characteristics Respondents’ Data Wife’s educational level University Husband’s occupational status Businessman Wife’s occupational status Housewife Family income (per month) Around 20000 SR Years of marriage 13 years Family number 6 Husband’s current age 41 Wife’s current age 41 Number of children 3 children Numbers of boys 2 boys Numbers of girls 1 girl (The age of their first child and last child) (15-6) Age of marriage; husband 25 Age of marriage; wife 25 Husband’s educational level University/ PhD Wife’s educational level University/ PhD Husband’s occupational status Professional/doctor Wife’s occupational status Professional/doctor Family income (per month) Around 33000 SR Years of marriage 16 years Family number 7 Husband’s current age 43 Wife ’s current age 35 Number of children 5 children Numbers of boys 1 boy Numbers of girls 4 girls (The age of their first child and last child) (18-4) Age of marriage; husband 24 Age of marriage; wife 16 Husband’s educational level University Wife ’s educational level University Husband’s occupational status Administrative Wife’s occupational status Administrative Family income (per month) Around 30000 SR Years of marriage 19 years Family number 8 Husband’s current age 45 Wife’s current age 46 Number of children 12 Numbers of boys 6 boys Numbers of girls 6 girls (The age of their first child and last child) (27-5) Age of marriage; husband 17 Age of marriage; wife 18 Husband’s educational level Elementary Wife’s educational level Illiterate Husband’s occupational status Unskilled labour Wife’s occupational status Housewife Family income (per month) Around 3000 SR Years of marriage 28 years

89 Case Number Family Characteristics Respondents’ Data Family number 9 Husband’s current age 46 Wife’s current age 36 Number of children 5 children Numbers of boys 2 boys Numbers of girls 3 girls (The age of their first child and last child) (21-2) Age of marriage; husband 23 Age of marriage; wife 17 Husband’s educational level University Wife’s educational level High school Husband’s occupational status Businessman Wife’s occupational status Housewife Family income (per month) Around 31000 SR Years of marriage 23 years Family number 10 Husband’s current age 46 Wife’s current age 45 Number of children 3 children Numbers of boys 3 boys Numbers of girls No girl (The age of their first child and last child) (18-10) Age of marriage; husband 21 Age of marriage; wife 20 Husband’s educational level University/master Wife’s educational level High school Husband’s occupational status Administrative Wife’s occupational status Housewife Family income (per month) Around 15000 SR Years of marriage 25 years Family number 11 Husband’s current age 47 Wife’s current age 45 Number of children 5 children Numbers of boys 1 boy Numbers of girls 4 girls (The age of their first child and last child) (21-1) Age of marriage; husband 24 Age of marriage; wife 22 Husband’s educational level Diploma Wife’s educational level University Husband’s occupational status Administrative Wife’s occupational status Professional/teacher Family income (per month) Around 20000 SR Years of marriage 23 years Family number 12 Husband’s current age 49 Wife’s current age 40 Number of children 6 Numbers of boys 2 boys Numbers of girls 4 girls (The age of their first child and last child) (20-3) 90 Case Number Family Characteristics Respondents’ Data Age of marriage; husband 28 Age of marriage; wife 19 Husband’s educational level University Wife’s educational level High school Husband’s occupational status Professional Wife’s occupational status Housewife Family income (per month) Around 60000 SR Years of marriage 21 years Family number 13 Husband’s current age 53 Wife’s current age 48 Number of children 4 children Numbers of boys 4 boys Numbers of girls No girls (The age of their first child and last child) (28-19) Age of marriage; husband 20 Age of marriage; wife 15 Husband’s educational level University Wife’s educational level Secondary Husband’s occupational status Professional Wife’s occupational status Housewife Family income (per month) Around 60000 SR Years of marriage 33 years Family number 14 Husband’s current age 54 Wife’s current age 44 Number of children 5 children Numbers of boys 3 boys Numbers of girls 2 girls (The age of their first child and last child) (24-7) Age of marriage; husband 29 Age of marriage; wife 19 Husband’s educational level University Wife’s educational level University Husband’s occupational status Professional Wife’s occupational status Administrative Family income (per month) Around 40000 SR Years of marriage 25 years Family number 15 Husband’s current age 56 Wife’s current age 41 Number of children 5 children Numbers of boys 1 boy Numbers of girls 4 girls (The age of their first child and last child) (23-6) Age of marriage; husband 32 Age of marriage; wife 17 Husband’s educational level Diploma Wife’s educational level University Husband’s occupational status Unskilled labour Wife’s occupational status Professional/teacher 91 Case Number Family Characteristics Respondents’ Data Family income (per month) 10000 Years of marriage 24 years Family number 16 Husband’s current age 56 Wife’s current age 49 Number of children 6 children Numbers of boys No boys Numbers of girls 6 girls (The age of their first child and last child) (25-6) Age of marriage; husband 29 Age of marriage; wife 22 Husband’s educational level University/master Wife’s educational level Secondary Husband’s occupational status Professional Wife’s occupational status Housewife Family income (per month) Around 21000 SR Years of marriage 27 years

Conclusions

This chapter establishes the methodological research approach that was employed in the study, within the context of mixed methodology. This included qualitative in-depth interviews, as well as a large scale quantitative survey, in order to extract information pertaining to fertility issues in Jeddah, Saudi Arabia. The city of Jeddah was chosen as the focus for this study. As it has seen recent substantial population growth, this allowed for a selection of the broader urban population of Saudi Arabia and was therefore a prime location for studying fertility change. Additionally, due to Jeddah’s nature as a liberal and cosmopolitan city, it was easier to conduct a study of such a sensitive nature here than elsewhere in Saudi Arabia. A further important issue concerning the choice of Jeddah as a study site was that the researcher is resident in this city, thus enabling the researcher to conduct sensitive research using the social networks of her family, which provided appropriate access to the study respondents.

The research used a questionnaire survey and in-depth interviews as the methods of data collection. The questionnaire sample size was 400 respondents, which included 200 males and 200 females. In order to obtain significant information concerning changes in reproductive behaviour, the questionnaire was repeated twice over a period of 8 years’ gap, and each time comprised 200 respondents. Both surveys were collected in several places, including major hospitals in Jeddah for the female sample and various major business enterprises in Jeddah for the male sample. The best possible sample in the Saudi Arabian social context was therefore a

92 multi-stage cluster sample. This study applied one of the main methods of administering questionnaires, which was the face-to-face survey, mostly using closed questions. The male questionnaires were conducted through a male assistant researcher (due to cultural constraints), and the female questionnaires were conducted through the researcher. In-depth interviews were conducted using 16 females and 16 males (as 16 married couples, a total of 32 interviewees). The researcher applied a snowball sample technique, dependent on the researcher’s social and family acquaintance networks, because of the sensitivity of the research subject on reproductive decision-making. The researcher required the approval of the respondents, and a determined effort was made to build a solid rapport and good relationships with the respondents, in order to obtain as much explicit and honest information from them as possible. All interviews took place in the married couples’ homes, based on the desire of the interviewees. Two important issues discussed in this chapter have been reflexivity and positionality as these can have a major impact on the value and validity of research findings. Interestingly, this part of the chapter was very important and significant as it explained in great detail the specific context in which the research was conducted. Finally, a description of the characteristics of surveys and interview samples was presented.

93 Chapter Four Insight on Saudi Arabia and Jeddah’s Culture

Introduction

This chapter presents some brief information regarding Saudi Arabia, as it is essential to have some knowledge as to the formation of the Kingdom, and in particular its cultural background. This will assist an understanding of the principles which have guided the Kingdom's development and have thus influenced policy with respect to reproductive services and access to family planning. This chapter also provides a socioeconomic and cultural contextualization of the society of Saudi Arabia which will aid an understanding of the position of women in society and the role of Islam, particularly in influencing policy- making.

This chapter is divided into seven main sections: the history of Saudi Arabia, the role of , Saudi culture and women, the economy of Saudi Arabia, the development plans of Saudi Arabia, education and health care services, and lastly, reproductive services and attitudes towards family planning.

The History of Saudi Arabia

Firstly, a brief history of the development of the state of Saudi Arabia will be given. On September 18th 1932, the disparate tribes that inhabited approximately four-fifths of the Arabian Peninsula were officially unified by King Abdul Aziz Ibn Saud, to form a single nation founded upon Islam. Saudi Arabia is in fact regarded as ‘the cradle of Islam’.

However, the history of the involvement of the Al-Saud family started long before 1932, and in actuality the foundation of the Kingdom of Saudi Arabia passed through three stages. The first stage, from 1744-1818, was initiated by the union between Muhammed Ibn Saud, the governor of Dareea (a city in Najed region, which is now in the middle of Saudi Arabia and named Al- Riyadh Administrative Region), and a religious leader, Muhammed Ibn Abdul-Wahab. The two men agreed to establish a nation based on true Islamic doctrine. The new Al-Saud nation 94 therefore came into being due to the political power of Al-Saud and the religious support of Muhammed Ibn Abdul-Wahab (Abdouh 1999; Al-Otheamen 2005; Ibn-Bsher 1971). By the beginning of the 18th century, most of the Arabian Peninsula was under the jurisdiction of the Al-Saud government, following wars with several local states governed by other tribes to unite those states under the nation of Al-Saud. However, the first stage of the Al-Saud government came to an end when it tried to take control of the region (now in the west of Saudi Arabia and named the Administrative region of Makah Al-Mokaramah). The Hejaz region was under the control of the Utman[u1] Empire and represented an important part of this empire because it included the two Holy Mosques of Muslims. Thus the Utman Empire, through their Egyptian governor, fought a war with the Al-Saud government; they won and retrieved the Hejaz region for the Utman Empire.

The second stage, from 1823-1891, followed the war with the Utman Empire. A member of the Al-Saud family attempted to congregate the tribes which supported their government and this formed the second stage of the Al-Saud government. However, the regime was not stable or well established and included only some parts of the Arabian Peninsula (the middle region and some of the west and south regions). This was due to disagreements between members of the Al-Saud family and also wars with other local states governed by different tribes, as well as the war with the Utman Empire. Therefore, the second stage of the Al-Saud government came to an end as a result of this struggle (Al-Otheamen 2005; Al-Gamdi and Halwani 2000; Ibn-Bsher 1971).

The third stage of the Al-Saud government, and the beginning of the Kingdom of Saudi Arabia, commenced when King Abdul Aziz Ibn Saud tried to regain the authority of his ancestral Al- Saud family. Control of Riyadh city was retrieved in 1902, but it took over 30 years to establish the nation of the Kingdom of Saudi Arabia. Throughout these 30 years he engaged in several wars with local states governed by other tribes in an effort to gain control over Najed, the middle region, then the east region, followed by the north, then the south, and lastly the Hejaz, which is the west region. In order to consolidate his control he signed a treaty with the Utman Empire in 1914, and an important treaty that helped to consolidate his authority with Great Britain in 1915 (Al-Dugani 2003; Atar 2000; Al-Gamdi and Halwani 2000; Al-Otheamen 2005). Thus, the formation of the Saudi Arabian state has a complex history, and is tied closely to the Islamic religion. This role of Islam in Saudi Arabian society is discussed below.

95 The Role of Islam

To understand the history of the Kingdom of Saudi Arabia and its political, economic and social development, it is also necessary to understand that Islam permeates every aspect of a Muslim's life, and also permeates every aspect of the Saudi Arabian state, particularly with respect to policy-making and efforts to bring benefits to its citizens.

As presented previously, the Al-Saud family based their authority and the developing nation state on the Islamic religion from the beginning. This base helped to establish a much more cohesive nation than other local states or governments that were founded on a purely tribal background. The Al-Saud family aimed from the start to unify the different tribes of the Arabian Peninsula as one nation, and the religious foundation was a very important element in uniting and joining those different tribes (Abdouh 1999; Abo-Aleea 1997; Al-Otheamen 2005; Ibn-Bsher 1971).

Moreover, King Abdul Aziz Ibn Saud started the Al-Ekwan group in 1913. This group was framed or based on religious and military foundations. King Abdul Aziz Ibn Saud employed this group in two important ways. One was to assist the settlement of various tribes of wandering Bedouins, by convincing those tribes of the benefits of settlement and offering them free land, as well as teaching them the basic doctrine of Islam. The second was to support the King in his mission to unify the different tribes in the Arabian Peninsula under one nation. The King used the Al-Ekwan group as an unofficial military force, to support his government and defend his territory against the enemies of the Saudi nation before they all united under the Al-Saud government (Delamy and Rebiay 1999; Abo-Aleea 1997; Ibn- Bsher 1971).

As Saudi Arabia is the birthplace of the Islamic religion (with the presence of the two holy cities and mosques of Mecca and Medina) and as the Islamic doctrine is so central to the original founding of the nation state, it is likely that the Islamic influence in the Saudi Arabia social context is more pronounced and more significant than in other Islamic countries. Furthermore, the very foundation of the Saudi Arabian constitution is the Holy Quran, whose basic principles are succinctly expressed in the following quote from the Saudi constitution:

96 The Quran is the clear spring and the inexhaustible source, from which the monarchic system in Saudi Arabia derives the form of government by the honourable of Allah, in accordance with His Holy Book, and the immaculate Sunna of his messenger (peace be upon him). The King and the Council of State along with the Council of Ministers constitute the executive powers in the State (Abo-Talib 1984).

It is important to appreciate that there are two sorts of legislation in Saudi Arabia: legislation based on Islamic doctrine and legislation which includes government regulations (civil laws). First, legislation based on Islamic doctrine is based on the Holy Book the Quran and the immaculate Sunna (Prophet Mohammed’s sayings and actions). For example, Kalaf (1986, p.32) indicates that the Quran includes Islamic law, which permeates every aspect of a Muslim's life: ‘the Quran contains 70 verses regarding personal status law, 70 verses about the law of civil procedure, 30 verses concerning criminal law, 25 verses about internal and international law, 13 verses regarding legal and judicial law, ten verses about commercial and fiscal law, and ten verses concerning constitutional law’. Second is the legislation that includes government regulations (civil laws), which are based on the King’s legislative power in association with the Council of State and the Council of Ministers (Al-Derab 1983; Abo-Talib 1984; Shalhop 2005).

From the beginning of the establishment of the Kingdom of Saudi Arabia, the King has held the legislative power, and this legislative power has been supported by religious leaders. In order to organize the religious authority, King Abdul Aziz designated one religious leader (Mufti) to be the official expounder of the Islamic law Fatwa in 1954, and in 1973, due to the increase of Mufti responsibilities, an institution of religious leaders was founded to be responsible for the religious Fatwa; this is named Dar Ifta, the consultant committee to the official expounder Mufti (Al-Sheak 1993; Al-Sineady 1989).

This institution then developed into a larger institution named The General Presidency of Scholarly Research and Ifta. This religious institution was, and still is, supportive of the King’s legislative power (Shalhop 2005; Wahba 1956). For example, when problems related to drugs became prevalent in Saudi Arabia in 1987-1988, King Fahad consulted the institution of religious leaders concerning legislation on the drugs problem, as he wanted to implement stern sanctions. In response, the institution of religious leaders released a law (Fatwa) that allowed

97 the death penalty for drug dealers (Shalhop 2005, p.262). Also, Findlay (1994), through his writing about the Arab world, stated that even though Saudi Arabia is developing the economy and infrastructure, yet it insists on sustaining its traditional values and in particular Islamic beliefs. Thus, the links between the head of state and Islamic religious bodies are strong and Islamic beliefs permeate every aspect of life in Saudi Arabia. This is particularly so regarding the role of women.

Saudi Culture and Women

Patriarchy and Gender System

Saudi Arabia is a patriarchal society: males have authority over women. moreover, women in Saudi Arabia are living with patriarchy that is supported by a tribal background and a strict gender system in different spheres of life. This patriarchy is practised in different forms, both at the household level and at an institutional level.

Firstly, at the household level, men are responsible for the women in their families as they are the mahrams (close male relatives). Fathers, brothers, husbands and uncles (mahrams) have control over the women in their family. For example, in the case of a girl’s marriage, her father, brothers or uncles are responsible for helping in the decision-making process regarding approval of the marriage; the girl generally cannot marry without the approval of one of her mahram, otherwise she will be ostracised and she becomes a source of shame to her family. After marriage the husband assumes control and responsibility for his wife’s life, because most women are totally dependent on men for economic support (particularly if they do not have any independent means of support, either through work or inheritance from their birth family). This economic dependency of women gives men control over women within the family, whereas women with independent means can have more freedom (for example to buy their own necessities), and this independence may give them the opportunity to participate in the financial support of the family, although they still have to operate under their male mahram and get his approval.

98 Secondly, at the institutional level, women’s access to the public sphere is very limited. For example, women’s participation in the labour market in Saudi Arabia is still insignificant (see Table 4.2), so most women are totally dependent on men for economic support. Furthermore, Saudis live in a truly segregated society and cultural traditions disapprove of men and women mixing. For example, women are not allowed to enter most government organizations or even private business enterprises: thus, women must depend on men to carry out most official or legal procedures, as for example arranging an electricity supply for a new house, or a telephone line, or a lawsuit. Also, in Saudi Arabia, the education system is segregated at all levels, with separate schools and universities for males and females. In hospitals, women can follow up with a male physician (if she wants and her husband agrees) or the husband can accompany his wife to see her physician, but the waiting rooms are separated.

Additionally, women are not allowed to drive in Saudi Arabia, and thus they have to depend on men for transportation (either their close male relatives or drivers); neither are women in Saudi Arabia allowed to travel outside the country without being accompanied by their mahram, or if the mahram cannot go, the woman must have written permission from her mahram. Moreover, women’s role in decision-making in the society is very limited. Even though recently, in 2006, the government assigned six chairs for women in the state consultative council (Magless Shura), those women were not allowed to attend the regular or periodic meetings of the male members. Instead, they were assigned as consultants to the male members in cases that are related to women’s issues, and they had a very limited role in decision-making. In 2013, a progressive step was made by the government; they allocated 30 seats for women in the state consultative council (Magless Shura), and they allowed the females to attend the periodic meetings.

Having looked at basic information about women’s situation in a patriarchal society and the gender system in Saudi Arabia, it is pertinent to give detailed information regarding the beliefs about women in Saudi Arabian society, which is the focus of the next section.

Beliefs about Women

Saudi Arabian society is more than just a traditional society; it also incorporates modern social influences, depending on regional variations and socio-cultural formations. Saudi Arabia is

99 unique in that the state oversees the land of the birth of Islam - the holy mosques in the cities of Makkah and Medinah, and the nation’s laws are founded on Sharia law, based on religious tenets as specified in the Quran by way of the sunna (Prophet Mohammed’s sayings and actions). An intrinsic part of Islamic belief is the importance of family cohesiveness (including the extended family), and that the family is the foundation of society, providing security and care-giving to all its members. The extended family structure thus remains a powerful force in identity construction and social organization in Saudi Arabia. Social relationships are family based, and as Yamani (1996, p.274) has noted, ‘the family (a’ila) is held to be the basic unit of friendship, obligation, loyalty, moral support, socialization and economic health. Generally a person’s patronymic group identifies a person’s background and social status’.

Traditionally, men were responsible for providing all requirements and necessities for the household, including shopping for all clothing and groceries. In general, men were responsible for every activity outside the home, because women’s movements outside the home were very limited. Women’s responsibilities were firmly centred on taking care of the children, maintaining the household and food preparation routines. This means in general that women’s roles have centred on the home and child-rearing (Al-Ansary 1980; Al-Safe 1997; Gazaz 1994; Magrabi 1985). This is still the case but recently there has been more freedom for women outside the household (for example, women can go to various shopping markets, schools, hospitals etc., with their husband’s permission), because from the early 1980s, particularly in big cities and urban areas, female education has been encouraged and easily obtainable (this will be discussed in more detail in the next sub-section). Whilst family remains the priority in modern Saudi women’s lives, education has provided opportunities that have enabled some women to expand their contribution to further socialization and modernization as well as protecting family values. Nonetheless, the fact that Saudi Arabia still remains a patriarchal society means that social traditions and values centre women’s roles on domestic labour, and almost all men and many women believe that domestic duties are a female responsibility (Al- Safe 1997; The Saudi Arabia Cultural Meeting 2004, 2006; Yamani 2000).

An important reference must be made here to regionalism within Saudi Arabia. A distinguishing feature of women in the Hejaz (western Saudi Arabia), is that they are from a region which has a more heterogeneous character than other locations in the Kingdom. The reason for this is that the Hejaz, and in particular Jeddah, has a long history as a major port of

100 trade and a gateway for Hajj pilgrim’s in-route to the holy cities of Makah and Medina. Consequently, Jeddah has always been known for its distinctive economic and multicultural activities, along with a high level of developmental reform directly influenced by women’s social participation and intervention. There is considerable evidence that in 14th Century Jeddah, female education had already taken root, by way of Islamic (religious) and fine arts scholars, albeit in private homes or in mosques, and families would send their children to them to be educated (Kuttab) (for further support of this viewpoint see: Al-Ansary 1980; Al- Safe1997; Gazaz 1994; Magrabi 1985). Also, before and during the 1950s, the more affluent families sent their children (of both sexes) to be educated abroad (Yamani 1996).

The position of women in Islamic society in general, and in Saudi Arabian society in particular, is a complex and frequently misunderstood phenomenon. It is certainly true that Muslim and Western views with regard to the role of women show sharp cultural differences, but the stereotype of Muslim women as uneducated individuals, with no rights and no opportunities, is unfounded and unjust. The Holy Quran gave women economic and social rights long before such rights were attained by Western women. For example, from the beginning of Islam (in the 6th century, and Muhammad: 570 – 632 is the prophet of Islam), women have been legally entitled to inherit and bequeath property, holding their wealth in their own names even after marriage, without obligation to contribute that wealth to their husband or their family. To Muslims, the family is considered the basic social unit, and in order for it to be stable and to provide full opportunities for all its members, it is considered necessary for women to seek fulfilment in undertaking this obligation to the family, and thus to society at large. Thus the legitimate aspirations of the individual (particularly in the context of women) for fulfilment, versus society's duty to provide a social environment in which such ambitions can be fulfilled by as many people as possible, requires delicate balancing and finesse by any family care-giver or social arbiter, irrespective of creed or culture (Al-Safe1997; Magrabi 1985;Yamani 1996).

After presenting general beliefs about women in the Saudi Arabian context, it is also important to discover how such beliefs filter through women’s education in Saudi Arabia.

Women and Education Female education dates from the beginning of Islam and the Islamic doctrine assigns great attention to education and encourages believers to be educated. For example, the Surat Al-alq,

101 the first verses sent from God to his Prophet Mohammed, states “Read by the name of your God”; also in the Surat Al-Mugadila “God promotes and elevates the believers who are educated”. Further, there are many sayings of the Prophet Mohammed which urge Muslims to be educated: for example, “God provides the educated believer” and “God will reward the believers who are educated with heaven”.

In the Arabian Peninsula there is some evidence that there were places (called Kuttab) for basic education (reading and writing, with a particular focus on teaching how to read the Quran) and there is considerable evidence that education had taken root; there were many Kuttab in the west of Saudi Arabia: Makah, Medina, and Jeddah from the 14th Century (Al-Dakeel 2000; Al- Hukaul 2003; Abdullah 1982; Al-Trabulsi 2006). Also, there is considerable evidence that there were many Kuttab in other cities of Saudi Arabia such as Attaif, Riyadh and Al-Ahsa from the 18th century (Ameen 1978; Al-Dakeel 2000; Al-Hukaul 2003; The Ministry of Education 1970, 1977). The Kuttab were in private homes or mosques and families would send their children to them to be educated (Al-Ansary1980; Al-Safe1997; Gazaz 1994; Yamani 2000). Al-Dakeel (2000, p.68) noted that when formal school education for females was introduced in Saudi Arabia in 1960, there were around 44 private schools (Kuttab) distributed in the country as follows; 14 in Makah, 4 in Riyadh, 17 in Jeddah, 3 in Medina, 3 in Attaif, one in , one in , and lastly one in Al-. Although female education started after that of males, it has experienced a rapid increase at most levels of education (Table 4.1 and Table 4.2). The gender ratio of total enrolment has decreased from 2.16 boys for each girl in 1975 to about 1.06 boys for each girl in 2002, and the growing numbers of educated females (15 years of age and above) is estimated at 59.3 percent in 2002 compared to 82.9 percent for males (United Nations 2003). Recent data from UNESCO shows that in 2011, the literacy rate for those aged 15 and above is 81.3 percent for females and 90.4 percent for males (UNESCO 2013).

Table 4.1 Enrolment Ratio by Gender and Education Level (1975-2000) % Levels Primary level Secondary level Tertiary level Combined gross (elementary) (high school) enrolment Years Male Female Total Male Female Total Male Female Total Male Female Total 1975 64.0 36.0 50.7 15.0 4.9 10.1 10.7 2.5 6.7 44.1 23.0 33.9 1980 72.5 42.8 57.8 25.1 11.7 18.5 14.1 7.0 10.6 51.4 29.6 40.7 1985 78.2 56.0 67.3 30.5 21.8 26.2 18.0 10.1 14.1 57.4 40.4 49.0 2000 97.5 94.5 96.0 92.8 88.2 90.5 55.9 58.0 57.0 87.1 84.5 85.8 Source: The Human Development Report of Saudi Arabia 2003.

102 Table 4.2 Total Number of male and female students in Education Level (2007-2010) Years and السنوات والجنس 2007 2008 2009 2010 Sex

ذكور إناث جملة ذكور إناث جملة ذكور إناث جملة ذكور إناث جملة

مراحل التعليم Stages of education Total Female Male Total Female Male Total Female Male Total Female Male

ابتدائي Elementary 3321066 1629959 1691107 3255243 1583377 1671866 3211387 1562795 1648592 3173807 1547555 1626252 التعليم

المتوسط Intermediate 1595034 780380 814654 1518391 741830 776561 1449681 709173 740508 1432605 702060 730545 العام Public Education Public ثانوي Secondary 1441404 674428 766976 1388060 659854 728206 1338413 626662 711751 1313842 616451 697391

المجموع Total 6357504 3084767 3272737 6161694 2985061 3176633 5999481 2898630 3100851 5920254 2866066 3054188

Source: The Ministry of Economy and Planning, Statistical Survey of 2010.

In formal education, female enrolment ratios have greatly increased and levels of illiteracy declined significantly from 40 percent in 1992 to 21 percent in 2004 (Ministry of Economy and Planning 2004). Recently, the adult illiteracy rate for both males and females has been reduced to 14.4 percent (Human Development Report 2013). Female education includes providing girls with basic knowledge and skills, and also focuses on developing their roles as mothers and wives. Further, schools and educational institutions (at all educational levels) in Saudi Arabia are totally segregated (Al-Dakeel 2000; Al-Hukaul 2003; Yamani 2000; The Ministry of Education 1977). Islamic beliefs have not only influenced the educational structure in Saudi Arabia but also the political position of women, as is discussed in the following sub-section.

Women and Politics In Saudi Arabia, women’s role in political activities is very limited; however, recently Saudi women have made progress in the development of the political role of women, which includes first, membership of Jeddah’s Chamber of Commerce and second, membership of the State Consultative Council (Magless Shura) as discussed below.

As a result of some women holding prominent positions in business and even in the state oil company, various obstacles to advancement and broader career options for some women are rapidly diminishing. For instance, Jeddah’s Chamber of Commerce comprises private enterprises with a president and a board of directors, of which there are eighteen members. Twelve of these members of the board are elected, and six are hired directly by the president. For the first time ever, in 2005, from the eighteen members, two women were elected, and two

103 more were hired directly by the president; so as a result the glass ceiling of both private and governmental enterprises is starting to be breached. In particular, women are now demanding the right to operate on their own behalf, without the obligatory male acting as power of attorney (wakil).

Furthermore, in June 2006 the government assigned six chairs for women in the state consultative council (Magless Shura), and in 2013 they assigned 30 chairs for women. Through this process the government is finally giving women the opportunity to participate in law making, which is particularly important with respect to women and family-related issues. Thus, although Islamic values and beliefs are still of the utmost importance in Saudi Arabia, the position of women is slowly changing. This is also reflected in women’s position in paid employment.

Women and Paid Employment The government of Saudi Arabia has made huge investments in female education (see Table 4.6) and therefore makes great efforts to create various job opportunities for women to raise female participation in the labour force (see Table 4.3). The Human Development Report of 2013 states that female participation in the workforce was 17.7 percent compared to 74 percent for males, which reveals an additional progression by almost 8 percent in the women’s labour force. This has increased due to the progress of development and the transformation of the Saudi Arabian economy from a traditional economy to a more modern and industrialized one (Al-Dakeel 2000; Ministry of Economy and Planning 2011; The Saudi Arabian Cultural Meeting 2006).

Table 4.3 Percentage Distribution of Population at Working Age by Work Status and Gender % Male Female Average (male/female) %

Participation in the labour force (1) 62.2 10.0 36.0

Non-participation in the labour force (2) 37.8 90.0 64.0 Includes population with economic activity, whether employed or job seekers. Includes students, housewives…..etc. Note: Total population at working age stood at 9542.2 thousand, of which 4749.5 thousand were males and 4792.7 thousand females (2002). Source: The Human Development Report of Saudi Arabia 2003.

104 Therefore, the government is looking to develop new policies to find the most appropriate ways of expanding women’s participation in the socioeconomic development of the country, without compromising social and religious values (Al-Dakeel 2000; Al-Hukaul 2003; Ibn-Dehash 1996; The Saudi Arabia Cultural Meeting 2004, 2006). However, the substantial and growing number of females graduating at different educational levels makes it difficult for the government to ensure employment opportunities, especially in the fields of female education, health and social services and the government sector, as in these disciplines employment opportunities have been approaching saturation levels (Al-Hukaul 2003; The Saudi Arabia Cultural Meeting 2004, 2006). According to the Human Development Report of Saudi Arabia (2003), of the total female workforce, 82.7 percent are in the education sector and 7.2 percent in the health and social sector. This is due to the considerable role of the government sector in providing female education and health services.

Consequently, there are still many limitations to female participation in the labour force, which is of concern to social planners in the government. Those limitations include the mismatch between educational qualifications and labour market requirements, the limited employment sector opportunities available for women, the organizational constraints such as commuting between home and workplace, and the lack of childcare and maternity related facilities (The Human Development Report of Saudi Arabia 2003).

Although there are many constraints on women’s work in Saudi Arabia, data from the Saudi census in 2004 show that some females do enter a wide range of economic activities (see Table 4.4). However, it is not clear if those females were working in those economic activities themselves or whether they owned the business or worked as managers and hired other people to work for them. Despite these shortcomings, Table 4.4 does demonstrate that some (a minority of) Saudi females do work in some economic activities that are traditionally a male preserve in Saudi Arabian society, such as electricity, gas and water, construction and building, wholesale and retail trade and repair of motor cars, mining and quarrying.

Unfortunately, no there is no recent detailed data about this issue (as Table 4.4). The only available information is that in 2013, the Labour Force Survey results showed that nearly three- quarters of female workers were employed in the Saudi education sector, at a rate of 71.7% and

105 11.7% work in the activities of human health and social services (Ministry of Economy and Planning 2013).

Thus far, this chapter has outlined the socio-political make up of Saudi Arabia, with a specific focus on women’s positions. Next, the economic situation of Saudi Arabia will be examined.

Table 4.4 Employed Saudi Female Population (15 years and over) by Main Economic Activity in 2004 Main Economic Activity Numbers % Agriculture, Hunting and Forestry 1441 0.32 Fishing 15 0.003 Mining and Quarrying 1125 0.25 Manufacturing 2233 0.49 Electricity, Gas and Water 120 0.03 Construction and Building 660 0.15 Wholesale and Retail Trade and Repair of Motor Cars etc. 2594 0.57 Hotels & Restaurants 656 0.14 Transport, Storage and Communications 893 0.19 Financial Intermediation 2116 0.47 Real Estate, Renting and Business Activities 1120 0.25 Public Administration, Defence and Compulsory Social Security 27932 6.14 Education 377957 83.0 Health and Social Services 32784 7.2 Other Community, Social and Personal Services Activities 2043 0.45 Private Household with Employed Persons 1480 0.33 Extra-Territorial Organizations and Bodies 111 0.02 Total 455280 100% Source: The Ministry of Economy and Planning, Saudi Arabia Census of 2004.

Economy of Saudi Arabia

Saudi Arabia was a poor country until the Second World War. The national income was very low, predominantly owing to its geographical nature as a desert country with limited resources. However, the situation has changed since the 1930s, when petroleum was discovered in Saudi Arabia. The beginning of socioeconomic development in Saudi Arabia was in the 1970s, due to the increase in petroleum revenues (Al-Aqabi 1984; Al-Shak et al 2002; Mushkis 2000). This

106 large increase in national income enabled the government of Saudi Arabia to direct petroleum revenues towards building the infrastructure of the country. The economy of Saudi Arabia depends fundamentally on petroleum revenues (see Figure 4.1) as Saudi Arabia possesses 22.1 percent of the world's proven petroleum reserves, and is ranked as the largest exporter of petroleum, where petroleum accounts for more than 90 percent of the country's exports and nearly 92 percent of government revenues (OPEC 2012; The Annual Report of Saudi Arabian Monetary Agency 2012).

Figure 4.1 OPEC Shares of World Crude Oil Reserves in 2013

Source: Adapted by Researcher from OPEC Annual Statistical Bulletin 2013.

However, petroleum prices are under constant flux (increasing or decreasing) due to changing commodity prices (see Figure 4.2). For example, firstly oil prices increased in 1974 after the Arab-Israeli war, and secondly they decreased in the mid-1980s due to an excess of worldwide oil as a result of the development of more oil fields around the world. Thirdly, in 1997 a decrease in oil prices occurred because of the economic crisis in East Asia and the rise of oil production from countries outside The Organization of the Petroleum Exporting Countries (OPEC). Fourthly, in 1999 the oil price again started to increase, affected by the growing economy in south-east Asia, and the reduction of oil production from OPEC and non-OPEC countries (Ministry of Planning 2001; OPEC 1999, 2005). In 2010, the oil price further increased due to the increased demand for oil and the disturbances in the Middle East (see Figure 4.3). However, the oil price has now dropped to around 35 US dollars per barrel due to the world economy.

107 Figure 4.2 Changes in Saudi Arabian Oil Prices from 1970-2006

70.00

60.00

50.00

40.00 Arabian Light

30.00 North Sea (Brent)

20.00

Oil Price in U.S.$ Per Barrel 10.00

0.00 1970 1975 1980 1985 1990 1995 2000 2005 2006

Source: Adapted by Researcher from The Annual Report of Saudi Arabian Monetary Agency 2007.

Figure 4.3 Changes in Saudi Arabian Oil Prices From 2003-2012

Source: Adapted by Researcher from the Annual Report of Saudi Arabian Monetary Agency 2012.

Despite the reliance on oil income, the Saudi Arabian government, from the time of the first five year plan (1970-1974), has also attempted to stimulate economic diversification through promoting varied resources to support the national income, as diversification of the economy ensures a stable economy for the country. Therefore, for example, the Saudi Arabian government has promoted manufacturing, especially in industries based on oil such as the petro-chemical trade, agriculture and fishing activities (Al-Sharif 2002; Al-Shak et al. 2002).

As a result of this economic diversification, the share of non-oil sectors in real GDP has increased accordingly from different economic activities (Table 4.5). Thus, this diversification strategy appears to be working.

108 Table 4.5 Gross Domestic Product (GDP) by Economic Sector at Constant Prices (Million Riyals) % % Change Change 2003 2005 2009 2011 in in 2005 2011 A. Industries and other producers (excluding government services’ producers) 1- Agriculture forestry & fishing 36,751 39,518 4.3 39,536 41,086 2.8 2- Mining & Quarrying 195,055 220,325 6.1 200,131 213,571 4.4 a. Crude oil & Natural Gas 192,452 217,639 6.1 197,095 210,354 4.4 b. Other mining & Quarrying 2,603 2,685 1.2 3,036 3,216 3.7 Activities 3- Manufacturing Industries 76,142 87,087 7.1 105,100 125,931 12.7 a. Oil Refining 19,914 22,585 4.4 21,615 22,642 3.5 b. Other Industries 56,227 64,502 8.1 83,485 103,288 14.9 4- Electricity & Gas & Water 10,569 11,866 5.4 14,973 17,003 5.2 5- Construction 45,550 51,178 5.5 57,982 69,843 11.7 6- Wholesale & Retail Trade & 54,204 60,392 6.2 72,992 84,792 7.1 Restaurants & Hotels 7- Transport & Storage & 35,046 41,508 9.6 59,946 72,063 10.6 Communication 8- Finance, Insurance Real Estate 84,793 94,470 6.8 107,517 112,529 3.0 and Business services a. Houses Ownership 46,080 50,110 4.6 54,875 57,672 3.1 b. Others 38,713 44,360 9.4 52,641 54,857 2.9 9- Community & Social & 25,552 28,194 5.4 32,267 37,390 9.4 Personal services 10- Minus calculated banking 14,804 15,536 3.9 15,869 16,376 2.0 services B. Government Services’ 129,326 141,533 7.1 152,510 173,261 6.3 Producers Total (excluding import duties) 678,183 760,534 6.5 827,085 931,093 7.1 Import duties 7,854 8,972 8.4 9,853 10,756 4.8 GDP 686,037 769,506 6.6 836,938 941,849 7.1 Source: The Annual Report of the Saudi Arabian Monetary Agency 2007, 2012.

The Human Development Report of Saudi Arabia (2003) noted that Saudi Arabia’s GDP increased sharply in 1970, with the corresponding oil price rise of the same year, so the GDP was at $1145 per capita in 1970. Changes in the Saudi Arabian GDP are basically influenced by changes in oil prices, and also by rapid population growth (See Chapter One for information about population growth). In 2006, the country’s GDP was 1,296,457 (million Riyals), with

109 707,727 coming from the oil sector and 588,730, from the non-oil sector (see Figure 4.4). In 2011, the GDP was 2,239,073 (million Riyals), with 1,288,599 coming from the oil sector and 933,174, from the non-oil sector (see Figure 4.5). This increase in the national GDP also influenced the per capita GDP, which was increased from $7070 (per year) in 1992, to $14,765 (per year) in 2005, and become $21,046 (per year) in 2011.

Figure 4.4 Gross Domestic Product (GDP) by Sector (million Riyals)

1,400,000

1,200,000

1,000,000

800,000 GDP Oil Sector Non-Oil Sector 600,000 Million Riyals Million

400,000

200,000

0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Years

Source: The Annual Report of the Saudi Arabian Monetary Agency 2007.

Figure 4.5 Trends of Actual Oil and Non-Oil Revenues by billion Riyals

Source: The Annual Report of the Saudi Arabian Monetary Agency 2012.

110 The Development Plans of Saudi Arabia

The economic situation in Saudi Arabia has paved the way for the creation of a series of development plans. The nation of Saudi Arabia required an organized effort to direct socioeconomic development along with building the country’s infrastructure, and thus the government initiated the first 5-year development plan in 1970. It is therefore important to present some brief information concerning the focus of each development plan, which will lead to an understanding of the socioeconomic background of Saudi Arabia in which reproductive decision-making is set.

