Islamic University
Midwifery Department
Women issue & Ethics in Midwifery
Prepared by Dr. Areefa Said Al-Bahri 2015
Table Of Content
Chapter 1 Introduction Chapter 2 definition of Ethics &Ethical Principles Chapter 3 International Midwifery code (ICM) Chapter 4 Ethical decisions& reproductive health of women Chapter 5 Consent Form Chapter 6 Patient rights Chapter7 Character of moslem nurse Chapter 8 Ethical dilemmas Chapter 9 Palestine council of health
Chapter 10 the most topics regarding women's health
Chapter 11 counseling & topics of counseling.
Chapter 12 family planning methods .
Chapter 13 breast feeding .
Chapter 14 cancer
Chapter 15 infertility.
Chapter 16 Menopause and old women
Chapter 17 -violence against woman
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Women’s health Care
Chapter 1 Introduction
What is a Midwife?
Most midwives are health care providers who offer services to women of all ages and stages of life with their advanced education and their focus on research and partnering with women. Today’s woman expects the best care. She expects her provider to understand the value & individual needs. She wants a provider who will partner with her to make health decisions. Midwives focus on what is most important to each woman’s unique situation and values and often work with other members of the health care team. It’s time to think about whether a midwife might be the right choice for you.
Midwifery Fields and places of Job
Many midwives focus not only on maternity care, but also on the full range of a woman’s health needs. Certified nurse-midwives (CNMs) and certified midwives (CMs) provide care starting with a woman’s first period until after menopause, plus all the important health events in between, such as:
General health care services Annual gynecologic exams Family planning needs Treatment of sexually transmitted infections Care during teenage years Care for pregnancy, labor, and birth Menopause care
CNMs and CMs are independent health care providers. They also work with other members of the health care team, such as physicians and nurses, to provide the highest quality care. They work in a variety of settings, such as hospitals, medical offices, clinics, birth centers, and homes. They provide general health care services, gynecology care, family planning, as well as maternity care (before, during, and after childbirth). They are covered by most insurance.
Types of Midwives
Certified Nurse-Midwife (CNM)
CNMs are registered nurses with graduate education in midwifery. They have graduated from a nurse-midwifery education program. This education includes a university degree as well as hands-on clinical training by practicing CNMs.
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CNMs provide general women’s health care throughout a woman’s lifespan. These services include general health check-ups and physical exams; pregnancy, birth, and postpartum care; well woman gynecologic care; and treatment of sexually transmitted infections. CNMs are able to prescribe a full range of substances, medications, and treatments, including pain control medications. CNMs work in many different settings, such as hospitals, health centers, private practices, birth centers, and homes.
Certified Midwife (CM)
CMs are midwives with a bachelor’s degree in a field other than nursing who have graduated from a graduate-level midwifery education program accredited by the midwifery education program for CMs includes health-related skills and training in addition to midwifery education, which is the same as that of CNMs. They have passed the national certification exam. CMs provide the same services as CNMs, practice in the same settings, and receive the same preparation as CNMs to safely prescribe a full range of substances, medications, and treatments, including pain control medications.
Certified Professional Midwife (CPM)
CPMs prepare for a national certification exam administered by the North American Registry of Midwives (NARM) in different ways. There are two primary pathways for CPM education with differing requirements: The health care services provided by CPMs are not as broad as those of CNMs and CMs. CPMs provide pregnancy, birth, and postpartum care for women outside of the hospital—often in birth centers and homes. CPMs are not able to prescribe most medications.
Other Midwife
These midwives may or may not have formal education and have not passed a national certification exam. They may or may not be licensed. Their services are usually focused on pregnancy and birth, and they are unable to prescribe most medications.
Role as Midwives
Unfortunately, many people don’t really know what role midwives play in women’s health care today. The truth is that midwives approach health care using science and evidence. They base their expert, personalized service for women and newborns on their education and experience. In fact, certified-nurse midwives (CNMs) and certified midwives (CMs) can offer services beyond maternity care, including women’s and general health care services from the teenage years through adulthood and into the elder years.
A Midwife’s Approach to Health Care
When seeking a partner for your women’s health care, it’s important to understand how different kinds of providers will have a different approach to care. Midwives are skilled in creating a health care experience that is modified to your personal preferences and health care needs. They will work with you to decide on important decisions such as where and 3 how you want to give birth or how you want to approach your changing needs as you move into menopause.
Why Choose a Midwife?
Choosing a midwife offers you a chance for expert personalized care based on research and evidence. Midwifery care does not rely on providing a specific set of childbirth procedures or practices for all women. Instead, midwives tailor care to meet the wants and needs of each woman and her baby. In this way, midwives maintain the best conditions possible for a safe and healthy outcome for all involved.
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Chapter 2
* Definition of Ethics: Ethics came from the Greek word {Ethos} which means: (custom, habit, conduct). And also ethics defined as "the science that approaches human actions in forms of Right or wrong" and these actions are {Voluntary actions}.
Principles of ethics Beneficence: Beneficence is to act in the best interests of the patient, and to balance benefits against risks. The benefits that medicine is competent to seek for patients are the prevention and management of disease, injury, handicap, and unnecessary pain and suffering and the prevention of permature or unnecessary death.
Autonomy Autonomy means to respect the tight of the individual. Respect for autonomy enters the clinical practice by the informed consent. This process usually understood to have 3 elements, disclosure by the physician to the patient's condition and its management, understanding of that information by the patient and a voluntary decision by the patient to authorize or refurs treatment.
Respect: you must respect pt's autonomy, dignity& liberty.
Non maleficence It means that a health personnel should prevent causing harm and is best understood as expressing the limits of beneficence. This is commonly known as "primum non nocere" or first to do on harm. Confidentiality Confidentiality is the basis of trust between health personnel and patient. By acting against this principle one destroys the patient trust.
The right not to be restrainted, neglected or discharged from care without an opportunity to find other health provider. The right to absolute privacy The right to accept or to refuse treatment. The right to full disclosure of financial factors involved in her care. The right to know who will participate in her care and obtain additional consultation of her choice. Altruism: Is to protect the community by supporting actions, to meat the health and social need of the public.
Paternalism: Is to protect the weak person. Veracity: Is the obligation to tell the truth. Fidelity: Is the obligation to loyal to the pt. community and profession.
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Justice: Is to be fair, and equitable to all pts Regardless of any service you want to give. Egoism: Is the right to maximize personal benefits. Utilitarianism: Is the greatest good for the greatest members.
legal and ethical principles in the provision of health services
1. Informed decision making. Patients or individuals who require health care services have right to make their own decision about the opinions for treatment or other related issues. The process of obtaining premission is called informed consent. The health care provider should disclose the following details: The individuals is currently assessed health. Reasonably accessible medical, social, and other means of response of the individual's conditions including predictable success rates, side effects and risks. The implications for the individual's general, sexual and reproductive health and lifestyle deteriorating any of the options or suggestions. The health provider's reasoned recommendation for particular treatment option or suggestion.
2.Surrogate decision makers: Surrogate decision makers [parents, caregivers, guardians] may take the decision if the affected individual's ability to make a choice is diminished by factors such as extreme youth, mental processing difficulties, extreme medical illness or loss of awareness.
2. Privacy and confidentiality A patient's family, friend or spiritual guide has no right to medical information regarding the patient unless authorized by the patients. The following points of confidentiality are to be kept in mind: Health care providers duties to protect patient's infromation against unauthorized disclosures. Patient's right to know what their health care providers think about them. Health care provider's duties to ensure that patients who authorize releases of their confidential health related information to other. Exercise an adequately informed and free choice. 3. Competent delivery services: Every individaul has a right ot receive treatment by a competent health care provider who knows to handle such situations quite well. According to the laws, medical negligence is shown when the following 4 elements are all established by a complainig party. A legal duty of care must be owed by provider to the complaining party. Breach of the established legal duty of care must be shown, which means a health care provider has failed to meet the leaglly determined standards of care. Damage must be shown. Causation must be shown.
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4. Safety and efficacy of products: Health care providers are resposible for any accidental or deliberate use of products that differs from their approved purposes or mthods of use, for instance, the dosage level for drugs. Look for the drug contraindications, drug expiry damage of diluted sterilization solvents etc.
5. Code of ethical midwifery practice Midwives rights: The right to refuse care to patients with whom no midwife-patient relationship has been established. The right to be provided adequate information from patients upon which caring is based. The right to receive honest, relevant information from patients upon which caring is based. The right receive reasonable compensation for services rendered.
Midwives resposibilities: The obligations to serve as the protector of normal birth, alert to possible compications, but always on guard arbitrary interference in the birthing process for the sake of convenience or the desire to use human beings in scientific studies and training.
The obligation to honour the confidence of those encountered in the course of midwifey practice and to regard everything seen and heard as inviolable, rememvering always that a midwife's highest loyalty is owed to her patient and not her health care providers.
The obligation to provide complete, accurate and relevant information to patients so that can make informed choices regarding their helath care.
The obligation, when referring a patient to another health care provider, is to remain responsible for the patient until she is either discharged or formally tranfered.
The obligation never to comment on another midwife's or other health provider's care without first contacting that practitioner personally. The responsibility to develop and utilize a safe and efficient mechanism for medical consultation, collaboration and referral.
The obligation to pursue professional development through ongoing evaluation of knowledge and skills and continuing deucation including diligent study of all subjects relevant to midwifery.
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The responsibility to assist others who wish to become midwives by nohestly and accurately evaluating their potential and competence and sharing midwifery knowledge and skills to the extent possible without violating another section in this code.
The obligation to pursue professional development through ongoing evaluation of knowledge and skills and continuing education including diligent study of all subjects relevant to midwifery.
Unprofessional conduct: Knowingly or consistently failing to accurately document a patient's condition, responses, progress or other information obtained during care. This includes failing to make admissions, destroying entries or making false entris to midwifery care. Performing or attempting to perform midwifery techniques or prodecures in which the midwife is untrained by experience or education. Mainpulating or affecting a patient's decision by withholding or misrepresenting information is violation of patient's right to make informed choices in their health care. Failure to report to the applicable state board or the appropriate authority in the association, within a reasonable time, the occurrence of any violation of any legal or professional code. Failing to give care in a reasonable and professional manner, including maintaining a patient load, which does not allow for personalized care by the primary attendant. Leaving a patient intrapartum without providing adequate care for the mother and infant. Delegation of midwifery care or responsibilities to a person who lacks ability or knowledge to perform the function or responsibility in question.
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Chapter 3
International Code of Ethics for Midwives The aim of the International Confederation of Midwives (ICM) is to improve the standard of care provided to women, babies and families throughout the world through the development, education and appropriate utilization of the professional midwife. In keeping with this aim, the ICM sets the following code to guide the education, practice and research of the midwife. This code acknowledges women as persons with human rights, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust and the dignity of all members of society. The code addresses the midwife’s ethical mandates in keeping with the Mission, the International definition of the Midwife, and standards of ICM to promote the health and wellbeing of women and newborns within their families and communities. Such care may encompass the reproductive life cycle of the woman from the pre-pregnancy stage right through to the menopause and to the end of life. These mandates include how midwives relate to others; how they practice midwifery; how they uphold professional responsibilities and duties; and how they are to work to assure the integrity of the profession of midwifery.
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Chapter 4
Ethical decisions and reproductive health of women
Ethics in gynaecoogic practice Beneficence-based and autonomy-based clinical judgements in gynaecologic practice are usually in harmong, like management of ruptured ectopic preganancy. Sometimes they may come into conflicts. In such situation, one should not override the other. Their differences must be negotiated in clinical judgement and practice to determine which management strategies protect and promote the patient's interest.
Ethics in obstetric practice There are obvious beneficence-based and autonomy based obligation to the pregnant patients. While the health professional's perspective on the pregnant woman's interest providers the basis of beneficence based obligations, her own perspective on those intersts provides the basis for autonomy-based obligations. Because of insufficiency developed central nervous system, the fetus cannot meaningfully be sail to possess values and on its interest. Therefore, there is no autonomy based obligation to the fetus.
Ethics and assisted reproduction: It involves many issues like donor insemination, IVF, egg sharing, freezing and storing of embryos, embryo research and surrogacy. Still many ethical issues are involved in IVF. First there is a big question whether the in vitro embryo is a patient or not. It Is appropriate to think that it is a pre-viable fetus and only the woman can give it the status of a patient. Hence pre-implanatin diagnostic counselling is non-directive and counselling about how many embryos to be transferred should be evidenced based. Donor insemination raises the issue whether the child should be told about his genetic father or not. Egg sharing is also surrounded by many ethical issues. Ethics changes from time to time keeping step with changing social values, the surrogacy issue of India today, a lengthy article has appeared supporting surrogacy with the name of the center, the photos of the physician and number of happy surrogate mothers.
Ultrsonography: There are many issues involved like competence and refrral, disclosure, confidentiality and routine screening. The formost issue is that the sonologist must be cometent enough to give a definitive option. Now routine screening is adopted at 18-20 weeks, but prior to screening the prenatal informed consent for sonogram must be taken. Strict confidentiality sould be maintained.
Genetics and ethics:
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The Process of genetic research raises difficult challenges particularly in the area of consent, community involvment and commercialisation. However it must be recongnized that many of these issues are not unique to genetics but rather represents variations and new twists on problems that arise in other types of research. Results of genetic research should be provided to subjects only if the tests have sufficient clinical validity. Results should never pedigree research.
Policies regarding disclosure of test results should be included in the informed consent process. The genomic are posses challenges for the international community and research enterprises. Council for international organization of medical sciences [CIOMS] guideling should address the ethical issues of genetics. The goal is to care and protect greatest sources of human suffering and premature death and to relieve pain and suffering caused by the disorder.
Lord Fraser's ethical recommendations include: We should assess whether the patient understands advice. We should encourage the parent involvemant. We should take into account whether the patient is likely to sexual intercourse without contraceptive tratment. We should assess whether the physical, mental health would likely to suffer, if contraceptive advice is not given.
Embryonic stem cell research and ethics: This involves many ethical issues and first and fore most is, it is destroying a life by destroying the fertilized embryo. This raises the fundamental question of when life starts. Does human life begin at gastrulation [next step after blastula], at neurulation [formation of a primitive streak, first signs of movement] or at the moment of sentience [consciousness]? When can embryo first feel pain or first suffer?. The goal should be minimize the exploitation of human embryos at any stage of development.
The Impact of law on ethics: Ethics is involved with moral judgements, and the law, however, concerns public policy. At one level it defines what one can /cannot or must / must not do to aviod risk of legal penalty. Ethics encompasses such more than law. Ethics can determine what is right is the sense that it is good. The interntion of law is to define what is right in the sense that it is or is not permitted. It can be safely concluded that not only is determining that something is unethical, neither a necessary nor a sufficient reason to make it illegal, but also determining that something is lawful does not necessarily make it ethical. In many occasions the law assist clinical decision-making by setting parameters which hepls both the patient and physician.
potential areas of litigatin in gynaecology Intraoperative problems – 32% 13
Failure of diagnosis or delay in diagnosis – 17% Failure to recognize complications – 7% Failed Sterilization – 6% Failure to warn or inadequate consent – 3%
Examination of gyaecological Patient Professional and personal conduct Prior to examination consent must be taken and she must be informed about the nature of examination. Examination should be done in a closed space in comfortable position maintaining the privacy in presence of a female attendant. The attendant should not be the relative of the patient.
Forensic gynaecology Sexual assault and rape must be handled in a sensitive manner while complying with forensic procedure. Domestic violence and sexual violence in areas of conflict are now recognized as major factors in women's health as studied by the united-nations and by human rights groups.
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Chapter 5 Consent Form
Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration and understanding. Consent signifies a possible defense (justification) against civil or criminal liability be the doctor. The consent form is the single most important document, created in the presence of the patient, which removes obstacles to effective communication concerning choice. The key to effective communication is : . Engaging with the patient Empathizing with her needs. . Educating her as to the available options. . Enlisting her approval for the appropriate choice.
Only after engagement, empathy, and education is it appropriate for a clinician to ask for the approval of the patient. It will always be appropriate to record the decision. It will sometimes be appropriate for the patient to append her signature to an appropriate form. Vaild consent must be taken from the patient.
Legal problems occur in certain conditions as follows: Continuation of pregancy after the procedure. Excessive or continued bleeding due to incomplete evacuation. Injury to the organs either to the uterus or to the other organs. Failure to diagnosis ectopic pregnancy while perfoming maternal exam.
Types of Consent Medical consent Consent is one of the critical issues in the area of medical treatment. The earliest expression of this fundamental principle, based on autonomy, is found in the Nuremberg Code of 1947. The Nuremberg Code was adopted immediately after World War 2 in response to medical and experimental murders committed by the German Nazi regime. The code makes it mandatory to obtain voluntary and informed consent of human subjects. Similarly, the Declaration of Helsinki adopted by the World Medical Association in 1964 emphasizes the importance of obtaining freely given informed consent for medical research. Medical Council of India (MCI) has laid down guidelines that are issued as regulations in which consent is required to be taken in writing before performing an operation. The MCI guidelines are applicable to operations and not cover to the extent other treatments or procedures. These are covered under Implied and expressed consent
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Consent is perhaps the only principle that runs through all aspects of health care provisions today. It also represents the legal and ethical expression of the basic right to have one's autonomy and self-determination. If a medical practitioner attempts to treat a person without valid consent, then he will be liable under both tort and criminal law. Patient must give valid consent to medical treatment; and it is his prerogative to refuse treatment even if the said treatment will save his or her life.
LAW AND MEDICAL CONSENT The rights (autonomy) of the patient have deeply eroded the old model of doctor- patient relationship. "Doctors are no more Gods". There have been significant changes in the doctor patient relationship with the advancement of technology in day-to-day practice. More and more patients are becoming aware of their rights and are keen to make free choice and decision on their treatment. This helps them to choose the treatment of their choice from the options available and to select a physician of their choice. Informed consent was practically non-existent till the time COPRA (Consumer Protection Act) came into existence. This is seen as more of a legal requirement than an ethical moral obligation on part of the doctor towards his patient. The patient has now the ability to select or dismiss their doctor and to choose the treatment of their choice from the options available. Important aspect of several Medical Consumer litigations is improper consent.
1. INFORMED CONSENT: . It is defined as voluntary acceptance after full understanding, by a competent patient, of a plan for medical care after physician adequately discloses the proposed plan, its risks and benefits, and alternative approaches. . The decision-making capacity is free from coercion or manipulation by the patient/doctor COMPONENTS: Informed consent must contain four vital components: . Mental capacity of the patient to enter into a contract (This also includes his ability to understand information given). . Complete Information to be provided by doctor.
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. Voluntary acceptance of the procedure by the patient . Should be person and the procedure specific
CONSENT AND MEDICAL ETHICS The Hippocratic Oath prevalent for centuries has granted doctor the right to decide in the best interest of the Patient. But the same has been conflicted with the trend of twentieth century right of "freedom to control health as well as avoiding non-consensual medical treatment." Clinical ethics teaches physicians, a wide range of specific ethical issues. o Informed consent, truth telling, o End-of-life decisions, o Advance directives (Substitute decision making for incompetent patients) o Emergency consent CONTENTS OF THE CONSENT: Condition (Disease) of the patient Purpose and Nature of intervention Consequences of such intervention Any Alternatives available Risks involved Prognosis in the absence of intervention The immediate and future cost The knowledge regarding the intervention should be in an understandable language and format so that decision in the form of authorization by patient can be made. Types of Consent 1.Expressed consent: It may be oral or in writing. Though both these categories of consents are of equal value, written consent can be considered as superior because of its evidential value. A. Oral: Oral consent should be taken in the presence of uninterested third party. Mainly in cases where intimate examination of female is required. Tests necessitating removal of body fluids, radiological examination can be done after securing oral consent. B. Written: It is advisable to take written consent in the presence of disinterested third party (this third party is only to attest the signature of the patient). Consent should be taken in the patients own language. Written consent is mandatory in every invasive diagnostic/ therapeutic procedures or any medico legal examination. 2. Implied consent: Implied consent may be implied by patient's conduct.
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So it is basically the conduct of the patient when he comes to the doctor for examination / treatment. Doctor should remember that this is only for routine examination as well as treatment. This does not extend to the performance of intimate examination or diagnostic procedures. If there is slightest chance of any complication express consent should be taken.
3. SURROGATE CONSENT: This consent is given by family members for minors or dead. Generally, courts have held that consent of family members with the written approval of 2 physicians sufficiently protects a patient's interest.
4. ADVANCE CONSENT: It is the consent given by patient in advance before death.
5. PROXY CONSENT: It indicates consent given by an authorized person before or after death. If an unconscious patient brought by police from road and operation essential to save life 2or3 doctors to give consent by signing on consent form, preferably along with police. Informed consent obtained after explaining all possible risks and side effects is superior to all other forms of consent and legally defensive.
CONSENT PROFORMA I_____ S/D/W of _____ aged __ Address_____ under the treatment of Dr _____ do hereby give consent to the performance of _____(procedure/treatment) and to the administration of _____ (anesthesia) upon myself / upon ____ aged __ who is related to me as ___. The nature and purpose has been explained to me by Dr____. I declare that I am more than 18 years of age. I have been informed that there are inherent risks involved in the treatment. No assurance has been given to me regarding the success of the treatment. I have given this consent voluntarily out of my free will without any pressure. Place: Date & Time:
SIGNATURE
I hereby declare that I have explained in detail regarding the case to the patient and answered all his queries to his satisfaction in a language that he could understand. Place: Date & Time: Signature of the Doctor
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WHO CAN GIVE CONSENT Simple medical examination the minimum age of consent is 12 years. For consenting to have any major diagnostic or therapeutic procedure or surgery the age is above 18 years (I.P.C. Section 87-93). The patient should be mentally sound and he / she should not be under any fear or threat or any false conception. The patient should not be intoxicated or sedated. Incomplete information about the patient's diagnoses, therapeutic plan etc. is a commission than misconception of commission. CONSENT REQUIRED i. Somebody else other than the "Patient" wants him to be medically examined and a medical certificate to be issued (employers,). ii. Consent of the concerned person must be obtained otherwise the doctor runs the risk of liability to pay damages. Such as a. Issuing certificate involving complicated process of examination or infertility in women. b. When the process is likely to affect the physical or mental well-being of the patient e.g financial loss. c. Damage to reputation, social status (STD, HIV etc.). d. Procedures violating rights of spouse is in cases such as Sterilization, artificial insemination. Evan after the consent is taken the examination should be done in presence of third person (nurse, female attendant) while examining a female patient. DIFFICULTY IN OBTAINING CONSENT The difficulties in getting informed consent include: a. Incompetence and mental incapacity of the patient, b. Unusual (socio, religious) beliefs of patient. c. Extent of truthful disclosure, d. Incompleteness of information disclosed e. Advance directives by terminally ill patients or those who anticipate grave illness. f. Durability of power of attorney for health care, when holder gives the consent and decisions in advance
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Chapter 6 Patient’s Bill of Rights 1- The pt. has the right to considerate and respectful care. 2- The pt. has the right to obtain from his physician complete current information concerning his diagnosis, treatment, and prognosis in terms the pt. can be reasonably expected to understand. 3- The pt. has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment, Except in emergencies. 4- The pt. has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his / her action. 5- The pt. has right to every consideration of his privacy concerning examination, and treatment is confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the pt. to be present. 6- The pt. has the right to expect that all communications and records pertaining to his care should be treated as confidential. 7- The pt. has the right to expect that within its capacity a hospital must make reasonable response to the request of a patient for services. *The hospital must provide evaluation, service, and/or referral as indicated by the urgency of case.
* When medically permissible, a pt. may be transferred to another facility only after he has received complete information and explanation concerning the needs for and alternatives to such a transfer. 8- The pt. has the right to obtain information as to any relationship of his hospital to other health care and educational institutions in so far as his care is concerned, the relationships among individuals, by name, who are treating him. 9- The pt. has the right to advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. 10- The pt. has the right to expect reasonable continuity of care. He has the right to know in advance what appointment times and physicians are available and where. 11- The pt. has the right to examine and receive an explanation of his bill regardless of source of payment. 12- The pt. has the right to know what hospital rules and regulations apply to his conduct as a patient.
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Chapter 7
Characters of Moslem Nurses: All nurses & midwives regardless of what believes they have are expected to demonstrate a Variety of characteristics, but the following ones should always be in the mind and practiced by the Moslem nurse/midwife: 1- Excellence of Practice: This is illustrated by:- a) Seeking the best level of work and practice. b) Seeking continuity of education and knowledge formal and informal, which will for sure be positively reflected on the work environment? 2- Commitment: Moslem nurses need to be committed to their profession and should not see it as a source of income only, but should devote themselves and time for it. This is especially important because lack of commitment will lead to malpractice and negligence. 3- Mercy: Mercy is a very important character in the Moslem’s personality, and it (Rahma) was deducted from name of Allah (Al-Rahman) The most Merciful. Moslem fighters were very kind and merciful with the injured persons among their enemies during the different Islamic battles throughout the history. This means that we have to be extremely merciful with patients from our own people. 4- Kindness: It needs to be the character of our communication with:- - Patients. - Visitors. - Doctors. - Colleagues. - Others.
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Chapter 8 Ethical dilemmas What is an ethical dilemma? A situation offering potential benefits and could be considered unethical. Stealing money Lying Steps to dealing with an Ethical Dilemma 1. Recognize 2. Facts 3. Options 4. Test 5. Decide 6. Check 7. Action Do I Know all the facts? Know the facts before deciding to take action. Did you see this happen? Do you know the whole story? What option do I have and will they work? What can I do? Nothing Report the situation Confront my supervisor
What will work? Doing nothing has no consequence for me Reporting the situation takes it out of my hands Confrontations can cause more upset What do I feel is that right thing to do? How do I decide what to do? Making a decision Could I get in trouble? Could this hurt or help the situation? Is this the right decision for me? Double check your decision How will I feel I make this decision?
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How would I feel if someone found out? What would others think about my decision? Putting your decision into action Make the phone call Write the report Follow through with you decision.
Chapter 9
Palestine council of health Code of professional conduct Purpose: This code aims at maintaining professional behavior among nursing personnel, thus contributing to protecting the rights of clients to quality services. Definition of terms: Conduct: refers to the behavior of all categories of nursing personnel. Behavior includes your actions when on and off duty.
Accountability: responsibility about all over your work.
The profession: refers to nursing with all its specialties.
Professional knowledge: refers to the nursing knowledge acquired from formal and informal educational opportunities that guide competence in practice.
Client: refers to all consumers of health care services.
I. As a member of the nursing profession, you are personally accountable for your conduct towards yourself therefore, you must: 1. Use your professional knowledge to ensure safe midwifery practices in all environments. 2. Use your knowledge in health promotion and protection. "This includes your involvement in patient and health education activities".
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3. Be responsible for improving the quality of the care by keeping up with professional development and continuously upgrading your knowledge. 4. Recognize limitations within your competence and your knowledge and decline duties which you are unable to perform as a result of these limitations. "This includes competence in using equipment and technology. 5. Accept responsibility for the outcome of your decisions and actions. 6. Participate in the development and implementation of health policies. 7. Ensure that you are physically fit to carry out your duties. "Ensure that you are not under the influence of drugs or alcohol. Also, do not exhaust yourself by maintaining two full time jobs". 8. Abide by the institution’s regulations with regards to your professional attire. "Avoid wearing jewelry and slippers , chewing gum or eating nuts when on duty. Take off the uniform when off duty and wear identity badges when on duty". 9. Refrain from smoking when on duty and abide by hospital polices in regards to this matter. 10. Avoid accepting gifts from advertising agents.
II. As a member of the nursing profession, you are personally accountable for your conduct towards your clients. There for, you must: 1. Recognize the individual needs of clients and their families. " Respect the individuality of clients and their right in maintaining their dignity. "Avoid loud voice. Call clients by name and maintain their privacy and, avoid violence with clients including restraining patients for your comfort. 2. Treat all clients with respect regardless of age, gender, class, religion or race. 3. Protect and encourage client's independence and self-care. 4. Act as the clients advocate and protect their rights at all times. "Protect the rights of clients as in the Palestinian charter of patient’s rights". 5. Ensure that clients understand the purpose and nature of care and treatment. 6. Respect the client's right of dying with dignity. "Be familiar with the different religious rites". 7. Report to a person in charge any circumstance, behavior or setting that could affect the physical, social or psychological welfare of clients and hinder you from delivering quality care. 8. Maintain the confidentiality of client's information and use discretion in sharing that information. "Maintain confidentiality when you access computers. Use judgment in sharing information and comply with the law when disclosing information to police. And comply with institutional policy in giving information to the media making sure that you always protect the client's right to privacy".
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9. Document all treatments given to clients. 10. Treat all documents as official records and refrain from altering them. "Avoid using correction fluid (tipex) and erasers. 11. Be aware of the ethical implications of research carried out on clients and ensure consent. "Provide appropriate information to enable informed judgment to be made by clients. 12. Maintain a professional relationship with all clients. "This includes not accepting personal gifts or favors ". III. As a member of the nursing profession, you are personally accountable for your conduct towards other professionals. Therefore you must: 1. Work in a cooperative and collaborative manner with other health professionals and respect their contribution in the delivery of care. 2. Report to an authorized person where the health or safety of your colleagues is at risk. 3. Transmit knowledge, skills and attitudes to staff and students in your charge. 4. Be responsible for the overall care provided by staff and students in your charge. 5. Recognize the limitations of staff and students when delegating tasks. 6. Report to an authorized person any incident which might occur from staff and students in your charge. 7. Contribute actively to managing conflicts and solving problems. "Control your emotions and accept constructive criticism". IV. As member of the nursing profession you are personally accountable for your conduct towards the profession therefore you must: 1. Contribute to the expanding body of nursing theory and its applications. "You can contribute within your abilities and circumstances 2. Be aware of the ethical implications of policies and / or procedures in your area of practice. 3. Develop and share nursing knowledge through research. 4. Refrain from participating in any form of torture of imprisonment. 5. Ensure that people trust and respect your profession. 6. Support other nurses in their professional roles. 7. Be responsible for furthering the goals of the profession. "Support and participate in activities that lead to the development of the profession". 8. Support the philosophy and polices of your institution. "Be aware of the philosophy and polices of your institution and participate in developing them towards professionalism. V. As member of the nursing profession you are personally accountable for your conduct towards the environment therefore you must: 1. Show interest in the society's problems that affect health. 25
2. Realize that your personal health attitude influence your community and surroundings. 3. Take into account the economic aspects in nursing. 4. Cooperate with other professions in promoting community and national efforts to meet the health needs of the public. "Participate in health campaigns and educational activities organized by the community. And cooperate with other professions in maintaining a healthy environment and / or controlling health hazards.
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Introduction Women’s health Issues
• Definition Women's health is an example of population health or general health that, is defined by the World Health Organization as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health. women and men share many similar health challenges, the differences are such that the health of women deserves particular attention. For example, complications of pregnancy and childbirth are the leading cause of death in young women aged between 15 and 19 years old in developing countries. The average life expectancy has almost doubled for women (79 years for women and 73 years for men). Because of the gender gap in lifespan, women comprise approximately two thirds of the population older than 65 and three fourths of the population aged 85 years and older. • With advancing age and onset of menopause, women's risk factors for disease is comparably similar to men's. • Although the same disease may affect women as men, it is thought that biological mechanisms and psychosocial differences influence the clinical course of the disease (natural history) differently in women. • The number of women working has doubled within the past 51 years. • The effect of work stress, new environmental exposures and multiple roles is expected to have health and social impact. •
What are the most topics regarding women's health 1- Cancer: Two of the most common cancers affecting women are breast and cervical cancers. • The latest global figures show that around half a million women die from cervical cancer and half a million from breast cancer each year. • The vast majority of these deaths occur in low and middle income countries where screening, prevention and treatment are almost non-existent, and where vaccination against human papilloma virus needs to take hold
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In Gaza Strip 3,646 cases of cancer were reported in 1995-2000: The incidence rate per 111,111 population was 59.9 (57 in male and 62.9 in female). Incidence rate of cancer per 111,111 population among persons aged 51 years and above was 415.2 (male: 516 and female: 325). About 81% of cancer was solid cancer and the rest (19%) were hematological malignancies. The most common cancer morbidity in the general population was breast (15.7%), lymphomas (9.1%), bone marrow (9.1%), bronchus and lung (8.7%), colorectal (7.4%), brain and other nervous system (4.8%), urinary bladder (4.7%), stomach (3.5%), liver (3.3%), and prostate (2.9%). In male, bronchus and lung cancer is the first leading cause of cancer morbidity (14.7%). In female, breast cancer (31%) is the first one.
2-Reproductive health: Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years. Unsafe sex is a major risk factor – particularly among women and girls in developing countries. This is why it is so important to get services to the 222 million women who aren’t getting the contraception services they need. 3- Maternal health: • Many women are now benefitting from massive improvements in care during pregnancy and childbirth introduced in the last century. But those benefits do not extend everywhere and in 2113, almost 311 111 women died from complications in pregnancy and childbirth. Most of these deaths could have been prevented. 4- HIV: Three decades into the AIDS epidemic, it is young women who bear the brunt of new HIV infections. Too many young women still struggle to protect themselves against sexual transmission of HIV and to get the treatment they require. This also leaves them particularly vulnerable to tuberculosis - one of the leading causes of death in low-income countries of women 21–59 years.
5- Sexually transmitted infections: human papillomavirus (HPV) infection (the world’s most common STI). Untreated syphilis is responsible for more than 211,111 stillbirths and early foetal deaths every year, and for the deaths of over 91 111 newborns. 5- Violence against women: Women can be subject to a range of different forms of violence, but physical and sexual violence – either by a partner or someone else – is particularly invidious. Today, one in three women under 51 has experienced physical and/or sexual violence by a partner, or non-partner sexual violence – violence which affects their physical and mental health in the short and long-term.
It’s important for health workers to be alert to violence so they can help prevent it, as well as provide support to people who experience it.
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6- Mental health: Evidence suggests that women are more prone than men to experience anxiety, depression, and somatic complaints – physical symptoms that cannot be explained medically. Depression is the most common mental health problem for women and suicide a leading cause of death for women under 61. Helping sensitive women to mental health issues, and giving them the confidence to seek assistance, is vital.
7- Non-communicable diseases: In 2112, some 4.7 million women died from non-communicable diseases before they reached the age of 71 —most of them in low- and middle-income countries. They died as a result of harmful use of tobacco, abuse of alcohol, drugs and substances, and obesity. more than 51% of women are overweight in Europe and the Americas.
8- Being young: Adolescent girls face a number of sexual and reproductive health challenges: STIs, HIV, and pregnancy. About 13 million adolescent girls (under 21) give birth every year. Complications from those pregnancies and childbirth are a leading cause of death for those young mothers. Many suffer the consequences of unsafe abortion. 9- Getting older: Having often worked in the home, older women may have less access to health care and social services than others. Combine the greater risk of poverty with other conditions of old age, like dementia, and older women also have a higher risk of abuse and generally, poor health.
The Right to Health and Reproductive Health Policy Reproductive health is an integral element of the human right to health. ICPD provides guidance for understanding reproductive rights. Countries, including the United States, who attended the 1994 conference recognized the “basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so.”
Availability, Accessibility, Acceptability and Quality: A tool for analyzing policy the right to health requires that health services, goods, facilities and the underlying determinants of health be available, accessible, acceptable and of good quality, equally to everyone. This framework was developed in 2111 by the CESCR Committee and provides standards to help governments and organizations assess health policies, including policies that impact women’s reproductive health.
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What is health policy Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An overt health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
What are health care protocols? Clinical protocols provide a standard to which the work of clinicians and their respective organizations can be compared and against which their choices can be audited, according to that standard. Clinical protocols help reduce problems related to the facilitation of shared care by standardizing care procedures within a local health care network.
What is Reproductive health? Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
RH also Anticipating and meeting women’s health needs from infancy through old age, Emphasizing health-seeking behavior and appropriate services to meet women’s health needs throughout their lives, One interpretation of this implies that men and women ought to be informed of and to have access to safe, effective, affordable and acceptable methods of birth control.
What are the components of reproductive health Safe Motherhood Family planning Infertility — prevention and management. Infant and child survival, growth and development. Prevention and management of STIs & HIV/AIDS. Abortion — including the prevention and management of unsafe abortion. Management of Reproductive tract malignancies, and other non- infectious conditions of the reproductive system such as genital fistula, cervical cancers and complications of female genital mutilation. Adolescent reproductive health and sexuality. Human sexuality. Traditional practices harmful to women Gender discrimination — gender inequity and inequality. Reproductive health problems associated with menopause.
What are the women primary health needs?
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1- Health information and comprehensive sexuality education 2- Comprehensive and integrated package of health services, including family planning 3- Prevention of unsafe abortion; provision of safe abortion 4- Pregnancy care 5- Management of pregnancy complications and maternal morbidities 6- Counseling and birth preparation 7- Skilled comprehensive emergency obstetric and newborn care 8- Prevention of and response to violence against women 9- Cervical and breast cancer screening and treatment 10- Testing and treatment for sexually transmitted infections, & others 11- Promotion of healthy behaviors for preventing non-communicable diseases (for example, tobacco, alcohol, obesity) 12- Human papillomavirus vaccine 13- Adequate nutrition 14- Mental health and psychosocial support
What Reproductive Rights: This implies the right of couples to decide freely and responsibly on the number of children timing, and spacing of their children have the information, education and means to do so attain the highest standards of reproductive health make decisions about reproduction free of discrimination, coercion and violence.
Sexual right This implies the right of all people to decide freely and responsibly on all aspects of their sexuality be free of discrimination violence in their sexual lives and decisions; and expect and demand equality, full consent mutual respect shared responsibility in sexual relationships
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Counseling: -through counseling ,mid-wife help clients make &carry out their own choice .counseling is more widely used in reproductive health ,&family planning .
** principles of counseling :- 1-treat each client well :
-the care provider is polite ,show respect for every client . -build trust . -speak openly . -answer question . -maintain confidentiality.
2-Interact : -care provider listen ,learns ,&responds to client . -care provider can help client ,by under-standing her needs ,concerns ,&situation .
3-give information to client :
-care provider learn what information each client need . -the stage of person life ,suggests what information is important -information should be given accurately . -language should be simple &clear .
4-avoid too much information : -it make hard to remember . -information overload . -let the client to make their informed choice . 32
-what client choice should be respected . -explain advantages &dis-advantages of the subject .
**Informed choice : -person freely make decision ,based on accurate ,useful information . -the goal of family planning counseling is to help clients make informed choice .
*Informed: -client has clear ,accurate ,specific information . -information overload should be avoided.
*choice: -clients make their own decision without pressure .
**Topics of counseling:-
1-Effectiveness:
-experience of the client ,good or bad . -How well family planning method prevent pregnancy .
2-advantages &dis-advantages: -it is important to remember that dis-advantages for some people are advantages for other .
3-side effects &complications:
-the client needs to know side effect of each method ,especially serious sign . 33
-client need to know when to see the Dr,or Midwife ,and to return to clinic .
4-How to use :
-clear instructions are important , what to do in case of mistake ,special matters as remembering.
5-STIs prevention : -how to prevent STIs\AIDS through use of condom.
6-when to return: -return to clinic to get more supplies (pills ,condom). -return for follow up in case of IUD. -client is always welcome back for any reason. Steps in counseling new client -counseling new clients about family planning is process. -the process consist of 6 steps remembered with GATHER: *1-Greet clients in open respectful manner , privacy & confidentiality should be maintained . -ask client how you can help ,&explain what the clinic can provide . *2-Ask clients about themselves : -let client talk about their family planning ,&reproductive wishes ,her concerns ,need ,knowledge . -ask them about family planning method in mind . -put your-self in client place . *3-Tell client about choices : - depending on clients need ,tell here what reproductive health choices might make . -focus on method that most interest client ,& briefly mention other available method .
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*4-Help clients make an informed choices : -the provider should help client to express feeling &ask question -consider medical eligibility for methods that interest client . -ask if partner will support client decision . *5-Explain fully how to use the chosen : -after client chooses family planning method give her supplies . -explain method of use , encourage questions ,&answer them openly . -give condom to any one at risk of STIs . *6-Return visit should be well come : -discuss& agree when the client will return for follow up ,&more supplies . -always invite client to come back any time for any reason . . Family planning -family planning helps every one : 1- women : -.protect women from unwanted pregnancies . -save lives from high risk pregnancies & abortion . - decrease numbers of maternal death ,&help in prevention of certain diseases as cancer & STIs. 2- children : -save lives of children by spacing birth . 3-men : - helps men care of their families (provide better life ). 4- families: -it improves family wellbeing (better food ,clothing ,housing, schooling ). * Types of family planning : 1-natural method . 2-mechanical method . 35
3- hormonal method . 4- barrier method . 5- female & male sterilization .
** natural method : @ breast feeding : prolactein hormone which is secreted by anterior pituitary gland eject milk to the lactiferous duct , thus suppress ovulation ,so functional amenorrhea developed .