The first Government 5-year development plan covered the period from 1970 to 1974. This plan was formulated under very difficult socioeconomic circumstances, especially after the Middle East crisis of 1967 which seriously affected Saudi Arabia’s gross domestic product (GDP), as oil values plummeted to an all-time low. Socioeconomic development only started to pick up and gain momentum after the second and third plans (1975-1979 and 1980-1984) were undertaken, due to an increase in the price of oil, resulting in an increase of funds in the Government’s exchequer, which led to increased availability of finance for further development of the nation’s infrastructure. The most significant period of heightened development occurred during the ‘economic leap’ between 1980 and 1990.

During the fourth (1985-1989), fifth (1990-1994) and sixth five-year plans (1995-1999), Saudi Arabia withstood another decrease in oil prices owing to black market oil sales from other oil producing countries which did not adhere to agreed quotas, and also owing to the financial constraints of the Gulf War of 1990. However, because of Government savings accrued from profits from previous budget plans, development continued with an increasing focus and funnelling of resources into manufacturing, agricultural and construction sectors to name a few; this in effect diversified economic development alongside oil related industries. The seventh, eighth, and current ninth five-year plans (2000-2004, 2005-2009 and 2010- 2014) saw, and continue to see, oil prices on the increase (with some of the highest prices for oil ever encountered). Commensurate with this, profits from myriad other development resources are also increasing, enabling the Saudi economy to keep abreast with the economies of the rest of the developed world (Ministry of Economy & Planning of Saudi Arabia, The Development Plans 2001, 2005, 2013). However, these oil profits have

111 decreased since 2015 to around 35 US dollars per barrel, which could influence the new development plans.

Table 4.6 presents government expenditure on major sectors of society during the development plans from 1979 to 2014, which has led to significant improvements in the standard of living of Saudi Arabia’s citizens. It is noted from Table 4.6 that in the first three plans, the focus was on building infrastructure, then after the basic infrastructure of the society was established, from the fourth plan on, government expenditure was directed mostly towards human resources and health. At present, much spending is directed towards improving educational services, which is the most important development objective of the Saudi Arabian government today. Moreover, the eighth and ninth plans show the progression of government spending and its aims to achieve numerous objectives, such as; to ensure tangible advances in the standard of living; achieve balanced development among the regions of the Kingdom; develop the structure of the national economy, diversify its productive base, and enhance its competitiveness; and accelerate transformation to a knowledge-based economy’ (Ministry of Economy & Planning of Saudi Arabia 2013).

Table 4.6 Structure of Actual Development Expenditure during the Development Plans (percent)

Source: Ministry of Economy & Planning of Saudi Arabia 2013.

In order to show the influence of such development plans on the socioeconomic development of Saudi Arabia, it was decided to use the Human Development Index (HDI) of 2005 and 2013, as this is a composite indicator of socioeconomic development. It covers three dimensions of

112 human welfare: income, education and health. Its purpose is not to give a complete picture of human development but to provide a measure that goes beyond income. The HDI is a barometer for changes in human well-being and for comparing progress in different regions. Data for these indicators provide a statistical reference for assessing the progress in each country towards the Millennium Development Goals and their targets. Table 4.7 shows data for the Human Development Index of Saudi Arabia, which has classified Saudi Arabia as having high human development and ranked it 57th globally in 2013. However, while, for example, life expectancy is high (74 years), female economic activity and female income earnings are low (5,987 US$), and this has resulted in a relatively low Gender Inequality Index (GII) rank of 145 and value of 0.682.

Table 4.7 Human Development Index of Saudi Arabia (Some Indicators) 2005 2013 Human development index (HDI) value 0.812 0.782 Life expectancy at birth (years) 72 74.1 (70M-74F) Adult literacy rate (% ages 15 and above) 82.9 86.1 GDP per capita (PPP US $) 15,711 21.430 Education index 0.806 0.689 GDP per capita (PPP US $) rank -19 -21 minus HDI rank Probability at birth of not surviving to age 40 (% of 5.7 4.7 cohort) Adult illiteracy rate (% ages 15 and older) 17.1 14.4 MDG Children under weight 14 5.3 for age (%under age 5) (WHO 2011) Health expenditure per capita (PPP US $) 601 3.1 % of GDP MDG Births attended by skilled health personnel (%) 91 91 Physicians (per 100,000 people) 137 90 Gender-related development index (GDI) 70 (Rank) GII (Rank) 145 0.783 (value) 0.682(value) Estimated earned income (PPP US $) 4,031 (F) 5,987 (F) 25,678 (M) 36,662 (M) Gender empowerment measure (GEM) 92 (Rank) GII (Rank) 145 0.254 (value) 0.682(value) Female economic activity (ages 15 and above) 17.6 (Rate) Labour force participation 118 (Index) (%ages 15 and above) As % of male rate 17.7(Female) 22 74.1(Male) Source: United Nations, Human Development Report 2005, 2013.

113 The situation of Saudi Arabia as a major oil producer globally and an important agent in the world economy gives it a major opportunity to benefit from its wealth (especially the continuing rise in oil prices). It is therefore expected that in the future Saudi Arabia will generate a substantial development plan with two main strands: an internal development plan to promote massive investment in infrastructure, healthcare, education and transport across the country and a second strand allocating resources towards achieving the Millennium Development Goals (MDGs), which will support the progress of global development.

To this end, in November 2005, Saudi Arabia became the 149th member of the World Trade Organization (WTO); this accession necessitated major and rapid economic expansion and obligatory reforms, particularly in the foreign investment arena. With a high population growth rate of 2.9 percent, the government now faces great challenges in balancing efforts to hasten socioeconomic development as required by a burgeoning population, with efforts to prepare its economy and companies (by way of raising standards of efficiency and productivity). In the next section, details of these efforts in the health and education sectors are given, as they form an important backdrop to the study.

Education and Health Care Services

In order to be equal to the challenges of the developmental process (both social and economic), the Saudi government has devoted vast resources to and massive expenditure on education at all levels, taking into account the educational aspirations of all Saudis, ostensibly by providing free education for all. Efforts are particularly focused at higher levels as the need for a pool of highly educated citizens capable of managing a complex modern economy is of paramount importance. Thus, the educational system has been continuously and systematically expanded to accommodate the ever-growing demand for education and education related services. Through this investment, the Saudi government has been able to ensure an educated and trained national workforce to carry forward the Kingdom's future development.

Therefore, to ensure that the entire population is literate and numerate, primary, secondary and tertiary education is provided free of charge and is largely the responsibility of the Ministry of Education. All government schools teach in Arabic, and have (basic) English language sessions on a weekly basis. Although the vast majority of children are educated through the state

114 system, there is also a burgeoning private educational sector catering for all scholastic levels, with many offering optional studies in English (as well as other languages) as part of the core curriculum. The education curriculum includes basic knowledge and skills, with an emphasis on religion that focuses on teaching the basic principles of Islamic doctrine at all educational stages.

The education system in Saudi Arabia is basically divided into three main stages: the first stage, which comes after kindergarten, includes six years of primary schooling; this is followed by three years of secondary schooling; and lastly another three years of higher schooling or tertiary level. All the above stages comprise what is called the general education level. After that comes university or college education. At every level of education, numbers of pupils have increased yearly, with a dramatic increase (especially in the numbers of female students attending at secondary and tertiary levels) over the past decade (refer back to Table 4.1). Furthermore there has been an exponential increase in specialist language schools, literacy schools, specialist education centres and specialized institutes catering for those who wish to take computer courses, through to hospitality, fashion and design courses, to name a few.

In addition to the growth in educational facilities, health care services have greatly improved. In any national health service, the provision of comprehensive and efficient primary healthcare is of crucial importance (see Table 4.6 for the Development Index of some health indications). Saudi Arabia has established numerous hospitals and medical centres, free for all citizens and residents (Al-Sharif 2002; Al-Shagawi 2003; Ministry of Planning 1998, 2001; Ministry of Economy & Planning of Saudi Arabia 2013.). An important part of any health service is its reproductive service, and as this is of particular significance for this research, it is discussed in detail below.

Reproductive Services and Attitudes towards Family Planning

Maternity Services

The maternity services in Saudi Arabia are generally provided in hospitals or sometimes in clinics. Government hospitals are limited to big cities, whereas in small towns, clinics are available; this is also similar in the private sector. The big hospitals usually contain maternity services, while in clinics, if a maternity service is available, it is usually less well equipped.

115 Therefore, mothers or women who live in a small town usually go to a nearby clinic for a follow-up. However if they have a critical problem or they need special care, they have to go to hospital in the nearest city.

In the case of Jeddah, it is a cosmopolitan city, and therefore it includes many hospitals and clinics; the hospitals are either public or private. Only one public and one private hospital in Jeddah is specifically for maternal health care, while the rest of the public and private hospitals have a section for maternal health care. Those hospitals provide medical care for pregnant mothers. Usually in private hospitals the mother chooses the doctor whom she wants to use during the pregnancy and the delivery, based on personal knowledge or through family experience, or based on friends’ and social network recommendations. In public hospitals, however, it is not easy to choose one doctor for follow-up during the whole pregnancy and delivery, so a woman might consult with several different doctors in the clinic.

Maternity services in Saudi Arabia do not include any services related to contraception, either in the public or the private health sectors, although women who seek information or advice about contraceptive use can request it from their doctors in the Obstetrics and Gynaecology clinics or from a pharmacist. Also, in Saudi Arabia there is no free contraceptive service in the public health sector and contraceptive methods are only available in the drugstores.

Interviews Regarding Attitudes towards Family Planning Programmes

In Saudi Arabia there is a dearth of information about family planning programmes as there is no such policy concerning this issue in the country. Therefore, in order to give some insight into attitudes towards potential family planning programmes in Saudi Arabia, four interviews were undertaken with the following key people: the Assistant Manager to the General Manager of the Ministry of Health and Primary Health Care in Jeddah Province; a religious sheik leader; and two members in the state consultative council (Magless Shoura).

Firstly, the interview with the Assistant Manager of the General Manager of the Ministry of

Health And Primary Health Care in Jeddah Province, D.[u2] Nuha Dashash, a consultant in family medicine, who is one of the few women occupying a position at this level in the

116 Ministry of Health. When asked about the attitudes or the standpoint of the Ministry of Health concerning operating a family planning programme, she said that the Ministry of Health did not have any intention of developing a family planning programme. Therefore, gynaecologists and obstetricians are currently responsible for medical and general guidance for mothers, such as advice to mothers to ensure follow-up visits with doctors, but are not responsible for family planning. However, she did indicate that the Ministry of Health organizes an education and guidance campaign for mothers with a private company that has products related to children (such as milk, nappies, and baby food). The Ministry of Health is responsible for the academic programmes and the private company provides free products for mothers. This campaign aims to provide mothers with important information about motherhood and children, through using short messages sent to mobile phones, via e-mail or post. She added that mothers were encouraged to participate in this campaign through free gifts, which have a positive influence in educating them. However, no programmes operating under the Ministry of Health cover any issues related to birth spacing or family planning.

Secondly was the interview with a religious Sheik (leader); this interview was very short as the Sheik had a very negative opinion regarding family planning programmes. The Sheik’s perspective was that family planning programmes are a western idea (i.e. non-Muslim), and are not acceptable in Muslim countries (the Sheik refused to reveal his identity).

Thirdly, the interview with a member of the state consultative council (Mangles Shoura), D.[u3]

Nauf Al-Deaass, who is an academic PhD holder in Islamic law. D.[u4] Nauf, contrary to many religious leaders in Saudi Arabia, was very positive about operating family planning programmes. His viewpoint was that Islam has a lot of concern for the quality of care of Muslim children, and family planning programmes would be a positive influence on educating and guiding families to ensure healthy children and mothers.

Lastly, a short interview was undertaken with another member of the state consultative council (Mangles Shoura), to elucidate his opinion regarding family planning programmes. This was Dr. Gazi Jamjoom, a physician. Dr. Jamjoom noted that family planning was a very useful idea, especially for maternal and child health, and several times during state consultative council meetings he has suggested operating a family programme in Saudi Arabia. Unfortunately his suggestion has always been met with a strong rejection.

117 Thus, it is clear from the above interviews that no formal policy exists with regard to family planning in Saudi Arabia, and it is unlikely to adopt any in the near future. Also, it may be speculated from these interviews that higher education levels might generate more liberal attitudes towards acceptance of change or new ideas in society. It seems also that some Muslims use Islam as an excuse for rejecting family planning, although this viewpoint did not necessarily represent all Muslims’ attitudes towards family planning. Further, the first and fourth interviews did not spell out or specify that the Saudi Arabian government do not adopt family planning programmes due to religious reasons; however, Dr. Nauf Al-Deaass’s interview indicated that there are many religious leaders who reject outright the adoption of any family planning programmes in Saudi Arabia. Reviewing the publications of the General Presidency of Scholarly Research and Ifta, it can be concluded that this religious institution is discouraging family planning programmes as they believe that Islam supports pronatalism. Although this institution does not believe that contraceptive practice for a limited time, or for birth spacing, is prohibited in Islam, they consider this is permitted only at the individual level (Council of Senior Scholarly 2004).

Alternatively, it is possible that the government policy to pay no attention to family planning programmes is because they are interested in increasing the Saudi Arabian population (see also Chapter Two, Islam and family planning). Since the government of Saudi Arabia has confidence in the economy (supported by the petroleum revenues along with other national income resources) it may be that they are not concerned about population growth and the resulting possible pressure on the economic resources of the country.

Conclusions

This chapter has presented a brief introduction to the social context and cultural background of Saudi Arabia and its political, economic and social development. It has also provided brief information regarding the formation of the Kingdom of Saudi Arabia, and the cultural principles which have guided the Kingdom's development. This shows that the relationships between the head of state and Islamic religious bodies were strong from the beginning of the formation of the state of Saudi Arabia and also that Islamic beliefs permeate every aspect of life in Saudi Arabia, which is particularly so regarding the role of women. This

118 socioeconomic and cultural contextualization of the society of Saudi Arabia assists us in understanding the position of women in society and the role of Islam, and particularly in influencing policy-making. Therefore, this chapter has provided a basis for understanding important information concerning Saudi Arabia, which could lead to a better understanding of the findings of this research.

This chapter further provided general understanding of beliefs about women, and how such beliefs filter through into women’s education, politics and work. First, there is some evidence that in the Arabian Peninsula there were places (called Kuttab) for basic education (reading and writing, with a particular focus on teaching how to read the Quran) in the cities of Makah, Medina, Jeddah, Attaif, Riyadh and Al-Ahsa from the 14th century. Although formal female education started after that of males, it has recently experienced a rapid increase at most levels. Female education includes providing girls with basic knowledge and skills, and also focuses on developing their roles as wives and mothers. Further, the schools and educational institutions (at all educational levels) in Saudi Arabia are totally segregated and separate males and females completely. Moreover, women’s role in political activities is very limited in Saudi Arabia. Nonetheless, recently Saudi women have made some advances in their roles in some of the decision-making aspects of society. This development in the political role of women includes first, membership of Jeddah’s Chamber of Commerce and second, membership of the State Consultative Council (Magless Shura). This chapter shows that women’s participation in the formal employment sector is very limited in Saudi Arabia. Currently there are still many limitations on female participation in the labour force, which is of concern to social planners in the government. Those limitations include a mismatch between educational qualifications and labour market requirements, the limited employment sector opportunities available for women, organizational constraints such as commuting between home and workplace, and the lack of childcare and maternity related facilities.

Furthermore, this chapter presented brief information regarding the economy and development plans of Saudi Arabia. The situation of Saudi Arabia as a major oil producer globally and an important agent in the world economy presents a major opportunity to benefit from its wealth (especially in the wake of the continuing rise in oil prices). It is therefore expected that in the future, Saudi Arabia will generate a substantial development plan with two main strands: an internal development plan to promote massive investment in infrastructure, healthcare,

119 education and transport across the country; and the second to allocate resources towards achieving the Millennium Development Goals (MDGs), which will support the progress of global development. Currently, the development plan focuses on improving health and educational services as the most important development objectives of the Saudi Arabian government today. This chapter has presented detailed information on these health and education sectors, as they form an important backdrop to the study. Also, as an important part of any health service is its reproductive services, and as this is of particular significance for this research, this chapter has discussed the reproductive services in Saudi Arabia. It is, however, clear that in Saudi Arabia there is no family planning programme as such and although two interviewees from the government did express support for such a policy, such a programme is unlikely in the foreseeable future.

120 Chapter Five Continuity and Change in Fertility Trends over a Period of Eight Years

Introduction

The previous chapter provided a brief introduction to the background of Saudi Arabia. This background will help the reader to contextualize the explanations for, and interpretations of, the reproductive behaviour patterns examined in the discussions that follow. This chapter’s purpose is to present both surveys’ outcomes (2005 and 2013). Also, this chapter explores the changes that could appear in fertility trends and their impact on reproductive decision-making through presenting the findings of the 2013 survey and comparing it with the 2005 findings. Both surveys covered three main issues: first, social structure and fertility patterns; second, the role of gender in the decision-making process concerning reproduction; and third, the influence of social networks and contraception decisions on reproductive behaviour.

Social Structure and Fertility Patterns

Introduction

This section focuses on the socioeconomic and demographic factors that impact fertility trends in Jeddah, Saudi Arabia. In order to establish a deep understanding of fertility trends in Jeddah, it was important to first investigate the relationship between socioeconomic and demographic factors, and reproduction. Indeed, socioeconomic factors are important features in most studies concerning childbearing (Acharya 2010; Osiewalska 2015; Rutayisire et al. 2013; Ushie et al. 2011). It is important also to explore the influence of cultural values on fertility behaviour, as the Ideational Theory emphasises the role of culture in explaining fertility differences (Lesthaeghe 1980). Thus, it was considered important to ascertain the cultural context that may influence the age of couples at marriage, the value placed on children and the preferred sex of the child. Also explored were the socioeconomic and demographic elements that might assist in predicting family size. This section will discuss the following factors: age at marriage, the value of children and family, and preference regarding a child’s sex.

121 Nuptial Regimes Concerning Age at Marriage in 2005

The 2005 survey results revealed that the modal age at marriage for the male sample was 23 years, ranging from 18 to 34 years, while the modal age at marriage for the female sample was 18 years, ranging from 14 to 35 years. This result indicates that between survey respondents, women usually marry at an earlier age than men. Comparing this result to national data from World Bank in 2001, which showed that the median age at first marriage for females was 17, it seems that a rise in the age at marriage for females occurred (See Chapters One and Two).

Additionally, to obtain further information regarding the demographic and socioeconomic factors that could influence age at marriage, the following variables were examined; current age of parents, parental education levels, family income and parental occupational status. First, the survey data demonstrated a variation in age at first marriage between different age groups, in that for males the mean age at marriage for the age group from 15-39 is 25, and for the age group from 40-60 is 24. Similarly, this variation exists for females, in that the mean age at marriage for those now 15-39 is 20, but for the age group from 40-60 it is 18. Thus, it seems that the younger age group (15-39) in the survey sample delayed marriage longer than the older age group (40-60), by two years for the females and by one year for the males. Second, the survey results showed a difference in the age at first marriage between different educational levels (Table 5.1). It can be said that both males and females with higher educational levels are more likely to delay marriage than those who are less educated.

Table 5.1 Gender Education and Median Age at Marriage Education Levels N Median Age at N Median Age at Male Marriage Female Marriage Illiterate 1 Married at 25 1 Married at 15 General Education 29 23 58 18.8 University Education 70 24.8 41 21 Source: Fieldwork, 2005

Third, the survey results showed a difference in the age at first marriage between different occupational statuses only for the female sample (Table 5.2). Thus, it appears that working women are more likely to delay marriage than housewives.

122 Table 5.2 Gender, Occupational Status and Median Age at Marriage Male Occupational N Median Age Female N Median Age Status Male at Marriage Occupational Female at Marriage Status Professional Labour 94 24.4 Working-woman 27 21.8 Non-professional 6 23 Housewife 73 18.8 Labour Source: Fieldwork, 2005

Lastly, the survey results did not show a difference in the age at first marriage between different income categories (Table 5.3). However, Table 5.3 revealed a slight difference between the low income <5000 and the higher income category, in that the higher the income category, the longer the marriage is postponed.

Table 5.3 Family Income and Median Age at Marriage by Gender Family Income N Median Age N Median Age Male at Marriage Female at Marriage < 5000 19 23.4 30 19 5001-10000 35 24.7 39 19.5 >10000 46 24.4 31 20.3 Source: Fieldwork, 2005

The Change in Nuptial Regimes Concerning Age at Marriage in 2013

The new survey results showed that the mean age at marriage for the male sample was 27, ranging from 18-36, while the mean age at marriage for the female sample was 21, ranging from 14-29. This result reveals that female respondents usually marry earlier than male respondents. It seems that there is an impressive change in the age of marriage of both genders in that the mean age of marriage rose for males from 23 in 2005 to 27 in 2013 and also for females from 18 in 2005 to 21 in 2013. This means a change of 4 years for males and 3 years for females in a period of 8 years (2005-2013).

Moreover, the survey data established a difference in the age at first marriage between different age groups, in that for males, the mean age at marriage for the age group from 15-39 years is 27.2 and for the age group from 40-60 is 26.3. Likewise, this difference exists for females, in that the mean age at marriage for those now 15-39 is 21.6 but for the age group from 40-60 it is 20.2. Thus, it seems that the younger age group (15-39) in the study respondents delayed

123 marriage more than the older age group (40-60), by one year for the males and almost one and a half years for the females.

Also, the survey results did not display a variance in the age at first marriage between different educational levels in the male sample (Table 5.4). On the other hand, they did show significant difference between different educational levels in the female sample.

Table 5.4 Gender Education and Median Age at Marriage Education Levels N Median Age at N Median Age at Male Marriage Female Marriage General Education 29 26.66 29 20.4

University Education 71 26.86 71 21.6

Source: Fieldwork, 2013

The survey results did not reveal a difference in the age at first marriage between diverse occupational statuses either the male or female sample (Table 5.5).

Table 5.5 Gender Occupational Status and Median Age at Marriage Male Occupational N Median Age Female N Median Age Status Male at Marriage Occupational Female at Marriage Status Professional 25 26.5 Working-woman 43 21.8

Business 1 24 Housewife 57 20.8

Administrative 69 27

Skilled labour 5 26

Source: Fieldwork, 2013

Lastly, the survey results did not also show a difference in the age at first marriage between different income categories for either male or female samples (Table 5.6).

Table 5.6 Family Income and Median Age at Marriage by Gender Family Income N Median Age N Median Age Male at Marriage Female at Marriage 5000-10000 33 27.3 43 21.4

10001-20000 46 26.3 34 20.6

>20000 21 26.9 23 21.9

Source: Fieldwork, 2013

In 2005, male education had minor influence on age at marriage, unlike in 2013, as the mean age of marriage rose by 4 years in the male sample (from 2005 to 2013). However, female

124 education levels still have significant influence on the age of marriage. Male occupation status did not show any influence on the age of marriage, as before, in the 2005 outcome. Meanwhile, female occupation status had significant influence on the age of marriage by a difference of two years in 2005, and yet it did not have any influence in 2013.

The family income seems not to be an important factor in explaining the difference in the age of marriage either in 2005 or in 2013. However, by comparing the means only in 2005 it was clear that high income influences the delay on the age of marriage, which is not clear in 2013. Thus, it can be concluded that the rise in the age of marriage in 2013 diminished the impact of the socioeconomic factors, yet female education could be considered as an important element in relation to the age of marriage.

The Value Placed on Children and Family in 2005

Figure 5.1 represents how both males and females see the value of children; this was a multi- choice question with the following options: A) main purpose for marriage, B) joy of life, C) cannot imagine life without them, D) basic grounds for a stable marriage, E) enhancement of parents’ position in the family and society. These values were selected based on reviewing the literature related to Saudi Arabian society and other Gulf States, concerning cultural characteristics in general and family and children in particular.

Figure 5.1 The Value of Children by Gender

100 90 80 70 60 Male 50 Female count 40 30 20 10 0 Main purpose Joy of life Cannot Basic grounds Enhancement for marriage imagine life for a stable of parents without them marriage position in family & society

Source: Fieldwork, 2005

The results showed that both males and females chose ‘Joy of life’ (this means children are a blessing) as their highest priority because it is based on the Islamic belief that children have 125 been mentioned in the Quran as a blessing and the joy of life (Surah: Al-Oumran, 14; Al-Kahf, 46; Al-Hadeed, 20). All Saudi Arabian citizens are Muslims; therefore the government and people follow Islamic principles and rules. This brings about the situation in which 80 female and over 90 male parents chose ‘Joy of life’ as the most important and highest value that is related to children. Also, this result may serve as an example of the fundamental role that religion plays in people’s lives, beliefs and choices in Saudi Arabia, which then may also show the vital role of religion in reproductive decision-making.

The second choice was option D, ‘Basic grounds for a stable marriage’ with 71 female and 50 male respondents choosing this value. This result offers empirical support to Mason’s (1987) claim that in societies where gender inequality exists, children are valued as insurance against a divorce. As women in such societies are economically dependent on men, they consider children as a way to ensure that the husband supports his family financially. This appears to be the case among the study respondents, in that generally Saudi Arabian women have limited opportunities in the labour market and also there are many restrictions on their movements, which makes them to a great extent dependent on men. For that reason, 71 female respondents believe that their children will stabilize and give permanence to their marriage (see also Figure 5.4 in the next section, which shows that over 40 female respondents believe that if they did not have male children their husband would marry another wife). This outcome is also supported by many researchers who have investigated Arab and Muslim societies. For example, Richards and Waterbury (1998, p.85) note, ‘Muslim women try to have large families as a kind of insurance policy against divorce.’ Also, Davis (1998, p.145) has indicated that ‘in most Muslim countries, the wife views offspring as a means of holding her husband’(see also, Hamad 2013; Spierings 2010; United Nations 2011; World Bank 2013). Further, a number of research studies which report the influence of infertility on divorce among Arabs and Muslims mention that infertility is considered a legitimate reason for divorce: especially if it is the wife who is infertile. Also, infertility produces enormous stress on the marital relationship (El-Saadani 2006; Nyarko and Amu 2015; Obeidat et al. 2014).

Moreover, these results in relation to children as basic grounds for a stable marriage may reflect the nature of spousal relationships in the Saudi Arabian context, as both sexes regard children as a substantial cause of marital stability. This might mean that both spouses consider children as a major source of emotional or psychological sustenance, instead of depending on the close

126 relationship between themselves. Many scholars have emphasised the role of companionship between spouses in influencing fertility decisions. For example, Caldwell (1982) and Oppong (1983) and also Mason (1987) argue that when relationships between couples become more egalitarian, the psychological costs of children increase, as more consideration towards the mother’s health and well-being will greatly influence reproductive decision-making (so couples may practise long birth spacing, use contraception, limit family size). Also, Friedman et al. (1994) hypothesise that couples consider having children as a way to enhance their marital solidarity.

The third most popular choice was different for the respective genders: the male respondents chose ‘Main purpose for marriage’ (41 males and 11 females), whereas the female respondents chose ‘Enhancement of parents’ position in the family and also society’ (32 males and 52 females). It seems that considering children as a main purpose for marriage is related to the second choice (children are basic grounds for a stable marriage), which could mean that parents look at children as a source to fulfil their need for psychological sustenance. Also, around 30 male respondents said they cannot imagine life without children (Figure 5.1), which could support the idea that men consider children as a source of psychological and emotional fulfilment. Also, Faour (1989), in his article 'Fertility Policy and Family Planning in the Arab Countries', notes that, ‘the Arab fertility is deeply influenced by Muhammad’s call to Muslims to “get married and multiply” so many Muslim Arabs believe that procreation is one of the most important objectives of marriage. The bride’s status in her husband’s household and kinship network remains unstable and inferior until she delivers a baby (see also Hamad 2013; Obeidat et al. 2014; Spierings 2010).

The fact that 32 males and 52 females chose ‘Enhancement of parents’ position in the family and society’ could provide empirical support for Caldwell’s theory of intergenerational wealth flow as he notes that in a traditional society children promote their parents’ social status and bring honour to the family. Also, it could support Mason’s (1987) argument that gender inequality makes women believe that children are an assurance of better status in the family and society. Also, the literature on the Arab context emphasises the essential role of family as a basic unit in society, and gender roles in that context specify women’s role to bear domestic responsibilities, and such a context makes women more attached to children. For example, Hijab (2001, p.44) states, ‘many Arabs tend to consider the family as the lynchpin of society

127 and women as the core of the family.’ Also, through his article that reviewed a considerable amount of literature about women in Muslim societies, Waines (1982, p.647) stated, ‘In Muslim society the high valuation of children, and female socialization stresses the reproductive role of women as an independent source of prestige and honour for kinsmen themselves, and ascribes high status to the wife-mother role - a status of respect.’

In addition, to gain further insight into the value of children as a way of understanding fertility patterns in Jeddah, Saudi Arabia, it was helpful to explore the motivation behind having a large family (over three children). Figure 5.2 represents what both males and females regarded as the motivation for having more children. Those motivating values were selected based on reviewing the literature related to Saudi Arabian society and other Arabian societies, concerning cultural characteristics in general and family and children in particular (see Chapter Two and Chapter Four).

Figure 5.2 What is Regarded as Motivation for Having Many Children (over Three) by Gender

90 80 c 70 60 50 Male 40 Female 30 20 10 0 High Enjoyment High Pressure Support in rewards of life status in from old age from God society family and relatives

Source: Fieldwork, 2005

These results showed that male responses were ordered as follows (from highest priority to lowest); ‘enjoyment of life’, ‘support in older age’, and ‘high rewards from God’. The responses from the female sample were ordered as follows (from highest priority to lowest): ‘enjoyment of life’, ‘support in older age’, ‘high status in society’, and ‘high rewards from God’. However, the study respondents generally did not consider ‘pressure from family and relatives’ as a motive for having a large family, as very few respondents (male or female) chose it (this may be a sign that the extended family has only a small influence on a couple’s reproductive decision-making).

128 Over 80 female respondents and 70 male respondents chose ‘enjoyment of life,’ while 35 female respondents and over 60 male respondents chose 'high rewards from God' as motivation for having a large family size. These two motivations are related to religion (see choosing ‘Joy of life’ as the value of children Figure 5.1) and may serve as an example of the fundamental role that Islam plays in people’s beliefs and choices in Saudi Arabia, which then may also show the vital role of religion in reproductive decision-making. Many Muslims believe that having many children will make the Prophet proud as they contribute to increasing the number of Muslims (they base their belief on one well-known Hadeeth, “Marry the one who is loving and fertile, for I will be proud of your great numbers before the nations”).

These results also support Hasna’s (2003) study, which investigated the link between Islam and the reproductive behaviour of Muslims in Jordan. The study was based on in-depth interviews with 58 men and women and with 15 policy-makers. Hasna (2003) notes that children have been depicted in the Quran as great assets, and many Muslims believe that it is their religious duty ‘to multiply and populate the earth’ (p.184). Hasna (2003) found that even though many parents face economic difficulties, they believe four children to be an ideal number. Jordanian parents named several values attached to children including; support in old age, a duty for good Muslims, a pleasure and a continuation of the human race, and that they carry the family name (see also Obeidat et al. 2014; Westoff 2010; World Bank 2010).

Support in older age also represents another significant motive for having many children in the Saudi Arabian context (with almost 70 males and 80 females choosing this motive). In the context of Saudi Arabia, caring for elderly members of the family is an important obligation for younger ones, and a matter of great shame if this is not done (especially when it is a person’s own children). As a consequence of such an elevated consideration towards family kinship, it is difficult to find institutions to take care of the elderly, and even if any are to be found, they would be of a very low standard (for support of this view in the Gulf region, see Mohammed 2003; and in Saudi Arabia see Al-Safe 1997). This result has also been reinforced by the writings of well-known scholars (Cain 1980, 1982; Dharmalingam 1994). For example, Caldwell (1982) argued that in pre-transition societies, children undertake the responsibility of taking care of parents in their old age. Additionally, Mason (1987) argues that in such societies women in particular count on their children to support them in old age, as they greatly depend on men because they have limited opportunities outside the household. Furthermore, recent

129 studies re-examining the old-age security factor confirm this relationship. For example, Jayachandran (2014), in her article about gender inequality in the developing countries, noted that old age support is an important factor that influences fertility behaviour (see also Ibisomi and Odimegwu 2011; Sen 2013).

As relatively few male respondents chose ‘high status in society’ as a motive for having many children, this result may possibly be a sign of changing attitudes towards large family size. This might be an indication that even though children are highly valued in the Saudi Arabian culture, only 10 male respondents believed that a large family would promote their status in society. On the other hand, 40 female respondents chose this motive (this result is also related to the previous outcome about the value of children in Figure 5.1).

It is clear from the above results that Saudi Arabians place great value on children, which might influence their fertility behaviour. This could also explain the outcome of the male and female surveys, which showed that the modal number of children in the family was 4 (2 male, 2 female). It also helps to explain the fact that in Saudi Arabia the total fertility rate was (TFR 4.1) in 2005 and it is higher than the other Gulf States.

The Change in the Value Placed on Children and Family in 2013

Figure 5.3 The Value of Children by Gender

120

100

80

60 Male 40 Female

20

0 Main purpose for Joy of life Can not imagine life Basic ground for Enhance your position marriage without them marriage stability in the family & society

Source: Fieldwork, 2013

The results in Figure 5.3 revealed that both males and females chose ‘Joy of life’ as their highest priority, with 97 female and over 98 male parents choosing ‘Joy of life’ as the most important and highest value that is related to children. The second choice was ‘Basic grounds

130 for a stable marriage’ with 90 female and 71 male respondents choosing this value. The third most popular choice was ‘cannot imagine life without them’ with 53 females and 62 male respondents. The fourth choice was ‘Main purpose for marriage’ (66 males and 42 females). It seems that considering children as the main purpose for marriage is related to the second choice (children are basic grounds for a stable marriage), which could mean that parents look at children as a source to fulfil their need for psychological sustenance. Meanwhile, only 27 males and 26 females chose ‘Enhancement of parents’ position in the family and society’.

Figure 5.4 What is Regarded as Motivation For Having Many Children (over Three) by Gender

120

100

80

60 Male

Female 40

20

0 High rewards from Enjoyment of life High status in Pressure by family Support in old age God society and relatives

Source: Fieldwork, 2013

The findings from Figure 5.4 show that responses were ordered (from highest priority to lowest) as; ‘enjoyment of life’, ‘support in older age’, ‘high rewards from God’, and high status in society’. However, the study respondents generally did not consider the ‘pressure from family and relatives’ as a motive for having a large family.

The value system in any society usually does not change in a short time; it generally takes many years to notice a great change in traditions and values. Thus, it can be seen that the study respondents in 2013 chose almost the same values as the study respondents in 2005. Although, it was obvious that the changes that occur in society have some influence on the priority of people’s choices, especially the female responses.

For the value of children, female responses increase in the choice that children are considered as the main purpose of marriage, from 12 in 2005 to 42 in 2013, and also the male responses increase for this choice from 42 in 2005 to 66 in 2013. For females, this could mean that

131 marriage is not a goal in itself in their life as they become more independent, or reflect the changes that have occurred in the gender system from a few years ago for both genders, as the divorce rate increases in the society, and so children become the foremost part in a spouse’s life or marriage.

The increase in the former choice also related to an increase in another related value, which is that children are considered as basic grounds for a stable marriage. The male responses rose from 36 in 2005 to 71 in 2013, while the female responses rose from 70 in 2005 to 90 in 2013. Also, it is related to an increase in the choice ‘cannot imagine my life without them,’ rising from 28 in 2005 to 62 in 2013 for males and from 4 in 2005 to 53 for females.

On the other hand, a reduction of one value, ‘Enhancement of parents’ position in the family and society’ was clear in 2013, falling from 36 in 2005 to 27 in 2013 for males and a clearer reduction for females, from 55 in 2005 to 26 in 2013. This reduction in that value might explain the decrease in fertility levels in the society.

The female respondents who chose the motivation that having many children means high status in society reduced from 40 in 2005 to 12 in 2013. This could reflect the changes in women’s socioeconomic status in society as the increase in women’s participation in the labour market has opened job opportunities for females (also, this reduction in that value could explain the decrease in fertility levels in the society).

Sex Preference in 2005

The Importance of Having Male Children To add a large-scale perspective to this issue, it is significant to present the survey analysis. In the survey, both males and females were asked if they believed it was important to have male offspring. The respondents who replied ‘Yes’ were then asked to specify the most important reason for having male children. The survey results for the male sample indicated that only 12 out of 100 respondents reported that it was not important to have male children. Interestingly, those who reported that it was not important to have male children already had male children (except for two who were newly married). The remainder of the respondents (88 males out of 100) believed that it was important to have male offspring. In contrast, the female sample had

132 no respondents who reported that it was not important to have male children, as all respondents believed in the importance of having male offspring. In order to investigate the impact of sex preference on family size, Table 5.7 shows a significant difference in family size between respondents who prefer male children and the ones who did not, so it appears that respondents who prefer male children have more children.

Table 5.7 Male Preference and Median Family Size Sex Preference Mean Std. Deviation N No 2.92 2.539 12 Yes 4.19 2.442 188 Total 4.11 2.460 200 Source: Fieldwork, 2005

However, as Figure 5.5 reveals, there were differences in what both males and females considered to be the most important reasons for this preference for male offspring. For male respondents, the options ranked respectively: ‘security in older age’, ‘continuity of family name’, ‘inheritance law’ and lastly, ‘high male social status’. The female options were ranked respectively: ‘inheritance’, ‘security in older age’, ‘male social status’, and lastly ‘continuity of family name’. It can be seen from these results that both male and female study respondents based their belief in the importance of having male children on cultural values and traditions.

Figure 5.5 Importance of Having Male Children by Gender

60

50

40 male 30 female count 20

10

0 no importance high social inheritance law carry family old age status name security

Source: Fieldwork, 2005

For male respondents, ‘security in older age’ and ‘continuity of family name’ choices both reflect the flow of wealth from children to parents within the gender system of the pre- transition (traditional) society of Saudi Arabia (the issue of wealth flow was discussed in detail

133 in the previous section). What is more, many males believe that in the Saudi Arabian context, not only do male children represent security in old age, but they also ensure the continuity of the father’s family name. These results obviously show evidence of a preference for male offspring in Saudi Arabia, and the importance of having male children was based on Saudi Arabian conceptualizations of gender role requirements as in responsibilities and duties; this is in effect a patriarchal society giving primacy to males over females in many social aspects.

Furthermore, the other reasons which males in the survey chose as justification for male preference were ‘inheritance law’ and ‘male high social status’. According to Islamic inheritance law, if the father of a family dies and does not have sons (even if he has daughters), other relatives from his family (such as brothers) will be included in his inheritance. If the father has a son, his inheritance will go to his wife and children only. Thus, males in the survey showed a concern for economic support of their family (wife and children) after they pass away. As Saudi Arabia exhibits a particularly low rate of female labour force participation, this makes women generally dependent on men. Consequently, this could explain why males in the survey think it is important to have male children. On the other hand, for female respondents, ‘inheritance’ was the most important justification for preferring male offspring instead of ‘security in older age’ (the issue of old age support was discussed in detail in the previous section). This was also related to the division of labour between genders in the Saudi Arabian context, and patriarchy, which places many restrictions on women’s access to the public sphere and centres their role on domestic labour. This makes women more dependent on male relatives. Also, because of Islamic inheritance law, women can access their husband’s inheritance only through their sons. Moreover, similar to male responses, females believe that males have a higher status than females in the Saudi Arabian social context. All the preceding grounds may justify a preference for having sons in the Saudi Arabian context.