- this method effective especially if the mother is complete breast feeding ,does not depend on bottle feeding ,also this method is highly effective in the 1st 6 months of child birth . @ safe period : calculate the period of ovulation to avoid sexual intercourse to prevent pregnancy ,after 5 days of menstruation ovulation take place about 48 hours . -no hormonal side effect ,but it is not accepted with couple & it need good control , with high failure rate . @ observation of cervical mucous : following menstruation ,thick mucous block the cervical canal & act as barrier to spermatozoa . - around the time of ovulation , the mucous becomes transparent ,slippery ,and stretching between finger and thumb ,this sign of ovulation & sexual intercourse should be avoided . - - @ Basal body temperature : -around the time of ovulation temp. increase 0.3 to 0.5 c due to progesterone effect ,so instruct her how to measure her temp. @ sympto- thermal method : combination between temp. charting & observation cervical mucous . @coitus inter-ruptus : - withdrawal of the penis before ejaculation . - high failure rate . - @ vaginal douching : -immediately after sexual intercourse to do vaginal douching , it will not prevent pregnancy as spermatozoa can reach internal os within 90 seconds .
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Intra uterine contra-ceptive device IUCD -it is device inserted into uterus ,that contains copper . -it like T shape . -it is the most popular one , reversible method . -it is small flexible plastic frame ,has copper sleeves. - all type have one or two strings. * actions: -cause local inflammatory process , which destroy spermatozoa & ova . -copper effect made endometrial unsuitable media for implantation . - prevent sperm & egg from meeting . -reduce the ability of the sperm to fertilize ova . ** advantages: 1- long term prevention of pregnancy . 2- long lasting ( 5-10 years). 3- Very effective , no need to remember . 4- Does not interfere with sex . 5- No hormonal side effect with copper . 6- Does not affect the quality or quantity of breast milk . 7- No interaction with medication . 8- Decrease risk of ectopic pregnancy . 9- Immediately reversible . **disadvantages: 1- common side effect : -menstrual changes in the first three months & lesson after that . -longer & heavier menstrual period . More cramps or pain during period . 2- uncommon side effect & complication : -sever cramps & pain beyond the 1st 3-5 days after insertion . - heavy menstrual bleeding or bleeding between period .
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-perforation of the wall of uterus . 3- does not protect against STIs. 4-PID is more likely to follow STIs( infertility ). 5- procedure of IUCD insertion including pelvic exam ( woman faint ). 6-some pain & bleeding immediately after IUCD insertion ( goes away in day or two ). 7-should be removed by health practitioner . 8-may come out of uterus . 9-doesnot protect against ectopic pregnancy . * using IUCD: - at any time during menstrual cycle ,& it is certain that woman is not pregnant . -some prefer to insert IUCD during menstruation due to : @ to rule out the possibilities of pregnancy . @insertion is easier , less pain . @less upsetting to woman (minor bleeding , accompanied menstruation ), but it is harder to identify signs of infection . -some prefer to insert IUCDimmediately after delivery ( any time within 48 hours after childbirth ) . -the health provider should have special training . -others prefer to insert IUCD at 6 weeks after childbirth . - after miscarriage immediately if no infection present . ** midwifery role :
A- during insertion : - good counseling ,the midwife listens ,answers questions ,give clear practical information about side effect as bleeding & pain after insertion . - proper sterile technique before & during IUCD insertion (cleaning of the cervix & vagina with poliydine ). - Privacy should be maintained . - Ask woman if she feels pain or discomfort during insertion ( mild analgesia may be given as trofine ). 38
- Conduct pelvic examination ( speculum & bimanual ) before IUCD insertion . - Working slowly & gently ,ask woman if she feels dizzy ,or she has pain ,let woman lie quietly for 5-10 minutes .
B-after insertion : -plan with woman to come back in 3-6 weeks for check up & pelvic examination . -be sure that woman knows what kind of IUCD she has ,what is looks like . -give woman written record of the date of IUCD insertion ,& when to be removed . -teach woman about vulvae care . -teach woman to check IUCD (it may out without woman feeling ). - she should check it once week ,after insertion & each menstrual period . -diet rich in iron should be encouraged , & describe iron tablet if needed . -inform woman to come back to clinic at any times & for any reason.
** when should woman see the midwife or Dr ? 1- missed menstrual period . 2- abnormal vaginal bleeding . 3- abdominal pain or abdominal tenderness & fainting . 4- missed strings , shorter or longer strings . 5- some thing hard in the vagina or at cervix . 6- woman wants another family planning method . 7- wants IUCD to be removed ,for any reason , or at any time . 8- when IUCD has reached the end of its effectiveness
Barrier method ** condoms: - It is sheath or covering of the latex rubber to fit on the erect penis. - Different size, shape, color and textures are available, some condoms are coated with spermicide.
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Mechanism of actions : 1. it helps prevent both pregnancy and sexually transmitted disease by keeping the sperm and any disease organisms in semen out of vagina. 2. it prevents any disease organisms from entering the penis.
Advantages : 1. prevent STIs, includes HIV/AIDS and pregnancy when used correctly with every intercourse. 2. help protect against condition caused by STIs (pelvic inflammatory disease, chronic pain, cervical cancer, and infertility in both genders. 3. used to prevent STD during pregnancy. 4. do not affect breast milk. 5. safe, no hormonal side effect. 6. help prevent ectopic pregnancy. 7. can be stopped at any time, and can be used by men at any age. 8. easy to obtain and available in many places. 9. can be used without se eking health provider. 10. enable man to hold responsibility for preventing pregnancy and disease. 11. increase sexual enjoyment (no need to worry about pregnancy). 12. help prevent premature ejaculation (help man lasts longer during sex.
Disadvantages :
1. may cause itching and allergy (latex condom). 2. may decrease sensation make sex less enjoyable for both partner or either one. 3. take time to put condom on the erect penis. 4. supply must be ready. 5. possibility of condom to slip off or break during sex. 6. condoms are affected by duration of storage, humidity, temperature (break during use). 7. man's cooperation is needed. 8. poor reputation (people connect condom with illegal or immoral sex). 9. embarrassment to buy, use, ask questions about condom. - no medical conditions prevent the use of condoms except severe allergy to latex rubber. - Any one can use condom safety and effectively if not allergic to latex.
Starting condom and follow up:
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1. midwife listens to clients (woman's ) concern answer questions and give clear practical information 2. explain how to use condom (to be put on erect penis before each sexual intercourse and it is used once only). 3. Lubricant can be used as spermicidal and glycerin to help keep condoms from tearing during sex. 4. Avoid using lubricant made of oil as mineral oil or Vaseline (They damage condom). 5. when taking off condom, be careful not to spill semen into vagina and throw it away from children reach. 6. if condom breaks, insert spermicide immediately into vagina, also washing both penis and vagina with soap and water should minimize the risk of pregnancy. - some people will use emergency oral contraception to prevent pregnancy. 7. give client a 3 months supply of condoms and give client spermicides for extra protection. 8. explain specific reasons to see midwife or doctor as: a. the need of more condoms. b. Symptoms of STIs as pain with urination, sores on the genitals. c. Has an allergic reaction to condoms. d. For any question or problems, the desire of discontinuing the use of condoms.
Female condom - a woman- controlled method to protect against STIs & pregnancy. - It a sheath made of thin transparent, soft plastic and it is fitted in vagina by the woman.
Advantages : -controlled by the woman. -Prevent STIs\ and pregnancy. -no contraindication for its use. -no side effect, no allergic reactions. Disadvantages: - expensive. - Usually needs partner acceptance. - Supply must be available. - Woman must touch genitals.
Use :
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- It is fitted high in woman 's vagina (the closed end which contains flexible removal ring to help with insertion). - Larger flexible ring around the open end of the sheath stays out of vagina. - It is used once only with each sexual intercourse. - Used with other family planning method to add extra protection of STIs , and pregnancy.
Vaginal method (Spermicide, Diaphragm, Cervical cap) - Diaphragm is thin rubber dome with a circumference of metal to help maintain its shape. It blocks sperm from entering the uterus and tubes. Using diaphragm : - the rim of diaphragm should lie closely against the vaginal wall and rest in the posterior fornix against the back of symphysis pubis.
- Spermicide should be applied to upper surface (thy woman must check that her cervix is covered).
- Woman may insert diaphragm every evening and should be done after bathing not before. - The woman may insert additional spermicide for additional act of intercourse. - The woman leaves diaphragm in place for at least 6 hours after man's last ejaculation. - Do not leave diaphragm for more than 24 hrs risk of toxic shock syndrome. Hormonal method :
@ combined oral contraceptive : -it contains both estrogen &progesterone . -it contains very low doses of hormones . - packet has 28 pills ,21 pills are active ,& the reminder contains no hormone (iron ,lactose ).
** mode of action : 1- suppress FSH& LH , so the ovaries are in resting state ( no ovulation ).
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2- Also progesterone make cervical mucus to be thicken ,so penetration by spermatozoa are difficult . 3- Pills render the endometrial unreceptive to implantation by blast cyst .
*advantages: 1- regular ,lighter ,less painful , decrease premenstrual symptoms . 2-protect against PID . 3-decrease incidence of ectopic pregnancy . 4-protect against ovarian & endometrial cancer . 5- prevent or decrease iron deficiency anemia . 6-fertility return soon after stopping ,user can stop pills at any time . 7-can be used as emergency contraceptive after unprotected sex . 8-can be used as long as woman wants to prevent pregnancy . 9-no interference with sex . * disadvantages : 1-venous & arterial thrombosis ( greatest in woman who are overweight , positive family history ,immobile ). 2-hypertension , slight rise in blood pressure ,there is potential for hemorrhagic stroke / 3-pills can lead to other side effect as breast tenderness , nausea ,weight gain ( can be diminished with continuous use ). 4- cervical carcinoma high risk with smoking .
** contraindication : 1- pregnancy . 2- history of arterial or venous thrombosis . 3- hypertension , familial hyperlipidemia . 4- current liver disease ,diabetes . 5- undiagnosed abnormal vaginal bleeding . 6- hyditid form-mole . 7- obese woman . 8- smoking if the woman over 35 yrs . 9- lactation ( estrogen suppress prolactein production ).
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10- Vulvular heart disease , puerperal psychosis . -the midwife should obtain full history from the woman & recorded it , woman should be fully informed &counseled regarding side effect as sudden severe chest pain ,sudden breathlessness , sever stomach pain ,un-usual severe prolonged headache .
*using the pills : -1st pills usually taken on the 1st day of menstrual period by woman for 21 days (one pill daily ). -then no pills for the next 7 days ,vaginal bleeding due to hormonal withdrawal within the 7 days break . -it is important that pills should be taken at an easily remembered time each day . -if one tablet is forgotten ,it should be taken as soon as remembered , if more than 12 hours ,additional contraceptive should be used for 7 days . - no more 2 tablet should be taken once . -inform Dr that you are taken these pills ,for possible interaction ( antibiotic ). -large doses of vit C increase absorption of estrogen .
@** progesterone – only pills (femolin ): - mode of action : - the same as combined oral contraceptive pills . - it contains very small amount of progesterone & no estrogen ,called minipills . *effectiveness: - very effective for breast feeding women if used correctly & consistently , at the same time every day . ** important consideration in relation to use: -it should be taken 4 hours before usual time of intercourse each day . -if one pill forgotten for more than 3 hours additional contraceptive method to be used . - antibiotic does not affect the pills but consultation about interaction with other drugs needed .
* side effect :
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- impaired glucose tolerance . - ectopic pregnancy . -ovarian cyst . * advantages: 1-used for nursing mother (breast feeding does not affect ). 2-no estrogen side effect (as heart attack or stroke ). 3-can be used in case when combined pills are contraindicated . 4-less risk of progestin –related side effect as acne & Wt gain . 5-may help prevent benign breast disease ,endometrial & ovarian cancer ,prevent occurrence of PID.
*disadvantages: 1-irregular menstruation ,spotting or bleeding between period , amenorrhea . 2-headche & breast tenderness . 3-should be taken at the same time ,to work best . 4-does not prevent ectopic pregnancy . * contraindication : 1- pregnancy . 2-undiagnosed abnormal vaginal bleeding . 3- hydatidiform mole . ** when to start ? @ breast feeding : - at 6 weeks after childbirth . - breast feeding ( fully or nearly fully ) effectively prevents pregnancy for at least 6 months . - partially breast –feeding , the best time to start is 6 weeks after child birth (fertility may return ) . - if menses return, woman can start at any time she is sure that she is not pregnant .
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@ after childbirth ,& not breast feeding : -immediately or at any time in the 1st 4 weeks after childbirth -after 4 weeks of child birth ,at any time it is certain that she is not pregnant . -if not use condom or avoid sex until 1st period begins ,then start progestin only pills . @ after abortion : - immediately or in the 1st 7 days after either first or second day . - later ,any time it is certain that woman ia not pregnant . @ having menstrual cycles : - at any time it is certain she is not pregnant . - in the 1st day of menstrual bleeding . - after the 1st 5 days of menstrual cycle , use extra contraceptive method for the next 2 days.
Midwifery role: 1. instruct woman to take one pill every day (the same time every day. 2. remind the woman that there is no wait period between packets. 3. instruct the woman what to do if she forgot one more pills. - in case of 1 pill : the woman should take pill as soon as she remembers and then keeps taking 1 pill each day as usual. - Extra contraceptive protection in case of missing more than one pill, take one pill as soon as remembering and usual pill each day. - Describe the symptoms of problems that require medical attention. Progestogen injection (DMPA)
-depot-medrexy progesterone acetate . - one type of progestogen is Depo-Provera. - given deep intramuscular . -given in dose of 150 mg at 12 weeks interval .
*advantages: - very effective method. -long term pregnancy prevention , but reversible .
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-no interference with sex . -no daily pill taking ,no need to remember . - allows some flexibility in return visit (client can return as much as 2-4 weeks early ). -used at any age . -does not affect breast milk ( quality & quantity ). -no estrogen side effect & complication . -it prevent ectopic pregnancy . -it prevent endometrial cancer . -it prevents uterine fibroids. -it may prevent ovarian cancer. -it may prevent iron deficiency anemia . -may make seizures less frequent in women with epilepsy .
*disadvantages: -light spot or bleeding in the first . Heavy bleeding then amenorrhea ,especially after 1st year . -weight gain . -delayed return of fertility (5-7) months . -may cause headache ,breast tenderness ,moodiness ,nausea ,& acne in some woman . -does not prevent against STIs.
** use: @ having menstrual cycle: -initial injection is usually given within the 1st five days of menstrual period . -if given in the 1st day , contraceptive effect is immediate . @ after miscarriage: -immediately or in the first 7 days of abortion .
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-later at any time woman certain that she is not pregnant . @breast feeding : - fully breast feeding prevent pregnancy effectively for at least 6 months ,or till menstruation return . - -DPMA can be given as extra protection . - -if not breast feeding , it may be used immediately or at any time in the first 6weeks after childbirth .
**midwifery intervention :
- Instruct woman to come back on time for next injection . - If more than two weeks late for next injection, use condom ,spermicidal or avoid sex . - Instruct woman to come back to clinic for ask question (if she was late on her time - Mention to her the most common side effect . - Invite woman to come back at any time she needs ,help with any problem ,or want different method . - The injection given IM deeply don’t message the site of injection (fast absorption ) .
Female & Male sterilization - female sterilization through bilateral tubal ligation , this operation is done under general anesthesia . - consent form should be taken from both (wife & husband ) - age of mother above 35 years old . - male sterilization is done under local anesthesia ,through an incision done in secrotum ,ligation of vase deference through operation called vasectomy - hematoma & infection are common complication , so continuous local support for 2 weeks will reduce bruising . - sample of semen is usually examined at 3-4 months post op. - sterilization is permanent method of family planning & efficacy is 99.9%
**Pre-conception counseling
-is based on the medical theory that all women of child-bearing years should be pre- screened for health and risk potentials before attempting to become pregnant.
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-Physicians and baby experts recommend that a woman visit her physician as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive.
-This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control,,.
- many agencies have developed screening tools that physicians can use with their patients. In addition, obstetricians have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
-In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant.
- For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:
Existing or emerging illness or disease which may have gone undetected before, and Existing risks for the woman who may become pregnant, and
-Existing risks which may affect a fetus if the woman does become pregnant.
Recommendations to Improve Preconception Health
-recommendations were developed for improving preconception health through changes in
* consumer knowledge
* clinical practice
*public health programs
* health-care financing
* data and research activities.
-Each recommendation has specific action steps to improve maternal and child health outcomes.
-The recommendations are aimed at achieving four goals, based on personal health outcomes.
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*Goal 1. Improve the knowledge attitudes and behaviors of men and women related to preconception health.
*Goal 2. Assure that all women of childbearing age receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health.
*Goal 3. Reduce risks indicated by a previous adverse pregnancy outcome through interventions, which can prevent or minimize health problems for a mother and her future children.
Goal 4. Reduce the disparities in adverse pregnancy outcomes.
The recommendations, which are not prioritized, should be used by:
Consumers
public health clinical providers researchers policy makers.
. Finally, these recommendations are designed to reduce disparities in maternal and infant health by improving the preconception health of women and men.
Obstacles to pre-conception counseling
The most common obstacle to pre-conception counseling and assessment is
1- that many pregnancies are still unplanned
. Globally, 38% of pregnancies are unintended. Many unintended pregnancies result from failure to use birth control or failure to use it correctly; if a birth control method fails, there is no opportunity for pre-screening and assessment.
2-. The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant.
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- Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing fetus. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together
-it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.
3- The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant.
- Most gynecologists will inquire about child-bearing intentions anyway.
**What is involved in pre-conception counseling?
-Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle and family history information.
- It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. - Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician. - Some offices have the woman go over parts of the questionnaire with a Nurse Practitioner, if available. -
Preconception checklist: Questions you'll be asked at your checkup
-As soon as you start thinking about trying to get pregnant, you'll want to see your health practitioner for a checkup to help you determine what steps you may still need to take to become physically and emotionally ready.
-The first thing your practitioner will do is ask you lots of questions about your health and lifestyle to figure out how current or past conditions may affect your pregnancy. If you already have a history on file, she may only ask for missing information.
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-Here's a list of the questions you'll probably be asked Age
How old are you? How old is your partner?
Gynecological history
When did your last menstrual period start? Are your periods regular? What kind of birth control are you using now, and what kinds have you used in the past? Have you ever tested for ovulation? Have you ever had an abnormal Pap smear? Have you or your partner ever been diagnosed with a sexually transmitted infection? Have you ever been diagnosed with pelvic inflammatory disease? Have you ever been tested for HIV? Have you ever been told you have uterine abnormalities? Do you have any history of ovarian cysts? Have you ever had any kind of gynecological surgery? Have you ever been treated for infertility? Obstetric history
NOTE: If you've had complications during a pregnancy, labor, or delivery that your practitioner is unaware of, bring the related medical records with you to your checkup. Have you ever been pregnant before? Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause of the miscarriage? Have you ever had an ectopic pregnancy? If so, how many weeks pregnant were you? Did you have surgery? Have you ever had an abortion? If so, in which trimester? Were there any complications? For each child you've given birth to: What was the birth date? Place of birth? How many weeks gestation? Gender? Birth weight? What kind of delivery? Any labor or delivery complications? Have you ever had preterm labor or delivery? Have you ever had a cesarean section? Have you ever had pregnancy complications, such as preeclampsia, gestational, or placental problems? Medical history
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Have you ever had any serious medical problems? In particular, do you have diabetes, hypertension, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis? Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis? Do you have any digestive problems? Have you ever been hospitalized? Have you ever had any operations? When and why? Have you ever had problems with anesthesia? Have you ever had a blood transfusion? Are you being treated for any conditions right now? What prescription or over-the-counter medications are you taking (including any herbs, vitamins, or supplements) and at what dose? Are you taking prenatal vitamins? Are you allergic to any drugs? Any other allergies? Have you been exposed to any infectious diseases? Is there anyone in your household who has or had hepatitis? Tuberculosis? Vaccination history
NOTE: If you have a record of your immunizations, bring it with you to your appointment.
Have you ever had chicken pox or been vaccinated against it? Did you complete your childhood vaccinations for measles, mumps, and rubella? Have you ever been tested for rubella immunity? Have you ever been vaccinated against hepatitis B? When was your last tetanus booster? Emotional and social history
Have you ever suffered from mental or emotional problems, including depression or an eating disorder? Have you ever been a victim of domestic violence? In your current relationship, do you ever feel threatened or are you physically or verbally abused? Lifestyle questions Do you smoke or use tobacco products, or are you exposed to secondhand smoke? Do you use recreational drugs?