The Implications of Sex Preference

The above results have indicated evidence for a preference for male offspring. Below, the implications of this for fertility decision-making are elaborated. An investigation was undertaken to illustrate what male respondents from the survey would do, along with what the females thought their husbands would do, if all their offspring were girls. Figure 5.6 shows that male responses were ordered from highest priority to lowest; ‘never stop having children

134 until a male child is born’, ‘do nothing’, ‘marry another wife’, and finally, ‘not knowing what they will do’. The female sample reported what they thought their husband would do from highest priority to lowest in the following order; ‘never stop until a male child is born’, and ‘marry another wife’. It is obvious from Figure 5.6 that men are interested in having male children, but also that women are totally convinced that men have a preference for male children, so their responses show that they were sure that their husband would try to have a son if they currently only had girls. Moreover, according to Islamic law, men may have four wives at the same time; they thus hold an all-powerful role in marital relationships, which explains preference for male offspring and its effect on fertility levels (in this study the 2005 survey results show that only eight males have two wives, and only five females reported they are in a polygamous marriage).

However, it is clear from Figure 5.6 that females have significant worries about having sons; this is evidenced by the fact that over 40 female respondents stated that their husband would take another wife if they had only female offspring. However, where male respondents illustrated their desire for sons, it seems they were more relaxed concerning this issue than females (almost 30 said they would do nothing and 8 said they did not know what they would do). This result could be a reflection of harmony with the responses of males from the interviews (regarding the importance of having male children), where many men said that the matter of having boys or girls depended on ‘God’s Will’. Alternatively, this result might be a reflection of gender relations in the Saudi Arabian context, where men have great authority over women, so they have the power or authority to act when they need to do so, and hence they do not feel the need to worry about this issue.

Figure 5.6 What Men would Do if They had Only Daughters

60

50

40 male 30 female count 20

10

0 do nothing I don't know never stop until a marry another wife male child is born What husbands would do if they had girls only

Source: Fieldwork, 2005

135 Furthermore, when both sexes were asked if having girls only would affect their fertility decisions, the results showed that all female (N=100) and many male respondents (N=72) reported that if they only had girls it would definitely impact on their fertility decision-making, encouraging them to have another child in the hope that it would be a boy. It therefore appears that preference for sons is a crucial element in fertility decisions in Saudi Arabia.

Moreover, by way of comparison to the previous factor of having girls only, it was productive to determine what male respondents would do, along with what the females thought their husband would do, if all offspring were boys. Figure 5.7 reveals that male responses were ordered (from highest priority to lowest); ‘do nothing’, ‘never stop having children until a female child is born’, ‘not knowing what they will do’, and lastly, ‘marry another wife’, while female respondents reported what they thought their husband would do in the following order; ‘don’t know’ and ‘do nothing’. Thus, it is evidenced that men held a preference for male children by the fact that over 60 male respondents stated that they would do nothing if they had only male offspring. This was different to male responses to the previous question, ‘if all offspring were girls’, with around 30 male respondents stating they would do nothing if they had only female offspring. In contrast, women’s responses showed that they were not worried about ‘having boys only’, so women’s responses supported the idea that men had a preference for sons.

Figure 5.7 What Men Would Do if They Had Boys Only

70 60 50

40 male female count 30 20 10 0 do nothing I don't know never stop having marry another wife children until a female child is born What husbands would do if they had boys only

Source: Fieldwork, 2005

136 Following on from this, when both males and females were asked if having boys only would affect their fertility decisions, the results revealed that the majority of both male (N=83) and female (N=99) respondents reported that having boys only would not influence fertility decisions. This is in direct contrast to the responses if only girls had been produced. Accordingly, it became apparent that there is indeed a preference for sons over daughters in Saudi Arabian society, and as such this can be construed as an effective element regarding fertility decision-making.

The Change in Sex preference in 2013

The Change in Importance of Having Male Children

The survey outcomes indicated that only 8 male and 2 female respondents reported that it was not important to have male children. The remainder of the respondents (92 males and 98 females) believed that it was important to have male offspring. Figure 5.8 demonstrates that, for male respondents, the options ranked respectively: ‘security in older age’, ‘inheritance law’, ‘continuity of a family name’, and lastly, ‘high male social status’. The female options were ranked respectively: ‘inheritance’, ‘security in older age’, ‘continuity of a family name’, and ultimately ‘male social status’.

Figure 5.8 Importance of Having Male Children by Gender

45

40

35

30

25 Male 20 Female 15

10

5

0 No importance High social status Inheritance law Carry family name Old age support

Source: Fieldwork, 2013 Survey results revealed a clear preference for male children based on several reasons. Also, Table 5.8 shows a difference in the family size between the two groups by almost one child.

137 Table 5.8 Male Preference and Median Family Size Sex Preference Mean Std. Deviation N No 2.58 1.564 12 Yes 3.32 1.614 188 Total 3.28 1.616 200 Source: Fieldwork, 2013

It seems that the high social status of males still exists in the point of view of respondents, both male and female, although it has not influenced their family size. While in 2005, this factor did show a significant difference on family size, in 2013 it showed only a slight difference on family size, which means that the preference for males might reduce a little.

The Change in Implications of Sex Preference

Figure 5.9 What Men Would Do if They had Only Daughters

60

50

40

30 Male

20 Female

10

0 Do nothing I don't know Never stop until a male Mary another wife child is born

Source: Fieldwork, 2013

Figure 5.9 displays that male and female responses were ordered, from highest priority to lowest as; ‘not knowing what they will do’, ‘never stop having children until a male child is born’, ‘do nothing’, and finally, ‘marry another wife’.

Furthermore, when both sexes were asked if having girls only would affect their fertility decisions, the results showed that female (N=73) reduced from 100 in 2005 and also many male respondents (N=77) reported that if they only had girls it would definitely impact on their fertility decision-making, encouraging them to have another child in the hope that it would be a boy.

138 Figure 5.10 What Men Would do if They had Boys Only

90 80 70 60 50 Male 40 30 Female 20 10 0 Do nothing I don't know Never stop until a female child is born

Source: Fieldwork, 2013

Figure 5.10 shows that the majority of both male and female respondents chose ‘do nothing’, and few chose ‘not knowing what they will do’. Meanwhile, only 10 male respondents chose ‘never stop having children until a female child is born’. Thus, it is evidenced that men held a preference for male children. Also, women’s responses showed that they were not worried about ‘having boys only’, so women’s responses supported the idea that men had a preference for sons. This is similar to the outcome of 2005.

Furthermore, when both males and females were asked if having boys only would affect their fertility decisions, the results revealed that the majority of both male (N=80) and female (N=90) respondents reported that having boys only would not influence fertility decisions. This is in direct contrast to the responses if only girls had been produced.

It appears that the female worry about their husband taking another wife had reduced greatly from around 42 in 2005 to 5 in 2013, and the respondents who said they ‘do not know’ what to do if they had only daughters was greatly increased in 2013, as it was only 8 males in 2005 (Figure 5.9). Also, the respondents who said that they would never stop having children until a male child is born decreased compared to 55 females and 42 males in 2005. All the above could be indications of a decrease in the significant influence of male preference in fertility decisions.

However, the result from Figure 5.10 demonstrates that there is no clear difference in the responses to this issue from 2005 to 2013, which include that male preference still exists in the society, but might not be as robust as before.

139 The Role of Gender in the Decision-Making Process Concerning Reproduction

Introduction

The previous section presented some of the socioeconomic and demographic factors that impact on fertility patterns in Jeddah, Saudi Arabia. This section covers the status of women in the country and the influence of this on the reproductive decision-making process. This section is important as it draws attention to the influence of the gender system on decisions regarding reproduction in Saudi Arabian society. In particular, it explores women’s status and illustrates their role in reproductive decision-making. This helps to establish a comprehensive understanding of fertility patterns in Jeddah, Saudi Arabia. A sizeable body of literature emphasizes the influence of this gender system on fertility decision-making in other developing countries, in that comparable gender systems and more empowered women impact on the transformation in reproductive decision-making, which consequently produces a shift in fertility trends (Jatrana and Pasupuleti 2013;Mason 1997, 2001, 2003; Moghadam 2003; 2005, 2011; Samari and Pebley 2015; Upadhyay and Karasek 2012). This thesis therefore contributes to the growing body of knowledge that explains the link between gender roles and fertility trends.

Dimensions of Women’s Status in 2005

This study sheds light on the dimensions of women’s status in the Saudi Arabian context through emphasis on the following factors; the division of responsibilities within the household, control of material resources, and flexibility in movement. As a result of exploring these different dimensions, this study works to fill the knowledge gap and contribute rich and valuable insights into women’s status and into gender structure in the Saudi Arabian context.

Gender-Based Roles

On the basis of establishing an exploration of the division of labour by gender among study respondents, it was considered valuable to review the opinions of both male and female respondents regarding their attitudes towards the responsibility for children and childrearing activities. Figure 5.11 shows that opinions are unanimous on this issue as all of the 100 female respondents agreed that caring for children was their fundamental responsibility within the

140 family. Likewise, most male respondents held a similar viewpoint (at 88 out of 100). This is consistent with the traditional sexual division of labour in Saudi Arabia.

Figure 5.11 The View of Caring for Children as Women’s Responsibility

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100

80

male 60 female count

40

20

0 disagree neutral agree

Source: Fieldwork, 2005

Considering the relationship between the traditional gender-based division of labour and family size, Table 5.9 revealed that 88 of the male respondents believed in the traditional division of labour by sex, only two males disagreed and ten males chose neutral; although it is not clear why these 12 men did not agree or fully agree with the traditional division of labour (for the two men who chose to disagree both have a general educational level, and are in professional occupations, while of the ten men who chose to be neutral, one is illiterate, five have a general educational level, and four have a university education, two are in unprofessional labour and eight have a professional occupation Also, they represent different age categories). However, when considering the influence of caring for children as men’s responsibility (as shown in Table 5.10) this shows that when fathers become more involved in taking care of children, family size drops: especially in the younger generation.

Table 5.9 Male View on Caring for Children as Women’s Responsibility in Relation to Family Size Their Their Their Median Number of Number of Median Number of Median Number of Respondents Respondents Number of Respondents Number of Children Children Children Who Said Age Groups Who Disagree Disagree Neutral Who Agree Agree Neutral Have 3 15-30 1 1 Have 1 child 15 2 children 31-45 - 5 4 56 4 Have 7 46-60 1 4 7 17 6 children Total 2 10 88 Source: Fieldwork, 2005

141 Table 5.10 Caring for Children as Men’s Responsibility in Relation to Family Size Their Their Their Median Number of Number of Median Number of Median Number of Respondents Respondents Number of Respondents Number of Children Children Children Age Groups Who Disagree Disagree Who Said Neutral Who Agree Agree Neutral

M F M F M F 15-30 2 41 2 4 10 2 10 1 1 31-45 4 23 5 16 14 4 41 0 4 46-60 0 8 7 10 3 6 13 0 7 Total Source: Fieldwork, 2005

In the Saudi Arabian context, the father is the head of household and he is the main supporter of the family economically; this is also supported by the Islamic doctrine (Surah: Al-Nesa- verse 34, “Men are the protectors and maintainers of women, because they support them from their means”). Thus, it was invaluable to scrutinise who was financially responsible for children. As shown in Figure 5.12, 75 of the male respondents and 74 of the female respondents reported that the husband (head of household) is financially responsible for children. This makes many men think they are responsible only for providing for the family economically; however, Islam does not specify childrearing as a women’s job only. At the same time, Figure 5.12 reveals that despite limited opportunities for women in paid employment (see Chapter Four), 25 male and 26 female respondents reported that the financial support for children was the responsibility of both husband and wife. This means that there are some women who are sharing the financial responsibility with their husband, and yet at the same time they are also upholding the responsibilities of taking care of children.

Figure 5.12 Who is Financially Responsible for Children?

80 60 40 male 20 female 0 husband husband and wife

Source: Fieldwork, 2005

The above result reflects the Saudi Arabian gender system, which upholds childbearing and childrearing as an imperative and basic role in a woman’s life (Figure 5.11). To investigate this further, it was essential to focus on men’s roles or share of responsibility for children and 142 household tasks. Figure 5.13 gives the descriptive counts for both male and female responses with regard to what help husbands gave with caring for children. It shows that 75 of female respondents stated that their husband’s main contribution consisted largely of taking family members out for entertainment-type activities. This is normal in Saudi Arabian culture where only men can drive cars, so it is common that the father takes his family out for activities outside the home. Only 16 female respondents reported that their husbands contribute by visiting their children’s school or taking their children to the doctors, and 9 female respondents noted that the father helped with the children’s schoolwork. In Saudi Arabia, the school system is segregated, so only the fathers can go to boys’ schools, and mothers cannot drive so they need to be accompanied (e.g. by their husband or a driver) on visits such as taking children to the doctor.

Figure 5.13 shows that 43 male respondents note that they help with children by taking family members out for entertainment-type activities, and 39 male respondents said they assisted children with home tutoring. Only 11 male respondents reported that they help by visiting the children’s school (sons) or taking children to the doctor. Four male respondents stated that they share in infant feeding, and only 3 male respondents said they do not help care for the children at all. It appears from Figure 5.13 that male respondents consider helping in teaching the children is an important contribution in taking care of children, as 39 said they did so, while the female response considered taking family members out for entertainment-type activities as the main contribution of their husbands (the male and female sample are not couples). Indeed, male and female responses could reflect the traditional division of labour by sex (Figure 5.11, Figure 5.12 and Figure 5.13).

Figure 5.13 The Kind of Help with Childcare Given by Husbands

80

70

60

50 Male 40 Female count 30

20

10

0 Infant feeding Children Go out and Visit school Do nothing teaching playing with and doctors

Source: Fieldwork, 2005

143 Women’s Status and ‘Permission Issues’

This study now explores ‘permission issues’, which are based on the requirement that a woman must seek her husband’s permission in order to leave her house and make purchases. When gender viewpoints regarding the permission women need to buy something for themselves were examined, 69 female respondents reported that they required their husband’s permission and 56 male respondents reported that their wives had to get their permission (see Figure 5.14).

However, the outcome reveals that men are largely in charge of the financial resources within the family, which reflects the division of power in the household in favour of the male. This outcome may possibly be because in the Saudi Arabian context it is generally men who earn the money and they are the main providers of economic support for the family. Thus, it seems more appropriate for the wife to ask her husband’s permission to use his money, especially if she wants to buy something for herself.

Figure 5.14 The Requirement of Permission for Women to Buy Something for Themselves

80

70

60

50 Male 40 Female Count 30

20

10

0 Do not need permission Do not need permission if Need husband permission its her money

Source: Fieldwork, 2005

Analogous to permission issues, it was pertinent to examine both male and female viewpoints regarding the need for women to seek their husband’s permission to go out. The survey results reveal that both genders are of the same opinion; 94 males and 98 females indicated that women needed permission from their husbands to go out. Thus, it is clear that women’s mobility usually depends on their husband’s permission. The belief originates in religious doctrine, indicating that the wife needs permission before going outside the home. The Islamic doctrine justifies this principle in that it aims to protect women from harm, although it does not require the wife to ask permission every time she wants to go out. It is in practice, therefore, a general agreement from the husband on the places the wife can visit.

144 The Change in Dimensions of Women’s Status in 2013

The Change in Gender-Based roles

Figure 5.15 The View of Caring for Children as Women’s Responsibility

120

100

80

60 Male Female 40

20

0 Disagree Neutral Agree Source: Fieldwork, 2013

Figure 5.15 demonstrates that from the male sample, 84 agreed with the traditional gender- based division of labour, only one male disagreed and 15 chose neutral (the only man who chose to disagree has a university level of education, and is in an administrative occupation, while, of the 15 men who chose to be neutral, five have general educational level, and ten have a university education, two are in professional occupations, ten have administrative occupations, and three are in skilled labour). All of the 100 female respondents agreed on the idea of the division of labour in the Saudi Arabian context. Also, they represent different age categories, as shown in Table 5.11. This is an analogous result with 2005, which signifies that the traditional sexual division of labour still exists in Saudi Arabia.

Table 5.11 Male View on Caring for Children as Women’s Responsibility in Relation to Family Size Their Their Their Number of Median Number of Median Number of Median Respondents Number of Respondents Number of Respondents Number of Children Children Children Age Groups Who Who Said Disagree Neutral Who Agree Agree Disagree Neutral 15-30 1 Have 3 3 2 7 1 children 31-45 - 5 3 60 3 46-60 - 7 4 17 5 Total 1 15 84 Source: Fieldwork, 2013

145 Table 5.12 Caring for Children as Men’s Responsibility in Relation to Family Size Number of Their Number of Their Number of Their Respondents Median Respondents Median Respondents Median Number of Number of Number of Children Children Children Age Groups Who Disagree Who Said Neutral Who Agree Agree Disagree Neutral

M F M F M F 15-30 1 5 2 3 13 2 6 20 1 31-45 1 12 4 13 20 4 52 23 3 46-60 0 4 7 3 1 4.5 21 2 5 Total 2 21 19 34 79 45 Source: Fieldwork, 2013

However, when considering the influence of caring for children as men’s responsibility (as shown in Table 5.12), it could be said that whenever the men do not fully agree with the traditional division of labour between sexes, and are also more involved in taking care of child responsibilities, there is more probability of preferring a smaller family size (this is like the outcome of 2005: however what is different in the 2013 survey is that the influence was clear in all age groups).

Albeit that the relationship between taking care of childcare responsibilities is not very definite, it appears that there are some changes in the viewpoint concerning this issue, as from the 16 male respondents who do not fully agree regarding the traditional gender-based division of labour, 11 of them have a university education. Also, 124 respondents (79 males and 45 females) think that men should be involved in taking care of childcare responsibilities compared to 65 (64 males and only one female) in 2005. This could be an indication of an escalating change in how the new generation regards the gender-based division of labour, which may possibly lead to better gender equality.

Figure 5.16 Who is Financially Responsible for Children?

100 90 80 70 60 50 Male 40 Female 30 20 10 0 Husband Husband&Wife Source: Fieldwork, 2013

146 Figure 5.16 shows that 85 of the male respondents said that they were financially responsible for family income and only 12 said that the financial support for children was the responsibility of both husband and wife. However, it seems that female respondents reported a different situation from male respondents, as they said that they had become more involved in family income than in 2005 as the numbers reporting involvement had increased slightly, from 26 to 33 in 2013.

At the same time, women are also upholding the responsibilities of taking care of children, as all female respondents and the majority of male respondents agree that taking care of children is women’s responsibility.

Figure 5.17 The Kind of Help with Children Given by Husbands

140

120

100

80

60 Male Female 40

20

0 Infant feeding Children Go out & Visit school & Assist in Do nothing teaching playing with doctors household children duties Source: Fieldwork, 2013

Focusing on men’s roles or share of responsibility for children and household tasks, Figure 5.17 shows that 39 males and 12 females reported that the husband shares in infant feeding (this was only four males in 2005). Also, 58 males and 33 females said that the husband assisted children with home tutoring (this was 39 male and only 9 female respondents in 2005). Both male and female respondents agree that the main contribution of the husband’s help consisted largely of taking family members out for entertainment-type activities, with 118 males and 85 females agreeing (this was 75 females and 43 males in 2005), followed by visiting their children’s school or taking their children to the doctors, at 59 males and 53 females (this was only 16 females and 11 males in 2005). Meanwhile, 30 males and only 5 females said that the husband assists in household duties (surprisingly, no one chose this option in 2005). Lastly, only 3 males

147 and 15 females said that the husband does not help in caring for the children or household duties at all (only 3 male respondents chose this option in 2005).

It appears that there is more male involvement in household or domestic responsibility and in childrearing compared to the responses in 2005. Nonetheless, male and female responses up until now could reflect the traditional division of labour by sex, and the Saudi Arabian gender system.

The Change in Women’s Status and ‘Permission Issues’

Figure 5.18 The Requirement of Permission for Women to Buy Something for Themselves

60

50

40

30 Male

20 Female

10

0 Do not need permission Do not need permission if its her Need husband permission money Source: Fieldwork, 2013

Figure 5.18 illustrates that there is a significant change in the matter of the permission women need to buy something for themselves, as only 29 females said they required their husband’s permission and 37 male respondents said that their wives had to get their permission (compared to 69 female and 56 male respondents in 2005).

Regarding the issue of permission to go out, a slight change occurred only in female respondents, as 90 females said that they required their husband’s permission to go out (compared to 98 female respondents in 2005).

Gender, Decision-making and Reproduction in 2005)

Discussing Reproductive Decisions

This aspect of the study explores elements affecting fertility behaviour and begins by considering discussions about family size. This is important because it reveals gender relationships with respect to reproductive decision-making. Table 5.13 shows that 65 females

148 from the survey respondents reported that they did not have discussions with their spouse regarding reproductive decisions. By contrast, 64 males from the survey respondents explained that they did discuss reproductive decisions with their spouse (these conflicting responses will be elaborated on below through qualitative analysis). Table 5.13 also illustrates that parents who did discuss reproductive issues were more likely to have fewer children, with family size dropping to a median of 3 children. For those parents who did not discuss reproductive issues, the median family size was larger (4 children). These results suggest that if spouses did discuss reproductive matters, this could result in reduced fertility levels. Unfortunately, there are no available comparable statistics regarding this issue from Saudi Arabian government sources or other studies.

Table 5.13 Discussing Reproductive Issues in Relation to Family Size Their Their Number of Median Number of Median

Respondents Number of Respondents Number of Children Children Age Groups Who did not Who did not Who did Who did Discuss Discuss Discuss Discuss M F M F 15-30 5 29 2 11 23 2 31-45 20 25 6 41 12 3 46-60 10 9 7 13 2 6 Total 35 63 65 37 Source: Fieldwork, 2005

To gain further information regarding the socioeconomic factors that could promote positive spousal discussion with respect to reproductive issues, the following variables were examined: current ages of parents, parental education levels, family income and parental occupational status. Firstly, it seems that the younger generation have slightly more egalitarian relationships with their spouses than the older generation: 39 out of 52 from the young husbands (15-39 years old) reported that they discuss reproductive issues with their wives compared to 26 out of 48 from the older husbands (40-60). Also, this difference between age groups was more obvious in the female sample, with 33 out of 78 from the young wives (15-39) reporting that they discuss reproductive issues with their husbands compared to 4 out of 22 from the older wives (40-60).

Secondly, Table 5.14 shows that there is a distinct variation between different educational levels (excluding the illiterate cases). It is clear from Table 5.14 that men with higher educational levels were more likely to discuss reproductive issues with their wives, and the

149 level of education appeared to be more significant in explaining a woman’s propensity to discuss family size than for men. This might be because when women are highly educated they tend to have a greater ‘voice’.

Table 5.14 Gender Education Related to Discussing Reproduction Issues Discussion Total No Yes Male Education General Education Count 52 32 84 Expected Count 41.4 42.6 84 University Education Count 46 69 115 Expected Count 56.6 58.4 115 Total Count 98 101 199 Female Education General Education Count 67 43 110 Expected Count 53.0 57.0 110 University Education Count 28 59 87 Expected Count 42.0 45.0 87 Total Count 95 102 197

Source: Fieldwork, 2005

Further examination of this issue and its relationship to the influence of the family income is also instructive. Table 5.15 showed that family income has a small impact on the existence of spousal discussion concerning fertility matters.

Table 5.15 Family Income Related to Discussing Reproduction Issues Discussion Total Income of family No Yes <=5ooo Count 30 19 49 Expected Count 24.0 25.0 49.0 5001-10000 Count 37 37 74 Expected Count 36.3 37.7 74.0 >10000 Count 31 46 77 Expected Count 37.7 39.3 77.0 Total Count 98 102 200 Expected Count 98.0 102.0 200.0 Source: Fieldwork, 2005

Finally, Table 5.16 demonstrates obvious variation between males in professional posts and males with non-professional jobs. Likewise, for females, Table 5.16 shows a variation between the two groups of working women and housewives. Accordingly, it can be said that males in occupations that require high levels of education engaged in more discussion with their spouses concerning fertility issues. Correspondingly, males in occupations that are not necessarily related to a high level of education had less discussion with their spouse concerning fertility issues. Also, working females were more likely to discuss reproductive matters with their spouse. This could be related to the improvement in women’s status through education and

150 work, which is likely to give women a greater voice and autonomy within the family and hence enable them to discuss reproductive matters with their husbands.

Table 5.16 Gender Occupational Status (Recoded) by Discussing Reproduction Issues

Discussion Total No Yes Husband’s Occupation Professional Labour Count 68 93 161 Expected Count 78.9 82.1 161 Non-professional Count 30 9 39 Labour Expected Count 19.1 19.9 39 Total Count 98 102 200 Female Work Status Working Count 17 35 52 Expected Count 25.5 26.5 52 Housewife Count 81 67 148 Expected Count 72.5 75.5 148 Total Count 98 102 200

Source: Fieldwork, 2005

Gender Power in Fertility Decisions

Table 5.17 shows that 64 females from the survey respondents reported that their husbands had the final say in decision-making regarding reproduction. Also, 65 of the male survey respondents said that they had the final say. Also, it is obvious that where the husband controlled fertility decision-making, the family size increased, but when the fertility decisions were shared, the family size decreased. This indicates that whenever the reproductive decision was shared between spouses, there was a greater probability that family size would be smaller. Unfortunately there are no comparable government statistics for Saudi Arabia in general.

Table 5.17 Gender Power in Fertility Decisions and Family Size Their Their Median Number of Number of Median Number of Respondents Respondents Number of Children Children Age Husband has Husband has Family have Family have Groups Decision Decision Decision Decision M F M F 15-30 8 30 2 8 22 2 31-45 38 25 5 23 12 3 46-60 19 9 7 4 2 5 Total 65 64 35 36 Source: Fieldwork, 2005

151 Since further understanding is needed concerning the socioeconomic factors that impact on the control of decision-making in the family, the following factors will be investigated; age of parents, education levels, family income and occupational status. Firstly, it seems that the relationship between age group and who controls reproductive decisions within the family is not very robust, as 29 out of 52 (comprising 56%) from the young husbands (15-39) reported that they were in control of reproductive decisions compared to 36 out of 48 (comprising 75%) from the older husbands (40-60), showing that the younger husbands appear to have more egalitarian relationships with their spouse than the husbands from the older generation. Similarly, 46 out of 78 (comprising 59%) from the young wives (15-39) said that their husband controlled reproductive decisions, and 18 out of 22 (comprising 82%) in the older group (40- 60).

Secondly, when exploring the effect of male and female educational levels with regard to who controls the reproductive decisions, while excluding the illiterate cases (1 of the male sample and 3 of the female sample), the cross-tabulation (Table 5.18) illustrates a clear difference between the impact of female educational levels, and a not very clear difference with male educational levels. It is evident from Table 5.18 that women with a higher education had greater roles in reproductive decision-making than women with low levels of education. Yet educational status is not fully effective, given that it is operating under a strict gender system (as Table 5.18 shows that in half of highly educated males and females, the husband is controlling fertility decisions).

Table 5.18 Gender Education and Gender Power in Fertility Decisions

FINAL DECISION Total Husband Family Male Education General Education Count 59 25 84 Expected Count 54.0 30.0 84 University Education Count 69 46 115 Expected Count 74.0 41.0 115 Total Count 96 95 199 Female Education General Education Count 88 22 110 Expected Count 70.4 39.6 110 University Education Count 38 49 87 Expected Count 55.6 31.4 87 Total Count 126 71 197 Source: Fieldwork, 2005

152 Thirdly, the cross-tabulation in Table 5.19 illustrates some differences between the highest income category and the other income categories, showing that when the family income was high, the final say was more likely to be shared between spouses; this is possibly because high income groups are representative of parents with higher education and a superior occupational status.

Table 5.19 Family Income and Gender Power in Fertility Decisions FINAL DECISION Total Husband Family Income of <=5ooo Count 33 16 49 Family Expected Count 31.6 17.4 49 5001-10000 Count 50 24 74 Expected Count 47.7 26.3 74 >10000 Count 46 31 77 Expected Count 49.7 27.3 77 Total Count 129 71 200

Source: Fieldwork, 2005

Lastly, when investigating the influence of male and female occupational status (professional and non-professional jobs for males, and working and non-working for females) on which gender has the final say on decisions regarding reproduction, the cross-tabulation in Table 5.20 illustrates that men with occupations related to a higher level of education are more likely to share this decision-making with spouses, whereas men with occupations that require a lower level of education are more likely to have the final say regarding fertility decision-making. Moreover, working women are more active participants in decision-making regarding reproduction than are non-working wives. But this relationship is still far from complete, as for 98 out of 161 husbands with professional work and 25 out of 52 working wives, the husband still controls such decision-making, which is similar to the impact of educational status.

Table 5.20 Gender Occupational Status and Gender Power in Fertility Decision-making FINAL_DECISION Total Husband Family Husband's Professional Labour Count 98 63 161 Occupation Expected Count 103.8 57.2 161 Non-professional Labour Count 31 8 39 Expected Count 25.2 13.8 39 Total Count 129 71 200 Female Work Status Working Count 25 27 52 Expected Count 33.5 18.5 52 Housewife Count 104 44 148 Expected Count 95.5 52.5 148 Total Count 129 71 200

Source: Fieldwork, 2005

153 The Change in Gender, Decision-Making and Reproduction in 2013

The Change in Discussing Reproductive Decisions

It seems from Table 5.21 that the couples who discuss reproductive issues have a smaller family size. There is a clear change in the attitude toward discussing reproductive issues especially in female respondents, as 62 females from the survey respondents reported that they discussed reproductive decisions with their spouse (only 37 female respondents said that they discussed reproductive issues in 2005), while in male respondents there is no change regarding this aspect. Also, it seems that there are comparable responses between male and female respondents, unlike in 2005, when there were contradictory responses.

Table 5.21 Discussing Reproductive Issues in Relation to Family Size Their Their Number of Median Number of Median Respondents Number of Respondents Number of Children Children Who did Who did not Who did Who did Age Groups not Discuss Discuss Discuss Discuss M F M F 15-30 3 5 1 7 33 2 31-45 20 28 4 46 27 3 46-60 15 5 5 9 2 4 Total 38 38 62 62 Source: Fieldwork, 2013

Moreover, it is clear that the younger generation have more egalitarian relationships between spouses, as 80% of the younger age group (15-30) said they discuss reproduction issues. This was followed by 73% in the age group from 31-45, and only 35.5 % in the older age group said that they discussed reproduction issues.

Table 5.22 Gender Education Related to Discussing Reproduction Issues Discussion Total No Yes Male Education General Education Count 37 20 57 Expected Count 21.7 35.3 57.0 University Education Count 39 104 143 Expected Count 54.3 88.7 143.0 Total Count 76 124 200 Female Education General Education Count 39 26 65 Expected Count 24.7 40.3 65.0 University Education Count 37 98 135 Expected Count 51.3 83.7 135.0 Total Count 76 124 200

Source: Fieldwork, 2013 154 Table 5.22 shows that more education for male respondents in the new survey influences discussion between spouses. Also, more education for female respondents in the new survey influence such discussion, which means that the more educated the spouse, the more discussion happens between them. This is similar to the outcome of the 2005 survey. Also, the cross- tabulation in Table 5.23 does not show any differences between income categories.

Table 5.23 Family Income Related to Discussing Reproduction Issues dis child Total No Yes Count 29 47 76 5000-10000 Expected Count 25.1 50.9 76.0 Count 24 56 80 Family income (SR/month) 10001-20000 Expected Count 26.4 53.6 80.0 Count 13 31 44 >20000 Expected Count 14.5 29.5 44.0 Count 66 134 200 Total Expected Count 66.0 134.0 200.0 Source: Fieldwork, 2013

Table 5.24 Gender Occupational Status (Recoded) by Discussing Reproduction Issues Discussion Total No Yes Husband’s Occupation Professional Count 17 43 60 Expected Count 22.8 37.2 60.0

Business Count 9 10 19 Expected Count 7.2 11.8 19.0

Admin Count 45 63 108 Expected Count 41.0 67.0 108.0

Skilled Count 5 8 13 Expected Count 4.9 8.1 13.0

Total 76 124 200 Female Work Status Working Count 17 66 83 Expected Count 31.5 51.5 83.0 Housewife Count 59 58 117 Expected Count 44.5 72.5 117.0 Count Total 76 124 200

Source: Fieldwork, 2013

155 From Table 5.24, it appears that there is no noticeable difference between various occupations in the male respondents in the new survey; this is unlike the 2005 results. Meanwhile, for female work status, the cross tabulation did show a significant difference between housewives and working wives, as the working females were more likely to discuss reproductive matters with their spouse. This is similar to the 2005 results.

There are more educated male respondents in the 2013 survey, and more educated female respondents in the new survey (see the characteristics of the survey samples in Chapter Three). Further, it seems that the conflicting responses which were seen in 2005 have lessened in 2013, and there are similar responses between male and female respondents, unlike in 2005, when there were contradictory responses. Further, more female respondents reported having discussions with their spouses regarding reproductive issues, which was not the case in 2005, as they formed only a third of the sample. Further, the survey results show that from several socioeconomic factors, only parents’ age and education, along with women’s occupational status, influence the availability of discussion between spouses regarding reproductive matters.

The Change in Gender Power in Fertility Decisions Table 5.25 revealed a slight rise in female respondents who have shared decision-making, and it is obvious when the decision-making is shared between spouses that family size is reduced (which is similar to the outcome of the 2005 survey).

Table 5.25 Gender Power in Fertility Decisions and Family Size Number of Their Median Number of Their Median Respondents Number of Respondents Number of Children Children Age Husband has Husband has Family have Family have Groups Decision Decision Decision Decision M F M F 15-30 2 11 2 8 27 1 31-45 38 40 4 28 15 3 46-60 19 6 5 5 1 4 Total 59 57 41 43 Source: Fieldwork, 2013

Further, when considering age differences, it seems that in the younger generation there is more possibility for shared decision-making between spouses, as 73% of the age group from 15-30

156 said that they take shared reproductive decisions, compared to 35% and 20% from the older age groups of 31-45 and 46-60 respectively.

Table 5.26 Gender Education and Gender Power in Fertility Decisions FINAL DECISION Total Husband Family Male Education General Education Count 52 5 57 Expected Count 33.1 23.9 57.0 University Education Count 64 79 143 Expected Count 82.9 60.1 143.0 Total Count 116 84 200 Female Education General Education Count 57 8 65 Expected Count 37.7 27.3 65.0 University Education Count 59 76 135 Expected Count 78.3 56.7 135.0 Total Count 116 84 200 Source: Fieldwork, 2013

The cross tabulation in Table 5.26 shows that male and female education influences the decision-making in the family (which is similar to the outcome of the 2005 survey for the female respondents and dissimilar to the male respondents in 2005).

Table 5.27 Gender Occupational Status and Gender Power in Fertility Decision-making FINAL DECISION Total Husband Family Husband’s Occupation Professional Count 25 35 60 Expected Count 34.8 25.2 60.0

Business Count 13 6 19 Expected Count 11.0 8.0 19.0

Admin Count 69 39 108 Expected Count 62.6 45.4 108.0

Skilled Count 9 4 13 Expected Count 7.5 5.5 13.0 Total 116 84 200 Female Work Status Working Count 33 50 83 Expected Count 48.1 34.9 83.0 Housewife Count 83 34 117 Expected Count 44.5 72.5 117.0 Total Count 116 84 200 Source: Fieldwork, 2013

There is a significant difference between various occupational statuses in the male and also in the female respondents, which is revealed from the cross tabulation in Table 5.27. These findings indicate that males with professional occupations are more likely to have shared decisions. Also, working females were more likely to make shared decisions in the family. This outcome is comparable to the outcome of the 2005 survey.

157 Table 5.28 Family Income and Gender Power in Fertility Decisions

Final Say No. Children Total Husband h+w Count 53 23 76 5000-10000 Expected Count 44.1 31.9 76.0 Count 37 43 80 Family Income (SR/Month) 10001-20000 Expected Count 46.4 33.6 80.0 Count 26 18 44 >20000 Expected Count 25.5 18.5 44.0 Total 116 84 200

Source: Fieldwork, 2013

The cross-tabulation in Table 5.28 shows that family income impacts upon the decision-making in the family. This means that families with a higher income are more likely to have shared decision-making. This outcome is dissimilar to the outcome of the 2005 survey.

There is a very slight change in the responses concerning this issue compared to the responses of 2005, as the respondents who reported that they have shared decision-making increased slightly (from 71 to 84 respondents). This means that the social context of Saudi Arabia still embraces the traditional gender ideology and the patriarchal culture. However, it is obvious that whenever the reproductive decision was shared between spouses, there was a greater probability that the family size would be smaller. Further, it reveals that socioeconomic factors (parents’ age, education levels, family income and occupational status) impact the decision- making within the family.

The Influence of Social Networks and Contraception Decisions, on Reproductive Behaviour

Introduction

The previous section draws attention to the influence of the gender system on decisions made regarding reproduction in Jeddah, Saudi Arabia. This section highlights the influence of social networks in Jeddah, Saudi Arabia on attitudes towards contraception. Many studies reveal that in traditional societies or in developing countries the reproductive decision-making of couples is greatly influenced by members in their social networks (for support of this viewpoint see: Bongaarts and Watkins 1996; Bongaarts et al. 2012; Khatun 2011; Kohler 2001, 2012; Kohler et al. 2013; Mosha and Ruben 2013). Therefore, it was considered significant to investigate the influence of social networks on reproductive decision-making.

158 Thus, this section draws attention to the influence of the cultural values of social networks on reproductive behaviour and their influence on the diffusion of contraceptive methods among study respondents. This section will cover the following issues: contraception diffusion and the role of social networks; the mode of contraceptive practices; planning family size; and lastly, the influence of close familial networks on determining fertility behaviour patterns in Jeddah, Saudi Arabia.

Contraception Diffusion and the Role of Social Networks in 2005

It was first important to explore the knowledge concerning contraception amongst the survey respondents. [u5]The survey results show that all respondents (100 males and 100 females) report knowledge of contraception. In the questionnaire survey, respondents were asked first if they knew any method of contraception and then asked what kinds of contraception they knew of; this was a multi-choice question with the following options: pills, condom, withdrawal, IUD, and other. Table 5.29 shows the type of contraceptive methods that both male and female respondents said they knew of or had heard about. It seems from Table 5.29 that many of the female respondents report knowledge of contraceptive methods used by women, such as pills and IUD, while very few females report knowledge of contraceptive methods used by men. Male respondents state knowledge of the range of different types of contraceptive methods. In general, for both males and females, the most known method of contraception was the pill.