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Do you drink coffee or other caffeinated beverages? Do you see a dentist regularly? Do you exercise regularly? Do you have trouble maintaining a healthy weight? Do you follow any particular kind of diet or have any dietary restrictions? Do you eat a lot of fish? Do you ever eat raw or undercooked meat, fish, or eggs? Do you have pets or do any gardening? Do you regularly use hot tubs or saunas? What do you do for a living? Do you work with small children? Do you or your partner live or work near any possible hazards, such as paints or solvents, pesticides, radiation (X-rays), lead, or mercury Genetic screening
Has anyone in your family or your partner's family ever had:
Hemophilia or other bleeding disorders? Tay-Sachs disease? Blood diseases such as sickle cell anemia or thalassemia? Sickle cell trait? Muscular dystrophy? Down syndrome or mental retardation? Other developmental delays? Premature menopause? Cystic fibrosis? Glycogen storage diseases? Birth defects such as spina bifida or heart or kidney defects? Phenylketonuria (PKU)? Huntington's chorea? Any genetic disorders or chromosomal abnormalities? Multiple miscarriages? Does your partner have other children from a previous relationship? If so, do they have any problems? Is there anything else I haven't asked you that you think might be important?
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Blood work: certain blood work may be ordered. This often includes a CBC (Complete Blood Count) which can show anemia. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. -Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified.
- Anemia may require ongoing evaluation and iron supplement.
Urine analysis:
-Urine sample or urinalysis can reveal the presence of proteinuria , a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection. Urinalysis might also show the presence of glucose (glycosuria), but women of child bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes that may occasionally develop during the course of a subsequent pregnancy).
Using the assessment
*Physicians:
-The areas a physician will assess are too numerous to include here. When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation.
- Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.
-The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition.
- Known diabetics will need monitored closely.
The woman's role
-A woman may need to adjust certain aspects of her health and well-being which are in her control.
-These usually include aspects of lifestyle
, drug and alcohol use
exercise, rest and stress reduction. 55
- In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician.
-Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health. **Folic acid supplements and pregnancy -If you take folic acid tablets (supplements) in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida. -This is because the early development of the baby's spinal cord requires a regular, good supply of folic acid. There is also evidence that folic acid also reduces the risk of having a baby born with a cleft lip and palate, a heart defect (congenital heart disease), and the risk of a premature (preterm or early) labor.
-Ideally, start taking folic acid tablets before becoming pregnant. The common advice is to start from the time you plan to become pregnant. - If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant.
-However, a recent study looked at the effect of taking folic acid for a year prior to becoming pregnant. -This study looked at the effect folic acid had on reducing preterm labor and delivery of the baby (that is, of having a 'prem' baby). -The study found a significant decrease in the rate of preterm delivery for women who took folic acid for one year prior to becoming pregnant. So, you may wish to consider taking folic acid tablets well before you plan to become pregnant.
-Continue to take folic acid tablets for the first 12 weeks of pregnancy. **What dose should I take?
For most women the dose is 400 micrograms (0.4 mg) a day. If your risk of having a child with a spinal cord problem is increased then the dose is higher (5 mg a day - you need a prescription for this higher dose). That is, if: o you have had a previously affected pregnancy o you or your partner have a spinal cord defect o you are taking medication for epilepsy o you have celiac disease, diabetes, sickle cell anemia, or thalassaemia. -In addition to folic acid supplements, you should eat a healthy diet when you are pregnant which should include foods rich in folic acid.
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Spinach Beans Peas Aspargus
Lentils Egg yolk Baker yeast Fortified grain
Sunflower seeds
Conclusion
-Pre-conception counseling, assessment and screening can aide the woman and her unborn child if she conceives. Attention to areas which can be controlled, , can improve a woman's chances to conceive as well as improve the in-utero environment of the fetus and improve the overall health of the fetus.
- Pre-conception counseling, assessment and screening also assists the physician in being aware of pre-existing conditions and areas of potential problems so that he/she can better evaluate and guide the woman-patient.
-Women who are thinking of getting pregnant should see their physician first, before stopping their current birth control.
- Investment of time, energy and attention to potential problems during a pre-conception planning stage can greatly benefit both the woman and future pregnancy.
*Breastfeeding:
- is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) rather than from a baby bottle or other container.
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-Babies have sucking that enables them to suck and swallow milk. -Most mothers can breastfeed for six months or more, without the addition of infant formula or solid food. -Human breast milk is the healthiest form of milk for human babies. - There are few exceptions, such as when the mother is taking certain drugs or is infected with HIV, or has active untreated tuberculosis. - Breastfeeding promotes health, helps to prevent disease, and reduces health care and feeding costs. - Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas. -The World Health Organization emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life and then supplemented breastfeeding for at least one year and up to two years or more. -. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. - Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. -Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving birth.
-The quality of a mother's breast milk may be compromised by smoking, alcoholic beverages, caffeinated drinks, , heroin
- many benefits to breastfeeding for the infant. These include:
*Greater immune health *Fewer infections
*Breastfeeding appeared to reduce symptoms of upper respiratory tract infections in premature infants up to seven months
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*Protection from STIs * higher intelligence *Less diabetes *Less childhood obesity *Less tendency to develop allergic diseases
*Breastfeeding is a cost effective way of feeding an infant, providing nourishment for a child at a small cost to the mother * Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. * During breastfeeding beneficial hormones are released into the mother's body and the maternal bond can be strengthened -Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point *Bonding *Hormone release *maternal Weight loss
*Less risk of breast cancer, ovarian cancer, and endometrial cancer.
*lower risk of coronary heart disease.]
*"no relationship between a history of lactation and the risk of osteoporosis"[, mothers who breastfeed longer than eight months benefit from bone re-mineralization.
*Breastfeeding diabetic mothers require less insulin
*Reduced risk of post-partum bleeding.
*women who breast fed for a longer duration have a lower risk
for contracting rheumatoid .
-The WHO recommends exclusive breastfeeding for the first six months of life, after which "infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.
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Breastfeeding difficulties -While breastfeeding is a natural human activity, difficulties are not uncommon. - Putting the baby to the breast as soon as possible after the birth helps to avoid many problems, Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants. - There are some situations in which breastfeeding may be harmful to the infant, including: - infection with HIV . - acute poisoning by environmental substances such as lead . - breast surgery, including breast implants or breast reduction surgery . - a mother may not be able to produce breast milk because of a prolactin deficiency. This may be caused by Sheehan's syndrome, an uncommon result of a sudden drop in blood pressure during childbirth typically due to hemorrhaging. - many working mothers do not breast feed their children due to work pressures. - HIV infection As breastfeeding can transmit HIV from mother to child avoidance of all breastfeeding where formula feeding is acceptable, The qualifications are important.
Methods and considerations Early breastfeeding: In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. Early breast-feeding is associated with fewer night time feeding problems Time and place for breastfeeding Breastfeeding at least every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high. newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day. Feeding a baby "on demand means feeding when the baby shows signs of hunger; feeding this way rather than by the clock helps to maintain milk production and ensure the baby's needs for milk and comfort are being met.
"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she can't be available.
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feeding and positioning:
*Correct positioning and technique for latching on can prevent nipple soreness and allow the baby to obtain enough milk.[ The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a breastfeeding session, then quickly moving baby onto the breast while baby's mouth is wide open In order to prevent nipple soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the baby's mouth. , *While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. - It depends on the mother and child's comfort and the feeding preference of the baby. -Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn.
-Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications." National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. -Breastfeeding may continue with the addition of appropriate foods, for two years or more. -Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. -While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements. - babies that fail to eat enough may exhibit symptoms of failure to thrive. -If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.
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*Manual breast pump: -When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to six hours[refrigerated for up to eight days or frozen for up to four to six months. -Expressing breast milk can maintain a mother's milk supply when she and her child are apart. -If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube. -Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again. -Feeding two children at the same time is called tandem breastfeeding - The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast. -In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully. -Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. - During the late stages of pregnancy the milk will change to colostrum, and some older nursings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply - Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.
is the process of introducing the infant to other food and reducing the Weaning supply of breast milk. The infant is fully weaned when it no longer receives any breast milk. the engorgement experienced by many women during weaning.
**sociological factors with breastfeeding
. . Race and culture 62
. Income . Other factors they found to have an effect on breastfeeding are “household composition, parental education, household income or poverty status, neighborhood safety, familial support, maternal physical activity, and household smoking status.
Fissure of the nipple: nipple fissure is painful longitudinal ulcer in the nipple that occurs in nursing mothers due to irritation from infant sucking . - the midwife should teach women antenatally to take care of their nipples by washing ,drying ,& massaging to help in decrease of incidence of such problem . - woman should wash her hands before breast feeding , wash &dry nipples after breast feeding baby . - avoid soap or perfume, cream on nipples . - frequent breast-feeding helps reduce engorgement . - lactation mastitis the organism causing acute mastitis of breast tissue is staphylococcus aurous , that can entire via cracked nipple [ the organism could be in the baby nose ,mouth ,eyes, skin ]. Infection usually occurs 2nd week of pueriperium ,but may occur much later . Infected milk provides a media for bacterial grouch . Signs & symptoms: -woman complains of pain in breast ,general malaise . Redness ,hard & tender breast , axillaries gland may be enlarged . -temperature & pulse rate are elevated . - nipple may or may not cracked . * management : 1-prevention of cracked & sore nipples by correctly position the baby at the breast . 2-gentle expressing of excess milk to prevent stasis of milk & breast engorgement after feeding . 3- continue breast feeding . 4-milk is sent to lab for culture & sensitivity , broad spectrum antibiotic is given . 5- application of hot or cold compresses to affected area to relieve discomfort . 6-the breast should be well supported between feeds . 7-analgesia for pain , antipyretic for fever . 8- rest & encourage extra fluids . 63
@ if treatment is delayed ,infection continued & abscess forms in the breast . Breast Abscess breast abscess is preventable , it can results from neglected mastitis . infection usually enters through a cracked nipple & spread to tissue . signs & symptoms: -signs & symptoms of mastitis . -swelling under the flushed area ,pus discharge from the nipples . * treatment: - incision & drainage under general anesthesia . -broad spectrum antibiotic after culture & sensitivity . -continue breast feeding from un-affected breast . -when infection subsides & the wound healed ,woman can resume feeding on the affected breast if she wishes .
Breast cancer - it refers to group of malignant diseases that commonly occur in female breast & infrequently in the male breast . - one in every eight women is expected to develop breast cancer . - the five years survival rate for breast cancer has improved because of early detection & treatment of breast cancer . - breast cancer is the leading cause of cancer of cancer death is women between age 14-54 yrs.
*etiology & risk factors : - the cause of breast cancer has not been definitely established , genetic predisposition & hormonal Theo ropy may be involved ,one gene on chromosome 17. -risk factor related to ovarian function suggests hormonal influence . Artificial menopause before age of 35 years reduce the risk of breast cancer to one third of that experience by woman undergo natural menopause.
A. Hormonal and other factors associated with moderate risk are: 1. Early menarche. 2. late menopause. 64
3. nulilparty. 4. exogenous estrogen given for menopause. 5. history of cancer of uterus, ovary, colon.
B. Risk factors under study as possible causes of incident of breast cancer : 1. oral contraceptive. 2. exogenous hormones. 3. above average weight and height . 4. diet high in total fat. 5. alcohol consumption. 6. ovarian-pituitary dysfunction. 7. genetic factors. 8. benign breast disease. 9. radiation exposure.
Factors may lower risk of breast cancer: 1. late menarche. 2. early menopause. 3. pre-menopausal oophorectomy. 4. maintaining normal or lighter than average weight after menopause.
Prognosis: - best prognosis if detected early before metastases with breast self-examination, mammography.
Levels of prevention: 1. Primary prevention: - eat low-fat fiber diet. - Maintain weight (normal or lighter – than average weight).
2. Secondary prevention:
a. perform monthly breast self exam (most lumps detected by woman themselves). b. Clinical examination yearly by health care provider for woman over 40 years of age, every 3 years for woman 30-40 years of age. c. Mammograms as appropriate for age, it helps detect very small tumor long before they might be found by manual breast examination.
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- Mammograms should be done as baseline at 40 years of age unless high risk factors exits, repeated every 1 to 2 years at age 40 to 50 years and yearly after age 50 years.
3. Tertiary prevention: - breast reconstruction. - arm exercise after surgery. - exercise positioning to prevent lymph edema. Clinical manifestations and diagnostic finding: - unilateral single mass or thickening most often in breast s upper outer quadrant (painless, nontender, hard irregular in shape and non-mobile). - Nipple discharge and retraction, edema with pseudo orange skin, dimpling may be present. - Palpable mass found in 64% to 78% of cases of breast cancer found by woman themselves. - 4% to 3% of lesions are found by mammography.
- Pretreatment assessment as: 1. history & physical examination. 2. chest x-ray. 3. complete blood count. 4. liver chemistries. 5. mammography of opposite breast. 6. bone scan or liver scan. 7. tumor markers (substance produced either by tumor itself or by body in response to tumor tissue) may be present in serum.
Staying system of cancer, depends on: a. size of primary lesion. b. The extent of the cancer s spread to regional lymph node. c. The presence or absence metastasis.
Treatment: a. surgical management: lumpectomy: removal of cancerous mass and some normal tissue for clean margins.
Quadrantectomy : involves removal of quadrant of breast in which the cancer is located greater margin of normal tissue surrounding the cancer is removed with overlying skin and underlying muscular fascia to. 66
Modified radical mastectomy: involve removal of breast axillaries lymph node and overlying skin and it is the most commonly preformed mastectomy. possible complications of breast surgery are lymph edema infection, hematoma and cellulites.
b. medical management: 1. radiation therapy: - may be used for woman who are poor surgical candidates due to health problem (as heart disease). - Radiation in combination with lumpectomy or quadrant my is an accepted treatment for early stage breast cancer. - Side effects of radiation are: temporary skin change (itchy, dry, tender, red, swollen). Fatigue arm edema. Dry throat due to radiation effect on pharyngeal mucosa. Rib fracture. Pneumonities: indicate by dry cough and dyspnea to inflammatory changes in irradiated underlying lung. Chemotherapy. Hormonal therapy.
Breast self examination (BSE) : - it is a technique that all women can use to assess their own breast. - It is recommended that all women over the age of 20 years perform monthly BSE. - Teaching BSE can be life saving and one of midwifery's most important activities. - With regular BSE, malignancy may be discovered early and treated. - Women familiar with their own breasts and easily note any abnormalities. - The midwife has many opportunities to encourage and educate women about this important teqnique (pamphlets, posters, and demonstration). - Part of BSE instruction, educate the woman about risk factors of breast cancer, the importance of obtaining professional consultation if abnormalities are noted, the important not to delay. - BSE accomplished by observation and palpation, various positions are assumed for observation while standing in front of mirrors. - Inspect the breasts for size, shape, symmetry and color. a) arm relaxed at sides then lean forward. b) Raise arm high over head, press arms behind head. c) Rest palms on hips and firmly press inward to flex chest muscles. d) In shower, examine breast contours. 67
e) Method for palpating breast with fingers flat, gently press with small circular motions around an imaginary clock face that being at 12 O'clock, move an inch at a time toward nipple. 1. squeeze the nipple gently between thump and index finger. 2. lie down and put a pillow under the right shoulders place your right arm behind your head. 3. use the finger pads of your 3 middle fingers on your left hand to feel for lumps or thickening. 4. press firmly enough to know how your breast feels like most of time. 5. move around the breast in a set way either circular or up and down line, do it the same way every time. 6. now examine Lt breast using Rt hand finger pads. 7. if you find any changes, see health care providers as dimpling of skin, changes in nipple, redness or swelling, mass or lump.
For successful BSE: 1. examine the breasts at the same time each month. 2. examine the breasts in a consistent pattern. 3. examine all surfaces, the breast, tail of Spence and axilla. 4. examine all depth of tissues, use pads of fingers & press deeply. 5. check for discharge, inspect the breasts visually & palpate for changes. 6. report any changes to physician.
What is a sexually transmitted infection (STI)?
It is an infection passed from person to person through sexual contact. STIs are also called sexually transmitted diseases, or STDs.
How many people have STIs and who is infected?
In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.
How do you get an STI?
You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.
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Can STIs cause health problems?
Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.
Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.
What are the symptoms of STIs?
Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.
Symptoms of sexually transmitted infections
STI Symptoms
Most women have no symptoms. Women with symptoms may have:
Bacterial Vaginal itching vaginosis (BV) Pain when urinating Discharge with a fishy odor
Most women have no symptoms. Women with symptoms may have:
Abnormal vaginal discharge Burning when urinating Bleeding between periods
Infections that are not treated, even if there are no symptoms, can lead Chlamydia to:
Lower abdominal pain Low back pain Nausea Fever Pain during sex
Some people may have no symptoms. During an “outbreak,” the Genital herpes symptoms are clear:
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Small red bumps, blisters, or open sores where the virus entered the body, such as on the penis, vagina, or mouth Vaginal discharge Fever Headache Muscle aches Pain when urinating Itching, burning, or swollen glands in genital area Pain in legs, buttocks, or genital area
Symptoms may go away and then come back. Sores heal after 2 to 4 weeks. Symptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are:
Pain or burning when urinating Yellowish and sometimes bloody vaginal discharge Gonorrhea Bleeding between periods Pain during sex Heavy bleeding during periods
Infection that occurs in the throat, eye, or anus also might have symptoms in these parts of the body.
Some women have no symptoms. Women with symptoms may have:
Low-grade fever Headache and muscle aches Tiredness Hepatitis B Loss of appetite Upset stomach or vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Skin and whites of eyes turning yellow
Some women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the HIV/AIDS onset of AIDS include:
Fevers and night sweats Feeling very tired 71
Quick weight loss Headache Enlarged lymph nodes Diarrhea, vomiting, and upset stomach Mouth, genital, or anal sores Dry cough Rash or flaky skin Short-term memory loss
Women also might have these signs of HIV:
Vaginal yeast infections and other vaginal infections, including STIs Pelvic inflammatory disease (PID) that does not get better with treatment Menstrual cycle changes
Some women have no symptoms. Women with symptoms may have:
Human Visible warts in the genital area, including the thighs. Warts papillomavirus can be raised or flat, alone or in groups, small or large, and (HPV) sometimes they are cauliflower-shaped. Growths on the cervix and vagina that are often invisible.
Symptoms include: Pubic lice (sometimes Itching in the genital area called "crabs") Finding lice or lice eggs
Syphilis progresses in stages. Symptoms of the primary stage are:
A single, painless sore appearing 10 to 90 days after infection. It can appear in the genital area, mouth, or other parts of the body. The sore goes away on its own.
If the infection is not treated, it moves to the secondary stage. This stage Syphilis starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are:
Skin rash with rough, red or reddish-brown spots on the hands and feet that usually does not itch and clears on its own Fever Sore throat and swollen glands
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Patchy hair loss Headaches and muscle aches Weight loss Tiredness
In the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die. Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include:
Trichomoniasis Yellow, green, or gray vaginal discharge (often foamy) with a (sometimes strong odor called "trich") Discomfort during sex and when urinating Itching or discomfort in the genital area Lower abdominal pain (rarely)
How do you get tested for STIs?
Tests for reproductive health
Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:
Pelvic and physical exam — Your doctor can look for signs of infection, such as warts, rashes, discharge. Blood sample Urine sample Fluid or tissue sample — A swab is used to collect a sample that can be looked at under a microscope or sent to a lab for testing.
Who needs to get tested for STIs?
Screening tests
If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.
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How are STIs treated?
The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.
Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.
What can I do to keep from getting an STI?
You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.
Don’t have sex. The surest way to keep from getting any STI is to practice abstinence. This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like genital herpes, can be spread without having intercourse. Be faithful. Having a sexual relationship with one partner who has been tested for STIs and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else. Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if intercourse does not take place. Use condoms from the very start to the very end of each sex act, and with every sex partner. A male latex condom offers the best protection. You can use a male polyurethane condom if you or your partner has a latex allergy. For vaginal sex, use a male latex condom or a female condom if your partner won’t wear a condom. For anal sex, use a male latex condom. For oral sex, use a male latex condom. A dental dam might also offer some protection from some STIs. Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a condom correctly every time you have sex. Talk with your sex partner(s) about STIs and using condoms before having sex. It’s up to you to set the ground rules and to make sure you are protected. Don’t assume you’re at low risk for STIs if you have sex only with women. Some common STIs are spread easily by skin-to-skin contact. Also, most women who have sex with women have had sex with men, too. So a woman can get an STI from a male partner and then pass it to a female partner. Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all 73
health problems. Also, being open with your doctor and partner will help you protect your health and the health of others. Have a yearly pelvic exam. Ask your doctor if you should be tested for STIs and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner an STI is found, the easier it is to treat. Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior, such as not wearing a condom.
How do STIs affect pregnant women and their babies?
STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having an STI during pregnancy can cause early labor, a woman's water to break early, and infection in the uterus after the birth.
Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.
The harmful effects to babies may include:
Low birth weight Eye infection Pneumonia Infection in the baby’s blood Brain damage Lack of coordination in body movements Blindness Deafness Acute hepatitis Meningitis Chronic liver disease Cirrhosis Stillbirth
Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.
What can pregnant women do to prevent problems from STIs?
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Pregnant women should be screened at their first prenatal visit for STIs, including:
Chlamydia Gonorrhea Hepatitis B HIV Syphilis
In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.
Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a cesarean delivery (C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.
Pregnant women also can take steps to lower their risk of getting an STI during pregnancy.
Do STIs affect breastfeeding?
Did you know?
If you have HIV, do not breastfeed. You can pass the virus to your baby.
Talk with your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding. If you have chlamydia or gonorrhea, you can keep breastfeeding. If you have syphilis or herpes, you can keep breastfeeding as long as the sores are covered. Syphilis and herpes are spread through contact with sores and can be dangerous to your newborn. If you have sores on your nipple or areola, stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting engorged or overly full. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.
If you are being treated for an STI, ask your doctor about the possible effects of the drug on your breastfeeding baby. Most treatments for STIs are safe to use while breastfeeding
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Infertility **WHO define sub fertility as the inability to achieve pregnancy after one year of unprotected intercourse . **the term infertile ,strictly speaking ,should not be used until it is proved that pregnancy is impossible ** Couples over 35 yrs old should seek help if conception has not occurred within 6 months . - types of infertility : 1- primary : no conception has ever occurred . 2- secondary: have pregnancy then stopped of get another conception .
**male causes : 1-dysfunction of hypothalamus . 2- pituitary dysfunction . 3-adrenal problem . 4-thyroid dysfunction . 5- diabetes mellitus . 6- celiac disease . 7- renal failure . 8-testicular disorder . 9- chemotherapy . 10- absence of seminal ducts . 11-infection of prostate gland & seminal vesicles . 12- psychosexual problem { impotence } 13- hypospadious ,epispadious . 14- retrograde ejaculation [ into bladder ] 15- high temperature of testes . 16-trouma to testes . 17- infection of testes { orchitis }. 76
**Female causes : 1- dysfunction of hypothalamus ,pituitary ,adrenal ,thyroid glands . 2- D.M 3- Celiac disease 4- Renal failure 5- Obesity 6- Anorexia nervosa 7- Excessive exercise 8- Ovarian cyst or tumor 9- Poly cystic ovary 10- endometriosis 11- infection of fallopian tube 12- previous tubal surgery 13- psychosexual problem [ vaginismus ] 14- infection of vagina 15- cervicitis 16- antis perm antibodies in mucous 17- defect of implantation 18- tubal obstruction ** investigation : - history - physical examination [ genitalia ,varicocele ,hydrocele ,bimanual speculum examination ** male investigation : @ semen analysis : the basic test for male infertility ,it should be carried out before any investigations . -specimen are obtained by masturbation after 2-3 days of abstinences of sexual intercourse & examined in the laboratory within one hour . Normal values : -volume : 2-6 ML -total sperm count : 35 million to 40 million –motility : more than 60% of the sperm moving forward -morphology : more than 60% of the sperm should appear normal @ agglutination of sperm in the semen specimen may be due to :
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Antis perm antibodies due to trauma or vasectomy . @biopsy of the testes : will show whether sperm are produced . @ chromosome studies : blood smear to identify chromosomal abnormality . @ blood test for hormone level : FSH, & LH,testestrone level . @ postcoital test : Aspiration of cervical mucous from the female at fertile time within 6 hours of intercourse ,the ability of the sperm to penetrate the mucous . **Female Investigation : @ test to establish whatever ovulation is occurring : Cervical mucous : becomes clear stretchy at ovulation - at ovulation LH measurement - * basal body temperature drops slightly before ovulation then rise 0.3 - Ultrasound : detect of ovulation & thickening of the endometrium - Hormonal assay : blood test of hormones as estrogen & progesterone ,FSH,LH also thyroid function ,prolactin level should be done . @ Hystro-salpingography : Done at 9th day of menstruation Under guidance of x-ray Could be diagnostic & treatment of infertility . @ hysteroscopy @ laparoscope ** what about treatment of infertility : -treat the underlying cause -give antibiotic if infection present . -give medication to stimulate ovulation in form of hormones @ artificial insemination @ Invitro-fertilization { IVF} @ surrogate mother @ adoption
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Menopause Overview : - menopause derived from Greek word menos (month) and pauses (ending) which means the end of menstrual cycle, the central external marker of human female fertility. Occurred after six months of secondary amenorrhea in woman aged 45 years or over. - the woman at menopause can except to live for some 30 years in a state of relatively profound estrogen deficiency. - Menopause simply is the transition from fertility to infertility which attended by a wide variety of symptoms, signs and metabolic adjustment, the ultimate cause of which is a major reduction in the level of circulating estrogen .
Climacteric : Is the period of life around the menopause when ovarian function is gradually declining (rung of a ladder).
Physiological changes: 1. hormonal changes: - estrogen level decreases markedly. - The main circulating estrogen is Estrone (EL) produced by peripheral conversion of androstenedione in fat. - Androstenedione is produced mainly by suprarenal, ovarian stroma produces androstenedione for short period after menopause.
NB: although circulating estrogen is a week type (estrone) and is of low concentration, manifestation of relative estrogen excess may occur as endometrial hyperplasia and carcinoma. - FSH , LH production by anterior pituitary gland increases markedly in response to low estrogen level. - a few years later, the secretion of FSH, LH starts to decrease. - Thyroid function usually decreases slightly after menopause. 2. Osteoporosis: - loss of bone density (protein matrix and calcium). - Diminished osteoblastic activity due to steroid hormone deficiency. - Bone resorption greater than bone formation. - The bone becomes more liable to fracture after a minimal or moderate trauma. - Traumatic fracture affects distal radius and femoral neck while non-traumatic affects the vertebra. 79
3. cardiovascular system: - estrogen deficiency leads to lowering of HDL level and elevation of LDL level and increase total cholesterol. - This change predisposes to atherosclerotic changes which increase the incidence of ischemic, coronary heart disease. 4. Genito-urinary system: - Estrogen deficiency leads to gradual atrophy of the vaginal uterus, tubes ovaries, pelvic fascia and uterine ligaments. - It also leads to decreased vaginal acidity. - Senile vagnitis and endometritis due to diminished vaginal acidity and atrophy of epithelium, absence of endometrial shedding. - Prolapsed and stress incontinence may occur due to atrophy of ligaments and fascia. - Breasts also undergo postmenopausal atrophy. - Frequency of urination, dysuria and urgency not associated with positive urine culture.
Path physiology: 1. premature ovarian failure:
secondary amenorrhea due to ovarian failure to generate estrogen may occur at any age & if below age 45 years may be accounted as premature . -these patients exhibit low plasma oestrogen , high level of FSH,LH& symptoms pattern suggestive estrogen deficiency - premature ovarian failure associated with other autoimmune endocrinopathies -the site of action of an antibody attack on the hypothalamic –pituitary ovarian axis is unknown . 2- surgical menopause : -if for any reason both ovaries are surgically removed ,an obligatory menopause is immediate . -at hysterectomy in premenopausal patients even if both ovaries are conserved .
3-other causes of menopause : - use of gonadotriphin = releasing hormone antagonist in treatment of endometriosis or preoperative of leiomyoma fibroid to suppress ovarian steroid output completely .
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-if such treatment given continuously for over 6 months ,it may result in major metabolic consequences as loss of skeletal tissue . - the management of malignant disease in young women . -suppression of ovarian steroid output is physiological during lactation when recurrent cycles of prolactin release inhibit both gonadotrophin drives to ovaries & intra- ovarian steroid genesis * symptoms of menopause : -symptoms may begin long before the cessation of menstruation . -these symptoms triggered by relative fall in circulating oestradiol. -the physical symptoms include vasomotor symptoms of hot flushing & night sweats ,the duration may from a few weeks to many years due to excess FSH ,LH . -hot flushes is a vascular response to disturbances of thermoregulatory center in hypothalamus = activation of physiological mechanism as continuous flushing & perspiration ,which result in heat loss by radiation & vaporization . - repeated awakening from sleep with consequent loss of sleeping quantity & quality . - vaginal dryness associated dyspareunia . -the vaginal folds is dependant on oestrogen for the depth & lubrication of its sequmaous epithelium . -dyspareunia & loss of libido . -menopausal women are affected by a psychological problem that can be equally distressing & disabling as physical symptoms . -in addition ,the perimenopausal years are frequently marked by life events as divorce ,death of partner ,departure of children . -also intrinsic personality type may exert influence with symptoms among women with tendency of anxiety –neurosis & low self esteem . - menopausal syndrome : A variety of symptoms include : fatigue irritability nervousness headache depression
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**management : 1- hormonal replacement therapy : - each patient should be examined & counseled on the individual nature of her problem . - hormone therapy is offered when the presence of symptoms or effect due to oestrogen deficiency may interfere with personal , marital or occupational welfare . - mode of treatment : - a- oestrogen via oral route - oestrogen absorbed from stomach & duodenum to portal system & through liver to its other target site . - it can be taken at any time of the day cheap & well tolerated . - b-transdermal oestrogen . - c- progestogen . - d- gondaminmetic therapy . ** contraindication of hormonal replacement therapy : 1 –present or suspect pregnancy . 2- suspicious of breast cancer . 3-suspoicious of endometrial cancer . 4-acute liver disease . 5- uncontrolled hypertension . 6- confirmed venous thrombosis ** management of patient receiving HRT: - preparing the patient for symptoms that mark reintroduction of oestrogen & progesterone into circulation . - the longer the elapse time since menopause , the more likely these symptoms are to arise . - these symptoms are temporary & remit by three months ,these symptoms are : - breast tenderness - increase appetite - calf cramp - nipple sensitivity - weight gain - * annual review of : Breast . Blood pressure Pelvic examination
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دور المرأة فً بناء المجتمع قضٌة المرأة:
إن مما ٌجب علٌنا أن نعلمه: أن أعداء هللا ٌخططون لٌل نهار للقضاء على هذا الدٌن، وٌسعون إلطفاء نور هللا بأفواههم، وٌجتهدون وٌدأبون من أجل أن ٌبذروا فً هذه األمة بذور الشر والخالف والفرقة؛ لٌبعدوها عن الصراط المستقٌم، ولٌمزقوها ولٌدمروا فٌها القلوب والعقول؛ لكً تصبح األمة اإلسالمٌة أم ًة ذلٌل ًة منقاد ًة لشهواتها، فٌقودونها كما تقاد الدابة من شهواتها إلى ما ٌرٌدون، وكما خطط لها األعداء المتربصون باإلنسانٌة جمٌعاً. هذه قضٌة ٌجب أن نعلمها، وأن نع َّد العدة لنقاوم هؤالء األعداء، ونعلم مداخلهم التً منها ٌدخلون إلى مجتمعنا لٌخربوه. إن موضوع المرأة لمن أعظم ما ٌنبغً أن نعلمه وأن نعرفه.
قضٌة المرأة بٌن الماضً والحاضر:
كانت القضٌة المتعلقة بالمرأة فٌما مضى من العصور، قضٌة آداب وأخالق وحٌاء، وهً قضٌة من قضاٌا اإلٌمان الواجب؛ ٌتحدثون من أجل اآلداب واألخالق فً المجتمع المسلم، لكً ال تنتهك ولتبقى متماسكة. ولكن الذي حصل فً هذا الزمان، أن القضٌة لم تعد بهذه المثابة فحسب، وإنما هً قضٌة دٌن أو ال دٌن، بمعنى: هل نتبع القرآن كالم هللا عز وجل ونتبع هدي محمد ، أم نتبع ما علٌه الٌهود والنصارى، ونقول: إن ما جاء به القرآن قد عفا علٌه الزمن ومضى وانتهى؟
فالقضٌة لٌست قضٌة خلل فً األعمال، إنما هً خلل فً أصل اإلٌمان، فقضٌتنا قضٌة إٌمان وعقٌدة، وإن كانت فً ظاهرها قضٌة اجتماعٌة؛ فالفتاة التً تتحجب فً هذا الزمن، تتحجب عن إٌمان ودٌن واعتقاد بأنها تطٌع هللا عز وجل وهذا هو الحق وأن ما عداه هو الباطل، ال ٌنظر إلٌه وال ٌؤبه له. وأما التً تتهتك، أو من ٌكتبون دعوات التهتك والتبرج والسفور، فإنهم ٌقولون بلسان المقال أو بلسان الحال: إن هذا الدٌن قد استنفد أغراضه وقد عفا علٌه الزمن، وقد ذهب إلى غٌر رجعة، وإنما األمر الٌوم أمر متابعة الغرب، وتقلٌد تلك المجتمعات المتطورة المتقدمة. إن مما ٌثٌرونه وٌبلبلون به أفكار الشباب قولهم: إن المرأة المسلمة ممتهنة أو مظلومة أو عاطلة عن العمل، وما أشبه ذلك من الدعاوى التً نراها على صفحات الجرائد والمجالت، وفً المحافل وفً كل مكان ٌستطٌعون فٌه أن ٌقولوا أمثال هذا الكالم. فماذا ٌرٌدون به؟ أٌرٌدون إنصاف المرأة؟! أٌرٌدون أن ٌرفعوا عنها الحٌف والخوف؟! أٌرٌدون أن ٌنزلوها المنزلة التً تلٌق بها؟! فلننظر إلى حال المرأة فً ظل هذا الدٌن، وإلى حالها فً ظل غٌره.
مكانة المرأة عبر التارٌخ:
لسنا بحاجة إلى أن نستعرض قضٌة المرأة عبر التارٌخ، ولكن ٌكفً أن نعلم أنه إلى القرن السابع عشر المٌالدي فً أوروبا كان من حق الرجل أن ٌبٌع زوجته، وإلى هذه اللحظة ال تزال دول أوروبٌة معروفة إلى الٌوم بأنها ال تعطً المرأة حق االنتخابات، فهً لٌست محسوبة من ضمن الشعب الذي ٌحق له أن ٌنتخب، وإلى هذه اللحظة ال تملك المرأة أن تستقل باسمها، وإنما بمجرد أن تتزوج أي زوج فإنها تصبح تابعة له باالسم، وفً كثٌر من الدول ال ٌحق للمرأة أن 83
تتملك شٌئاً أبداً، فضالً عن أنهم كانوا على حال أشد من ذلك فٌما هو ثابت فً نظرٌاتهم الفلسفٌة منذ عهد الٌونان، فقد كان فالسفة الٌونان ٌكتبون -وكتاباتهم موجودة إلى الٌوم- وٌتساءلون هل المرأة إنسان أم ال؟! وهل للمرأة روح أم لٌس لها روح؟! أما رهبان الكنٌسة فحدث وال حرج، فقد كانوا ٌرون أنها شٌطان رجٌم، وأنها منبع الخطٌئة، ومصدر الشر، وأن من خطرت فً قلبه صورة امرأة أو تعلق بها أو اشتهاها، فإنه قد ٌطرد من ملكوت هللا؛ ألنه بذلك ٌفكر فً الدنس والخطٌئة.
إن المٌل من الذكر إلى األنثى أمر طبٌعً فً بنً اإلنسان، لكن هذا المٌل عند الغربٌٌن ٌأخذ شكالً آخر، وهو الشكل المحرم والممنوع والمحظور والمدنس حتى وإن حصل علٌه؛ ولذلك فإن األمم األخرى -جمٌعا ً- ولٌس المسلمون فقط، إذا احتاج الواحد منهم إلى الزواج تزوج، فإذا تزوج شعر أنه قضى وطره وانتهى األمر، إال الغربٌٌن من النصارى أو من اتبعهم من رهبان البوذٌٌن؛ ألنهم ٌنظرون إلٌها نظرة الدنس واالحتقار والخطٌئة، فحتى وإن تزوج، فإنه كان ٌُ ْن َظر إلٌه -فً العصور الوسطى على األقل- أنه اقترف الدون، وفعل غٌر الصواب الذي هو أقل درجة، وإن لم ٌنظر إلٌه على أنه أخطأ خطأً محضاً، لكنه لم ٌأت باألولى واألفضل. من المعلوم أن الغرب لم ٌنظم حٌاته وفق القوانٌن الحدٌثة إال بعد أن وضع أول قانون فً أوروبا فً القرن التاسع عشر عام )1814م(، وهو قانون نابلٌون، ثم بعد ذلك أخذت بقٌة الدول تشرع القوانٌن وتضع األنظمة. وفً ذلك الوقت وضعت وشرعت القوانٌن التً تنظر إلى المرأة نظرة إجحاف وكأنها من سقط المتاع، إال أن أولئك الهدامٌن أخذوا ٌنشرون هذه األفكار بغرض إثارة المجتمع بعضه على بعض، لغرض التجارة المحرمة؛ ألن كثٌراً منهم كانوا ٌتاجرون فً هذه المتع المحرمة، وال سٌما الٌهود، وهذا أمر معروف عنهم إلى الٌوم، فهم ملوك البغاء فً األرض فٌهمهم أن ٌتاجروا بجسد المرأة، فإن كانت المرأة ٌهودٌة، فإنهم ٌحتسبون ذلك لها، كما احتسبوه إلستٌر تلك التً جعلوا لها سفراً فً التوراة، وذلك عندما أسر الٌهود إلى بابل، فً بالد الفرس، فأقامت تلك الداعرة الفاجرة العالقة مع ملك الفرس، واستطاعت أن تحرر شعبها بتلك العالقة نتٌجة إغرائها لملك الفرس بحمالها، وس َّطروا ذلك فً التوراة، وجعلوا لها سفراً فٌها، وٌقولون: إن كانت المرأة ٌهودٌة وخدمت مصالح الٌهود ولو بعرضها فهذا ٌحتسب لها، وإن كانت نصرانٌة أو أممٌة من األممٌٌن، فهؤالء كالحٌوان بل أحط من ذلك، فال نظر وال اعتبار ألعراضهم وال لما هو مقدس عندهم.
ُ قال هللا ُس ْب َحا َن ُه َو َت َعا َلى: } َم ْن َع ِم َل َصالِحاً ِم ْن َذ َك ٍر أَ ْو أ ْن َثى َو ُه َو ُم ْؤ ِم ٌن َف َل ُن ْح ٌِ ٌَ َّن ُه َح ٌَا ًة َط ٌِّ َبة{]النحل:97[ جعل هللا تبارك وتعالى الحٌاة الطٌبة -وهً الحٌاة فً الدنٌا- لمن عمل صالحاً من ذكر أو أنثى، فالرجل والمرأة كل منهما مكلف بعبادة هللا، ومأمور بطاعة هللا، ومسئول بٌن ٌدي هللا ، فهذه المرأة التً كانت فً الجاهلٌة توأد، وكانت تباع فً بالد الروم واإلغرٌق وال قٌمة لها، فٌأتً هذا الدٌن فٌجعلها فً تلك المنزلة، فجعل منهن النساء العالمات، كأمهات المؤمنٌن -رضً هللا تعالى عنهن- وكأولئك الصحابٌات، والنساء الطاهرات، الذي لم ٌشهد تأرٌخ اإلنسانٌة أمثالهن فً الطهارة والعفة.
دعاة تحرٌر المرأة:
لما نقل دعاة تحرٌر المرأة هذه القضٌة إلٌنا لم ٌنقلوها على أنها قضٌة مظلوم ٌُن َت َص ُر له، بل نقلت على أنها قضٌة امرأة مقابل رجل، وقضٌة ذكر مقابل أنثى؛ وهكذا استطاعوا أن ٌمزقوا المجتمع وأن ٌوجدوا هذه الفرقة بٌنه لٌتمزق، فأي مكان للرجل فٌه موضع قدم قٌل: وأٌن مكان المرأة؟! وقٌل للمرأة: وأٌن دورك؟! وأي مكان للمرأة، ٌقال للرجل: لماذا ٌترك المكان للنساء فقط؟ وهكذا حتى تتناحر المجتمعات، والمجتمعات الغربٌة من المعلوم أنها مجتمعات متفككة ال روابط فٌها، فإذا بلغت الفتاة الثامنة عشرة تطرد من بٌت أهلها، وتعٌش كما تشاء وأٌنما تشاء مع من تشاء، وكذلك الحال مع الشاب من الذكور، ومن هنا فإن كل جماعة وفئة فً المجتمع تحتاج إلى تكتل تنظم تحت لوائه لتنتصر إذا ظلمت من
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قبل اآلخرٌن، ولذا نجد العمال لهم تكتالت مقابل أصحاب رءوس األموال، والطالب لهم تكتالت مقابل الجامعات، النساء أٌضاً البد أن ٌتكتلن وإال ِض ْع َن، فتتكتل النساء وٌجتمعن وٌنشئن الجمعٌات.