Table 5.29 Knowledge of Contraceptive Methods by Gender N N Knowledge of Contraception Male Female Pills 89 99 Condom 54 9 Withdrawal 48 26 IUD 66 97 Source: Fieldwork, 2005

After revealing that all survey respondents have some knowledge of contraception, it was necessary to investigate the source of this knowledge (the question only asked the respondents about the source of their knowledge of contraception; it did not specify what this knowledge was). Figure 5.19 shows both male and female respondents’ knowledge of contraception, and the differences between the genders (there are multiple answers for each respondent). Figure 5.19 therefore shows a difference between male and female responses. The male response was virtually contained in two areas: ‘learn from the media’ and ‘learn from their friends’. Very few

159 males report learning about contraception from their spouse, family or physician. By contrast, female responses show knowledge of contraception as coming from different resources ordered as the following: ‘learn from family’, then ‘learn from their friends’ and ‘learn from physician’, only a small percentage chose ‘learn from the media’ (see Figure 5.19).

Many male survey respondents (n: 75) said that they had learnt about contraception from the media, which comprises newspapers, television channels, and the Internet. In Saudi Arabia, any house can receive TV channels from around the world without any constraint from the government. It is unusual for Saudi Arabian TV channels to show any information about contraceptive methods, but this information is available on other TV channels. An example is family planning campaigns in Egypt, which always show educational commercials on their TV channels.

Figure 5.19 From Which Source Does Each Gender Learn About Contraception?

90

80 70

60

50 Male Female count 40

30

20

10 0 Media Spouses Family Friends Physician

Source: Fieldwork, 2005

Male and female choices were different in that male respondents largely based their knowledge on sources outside the family network. This might be explained as men wanting to show that they are independent as they source their knowledge mostly from media and friends. However, it is interesting that some men learn about contraceptive methods from their spouse but no women from the survey respondents reported that they learned about these from their spouse. This might be because some men believe that contraception is a woman’s concern.

160 On the other hand, female respondents mostly depended on close networks, i.e. ‘family and friends’ as a source of knowledge. This might be due to women’s need for more detailed information or experiences about contraception. Also, Figure 5.19 shows that 39 female respondents said that they had learned about contraception from their physician, as they can provide them with detailed information (as for example how to use them, side effects, and which is the most suitable). This is understandable as in Saudi Arabia there is no service which could provide reliable advice on contraception.

To gain additional information about the prevalence of contraceptive methods in the society of Jeddah, Saudi Arabia, it was useful to explore the prevalence of contraceptive practice within the social networks of survey respondents (males and females). Figure 5.20 shows responses regarding family members and friends from close social networks using contraception, and it is clear that the majority of parents’ social networks did use contraception (82 male respondents reported that they know members from their social networks who use contraception and all of the 100 female respondents reported the same). This outcome is reasonable as it relates to previous responses reported in Figure 5.19, where many females reported that they had learnt about contraception from close social networks (85 said family and over 50 said friends). Also, 49 males said that they had learnt about contraception from friends.

Figure 5.20 Family and Friends Used Contraception

120

100

80 Male 60 Female count 40

20

0 No Yes

Source: Fieldwork, 2005

In light of previous outcomes that showed that many members of parents’ social networks had used contraception, it was important to explore respondents’ beliefs regarding contraceptive use. It is obvious from Table 5.30 that both males and females generally are comparable in their viewpoint about using contraception, which is that it is permitted if needed (this means in order to use contraceptives for reasons such as birth spacing, the benefit of the mother’s health, and

161 for time to take care of other children). However, the male viewpoint was more liberal, as 17 males believe that contraception is permitted in Islam (without any constraints) compared to none from the female sample. Only very few male and female respondents believe that Islam discourages the use of contraception. Thus, it is natural to find a high diffusion of contraceptive knowledge and practice among survey respondents (Table 5.28 and Figure 5.20). Furthermore, it can be seen from Table 5.30 that when parents thought contraceptive practice was permitted, family size reduced (but only when we consider the difference between various age groups).

Table 5.30 Point of View Regarding Contraception in Relation to Family Size The Median The Median Number of Number of Number of Number of The Median Respondents Children for Respondents Children for Number of Number of View of who said who Said who said who Said Respondents Children for Contraception Contraception Contraception Contraception Contraception who said who Said is is is Permitted if is Permitted if Contraception Contraception Discouraged Discouraged Needed Needed is Permitted is Permitted M F M F M F 15-30 - 3 2 14 49 2 2 - 1.5 31-45 2 2 5.5 48 35 4 11 - 3 46-60 - - - 19 11 7 4 - 6.5 Total 2 5 81 95 17 Source: Fieldwork, 2005

Moreover, it appears from Table 5.30 that 13 out of the 17 males who believe that contraception is permitted in Islam are from the younger age group (15-45), and with a high level of education. On the contrary, 6 out of the 7 respondents who believe that Islam discourages contraceptive use are from the respondents with general education level (see Chapter Two for detailed information about the relationship between Islam and contraception). A high level of education could broaden a person’s avenue to the world, so it might be that educated people become aware of other Muslim countries' approaches to family planning programmes, so they may become more agreeable about contraceptive practice.

The Change in Contraception Diffusion and the Role of Social Networks in 2013

The survey result shows that 97 males and 100 females report knowledge of contraception (comparable outcome of 2005 survey). Table 5.31 displays the type of contraceptive methods that survey respondents said they knew. It appears that both male and females have good knowledge about several types of contraceptive methods.

162 Table 5.31 Knowledge of Contraceptive Methods by Gender N N Knowledge of Contraception Male Female Pills 81 98 Condom 65 56 Withdrawal 45 49 IUD 69 88 others 13 9 Source: Fieldwork, 2013

Figure 5.21 From Which Source Does Each Gender Learn About Contraception

80

70

60

50

40 Male Female 30

20

10

0 Media Spouses Family Friends Physician

Source: Fieldwork, 2013

When an exploration was taken to determine the source of contraception knowledge Figure 5.21 demonstrations both male and female responses which represent multiple answers for each respondent. Male knowledge of contraception comes mainly from the media, then from spouse, friends, family and very few chose physician (respectively), while, female knowledge of contraception comes from different resources ordered as the following: ‘learn from family’, ‘learn from physician’, ‘learn from their friends’ then ‘learn from the media’ and few chose ‘learn from spouse’. It is obvious that in general male respondents based their knowledge on sources outside the family network, on the other hand, female respondents mostly depended on close networks (this is comparable to the 2005 survey results).

163

Figure 5.22 Family and Friends Used Contraception

120

100

80

60 Male Female 40

20

0 No Yes Source: Fieldwork, 2013

Figure 5.22 displays that the majority of parents’ social networks did use contraception (62 male respondents reported that they know members from their social networks who use contraception and 96 females respondents reported the same). Though, unexpectedly there is a decrease in the number of males who said they know members from their social networks who use contraception in comparison to the response of the 2005 survey, this might be a result of a reduction in the males who rely on their friend as a source of contraceptive knowledge (from 49 in 2005 to 26 in 2013).

Table 5.32 Point of View Regarding Contraception in Relation to Family Size The Median The Median Number of Number of The Median Number of Children for Number of Children for Number of View of Respondents those who Respondents those who Number of Children for Contraception who said Said who said Said Respondents those who Contraception Contraception Contraception Contraception who said Said is is is Permitted if is Permitted if Contraception Contraception Discouraged Discouraged Needed Needed is Permitted is Permitted M F M F M F 15-30 - 1 Have one child 6 18 1 4 19 2 31-45 2 0 Each have 3 36 27 4 28 28 3 children 46-60 3 1 4.5 15 4 5 6 2 4.5 Total 5 2 57 49 38 49 Source: Fieldwork, 2013

It is clear from Table 5.32 that males and females hold almost comparable viewpoint about using contraception, as 57 males and 49 females believe that using contraception is permitted if needed, while 38 males and 49 females believe that using contraception is permitted in Islam.

164 Furthermore, it appears from Table 8.16 that the younger generation and the more educated parents hold more liberal beliefs concerning contraceptive use (from the 87 males and females who believe that using contraception is permitted, 33 males and 39 females have a university education). Nonetheless, no significant difference was found between the viewpoints about using contraception and family size.

Almost all survey respondents have knowledge about contraception, which is like the 2005 survey results; however, their knowledge about the types of contraceptive methods differs from the survey results of 2005: especially in the female response. It seems that the female respondents have greater knowledge about contraceptive methods used by males, or it could be that they are not as embarrassed to mention those methods.

There are also some changes in the source of contraceptive knowledge of both genders. The male responses show some increase in the males who chose their spouse as the source of their knowledge (there were only 18 such responses in 2005) and this choice has become the second choice. Also, there is a slight rise in the males who depend on family as the source of their knowledge compared to the male response in 2005. Moreover, 13 females chose their spouse as source of their knowledge, while no one chose this in the 2005 survey. This could be a symptom of a more open relationship between spouses and more attachment to family or being closer to family. Further, it appears that there is a significant increase in the number of females who depend on their physician as the source of contraceptive knowledge; this could imply that women build their knowledge about contraception from a reliable and trustworthy source, which could lead to safer use of contraception.

There is a clear change in both gender viewpoints regarding contraceptive use, as 87 respondents believe that using contraception is permitted in Islam, compared to only 17 males in 2005. What is unpredicted is that females are more likely than males to use contraception (38 males and 49 females). This could be an indication of a more liberal attitude toward contraceptive use, and also a greater voice for women.

The Mode of Contraceptive Practices in 2005

In light of previous outcomes which showed that many members of parents’ social networks had used contraception, it was important to examine contraceptive practice between survey respondents to explore the influence of social networks on this issue. It appears from Figure

165 5.23 that the majority of both males and females (89 out of 100 males, and 74 out of 100 females) did use contraception (however, no data were collected on when and for how long they had been using contraception). There are no available data on the use of contraception in Jeddah, Saudi Arabia, which makes it difficult to ascertain if there has been any increase in contraceptive use here.

Figure 5.23 Ever Used Contraceptives by Gender

100 90 80 70 60 Male 50 Female count 40 30 20 10 0 No Yes

Source: Fieldwork, 2005

Further information gained from a survey about the type of contraception used by survey respondents is shown in Table 5.33. It shows that the use of contraceptive pills is the most common method (from the response of 57 males and 63 females) and after this is the IUD (from the response of 36 males and 39 females). Nevertheless, it was obvious that there is a low report from the female respondents (only 2) about the male methods (withdrawal and condom). Yet with more male than female respondents reporting use of male methods for contraception (23 for withdrawal and 24 for condom), it seems that survey respondents (both male and female) have used more female methods than male methods. These male and female respondents are not couples, so it is possible that the husbands of female respondents did not use male methods.

Table 5.33 The Method of Contraception Used by Gender The Method of Contraception Male Female Pills 57 63 IUD 36 39 Withdrawal 23 2 Condom 24 0 Source: Fieldwork, 2005

166 For the respondents who had not used contraception, 9 out of the 11 male respondents are under the age of 45 years, while all of the 26 females who had not used contraception were under the age of 45 years. Table 5.34 shows the reasons these respondents give for not using contraception. It is obvious that the desire for more children is the major reason for not using contraception: especially since most of these respondents are under 45 and they can possibly have more children. Only 3 respondents give religion as a reason for not using contraception (1 male and 2 females report their spouse’s rejection of contraception because of religious reasons). Thus, contraceptive use might increase more later in life when couples do not want any more children.

Table 5.34 Reasons for Not Using Contraception by Gender Reason for not using contraception Male Female I didn’t know about it - - I don’t need it because of wanting 10 24 more children My wife wants more children - - I consider it as discouraged or 1 - prohibited in Islam My spouse considers it as - 2 discouraged or prohibited in Islam Total 11 26 Source: Fieldwork, 2005

Taking into consideration the preceding results, which show that the majority of survey respondents (89 males and 74 females) indicated that they did use contraception, it was useful to explore the pattern of contraceptive use in order to gain more information about contraceptive practice among survey respondents.

Table 5.35 indicates that the majority of survey respondents both male and female, practised birth spacing (83 males and 72 females). However, while the majority of both male and female respondents did practise birth spacing, it did not affect family size. Furthermore, when an investigation was undertaken to discover what both male and female respondents considered as an ideal period for birth spacing, the result showed that both men and women selected two years (the median period was 2 years). This could explain why practising birth spacing did not affect family size, as parents usually keep spacing periods short. It also did not alter their desire for a generally large family size.

167 Table 5.35 Did Practise Birth Spacing in Relation to Family Size Their Their Median Median Number of Number of Number of Number of Respondents Respondents Children Children No Yes Age Groups M F M F 15-30 3 23 2 13 30 2 31-45 10 5 4 51 31 4 46-60 4 - 7 19 11 6.5 Total 17 28 83 72 Source: Fieldwork, 2005

In a further exploration of the influence of contraceptive practice on family size, the data in Table 5.36 do not reveal a clear difference between the two groups (those who used and those who did not use contraceptives), although a majority of both male and female respondents did use contraception. It showed an unexpected result in that the couples in the age group from 31- 45 who did use contraception had more children than the couples who did not use contraception (however, this age group was very small and represented less than 5% of the sample). However, unfortunately, data had not been collected about when and for how long they had been using contraception, which means that the information about contraceptive use is not useful to examine the influence of contraceptive use on family size.

Table 5.36 Ever Used Contraception in Relation to Family Size Number of Their Median Number of Their Median Respondents Number of Children Respondents Number of Children Age Groups No Yes M F M F 15-30 4 22 2 12 29 2 31-45 5 4 2 57 34 4 46-60 2 - The two cases have 7 20 11 6.5 children Total 11 26 89 74 Source: Fieldwork, 2005

It seems from the survey results for this study that the use of contraception did not affect the family size of the survey respondents. Also, when couples used contraception for birth spacing purposes, their family size was not influenced. This might be a reflection of the cultural norms which highly value children and do not encourage low fertility patterns.

168 Change in the Mode of Contraceptive Practices in 2013

Figure 5.24 Ever Used Contraceptives by Gender

100 90 80 70 60 50 Male 40 Female 30 20 10 0 No Yes Source: Fieldwork, 2013

It is noticeable from Figure 5.24 that the majority of both males and females (83 males, and 94 females) did use contraception. Further, Table 5.37 shows the type of contraception used by survey respondents. It demonstrates that the use of contraceptive pills is the most common method (from the responses of 53 males, 60 females), followed by the IUD, then the condom and lastly the withdrawal method. However, it seems that survey respondents (both male and female) have used more female methods than male methods.

Table 5.37 The Method of Contraception Used by Gender The Method of Contraception Male Female Pills 53 60 IUD 30 30 Withdrawal 17 19 Condom 25 25 Others 1 0 Source: Fieldwork, 2013

Table 5.38 Reasons for Not Using Contraception by Gender Reason for not using contraception Male Female I didn’t know about it - - I don’t need it because of wanting more children 17 - My spouse wants more children - 6 I consider it as discouraged or prohibited in Islam - - My spouse considers it as discouraged or prohibited in Islam - - Total 17 6 Source: Fieldwork, 2013

169 Out of only 23 respondents who did not use contraception, Table 5.38 show that the desire for more children is the only reason given for not using contraception. For males, 16 out of 17 respondents are from the older age group, with ten from 31-45 and 6 from 46-60, and for the females 2 are aged from 15-30 and 4 from 31-45. This means that those respondents possibly will have more children.

Table 5.39 Did Practise Birth Spacing in Relation to Family Size Number of Their Number of Their Respondents Median Respondents Median Say No Number of Say Yes Number of Children Children Age Groups No Yes M F M F 15-30 3 7 1 7 31 2 31-45 21 14 3 45 41 4 46-60 7 2 5 17 5 5 Total 31 23 69 77 Source: Fieldwork, 2013

Table 5.39 points out that the majority of survey respondents, both males and females, did practise birth spacing (69 males and 77 females). The modal ideal period for birth spacing was 3 years for both male and female respondents. Nevertheless, while the majority of both male and female respondents did practise birth spacing, this did not impact family size. This could be a result of somewhat short spacing periods. Table 5.40 indicates that the majority of both male and female respondents did use contraception (83 males and 94 females). However, no significant difference was found in family size.

Table 5.40 Ever Used Contraception in Relation to Family Size Their Their Median Median Number of Number of Respondents Number of Respondents Number of Say no Children Say yes Children Age Groups No Yes M F M F 15-30 1 2 1 9 36 2 31-45 10 4 3 56 51 4 46-60 6 0 5 18 7 5 Total 17 6 83 94 Source: Fieldwork, 2013

It is clear that there is some change in the female responses, as the females who reported using contraceptive methods increased in comparison to the 2005 outcome (from 74 to 94). This could be a result of either greater voice for women or greater empowerment for women.

170 Moreover, it seems that there is a notable growth in the female respondents who reported the use of male methods (withdrawal and condom), in contrast to only two females in the 2005 survey. However, this high practice of contraceptive methods did not show a significant impact on family size.

In the latest survey, no respondent gave other reasons for not using contraception but wanting to have more children, which implies a greater acceptance of contraceptive practice. Furthermore, no significant change was noticed for birth spacing practice except for a small rise in the preferred ideal period for birth spacing (by one year), which did not impact family size: this is because it is the respondents’ ideal period, not the actual practice.

Planning or Not Planning Family Size in 2005

Survey results found that 60 percent of both male and female respondents reported that they did not plan for the number of children (56 males, 64 females), whilst 40 percent of respondents (44 males, 36 females), did plan for the number of children they would have (see Table 5.41). When the preferred family size was examined, the survey data indicated that the modal ideal number of offspring was 5 children in total, with 3 boys and 2 girls, for the male sample. In slight contrast, the female sample displayed a lower preference, with 4 children in total, and 2 boys and 2 girls. These results reveal that the ideal family size in Saudi Arabia is relatively large compared to other Gulf States, as well as most of the MENA countries (Figure 1.1), with male respondents showing a slight preference for male children over female children, unlike female respondents who showed a similar preference for male and female children. However, these results only represent the ideal family size of 80 respondents, 44 males and 36 females (who said they plan family size).

Table 5.41 Planning Decisions and Reproductive Outcomes Number of Their Number of Their Respondents Median Respondents Median Number of Number of Children Children Age Groups No Yes M F M F 15-30 7 29 2 9 22 2 31-45 31 27 5 31 11 3.5 46-60 18 8 7 4 3 5 Total 56 64 5 44 36 3 Source: Fieldwork, 2005

171 Table 5.41 shows that spouses who planned for the number of children they would have were more likely to have smaller family sizes than those who did not plan: particularly in the age groups from 31-45 and 46-60. The median number of children reduced by one child for the spouses who planned in the age group 31-45, and by two children in the age group 46-60. Thus, it can be said that if parents are making active planning decisions, it leads to a reduction in family size (note: no difference was found among the younger age group from 15-30, which might be because this group had not completed their childbearing). Unfortunately there are no available data regarding this issue from the government of Saudi Arabia’s statistical resources, so it is difficult to compare this data from Jeddah with other parts of Saudi Arabia.

To gain further information regarding the demographic and socioeconomic factors that could influence planning and decision-making, the following variables were examined: current ages of parents, parental education levels, family income and parental occupational status.

Firstly, it seems that the younger generation is more likely to plan family size than the older generation: 28 out of 52 young males, 53 percent of this age group (15-39), reported that they did plan their family size, compared to 16 out of 48 older males, 33 percent of this age group (40-60). Also, this difference between age groups was obvious in the female sample, with 32 out of 78 young females, which is 41 percent of this age group (15-39) reporting that they did plan their family size compared to 4 out of 22 older females, which is 18 percent of this age group (40-60).

Secondly, the influence of male education on planning family size, which is revealed in the cross-tabulation in Table 5.42, demonstrates a slight difference between the groups that represented male educational levels (one case was excluded from the male sample, which was the only illiterate individual). Those men who had been to university were more likely to plan family size, whilst men with a general education level were less likely to plan. In the case of females, Table 5.41 shows a much clearer difference between the groups of females based on educational levels, which suggests that female educational levels could effectively influence family-planning decisions (three cases have been excluded from the female sample, who were illiterate, as they have a small expected count). Table 5.42 reveals that parents with high educational levels are more likely to practise family size planning. However, the results show

172 that female education has a more effective influence than male education on family-planning decisions.

Table 5.42 Gender Education and Planning Decisions

Planning Family Size Total Did Not Plan Planning Male Education General Education Count 59 25 84 Expected Count 50.7 33.3 84 University Education Count 61 54 115 Expected Count 69.3 45.7 115 Total Count 120 79 199 Female General Education Count 80 30 110 Education Expected Count 65.3 44.7 110 University Education Count 37 50 87 Expected Count 51.7 35.3 87 Total Count 117 80 197

Source: Fieldwork, 2005

Thirdly, the influence of family income on planning family size was explored. The cross- tabulation shows that in this study, family income had little influence on planning decisions and no significant difference was found (see Table 5.43).

Table 5.43 Family Income and Planning Decisions plan number of childen no plan yes-planned Total income <=5ooo Count 31 18 49 of family Expected Count 29.4 19.6 49.0 5001-10000 Count 45 29 74 Expected Count 44.4 29.6 74.0 >10000 Count 44 33 77 Expected Count 46.2 30.8 77.0 Total Count 120 80 200 Expected Count 120.0 80.0 200.0

Source: Fieldwork, 2005

Lastly, parental occupational status was considered. By examining the influence of male occupational status (professional and non-professional jobs) on the planning of family size, the cross-tabulation shown in Table 5.44 illustrates a small variation between the two groups. Males in professional jobs were more likely to plan for family size than males in non- professional posts. However, both groups were still much more likely not to plan family size than to do so. Similarly, with female occupational status (working and housewife), Table 5.44

173 demonstrates a small variation between the two groups of working-women and housewives, which indicates that female work had very little impact on planning decisions, and that the potential of planning family size was almost equal between the two groups. This means that female occupational statuses have only a minor effect on decision-making.

Table 5.44 Gender Occupation (Recoded) and Planning Decisions Planning Family Size Occupational Status Total Did Not Plan Planned Male Occupation Professional Labour: Count 90 71 161 Expected Count 96.6 64.4 161 Non-professional Labour: Count 30 9 39 Expected Count 23.4 15.6 39 Total Count 120 80 200 Female Occupation Working : Count 25 27 52 Expected Count 31.2 20.8 52 Housewife: Count 95 53 148 Expected Count 88.8 59.2 148 Total Count 120 80 200 Source: Fieldwork, 2005

After exploring the information on planning family size and its relation to family size and also to socioeconomic factors, it was important to explore the reasons which 60 percent of survey respondents gave for not planning family size, in order to obtain important information about planning issues. Figure 5.25 represents what 120 respondents (56 males and 64 females) indicated as a reason for not practising family planning. The results from the male sample showed that the options were (ordered from highest priority to lowest) as follows: ‘it depends on God’, ‘never thought about it’, followed by ‘want as many as possible’ and lastly, ‘undecided’. The results from the female sample showed that options were (ordered from highest priority to lowest); first ‘it depends on God’, then, ‘want as many as possible’, followed by ‘never thought about it’ and lastly, ‘undecided’.

Figure 5.25 Reasons for Not Planning for Family Size

70

60

50

40 Male Female count 30 20

10

0 Undecided Never thought Depends on Want children as about it God's Will many as possible

Source: Fieldwork, 2005 174 Thus, it can be said from Figure 5.25 that the religious reason ‘it depends on God’s Will’ is the most important reason for not planning family size (31 males and 58 females).

The Change in Planning or Not Planning Family Size in 2013

It appears from Table 5.45 that 48.5 percent of respondents (48 males, 49 females), did plan for the number of children they would have, whereas 51.5 percent of respondents (52 males, 51 females) reported that they did not plan for number of children. Further, the survey data showed similar preferences for male and female children and that the modal ideal number of offspring was 4 children in total, with 2 boys and 2 girls, for both male and female respondents. However, these results only represent the ideal family size of 97 respondents, 48 males and 49 females (who said they plan family size).

Table 5.45 Planning Decisions and Reproductive Outcomes Number of Their Number of Their Respondents Median Respondents Median Number of Number of Children Children Age No Yes Groups M F M F 15-30 5 10 1 5 28 2 31-45 26 35 4 40 20 3 46-60 21 6 5 3 1 4 Total 52 51 48 49 Source: Fieldwork, 2013

Moreover, Table 5.45 shows that spouses who planned for the number of children they would have were more likely to have smaller family sizes by one child than those who did not plan for the age group 31-45 and 46-60. Furthermore, it appears from Table 5.45 that the younger generation is more likely to plan family size than the older generation, and that 69 percent of the younger age group (15-30) and also 83 percent of the 31-45 age group practise planning, in contrast to only 13 percent of the older age group (46-60).

175 Table 5.46 Gender Education and Planning Decisions Planning Family Size Total Did Not Plan Planning Male Education General Education Count 42 15 57 Expected Count 29.4 27.6 57.0 University Education Count 61 82 143 Expected Count 73.6 69.4 143.0 Total Count 103 97 200 Female Education General Education Count 44 21 65 Expected Count 33.5 31.5 65.0 University Education Count 59 76 135 Expected Count 69.5 65.5 135.0 Total Count 103 97 197 Source: Fieldwork, 2013

The cross-tabulation in Table 5.46 demonstrates that males and females who had university education were more likely to plan family size (this is similar to the outcome of the 2005 survey).

Table 5.47 Gender Occupation (Recoded) and Planning Decisions Planning Family Size Total No Plan Planning Husband’s Occupation Professional Count 25 35 60 Expected Count 30.9 29.1 60.0

business Count 12 7 19 Expected Count 9.8 9.2 19.0

admin Count 58 50 108 Expected Count 55.6 52.4 108.0

skilled Count 8 5 13 Expected Count 6.7 6.3 13.0 Total 103 97 200 Female Work Status Working Count 26 57 83 Expected Count 42.7 40.3 83.0 Housewife Count 77 40 117 Expected Count 60.3 56.7 117.0 Count Total 103 97 200 Source: Fieldwork, 2013

Further, when parental occupational status was considered, the cross-tabulation shown in Table 5.46 shows that males with professional occupations were more likely to plan for family size, as 58 percent of males in this category practised planning for family size. In contrast, Table 5.46 displays a clear variation between the two groups of working women and housewives, in that working women are more likely to plan for family size than housewives (as 69 percent of the working-women plan for their family size, while only 34 percent of the housewives practise planning). 176 Lastly, the influence of family income on planning family size was explored. Table 5.48 shows that family income had little influence on planning decisions (as 57 percent of the families with higher income >20000 did plan for family size compared to 42 percent from the families with the lowest family income of 5000-10000).

Table 5.48 Family Income and Planning Decisions Plan Number of Children Total No Plan Yes-planned Count 44 32 76 5000-10000 Expected Count 39.1 36.9 76.0 Count 40 40 80 Family Income (SR/Month) 10001-20000 Expected Count 41.2 38.8 80.0 Count 19 25 44 >20000 Expected Count 22.7 21.3 44.0 Count 103 97 200 Total Expected Count 103.0 97.0 200.0 Source: Fieldwork, 2013

Figure 5.26 Reasons for Not Planning for Family Size

45

40

35

30

25 Male 20 Female 15

10

5

0 Undecided Never thought about it Depends on God's will Want children as many as possible Source: Fieldwork, 2013

Figure 5.26 represents what 103 respondents (52 males and 51 females) indicated as a reason for not practising family planning. The major cause that both male and female respondents gave is a religious reason which is, ‘it depends on God’s Will’ (37 males and 39 females). Followed by ‘undecided’ for the male sample and ‘never thought about it’ for the female sample: this could be explained by assuming that those parents are not concerned about their family size. Very few respondents chose the other factors.

There was an increase in the number of respondents who planned for the number of children they wanted to have: particularly in the female sample. However, in general the percentage increases from 40 percent in the 2005 survey to 48.5 percent in 2013. Also, the ideal number of 177 children for the respondents who said they plan family size had decreased for the male sample from a total of 5 children in 2005 to 4 children in 2013. The survey results illustrate a more influential effect of male educational levels and also women in work on planning for family size than the survey of 2005.

Moreover, even though the most important reason given for not planning family size was due to religious reasons, which is similar to 2005 outcomes, in the latest survey there is some reduction in the number of females who take this choice in comparison to the number in 2005 (as it was 58 in 2005 and 39 in 2013). This could be a result of more females choosing to plan for their family size.

Influence of the Extended Family in 2005

The preceding subsection has shown that 60 percent of survey respondents did not plan for family size, which could reflect aspects of social networks and their modes, as well as the influence of cultural values in the society which are not supportive of family planning concepts.

Thus, it is necessary to inspect another important mode of social networks and cultural values that might affect reproductive decisions and this is the role of the extended family in the reproductive decision-making process. Extended family here includes close kin, being related by blood or by marriage, and which mostly comprises the following members; birth parents, parents-in-law, grandfathers and grandmothers. In some cases it also includes sisters, brothers, uncles and aunts.

Firstly, it was considered important to determine whether the financial support of the extended family influenced the reproductive behaviour of the parents or not. Table 5.49 demonstrates that 79 males and 68 females reported that they did not have financial support from their extended families. From the 79 males who not did receive financial support, 59 have a university education, 18 have a general education, and one is illiterate, while from the 68 females who did not receive financial support, 30 have a university education, 37 have a general education, and one is illiterate. It can be concluded from these data that there is no clear difference between various educational levels and who has financial support from their extended families.

178 Table 5.49 Extended Family Financial Support and Family Size Their Their Number of Median Number of Median Respondents Number of Respondents Number of

Children Children Age Did not Did receive Groups receive support support M F M F 15-30 11 32 2 5 19 2 31-45 51 27 4 11 11 5 46-60 17 9 6.5 6 2 7 Total 79 68 4 22 32 4 Source: Fieldwork, 2005

Also, from Table 5.49, no clear difference was found in the median number of children between the younger families (age group 15-30) who receive financial support from their extended families and the families who do not have this kind of support. Meanwhile the financial support, or lack of it, did show some difference in the median number of children among the older age groups of 31-45 and 46-60 (see Table 5.48). Thus, it could be said from Table 5.49 that the reproductive decision-making of the younger age group (15-30) is not influenced by financial support or the lack of it but that this financial support does influence the reproductive decision-making of the older age groups (31-45 and 46-60).

Further investigations were made regarding the influence of the extended family in order to examine whether the extended family affected fertility decision-making. Table 5.50 demonstrates a slight difference between groups of parents who had varying degrees of input from the extended family. Half of the male respondents from the survey (49 males) note that their extended family does not impact on their decisions regarding fertility, while the other half note that their extended family partly affects their decisions on fertility. By contrast, over half the female respondents from the survey (62 females) report that their extended family moderately affects their decisions regarding fertility. From Table 5.50 it seems that the median number of children decreases among the younger age group (15-30) by one child when the extended family does not interfere in their decisions on reproducing. Meanwhile the extended family does not show any further impact on family size among the older age groups (31-45 and 46-60). Even though half of male respondents and the majority of female respondents indicated that their fertility decision-making is influenced by their extended family, the extended family has only a minor impact on family size in the nuclear family (see Table 5.50). There is no other study in Saudi Arabia that has covered this matter to enable a detailed comparison.

179 Table 5.50 Extended Family Effect on Reproduction Decisions Their Their Their Their Median Median Median Median N Number of N Number of N Number of N Number of Children Children Children Children Age Groups None Little Moderate Plenty M F M F M F M F 15-30 5 - 1 4 3 2 6 33 2 1 16 2 31-45 37 - 3.5 11 6 4 12 22 5 2 9 4 46-60 7 - 7 4 - 7 10 7 5 1 4 7 Total 49 - 4 19 9 4 28 62 4 4 29 3 Source: Fieldwork, 2005

The Change in the Influence of the Extended Family in 2013

Table 5.51 shows that 75 males and 71 females said that they did not have financial support from their extended families. Further, to explore the influence of education on receiving financial support from the extended family in the male sample, from the 71 university educated men, only 25 percent received support, and from the 29 men with a general education, only 24 percent received support. It can be said from these data that there is no clear difference between various educational levels and who has financial support from their extended families. Also, Table 5.50 did not show a significant difference, so the financial support does not influence the family size of the parents.

Table 5.51 Extended Family Financial Support and Family Size Number of Their Their Respondents Median Number of Median Number of Respondents Number of Children Children Age Did not Did receive Groups receive support support M F M F 15-30 5 28 2 5 10 1 31-45 52 38 3 14 17 4 46-60 18 5 5 6 2 5 Total 75 71 25 29 Source: Fieldwork, 2013

Table 5.52 revealed that 54 males and 43 females reported that their extended family does not have any effect on their reproductive decisions. Also, 30 males and 42 females said that their extended families have little impact on their fertility decisions. Only a few respondents either gender (16 males and 15 females) noted that their extended family partly influenced their decisions on fertility.

180 Table 5.52 Extended Family Effect on Reproduction Decisions Their Their Their Their Median Median Median Median Number Number Number N Number of N N N of of of Children Children Children Children Age Groups None Little Moderate Plenty M F M F M F M F 15-30 3 24 2 4 10 1 2 3 1 1 1 1.5 31-45 39 17 3 19 28 4 5 10 4 3 0 3.5 46-60 12 2 5 7 4 5 5 1 5 0 0 - Total 54 43 30 42 12 14 4 1 Source: Fieldwork, 2013

The majority of survey respondents reported that they did not receive financial support from their extended families, which is comparable to the outcome of the 2005 survey. Correspondingly, only very few respondents of both genders (n=31) indicated that their fertility decision-making was influenced moderately by their extended family, while this absolutely was not the case in the 2005 survey as almost half of the survey respondents reported that their extended family moderately affected their decisions regarding fertility. However, the extended family did not have a significant impact on family size in the nuclear family either in 2005 or in the 2013 survey.

However, it can be noticed from the latest survey that the extended family’s influence on parents in the nuclear family is lessening, and particularly in reproductive decision-making. This could be a consequence of the growing urbanisation in Saudi Arabian society.

Conclusion

It can be concluded from the 2005 survey that an important issue related to family size is the early age of marriage common in Jeddah, Saudi Arabia. However, higher educational levels are more likely to postpone marriage, which was also the case for working women. Also, it is clear that Saudi Arabians place great value on children and the family, as children represent the flow of wealth from children to parents. These values are based on Islamic beliefs that having a large family is complying with a religious duty. However, it seems that women’s position may affect the demand for children. Further, the study results displayed both parents’ preference for male children.

It can be concluded from the latest survey (2013) that there are important changes in reproductive behaviour from 2005 to 2013. These changes embrace the rise in the age at

181 marriage for both genders, and from some of the changes that were found in this study, the people’s priority towards the value of children could be a reflection of the enhancement of women’s status through education and participation in the labour force. This improvement in women’s status has produced a decrease in the motivation for having many children as a means of high status in society. Further the study shows that the preference for male children has been slightly reduced in society as it did not display any significant influence on family size.

Moreover, it can be concluded from this study that the social context in the Saudi Arabian society supports the traditional division of labour between the sexes. As many men from the 2005 survey believed that domestic duties are purely a woman’s responsibility, so they played only a minor part in household and child-rearing responsibilities, even if their wife worked, which puts a double burden on working women. It can also be concluded from exploration of ‘permission issues’ that Saudi Arabia is a patriarchal society and women’s autonomy is still controlled by men. The gender system in Saudi Arabia impacts on reproduction outcomes in that women have a limited say in these matters, and men are predominantly in control of decision-making within the family. However, educated women and working women are more likely to have discussions with their husbands, and have more effective influence on reproductive decisions within the family.

Nonetheless, the 2013 survey results revealed a growing change in the perspective of the new generation regarding the gender-based division of labour, as there is more involvement of males in household responsibility compared to the responses in 2005, and also, by some means less restrictions regarding permission issues, and this could contribute to greater gender equality. The survey findings displayed a significant change in the attitude toward discussing reproductive issues: especially from female respondents, along with some increase in the number of respondents who reported that they had shared decision-making. This could reflect positive changes in gender structure.

Furthermore, it can be said from the 2005 survey results that there is a high level of diffusion of contraceptive knowledge, and correspondingly that the use of contraceptive methods is also high among the study respondents and their social networks. The contraceptive pill was the most prevalent method used by study respondents. Also, both males and females believe that using contraception is permitted in Islam if needed. However, practising contraception and birth spacing did not show any particular influence on family size. The survey results also

182 revealed that 60 percent of survey respondents did not plan their family size. Moreover, the survey results revealed that the respondents who plan their family size are more likely to have a smaller family. However, the preferred family size in 2005 was relatively large, with five children preferred by male respondents and four children preferred by female respondents (this is for the 40 percent who reported planning their family size). However, the younger generation and parents with high educational levels are more likely to plan the size of their family. Additionally, the religious reason ‘it depends on God’ was the most important reason given by the survey respondents for not planning. Moreover, the survey results showed that financial support from the extended family had only some influence on the reproductive decision-making of the older generation, while survey respondents could independently make their decisions concerning family size, without great influence from their extended family.

However, the 2013 survey showed that the majority of respondents had knowledge about contraception (as did the 2005 results), but what is an important change is the increased closeness in the relationship between spouses, as they share information about contraception with each other. The latest survey findings demonstrate a more liberal attitude toward contraceptive use, particularly in females, which might influence the increase in the practice of planning for family size, and the decrease in the ideal number of children.

After presenting the analysis of the 2005 and 2013 survey findings, it is important to discuss in the next chapter the significant outcomes of this study from qualitative interviews and their explanation from the theoretical background.

183 Chapter Six Discussion, Evidence from Qualitative Interviews and Theoretical Explanations of Fertility Trends

Introduction

The previous chapter presented the quantitative data analysis for both surveys (2005 and 2013), endowing a large-scale perspective of reproductive trends in Jeddah, Saudi Arabia. This chapter delivers a discussion of in-depth interview analysis and corroborates the theoretical approaches that provide explanations for fertility behaviour in order to achieve the study’s main aim, which is establishing a better understanding of fertility trends and reproductive behaviour in Jeddah, Saudi Arabia.

Social Structure and Fertility Patterns

Nuptial Regimes Concerning Age at Marriage

The theoretical literature that underpins the determinants of marriage timing often draws from the Demographic Transition Theory. This theory emphasizes the impact of urbanization and modernisation on the changing family structure, women’s roles and gender relations, all of which then cause delays in marriage and a decline in fertility (Caldwell 1982; Goode 1963; McDonald 1985). Additionally, one of the fundamental theoretical arguments that explain the postponement of marriage is that urbanization and modernisation provide women with varied opportunities (through education and employment) in the non-household sphere (Caldwell 1982; Hirschman 1985; Mason 1987; Thornton et al. 1984). Davis and Blake (1956), and also Bongaarts (1978) stresses the role of age at marriage as a direct determinant of fertility level.

The age at marriage, especially for women, is an important factor affecting fertility levels, as an early age at marriage can increase female exposure to conception. The age of the woman at marriage is particularly important to fertility patterns because in the Saudi Arabian context reproduction is restricted to marriage. Islamic law forbids extramarital sex for both males and females and considers adultery a grave offence. Also Islamic laws specify penalties for adultery for both genders, which are flagellation for an unmarried person, and pelting with stones until death for a married person (Al-Zuhayli 1997; Sabiq 1957).

184 The in-depth interviews showed that 14 out of 16 women had married at 22 years or under, and only two women married later: one at 25 and one at 30 years of age (Table 6.1). Thus, it is difficult to notice any variations between different educational or occupational status for those who actually married at an early age or those who married late (as there were only two of the latter). Interestingly, only five of the women interviewed indicated that they would have preferred to marry at an early age, while the rest reported that they would have preferred to marry later (Table 6.1).