ألن المرأة إن لم تكن فً جمعٌة فلن تجد من ٌطالب بحقها؛ ألنها ستكون ضائعة فً حكم القانون!! فال بد أن تتكتل، ومن هنا تكونت الحركات والجمعٌات النسائٌة وما أشبه ذلك. وجاءوا إلٌنا فً بالد اإلسالم وهً البالد التً ال تعرف هذه الفرقة والتً ٌجب فٌها على المجتمع ككل أال تضٌع فٌه امرأة، وال طفل، وال إنسان، فإن لم ٌكن لها أب أو أخ ٌحمٌها، فال بد أن ٌتولى القاضً الوصاٌ َة علٌها، أو ٌقٌ َم وصٌاً علٌها أو ٌزوجها أو ٌنفق علٌها أو ٌحفظها فً دور للرعاٌة، فهً مصونة مكفولة، وٌكفً أن تذهب إلى القاضً، وتقول: إننً ال عائل وال محرم لً، وعندئذٍتصبح فً كفالة ولً األمر، وحق علٌه أن ٌفعل ذلك.
وهذا ال ٌوجد -أصال ً- فً أي نظام من األنظمة، فمثالً: الشٌوعٌة تحاول أن تدعً شٌئاً من ذلك، ولكن ال وجود له. أما المجتمعات اإلسالمٌة فإن الرجل قد ال ٌبالً لو ضاع منه عشرة أبناء، ولكن لو فقدت منه ابنته ٌوماً واحداً، الس َّودت الدنٌا فً عٌنٌه ولكأنها قامت القٌامة. ثم ٌؤتى إلى هذا المجتمع وٌقال للمرأة فٌه: تكتلً أٌتها المرأة، طالبً بحقك، اخرجً، لماذا الرجال لدٌهم المناصب والجامعات؟! لماذا لدٌهم الوظائف الفالنٌة؟! فأصبحت القضٌة قضٌة رجل وامرأة.
.. أهمٌة دور المرأة فً تنمٌة المجتمع
أهًُخ دوس انًشأح فٍ رًُُخ انًجزًع ..
إ ٖٓ أػظْ ٓخ طشًٚ ُ٘خ حُوشٕ حؾؼُشٕٝ ٓلّٜٞ حُظ٤ٔ٘ش حؾُخِٓش حُز١ طلخٝص كع ططز٤وٚ ر٤ٖ دٍٝ حؼُخُْ، ٌُٚ٘ٝ أفزق ٖٓ ر٤ٖ حألعظ حؼُخرظش ُو٤خط طوذّ حُٔـظؼٔخص، ٝد٤ُالً ٠ِػ إٔ حُظ٤ٔ٘ش أفزلض طؼَٔ ٓطِزخً ِٓلخً ٝأعخع٤خً ٌَُ حُٔـظؼٔخص حؼُٔخفشس، ٝرُي ُٔخ ط٘ط١ٞ ٚ٤ِػ ٖٓ ٓنخ٤ٖٓ حؿظٔخ٤ػش ٝحهظقخد٣ش ٝع٤خع٤ش ػٝوخك٤ش ٛخٓش، ٝأ٣نخً ُٔخ ٣٘ظٜ٘ػ ؾخ ٖٓ ٗظخثؾ كخعٔش ك٢ كخمش ٛزٙ حُٔـظؼٔخص ٝٓغظوزِٜخ.
ٝارح ًخٕ حُٜذف حألعخط ٖٓ حُظ٤ٔ٘ش ٞٛ عؼخدس حُزؾش ٝطِز٤ش كخؿخطٝ ،ْٜحُٞفٍٞ رْٜ ا٠ُ دسؿش ٓالثٔش ٖٓ حُظطٞس ٝط٤ٔؼن اٗغخ٤ٗظْٜ، كبٜٗخ ك٠ كذ رحطٜخ، ال طوّٞ اال رخُزؾش أٗلغْٜ حُز٣ٖ ْٛ أٝ ْٛعخثَ طلو٤وٜخ.
ٝك٢ اهخس حالٛظٔخّ رون٤ش حُظ٤ٔ٘ش حؾُخِٓش، ٝحٗطالهخً ٖٓ إٔ حُظ٤ٔ٘ش طشطٌض ك٢ ٓ٘طِوخطٜخ ٠ِػ كؾذ حُطخهخص حُزؾش٣ش حٞؿُٞٔدس ك٢ حُٔـظٔغ دٕٝ ط٤٤ٔض ر٤ٖ حُ٘غخء ٝحُشؿخٍ، ٣قزق حالٛظٔخّ رخُٔشأس ٝرذٝسٛخ ك٢ ط٤ٔ٘ش حُٔـظٔغ ؿضءحً أعخع٤خً ك٢ ٤ِٔػش حُظ٤ٔ٘ش رحطٜخ، رخإلمخكش ا٠ُ طؤ٤ػشٛخ حُٔزخؽش ك٢ حُ٘قق ح٥خش، رُي إٔ حُ٘غخء ؾ٣ٌِٖ ٗقق حُٔـظٔغ ٝرخُظخ٢ُ ٗقق هخهظٚ حإلٗظخ٤ؿش، ٝهذ أفزق ُضحٓخً إٔ ٣غٜٖٔ ك٢ ح٤ِٔؼُش حُظ٣ٞٔ٘ش ٠ِػ هذّ حُٔغخٝحس ٓغ حُشؿخٍ، رَ ُوذ أفزق طوذّ أ١ ٓـظٔغ ٓشطزطخً حسطزخهخً ٤ػٝوخً رٔذٟ طوذّ حُ٘غخء ٝهذسط٠ِػ ٖٜ حؾُٔخسًش ك٢ حُظ٤ٔ٘ش حالهظقخد٣ش ٝحالؿظٔخ٤ػش، ٝرونخء ٛزح حُٔـظٔغ ٠ِػ ًخكش أؽٌخٍ حُظ٤٤ٔض مذٖٛ .
حُظؼش٣ق رذٝس حُٔشأس ..
عطّشص حُٔشأس ك٢ حؼُقٞس حُوذ٣ٔش ٝحُلذؼ٣ش ٝخخفش ك٢ حُٔـظؼٔخص حإلعال٤ٓش أعطشحً ٖٓ ٞٗس ك٢ ٤ٔؿغ حُٔـخالص، ك٤غ ًخٗض ٌِٓش ٝهخم٤ش ؽٝخػشس ٝك٘خٗش ٝأد٣زش ٝكوٜ٤ش ٝٓلخسرش ٝسح٣ٝش ُألكخد٣غ حُ٘ز٣ٞش حؾُش٣لش.
ٝا٠ُ ح٥ٕ ٓخ صحُض حُٔشأس ك٢ حُٔـظؼٔخص حإلعال٤ٓش طٌذ ٝطٌذف ٝطغخْٛ رٌَ هخهخطٜخ ك٢ سػخ٣ش ر٤ظٜخ ٝأكشحد أعشطٜخ، ك٢ٜ حألّ حُظ٢ طوغ ٠ِػ ػخطوٜخ ٓغئ٤ُٝش طشر٤ش حأل٤ؿخٍ حُوخدٓش، ٢ٛٝ حُضؿٝش حُظ٢ طذ٣ش حُز٤ض ٝطٚؿٞ حهظقخد٣خط٢ٛٝ ،ٚ ر٘ض أٝ أخض أٝ صؿٝش، ٛٝزح ٣ـؼَ حُذٝس حُز١ طوّٞ رٚ حُٔشأس ك٢ ر٘خء حُٔـظٔغ دٝسحً ال ٣ٌٖٔ اؿلخُٚ أٝ حُظو٤َِ ٖٓ خطٞسطٚ.
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ٌُٖٝ هذسس حُٔشأس ٠ِػ حُو٤خّ رٜزح حُذٝس طظٞهق ٠ِػ ٤ػٞٗش ٗظشس حُٔـظٔغ اٜ٤ُخ ٝحالػظشحف رو٤ٔظٜخ ٝدٝسٛخ ك٢ حُٔـظٔغ، ٝطٔظٜؼخ رلوٞهٜخ ٝخخفش ٓخ ٗخُظٚ ٖٓ طؼو٤ق ٝطؤ٤َٛ ؼٓٝ ِْػٝشكش ُظ٤ٔ٘ش ؽخق٤ظٜخ ٝطٞع٤غ ٓذحسًٜخ، ػ ْٖٓٝ ٌٜ٘ٔ٣خ حُو٤خّ رٔغئ٤ُٝخطٜخ طـخٙ أعشطٜخ، ٠ِػٝ دخٍٞ ٤ٓذحٕ حٝ َٔؼُحؾُٔخسًش ك٢ ٓـخٍ حُخذٓش حؼُخٓش .
ٝٓ٘ز رذح٣ش حؼُوذ حؼُخ٢ُٔ ُِٔشأس )ٝ )75-1985كظ٠ ٓئطٔش ر٤ٌٖ 1996، رذأ حالٛظٔخّ حؼُخ٢ُٔ رون٤ش ط٤ٔ٘ش حُٔشأس ٝطٜ٘٤ٌٔخ ٖٓ أدحء أدٝحسٛخ رلؼخ٤ُش ؼَٓ حُشٝ ،َؿحؾُٔخسًش ك٢ حطخخر حُوشحس ك٢ ٓخظِق ٓ٘خك٢ حُل٤خس حُغ٤خع٤ش ٝحالهظقخد٣ش ٝحالؿظٔخ٤ػش ٝحؼُوخك٤ش، ٝهذ ٝحًذ ٛزح حالٛظٔخّ حؼُخ٢ُٔ حٛظٔخّ ٤ؼًش ٖٓ حُذٝ ٍٝح٤ُٜجخص ٝحُٔ٘ظٔخص حُذ٤ُٝش ٝحإله٤ٔ٤ِش، ٝرُي ٖٓ خالٍ ػوذ عِغِش ٖٓ حُ٘ذٝحص ٝحُٔ٘خهؾخص ٝأٝسحػ حٝ َٔؼُحُٔئطٔشحص، ًخٕ آخشٛخ ٓ٘ظذٟ هٔش حُٔشأس حؼُشر٤ش رخُٔ٘خٓش ك٢ أرش٣َ 2000، ٓشٝسحً رٔئطٔش حُؤش حألٍٝ ُِٔشأس حؼُشر٤ش "حُوخٛشس ٝ ،"2000ٓئطٔش حُؤش حالعظؼ٘خث٤ش ُِٔشأس حؼُشر٤ش رخُٔـشد "ٞٗكٔزش 2001"، رخإلمخكش ا٠ُ ػذس ٓ٘ظذ٣خص كٍٞ حُٔشأس ٝحُغ٤خعش، ٝحُٔشأس ٝحُٔـظٔغ، ٝحُٔشأس ٝحإلػالّ، ٝحُٔشأس ٝحالهظقخد، ٝحُٔشأس ك٢ رالد حُٜٔـش، حُظ٢ ػوذص ك٢ ػذس دػ ٍٝشر٤ش.
ٝٓخ ٛزٙ حُذسحعش كٍٞ حُز٠٘ حُٔالثٔش ُظ٤ِؼْ حُلظ٤خص ٝحُٔشأس ك٢ رؼل رِذحٕ حؼُخُْ حإلعال٢ٓ اال دُـ٤ـَ ػـِـ٠ حٛظـٔـخّ حُٔ٘ـظٔـش حإلعـال٤ٓـش ُِظـشرـ٤ش ٝحؼُـِـٝ ّٞحؼُــوخكش ــ ا٣غ٤غٌٞ ــ رذٝس حُٔشأس ٝكشفٜخ ٠ِػ طٜ٘٤ٌٔخ ٖٓ دٝسٛخ حُلو٤و٢ ك٢ حُٔـظٔغ
ُٝوذ أًذص ٝأٝفض ٤ٔؿغ ٛزٙ حُٔ٘ظذ٣خص رٌخكش فٞسٛخ ٠ِػ مشٝسس دػْ دٝس حُٔشأس ٌٝٓخٗظٜخ ٝٓ٘لٜخ كن حؼَُٔ ك٢ ح٤ُٔخد٣ٖ ًخكش، حٗطالهخً ٖٓ أ٤ٔٛش ٌٓخٗش حُٔشأس ك٢ حُٔـظٔغ ٝدٝسٛخ ك٢ طلو٤ن حعظوشحس حألعشس.
٤ؾ٣ٝش حُٞحهغ حُذؿٞٔ٣شحك٢ ؼُذد حُغٌخٕ ك٢ رِذحٕ حؼُخُْ حإلعال٢ٓ أٚٗ ٣زؾِ 1028751 أُق ٗغٔش ػخّ ٝ ،2000طزؾِ حُٔشأس ٗقق ٛزح حؼُذد طوش٣زخً أ١ كٞح٢ُ 514.751 أُـق ٗغـٔش، ٝحُلـجش حؼُـٔش٣ش ُِزـ٘خص كـ٢ حؾُـش٣ـلش حؼُـٔــش٣ش ٓـٖ )6-14( كٞح٢ُ 91324 أُق ٖٓ ٓـٞٔع حُ٘غخء أ١ ر٘غزش %17.8.
٣ٝالكع حسطلخع ؼٓذالص خقٞرش حُٔشأس ك٢ ٛزٙ حُزِذحٕ، ٝرُي ٣شؿغ ا٠ُ حٞؼُحَٓ حالؿظٔخ٤ػش ٞػٝحَٓ طشطزو رخُظشحع حؼُوخك٢ ُٜزٙ حُزِذحٕ، ٛٝزح حُلـْ حُٔظضح٣ذ ٖٓ حُغٌخٕ سؿخالً ٝٗغخء ٣طشف عئحالً : ٓخ حألدٝحس حُظ٠ طوّٞ رٜخ ٛزٙ حُـٞٔع حُزؾش٣ش ٖٓ حُ٘غخء ك٢ كخمش حُٔـظؼٔخص حإلعال٤ٓش ٝك٢ ٓغظوزِٜخ ؟ ٝا٠ُ أ١ ٓذٟ طشطزو ٛزٙ حألدٝحس رٔخ ٤ٜ٣ت ُٜخ ٖٓ كشؿ حإلػذحد ٝٝعخثُٞٔ ِٚحٜؿش حُل٤خس كظ٠ طظلٍٞ ٖٓ دٝس ٝحػذ رخإلٌٓخ٤ٗش ا٠ُ هٞس ٓئػشس رخُلٝ ،َؼكظ٠ طقزق هخهش ٓ٘ظـش ال ػزجخً ػو٤الً ٞ٘٣ء حُٔـظٔغ رظٌخػشٙ.
ُٝإلؿخرش ٛ ٖػزٙ حألعجِش حُٔطشٝكش ٣شًض ٛزح حُلقَ ٠ِػ حألدٝحس حُظ٢ طوّٞ رٜخ حُٔشأس ك٢ ط٤ٔ٘ش حُٔـظٔغ، ٝكظ٠ ٣ٌٖٔ طلذ٣ذ ٛزٙ حألدٝحس الرذ أٝالً ٖٓ طلذ٣ذ حُٔلخ٤ْٛ حألعخع٤ش حُظ٢ طؼذ ٖٓ حٜؿُٞٔخص حألعخع٤ش ..
ٓلّٜٞ حُظ٤ٔ٘ش :
ؼ٣شف طوش٣ش حألْٓ حُٔظلذس ُِظ٤ٔ٘ش حُزؾش٣ش ؼُخّ 1997 حُظ٤ٔ٘ش رؤٜٗخ ٤ِٔػش ص٣خدس حُخ٤خسحص حُٔطشٝكش ٠ِػ حُ٘خط ٝٓغظٟٞ ٓخ ٣لووٚٗٞ ٖٓ سخخء، ٛٝزٙ حُخ٤خسحص ٤ُغض ٜٗخث٤ش أػ ٝخرظش. ٝرـل حُ٘ظش ػٖ حُظ٤ٔ٘ش كبٕ ػ٘خفشٛخ حألعخع٤ش حؼُالػش 86
طؾَٔ حُوذسس ٠ِػ حؼ٤ؼُ ك٤خس ه٣ِٞش ٝك٢ فلش ٤ؿذس، ٝحًظغخد حؼُٔشكش، ٝحُظٔظغ رلشؿ حُلق٠ِػ ٍٞ حُٞٔحسد حُالصٓش ؼ٤ؼُ ك٤خس الثوش. ٝال طوق حُظ٤ٔ٘ش ػ٘ذ ٛزح حُلذ، كخُ٘خط أ٣نخً ٣وذس٤ؿ ٕٝذحً حُلش٣ش حُغ٤خع٤ش ٝحالهظقخد٣ش ٝحالؿظٔخ٤ػش ٝاطخكش حُلشؿ أٓخْٜٓ ُإلرذحع ٝحإلٗظخؽ.
ٓلّٜٞ ط٤ٔ٘ش حُٔـظٔغ :
ػ ّشكض حألْٓ حُٔظلذس ط٤ٔ٘ش حُٔـظٔغ رؤٜٗخ ح٤ِٔؼُخص حُظ٢ ٣ٌٖٔ رٜخ طٞك٤ذ ٜٞؿد حُٞٔحه٤ٖ٘ ٝحُلٌٞٓش ُظلغ٤ٖ حألكٞحٍ حالهظقخد٣ش ٝحالؿظٔخ٤ػش ٝحؼُوخك٤ش ك٢ حُٔـظؼٔخص ُٝٔغخػذطٜخ ٠ِػ حالٗذٓخؽ ك٢ حُٔـظٔغ ٝحُٔغخٛٔش ك٢ طوذٚٓ رؤهق٠ هذس ٓغظطخع.
ٓلّٜٞ حُذٝس :
حُذٝس ٞٛ ٓـػٞٔش ٖٓ حُقلخص ٝحُظٞهؼخص حُٔلذدس حؿظٔخ٤ػخً ٝحُٔشطزطش رٌٔخٗش ٤ؼٓ٘ش. ٝحُذٝس ُٚ أ٤ٔٛش حؿظٔخ٤ػش ألٚٗ ٞ٣مق إٔ أؾٗطش حألكشحد ٓلٌٞٓش حؿظٔخ٤ػخً، ٝطظزغ ٗٔخرؽ ع٤ًِٞش ٓلذدس، كخُٔشأس ك٢ أعشطٜخ طؾـَ ٌٓخٗش حؿظٔخ٤ػش ٤ؼٓ٘ش، ٣ٝظٞهغ ٜ٘ٓخ حُو٤خّ رٔـػٞٔش ٖٓ حألٗٔخه حُغ٤ًِٞش طؼَٔ حُذٝس حُٔطِٞد ٜ٘ٓخ.
ٝرخُ٘غزش ُِٔشأس كخُذٝس ح٤ؼُٔخس١ ُٜخ ًبٓشأس ٝصؿٝش ٝأّ، أ١ حُذٝس حُز١ ٣ظٞهٜ٘ٓ ٚؼخ حُٔـظٔغ ٣ٝ٘ظظش ٜ٘ٓخ حُو٤خّ رٚ، ٣ظلن حطلخهخً ًز٤شحً ٓغ دٝسٛخ حُل٢ِؼ إ ُْ ٣ظطخرن ٚؼٓ.
ٓلّٜٞ حُذٝس حالؿظٔخ٢ػ :
ٞٛ حألؾٗطش حُظ٢ طوّٞ رٜخ حُٔشأس ك٢ ٗطخم أعشطٜخ ٝخخفش ٓخ ٣ظؼِن رظشر٤ش أر٘خثٜخ ػٝالهش أعشطٜخ رـ٤شٛخ ٖٓ حألعش حألخشٟ خالٍ ٤ِٔػش ؾٗخهٜخ ح٢ٓٞ٤ُ ٝحالؿظٔخ٢ػ.
ٓلّٜٞ حُذٝس حؼُوخك٢ :
ٞٛ هذسس حُٔشأس ٠ِػ طو٤٤ْ ٓخ طظِوخؼٓ ٖٓ ٙخسف ِٞؼٓٝٓخص ٖٓ ٝعخثَ حإلػالّ حُٔخظِلش رٔخ ٣ذػْ دٝسٛخ ك٢ ؼٓخؾ٣ش هنخ٣خ حؼُقش ٝحالٗلظخف ٠ِػ حؼُخُْ حُخخس٢ؿ. ؼِ٣ٝذ حُظ٤ِؼْ دٝسحً ٛخٓخً ك٢ ٛزح حُٔـخٍ ك٤غ أٚٗ ًِٔخ ٗخُض حُٔشأس هغطخً أًزش ٖٓ حُظ٤ِؼْ ًِٔخ ًخٗض أؼًش كٜٔخً ٝادسحًخً ٝٓوخٝٓش ُإل٣لخءحص ٝحُظؤ٤ػشحص حُغِز٤ش حُظ٢ هذ ٣٘وِٜخ حالطقخٍ رخؼُخُْ حُخخس٢ؿ.
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ٝحهغ دٝس حُٔشأس ك٢ ط٤ٔ٘ش حُٔـظٔغ
٠ِػ حُشٞؿٝ ٖٓ ْؿد طزخ٣ٖ ك٢ حُز٠٘ حألعخع٤ش حالهظقخد٣ش ٝحؼُوخك٤ش ٝحُغ٤خع٤ش ُزِذحٕ حؼُخُْ حإلعال٢ٓ، اال إٔ حُذ٣ٖ حإلعال٢ٓ ٞٛ د٣ٖ حُـخُز٤ش حؼُظ٠ٔ ُغٌخٕ ٛزٙ حُزِذحٕ.
ُٝٔخ ًخٕ حُذ٣ٖ حإلعال٠ٓ أؼًش طوذٓخً ٖٓ أ١ د٣ٖ آخش رخُ٘غزش ؾُٔخسًش حُٔشأس ك٢ حُٔـظٔغ، ألٚٗ أػط٠ فٞسس ٓظٌخِٓش ػٖ دٝس حُٔشأس ٌٝٓخٗظٜخ ك٢ حُٔـظٔغ، كخُوشإٓ ٝحُلذ٣غ ٝحُظلغ٤ش ٝحالؿظٜخدحص حُٔخظِلش طؼط٢ حُٔشأس ٌٓخٗش خخفش طُظش٤ِٔػ ْؿخً ا٠ُ أػشحف طؾش٤ؼ٣ش ط٢ِٔ ٜ٤ِػخ كوٞهٜخ ٝٝحؿزخطٜخ عٞحء ًخٗض حر٘ش أّ صؿٝش أّ أٓخً، كبٗ٘خ ٗلظشك ٞؿٝد ططخرن ا٠ُ كذ ٓخ ك٢ حألٝمخع ك٢ ٛزٙ حُزِذحٕ، ُٝزُي طْ حخظ٤خس رؼل دٍٝ حؼُخُْ حإلعال٢ٓ ٤ؼً٘ش ٓخظخسس ؼِٔٓش ُزخه٢ حُذٍٝ ُ٘ظؼشف ٠ِػ أدٝحس حُٔشأس ك٢ ط٤ٔ٘ش ٛزٙ حُٔـظؼٔخص.
ٝك٤ٖ ٗ٘ظش ا٠ُ حُذٝس حُز١ طوّٞ رٚ حُٔشأس ك٢ حُظ٤ٔ٘ش، ال رذ إٔ ٗ٘ظش اٚ٤ُ ك٢ اهخس حُظ٤ٔ٘ش حؾُخِٓش رٌَ أرؼخدٛخ حالهظقخد٣ش ٝحالؿظٔخ٤ػش ٝحؼُوخك٤ش ٝحُغ٤خع٤ش، ٝك٢ اهخس حُظ٤ٔ٘ش حُٔغظٜذكش حُوخثٔش ٠ِػ حألفخُش ٝحُظـذ٣ذ حُلنخس١. ٝ طـضثش حُذٝس ك٢ ٛزح حُلقَ ا٠ُ ػذس أدٝحس ٞٛ رـشك حُظٞم٤ق، ٝطلغ٤ش ا٠ُ أ١ ٓذٟ طغظط٤غ حُٔشأس إٔ طؾخسى ٝطغخْٛ رلؼخ٤ُش ك٢ حُظ٤ٔ٘ش، ٝٓخ حٞؼُحَٓ حُظ٢ طئػش ك٢ ؼٓذالص اعٜخّ حُٔشأس ك٢ حُظ٤ٔ٘ش ك٢ ظَ حُٔظـ٤شحص ٝحُظطٞسحص حُظ٢ هشأص ٠ِػ ٛزٙ حُٔـظؼٔخص ؟ ٝٓخ حٞؼُحَٓ حُظ٢ طٞحٚؿ حُٔشأس ُِو٤خّ رٜزٙ حألدٝحس ٝطٞؼم حٗذٓخٜؿخ ٝحُظضحٜٓخ رخؾُٔخسًش حُلنخس٣ش حٌُخِٓش ك٢ ف٘خػش حُل٤خس رٌَ أرؼخدٛخ رذءحً ٖٓ كوٜخ حُطز٠ؼ٤ ك٢ كش٣ش حُلشًش ٝحالٗظوخٍ، ا٠ُ رسٝس حُظؤ٤ػش ك٢ ف٘غ حُوشحس ٝحإلعٜخّ ك٢ طلذ٣ذ حُٔغخس.
حُذٝس حالؿظٔخ٢ػ ٝحؼُوخك٢ :
ٗظشس حإلعالّ ٌُٔخٗش حُٔشأس حالؿظٔخ٤ػش :
ُٔخ ًخٕ حإلعالّ ٞٛ د٣ٖ حُـخُز٤ش حؼُظ٠ٔ ٖٓ عٌخٕ دٍٝ حؼُخُْ حإلعال٢ٓ، ٝأكذ حٞؼُحَٓ حٌُزشٟ ك٢ كشًش حُلنخسس حؼُشر٤ش حإلعال٤ٓش ٓخم٤خً ٝكخمشحً ٝٓغظوزالً، كبٕ حألٓش ٣وظن٢ إٔ ٗشًض ٠ِػ ٌٓخٗش حُٔشأس حالؿظٔخ٤ػش ك٢ حإلعالّ، ٝك٢ ٛزح حُقذد، كبٕ حإلعالّ هذ عخٟٝ ر٤ٖ حُشٝ َؿحُٔشأس ك٢ حٌُشحٓش حإلٗغخ٤ٗش ٝحعظخِلٜٔخ ؼٓخً ؼُٔشحٕ حٌُٕٞ، ًٔخ ٠ٜٗ حُوشإٓ ػٖ ًشح٤ٛش حُز٘ض، ٝكشّ ٝأدٛخ، ًٔخ ًخٕ ٓظزؼخً ك٢ حُـخ٤ِٛش.
إ حُوشإٓ حٌُش٣ْ هذ عخٟٝ ر٤ٖ حُشؿخٍ ٝحُ٘غخء ك٢ حُٞحؿزخص حُذ٤٘٣ش ٝك٢ حُٔغئ٤ُٝش ٝك٢ حٞؼُحد ٝحؼُوخد، ك٤غ رًش ك٢ ٓلٌْ آ٣خطٝ { : ٚإٔ ٤ُظ ُإلٗغخٕ اال ٓخ ع٠ؼ ٝإٔ عٚ٤ؼ عٞف ٣شػ ْٟ ٣ـضحٙ حُـضحء حألٝك٠ { )عٞسس حُ٘ـْ، ح٣٥خص -41 ٝ ..)39حإلٗغخٕ ٛ٘خ ؾ٣َٔ ًالّ ٖٓ حُزًٞس ٝحإلٗخع رطزؼ٤ش حُلخٍ.
ًٔخ أًذص حُغ٘ش حُ٘ز٣ٞش ٠ِػ حُٔغخٝحس ك٢ ؼٓخِٓش حُزًٞس، كخُلذ٣غ حؾُش٣ق ٣وشس <عخٝٝح ر٤ٖ أٝالدًْ ك٠ حؼُط٤ش كِٞ ً٘ض ٓلنالً أكذحً ُلنِض حُ٘غخء>. ٝحُٔغخٝحس ك٢ حؼُطخء طٔظذ ٖٓ طشر٤ش حألهلخٍ ٝسػخ٣ظْٜ ا٠ُ اطخكش حُلشؿ حُٔظٌخكجش ٞٔٗ ُْٜحً ػٝٔالً ؾٓٝخسًش ٖٓ خالٍ ٓخ ٣ظٔظٞؼٕ رٚ ٖٓ كوٞم ٝٓخ ٣ظلِٚٗٞٔ ٖٓ ٓغئ٤ُٝخص، ٣ٝوشس حُشعٛ #ٍٞزٙ حُٔغخٝحس ر٤ٖ حُزًش ٝحأل٠ؼٗ ر٘ق٤لظٚ ُِ٘غخء حُالث٢ ؿجٖ ُٔزخؼ٣ظٚ ٞ٣ّ كظق ٌٓش : <ٖٓ ًخٗض ُٚ أ٠ؼٗ كِْ ٣جذٛخ ُْٝ ٜٜ٘٣خ ُْٝ ٣ئػش ُٝذٙ ٜ٤ِػخ أدخِٚ هللا حُـ٘ش>.
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أػطض حؾُشؼ٣ش حإلعال٤ٓش حُٔشأس كش٣ش حالخظ٤خس ٝحُوشحس ٝكن حُظؼشف ٠ِػ ٖٓ ٣ش٣ذ إٔ ٣ظضٜؿٝخ، ٝٓغ إٔ حإلعالّ هذ حعظٜـٖ حُطالم ِٚؼؿٝ أرـل حُلالٍ، اال أٚٗ ُْ ٣وقش حُلن ك٠ِػ ٚ٤ حُشؿَ، ًٔخ ٣ـش١ حُلْٜ حُوخثْ ٠ِػ طوخ٤ُذ ٝأػشحف حؿظٔخ٤ػش،
ٝحُخالفش إٔ حإلعالّ ٣شع٢ هخػذس ٤ٌٓ٘ش ٌُٔخٗش حُٔشأس رخُ٘غزش ٌُشحٓظٜخ ُٝٔغخٝحطٜخ رخُشٝ َؿُلوٜخ ك٢ حؾُٔخسًش حُل٤ِؼش حؼُش٣نش ك٢ ؽئٕٝ حُل٤خس، ًٔخ كؼِض ٤ؼًش ٖٓ كن٤ِخص حُ٘غخء ك٢ ٤ؼًش ٖٓ كوذ حُظخس٣خ.
ٓغخٛٔش حُٔشأس ك٢ حُظ٤ٔ٘ش حالؿظٔخ٤ػش ٝحؼُوخك٤ش :
٣شؿغ حٛظٔخٓ٘خ رخُذٝس حالؿظٔخ٢ػ ٝحؼُوخك٢ ُِٔشأس ا٠ُ ا٣ٔخٗ٘خ رخُز٤جش حُظ٢ ؼ٤ؼ٣ كٜ٤خ حُطلَ ك٢ حُغٞ٘حص حأل٠ُٝ ٖٓ ػٔشٙ، ٠ِػٝ ٙٞٔٗ ٓغظوزالً، كخُٔشأس طؼِذ دٝسحً سث٤غخً ك٢ ط٤ٔ٘ش حُٞٔحسد حُزؾش٣ش حُقـ٤شس، كخألعشس ٢ٛ حُٔئعغش حُظشر٣ٞش حأل٠ُٝ ُظشر٤ش حُطلَ ٝطؾ٘جظٚ، كٜ٤خ ٞ٣مغ كـش حألعخط حُظشر١ٞ ك٤غ ٌٞ٣ٕ حُطلَ ػـ٤٘ش هؼ٤ش ٣ظوزَ حُظ٣ٝ ٚ٤ؿٞظٞؼد٣ٝ ِٙظوو ٓخ ٣ذٝس كُٚٞ ٖٓ فٞس ػٝخدحص ٝطوخ٤ُذ ػٝوخكش حُز٤جش حُظ٢ ؼ٤ؼ٣ كٜ٤خ، ٝكٜ٤خ أ٣نخً ٣ظؼِْ ٓزخدة حُل٤خس حالؿظٔخ٤ػش ٝحؼُٔخسف ٝحؼُخدحص حُقل٤ش حُغ٤ِٔش.
ٝسػخ٣ش حُٔشأس ألر٘خثٜخ طزذأ هزَ ٤ٓالدٝ ،ْٛرُي ٖٓ خالٍ حخظ٤خسٛخ حُظـز٣ش حُغ٤ِٔش حُٔظٌخِٓش حُظ٢ طل٤ذ فلظٜخ أػ٘خء حُلَٔ ٝحُشمخػش، ٝرُي ٝهخ٣ش ٝكٔخ٣ش ُألهلخٍ، كظ٠ ال ٣ظؼشمٕٞ ك٢ ٛزٙ حُٔشكِش ا٠ُ طؤخش حُٞٔ٘ أٝ هِش حُل٣ٞ٤ش ٝٗوـ حُٔ٘خػش، ٝص٣خدس حُوخر٤ِش ُألٓشحك حؼُٔذ٣ش، ٞؾ٤ؼ٤ُح سؿخالً أفلخء أه٣ٞخء.
ٝط٢ٔ٘ حُٔشأس هخهخص أر٘خثٜخ ػٖ هش٣ن اؽشحًْٜ ك٢ ٓٔخسعش حُش٣خمش، ًٝزُي ط٤ٔ٘ش ح٢ػُٞ حُلٌش١ ٝحؼُوخك٢ ُذٜ٣ْ، ٝط٤ػٞظْٜ د٤٘٣خً ٝع٤خع٤خً كظ٠ ال ٣وٞؼح كش٣غش ؿُٞٔخص حُظطشف، ٝطشعخ كٜ٤ْ حُو٤ْ ٝحُغِٞى ٝحؼُخدحص حإلعال٤ٓش حُٔطِٞرش، ٛٝزٙ حُظ٤ٔ٘ش ٝحُظشر٤ش طو٠ِػ ّٞ أعخط حُٔغخٝحس ر٤ٖ حُزًٞس ٝحإلٗخع، كٌَ ٓخ ٣ظِوخٙ حُطلَ ٖٓ ػ٘خ٣ش ٝسػخ٣ش ٝط٤ٔ٘ش ك٢ حُغٞ٘حص حأل٠ُٝ ٖٓ ػٔشٙ ؾ٣ٌَ أهق٠ كذ ٓخ عػ ٚ٤ِػ ٌٕٞ٤٘ذ رٝ .ٚؿِٞدٝس حُٔشأس ال ٣٘لقش ك٢ رُي كوو رَ ٣ظؼذحٙ ا٠ُ ٓخ طوّٞ رٚ ٖٓ أػٔخٍ حالهظقخد حُٔ٘ض٢ُ حُخخفش رظشط٤ذ حُٔ٘ضٍ ٝط٘ظ٤لٝ ،ٚطق٤٘غ حُـزحء، ٝطٞص٣غ دخَ حألعشس ٠ِػ رٞ٘د حإلٗلخم حُٔ٘ض٢ُ، ًٔخ أٜٗخ ك٢ رؼل حألك٤خٕ طظلَٔ حُٔغئ٤ُٝش ًخِٓش ك٢ كخُش ٤ؿخد حُضؽٝ أٝ ٝكخطٛ ،ٚزح رخإلمخكش ا٠ُ ِٜٔػخ خخسؽ حُٔ٘ضٍ.
ٝطؼظٔذ دسؿش اعٜخٓخص حُٔشأس حالؿظٔخ٤ػش ٝحؼُوخك٤ش ٠ِػ ٓذٟ حُخذٓخص حُٔوذٓش ٖٓ حُٔـظٔغ حُظ٢ طغخػذٛخ ٠ِػ حُو٤خّ رٜزٙ حألدٝحس، ٝطظؼَٔ ك٢ ؾ٘ٓآص ُِخذٓخص حالؿظٔخ٤ػش ًخُٞكذحص حالؿظٔخ٤ػش، ٝدٝس حُلنخٗش، ٝٓشحًض حُظذس٣ذ ٝحُظ٣ٌٖٞ ح٢ُٜ٘ٔ، ٌٝٓخطذ حُظٝ ٚ٤ؿٞحالعظؾخسحص حألعش٣ش، ٝٓشحًض حُخذٓخص حُقل٤ش حُٔظؼِٔش ك٢ حُٔغظؾل٤خص حؼُخٓش ٝٓغظؾل٤خص حُٞالدس، ٝٓشحًض سػخ٣ش حُطلُٞش ٝحألٞٓٓش، ٝحُٔغظٞفلخص، ٝٓشحًض ط٘ظ٤ْ حألعشس، ؾ٘ٓٝآص حُخذٓخص حؼُوخك٤ش حُظ٢ طؼِٔض ك٢ ٝعخثَ حإلػالّ، ٝحٌُٔظزخص، ٝحألٗذ٣ش حُش٣خم٤ش ٝحالؿظٔخ٤ػش.
٤ُٝغض حُٔشأس ك٢ كخؿش ا٠ُ حُخذٓخص كوو، ٌُٜ٘ٝخ ك٢ كخؿش أ٣نخً ا٠ُ اػذحدٛخ حإلػذحد حُـ٤ذ ٝطٜ٘٤ٌٔخ ٖٓ حُو٤خّ رٌَ ٛزٙ حإلعٜخٓخص، كبرح ًخٕ حُٔـظٔغ ٣ش٣ذ حالعظلخدس ٖٓ ٓغخٛٔش حُ٘غخء ًخِٓش ك٢ حُظ٤ٔ٘ش، كٚ٤ِؼ إٔ ٣غخػذ٠ِػ ٖٛ أدحء دٝسٖٛ رخإلػذحد ٝحإلؿشحءحص حُظ٢ طغخػذ٠ِػ ٖٛ طلَٔ ٓغئ٤ُٝظ٣ٝ ،ٖٜظنٖٔ ٛزح حإلػذحد أُخٜٖٓ رخِٞؼُٔٓخص حٌُخك٤ش ك٢ حُٞ٘حك٢ حُقل٤ش ٝحؼُوخك٤ش ٝحُز٤ج٤ش، ًٔخ ٣ظنٖٔ ٛزح حإلػذحد ط٤ٔ٘ش ٜٓخسحط٠ِػ ٖٜ حعظخذحّ ٛزٙ حِٞؼُٔٓخص ك٢ ًَ ٞٗحك٢ حُل٤خس، ٝطذ٤ػْ حطـخٛخطٝ ،ٖٜا٣ٔخٜٖٗ رؤ٤ٔٛش دٝسٖٛ ك٢ ط٤ٔ٘ش ٓـظٝ ٖٜؼٔط٤ٔ٘ش ح٢ػُٞ حؼُوخك٢ ُذٜ٣ٖ ُظظؼشكٖ ٠ِػ ٓخ ٣ذٝس كُٜٖٞ ك٢ حؼُخُْ حُٔل٢ِ ٝحُخخس٢ؿ، ُٝظؼشكٖ كوٞهٝٝ ٖٜحؿزخطٛٝ ،ٖٜزح ال ٣ظؤط٠ اال ػٖ هش٣ن حُٔض٣ذ ٖٓ حُخذٓخص حُظ٤ٔ٤ِؼش ٝحُزشحؾٓ حؼُوخك٤ش حُٔوذٓش ُِٔشأس.
ططٞس حألٝمخع حالؿظٔخ٤ػش ٝحؼُوخك٤ش ُِٔشأس ك٢ رِذحٕ حؼُخُْ حإلعال٢ٓ :
ٓ٘ز حؼُوذ حؼُخ٢ُٔ ُِٔشأس )1985-1975(، رذأص حُلٌٞٓخص طٜظْ رؤٝمخع حُٔشأس ك٢ ًخكش حُٔـخالص ٝط٠ِػ َٔؼ طلغٜ٘٤خ، ٝط٤ٌٖٔ حُٔشأس ٖٓ حؾُٔخسًش حُلؼخُش ك٢ ٤ٔؿغ ٓـخالص حُل٤خس، ٝحعظٜذكض حؼُوٞد حُٔخم٤ش ك٢ ؼٓظْ حُزِذحٕ حإلعال٤ٓشحُظٞعغ 89
ك٢ ٗطخم حُخذٓخص حالؿظٔخ٤ػش ٝٓشحكن حُز٤٘ش حألعخع٤ش ٝطٞع٤غ ٗطخم حُظٔخعي حالؿظٔخ٢ػ ٝحُٔض٣ذ ٖٓ حُظلغ٤٘خص ك٢ ًخكش ٞؿحٗذ حُشكخٙ حالؿظٔخ٢ػ.