Table 6.1 The Actual and Preferred Age at Marriage and Socioeconomic Status for the Interviewee Females Preference Family Current Age at Education Occupation for Age at Number Age Marriage Marriage 1- 23 19 University Professional/doctor Early 2- 26 22 University Professional/doctor Late 3- 31 19 University Housewife Late 4- 38 30 University Professional/teacher Late 5- 35 22 University Housewife Late 6- 41 25 University/ PhD Professional/doctor Late 7- 35 16 University Administrative Late 8- 46 18 Illiterate Housewife Early 9- 36 17 General education Housewife Early 10- 45 20 General education Housewife Late 11- 45 22 University Professional/teacher Late 12- 40 19 General education Housewife Late 13- 48 15 General education Housewife Early 14- 44 19 University Administrative Late 15- 41 17 University Professional/teacher Early 16- 49 22 General education Housewife Late

However, it can be seen from Table 6.1 that there is a variation between different age groups concerning the timing of marriage, with two out of the five women who said that they would have preferred early marriage being over 45 years. Also, there was apparent variation between various educational levels concerning marriage timing (three out of six women who have low educational levels said they preferred early marriage, while only two out of ten women who have high educational levels said they preferred early marriage). Thus, it can be said that women with higher educational levels are more likely to want to postpone marriage, although, among the interviewees there was no clear variation between different occupational statuses (paid work and housework).

Moreover, despite the diverse viewpoints expressed towards the preferred age of marriage, the fact that 14 out of 16 women were married at an early age (22 years and under) could reflect

185 that in the Saudi Arabian context, many women consider marriage an advantage. In the Saudi Arabian context, women encounter numerous obstacles to independence, one of these being that in such a culture there are severe restrictions on women’s movements (especially for single women). They must also pay careful attention to their appearance outside their homes or risk earning a bad reputation. As well as gaining greater social mobility through marriage, women can also ensure their future well-being, as women’s participation in the labour market is limited. Accordingly, early marriage brings advantages to women. For example, one woman noted that the considers early marriage to be an advantage. She is resigned to the fact that she has very limited independence, and also she is pragmatic about her situation (with low educational level), and feels that she has benefited from her early marriage. This woman noted: Marriage is both an aim and the basis of a woman’s future. This is what my family has taught me. Also I did not have high ambitions regarding my education, and thus marriage guaranteed a safe future for me. Besides that, in our culture women gain more freedom when they marry, and before a girl is married her parents worry and are fearful for their daughter’s reputation. Thus they apply many restrictions and limitations on their daughter’s movements until she marries. So I married when I was 15 years old. (Female, 48 years, 4 children, general education, and housewife)

However another woman who was also married at an early age said that she accepted this under huge pressure from parents who wanted her to follow cultural traditions. She also considers that early marriage diminished her aspiration for higher education. Similarly, many interviewees believe that later marriage is sometimes preferable, as they believe that early marriage could reduce their opportunity to obtain a high level of education. They consider that a high educational level could enhance their chances of a career, which would ensure independence for women along with high social status. This is exemplified in the following quotes: Honestly, for me, marriage was not my basic aim or aspiration. All I wished for was to undertake postgraduate studies without any shackles, commitments or restrictions. But this is not acceptable in our culture, which considers marriage as inevitable or unavoidable, so of course I married. Also my parents believe that marriage is fundamentally the most important thing towards a girl’s or boy’s future. My mother thinks that if a girl does not marry before she is 19, there is a big problem, a ‘catastrophe’ for the family and the girl’s future. My father sees marriage as a preferable action religiously (Sunnah), and also considers marriage as providing psychological and emotional stability in human life. So it was unquestionable that we had to marry at an early age, and that’s what happened to me, as I was married at 16. After marriage my husband and 186 his family used all kinds of coercive actions and strategies to keep me away from my studies. So I was only able to finish my bachelor’s degree, and I could not fulfil my dream to undertake postgraduate studies. So I wish that my daughters attain higher levels of education, which will ensure them a respectable and high social status. I will also encourage them to work, because that will guarantee their independence, along with more fully developing their personality and intellects. I wish for them to finish their university education before starting their own families. (Female, 35 years, 5 children, university education, and administrative occupation)

A similar opinion about delaying marriage in order to obtain higher education came from another woman who also married at an early age and because of marital responsibilities was unable to finish her university degree. She regrets losing an opportunity to make a career, especially as her family faces some economic difficulties so that they cannot fulfil their children’s increasing needs. She said: I wish that I had a university degree and a job so I could contribute to the family income. At the beginning of our marriage my husband was a university student and also had a part time job. When I asked his permission to start my university education he said to me I do not have time to take you to university, and who would take care of our house. He said either my education or your education. But now when my elder son wants to register in a private university, as it has become very difficult to find a place in government universities, we cannot afford it. So he has registered on a diploma course. Also my second son is on his way to a university education, as he is in the last year of high school, and we will face the same problem as his older brother. (Female, age 45, 3 children, general education, and housewife)

Furthermore, some interviewees mention other advantages of postponing marriage in order to achieve higher educational levels; they point out the significance of the development of women’s personalities through education, as one woman articulated in the following example: I felt it was very important that I finished my university degree before I married, as I was able to develop my own ideas and personality which helped me to determine and affect the pattern or type of life I would like to have with my husband. The opposite is the case if a woman marries too young, as she cannot lead the type of life she wants to and is easily influenced by her husband and his family, which is mostly unfair or inequitable regarding her needs and desires. (Female, age 35, 2 children, university education, and housewife)

Views regarding the preferred age at marriage amongst men differed to those of women. When men were asked about their views concerning the age at which marriage should take place, 187 almost all male interviewees responded to this question by stating positive aspects of marriage. These men noted that Islam considers marriage as finalizing a man’s religious duties and all male interviewees articulated numerous advantages regarding marriage for both males and females, influenced by their Islamic beliefs. These included marriage providing a secure morality (Islamic law forbids extramarital sex for both males and females and considers adultery a grave offence) along with stable companionship for the family. These views are demonstrated in the quotations below. One man noted: By marrying, a man completes an important religious obligation, and it also helps to provide him with stability and security. Marriage also means the continuance of my name and my family’s name, so I married when I was 24 years old. (Male, age 47, with 5 children, general education, and administrative occupation)

Another man said:

I was missing companionship, and also I wanted stability and security so I thought the best thing to do was to marry early, so I married when I was 22 years old. (Male, 27 years, one child, university education, and professional occupation)

A further issue with respect to age at marriage is that of parental views and concerns over the preferred age at marriage for daughters. The data from the in-depth interview showed that many parents preferred their daughters to have completed university education prior to marriage. This could be an indicator of changing attitudes toward early marriage for women, which could in turn help to reduce fertility levels in Saudi Arabia in the future (especially if the number of women educated to a high level increases).

Discussion of Nuptial Regimes Concerning Age at Marriage

It can be concluded that early marriage is common among study respondents, as the survey found that the modal age of marriage for the male was 23 years and for the female 18 years in 2005. However, this had risen for males to 27 and for females to 21 in 2013, while this is still considered early particularly for females. This was also true for the female interviewees, with 14 out of 16 married at an early age (22 years and under). Saudi Arabia is a traditional society where early marriage is common, especially for females, and the cultural context considers it an advantage to women’s status. In traditional societies women have limited access to the public

188 sphere, which makes them dependent on males, and centres their roles on the household sphere. Thus, in such societies marriage is regarded as a security for the future, particularly when there is a lack of other alternatives such as schooling and employment.

However, an important outcome of the socioeconomic development that Saudi Arabia is experiencing is the increase in educational participation (especially for females). This could explain the attitudes toward early marriage of some of the female interviewees (See Table 6.1).

The survey results provide empirical support for the influence of certain socioeconomic factors (including education level and occupational status for females) as important factors that could delay marriage. This link was long-established by the Demographic Transition Theory, and the writing of well-known scholars (Caldwell 1982; Hirschman 1985; Mason 1987; Thornton et al. 1984), which stresses the role of urbanization in raising women’s age at marriage through providing them with varied opportunities outside the household through education and paid work. In Saudi Arabia, the data from the Demographic survey of 2007 revealed a significant increase in the age of marriage (see Chapter One); this might be related to the increase in female education in the country (see Chapter Four, Table 4.1). However, women's work in Saudi Arabia is still very limited, so it is difficult to determine its influence on the age of marriage.

Several studies suggest that female education opens new avenues for women to participate in the process of modernization and organize themselves in economic and social institutions (Nag and Singhal 2013; Palamuleni 2011; Unterhalter and North 2011; Weis 2014). For example, Nahar et al.’s (2013) study used data from the Bangladesh Demographic and Health Survey (BDHS) of 2007, to inspect the influences of socioeconomic and demographic factors on age at first marriage association connection to reproductive behaviour. Nahar et al. (2013, p.230) recognized a positive association between age at first marriage and age-specific marital fertility rates: the total parity per woman at the end of the reproductive period is expected to reduce by 0.196 for each 1-year delayed marriage. Also, a cross-sectional study by Abeynayake et al. (2012) of 32 developed and 34 developing countries used country level data (from 1989 to 2007) to examine marriage timing and fertility variances. The study found that marriage timing could explain the fertility differences between developed and developing countries and female

189 education’s influence on marriage timing in developed and developing countries, although the OLS regression was 1.892 (.434) with an Adjusted R Square of 0.600 in developing countries.

However, some studies emphasise other factors which could influence the timing of marriage in addition to female education, such as women who work and family income. For example, the research by Haloi and Limbu (2011, p.76,78) about the socioeconomic factors that impact the age at marriage of Muslim women in North-East India was based on structured plans of 1034 married women similar to those for the National Family Health Survey-2 (NFHS-2, IIPS.2000). The results of regression analysis indicate that the mean age at marriage is likely to increase with an increase in maternal education and household income (-0.2555 ± 0.0734). Also, Sivasankaran’s (2014) study in India, based on a survey sample of 980 working women, found that for each additional month worked, the age of marriage increases by about 1.1 months.

What is important about this thesis is that it provides a full perspective from society members regarding the cultural aspects and gender structure related to marriage, and also provides the actual reality for now as well as shedding light on perceptions for the future. However, age at marriage is an important predictor of family size.

The Value Placed on Children and Family

The ideational theories stress the role of cultural values in explaining fertility difference (Lesthaeghe 1980, 2010, 2014; Lesthaeghe and Surkyn 1988). According to the scholars of these theories, the fertility transition that occurred in European countries (1963-1970), and that is currently occurring in many developing countries, appears to be a result of the diffusion of new values and norms that cause a transformation in attitudes and beliefs concerning having children.

Evidence from the interviews provided an insight into the value of children and family in the Saudi Arabian context. The interview analysis raises three issues that link to the value of children and family; these are religious inspiration, pride toward kinship relationships, and old age security. All of these will be illustrated below through extracts from the interviews. First, it is clear that religious beliefs inspire respondents’ values that attach to children and family (in particular for males) and that many men rationalized their preference for wanting many children by their religious beliefs. So for example, one male stated:

190 ‘As it is known and believed from phrases of Islamic jurisdiction, marriage and children engender profound feelings and motivations and are much desired. As written in The Holy Quran, “Money and children are the ornaments of life,” and as our Prophet directed, “Be productive and multiply so I will be proud of you in front of other nations at the Day of Resurrection.” So of course I want a large family.’ (Male, 43 years, 5 children, university education, and administrative occupation)

Likewise, another male respondent (age 56, with 6 children, university education, and administrative occupation) gave a similar account but added that the more children they had, the more they felt they contributed to or fulfilled God’s commands. His wife seemed to hold a similar viewpoint to her husband, and accordingly devoted her life to her family. She even sacrificed her opportunity to gain a higher education in order to adhere to her domestic role, which seemed a priority to her. This might give an idea of gender roles in the Saudi Arabian context, where women are located in the domestic sphere. She noted: ‘My husband loves children very much, and I do too, and I knew from the beginning that he wanted a large family. Yes they do need a huge amount of attention, but I have devoted my life to them and have also sacrificed my education in order to give my children all the care and time they need.’ (Female, 49 years, 6 children, general education, and housewife)

The second feature that arose from the interviews was the issue of pride towards kinship. Saudi Arabian culture places great emphasis on kinship as it represents a source of cohesiveness. This issue could be a sign of the traditional values deeply rooted from the tribal background of the Saudi Arabian population, where the volume of kinship represents important sources of honour and power (see Al-Safe 1997; Yamani 1996, 2000, 2008, 2010). Thus, many men noted the desire to have many children as they wished to maintain the cohesiveness and collaboration within family relationships that they had with their own birth family. As one husband reported: ‘I always said to my wife that I wanted more and more children, and that God would send us good things… also as my family will be so large I can be very proud in front my relatives and they will be proud of me, as we have very collaborative kinship relations… so I now have 12 children. Even now I want to have more children, and as my wife has become weak and cannot have more children, I’m thinking to take another young wife.’ (Male, 45 years, 12 children, literate, and unskilled labourer)

191 A third explanation that arose from the interviews revolved around security in old age. Children are highly valued in Saudi Arabian society and there is a widespread belief that although children embody and represent a great responsibility, at the same time they are also a source of security in old age. However, it is obvious from the interviews that women are more concerned about this issue than men. This may support the argument that where women have restricted or limited opportunities outside the household they then depend on their children for support in old age. For example one woman said: ‘I feel it is so important that we have many children so when we become old (herself and her husband), our children can take care of us and we will not be lonely without putting too much pressure on our children. If we have many children, they can all share the responsibility of looking after us.’ (Female, 45 years, 5 children, university education, and professional occupation)

Discussion of the Value Placed on Children

The outcome of the survey and in-depth interviews were consistent as regards the value placed on children and family. Thus it is clear that the study respondents value their children and the family greatly, which mirrors the Saudi Arabian cultural context. Also, the study’s quantitative results provided an example of the fundamental role that Islam plays in people’s beliefs and choices in Saudi Arabia, which could show the vital role of religion in reproductive decision- making (see Figures 5.1, 5.2, 5.3 and 5.4). However, it seems that when males in the interviews reflected on this issue, they concentrated on religious influences and social and traditional values more than focusing on any security effect (in old age), but females’ and also males’ responses in the surveys showed their concerns regarding support in old age (many chose this value in 2005 and also in 2013). However, this result may have occurred because of differences in economic status between the survey and interview samples (in general the interview sample represented more middle and high income people, whereas the survey sample represented varied income statuses - low, medium, and high). Accordingly, male interviewees were not very concerned about the old age security factor and this viewpoint was supported by other studies. For example, in his paper about fertility change in Sub-Saharan African countries Holmqvist (2010) discovered that operating an old-age pension in some African countries could cause a reduction in fertility levels in the range of 0.5 to 1.5 children less per woman. In contrast, Conzo et al.’s (2015) study in Ethiopia which employed data from the last two Ethiopian Rural Household Surveys (ERHS, years 2004 and 2009), found that children act as

192 sources of support and insurance and that a high number of children is associated with a high social status. Also, in the paper by Lambert and Rossi (2013) relating to Senegal, using survey data from the "Poverty and Family Structure" (PSF) conducted in 2006-2007 and including 1,800 households, they noted that the family in most developing countries compensates for the lack of care facilities for the elderly. Thus in these countries many women see children and in particular sons as their support for old age. The likelihood of short birth spacing was multiplied by 1.5 to 2, and up to 4 for women who only have daughters.

Alternatively, it may be possible that males in the interviews did not focus on security in old age as they think it a natural value or obligation that children should take care of their parents when they become old. As a Saudi Arabian researcher explaining the value of the family in her culture, Yamani (1996, p.274) notes, ‘in Saudi Arabia, the family (a’ila) is held to be the basic unit of friendship, obligation, loyalty, moral support, socialization and economic help. Kinship remains the prime means of social organization and associations,’ (for further support of this viewpoint see Al-Safe 1997; Yamani 2000). However, Olivera (2011, p.29) in his article noted that the introduction of compulsory social security in developing countries might improve the ability of children to support parents and counter the decline in old-age support.

On the other hand, female interviewees, as in the surveys, laid emphasis on support in old age, which is understandable in the Saudi Arabian context, as women are robustly positioned in the domestic realm. What is more, the response of some women in the interviews brings to light gender roles in the Saudi Arabian context where women give priority to domestic responsibilities. This result has been evident and confirmed by the literature on gender roles in traditional societies, which shows that in such societies, women’s roles basically centre on the household sphere (Haghighat 2013; Lee-Rife 2012; Mason 1987, 2001,2003; Upadhyay and Karasek 2012; Ushie et al.2011). For example, this is seen in a study by Ibisomi (2008) in Nigeria, utilizing information collected from twenty-four focus group discussions (FGD) in both rural and urban areas, which comprised a total of eighty nine (89) men and eighty-five (85) women. The study reveals that having children is culturally related to lineage continuation and securing inheritance and also includes the prestige and respect accorded to parents in the community. Also, many parents regard children as a legacy and explain that they rely on them for support in old age.

193 This study will add to knowledge concerning the value of children as it offers a full insight to this issue in the developing world and Muslim society, while most previous researchers focus on children as a gift from God, which is related to the religious factor. Meanwhile, this study offers a more complete image of the value of children in general and about the large family, which is related to several factors, and not only the religious factor.

Sex Preference

The Importance of Having Male Children

Many studies have revealed that when there is a preference for a certain sex of child (such as the preference for male children) in a society, fertility rates tend to be high, since parents will continue to have children until the desired number and sex of children is attained (Basu and de Jong 2010; Chaudhuri 2012; Rai et al. 2014). A preference for boys is prevalent in patriarchal societies, and Saudi Arabian society is indeed patriarchal (see for example, Arnold et al 1998; Cleland et al 1983; United Nations 1985, 1987). Furthermore, Mason (1987) and Cain (1980, 1993) argue that the preference for a certain gender is related to women’s status in a traditional society, where women do not have economic independence, which increases their need to have male children as a security insurance.

This issue of preference for male offspring is explored through qualitative analysis below. The first point to make is that it is interesting to find that many men from the in-depth interviews said there was no difference between having boys or girls, but they then added that it was true that they wanted to have sons (or at least one son to carry on the name of the family). However, they emphasized that they did not have a preference for sons over daughters, and noted that they loved their daughters. Many men argued that the matter of having boys or girls depended on ‘God’s Will’. However, all those men who took this attitude already had a son. The following extracts will demonstrate these various attitudes. One man who only had daughters said:

‘I admit that I wish I had boys, but it is ‘God’s Will’ whether we get boys or girls, so I’m happy and content with what God has given me.’ (Male, 56 years, with 6 daughters, university education, and administrative occupation)

194 Also, another male respondent (with only one boy) indicated:

‘There is no difference between boys and girls; either is good and both are a blessing from God. Some families have concerns regarding boys because of the inheritance issue, but as for myself, I have a son already so it makes no difference to me. Also our Prophet had four daughters and three sons but the sons all died at a young age, so all his prosperity that lives until now is from his daughters.’ (Male, age 43, one son and 4 daughters, university education, and administrative occupation)

So although the majority of men from the interviews stated that they did not have a preference for sons over daughters, one man did note that he preferred to have only sons. He explained his preference due to the low social status of women in the society (this is consistent with the response of some males in the survey who believe that males have higher status than females in the Saudi Arabian context). This man said:

‘Yes I prefer boys to girls and I do not wish to have daughters. There are reasons for my preference, one being that I’m the only son in my birth family, and also I feel that in our culture, women are weak and have no rights like male children.’ (Male, 53 years, with 4 sons, university education, and professional occupation)

Additionally, a young man offered his perspective for preferring male children. He noted:

‘I believe that a father feels closer to his sons, as daughters feel closer to their mother.’ (Male age 27, with one son, university education, and professional occupation)

On the other hand, the analysis of the female interviews showed that all women thought it was important to have sons due to the social context (they gave the similar justification that survey respondents chose regarding preference for sons). Accordingly, they wanted to have at least one son. Some women expressed the opinion that the importance of having male children depended on the cultural context of the Saudi Arabian society (such as Islamic inheritance law, gender system). One woman who was influenced by these cultural traditions replied:

195 ‘Of course I think it is important to have a male child, especially in light of our Arabic culture and our Islamic inheritance law. Also, in our culture boys mean the continuance of the family name, in addition to his major role in taking care of family. So every time I became pregnant I prayed to God and wished it to be a boy, especially during the fourth and fifth pregnancies. After I gave birth to girls I felt sad but thank God my husband did not feel the same way as he is satisfied with our only son. Also women feel that sons give them more prestige and honour in the Arabic society. I don’t know whether having only one son will make me or my husband think of having more children in the future, or try another time.’ (Female, age 36, with one son and 4 daughters, university education, and administrative occupation)

Also a younger woman, who was affected by the society’s culture regarding preference for sons expressed her worry about having male children after she married. She stated:

‘I felt relieved when my first baby was a boy as you know there is preference for males in our culture.’ (Female, 23 years, 1 son, university education, and professional occupation)

Furthermore, the female sample revealed that out of 16 wives, ten reported that their husbands became happier when they had sons, which was a reason for them wishing to have boys. For example, one woman said;

‘My husband wished that his first baby be a boy but I had a girl so in the beginning he was not very happy, but later he came to know that when the first baby is a girl God blesses the parents, so he is content with what God gave us. Then I gave birth to two boys and he was delighted. Now everything the boys want he gives them as soon as possible, not like the girls whom he tells they have to wait when they ask for things.’ (Female, age 38, 2 sons and 2 daughters, university education, and professional occupation)

Discussion of the Importance of Having Male Children

It can be concluded from both the surveys and in-depth interviews that both males and females show a notable preference towards having male children. At the same time the interviews revealed that this was not considered an extreme or excessive attitude. This is because

196 preference for male offspring is understandable in a patriarchal culture where men have authority over women and there are vast limitations on women’s access to the public sphere, which means that parents deem that male children have a higher social status and more freedom in society and are more effective than female children. Furthermore, in patriarchal cultures, sons can give the mothers greater social mobility and also help fathers to take care of family responsibilities outside the home (e.g. women in Saudi Arabian society depend on men for many things such as transportation, most legal procedures and financial support). However, the survey analysis also reveals the cultural rationale supporting the desire for sons in the Saudi Arabian context, which is consistent with the responses from the interviews. These results are supported by the writings of Basu and Jong (2010), Chaudhuri (2012), Mason (1987), and Rai et al. (2014). For example, Hussain et al. (2015) state that in Pakistan, based on a survey sample of 200 fathers having at least one child living in Dera Ghazi Khan City, they found that the desire for the birth of a son as a first child was 47.0 percent. Also, Hussain et al. (2015, p.81) establish that for the whole region, male dominancy is common, and therefore continuation of their generation, transfer of their inheritance, customs, norms and values of male family members mostly focus on the birth of a son. For that reason, this desire for sons may slow down fertility transition in Saudi Arabia. Furthermore, a study by Chaudhuri (2012, p.178) which used data from India’s 2005–2006 National Family Health Survey found that the parity progression driven by the desire for sons accounted for 7% of births. Also, women without any sons were more likely than women without any daughters to continue childbearing at parities 1–4 (odds ratios, 1.4–4.5). From the above discussion it can be seen that although a majority of parents demonstrated preference for male children, at the same time there were variations in couples’ overall reasons for this preference, which in turn affected fertility decision-making, which the next section will examine.

This study extends the understanding of the son preference attitudes in developing countries and Muslim society in particular, as it can provide explanations for this preference, which are reflected in the cultural background and gender context.

The Implications of Sex Preference

The above results have indicated evidence for a preference for male offspring. Below, the implications of this for fertility decision-making are elaborated.

197 In-depth interview analysis showed that all men stated that their fertility decisions were not influenced by a preference for sons, while some women noted that their fertility decisions were influenced by their preference for male children. For example, one woman noted: ‘I thought of becoming pregnant with a fourth child because I wished for another son.’ (Female, age 36, one son and 3 daughters, general education, and housewife)

Likewise, another woman said: ‘I told my husband that I wanted to become pregnant one last time to try to have another boy, so I delivered my fifth child but it was a girl.’ (Female, 45 years, one son and 4 daughters, university education, and professional occupation)

Yet another woman stated: ‘Throughout my pregnancies I wished to have a boy, but more particularly in my sixth pregnancy because I had 5 daughters and knew that my husband really wished to have son, but I had another girl.’ (Female, age 49, 6 daughters, general education, and housewife)

Discussion of the Implications of Sex Preference

It is worth reflecting on these findings in greater depth. Firstly, I noticed that when men and women (in the interviews) were asked about sex preference for their offspring, the first reaction was that they showed a rejection or refutation of this principle. Later on during conversations (both with men and women), I perceived that there was indeed a preference for male children over female. This contradiction could be owing to the conflicts between male preference and Islamic beliefs. In Islam, the preference for boys over girls is considered inadmissible behaviour. Therefore, it is difficult for people to show such preferences, so even when someone demonstrated this behaviour, he/she gave many reasons to rationalize the importance of having sons in the Saudi Arabian context, which was not the case in the survey.

A previous study in Saudi Arabia by Kraif (2002) showed that a preference for sons influences fertility behaviour; this is evidenced by the fact that when families had more sons than daughters the family size was smaller than when the families with more daughters than sons. However, even though Kraif’s (2002) study confirmed this association, Kraif did not provide

198 any justification for this preference. Therefore, the outcomes of my study regarding the issue of male preference are unique, as they provide explanations and justifications for these preferences (quantitative and qualitative). It must be noted that two important matters emerged regarding this issue. The first was that I encountered the insight from the qualitative analysis that neither men nor women felt proud about the issue of preference for sons, as Islam considers this inadmissible behaviour. The second was that the social context and gender system in patriarchal Saudi Arabian society motivates parents to prefer male children, as males have more power and independence than females. Thus I think that an enhancement in the status of women in society would make such behaviour less socially acceptable, which could lead to reductions in family size in the future.

Moreover, given all the above results, it is apparent that the preference for sons presents as an important factor which could influence fertility behaviour and fertility levels. However, this factor might have more effect on fertility levels in the Saudi Arabian context, as Islamic law forbids abortion unless it is a critical situation (for example if the pregnancy is dangerous to the mother’s health). Thus, sex-selective abortions are unlikely to be practised in Saudi Arabia as abortion is illegal according to Saudi Arabian law. However, it appears that in some countries (China, Bangladesh, India, and South Korea), a preference for sons does not have a significant influence on fertility levels or slow down the fertility transition in these countries. The reason for this is the increased use of sex-selective abortion (Barot 2012; Bharadwaj 2013; Lin et al. 2014; Nelson 2010; Gilles 2012). An example for this in Portner’s (2015) study in India, the data for which came from three rounds of the National Family Health Survey (NFHS-1, NFHS- 2and NFHS-3) collected in 1992-93, 1998-99 and 2005-2006 respectively, the final sample consists of 115,210 Hindu women. Portner (2015, p.44) concluded that for well-educated Indian women, the predicted number of abortions during childbearing is six percent higher after sex selection became illegal than before, while the predicted fertility is eleven percent lower and around replacement level. Women with less education have substantially higher fertility and do not appear to use sex selection. Nonetheless, the latest report from the United Nations states that, in recent decades, sex-ratio imbalances have grown in favour of boy children in a number of South Asian, East Asian and Central Asian countries. Prenatal sex selection leads today to distorted levels of sex ratio at birth (SRB), reaching between 110 and 120 male births per 100 female births in several countries and pointing to the intensity of gender discrimination and son preference (UNFPA 2012, p.2).

199 The Role of Gender in the Decision-Making Process Concerning Reproduction

Dimensions of Women’s Status

Many sociological researchers highlight the importance of examining women’s status to explain fertility behaviour (for more support of this view, see Lee-Rife et al. 2012; Malhotra 2012; Mason and Smith 2000; Paul et al. 2014; Sivasankaran 2014; Ushie et al. 2011). For example, Muhammad and Fernando (2010) note that including women’s status in reproductive research enhances understanding of reproductive behaviour, bringing to light important issues that relate to reproductive behaviour such as power relations, autonomy, and decision-making. Additionally, Paul et al. (2014, p.282) indicate that ‘the status of women has been characterized by considering a multidimensional issue which can be indicated by education, occupation, discussed family planning with partners, household decision making, freedom of movement, age at marriage, political representation and legal rights’ (for support of this viewpoint see Jejeebhoy 2001; Mason 1997; Upadhyay et al. 2014).

Gender-Based Roles

As this study intends to explore the division of responsibilities within the household, in particular the responsibilities related to childrearing, it was considered important to review the sociological literature about the division of labour by gender. The traditional division of labour has been discussed by many well-known sociologists, who argue that cultural and social contexts shape the division of labour by sex, not the biological nature of each sex, and this division of labour ensures that women are dependent on men economically by centring their role within the household and in particular on childbearing and childrearing activities. Men’s roles, however, centre on work in the market place and providing economic support for the family. Also, Blumberg (1984) and Chafetz (1984) argue that the division of labour by sex is strongly related to power and status in a society, as the different roles of each gender produce different levels of power and status. Therefore, ascribing women’s roles to household labour which is without economic payment affects their status and power within the household and society. This issue has been discussed by Folbre (1983), who elucidated the relationship between patriarchal societies and the division of labour by sex. She stated that as the patriarchal

200 society limits female access to the public, in such societies women bear the majority of the cost of childrearing by devoting their time and effort to childcare, which then reduces this cost for the family. Folbre (1983) further noted that the demand for women’s paid labour to increase family income in many developed countries reduces the demand for women’s unpaid labour in the household. Thus, Folbre stated that by increasing female participation in the paid workforce the traditional division of roles between the sexes diminishes (Folbre based this claim on the western experience). McDonald (2000), in an article that addresses the theories of gender equity in fertility transition, states, ‘implicit in the gender system of a high-fertility society is that women devote a great deal of their time and energy to childbearing and childrearing,’ (p.431).

Analysis of interview data showed that all 16 interviewee husbands indicated that a wife takes primary responsibility for children. They added that they are responsible for the financial support of children and the family, but they said that they always find the time to take family members out for entertainment-type activities. Overall, 13 out of 16 interviewee husbands reported that in everyday care for children their role was very small (including teaching the children, visiting the doctors). Two interviewee husbands said they do not do anything concerning their children, as they do not consider these to be men’s jobs (during the interviews both had difficulty in giving detailed information about their children's ages and school levels). They noted that they are fully occupied outside the house, which they believe is their natural role as men (both husbands have general educational level, one is a businessman and the other has an unskilled job). Only one husband said that he shared a significant part in taking care of children, including feeding babies, putting them to sleep, teaching them, and taking them to doctors (this husband was referring to his life with a second wife who is twenty years younger than him and she takes care of his children from his previous marriage along with the children from their marriage; she also has a higher educational level than him and works and earns more money than him).

The most common reason that interviewee husbands gave for playing only a small part in everyday childcare was that childrearing was seen as a wife’s major responsibility and the husband’s major responsibility was providing financial support to their family. In comparison, all of the 16 interviewee wives noted that they took primary responsibility for childrearing. They indicated that they had had an upbringing in terms of cultural principles based on a

201 division of labour between genders, and that women are responsible for domestic chores and men responsible for employment outside the home, which provides financial support to the family. The housewives interviewed (8 wives) noted that they were exclusively occupied with child rearing and domestic responsibilities or devoted to their domestic labour. The working wives interviewed (8 wives) stated that they were doing their best to balance their basic responsibility for childcare with their careers, although they said that this double burden put them under huge pressure. However, all of the 16 interviewed wives reported that they had help (of different sorts) from extended family or housemaids in taking care of children, but even though this help was a great support, it was still a major responsibility (especially with a large family size).

To demonstrate the division of labour by gender, it is useful to present two interviewee families as an example - one family with a working wife and the other family with a non-working wife. In the first family, the interviewee husband said that he tried his best to share with his wife some duties in raising their children because she worked to help him with the family income. He admitted that he does so only occasionally, yet still feels that he is better than other husbands who do not do anything at home or with children. Thus, he noted:

‘My wife is responsible for providing almost everything related to child and household needs and requirements, in addition to taking care of the children. I help her in providing some of the basic household necessities, and also help her with taking care of children when she is too busy as when sometimes she is busy in teaching the older children, so I care for the young ones and take them out, or vice versa. Before, taking care of the children was the responsibility of women only, but because she is working to increase our income to share with me the burden of living expenses, I find I ought to, or have to, help her in her responsibilities or there is no way she will be able to meet all the children’s and household needs.’ (Male, age 43, with 5 children, university education, and administrative occupation)

His wife on the other hand said that every day in her life was a challenging experience, particularly with a large family and a demanding job (her work is from 7.30am to 3.30pm, and she on some days she finishes at 5pm). She said, ‘I felt I ought to have a paid job because my husband’s income is not enough to cover our large family requirements.’ She believes that her husband’s help is too occasional, and at the same time she feels that he is demanding. This woman explained the problems in managing her various responsibilities:

202 ‘In our culture in the past and the present, taking care of children is a woman’s responsibility from A to Z. I find myself responsible for almost everything related to domestic/household requirements and child related activities. I am responsible for everything related to my children’s needs both inside and outside the home, with minimal or occasional help from my husband. I found this responsibility was like a mountain on my shoulders, I felt this responsibility was far greater than my ability and capacity. For instance when I am very busy, he may take a child for a dental appointment or help them with homework, and accompany me to buy items of furniture. Even though I work to help my husband with finances, any neglect or omission in the household duties means that I face harsh criticism from my husband.’ (Female, age 36, 5 children, university education, and administrative occupation)

In the second family, the husband has a higher educational level than his wife. He states that he shares only a small role in childcare because he is very busy in fulfilling his family’s needs, as he is totally responsible for providing the financial support. At the same time he believes that he was not born to take care of children (as he is male) and childrearing is a woman’s responsibility, while his role is outside the household, as he is responsible for providing for his family. He said:

‘At the beginning of our marriage I helped my wife sometimes since I had plenty of free time and I took it as fun, but as my responsibilities have grown given that I’m a father of five children, I had to have two jobs to enable a proper living standard. Also, concerning taking care of my children, I’m impatient, so I cannot be in charge of constant responsibility towards my children. No way could I handle it. I only assist them sometimes with their school work. However, my wife is responsible for everything related to childrearing and domestic work, but she has help from a housemaid and from our extended family.’ (Male, 46 years, 5 children, university education, and professional occupation)

His wife has devoted her life to taking care of their children, and even sacrificed her university education in order to fulfil this responsibility. She believes that she was born to be responsible for childrearing (as all other women). She said:

203 ‘Everything concerning our house and children is completely my responsibility. My husband is so busy he has to work two jobs to meet our large family’s needs, so I’ve devoted my life to my children.’ (Female, age 36, 5 children, general education, and housewife)

Discussion of Gender-Based Roles

To summarize the study’s findings, it is obvious that the society in Saudi Arabia is influenced by gender divisions and assigns to women the responsibility for all domestic and child-rearing activities (Figures 5.11, 5.13, 5.15 and 5.17). Also, all husbands in the qualitative sample believed that the responsibility for taking care of children was a woman’s main duty in life and almost all husbands admitted that they engaged in only a small part of everyday childcare as they were fully occupied by career obligations to ensure financial support for the family. However, many believed that children were also their responsibility in that they provided economic support for the family.

The results of the study indicate that the Saudi Arabian context supports the traditional division of labour between the sexes. Moreover, the patriarchal structure of this society further supports this division of labour by sex by limiting female access to the public sphere, which reinforces women’s economic dependence on men and therefore leaves them to bear a greater part of the burden of childcare. However, it is important to point out that in Saudi Arabia it is expected that mothers will be provided with support from the older women in their extended family (or housemaid if the family can afford it). The social context of Saudi Arabia also reinforces the gender ideologies that restrict women’s roles within the household, with support from the education system, which prepares young females for their future as wives and mothers (for support of this viewpoint, see the writings of Doumato 2001, 2010 and Yamani 1996, 2010, who are among the very few researchers who write about the Saudi Arabian context in general). Mohammed (2003), through her important work that explores the demographic situation in Gulf regions, explains the relationship between the division of roles by sex and social status. She indicates that in Gulf States, ‘Motherhood is a woman’s most important role and primary mission in life, at the very essence of her identity, and that only through motherhood can a woman achieve a complete social construction/identity, as a whole person with a productive worthwhile status, and a sexual identity as a female,’ (p.75).

204 Additionally, Spierings (2010), in his article about Middle Eastern households, explained gender ideology by stating, ‘one of the often mentioned social institutions of Muslim and/or Arab culture that is considered to shape women’s employment is the traditional family structure, the traditional ideology regarding families and the position of women therein is part of what is called classic patriarchy, in terms of gender roles with regard to productive and reproductive labour, the core of the patriarchal gender contract is the male breadwinner/female homemaker model’ (p.3). Further, Kauser and Tlaiss ( 2011, p.40) note that in the Arab world, patriarchal structures influence gender ideology, promoting a traditional family structure in which married women are expected to concentrate on family life rather than attaining a career. Also, Bryan (2012), Hamad (2013) and Haghighat (2013) write about women’s status in the Arab world. They conclude that the patriarchal structure and gender division of labour outline women’s status there. However, for a better understanding, it is necessary to encounter the society’s culture.

Although these articles reveal how deeply the division of labour between sexes is rooted in the social context of Arabian cultures, there still is a scarcity of information concerning women’s status in Middle Eastern societies and especially in Saudi Arabia. Therefore, the outcome of this study will offer insight regarding this issue in Saudi Arabia.

Women’s Status and ‘Permission Issues’

Permission issues are, in actual fact, related to women’s autonomy and status, which in turn might affect fertility decisions. This relationship between a woman’s autonomy in the family unit and decision-making regarding her fertility has become the focus of a growing body of literature by scholars in the fields of both demography and sociology. Many studies have found that women’s autonomy has an inverse influence on fertility levels (Lee-Rife et al. 2012; Malhotra 2012; Folbre 1983; Mason 1987, 1997, 2001; Upadhyay and Karasek 2012). As stated earlier, recent studies about women’s status have found that freedom of movement and women’s roles in managing economic resources in the family are important elements in determining women’s status.

The interview analysis is needed to highlight the nature of gender relationships, particularly with respect to ‘freedom issues’. In-depth interviews showed that the husbands were in charge

205 of financial resources in the family; thus, it is the husband who controls spending in a family. In the patriarchal structure, the husband controls the economic resources and the spending in the family. The patriarchal structure in Saudi Arabia limits women’s access to the public sphere, and this increases women’s dependency on males and reduces their economic power. The following quotes will illustrate this issue by providing two examples from the interviewee wives, one housewife and the other a working wife, to show in more depth how both women feel about their economic power in both statuses (non-working and working). For example, the non-working wife feels less control over economic resources as she does not have her own economic resources, and believes that because of her early marriage she could not finish her education, which prevents her from having a paid job. She said:

‘My husband is responsible for the economic resources of our family, so we depend on him totally for financial support. Thus, of course my husband is in charge of decision-making in our family, because he is responsible as head of the household. I married at an early age and have a big family, so I did not finish my education; this does not allow me to get a job. Sometimes I wish that I had a job so I could have my own money to spend on my own necessities.’ (Female, age 48, 6 children, general education and housewife)

Another working wife indicated that in the Saudi Arabian context the male is the head of household and he is in charge of economic decisions in the family (as he is the main provider of the family) even though she has her own income and shares in providing for the family. However, having her own income gives her some freedom to buy her own necessities and enhances her economic independence. She noted:

‘I finished my university education and worked before I got married, and I continued working after marriage. Nonetheless, even though I share with my husband in providing the financial support for our family, my husband controls most of the decisions in our family. Without my husband’s permission I could not continue working, as he is the head of the household. However, my own money from work provides me with some freedom to get the things that I need or want to have.’ (Female, age 38, 4 children, university education and professional occupation)

In addition, the interview data concerning women’s freedom of movement show that in general women have made some progress regarding freedom of movement compared to their mothers’

206 generation (See Chapter Four). Traditionally it was rare to see women in public, while now it has become common to see females in various shopping markets, restaurants, and entertainment places which are all places for family members (the restaurants and entertainment places are arranged in two sections: one for males only and the other for families). The extent of the freedom of movement, though, differs between families and depends on cultural background (the extent of strictness to adhere to particular religious values, which is based on one Hadeeth, “No woman should stay alone with a strange man.”). So it depends on a Muslim’s interpretation of this Hadeeth; some Muslims believe it is a sin if a woman sits in the car with a strange driver, while others consider the car as not a closed place so the woman will not be alone in the car as there are many other people in the streets).

Thus, while all interviewee wives reported in general that they needed permission to go out, only four noted that they could go out only with their husbands or male relatives (as they do not have a driver), and the rest said they had permission from their husband to go out with drivers. This is exemplified by the following extracts from the interview data. One wife, who had freedom of movement as she had a driver, explained her situation in comparison to her mother’s. She noted:

‘It is true that I need my husband’s permission to go out, but generally he has given me his permission to go out for taking care of household necessities, such as taking my children to the doctor’s or visiting my girls’ school and going to the supermarket or for shopping so he just knows in general where I go. Also because he is so busy he hired a driver for the family. At the same time, I always face difficulty in arranging the schedule of the driver between my children’s schools and my appointments (as women cannot drive). However, this situation is much better compared to my mother’s generation, as she could only go out with my father or close male relatives. Also, in my mother’s time women rarely went outside the house, as the markets were only for men.’ (Female, age 31, 3 children, university education and housewife)

Conversely, another wife described her problems with regard to the permission needed to go out, as she did not have a driver because her husband believes it is not acceptable in Islam. She said:

‘My husband strongly refuses that I go anywhere with a driver, because the driver is a stranger and it is not right according to Islam that I go out

207 with a driver who is a stranger. So I only go out with him or sometimes he allows me to go with my brothers. This situation is very difficult for me, as I have to wait until he has free time to take me out for shopping and for the household and children’s necessities.’ (Female, age 45, 3 children, general education and housewife)

Discussion of Women’s Status and ‘Permission Issues’

Accordingly, it can be concluded from investigating permission issues that Saudi Arabia is a patriarchal society and in such a context the husband heads the household. This right that the husband has is supported by Islamic doctrine, which specifies the male as the head of household and therefore obliges him to provide economic support to the family (Surah: Al- Nesa- verse 34, “Men are the protectors and maintainers of women, because they support them from their means”). The patriarchal structure and the division of labour by sex in the Saudi Arabian context generally makes the female dependent on males, especially as they have limited access to paid work. This limited access to paid work puts some constraints on the females’ control over resources. Thus, according to Blumberg’s (1984), Chafetz’s (1984) and Folbre’s (1983) theories as mentioned earlier, which indicate that patriarchal society and division of labour by sex reduces females’ ability to achieve economic independence, it seems that the Saudi Arabian context places some limitations on female autonomy. On the other hand, the study results, particularly the qualitative analysis, reveal that although Saudi Arabian females face some limitations on this freedom of movement, they are making progress concerning their freedom of movement when compared to previous generations.

The link between a woman’s autonomy (which is related to permission issues) and reproductive decision-making has been supported by several studies. For example, Gordon et al. (2011, p.14) conducted a study based on data from a 2008 survey conducted by Marie Stopes International (MSI), which comprised 1,200 women from across Ethiopia. They found that visiting a health clinic increased the probability of using contraception by 27%, and the total magnitude of the indirect relationship of education on contraceptive use via attending a health clinic was 0.17 (z = 5.83, p<0.01). Also relevant here is Wado’s (2013) study in Ethiopia, based on data from the Demographic and Health survey, which involved 9,066 married women aged 15-49. The study found that freedom of movement is a good predictor for using or not using a reproductive health service and contraception use. The odds were higher with more freedom of movement

208 1.98 (1.75- 2.23). Additionally, a mini literature review by Najafi-Sharjabad et al. (2013) about the barriers to modern contraceptive practices among Asian women, revealed that limitations on women’s mobility and prohibition of accessibility to public places have been documented greatly in South Asian, Middle Eastern, and Central Asian societies. Therefore, these have become an important barrier to contraception use (p.184).

On the contrary, there are some studies which did not find any influence of certain dimensions of women’s autonomy on fertility behaviour. A study by Mishra et al. (2014) uses baseline data of the Measurement, Learning, and Evaluation (MLE) Project for the Urban Health Initiative in Uttar Pradesh, India. Data were collected from a representative sample of 6,431 currently married men in four cities of the state. Interestingly, the study did not reveal a relationship between restrictions on the wife’s mobility and current contraceptive use.

However, in a society such as Saudi Arabia, where many women face several levels of restriction that limit their economic independence and restrict their flexibility of movement, such knowledge is imperative in order to expand the understanding and awareness of women’s position in Saudi Arabian context. However, many studies underline the point that permission issues might influence fertility behaviour. In a society such as Saudi Arabia where many women face several levels of restriction that limit their economic independence and restrict the flexibility of movement, a reduction of these restrictions might influence fertility behaviour, as many studies confirm this relationship.

Gender, Decision-making and Reproduction

Examining the decision-making processes with respect to reproduction, including discussions between spouses regarding reproductive decisions and gender power in reproductive decisions, was important. Das and Tarai (2011), in a study in India based on NFHS-3 data which canvassed three sets of questions on decision-making to women from 15–49 years of age, indicate that ‘women’s decision-making power is an important determinant of health care, fertility and all the dimensions that influence fertility, like contraceptive use, adult mortality, child survival, antenatal care and maternal health care; also the impact of female decision- making power on fertility has an important implication for the well-being of developing nations’ (p.240). Furthermore, Malhotra (2012) and Upadhyay et al. (2014) indicated that the

209 relationship between gender and fertility behaviour is a focal point in explaining fertility outcome and the demographic shifts, and women’s empowerment was generally connected with number of children. Thus, women's status or power in the society at large and in the household is a vital contextual aspect for the expectation of their role in reproductive decision- making. In this study, an exploration of decision-making processes will therefore assist in understanding the influence of social and cultural values, as well as gender relationships, on people’s choices regarding reproduction. Such decision-making clearly varies amongst different sectors of society, so this section also investigates the impact of the following factors on reproductive decision-making: parental education levels, family income and parental occupational status. Hence, this section sets out to give a detailed account of the complexity of reproductive decision-making in Jeddah, Saudi Arabia.

There is a great body of theoretical literature emphasising the interaction of gender equality, women’s status and fertility behaviour (Blumberg 1991; Cain 1993; Caldwell 1983; Chafetz 1993). McDonald (2000, p.432), in his article, argues that ‘the fertility transition from high to low levels has been associated mainly by an increase in gender equity within the institution of the family,’ Mason (1987) also argues that women’s autonomy in reproductive decision- making becomes more influential if it is associated with more egalitarian relationships that allow more communication between spouses. She adds that egalitarian relationships or gender equality encourage the spouse to consider a mother’s health and the effect of high fertility on a mother’s well-being (see also Dharmalingam and Morgan 1996; Derose and Ezeh 2010; Osiewalska 2015; Yount et al 2012). Moreover, there is a large body of evidence that argues that education and paid work are key determinants of women’s independence from the male domain, which then enhances their power in decision-making within the family (Acharya 2010; Bongaarts 2010; Caldwell 1983; Bledsoe et al. 1999; Fadeyi 2010). However, some commentators argue that education and paid work have to be accompanied by greater gender equality in the social context (Derose et al. 2010; Lee-Rife 2010; Malhotra 2012; Vogl 2015).

Discussing Reproductive Decisions

Evidence from in-depth interview analysis reveals that out of 16 couples, 9 reported that they did discuss reproductive issues and 7 reported that they did not (see Table 6.2). Nevertheless, some housewives whose husbands had higher educational levels than themselves said that the

210 discussions were almost one-sided (they agreed to everything the husband said or discussed) as they believe that their husbands are more capable of making rational decisions because they have a higher level of education. Table 6.2 show a very small difference between various age groups (for the husbands who are under 44 years, 4 out of 7 said that they discuss reproductive issues, and for the husbands older than 44 years, 5 out of 9 said they discuss reproductive issues). It also appears from Table 6.5 that the husbands with high educational levels are more likely to discuss reproductive issues with their spouses (8 out of 12 husbands with university education said that they discuss reproductive issues with their spouses). Also, it appears from Table 6.6 that wives with high educational levels are more likely to discuss reproductive issues with their spouses (6 out of 10 wives with university education said they discuss reproductive issues with their spouses).

Table 6.2 Discussing Reproductive Issues (in-depth interview sample) Family Current Number Education Education Occupation Occupation Discussion Number Age of of Male of Female of Male of Female Children M F 1- 27 23 1 University University Professional Professional Yes 2- 30 26 2 University University Administrative Professional No 3- 35 31 3 University University Administrative Housewife Yes 4- 35 38 4 g-education University Businessman Professional No 5- 41 35 2 University University Businessman Housewife Yes 6- 41 41 3 University University Professional Professional Yes 7- 43 35 5 University University Administrative Administrative No 8- 45 46 12 g-education Illiterate Unskilled Housewife No 9- 46 36 5 University g-education Businessman Housewife Yes 10- 46 45 3 University g-education Administrative Housewife Yes 11- 47 45 5 g-education University Administrative Professional Yes 12- 49 40 6 University g-education Professional Housewife Yes 13- 53 48 4 University g-education Professional Housewife No 14- 54 44 5 University University Professional Administrative Yes 15- 56 41 7 g-education University Unskilled Professional No 16- 56 49 6 University g-education Professional Housewife No

(g-education=general education)

However, social and cultural values could influence the relationship between spouses. In the Saudi Arabian context, men have authority over women in many different spheres of life. In this case most men depend on Islamic beliefs to justify their position. For example, the Alqawama concept is used by men to support patriarchal power relations upheld through religious beliefs. The concept of Alqawama is based on the verse in the Quran that defines men as the protectors and maintainers of women, because they are obliged to support women financially. However, many Muslim men misinterpret this concept (Alqawama), believing that 211 men are women’s guardians and that the husband rules over his wife because men are more capable than women. Accordingly, it is believed that the husband has the power and the right to allow or to prohibit discussion within the family regarding fertility behaviour. Additionally, he has the authority to accept, or not, his wife’s opinions. This could explain the contradiction between male and female responses in the survey results whereby the majority of female respondents indicated that they did not have the freedom or ability to discuss reproductive matters, while the majority of male respondents reported that they discussed reproductive matters with their spouses. Many studies in developing countries have found that sometimes men believe that just by telling their wives what they want this means that they have had a discussion on reproductive issues; this may be the case in this study (see Link 2011; Mustafa et al. 2015; Rimal et al. 2015; Tilahun et al. 2014). Nonetheless, it is still difficult to determine the situation with respect to discussions about reproduction between marital partners. For the group of spouses who did discuss reproductive issues, there were two sub-groups; those in agreement and those not. The couples who had agreed on reproductive decisions since they held the same viewpoint felt that this allowed them to discuss reproductive matters openly, as illustrated by the following couple where the husband said:

‘Between my wife and I there is agreement in viewpoints regarding many things, including reproduction matters. We both love children and we agreed that it is better to have a big family so we will not be alone, plus they will support us when we get old. Generally we always have discussions to share our ideas before we make any decisions so I always share with my wife in decision-making, especially as almost all the responsibilities of children and the house fall upon my wife.’ (Male, age 54, 5 children, university education, and professional occupation)

His wife held the same ideas and was satisfied with the mutual discussion in her family, as she noted:

‘We always talk, discuss and share our opinions, so I have a fair part in decision-making in my family. Generally, we have concurrence in viewpoints, especially regarding reproduction issues. I worship children and I always want to have a big family so they will be around me to keep me company. They are my life.’ (Female, 44 years, 5 children, university education, and administrative occupation)

212 In contrast, another couple who also stated that they discussed reproduction issues did not reach agreement regarding reproductive decisions, as the wife embraced a different standpoint from her husband (she also has a higher educational level than her husband). Thus, this kind of discussion did not usually produce mutual or shared decisions. For example, the husband felt:

‘I believe it is not wise to listen to my wife’s opinions, and follow her ideas. Also as I’m the man and the head of the family so my family must follow my opinions. However sometimes I try to listen to my wife’s opinion, especially when she insists.’ (Male, age 35, 4 children, general education, and business occupation)

His wife showed her disappointment about her husband’s attitudes towards her opinions; she also called their discussion ‘one-sided’. She believed that spousal discussions could produce mutual decisions. She stated:

‘I always try to share my opinions with my husband, even though most of the time he refuses to listen to me, as he believes that everything must go his way because he is the man and the head of the family. However sometimes when I insist on telling him my opinion and he finds it right or okay, he does listen to me.’ (Female, 38 years, 4 children, university education, and professional occupation)

Within the group who said they did not discuss reproduction issues at all, one couple stated that they held different viewpoints. They found it was better not to discuss those issues because the husband knew that everything would go his way, and as he is the man and has the power as head of the household, he refused to listen to his wife. So he said:

‘We did not plan or discuss reproduction issues at all. Each pregnancy occurred naturally. I think at the beginning of our marriage we did not agree or we had different perspectives regarding the number of children because I wanted many children, and my wife just wanted no more than two or three. But we did not really discuss that issue thoroughly; just each of us knew what the other wanted. However, I did allow my wife to take contraceptives only for birth spacing but no more than three years, because I want a big family.’ (Male, age 43, 5 children, university education, and administrative occupation)

213 His wife showed her frustration that they did not have discussions on the matter and her opinions were considered unimportant. Even though she is highly educated and also works, it seemed that she had less autonomy, and felt she might face rejection from her husband if she continued to voice her opinions. She stated:

‘I thought I would like to have only two children, but my husband wanted to have lots of children. Given that I faced many problems at the beginning of our marriage, as a result I did not discuss this issue with my husband, because I knew that my opinions and preferences would be disregarded as a mere folly.’ (Female, 36 years, 5 children, university education, and administrative occupation)

Another couple also indicated that they did not discuss reproductive issues, because they believed it was not necessary; having children was a natural thing and the main purpose of life. So the husband said: ‘The purpose of marriage is to have children to populate the earth, so what is the need for discussion regarding this issue?’ (Male, age 45, 12 children, general education, and unskilled occupation)

His wife, who held the same reproductive goals as her husband, also believed that a woman must follow her husband. Thus she did not need to discuss anything with her husband. She said: ‘We never discuss reproductive matters; it is a natural outcome of marriage. I knew from the beginning of our marriage that my husband wants many children. I’m not against his ideas, and the woman should obey her husband, as he is the head of the family and holds the responsibility for our family. Also, we learned from our parents and family that children are the main purpose of life and they are a source of pride to the parents and family.’ (Female, age 46, 12 children, illiterate, and housewife)

Discussion of Discussing Reproductive Decisions

It can be concluded from the survey analysis that couples who discussed fertility issues had fewer children than couples who did not discuss them. It may be that greater discussion encourages spouses to think carefully about the responsibilities of having children, and the

214 well-being of the mother, which then influences reproductive decisions. This outcome provides empirical support for the theoretical argument that more communication between couples relates to greater equity in gender relationships and can reduce fertility levels (McDonald, 2000; Mason, 1987). This outcome is also prominently supported by several studies in other developing countries, which found in particular a significant relationship between spousal communication and contraceptive use, which then led to demographic transition. For example, Mohammed et al. (2014), undertook a cross-sectional study conducted from August 15 to September 1 2010, among married women aged 15–49 years in Debre Birhan District in Ethiopia, comprised a total of 851 study participants. They found that spouse communication and discussion, along with husband’s approval of contraceptive use, were significantly linked to modern contraceptive use; women who had had a discussion with their husband once were 4.50 times more likely to use modern contraceptives than those women who did not discuss this (AOR 4.50, 95% C.I 2.15–9.42), and those women who discussed it more than three times were 7.32 times more likely to use modern contraceptives than those women who did not discuss family planning use with their husbands at all (AOR 7.32, 95% C.I 3.60–14.86) (see also Kamal and Islam 2012; Islam et al. 2013; Link 2011; Mustafa et al. 2015). Furthermore, Rimal et al.’s (2015, p.1) qualitative study used focus group interviews including men and women to obtain in-depth knowledge. Spousal influence and interpersonal communication emerged as key factors in decision-making, and open interpersonal discussion, community norms, and perspectives are integral in enabling women and couples to use modern family planning to meet their current fertility desires. Also, Rasheed et al.’s (2011) study in India used a survey to collect data from 718 married women. It concluded that family planning practice is certainly influenced by the nature of communication between spouses in the household, particularly in a patriarchal structure. The study verifies that almost half of the women in the sample did not discuss issues concerning contraception use with their husbands, and also it appeared that the spouses who communicated had a smaller family size (p<0.001), as they were practising contraception more (p<0.05). Further, Samandari et al.’s (2010, p.122) study in Cambodia involved 706 married women. The study established that women who believed that their husband had a positive attitude toward contraception were more likely to use contraception than those who did not use a method (odds ratio 3.4), whereas women who were nervous about talking with their husband about contraception were less likely than others to use a method (0.6).

215 Despite the benefits of spousal communication, which could increase gender equity and women’s autonomy, sometimes discussion between spouses does not generate agreement in opinions (this was the case with some study respondents from the interviews). However, this conflict or disagreement between couples regardless of the existence of discussions possibly reflects gender stratification in the Saudi Arabian context. This was obvious from the interview analysis, which demonstrates that some men believe that they hold the right to make decisions and that women should accept their decisions. Men have supported this right due to religious beliefs and a cultural tradition that gives them this authority. Consequently, women generally surrender to this male authority, as they are mostly dependent on men. Also, some women do not discuss reproductive matters with their spouse as they believe that their opinion will be disregarded. This is also the case in many other developing countries, as in Mustafa et al.’s (2015) descriptive exploratory qualitative study in three provinces of Pakistan, which involved married women and men aged between 15 and 40, and 24 focus group discussions. They established that in general, contraceptive use was very low; however, they revealed that husband and wife communication about family issues including reproductive concerns was also very low and only a few spouses had some mutual understanding and communication. Mustafa et al (2015) concluded that gender-based power inequities in the regions contribute to the lack of spouse communication. Further, Char (2011, p.31) states in his PhD thesis about male involvement in family planning and reproductive health in India that successful inter-spousal communication is a key strategy to fostering shared decision-making and responsibilities on reproductive health matters. Globally, the Demographic and Health Surveys report low communication between spouses about family size and family planning in many developing countries. This outcome is also supported by the theoretical literature regarding gender equity, as for example Blumberg (1991); Cain (1993); Caldwell (1983); Chafetz (1993); McDonald (2000) and Mason (1987).

Furthermore, it was obvious from the survey’s results that being of the younger generation, as well as the educational and occupational statuses of both males and females, have a significant influence on promoting the discussion between spouses about reproductive issues. Nonetheless, interview data showed that sometimes women’s education and work did not give them greater autonomy: particularly if they faced a strict or tough masculine power regime within their household.

216 The link between education and communication between spouses has been established by several studies: for example, the Odwe and Khasakhala (2013) study based on data from Kenya’s Demographic and Heath Survey, using interviews and focus group. The authors established that spousal discussion regarding family planning issues can promote contraceptive use. Also, educated women are more likely to have better communication with their husband compared to uneducated ones.

Also, there are some studies which argue that educational levels would show an influence in a context that has a more egalitarian relationship between spouses. For example, Dodoo et al.’s (2014) research concerning the constraint of women’s autonomy in the reproductive and sexual realms, was conducted in the North Tongu district of the Volta region of Ghana, and applied in- depth interviews of 46 married female participants aged 18 years and over. Dodoo et al (2014) reveal that education does not change the allocation of reproductive rights and behaviour owing to traditional gender ideology in the country. Furthermore, the International Centre for Research on Women (ICRW, 2014) reports that improvements in women’s education along with increasing their participation in the labour market alone will not reshape gender relations. This could be enhanced when it is accompanied by other changes in the gender scheme and the cultural background that possibly will increase woman’s ability to control her own destiny.

In Saudi Arabia, women’s education is expanding (See Chapter Four), although the patriarchal structure of Saudi Arabia influences the gender context and lessens women’s autonomy, and thus education levels have not shown significant influence on women’s autonomy in many cases.

Gender Power in Fertility Decisions

The power relations involved in reproductive decision-making form an important issue that requires further explanation. This is partly due to the influence of the gender context and cultural traditions which determine which gender has the greater power in reproductive decision-making (for support of this view, see Beekle et al. 2006; Balk 1997; Dharmalingam and Morgan 1996; Morgan et al. 2002; Mason and Smith 2000). The influence of the gender context on husband-wife decision-making processes is therefore explored below.

217 The in-depth interview analysis revealed a contradiction regarding what was actually construed as the scope of ‘decision-making’, especially as revealed by male responses in the survey. This qualitative analysis showed that out of 16 couples, there were 5 couples who stated that the husband had the final say about reproductive decision-making, followed by 6 couples who reported that most of the time the husband had the final say but with some consideration for the wife’s opinions. Only 5 couples indicated that the final decision in this regard was a shared decision between the spouses (see Table 6.3). It appears that the older interviewee couples are more likely to share in the decision-making process, or this could be because they already have several children. However, it was difficult to note clear variations between socioeconomic statuses (education and occupation statuses) of couples as most of the couples noted that most likely the husband controlled reproductive decisions within the family. However, there is a small difference for those with a higher education (of both husband and wife), and also in particular husbands with professional jobs, who are more likely to have shared reproductive decisions.

Table 6.3 Gender Power in Fertility Decisions (in-depth interview sample) Family Current Number Education Education Occupation Occupation Final Say Number Age of of Male of Female of Male of Female in Children Fertility M F Decisions 1- 27 23 1 University University Professional Professional Mostly H 2- 30 26 2 University University Administrative Professional Husband 3- 35 31 3 University University Administrative Housewife Family 4- 35 38 4 g-education University Businessman Professional Husband 5- 41 35 2 University University Businessman Housewife Mostly H 6- 41 41 3 University University Professional Professional Mostly H 7- 43 35 5 University University Administrative Administrative Husband 8- 45 46 12 g-education Illiterate Unskilled Housewife Husband 9- 46 36 5 University g-education Businessman Housewife Mostly H 10- 46 45 3 University g-education Administrative Housewife Mostly H 11- 47 45 5 g-education University Administrative Professional Family 12- 49 40 6 University g-education Professional Housewife Family 13- 53 48 4 University g-education Professional Housewife Husband 14- 54 44 5 University University Professional Administrative Family 15- 56 41 7 g-education University Unskilled Professional Family 16- 56 49 6 University g-education Professional Housewife Mostly H (g-education=general education, mostly H= mostly husband)

In Saudi Arabia, it appears that in general men dominate women, which is part of the gender ideology of the patriarchal structure, and this influences power relations between genders, which then could influence reproductive decision-making. But what is different about the Saudi Arabian context is that men justify patriarchy by connecting it to religion (such as the Alqawama and the right to marry up to four wives at the same time). In addition, Islamic law

218 allows a husband to divorce by saying the word talaq (the wife can ask for a divorce called ‘Khul’, but the Islamic law in this case requires that the wife return her dowry; and this kind of divorce must happen through the Islamic judge). Accordingly, men hold the power in marriage relationships, and that gives many men the right to construct or formulize their own preferred ‘family law’. Thus, some men think that decision-making is a man’s responsibility as they have the ability to make more logical choices, as they believe that men are more rational than women. This is exemplified by the following interview quote where one husband notes: ‘The final say or decision must be the man’s because he is more rational than a woman, who is more emotional. So in our family the final say is mine, as it should be.’ (Male, age 43, with 5 children, university education, and administrative occupation)

Some men make the decisions within the family but they use a more gentle approach to convince their wives of their ideas. As one man said: ‘The final say is for me and no way have I allowed anything to happen in my family unless I approve that decision, but at all times I discuss matters with my wife and try my best to convince her, so as much as I’m democratic I’m a dictator, and I provide freedom within the family, but as much as I want to be I am the limit and restriction to that freedom.’ (Male, age 53, 4 children, university education, and professional occupation)

Contrary to the men who believe they should be in charge of decisions regarding reproduction, there are some who are more open to change, and so they share such decision-making with their spouses. Those men believe that shared decision-making will produce positive relationships between spouses, and more happiness in the family. For example, one husband said: ‘I believe that a happy family life needs cooperation and understanding between the spouses. Thus, I share everything with my wife including the decision-making and consequently we have harmony in my life with my wife.’ (Male, 49 years, 6 children, university education, and business occupation)

On the other hand, during interviews I noticed that many women were not comfortable or relaxed enough to give their opinions about who had the final say about decisions regarding reproduction. This might have been because they did not want any problems with their husbands after the interviews (as some women stated). Consequently, from the few responses I got from women, I had to depend on their short answers and interpret their body language. (for

219 more on this issue of silence, see Randall and Koppenhaver, 2004). The following extracts, along with my observation of body language from some wives, could demonstrate some wives’ frustration due to gender inequality and greater male power. For example, one wife responded to the question about the gender and power in reproductive decisions by first moving very close to me and almost whispering (this situation gave me the impression that she felt uncomfortable): ‘I almost divorced twice because my husband is very stubborn. He refuses to let me share in any decisions concerning our family including reproductive decisions. He always says to me, “I’m the head of household and everything must go as I want.” In the beginning of our marriage I tried to change his mind but after all the problems and after I have two children, I gave up because I do not want to destroy my family.’ (Female, age 26, 2 children, university education and professional occupation)

Some wives explained that cultural traditions degrade and dishonour divorced women. So from early childhood girls were brought up learning that husbands were to be obeyed. As one wife said, also in a very low voice and at the same time shaking her head and hands (an expression of saying ‘no way’ or ‘no hope’): ‘There is no way that my husband would let me share in our family decisions; he has always told me that he’s a man who never listens to women’s words. Also when I got married my parents told me that I have no place but your husband’s home; no women in our family have ever divorced, so you must obey your husband.’ (Female, age 46, 12 children, illiterate and housewife)

It was equally obvious that some educated wives were making sequential attempts to gain greater power in decision-making, but they used a latent and subtle strategy, because they did not want to confront their husbands (they believe that challenging the husband will cause serious problems in their marriage). For example, one wife explained how she uses indirect ways to convince her husband to listen to her opinions. She noted: ‘When I want to convince my husband about something, I tell him, “You have the final say about this issue but I wish that you could hear my view about this issue and then you can decide what to do about it.” Or sometimes I tell him, “Can you just think of what I say or think about this idea?” ’ (Female, age 40, 3 children, university education and professional occupation)

220 The wives who indicated that the decisions were shared in the family seemed happy as they were glad to have a significant role in decision-making. They felt that they were lucky compared to their mothers, as in the following example, where one wife said: ‘I feel very lucky that my husband considers my opinions. Thank God I’m not in my mother’s position, as she never had any say or any opinion about anything in the family. My father controlled every decision in our life. I think that as my husband studied at university in a foreign country, and also at the beginning of our marriage we lived in the USA; this makes him more liberal.’ (Female, age 44, 5 children, university education and administrative occupation)

Discussion on Gender Power in Fertility Decisions

To conclude regarding who has greater power in reproductive decision-making within households in Jeddah, Saudi Arabia, it is apparent from quantitative and qualitative analysis that men are predominantly in control. This is considered ‘natural’ as it is influenced by the patriarchal structure and traditional gender ideology of the Saudi Arabian context. Moreover, surveys and interview analyses of the study demonstrate that couples who have been together longer appear to make more mutual decisions; this may be because older couples become more mature and more aware of each other’s preferences. This outcome is also supported by other studies (see for example, Gupta 1995; Dodoo et al. 2014; Dyson and Moore 1983; Tilahun et al. 2014) which explain this link as signifying that as women are the main caretakers of domestic responsibilities and in particular childrearing, so as they become older they have many children and gradually gain a greater role in family decisions.

Notwithstanding this, the survey results reveal that mutual decision-making regarding reproduction is related to a reduction in family size, as families where the husband controlled such decisions had 1.2 more children than families who had shared in these decisions. This result could present an empirical example for the theoretical argument that greater gender equality in relationships could reduce fertility levels (Folbre 1983; McDonald 2000; Mason 1987). This link is evident in other studies in developing countries. For example, through her study in rural Nepal, Chapagain (2005, p.41) used a survey of 223 couples and qualitative information from 40 informants, noting that ‘women’s power status explains variations in their participation in reproductive decision-making.’ However, Chapagain’s (2005) study shows that

221 participation in decision-making regarding contraception increases with the following factors; with high educational level or low educational level (86% vs. 60% respectively), with personal income for wife or not (84% vs. 58%) and being victims to wife-abuse or not (48% vs. 84%). Chapagain’s (2005) study is important as it includes both husbands and wives, whereas other reproductive research has usually excluded men. Involving both sexes in reproductive research enabled collecting both gender viewpoints, and valid information about gender relations (this is also the case in this study).

Tilahun et al.’s (2014, p.7) cross-sectional study collected data from March to May 2010 in Jimma zone, Ethiopia, using a multistage sampling design covering six districts, and for each of the 811 couples included in the survey, both spouses were interviewed. They found that spousal concordance on the importance of family planning has a positive impact on contraceptive practice. However, it was the husband’s favourable attitude towards family planning that determined a couple’s use of contraception. Husbands’ versus wives’ experience of spousal discussion and agreement about family planning was nearly three times more likely to be related to the use of contraception by these couples (husbands OR = 2.39 p < 0.001 and wives OR = 5.37 p < 0.001). In addition, a further study was carried out by Do and Kurimoto (2012) in five African countries used data from the DHS from 2006-2008. They found that greater gender equality and more power to women can significantly affect contraceptive practice (relative risk ratios, 1.1–1.3) and also, spouse agreement on reproductive issues is significant (1.3–1.6).

Some studies, however, did not evidence this relationship between gender equality and the reduction in fertility levels, as highlighted in the work of Upadhya and Karasek (2012), which analysed the DHS data from four of the most recent surveys in Sub-Saharan Africa; Guinea (2005), Mali (2006), Namibia (2006-2007) and Zambia (2007). The sample included 1,993 match couples in Guinea, 2,668 in Mali 8,44 in Namibia and 3,197 in Zambia. Upadhya and Karasek (2012, p.78) discovered that mutual household decision making was associated with a smaller ideal number of children only in Guinea (beta coefficient, 0.3), and thus women’s empowerment as assessed using currently available measures was not consistently associated with a desire for smaller families or the ability to achieve desired fertility in these Sub-Saharan African countries.

222 However, in the case of this study, the survey results show a lower family size where reproductive decisions are mutual (this mutual decision could be an indicator of more gender equality between spouses). Moreover, the survey and interview analyses for this study show that a higher education of both sexes and a high occupational status of males (also from survey analysis, working women and high income status) are more likely to make mutual reproductive decisions. Mutual decision-making could be considered as an indicator of gender equality. These results have been long-established in the writing of well-known scholars such as Caldwell (1983), Cleland et al. (1996), Jejeebhoy and Sathar (2001), Riley (1997) and Vlassoff (1996), who stress the role of education in increasing women’s independence from men, and providing them with opportunities outside the household, which then enhances gender equality. Other scholars have also evidenced this link, as in Bongaarts’ (2010) study in 30 sub-Saharan African countries based on data from DHS surveys. He concludes that women’s education is an important factor in reducing the ideal and actual family size, that the actual fertility levels for educated women are 3.4 compared to 6.3 for uneducated women, and that the preferred family size for those who are educated is 3.7, against 6.3 for uneducated women. Furthermore he explains these results by stating that the increasing education levels in these countries has led to women’s greater empowerment in households, including for reproductive decisions.

Furthermore, some studies have confirmed the relationship between high socioeconomic status and more mutual decisions (in particular female socioeconomic status), such as Mosha et al.’s (2013, p.9) study, using twelve focus group discussions and six in-depth interviews to collect information from married males and females aged 18–49. They found that women’s empowerment reflected their socioeconomic and employment status, educational levels, household organization, the dynamics of their marital relations, their involvement in domestic decision-making and fertility outcome.

Nonetheless, the study results (surveys and interviews) reveal that although a higher socioeconomic status (education, occupation, and income status) engenders more shared decisions within the family, it is not yet fully operative and is far from perfect. This argument has been introduced by researchers who feel that this link is not yet clear (Malhotra and Mather 1997; Balk 1997; Dodoo et al. 2014; ICRW 2014; Unterhalter and North 2011). Furthermore, the results of this study (in particular the in-depth interviews) reveal that the gender context and the patriarchal structure in traditional Saudi Arabian society give males authority over females. Also, in Saudi Arabia, cultural traditions reinforce from early childhood the expectation that

223 women should be obedient to men, and the social context makes women dependent on men, as they have limited access to the public sphere. On the other hand, men tend to support their authority with religious beliefs (such as the Alqawama concept), while in fact it is the traditional value system that gives men authority over women. This outcome is also prominently supported by the writing of Doumato (2001, 2003 and 2010), who is one of the very few researchers to write on the Saudi Arabian social context (her writing involves the general social and gender contexts, but does not include any information concerning reproductive behaviours). Doumato (2003, p.240) notes that ‘as Saudi Arabia is a patriarchal society, women in every part of the region deal with conservative gender ideology, which limits women’s access to the public sphere, and validates the gender ideology for women to be a stay- at-home wife and mother.’

Nonetheless, several studies in other developing countries confirm the correlation between the gender context and reproductive behaviours. For example, Obermeyer (1994), in his article about reproductive choice in Islam, states that ‘the reality of reproductive choice in countries of the Middle East clearly reflects the dominance of the traditional approaches to gender issues,’ (p.43). Also, a study by Derose et al. (2010, p.85) in Ghana, which investigated women’s autonomy in fertility decisions, utilized data from the DHS from 1988 to 2003, and involved 2099 married couples. The study concluded that the coefficient for the wife alone who wants to stop childbearing was -2.084, p≤0.01, suggesting that the wives’ preferences in discordant couples became significantly less important relative to the husbands’ preferences. In addition Fadeyi’s (2010) study in Nigeria, based on 1072 questionnaires and focus group discussions including both males and females, revealed that gender equality in general was low in the society, as almost over 70 percent of study respondents reported that husbands make the decisions, and this could explain the high fertility levels. That being said, the study established that educated women (above secondary education) are more likely to have shared decision, at 1.12 times more compared to uneducated women, and similarly, professional women, at 1.53 times more than unemployed women.

Furthermore, Chapagain (2005, p.39), in the qualitative data for her study in Nepal, states that ‘where the social expectation is that a husband should be superior to his wife and the wife should be submissive to the husband, husband’s domination and unequal conjugal relations seem natural.’ This male domination over household decision-making was supported by several

224 studies in different developing countries (see for example, Bandiera et al. 2015; Das and Tarai 2011; Ghosh 2015; Mohammed et al. 2014; Mosha et al. 2013; Mustafa et al. 2015; Spierings 2010). In the light of the above literature, it is considered ‘natural’ in a patriarchal society such as Saudi Arabia to find that men are predominantly in control of decision-making within the family. However, the link between high socioeconomic status (education, occupation and income) and more mutual decision-making that this study found might be a sign for future change in gender relationships in the Saudi Arabian context as a result of greater socioeconomic development.

Further, the outcome of this study concerning reproductive decision-making and its relation to gender power will help in the global efforts which have been established since the 1994 Cairo ICPD Program of Action. Also, it could assist in achieving the Millennium Development Goals that promote women’s empowerment, which will therefore enable females to be more involved in reproductive decision making, ultimately enhancing the reproductive health of women.

The Influence of Social Networks and Contraception Decisions on Reproductive Behaviour

As contraception is a sensitive topic in the Saudi Arabian context, only basic information on the role of social networks on fertility decisions could be discussed (the diffusion of contraceptive knowledge, ever used contraception, and planning family size). Hence, this study will adopt famous scholars of the social interaction theory, such as Kohler, Bongaarts and Watkins. Kohler (2001, 2011, 2013), through his several works exploring the relationship between fertility behaviour and social interaction, notes that women’s attitudes towards new contraception, and their readiness to implement modern contraceptive methods are affected by sociocultural and contextual factors, and predominantly by the acceptance and approval of those methods among their social networks. Additionally, Bongaarts et al. (2012), who have carried out numerous studies on social interactions and contemporary fertility transition in developing countries, state that information-sharing within social network members is a specifically important predictor in family planning adoption and practice by society members; however, those whose networks include others who practise family planning are more likely to

225 use it themselves (Bongaarts 2003, 2006, 2010; Bongaarts and Watkins 1996; Bongaarts and Casterline 2013).

Moreover, this study will utilize the embeddedness theory in explaining fertility behaviour. Bernardi and Klärner (2014, p.642) state that ‘men and women who interact with others, are embedded in social networks with specific structures, and act in relation to their social environment. So the intention to have a child, the value attributed to children, the support available to parents, and all of the other elements involved in childbearing decision-making are created, diffused, and transformed by social interaction’. Likewise, Willekens (2014, p.6) notes that ‘the demographic processes are embedded in a context or environment; they are situated in time and space. The significance of the historical, cultural and political contexts for the demographic transition illustrates the significance of embeddedness’.

Also, this study considers Ideational Theory, as it emphasises the relationship between culture and fertility behaviour. This is important, as both reproductive behaviour and contraceptive usage in Jeddah are influenced by the cultural background of Saudi Arabia, and especially by Islamic beliefs (see Chapter Two for more details about Islam and family planning). The main hypothesis in Ideational Theory is that cultural values can explain the variations in fertility behaviour patterns among different groups even if they have equivalent socioeconomic characteristics. The differences in cultural backgrounds between those different groups represent important influences in producing different fertility behaviour patterns. For example, Lesthaeghe and Surkyn (1988), in their article about cultural dynamics and economic theories of fertility change, argue that differences in religious beliefs, individualism, and secularism are important elements that help to explain the historical variations in European fertility patterns (see also Carlsson 1966; Friedlander et al. 1991; Woods 1987). However, Mason (1992) and Hirschman (1994) note that ideational theories make cultural factors the leading factors influencing fertility transition, although these theories cannot ignore the role of socioeconomic development in influencing fertility transition. Additionally, another version of ideational theory explains fertility transition through emphasizing the role of the diffusion of new cultural norms and values about low fertility patterns and birth control. For example, Montgomery and Casterline (1993), through their article which examined the diffusion of fertility control in Taiwan, acknowledge the significance of cultural factors through noting the influence of the

226 diffusion of a low fertility model on fertility behaviour patterns. Furthermore, Cleland (1985), in his work on reproductive change in developing countries, suggests that the diffusion of fertility control as an innovation is the basis of fertility decline in the developed world and many developing countries. Similarly, Retherford and Palmore (1983), in their work on the determinants of fertility in developing countries and the influence of diffusion processes, consider the socioeconomic development and the spread of contraception as two important factors that might influence the timing and speed of fertility transition.

Contraception Diffusion and the Role of Social Networks

Evidence from in-depth interviews showed that all 16 interviewee couples indicated that they knew about different methods of contraception (such as pills, condom, withdrawal, and IUD). Also, data from interviews revealed that the most common methods of contraception were pills and IUD as modern methods and withdrawal as a traditional method. Additionally, all 16 couples indicated that they knew relatives (family or friends) who used contraceptives. They stated that their sources of knowledge about contraception were from the media, family and friends, which is similar to the responses from the surveys. For example, an older respondent reported that it had become more common in society to hear about contraception, as one husband said: ‘Nowadays you can hear about contraception from non-regional channels on TV and also from some family members, not like before no one talked about such a topic.’ (Male, 56 years, 7 children, general education, and unskilled occupation)

Meanwhile, several female respondents stated that contraceptive issues are very normal conversation between women, for example one wife indicated: ‘At my work we chat sometimes with my friends about contraception, as we share each other’s experiences and the side effects of the contraceptive methods that we used, especially at the beginning of marriage time or the first time anyone wanted to use family planning methods.’ (Female, 35 years, 5 children, university education, and administrative occupation)

On the other hand, sometimes the knowledge from family and friends is not reliable or trustworthy, which could influence the point of view regarding contraception, As one wife noted: 227 ‘After I got married I heard about contraceptive methods from my peers and some older relatives, but most of things that I heard were negative, as the bad effect it produced on their health. But after having many children with short spacing I felt very weak. So, I visit the OB- GYN physician, she advised me to use contraception in order to have some rest to gain back my health.’ (Female, 46 years, 12 children, illiterate, and housewife )

However, the more educated wives generally base their knowledge on professional doctors, they think that an OB-GYN physician will advise them with the most subtle method, as one wife said: ‘I know about contraception from my family and friends, and I heard from them about their experiences with contraceptive practice, so when I decided to use it I went to my OB-GYN physician, and she guide me to the more safe method for my situation.’ (Female, 35 years, 2 children, university education, and housewife) The interview data reveal that all couples hold similar viewpoints about contraception and that all couples believe that temporary methods are permitted in Islam. As one husband noted: ‘Islam did not prohibit contraception, and we learned from our religion that some friends of Prophet Mohammed did practice azl (rhythm), and he did not reject that. However, I believe that permanent contraceptive method is discouraged in Islam.’ (Male, 35 years, 4 children, general education, and businessman)

Nevertheless, there is another husband who believes that using permanent contraceptive methods is allowed in Islam, especially if there is a threat on a mother’s life, although not everyone is open to discussing such matters, as they reply that it is better to request a religious man’s opinion. That husband is a professional doctor and thus I think that he has this view due to his medical education. He said: ‘Islam gives priority to human life, so if the mother’s health is in danger, a permanent contraceptive method is permitted.’ (Male, 41 years, 3 children, university education, and professional occupation)

Unfortunately there is a lack of detailed qualitative information on the practice of contraception in Jeddah because this was too sensitive an issue for interviewees to discuss openly. Even though the in-depth interview data are not explicit, however, it could be said indeed that there is a high diffusion of contraceptive knowledge among the population of this study.

228 Discussion on Contraception Diffusion and the Role of Social Networks

It can be said from the survey’s results that there is a high level of diffusion of contraceptive knowledge (see Tables 5.28 and 5.30), and also many members in the social networks of survey respondents did use contraception (see Figures 5.20 and 5.22). Also, the study results show that both male and female survey respondents reported knowledge of several methods of contraception. The interview analysis revealed a similar outcome to the survey results. This result could present an empirical example for the Social Interaction Theory, and in particular the writings of Bongaarts and Watkins (1996) and Kohler (2001), who stress the role of social networks in spreading awareness of contraceptive methods.

Also, numerous studies support the idea that in developing countries, people construct their knowledge of contraception based on their social networks. For example, this is supported by a study by Babalola et al. (2015) in Kenya and Nigeria, based on household surveys conducted by the Measurement, Learning & Evaluation project as part of a comprehensive strategy to evaluate the effects of the Urban Reproductive Health Initiative (NURHI) in Kenya and Nigeria, although the study focused on a sample of 1,570 women in Kenya and 4,511 women in Nigeria. They found that social interactions and influence, and contraceptive awareness, were very strong predictors in Nigeria (OR = 0.264, 0.164 respectively), whereas in Kenya, no significance was found for those variables. Meanwhile, in Longwe et al.’s (2012) study of 26 African countries, the data were derived from a harmonized set of Demographic and Health Surveys (DHS), and covered a time period of about two decades, covering the last decade of the 20th century and the first decade of the 21st century. Longwe et al. (2012) uncovered that the increase in contraceptive use was higher in districts with more knowledge and growing acceptance of contraceptives, social networks played important roles in spreading contraceptive knowledge and that women transformed this knowledge into behaviour. Also, Mosha and Ruben’s (2013, p.57) study in Tanzania, based on survey data collected from 440 married women, found that family planning practice increased when it spread across the couple’s social network (family and friends), and the logistic regression for social network and contraceptive use was (p= .007, OR =2.317 and 95% C.I = 1.537% lower and upper = 3.494%). Thus, it can be said that if diffusions of contraceptive knowledge happen in Saudi Arabia, contraceptive practice could increase, as it is currently low compared to other MENA countries (See Chapter One). Further, the embeddedness theory emphasises the role of social network in embedding

229 the value and norms relating to childbearing, and individuals in a social network are sharing the same cultural structures, which then affect their behaviour (Bernardi and Klärner 2014; Balbo and Mills 2011; Decat et al. 2013; Lyngstad and Prskawetz 2010).

Moreover, the survey’s results show that in general, males base their knowledge on sources outside the family network, whereas females depended on close networks, i.e. ‘family and friends’ as a source of information (Figures 5.19 and 5.21). The interview analysis revealed a comparable outcome. This result was also evident from many other studies that have also found that there is a difference between gender choices concerning the sources of information on contraceptive methods. For example, this was found in Adeyinka et al.’s (2012) research obtained data from the 2008 Nigeria Demographic Health Survey (NDHS), which included a sample of about 6790 women of reproductive age and six participants used for qualitative information. it was also found by: Ijadunola et al. (2010)[u6], in a study which employed both quantitative and qualitative research methods and included 402 men; and the Frini and Nabag (2013) study in Sudan, in which data was collected in 2 health centres and comprised 108 women using a structured questionnaire with interview. These studies concluded that there is variation in the way in which each gender derived their information on contraception and found that generally men draw their knowledge from observing the reproductive behaviours within their local networks without going into detail, whereas females seek detailed information from their close network members.

Lastly, the quantitative and qualitative respondents believe that contraceptive use is permitted in Islam if needed (e.g. for birth spacing, for the benefit of the mother’s health, to take proper care of living children). Very few male and female respondents believe that Islam discourages contraception. This result could explain the high diffusion of contraceptive knowledge and practice among study respondents and their social network. These results could present empirical evidence of the Ideational Theory, which emphasises the link between religious beliefs and fertility behaviour (Lesthaeghe and Surkyn, 1988). These results are also supported by the writings of well-known scholars who stress the diffusion influence on fertility behaviour. Montgomery and Casterline (1993), Cleland (1985) and Retherford and Palmore (1983) argue that the diffusion of contraceptive methods is the basis of fertility transition in the developed world and many developing countries.

230 Mode of Contraceptive Practice

Interview analysis displayed that all of the interviewees used contraception (which is similar to the survey outcomes). However, couples differ in their practice of contraception in that some couples believe in family planning and some not, so they use contraception for a limited purpose. Also there are some couples who did use contraception but for a very limited period, as they have some difficulty in conception (physical reasons or health complications) as did two couples in this study.

The data from the interviews show that there are few couples (only 4) who use contraception to plan family size, which means they use contraception regularly (the planning issue will be discussed later in this Chapter). The rest of the interviewees (12 couples) reported that they used contraception for spacing, which means only for a limited period. This could explain why the survey’s results found that contraceptive use did not show any influence on family size, as those parents might be using contraception only for a limited period.

Some couples believe that Islam encourages Muslims to have many children, and so they want to have a large family: thus, they think that using contraception must be for a limited time only for spacing childbirths or when the physician recommends it for the benefit of the mother’s health. As one wife noted: ‘My husband did not like me to use contraception because he wants to have many children, as he believes that God then will bless our family. So I gave birth to four children without taking any contraceptive methods. But after the fourth child I have had health complications, thus my physician advised me to use contraception as having another baby in a short time will cause serious problems to my health. So due to this situation my husband agreed that I use contraception for some period.’ (Female, 38 years, 4 children, university education, professional occupation)

However, sometimes the negative side effects of contraception or a bad experience could alienate the couples from continuous usage of contraceptive methods. This was exemplified by one wife who said: ‘Every time that I start using any modern contraceptive methods I face some health complications, and then I stop using it. So after I had the number of children that my husband and I wanted I began to practise traditional family planning methods.’

231 (Female, 40 years, 6 children, general education, and housewife)

Similarly, one husband thinks that contraceptive practice has a dangerous influence on women’s health, as he believes that God makes women only to bear children. He said: ‘My wife became very weak when she started using contraception, the doctor in the hospital told her to use pills, so she did, but she become unhealthy, it is the fault of contraceptive use.’ (Male, 45 years, 12 children, general education, and unskilled labour)

On the contrary, another husband thinks that using contraception is good and that if it is used under a doctor’s supervision it will not impact on women’s health, as he considers that multiple and close pregnancies will cause a bad influence on mother’s health. He noted: ‘My wife is using contraception, we regularly visit the clinic and seek the doctor’s advice, so she did, we are happy until now everything is ok.’ (Male, 35 years, 3 children, university education, and administrative occupation)

Nonetheless, only one couple reported that the wife has had a ‘tubal ligation’; they explain using this permanent method because their physician recommended it as another pregnancy could have been fatal for the wife (they also consulted other physicians who gave similar recommendations). The husband said: ‘There are some people who limit the number of children because of economic constraints; I do not think this is right. As for me, I depend on ‘God’s Will’ and what He decides for me. But when our physician told us that another pregnancy would kill my wife (and also other physicians gave us the same diagnosis), I was very afraid about my wife’s safety. So I decided to follow our physician’s recommendation to do a tubal ligation for my wife.’ (Male, age 56, 6 children, university education, and professional occupation)

It can be concluded from the interview analysis that even though all interviewees did use contraception, their practice of contraception is related to their fertility intentions (if they decide to plan their family size or not, which will be covered in the next section). The concern about the mother’s health is an important element that encourages contraceptive practice.

232 Discussion on the Mode of Contraceptive Practices

It can be concluded from the study results that there is a high level of diffusion of contraceptive practice among the respondents of this study. This could be as a result of high diffusion of contraceptive knowledge of the study respondents and also the high level of contraceptive practice by the social networks of the study respondents. The study results also reveal that the use of contraceptive pills is the most prevalent method being used by study respondents and the second most popular method is the IUD (Tables 5.32 and 5.36). These results could present an empirical example for the social interaction theory, and in particular the writings of Bongaarts and Watkins (1996) and Kohler (2001) which argue that if couples live in social networks where contraceptive practice is high, they become more likely to practice contraception.

This link has also been established by several studies: for example, by a study by Cleland et al. (2011) which utilized data from the Demographic and Health Surveys (DHSs), and tracked trends in 24 sub-Saharan African countries. the authors conclude that contraceptive practice increases as the local communities approve and provide family planning services. Cleland et al. (2011, p.137) found that the percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007). Also, Samandari et al.’s (2010, p.126) study, which took place in two rural regions of Cambodia and included 706 married women of reproductive age, revealed that the women who agreed with the statement “peers ever encouraged you to use a contraceptive method” had greater odds of contraceptive use than those who disagreed (odds ratio 1.4). Among low-parity women, agreeing with the statement, “most couples you know have used a contraceptive method” was positively associated with contraceptive use.

The survey’s results further revealed that using contraception for birth spacing purposes did not show any influence on family size. These results are in some way consistent with the results of Kraif’s (2002) study of the determinants of fertility levels of Saudi Arabia in general, which looked at data from the demographic survey of 1999. This survey was carried out by the

233 Ministry of Economy & Planning of the Kingdom of Saudi Arabia. The sample size comprised 23,000 families from all around the country. Kraif (2002) did not find any significant influence of contraceptive use on fertility level. Furthermore, Khraif explained that the reason the use of contraceptive methods did not impact on fertility levels is that the practice of contraception within families in Saudi Arabia is used primarily for birth spacing rather than limiting family size, although he did not provide any data to support his explanation.

However, in general there is a great gap in knowledge about the Gulf States, and in particular Saudi Arabia, regarding the information and statistics about contraceptive practices, in addition to the unavailability of family planning programmes in these states. Therefore, the information provided in this study may help in filling this gap.

Planning or Not Planning Family Size

The in-depth interviews revealed that only 4 couples planned for family size, while the rest (12 couples) report that they did not plan. It seems from Table 6.4 that the couples who planned family size were highly educated: particularly the husbands. It can also be seen from Table 6.4 that the younger generation is more likely to plan family size than the older generation: 3 out of 6 couples aged under 42 years planned their family size, compared to only 1 couple out of 10 couples aged over 42 years.

Table 6.4 Planning or Not Planning Family Size (in-depth interviews sample) Family Current Number Education Education Occupation Occupation Plan or Number Age of of Male of Female of Male of Female Not Children Plan M F 1- 27 23 1 University University Professional Professional Plan 2- 30 26 2 University University Administrative Professional Not plan 3- 35 31 3 University University Administrative Housewife Plan 4- 35 38 4 g-education University Businessman Professional Not plan 5- 41 35 2 University University Businessman Housewife Not plan 6- 41 41 3 University University Professional Professional Plan 7- 43 35 5 University University Administrative Administrative Not plan 8- 45 46 12 g-education Illiterate Unskilled Housewife Not plan 9- 46 36 5 University g-education Businessman Housewife Not plan 10- 46 45 3 University g-education Administrative Housewife Not plan 11- 47 45 5 g-education University Administrative Professional Not plan 12- 49 40 6 University g-education Professional Housewife Not plan 13- 53 48 4 University g-education Professional Housewife Plan 14- 54 44 5 University University Professional Administrative Not plan 15- 56 41 7 g-education University Unskilled Professional Not plan 16- 56 49 6 University g-education Professional Housewife Not plan (g-education=general education) 234 The decision to plan or not plan the family size is generally influenced by two perspectives of the Muslims: one is that children are gifts from God and Muslims must have many children (so they should not plan family size); and the other perspective which is that Muslims are responsible for providing good care for their children (so they should plan family size). This is based on the cultural values that are related to Islamic beliefs. The Muslims who hold the first perspective believe that it is wrong to practice family planning, as according to their interpretation of the Islamic doctrines, having a large family is complying with a religious duty of viewing children as gifts from God. They base this belief on the Quranic verse, “Money and children are ornaments of life,” (Surat Al-Kahf), and also on one Hadeeth (Prophet Muhammed’s words), “Be productive and multiply so I will be proud of you in front of other nations at the Day of Resurrection.” Furthermore, they believe that the means of living depends on ‘God’s Will’ so they do not need to fear poverty when they have many children. They rely on the Quranic verse, “Do not kill your children in fear of poverty, God will provide you plus your children with means of living” (Surat Al-anaam). However, Muslims who hold the second perspective support the Islamic beliefs which stress the importance of providing good quality care for children. For example, the Surat Al-Baqura verses states, “Every father is responsible for providing his children with their needs as best as he can.” Also there are many sayings of the Prophet Mohammed that urge Muslims to take good care of their children. For example, “Take good care of your children and be generous with them,” and “It is a sin for parents not to take care of their children.” Thus, any analysis of planning issues and fertility behaviour must be contextualised within an understanding of the importance of the Islamic faith and its influence on social attitudes and behaviour.

However, the qualitative analysis reinforced a deeper understanding of this issue: the four couples, who reported that they had planned to have a small family, did so because they were concerned about the quality of care and facilities they could provide for their children. For example, one husband said:

‘The idea behind my choice is I want to carry my responsibility toward my children in the best possible way. I know some parents who have a large number of children but they do not know anything about them, and sometimes they do not know all their children’s names. I think the best thing is to have children and be responsible enough to provide them with the best of everything, rather than having many children and not being able to adequately care for them. So I decided that three children is a

235 number I can handle, and we decided from the beginning of our marriage to plan for the children we want to have and we stuck to our plan.’ (Male, 41 years, 3 children, university education, and professional occupation)

Another husband who had planned his family size explained his interpretation of the Islamic beliefs about children, saying:

‘It is true that our religion urges us to marry and produce children but that does not mean to produce a baby every year… also our religion tells us to take good care of our children. So parents should organize and balance their financial resources and family size so they can provide their children with the best they can.’ (Male, 53 years, 4 children, university education, and professional occupation)

On the other hand, there were some differences in the explanations for not planning family size given by the different genders (among the 12 couples). Generally, men based their justification for not planning family size on religious reasons, which means they depended on ‘God’s Will’ that ‘God directs human life by destiny’, whilst also noting that children are considered as security for old age. For example, one husband said:

‘Actually the whole process of having children happens by God’s sanction and blessing. I told my wife once that I love and want to have many children, but we did not plan or discuss reproduction issues at all and each pregnancy occurred naturally. I also leave all our reproduction decisions open to ‘God’s Will’. I never thought about the ideal number of children for us and never think about negatives or consequences. Children are the joy of life and the happiness of the soul. At the same time they will take care of us when we get old.’ (Male, 43 years, 5 children, university education, and administrative occupation)

Based on the responses of wives who had not planned their family size, these can be divided into three kinds. The first kind give a religious justification for not planning their family size, the second kind see children as their main role in life and a large family as an advantage, while the third kind believe that a large family is a big responsibility when they are interested in expanding their role out of the domestic sphere. The following quotations will illustrate this point aptly.

236 The wives who justify not planning their family size for religious reason base their choice on their understanding of the Islamic beliefs that place a high value on children. As one woman said: ‘My husband and our families encourage us to have many children as our Islamic religion encourages all the Muslims to have many children to increase the number of Muslims. So my family is very big but I depend on God’s Will, I do not think of whether our income is enough or not.’ (Female, 46 years, 12 children, illiterate, and housewife)

Many women based their justification for not planning family size on gender role, as in Saudi Arabia, women’s role centres on reproduction. Thus women depend on the ability to reproduce to establish a prominent status within the family and society, along with old age security. One wife said: ‘I knew from the beginning of our marriage that my husband’s dream is to have a big family and I agree with him, as my children are my life and future. I achieved through my marriage all that I dreamed of. I also gain more freedom along with fulfilling my identity.’ (Female, age 36, 5 children, general education, and housewife)

By contrast, some wives were not happy about the lack of planning for family size. They needed to balance their main domestic role and their career (as they have paid jobs), so it became necessary for these women to plan for family size. But in doing this, some women faced many obstacles, especially in a patriarchal society. For example, one wife who has a high level of education and has a paid job expressed her suffering as a result of this situation (of not planning). She noted: ‘We did not plan any one of our five children. Now, after having grown-up and having become more mature with some experience in life, I felt that was the biggest mistake in my life. I will make sure to pass this lesson to my children in the future and that planning for their future (including reproductive decisions) should be their most important priority. In my case, we never discussed reproductive issues or planning anything in our life and that put me in a very difficult situation many times. For example when I was studying for my university degree or when I got a job, also when the eldest children needed more time and attention while I was so busy with the young ones which caused a decline in their school grades.’ (Female, age 36, 5 children, university education, and administrative occupation)

237 It can be concluded from the interview analysis that planning family size is not a widespread practice among the interviewees (as only 4 couples out of 16 couples had planned family size). However, it seems that when parents are concerned about the quality of care they provide for their children, they become more likely to plan for the number of children they want to have. Also, it was obvious that the couples who believe that Islam emphasises the quality of care provided to children are more likely to practise family planning, while the couples who believe that Islam encourages Muslims to have many children are more likely not to plan their family size. Moreover, there is a general belief that children represent great security for parents when they get old. In addition, many women value children as they secure a position in the family and society for their mother. Nonetheless it can be said from interview analysis that a gender- based structure in a patriarchal society such as Saudi Arabia puts some constraints on women’s participation in reproductive decision-making (as the last extract from an interviewee shows).

Discussion on Planning or Not Planning Family Size

It can be concluded from the survey analysis on planning family size that only 40 percent of survey respondents did plan their family size (in 2005), while in 2013 it increased to 48.5 percent. This outcome was also true for the interviewee couples (where 4 out of 16 couples did plan their family size, representing 25% of the interview sample). The survey’s results show that the preferred family size was 5 children for male respondents and 4 children for female respondents in 2005, while in 2013 it was 4 children for both male and female, which means that the ideal family size is relatively large among the survey’s respondents compared to other Gulf States, and most of the MENA countries (See Figure 1.1).

The likely outcome of lack of family planning in Jeddah, Saudi Arabia, or any society, is high fertility levels. This is reflected in the fact that in Saudi Arabia the total fertility rate (TFR) was still 3.2 for the period from 2005-2010, even though it has fallen from 6 in 1990. Mohammed (2003, p.63) has also noted that of the six Gulf States, Saudi Arabia and Oman have the highest initial levels of Crude Birth Rate (CBRs). Also, Saudi Arabia and Oman have experienced the slowest rates of decline in CBRs (0.2 percent and 0.4 percent per annum, respectively). Olmsted (2003) explains the high fertility levels in these two Gulf States by noting that ‘the stated policy in Saudi Arabia, Oman and Qatar was to maintain existing fertility levels and not to encourage birth control use,’ (p.87).

238 However, the survey’s results revealed that where parents do plan their family, it is related to a reduction in family size (see Tables 5.40 and 5.44). Furthermore, the survey’s results revealed that the younger generation were more likely to plan family size than the older generation and this was also the case for the interviewee couples (see Table 7.10). Moreover, the survey’s results showed that parents with high educational levels are more likely to practise family- planning (the interview analysis revealed a comparable outcome), although these results showed that male and female occupational statuses have a moderate effect on family-planning decisions. These results present empirical evidence for the ideas of well-known scholars who stress diffusion’s influence on fertility behaviour. Montgomery and Casterline (1993), Cleland (1985) and Retherford and Palmore (1983) note that the diffusion of the family planning concept and birth control, along with socioeconomic development, are important factors in fertility transition in the developed world and many developing countries. Thus, it was expected to find from the study results that the younger and the more educated respondents were more likely to plan their family size, as they are more likely to be open to new ideas and accept new concepts (such as contraceptive use and family planning). Moreover, Willekens (2014, p.7) highlights the role of diffusion processes and the significance of embeddedness in causing demographic transition in many countries. The embeddedness is illustrated in the many studies that view demographic transitions as part of larger transformations in society pointing at the influence of urbanization. Accordingly, as Saudi Arabia is venturing into more development this could produce a reduction in fertility level, and the beginning of a demographic transition process in the country.

Furthermore, the quantitative results reveal that the religious reason ‘it depends on God’ is the most important reason that the respondents give for not planning their family size. In a similar outcome, the interview analysis shows that for the husband, the family-planning decision- making is influenced by their religious beliefs on the value of children and some wives also share this attitude. The study results could present an empirical example for Ideational Theory as this theory emphasises the relationship between culture and fertility behaviours (Carlsson 1966; Friedlander et al. 1991; Lesthaeghe and Surkyn 1988; Woods 1987). The study results reveal that decisions about planning family size or not are based on the cultural values which are related to Islamic beliefs. Many Muslims believe it is wrong to practise family planning, as according to their interpretation of Islamic doctrine, having a large family is complying with a religious duty, as children are considered to be gifts from God. They base this belief on a

239 Quranic verse. At the same time it must also be noted that there is much evidence that Islamic beliefs stress the importance of providing good quality care for children. Thus any analysis of fertility behaviour must be contextualised within an understanding of the importance of the Islamic faith and its influence on social attitudes and behaviour. Although these beliefs are the outcome of various interpretations of the Islamic doctrine by many Muslims, there are also many Muslims who believe in planning family size, as they are concerned about the quality of care they want to provide for their children: they also base their beliefs on certain interpretations of the Islamic doctrine.

However, many sociological scholars who study the influence of religion on cultural values, and in particular Islam, note that they found different interpretations of the Islamic doctrine among different groups of Muslims. These scholars attribute this diversity of interpretations to diversity in the social context, as Muslims are of many different cultural, regional and ethnic backgrounds (Browne 2012; Dalmasso and Cavatorta 2010; Hasna 2003; McQuillan 2004; Obermeyer 1992; Omran 1992; Weekes 1984). These cultural norms and values shape or formulate the behaviour of society members. For example, McQuillan (2004), in his article on the relationship between religion and fertility, stresses the importance of religious beliefs in influencing people’s behaviour (including fertility behaviour). He notes that ‘more than most other social institutions, religions have elaborate moral codes that are meant to guide human behaviour, and many of the great religious traditions have given special attention to issues of sexuality, the roles of men and women, and the place of the family in the society,’ (p.27).

This link between religion and reproductive behaviour was evident also in other studies in developing countries. For example, Couwenberg’s (2010) study is based on qualitative research whereby data was collected in Irbid, located in the Northern part of Jordan, between March and May 2010, and included 25 women in the age group from 15 to 49. The study noted that several participants stated that it is forbidden: to pre-determine the number of births; to stop having children at all; or to have an abortion. They believe that the number of children in the family is ‘up to God’ (a similar response to this study). Further, a study by Browne (2012) concerning Islam and fertility in Senegal and Cameroon, based on data from Demographic Health Surveys and combined with information from qualitative focus group discussions, found that Muslim women were significantly less likely than their non-Muslim counterparts to use modern contraceptive methods (OR = .39; .494, respectively).

240 Additionally, the interview analysis shows that many wives believe that children represent great security for parents when they get old; some husbands also share this attitude (old age support was discussed in detail in Chapter Five under the value of children). This outcome is also prominently supported by the writing of eminent scholars like Caldwell (1982) in the Theory of Intergenerational Wealth Flows, and also by Mason’s (1987) argument that women’s position may affect the demand for children and gender inequality, making women believe that children are an assurance to a better status in the family and society.

This link was also evident in other studies in developing countries. For example, Hijab (2001, p.44), in her writing about the Arab world, states that ‘many Arabs tend to consider the family as the lynchpin of society and women as the core of the family.’ This is seen in the many studies in developing countries, as in Spierings’s (2010) work in Middle Eastern households, Ghosh’s (2015) study in India, Muhammad and Fernando’s (2010) research in Pakistan and Bandiera et al.’s (2015) study in Africa. All of these studies conclude that under-empowered women in the traditional societies commonly gain better social status through children as they can rely on them for possible old-age security, and especially on sons. This is also the case in Saudi Arabia. Furthermore, in her important work which explores the demographic situation in Gulf regions, Mohammed (2003, p.75) states that ‘only through motherhood can a woman achieve a complete social construction/identity, as a whole person with a productive worthwhile status.’ Also, more recently, the RAND report named Future Challenges for the Arab World (2011, p.6) noted that the momentum of cultural and religious traditions, and their use by religious leaders has worked to discourage female participation in the labour force, encouraging early marriage and large families while taking a dim view of birth control. Such attitudes serve to keep fertility rates higher than they otherwise would be. Additionally, in Haghighat’s (2013) article about women’s empowerment in the Middle East and North Africa, and also Hamad’s (2013) paper on the role of education and gender biases of women in Arab society, both state that in the MENA region, women’s primary role revolves around children and family.

Lastly, it was clear from the interview data that when parents are concerned about the quality of care and facilities which they can provide for their children they become more likely to plan their family size. This result could provide support for the writing of Becker (1991), who argues that the increase in the costs of child bearing could encourage the parents to shift from

241 the quantity of children to the quality of children. Also, Montgomery et al. (2000), through their article about the quantity-quality transition in Asia, note that ‘as many families decide to invest more intensively in their children fertility declined and an increase in school enrolments occurred in the countries of East and Southeast Asia.’ More recently Vogl’s (2015) work using micro-data from 48 developing countries, noted that increasing the attitude towards investment in children discourages the parents from having many children. Also, Ghosh’s (2015) study in India, based on a survey sample including 1,200 individuals (600 women and 600 men). The study found that aspirations for children have a significant negative effect on future childbearing.

The information that this study offers about planning family size could be very useful due to the lack of such data in Saudi Arabia. Also, it might help in providing an explanation for the changes that have occurred in fertility levels in the country.

Influence of the Extended Family

In Saudi Arabia, there is a strong cohesive kinship connecting extended family members, which involves moral and economic support. Many sociological researchers, through their work in Middle Eastern societies including Saudi Arabia, confirm the importance of kinship relations, as they are a representation of social solidarity (Al-Safe1997; Doumato 2001; Moghadam 2003; Mohammed 2003; Olmsted 2003). Furthermore, Yamani (2000), who is a Saudi researcher, indicates that ‘while Islam provides an ideological basis for social life in Saudi Arabia, the family unit is intrinsic to its order and manifestation, and within the extended familial structure lies a predominant patrilinear, patrilocal and patriarchal pattern enforced by the tribal values of honour and shame,’ (p.96). On the other hand, William Goode, the originator of Convergence Theory of Family Structure, argues that in modern and urban societies, extended family ties become less influential. Goode (1963, p.6) states that ‘wherever the economic system expands through industrialization family patterns change, extended kinship ties weaken, lineage patterns dissolve and a trend toward some form of the conjugal system generally begins to appear - that is the nuclear family becomes a more independent kinship unit,’ (see also Bongaarts 2001; Burch 1967; McDonald 1992). Therefore, it was considered important to examine whether the extended family plays a significant role in the reproductive decision-making of the parents in the nuclear family or not.

242 As there is a lack of other research in Saudi Arabia on the influence of the extended family on a couple’s planning of family size, it was considered important to investigate this issue in more depth through an in-depth interview analysis. This helps to explain this issue in the light of the Saudi Arabian cultural context, which places a great emphasis on kinship relationships. In this social context, the social interaction among extended family members is to support each other, or feel obligated to support each other, in a way that protects and maintains the society’s values, such as the high value placed on children. Thus, the interview analysis revealed that all the interviewees report they either had or are still having financial support from their extended families. This difference between survey respondents and interviewees could be because that the interviewees’ represent higher income categories and a higher socioeconomic status compared to the survey respondents.

Some of those couples had support from the family at the beginning of marriage; for others the extended family started to support them financially after they had children (especially many children), so they could manage to provide for all of their children’s needs. For example, one man said: ‘You know when children grow up their requirements increase exponentially, and both our [birth] families assisted us financially, especially my wife’s father who always helped us out by paying for school fees and other critical financial matters…in the future I will advise my children to practise family planning if there seems to be any problems relating to income.’ (Male, 43 years, 5 children, university education, and administrative occupation)

By the same token, one woman said: ‘I do not think we could make ends meet without my parents’ continued financial support, with all the various requirements and necessities of a family as large as mine (with five children to support), our income alone cannot ensure provision for all our family’s needs.’ (Female, 36 years, 5 children, university education, and administrative occupation)

In addition to the economic support that the extended family provides, it is useful to look at whether they also promote a preference for large families. Further investigation was carried out to explore the influence of the extended family, which is whether the members in the extended family encourage the new parents to have many children. This factor is important as it helps to understand the role of social networks in encouraging certain cultural values regarding

243 reproductive behaviour. Interview analysis illustrates that all the 16 couples also reported that their extended family always expresses views that reinforce the high value placed on family and children. But at the same time, all 16 couples indicated that their fertility decision-making was made independently within the nuclear family: particularly if the parents had high education levels and were convinced or decided to have a certain number of children or perhaps had concerns about the quality of care that children need. This is seen in the following two examples, in which the husband in the first family and the wife in the second family did not respond to their extended family’s encouragement to have more children. The man said:

‘From the beginning of our marriage we decided to have two to three children only, and that’s what happened. Both my and my wife’s extended family always try to encourage us and give us exhortations to have more children. My wife and I consider children as a great responsibility, especially today children’s necessities have increased tremendously so I don’t think we will change our decision.’ (Male, 35 years, 3 children, university education, and administrative occupation)

Also, one woman indicated: ‘Our extended families want us to have a big family, as they believe that God provides the economic support for the parent with every child that comes to the family. But after having four children, my health became weak and even the doctor advised me to use birth control. So I did.’ (Female, 38 years, 4 children, university education, and professional occupation)

However, there are some couples who do consider their extended family’s advice about having many children and hold the same viewpoint as their extended family, in which all believe that Islam promotes Muslims to have many children. For example, one man noted:

‘My and my wife’s extended families constantly encourage us to have a large family as they think children are gifts from God. So children bring God’s blessings and well-being to the family. Thus I have a big family as I believe the same thing as my extended family.’ (Male, 45 years, 12 children, able to read and write, unskilled occupation)

Also, one woman responded to my question on whether the extended family had any impact on reproductive decision-making by explaining how her extended family and also the extended family of her husband have greatly influenced her and her husband. She stated:

244 ‘Yes I think they have a major influence; in my case that was so true. My in-laws were encouraging and insisted on us having more children especially after the long period I had after our second child and now they encourage us to try another time so maybe I conceive another son. Also my family gives much more encouragement and inducement. In my father’s opinion 3-4 or 5 is not enough or acceptable; he thinks 12-16 or, better, 20 children is acceptable. My father used to give me very expensive and precious presents after the birth of each of my children. Additionally, he continues financial support to us (my own family). Furthermore, my father discusses this issue every week and gives us lectures on how precious children are. After the long period I had after our second child, he tried to convince me in the beginning of that period, then he sometimes stopped talking to me as punishment for refusing to have more children, and always reminded me or told me some Islamic reference regarding this issue from the Quran and Sunaa. So I think that without all those influences, especially from my family, certainly I would not have thought of having five children.’ (Female, 36 years, 5 children, university education, and administrative occupation)

In conclusion, the interview analysis revealed that the extended family plays a supporting motivational role in family size, by encouraging the high value of kinship relations and the importance of family. Nonetheless, spouses have the freedom to independently make their decisions regarding reproduction. So if the couple held the same viewpoint as their extended family concerning children, then the extended family became a motivation for parents to have a big family themselves, while if the couple held a different viewpoint to that of their extended family, they had the ability to make their own decisions on fertility matters.

Discussion on the Influence of the Extended Family

It can be concluded from the survey’s results that many respondents say that they did not have financial support from their extended families. Although all of the 16 interviewee couples said they have financial support from their extended families, those couples are from a higher socioeconomic status (except one couple) compared to the survey respondents.

The survey results showed that the financial support from the extended family did not influence the reproductive decisions of the younger age group (15-30 years) but did show some influence on the older age groups (31-45 years and 46-60 years). However, it can be said that both male and female survey respondents independently made their decisions concerning their family

245 size, without great influence from their extended family. This could impact on fertility levels in the future in Jeddah, Saudi Arabia, if changes occur in the preference for family size among new parents in the nuclear family. This was also the case for interviewees as the interview analysis shows that the extended family plays a supporting motivational role in influencing family size, by encouraging the high value of kinship relations and the importance of family. This motivation becomes more effective if the new parents hold a similar attitude towards children and the family. However, in general the interviewees indicated that they could make their reproductive decisions independently. These results could present an empirical example for the convergence theory of family structure of Goode (1963), as he expected the weakening of the extended family ties and the independence of the nuclear family unit, a link that has also been established in the writings of many family sociologists (see for example Bongaarts 2001; Burch 1967; McDonald 1992).

Moreover, as the study results revealed that many survey respondents did not have financial support from their extended families, this could lead to a reduction in family size in the future. Some studies in other developing countries report a decrease in the fertility level because of a decrease in financial support from the extended family. For example, Wusu and Isiugo-Abanihe (2006) performed a study in Nigeria that was based on qualitative data generated through nine focus groups, four with men and five with women. Each of the focus groups comprised between seven and nine participants. Wusu and Isiugo-Abanihe (2006) have noted that a notable decline in desired family size and ideal number of children has occurred in Nigeria as a result of a decrease in financial support from the extended family to new parents. Also, Caldwell et al. (1992) earlier supported this outcome in a study in Africa that was based on a schedule of detailed questions and accompanying in-depth interviews of 601 women aged 18- 49. Caldwell et al. (1992) state that the reduction in extended family support makes new parents more careful about the costs of raising children. Therefore, if the extended family support to the new parents diminishes, and if the pattern of small family size diffuses in Saudi Arabia, this could lead to a further decline in the fertility level in the future. Nevertheless, there are some studies in other developing countries which show that the extended family did support childrearing and also did influence reproductive decisions. A recent study by Ajayi and Owumi (2013, p.255) in Nigeria found that within the extended family system or lineage, the costs of raising children are not borne solely by the biological parents, as very close relatives also share the costs of rearing children, in terms of emotion, time, finance and other material support,

246 since all children together comprise the strength of the lineage. Additionally, Kumar’s study in India (2014) using both quantitative and qualitative data, which included 450 households, found that the mothers of young couples influenced their reproductive decisions concerning family planning use and family size preference (OR: 1.72; P<0.05).

Ultimately, the results of this part of the study might help in showcasing the decrease in the fertility level in Saudi Arabia and its correlation with the pattern and structure of the familial relationship. Also, this outcome might help in filling the gap in knowledge concerning the influence of the extended family’s role in reproductive decision making: especially in light of the change that is occurring in the structure of the family in urban societies.

Conclusions

It can be established from this study that an early age of marriage is still frequent in Jeddah, Saudi Arabia, and that this affects fertility levels. The structure of Saudi Arabian society makes early marriage advantageous to women, as they gain greater social mobility and their future well-being is guaranteed. However, there was also evidence of an increasing propensity to postpone marriage, as some women of high socioeconomic status thought that education was a more important aspiration. Moreover, as men hold the power in marital relationships, all men highlighted the benefits and positive accomplishments gained through marriage, such as providing a secure morality and stable companionship for the family.

Moreover, the value placed on children was based on a cultural context, such as the interpretation of Islamic beliefs that having a large family is complying with a religious duty, the pride toward kinship as they represent a source of sustenance and cohesiveness and also considering children as insurance for old age. Due to the above, Saudi Arabian culture places a high value on children. Also, it seems that women’s position may affect the demand for children, especially if the social context (as in Saudi Arabia) centres women’s role in the domestic sphere.

Further, the study results verified a preference for male children, and also indicated variations in couples’ overall responses with regard to this particular preference. In the Saudi Arabian context, the importance of having male children is based on Saudi conceptualizations of gender role requirements as to responsibilities and duties; this is, in effect, a patriarchal system giving primacy to males over females in many social aspects. For instance, parents deemed that male 247 children were more effective and had more freedom in society than female children. Also, in a patriarchal culture, sons could give mothers greater social mobility and also help fathers in taking care of family responsibilities outside the home. However, it is important to pay careful attention to the debate between religious beliefs, cultural background and power relations within the patriarchal gender system, as this constructs people’s attitudes and behaviours, which then help in understanding people’s perspectives towards fertility and reproduction.

Additionally, this study revealed that the social context in Saudi Arabian society encourages the traditional division of labour by gender. However, the patriarchal structure also provides further support for this by limiting female access to the public sphere, which strengthens women’s economic dependence on men and they then bear a greater part of the childcare burden. Almost all men admit that they engage in a very small part of everyday childcare as they are fully occupied by their career obligations to ensure financial resources for the family. Also, the patriarchal structure in Saudi Arabia in general gives the husband control over the economic resources, and puts some restrictions on women’s freedom of movement.

Moreover, the high fertility rate in Saudi Arabia is partly the outcome of the role of the gender in Saudi Arabian culture. The study found that under such a gender system, many women experience difficulties in discussing reproductive issues with their spouses, in particular if they face a strict or tough masculine power regime within the household. In addition men are mostly in charge of decision-making within the family, influenced by cultural inheritance, which is the norm in a patriarchal society such as Saudi Arabia.

Furthermore, the study results establish that there is a high level of diffusion of contraceptive knowledge, although interview respondents were not very open about discussing their detailed practice of contraceptive methods. However, they offer general information as they talk about their knowledge of several methods of contraception and their source of contraceptive knowledge. Also, the study found that overall, people believe that using contraception is permitted in Islam if needed (e.g. for birth spacing, for the benefit of the mother’s health, facilitating good care of living children). Planning family size was not very common among the study respondents, as from the interviewee couples, only 4 out of 16 couples planned their family size. Also, the interview analysis showed that for the husbands, family-planning decisions are influenced by their religious beliefs about the value of children: a belief that some wives share. Moreover, the interview analysis revealed that the decision over whether to plan

248 family size or not was based on cultural values which are related to Islamic beliefs. Many Muslims believe it is wrong to practise family planning, as they believe that having a large family is complying with a religious duty as children are considered to be gifts from God. There are also many Muslims who believe in planning family size as they are concerned about the quality of care they want to provide for their children. Furthermore, the interview analysis shows that many wives consider their children as a security for old age, a belief shared by some husbands. Also, the interview data revealed that holding high aspirations for children is an important factor that could encourage family planning. Lastly, the interview analysis and the study results showed that the extended family plays a supporting motivational role in influencing family size by highlighting the value of kinship relations and the importance of family.

After presenting the analysis of the study findings, it was important to discuss in the next chapter the significant outcomes of this study and their contribution to the knowledge of understanding reproductive behaviour patterns in Jeddah, Saudi Arabia. It was also vital to present some policy implications and make suggestions for future research.

249 Chapter Seven Concluding Remarks

Introduction

The population of the Kingdom of Saudi Arabia was estimated at 31.54 million in 2015, with a projected annual growth rate of 2.1 percent (UNFPA 2011; United Nations 2015). Meanwhile, previous data from the Saudi Arabian census of 2004 shows that the population size was 22,678,262 in 2004. Although there has been a significant decline in the total fertility rate (TFR), which had moved from around 6 in 1990 to 4 by 2004 and 3.2 in 2010, Saudi Arabia still retains the highest fertility rate in the Gulf region (see Figure 1.1). It is therefore clear that understanding population dynamics and fertility change represents an important and pressing concern for Saudi Arabia. This concern is all the more significant given that Saudi Arabia is a developing country (according to the United Nations and the World Bank) which has one of the highest population growth rates and fertility rates in the world.

According to United Nations reports on Saudi Arabia, the government of Saudi Arabia is facing a challenge in planning work in several areas in order to improve socioeconomic development and assist the fulfilment of the Millennium Development Goals (MDGs). Several economic and development reports from the World Bank (2005, 2007, 2010 and 2015) state that, despite enhanced growth prospects, current forecasted economic growth rates are not enough to fundamentally address the large development challenge, owing to its huge rise in population. Clearly understanding the dynamics of this population growth is crucial if Saudi Arabia is to respond to its development challenge. On this topic, this thesis can make a valuable contribution. Moreover, a further major and broader implication for this study is that a deep understanding of reproductive behaviour patterns in the area could help in the fulfilment of one important and fundamental Millennium Development Goal, which is to increase intervention for safe motherhood to prevent women from suffering from infections, injury and disability and to save the lives of half a million women and seven million infants who die each year (United Nations 2005, 2012, 2013).

250 This research aimed to provide a detailed understanding of fertility behaviour in Jeddah, Saudi Arabia, in an attempt to address these concerns around fertility change. This broad aim was established through the following main objectives: to establish a comprehensive understanding of the relationship between the gender system and reproductive behaviour; to determine the role of culture, religion and social networks in influencing family planning decisions; to analyse the changes that occur in fertility trends in a period of 8 years (2005-2013); to describe the function of using innovative methods in achieving such a sensitive study in a conservative society. The study aims were fulfilled through a comprehensive questionnaire survey that encompassed both male and female participants, along with information from in-depth interviews that supported the delineation of those objectives. Through a mixed method approach, this study has utilized the various benefits of combining both methods in one research project, which has resulted in the generation of a deeper understanding of fertility behaviour.

This chapter first identifies the important outcomes of this study in sections, then illustrates the more general contribution this study makes to the knowledge and literature on reproductive behaviours. It then presents some recommendations for policy- making, followed by the study’s limitations, and lastly outlines suggestions for future research on reproductive issues in Saudi Arabia.

Summary of Study Outcomes

The study outcomes indicate that an early age at marriage is common in Jeddah society, in particular for females (the modal age of marriage for males was 23 years, and was 18 years for females). While the latest survey demonstrated a rise in the mean age of marriage, of 4 years for males and 3 years for females in a period of 8 years (2005-2013), females still enter marriage at an early age (21). The qualitative data explained this outcome as based in the fact that, in traditional societies like Saudi Arabia, women have limited access to the public sphere which makes them dependent on males and centres their roles on the household sphere. Thus, in such societies, marriage is regarded as advantageous to women, as they gain greater social mobility with marriage and their future well-being is also guaranteed. Moreover, many men believe that marriage finalizes a man’s religious duties as a Muslim. They also highlighted the

251 benefits they accomplished through marriage, such as providing a secure morality and stable companionship for the family. However, many women (in the interviews) show their preference for postponing marriage in order to spend more years in education; this could be an important outcome of the socioeconomic development that Saudi Arabia is experiencing, and in particular of the increase in educational participation (especially for females).

Furthermore, this study revealed that Saudis place high value on children and the family, as children represent the flow of wealth from children to parents. This could be beneficial in explaining fertility behaviour in Saudi Arabia. The study shows that the values of children were based on the cultural context, such as the interpretation of Islamic belief that having a large family is complying with a religious duty. Also, these values reflect pride toward kinship relationships as they represent a source of sustenance and cohesiveness and also considering children as insurance for old age. By this means, Saudi Arabian culture places a high value on children. Furthermore, it seems that women’s position may affect the demand for children, especially if the social context (as in Saudi Arabia) centres women’s role in the domestic sphere. Nonetheless, the latest survey suggests that improvement in women’s status could reduce the dependence on children, and also decrease the motivation for having many children in order to gain high status in society.

The study results also show that both parents had a strong preference for male children, although the latest survey shows a slight decrease in this male preference. This in effect is a patriarchal system giving primacy to males over females in many social aspects, and Saudi Arabian society is indeed patriarchal. The qualitative data describes a situation where in a patriarchal culture, sons could give mothers greater social mobility and also help fathers in taking care of family responsibilities outside the home. Moreover, it is apparent that male preference presents an important factor that could influence fertility behaviour. However, a preference for sons might have more effect on fertility levels in the Saudi Arabian context, as Islamic law forbids abortion unless it is due to a critical situation. Thus, sex-selective abortions are unlikely to be practised in Saudi Arabia, as abortion is illegal according to Saudi Arabian law.

The study found that by and large, the social context in Saudi Arabian society supports the traditional division of labour between the sexes. Also, the patriarchal structure provides further

252 support for this by limiting female access to the public sphere, which strengthens women’s economic dependence on men and they then bear a greater part of the childcare burden. However, the latest survey showed a growing change in this division of labour as there is an increase in the men who think they should be involved in taking care of responsibilities linked to their children, and so they were more involved in household responsibility, which in turn could contribute to greater gender equality. The interview analysis provides further support for this general gender-based division of labour, as the majority of males stated that they believe that the responsibility for taking care of children is a woman’s most important duty in life. As well as this, almost all men admitted that they engaged in only a diminutive part of everyday care for children, as they were fully occupied by their career obligations, being mainly in charge of ensuring the financial well-being for the family. Also, all women from the interviews confirmed those male statements.

Moreover, this study concludes that the male is overall in control of economic resources and spending within the family, and also that women face some limitations on their freedom of movement. Although the latest survey found some decrease in these restrictions (over economic resources and movement). The interview data give supplementary clarification to the permission issue in that the patriarchal structure and the division of labour by sex in the Saudi Arabian context generally makes the female dependent on males, especially as they have limited access to paid work. Thus, they have low autonomy in controlling the economic resources within the household. Also, the interviewee results explain that the extent of strictness in obeying religious values regarding women’s movement outside the house could influence this matter. Therefore, in general, Saudi Arabia is a patriarchal society and women’s autonomy is predominantly still controlled by men.

Additionally, the results of the 2005 survey showed that many women found difficulties in discussing reproductive issues with their spouse. However, couples who discussed fertility issues had fewer children than couples who did not discuss such matters. Also, the generation as well as the educational and occupational statuses of both males and females have a significant influence in promoting the discussion between spouses about reproductive issues. The latest survey displayed a significant change in attitude toward discussing reproductive issues, and especially from female respondents (from 37 female respondents in 2005 to 62 in 2013). This could be a validation of the improvements in women’s status and a more egalitarian

253 relationship between genders. In-depth interview data revealed that discussion between spouses could generate more mutual reproductive decisions. Although sometimes discussion between spouses does not generate agreement in opinions, this conflict or disagreement between couples, regardless of the existence of discussions, possibly reflects gender stratification in the Saudi Arabian context. This was obvious from the interviews, which showed that generally men believed they had the right to decide about reproductive matters and that women should accept their decisions. As men are supporting this right by religious beliefs (Alqawama) and cultural tradition that gives the authority to men, women generally conceded to this male authority, and did not discuss reproductive matters with their spouse, as they believed that their opinion would be disregarded. However, interview data showed that sometimes women’s education and work did not give them greater autonomy, particularly if they faced a strict or tough masculine power regime within the household.

Moreover, this research reveals that men are predominantly in control of decision-making in the family, influenced by the society’s cultural traditions, which is construed as ‘natural’ in a patriarchal society such as Saudi Arabia. The latest survey revealed an increase in the number of respondents who reported that they had shared decision-making (from 71 to 84 respondents). However, whenever the reproductive decision was shared between spouses, there was a greater probability the family size would be smaller. Also, higher education of both sexes and a high occupational status both showed effective influence in precipitating more shared fertility decisions between spouses. Evidence from the in-depth interview analysis clarifies this outcome in that Saudi Arabian culture sustains the traditions that reinforce women’s obedience to men from early childhood, and the social context makes women dependent on males as they have limited access to the public sphere, which gives the men greater power in decision-making within the family. Men support this authority with religious beliefs (Alqawama and the right of divorce). However, the interviews showed that an enhancement in women’s status could produce more mutual reproductive decisions within the family.

In addition, the survey found that there is a high level of diffusion of contraceptive knowledge among study respondents and their social networks, and correspondingly the use of contraceptive methods is also high among them. Also, both males and females reported knowledge of several methods of contraception, and in general males base their knowledge on

254 sources outside the family network, whereas females depended on close networks. Furthermore, many male and female respondents believe that contraceptive use is permitted in Islam if needed. Only very few respondents believe that Islam discourages contraception. This result could explain the high diffusion of contraceptive knowledge and practice among study respondents and their social networks. Also, the study reveals that the use of contraceptive pills is the most prevalent method among study respondents and the second most popular method is the IUD. However, the latest survey displays a change in the female respondents, as more females reported their knowledge about contraceptive methods used by males. Besides, both male and female respondents said they took information from their spouse. This could be evidence of an increased closeness in the relationship between spouses and an expanded bond to the family and lessened masculine attitude. Plus, the younger generation and the more educated parents hold more liberal attitudes toward contraceptive use, as they believe that using contraception is permitted in Islam. Interview analysis revealed a similar outcome to the survey, but participants did not discuss their practice of contraception openly or in detail, as they found it too sensitive and private an issue. Although most of the interviewed couples used contraception only for a limited period, the analysis shows that if the couples have a good physician, this could make contraceptive practice safer with fewer side effects, and it might lead to better advice for the mother’s health.

Moreover, the survey results showed that only 40 percent of survey respondents did plan their family size. Also, the preferred family size was five children for male respondents and four children for female respondents. However, the latest survey displayed an increase in the number of respondents who planned for family size to 48.5 percent. Also, the ideal number of children decreased for the male sample to 4 children in 2013. Yet the ideal family size is relatively large among survey respondents compared to other Gulf States, and most of the MENA countries.

The survey results revealed that where parents do plan their family, this is associated with a reduction in family size, and the younger generation with high educational levels are more likely to plan family size. Moreover, the religious reason, ‘it depends on God’, was the most important reason that the survey respondents gave for not planning their family size.

The outcomes for the interviewed couples show that only 4 out of 16 couples did plan their family size and the decision whether to plan family size or not was based on cultural values that

255 are related to Islamic beliefs. Many Muslims believe it is wrong to practise family planning, as they believe that having a large family is complying with a religious duty, as children are considered to be gifts from God. There are also many Muslims who believe in planning family size, as they are concerned about the quality of care they want to provide for their children. Thus, interview analysis revealed that when parents are concerned about the quality of care and facilities they could provide for their children, they become more likely to plan their family size.

Furthermore, this study demonstrates that the extended family provides a supporting motive for parents to have a large family, by highlighting the value of kinship relations and the importance of family. Also, many survey respondents did not have financial support from their extended families. It seems from both surveys that the growing urbanisation in the Saudi Arabian society weakens the extended family influence, while almost all in-depth interview respondents indicated that they had financial support from their extended family. Nonetheless, the majority of couples stated that they have the freedom to make their reproductive decisions independently from their extended family.

After presenting the main findings of this study, the broader contributions of this study will be discussed below.

Importance of the Research

The broader contributions of this study revolve around three main issues: the implications for the sociological literature; the implications for fertility studies approaches; and the implications for research methods. All of these issues will be discussed in detail below.

Implications for Sociological Literature and Theory

In light of the above results, it can be said that this study has contributed in filling a gap in knowledge about reproductive decision-making in Saudi Arabia and has contributed towards information that will aid in understanding fertility patterns in Jeddah, Saudi Arabia. The original contributions regarding fertility patterns that this study has provided have involved six points: first, the study results provide further support to several theories that explain fertility behaviour, such as the demographic transition theory and wealth flow theory; second, the significant influence of the gender system on reproduction decision-making; third, the need to 256 advocate an approach that depends on several dimensions for examining women’s status; fourth, the importance of Islamic perspectives; fifth, the important influence of social networks on changing attitudes towards family planning and contraceptive use; and lastly, the role of cultural values in influencing fertility behaviour and the motivational values that encourage high fertility These are discussed in detail below.

Firstly, the study results provide further support to several theories that explain fertility behaviour. The outcomes of this study provide empirical support for the influence of socioeconomic factors as important factors that could delay marriage and reduce fertility. This is stressed by the Demographic Transition Theory, in that urbanisation is raising women’s age at marriage through providing them with varied opportunities outside the household through education and paid work. Also, the outcome of this study concerning the value placed on children could provide empirical support to Caldwell’s theory of intergenerational wealth flow, as he notes that in a traditional society, children promote their parents’ social status and bring honour to the family. Further, ideational theories stress the role of cultural values in explaining fertility difference, and thus the study results provide an example of the fundamental role that Islam plays in people’s beliefs and choices in Saudi Arabia, which could show the vital role of religion in reproductive decision-making.

Secondly, the study reveals the significant influence of the gender system on reproduction decisions in Saudi Arabia. The findings of this study were also supportive of the sociological literature that stresses the importance of understanding gender relationships, power relations, and the status of males versus females in the society as a way of explaining fertility behaviour (as for example, McDonald 2000; Mason 1987, 2001, 2003; Mumtaz and Salway 2007; Malhotra 2012; Upadhyay et al. 2014). Also, the study results could present an empirical example for the theoretical argument that greater gender equality in relationships could reduce fertility levels (Folbre 1983; McDonald 2000; Mason 1987). Moreover, the findings of this study agree with the theoretical perspective that female education and participation in the labour force enhances women’s status, which then improves their role in reproductive decision- making (Bbaale 2015; Caldwell 1983; Jeffery and Basu 1996; Jatrana and Pasupuleti 2013; Shapiro 2011; Unterhalter and North 2011). Nonetheless, this study also advocates the sociological position of some scholars who believe that women’s educational levels and

257 occupational status are in themselves not enough to enhance women’s status in decision- making unless accompanied by or related to a broader social context that supports gender equality. As Malhotra (2012) and Lee-Rife et al (2012) suggest, the gender system plays an important role in determining whether women’s education and economic activities actually increase women’s autonomy within the family.

Thirdly, this study advocates an approach that depends on several dimensions for examining women’s status, and this multiple approach has enabled this study to establish in-depth and thorough information about women’s status in Jeddah, Saudi Arabia. However, several studies have revealed that women’s educational levels and occupational status alone are not adequate for a sufficient examination of women’s status in the society (for support of this viewpoint see for example Acharya et al. 2010; Jejeebhoy 2001; Mason 1997, 2001, 2003; Malhotra 2012; Upadhyay et al. 2014; Wado 2013). That multiple approach was therefore carried out through the application of the following dimensions: division of domestic labour in respect of the responsibility for children, the role in reproductive decision-making, the ability for women to be able to buy something for themselves without permission, and the ability to go out without permission. Using such an approach enabled this study to present an extensive examination of women’s status in the Saudi Arabian context, which is indeed more valuable than if the study had focused only on women’s educational and occupational status.

Fourthly, this study illustrates the importance of Islamic perspectives in understanding reproductive behaviour. This research sustains the sociological argument that Islam is not a patriarchy. Much literature supports the idea that Islamic doctrine does not encourage male dominance over women, and in fact that this male dominance is related to cultural factors (Hasna 2003; Inhorn 1996; Obermeyer 1992, 1994; Omran 1992). Also, this study advances the debate by presenting pioneering information regarding the impact of Islamic beliefs on determining women’s roles in decision-making within the family. This is demonstrated through illustrating women’s part in the actual process of reproductive decision-making and the diversity in people’s interpretation of the Islamic doctrine; it also shows the implications between Islamic influence and gender relationships in the society.

Fifthly, this study helps to reveal the influence of social networks on changing attitudes towards family planning and contraceptive use. This study’s outcome could be considered

258 confirmation of the significance of social networks in changing attitudes towards contraceptive use, which is supported by many sociological scholars (Bongaarts and Watkins 1996; Bongaarts and Casterline 2013; Gandhi 2013; Kohler 2001, 2012, 2013). For example, Kohler (2013) notes that it has been argued that the diffusion of reproductive and contraceptive innovations through social interaction significantly accelerates the pace of fertility changes. Such an argument is supported by this research; this is also demonstrated with the majority of both male and female respondents using contraception as their social networks had already used it.

Lastly, this study additionally demonstrates the role of cultural values in influencing fertility behaviour, and the motivational values that encourage high fertility. This study advocates the viewpoint of sociological researchers that couples’ values and beliefs concerning having children influence their fertility behaviour. As Jones and Leete (2002, p.122) stated from their study in some Asian countries, ‘the ideational explanation of fertility change is linked with the cultural values that (are) attached to children. Thus, the value system could be a driving force to reproductive behaviour s’ (for more support of this issue see Conzo et al. 2015; Ibisomi and Odimegwu 2011; Khan et al. 2012; Lunani 2014; Sen 2013). Also, the study results could present empirical evidence to the Ideational Theory that emphasises the link between religious beliefs and fertility behaviour (Lesthaeghe 2010, 2014; Lesthaeghe and Surkyn, 1988). This study illustrates the important role of Islamic beliefs in promoting the high value placed on children in Saudi Arabian society, which influences planning decisions.

Implications for Fertility Study Approaches

In addition to making a contribution to the sociological literature, this study also has implications for approaches to fertility studies. As there have been few studies of fertility in Saudi Arabia, and there is a scarcity of information in general concerning the society of Saudi Arabia, the basic objective of this study was to contribute to presenting a deeper, gendered- based understanding of several issues in relation to fertility, and to seek to fill the gap in knowledge on fertility issues in Saudi Arabia. Therefore, in order to establish such deep understanding of fertility behaviour, this study employed a mixed methodology, to benefit from a combination of both quantitative and qualitative approaches. As Cameron (2011) and Heyvaert, et al (2013) emphasizes, using mixed methods provide pleasing results as a

259 consequence of bringing together a range of perspectives which offer unique insight into the complex process of learning in a subject domain.

Saudi Arabia is a conservative society in the sense of its entrenched patriarchal system and strict gender segregation. In addition, its social structure abides by and adheres to the Islamic faith and its traditional value system. Nevertheless, this study examines a very sensitive subject, reproduction, which is considered a private matter. Also, this study explores gender relationships, which is an issue that has rarely been studied in Saudi Arabia, as it is extremely delicate and prone to problems in data collection. Thus, a pragmatic approach to data collection was essential to attain the required but sensitive information. It was therefore decided that using quantitative methods to collect data from men and women on a large-scale was the most appropriate way to establish general patterns of and attitudes to fertility in Jeddah, Saudi Arabia. By contrast, qualitative methods using a small-scale sample were considered most suited for collecting in-depth data to understand those patterns. This mixed method approach was successful and is recommended in future approaches to fertility studies elsewhere, as it enabled profound data and better understanding on such a complicated and sensitive subject as reproductive behaviour.

A further important recommendation of this study is to include both male and female data collection as both are involved in this issue, and in particular to examine the power relationship between husband and wife to gain a complete understanding of the issues relating to fertility behaviour patterns. Although several previous studies have pointed out the potential importance of including men in reproductive research, in reality they have often only involved women. Greene and Biddlecom (2000, p.84) highlight this problem of excluding men from fertility studies by noting that ‘the neglect of power relations both inside and outside the relationship has made it difficult to make sense of reproductive decisions in different contexts. Also the lack of information on men implicitly overemphasizes female responsibility for reproductive behaviour’ (for further support of this viewpoint, see: Barker et al. 2011; Char 2011; DeRose and Ezeh 2005; Ghuman et al 2006; Ijadunola et al. 2010; Koffi et al. 2012; Mishra et al. 2014). This research employed a gender-based approach, and generated detailed insight from both men and women, and this approach is recommended in future studies for the depth of data it can provide.

260 Sensitivity to Cultural Context and Implications for Research Methodologies

The outstanding implication for this study emerged from the ability to examine such a sensitive subject as fertility, which is considered private and confidential in any society. In particular, information on this kind of sensitive issue becomes much more difficult to obtain in a conservative and segregated society such as that of Saudi Arabia. Thus, another important implication for this study relates to the possibility of providing qualitative data through the in- depth interviews. In particular, these interviews needed to include both men and women as Saudi Arabia is a truly segregated society and this qualitative data gave essential and valuable depth to this thesis.

Special arrangements were needed to access survey and in-depth interview respondents. This required informal procedures, so as the researcher, I had to call into play my (extended) family’s status and social networks in order to guarantee full co-operation from institutions and individuals alike, and to secure private, confidential, and credible understanding and endorsement. Thus, breaking down the wall between respondent and researcher in Saudi Arabia involved removing certain obstacles, and it was only by using familial and social networks and connections (wasta) as leverage, that I was able to overcome such obstacles in order to utilize bona fide and valid sociological data procurement methodologies.

Thus it is clear that this study has much to offer the methodological literature in arguing for researchers to take the cultural context into account and adapt and apply methods to that specific context. A geographical or spatial sensitivity to the employment of particular research methodologies is thus a final contribution of this study.

Policy Recommendations

After presenting the study outcomes and implications, it is useful to put forward the following policy recommendations, as they could assist in planning for the socioeconomic development of Saudi Arabian society. There are four key recommendations that arise from this study.

First, consideration should be given to the development of programmes and institutions for taking care of the elderly in order to reduce the pressure on family members, as they are currently taking full responsibility for caring for elderly members of the family. These institutions for the elderly could help to reduce the fertility level in Saudi Arabia, as many 261 parents believe it is better to have many children in order to care for them when they become old.

Second, there should be an enhancement of women’s participation in political decision-making, particularly in regard to women and children related issues. This demands several changes at the political level, as for example the full activation of women’s role in the state consultative council (Magless Shura), to enable them to participate in developing policies that act in favour of women.

Third, there needs to be an improvement in female participation in the national economy by increasing opportunities for women in paid employment, as well as developing policies to provide working women with more freedom to practise their work independently. This is important as it could reduce women’s dependency on men, which then could assist in enhancing their social status.

Fourth, there should be family planning counselling or support facilities operating to improve the awareness of safe motherhood and provide expert advice on contraceptive practice, and also offer free contraceptive services.

Study Limitations

This study has several general limitations, as does any study undertaken by a single researcher; these encompass time limits, efforts and ability. The time limit for this research was the time specified for the PhD scholar (in this case, on a part-time basis), while the efforts and ability of a single researcher are bounded or limited by, for example, the difficulty of handling a broader research issue or large scale sample, or looking at multiple regions. Ability to some extent was hampered by conducting the research at the same time as holding down a full-time job (Lecturer in Sociology Department in King Abdul Aziz University) and managing a family of five children.

Moreover, this study also faced several particular limitations related to the social context in which it took place. First, one of the major limitations of this study was the scarcity of references regarding reproductive matters and gender systems in Saudi Arabia, and also the difficulty in obtaining statistical data with respect to reproductive issues (for example, statistics 262 on contraceptive usage). This placed an important limitation on this study in terms of gaining comparative data.

The second difficulty or limitation was the cultural barrier or impediment to this type of research. This study concerns sensitive issues and it was conducted in an extremely traditional and conservative society and culture, where such matters are rarely discussed outside the medical arena. Furthermore, Saudis live in a truly segregated society and cultural traditions disapprove of men and women mixing, particularly when dealing with sensitive issues. Thereby, this study had to make several adjustments within the different stages of the research process. For instance, adaptations were made to the sample strategy: the adjustment was made through the process of sampling collection (I used a male assistant researcher to collect male respondents for the survey sample); and the utilization of the researcher’s personal social networks in order to obtain access to the survey and interview respondents (male and female). Also, the process of conducting research had at all times to be sensitive to religious implications, gender power relations and concerns, and this at times influenced the questions which I was able to ask and the analysis I have been able to make in the final written thesis.

Third, difficulties were encountered in respect to language issues: the researcher had a double burden due to doing the work twice, to translate from English to Arabic or vice versa. For example, the questionnaire and the in-depth interview questions were made available first in English (for review and correction by the supervisors) then translated to Arabic, as the study respondents are Arabic speaking, then translated back to English for writing up in the thesis. What was more difficult and time consuming was the translation of the in-depth interview transcripts to English, as they were all conducted in Arabic. At the same time, the translation work required close attention to preserve the accurate meaning of the responses. There is now a further issue regarding translation, as there is now a need to translate this whole thesis into Arabic to benefit the Arabic reader.

Lastly, this study was done remotely, as the researcher was a part-time student and resident in Saudi Arabia with only several trips to the UK to meet with supervisors face-to face. This presented a significant obstacle and some complications for the researcher, for example in arranging meeting schedules and access to the library. It also meant that some feedback on chapters was only provided in written format (via text and emails) rather than verbally.

263 However, despite these limitations, I believe I have produced a thesis to the best of my ability that truly does give a more detailed and elaborate understanding of fertility in Jeddah, Saudi Arabia.

Suggestions for Future Research

As this study is one of the earliest of its kind in Saudi Arabia in general and Jeddah in particular, there is certainly a considerable shortage of knowledge regarding reproductive issues and factors related to these in Saudi Arabia, especially using a gendered analysis and particularly producing in-depth qualitative data. However, there are some issues in relation to fertility behaviour that are suggested here as a possible basis for future research, all of which are important matters in understanding fertility behaviour and future trends of demographic factors in Saudi Arabia. Five key issues have been identified for future research.

Firstly, it is desirable to improve in-depth understanding of spouses’ marital relationships in the light of marriage formations, in order to discover the gender and power relationships between husband and wife within the broader context of marital relationships, and not just concerning reproductive issues. This is important as it could reveal areas where the wife has greater power (if there are any) and where she has less power within the marriage.

Secondly, to investigate women’s agency in their birth family, marriage family and society, to uncover the factors that could help to empower women or enhance women’s status and agency, as exploring women’s agency in different spheres could assist us to understand the social context in which women’s agency develops and interacts.

Thirdly, to look at societal viewpoints concerning women’s rights, including those of women themselves and through different generations, to inspect the changes in women’s roles and status among the new generation due to the increase in women’s education and participation in the labour force; it is also recommended to study the influence of globalization.

Fourthly, to carry out a comparative study of reproductive behaviour between different regions or districts in Saudi Arabia, as a way of uncovering the influence of urbanization and socioeconomic development on gender relationships, women’s status, and social networks impacts, in respect to fertility behaviour.

264 Lastly, to examine the attitudes of Saudi Arabian adults (younger generation) regarding marriage and family and including reproductive issues, which will help in explaining the attitudes of the new generation towards these issues, as that could assist in future social planning.

265 Appendix-1: Survey Questionnaire (Female Version)

Gender and Fertility in Saudi Arabia

Dear Respondent;

- This study focuses on establishing a profound and elaborate understanding of fertility patterns in Saudi Arabia through the examination of both women’s and men’s understandings and meanings of their reproductive experiences. - This study runs under King Abdul-Aziz University Sociology Department, and is by one of its lecturers, Engee Hariri. - The important issue of fertility has a major impact upon population change, composition and growth, and a stronger and in-depth understanding of fertility in Saudi Arabia is needed to aid in future planning strategies. Thereby, it is very important that you kindly complete the questionnaire for the sake of the study. - The researcher will adhere to the obligation of this information confidentiality. - The questionnaire shouldn’t take more than 30 minutes of your time.

My best regards

266 Survey for Women

Demographic Information

1- Name (Optional)/ Number:

2- Current age:

3- Age at first marriage:

4- Is this your first marriage? Yes No

4(a)- How many times have you been married?

5- Number of children: Male Female

6- Does your husband have another wife? Yes No

6(a)- How many wives does he currently have?

Socioeconomic status

7- Level of Education:

Education Illiterate General Education >=University Levels Your spouse’s Yours

7(a) If you have more than one wife currently, include their education levels:

Education Illiterate General Education >=University Levels

267 8- Occupational Status:

8(a)- Husband Husband's Professional Skilled Unskilled Business Administrative Occupation (doctor- engineer- teacher) Labour Labour

8(b)- Current Wives

Wife Professional Business Administrative House Skilled Unskilled Occupation (doctor-engineer- wife Labour Labour teacher) 1-

2-

3-

4-

9- Family Income (per month):

Income <2000 2000-5000 5001-10000 >10000

10- House property: Owned Rental

11- Type of house:

Bungalow Villa Flat (small + simple)

268 Gender and Fertility Behaviour

12- Did you plan (or think) of the number of children you wished to have?: (ideal family size)

No Yes

12(a)- Why?: - Don’t know - Undecided - I never thought about it - It depends on God; it’s not right to specify a certain number - As many as possible - Others

12(b)- Ideally, how many male and female children do you want?: M F

13- Do you wish to have any more children?:

No Yes

14- Do you discuss with your husband your preference for a particular number of children? A. No B. Yes C. Cannot discuss (it is not acceptable in our culture)

15 - Who does the decision-making in the family about reproduction: or, who decides when to have a baby?

A. Husband B. You (wife) C. Discuss + w + h D. Discussion between h + w + your family and your husband's family E. Unplanned F. Never discuss it

16- Do you share the same view as your husband about the number of children?

No Yes

17- Do you agree with your husband about reproduction decisions?:

Never Rarely Sometimes Often Always

269 18- Who has the final say about the number of children and when to have them?:

A. Husband B. Wife C. Discussion between w + h D. Discussion between h + w + your family and your husband family E. Unplanned F. other (specify)

19- How do you see the value of children? (you can tick more than one)

A. The main purpose for marriage B. The joy of life C. Cannot imagine my life without them D. Basic ground for marriage stability E. Enhance your position in the family + society

20-Do you think that children are a great responsibility? Please circle the appropriate number:

Rarely Sometimes Often Don’t agree 1 2 3 4 5 agree

21- Who is financially responsible for rearing children?:

A. Husband B. Husband and wife

22- Does your family have any financial support from extended family (husband family and wife's family)? A. No B. Yes

23- How do you view the importance of caring for children as women's responsibility?:

Low Moderate High Very low 1 2 3 4 5 Very high

24-Do you get any help with caring for your children?:

None Little Moderate Plenty

270 25-Who helps you with your children?:

Husband Your Eldest Husband Maid Friends family family siblings

26- How do you view the importance of men's responsibility in caring for children?:

Low Moderate High Very low 1 2 3 4 5 Very high

27- How does your husband assist you in your household?:

1. He assists with bottle or spoon- feeding my infant children 2. He assists with teaching my children letters and numbers/ homework supervision/Koran study 3. He assists by playing with my children for example; board/computer based/ educational games, or sports (physical) games for example; football, swimming, ice- skating etc. 4. He assists by taking my children out of the house to visit malls, places of interest, fast food outlets or any such place in order to provide me with a little time to do things I need to do, and that I cannot do with the children. 5. He assists by taking on the responsibility of handling all my children’s regular schooling and medical appointments (dental, ocular, general health check-ups etc.) 6. He assists with general household duties such as simple food preparation for the family and/or house tidying 7. Does none of the above. 8. Other? Please specify…

28- What do you consider or regard as the motivation for having plenty of children (or more children)? (you can tick more than one)

A. High rewards from God B. Enjoyment of life C. High status in society D. Pressures by family and relatives E. Support in old age F. Other

271 29- Do you think it is important to have male children?: No Yes

29(a) Why?: (choose the most important one)

A. Male status in society B. Inheritance C. Continuity of family name D. Old age security E. Other (specify)

30- What do you think your husband will do if you give birth to girls only? (choose one only)

A. Does nothing B. I don’t know C. Never stop having children until a boy comes D. Marry another wife E. Divorce

31-Would this influence your decision on having more children than your preferred number of children? A. No B. Yes

32- What do you think your husband will do if you give birth to boys only? (choose one only)

A. Does nothing B. I don’t know C. Never stop having children until a girl comes D. Marry another wife E. Divorce

33- Would this influence your decision on having more children than your preferred number of children?: A. No B. Yes

34- If you want to buy something for yourself do you need permission?:

A. No need B. No need (if I use my own money) C. Husband D. Husband’s family E. Your family

272 35- Who gives you permission to go out?:

A. Nobody B. Husband C. Husband’s family

36- Who accompanies you when you go out?:

A. husband or male relatives B. driver

37- In your opinion how the important is women's education for a better future for the family?

Not Slightly Very important Important important important at all

38- Do you agree that women's paid work will have a positive effect on family life?:

Strongly Strongly Disagree Neutral Agree disagree agree

Social Interaction and Fertility Decisions

39- Do you know any methods of contraception?: (if NO go to question 42)

No Yes

40- What kinds of contraception do you know of ?:

Pills Condom Withdrawal IUD Other

41-When did you learn about contraception?:

Before After After having marriage marriage children

273 42- From whom did you learn about contraception?: (you can tick more than one) A. My husband B. Myself (through media) C. My family D. My friends E. My physician

43- What is your point of view regarding contraception in Islam?:

Prohibited in Discouraged in Permitted when Permitted Islam Islam needed

44- With whom do you usually discuss your fertility behaviour, and your choice of contraception?:

A. Nobody B. Spouse C. Your husband's family D. Your family E. Your friends

45- Have you and your husband ever used contraception?: Yes No

45(a) - What type(s) have been used?:

Pills Condom Withdrawal IUD Other

45(b)- Why didn’t you use contraception?: A. I didn’t know about it B. My husband wants more children C. I don’t need it because of wanting more children D. My husband considers it discouraged or prohibited in Islam E. I consider it discouraged or prohibited in Islam F. Others

46- Who has the final say about using any method of contraceptive?:

A. Husband B. Wife (you) C. Discussion between w + h D. Discussion between h + w + husband family and your family E. My physician F. Other (specify)

274 47- Does anyone in your family or friends use contraception? No Yes

48- Does your husband prefer to practice birth spacing? No Yes

49-What does he consider an ideal period of time between children?

50- Do you prefer to practice birth spacing? No Yes

51-What do you consider an ideal period of time between children?

52- Did you practice birth spacing between your children? No Yes

53- Do family relatives have any influence on decisions about your family reproduction (having children) choices?:

Nothing Little Moderate Plenty

54- How do these people see the value of children?:

Very low Low Moderate High Very high Your husband Yourself Your husband family Your family Society

275 Appendix-2: In-depth Interview Questions (Female Version)

In-depth Interviews (for Women)

1- General Information:

- I am interested to know you, so can you tell me about your (own) family and your children (Your name in my research will not be used unless I have your permission)?

- Can you tell me about your education? In general do you think education will influence people’s way of thinking? (If high school level or less) Was it your choice to finish your education at that point? Why? Would you like to continue your education? Do you think your husband and your family (and family-in-law also) will support you?

- Economic stability is very important for the family; so tell me about your family income, and do you think it is a job which ensures that all family needs are met for now and in the foreseeable future? Do you work? Why? If not, would you like to work? Do you have any financial support from extended family?

2- Domestic Division of Labour in the Society

- What did you learn from your family and society about men’s and women’s roles, responsibilities and duties? What is the extent of freedom and authority that both genders have?

- What do you now think of men's and women's roles, responsibilities and duties? Do you think that there are some differences or similarities between your birth family and your own family?

- Do you feel that you have the freedom and the ability to practice in your own family what you want and believe in?

3- Gender and Social Networks in Relation to Reproduction

- Can you tell me the whole story of when and how you got married?

- How much value do you, your husband and extended family place on children? How much of a responsibility do you think they are? Who helps you with the caretaking of your children?

276 - In your opinion, who makes the most decisions; including reproductive decisions in the family? Do you and your husband discuss fertility issues? What do you discuss and do you agree with your husband about reproduction decisions? Who has the final say in these decisions? What did you plan or think at the beginning of your marriage about the number of children you wished to have (ideal family size and numbers of children from each sex)? Why?

- Do you think it is important to have male children, and why? What concerns do you and your husband have if you give birth to boys or girls only? Would this influence you or your husband’s decision to have more children than you originally preferred?

- What is the role or influence of extended family (on either side), on an individual man / woman’s life, regarding reproductive decisions?

- What do you think about family planning? How do you know about contraception? Do you use contraception? What kind and why? Do you face any conflicts related to contraceptive use?

- Do you think that at the present time there is conflict between desiring many children and affording them (in light of economic constraints)? What are your hopes and aspirations regarding your children’s (both sons and daughters) future?

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