ٝرزُض حُلٌٞٓخص حُٔشًض٣ش ك٢ ؼٓظْ ٛزٙ حُزِذحٕ ٜٞؿدحً ًز٤شس ُظٞع٤غ ٗطخم كق٤ٔؿ ٍٞغ حألهلخٍ ٠ِػ خذٓخص حُظ٤ِؼْ حألعخع٢، ًٔخ ٝعؼض ك٢ حُٞهض ٗلغٚ كشؿ حُلقٚ٤ِػ ٍٞ رخُٔـخٕ ُـ٤ٔغ حألهلخٍ، ػِٝٔض ٠ِػ سكغ ٓغظٟٞ ط٤ِؼْ حُز٘خص إل٣ٔخٕ ٛزٙ حُٔـظؼٔخص إٔ ط٤ِؼْ حُز٘خص ٞٛ حالعظؼٔخس حُٞك٤ذ حألؼًش كخ٤ِػش عٞحء ػِٔض حُٔشأس خخسؽ حُز٤ض أّ ُْ طؼَٔ، كٜٞ ٞؼ٣د رٔـػٞٔش ٖٓ حُٔ٘خكغ حإل٣ـخر٤ش ٠ِػ أكشحد حألعشس ٝطلغ٤ٖ أٝمخٜػخ حُقل٤ش ٝحُـزحث٤ش، ٝطلغ٤ٖ كظشحص حُلَٔ ٝحُٞالدس، ٝطخل٤ل ؼٓذالص ٝك٤خص حألهلخٍ ٝافخرظْٜ رخألٓشحك، رخإلمخكش ا٠ُ طلغ٤ٖ ٓغظٟٞ ط٤ِؼْ حألهلخٍ، ٣ٝئًذ ٛزح طوش٣ش حُظ٤ٔ٘ش حُزؾش٣ش ؼُخّ 2000، كٜٞ ٣شًض ٠ِػ حُقلش ٝحُظـز٣ش ٝحُظ٤ِؼْ ال ُو٤ٔظٜٔخ كلغذ، رَ أ٣نخً ُظؤ٤ػشحطٜخ حإل٣ـخر٤ش حُٔزخؽشس ٤ؿٝش حُٔزخؽشس ٠ِػ سأط حُٔخٍ حُزؾش١ ٝحإلٗظخ٤ؿش ٝحُوذسس ٠ِػ حؾُٔخسًش ٝحُظلخػَ حالؿظٔخ٢ػ. ُٝ٘ظؤَٓ طؤ٤ػشحص حُظ٤ِؼْ، كخؼُ٘ق حُٔ٘ض٢ُ ال٣ظؤػش رؼذد عٞ٘حص حُضٝحؽ أػ ٝٔش حُٔشأس ٝطشط٤زخص حؾ٤ؼُٔش أٝ ط٤ِؼْ حُضٝ ،ؽٝاٗٔخ طظؤػش رظ٤ِؼْ حُٔشأس، كوذ ُٞكع ك٢ حُٜ٘ذ ارح ًخٗض حُٔشأس هذ ٗخُض ط٤ِؼٔخً ػخ٣ٞٗخً كبٕ ؼٓذٍ كذٝع ٛزح حؼُ٘ق ٣٘خلل رؤؼًش ٖٓ ح٤ؼِؼُٖ.
ُٝوذ كووض حُزِذحٕ حُ٘خ٤ٓش ؼٓٝظٜٔخ ٖٓ دٍٝ حؼُخُْ حإلعال٢ٓ ح٤ؼٌُش ك٤ٔخ ٣ظؼِن رخُـزحء ٝحُقلش ٝحُظ٤ِؼْ، كل٢ حُلظشس ٖٓ ػخّ 1980 ا٠ُ ػخّ 1999 حٗخلنض ٗغزش عٞء حُظـز٣ش ٝٗغزش حألهلخٍ ٗخهق٢ حُٞصٕ ٖٓ 37% ا٠ُ ٝ ،%27خالٍ حُلظشس ٗلغٜخ حٗخلل ؼٓذٍ حُٞك٤خص ر٤ٖ حألهلخٍ رؤؼًش ٖٓ 50%، كزؼذ إٔ ًخٗض 168 كخُش ٌَُ أُق ُٞٞٓد أفزلض 93 كخُش. ٝخالٍ حُلظشس ٖٓ 1970 ا٠ُ ػخّ 1999 صحدص ٗغزش ٖٓ ٣لق٠ِػ ِٕٞ ٤ٓخٙ فخُلش ؾُِشد ك٢ حُٔ٘خهن حُش٣ل٤ش ك٢ حؼُخُْ حُ٘خ٢ٓ أؼًش ٖٓ أسرغ ٓشحص، ار حسطلؼض ٖٓ 13% ا٠ُ %71.
ٝحٛظٔض ٓقش رقلش حُٔشأس ٝطز٘ض ٓلّٜٞ حُقلش حإلٗـخر٤ش، ًٝخٕ ٛزح ر٘خء ٠ِػ طٞف٤خص حُٔئطٔش حُذ٢ُٝ ُِغٌخٕ ٝحُظ٤ٔ٘ش رخُوخٛشس 1994 حُز١ ٗـ ٠ِػ إٔ ٓزخدة حُٔغخٝحس ر٤ٖ حُـ٘غ٤ٖ، ٝكن حُٔشأس ك٢ حُقلش حإلٗـخر٤ش ك٣ٞ٤خٕ ُِظ٤ٔ٘ش حُزؾش٣ش.
٢٘ؼ٣ٝ ٓلّٜٞ حُقلش حإلٗـخر٤ش طوذ٣ْ حُخذٓخص حُظ٠ طلظخٜؿخ حُٔشأس ر٤ٖ كظشحص حُلَٔ ٝحُٞالدس، ٓغ حالٛظٔخّ رخُقلش حُ٘لغ٤ش ٝحالؿظٔخ٤ػش ُِٔشأس، ٛٝزح حُٔلّٜٞ ٣ظـخٝص ٓشكِش حؼُٔش حإلٗـخر٢ ٣ٝزذأ رخُطلُٞش ٣ٝغظٔش ا٠ُ حُٔشحٛوش ٝحؾُزخد ٝحُ٘نؾ ٝكظ٠ رؼذ حٗوطخع حُذٝسس حٜؾُش٣ش ُِٔشأس، ٝرزُي أفزلض حُٔشأس ك٢ ٓقش ٛذكخً ُٔـػٞٔش ٖٓ حُٔغخػذحص ٝحُخذٓخص حُقل٤ش ٝحُ٘لغ٤ش ٝحالؿظٔخ٤ػش ك٢ كظشحص ػٔشٛخ حُٔخظِلش ٝأػ٘خء حُلَٔ ٝحُٞالدس ٝٓخ رٜ٘٤ٔخ، ٝحؼٌٗظ ٛزح حُٞمغ ٠ِػ طٞٗظ أ٣نخً ك٢ٜ ٖٓ رِذحٕ ؽٔخٍ أكش٣و٤خ رخُـش حالٛظٔخّ رخُٜٞ٘ك رخُٔشأس. ٝطـخٝرض ا٣شحٕ ٓغ هنخ٣خ حؼُقش ٝٝحكوض ٠ِػ ط٘ل٤ز رشحٝ ؾٓحعؼش ُظلذ٣ذ حُ٘غَ ك٢ عز٤َ ر٘خء دُٝش ػقش٣ش، ٝكشمض ٠ِػ ًَ حُٔوز٤ِٖ ٠ِػ حُضٝحؽ ٖٓ حُـ٘غ٤ٖ حرظذحء ٖٓ ػخّ 1994 مشٝسس حالٗظظخّ ك٢ ٓلخمشحص ٝدسٝط ط٘ظ٤ْ حألعشس هزَ حُضٝحٝ ،ؽأفذسص كظٟٞ طز٤ق ط٘ظ٤ْ حألعشس ٝطؼو٤ْ حُ٘غخء ٝحُشؿخٍ ُِلذ ٖٓ حُ٘غَ، ٝك ّذص ٖٓ حُضٝحؽ حُٔزٌش ُِلظ٤خص.
ٝرخُ٘غزش ُِخذٓخص حُظ٤ٔ٤ِؼش، كوذ حٗخلنض حأل٤ٓش ك٢ حُذٍٝ حُ٘خ٤ٓش رلٞح٢ُ حُ٘قق، ك٤غ صحد ؼٓذٍ ؼٓشكش حُوشحءس ٝحٌُظخرش ر٤ٖ حُزخُـ٤ٖ رٔوذحس حُ٘قق : ٖٓ 48% ك٢ ػخّ 1970 ا٠ُ ػ %72خّ ٝ ،1998صحدص ٗغزش حُو٤ذ حُقخك٤ش ك٢ حُٔشكِظ٤ٖ حالرظذحث٤ش ٝحؼُخ٣ٞٗش ؼٓخً ٖٓ ػ %50خّ 1970 ا٠ُ ػ %72خّ 1998.
ٝك٢ ٓقش حسطلؼض ٗغزش حُو٤ذ حُقخك٢ ُِقق حألٍٝ حالرظذحث٢ ٖٓ ػ %75.12ــخّ 92/1993 ا٠ُ ػ %86.81خّ ٝ ،1999/98ًخٗض ٗغزش حُو٤ذ ُإلٗخع ػ %45.7ــــخّ ٝ ،1993/92حسطلؼض ا٠ُ ؼُ %48خّ 98/1999، أ١ إٔ ٗغزش حُِٔظلوخص ٖٓ حإلٗخع رخُقق حألٍٝ طوظشد ٖٓ ٗغزش ط٤ؼَٔ حإلٗخع ك٢ حُٔـظٔغ حُٔقش١ 49% طوش٣زخً كغذ اكقخء ػخّ .1996
ٛٝزح ؼ٣ذ أكذ حُٔئؽشحص حُٜخٓش حُذحُش ٠ِػ طلو٤ن طٌخكئ حُلشؿ حُظ٤ٔ٤ِؼش ٝإٔ هن٤ش حُٞ٘ع ك٢ حُظ٤ِؼْ أؽٌٝض ٠ِػ حالٗظٜخء.
أٓخ رخُ٘غزش ُإلٗخع حُزخُـخص، كوذ حٗخلنض حأل٤ٓش رػ %61.8 ٖٓ ٖٜ٘٤خّ 1986 ا٠ُ ػ %43.4خّ 1999
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ٝك٢ ػخّ 1998 ًخٗض ا٣شحٕ ٝحكذس ٖٓ 10 دٍٝ ك٢ حؼُخُْ طخِقض ٖٓ حُلـٞس حُخط٤شس ك٢ حُلشم ر٤ٖ ط٤ِؼْ حألٝالد ٝحُز٘خص، ؿٝٝذص 95% ٖٓ حُز٘خص أٓخًٖ ُٜٖ ك٢ حُٔذحسط حالرظذحث٤ش ٝحإلػذحد٣ش، ٝرِـض ٗغزش هخُزخص حُـخؼٓش كٞح٢ُ 40% ٖٓ كـْ حُطِزش ك٢ حُظ٤ِؼْ حؼُخ٢ُ، ٝحهظقشص 30% ٖٓ ح٤ٌُِخص ٠ِػ حُز٘خص كوو)18(.
ٝطـ٤ؾش أ٣ـنخً اكـذٟ حُـذسحعخص ػـٖ ط٘ظـ٤ْ حألعـشس ٝعِطش حُٔشأس ك٢ حُٔــظٔغ حُلنـش١ رخُٔـٌِٔش حؼُشر٤ش حُغـٞؼد٣ش اُـ٠ إٔ حُٔـشأس كـ٢ حُٔـظؼٔخص حؼُـشر٤ش طظٔـظغ رغِـطش ٤ؿـش سعـ٤ٔش، ٝأٜٗخ طٔــخسط ع٤طشس ه٣ٞش ٠ِػ هشحسحص أهخسرٜخ حألهـشر٤ٖ رخُ٘غـزش ؾُـئٕٝ حُضٝحٝ ،ؽهذ ػضص ٛزٙ حُغِطش ٤ؿش حُشع٤ٔش ُِٔشأس ك٢ حألعـش ٞٓمغ حُذسحعـش، عـلشٛخ حُٔـظٌشس ُِخخسٝ ،ؽاهخٓظٜخ حُط٣ِٞش ر٤ؼذحً ػٖ حُٞهٖ ٝدسحعش أر٘خثٜخ رخُٔذحسط حألؿ٘ز٤ش. أٓخ ح٣ٌُٞض كظؼَٔ ٌٓخٗش حُقذحسس ر٤ٖ رِذحٕ حُخؾ٤ِ ك٤ٔخ ٣ظؼِن رخُلش٣ش ٝحٌُٔخٗش حالؿظٔخ٤ػش حُظ٢ طظٔظغ رٜخ حُٔشأس.
أٓخ حُٔشأس ك٠ ٓ٘طوش ؽٔخٍ اكش٣و٤خ )طٞٗظ ٝحُـضحثش ٝحُٔـشد( كوذ حًظغزض هذسحً ٖٓ حُغِطش دحخَ اهخس حألعشس، ٝرُي ٗظ٤ـش ُذخٍٞ حُٔشأس ٓـخٍ حؼَُٔ خخسؽ حُز٤ض، ٝالعظوالُٜخ حالهظقخد١، ٝهذ أعلش ٛزح ػٖ طـ٤ش ك٢ حألٝمخع حالؿظٔخ٤ػش ٝحؼُوخك٤ش ُِ٘غخء، ٝطؼَٔ رُي ك٢ حخظ٤خسٖٛ ُِضٝ ،ؽٝحسطلخع عٖ حُضٝحٝ ،ؽطلذ٣ذ كـْ حألعشس.
ٝحرظذحء ٖٓ ػخّ 1994 طقخػذص مـٞه حُلشًش حُ٘غخث٤ش ك٢ ا٣شحٕ ُظـ٤٤ش هٞح٤ٖٗ حٝ َٔؼُكنخٗش حألهلخٍ. ٝحسطلغ ٓغظٟٞ ح٢ػُٞ حؼُوخك٢ ُِٔشأس ك٢ حُزِذحٕ حإلعال٤ٓش، ٝرُي حعظ٘خدحً ا٠ُ حُظطٞسحص ٝحُظـ٤شحص حُظ٢ هشأص ٠ِػ حؼُخُْ رقلش ػخٓش ،ٝحؼُخُْ حإلعال٢ٓ رقلش خخفش، ٖٓ ططٞس ط٢ؿٌُٞٞ٘ ٝحطغخع ٗطخم حالطقخٍ ر٤ٖ حُ٘خط، ٝطلغ٤ٖ عزَ حُ٘وَ ٝحُٞٔحفالص، ًَ رُي ٜٓذ إلكذحع طـ٤ش ك٢ ػوخكخص حُٔشأس حُظ٢ ًخٗض ط٘قذ ٠ِػ حؼُخدحص ٝحُظوخ٤ُذ. كخسطزو ٓغظٟٞ ح٢ػُٞ حؼُوخك٢ رخُظ٤ِؼْ، ك٤غ إ حُٔشأس ًِٔخ ٗخُض هغطخً أًزش ٖٓ حُظ٤ِؼْ، ًخٗض أؼًش هذسس ٠ِػ كٝ ْٜادسحى ٓخ طزغ ُٜخ ٝعخثَ حالػالّ، ٝأؼًش ٤ػٝخً رلوٞهٜخ حُظ٢ ؽشػظٜخ ُٜخ حُذُٝش، ًٝزُي ًخٗض أؼًش ٤ػٝخً رٔخ ٣ذٝس ك٢ ػخُٜٔخ حُٔل٢ِ ٝحؼُخ٢ُٔ ٖٓ طـ٤شحص ٝطلٞالص.
ُٝوذ ػٝوض دسحعخص ٤ؼًشس حُقالص حُغزز٤ش ر٤ٖ حُـزحء ٝحُظـز٣ش ٝحإلعٌخٕ ٝحُقشف حُقل٢ ٝحُشػخ٣ش حُقل٤ش ٝحُظ٤ِؼْ، ك٠ِؼ عز٤َ حؼُٔخٍ طوَِ حُقلش حُـ٤ذس حالكظ٤خؿخص ا٠ُ حُـزحء، ٝطض٣ذ حعظخذحٚٓ حُلؼخٍ ك٢ حُظـز٣ش، ًٔخ إٔ حُظلق٤َ حُظ٢ٔ٤ِؼ حأل٠ِػ ُٚ ٌٕٞ٣ أػش ط٢ِ٤ٌٔ ٓٔخ٠ِػ َػ حُظـز٣ش، ٣ٝظنق ٖٓ ٓـػٞٔش ًز٤شس ٖٓ حألدُش، إٔ حسطلخع ٓغظٟٞ طؼو٤ق حألٜٓخص ٣لغٖ حُٞمغ حُـزحث٢ ُألهلخٍ، ٣ٝظز٤ٖ ٖٓ دسحعش أؿش٣ض ك٢ ٞ٘ؿد آع٤خ، إٔ ؼٓذٍ ٗوـ حُظـز٣ش ٣وَ رٔخ ٣قَ ا٠ُ %20 ر٤ٖ أهلخٍ حُ٘غخء حُالط٢ ُْ ٣ظـخٝص طٜٔ٤ِؼٖ حُٔشكِش حالرظذحث٤ش ٓوخسٗش رؤهلخٍ حألٜٓخص حأل٤ٓخص)19(.
ٝك٢ ٛزح حُٔـخٍ أ٣نخً ٛ٘خى ٓـػٞٔش ٖٓ حٞؼُحَٓ طغخػذ ك٢ ط٤ٔ٘ش ح٢ػُٞ حؼُوخك٢ ُذٟ حُٔشأس، ٝطظلذ ٛزٙ حٞؼُحَٓ ٓغ حُٔظـ٤شحص حالهظقخد٣ش ٝحالؿظٔخ٤ػش حُظ٢ طظؼَٔ ك٢ حسطلخع ٓغظ٣ٞخص حُذخَ، ٝطٞ٘ع حٝ ُٖٜٔحألؾٗطش حالهظقخد٣ش ٝحالؿظٔخ٤ػش ٝحؼُوخك٤ش.
ًٔخ طؼِذ ٝعخثَ حالطقخٍ ٝحإلػالّ ٝٓذٟ حهظ٘خثٜخ، دٝسحً ٛخٓخً ك٢ ص٣خدس حٗلظخف حُٔشأس ٠ِػ ػوخكخص ؿذ٣ذس ٝك٢ عشػش طذكن حِٞؼُٔٓخص ٝحؼُٔخسف
ٝٗغظخِـ إٔ حُٔشأس حُٔغِٔش ٝحعؼش حؼُوخكش ٢ٛ حُظ٢ طغ٠ؼ ا٠ُ اكذحع حُظـ٤شحص ك٢ أٝمخع حُٔشأس حُٔغِٔش، ٝطلو٤ن حُٔغخٝحس حٌُخِٓش ك٢ حُلوٞم، رؼذ طضح٣ذ ؾٓخسًش حُٔشأس ك٢ ٓخظِق ٤ٓخد٣ٖ حُل٤خس، ِٜٔػٝخ خخسؽ حُٔ٘ضٍ، رخإلمخكش ا٠ُ حسطلخع ٓغظٞحٛخ حالؿظٔخ٢ػ ٝرشٝصٛخ ك٢ ػخُْ حألػٔخٍ ؾ٣ٌالٕ ٝحكذحً ٖٓ أرشص ٝأْٛ حُوٟٞ حؼُخِٓش ك٢ اكذحع حُظـ٤٤ش.
كبٌ نهًشأح انًسهًخ يُز عصىس اإلسالو األونً اهزًبو واضخ فٍ رهقٍ انعهى، فقذ ُعشف عٍ أيهبد انًؤيٍُُ، وعٍ َسبء انًؤيٍُُ أَهٍ كٍ دشَصبد عهً رهقٍ يب َزُضل عهً سسىل هللا )صهً هللا عهُه وسهى( يٍ آٌ انزكش انذكُى، ويب َىجه ثه عهُه انسالو يٍ آداة وأدكبو رزعهق ثبنذٍَ، وأسهًٍ فٍ رهقٍ انذٍَ انقبئى عهً انعهى، ونى َزشددٌ فٍ رنك فكٍ َسزفزٍُ سسىل هللا )صهً هللا عهُه وسهى( فٍ كثُش يٍ انًسبئم انفقهُخ انًزعهقخ ثأيىس دَُهٍ.
واسزًشد انًشأح انًسهًخ فٍ انعصىس انزبنُخ نعصش انُجٍ )صهً هللا عهُه وسهى( عهً صهخ قىَخ ثكزبة هللا رعبنً وسُخ َجُه انكشَى عهُه انسالو ويب َزصم ثهًب وَخذيهًب، كًب كبَذ عهً جبَت كجُش يٍ االهزًبو ثبنعهى، وانذساَخ، فًُب َُفعهب فٍ دَُهب وَهُئهب نذُبح كشًَخ هبَئخ، ورضخش كزت انزبسَخ وانزشاجى وانطجقبد ثأسًبء كثُش يٍ انُسبء انهىارٍ رعهًٍ 91
انكزبثخ وانقشاءح، وسوٍَ انذذَث وثشعٍ فٍ انفقه واإلفزبء، وكبٌ يُهٍ األدَجبد وانشبعشاد، ثم وثشص يٍ انُسبء يٍ أرقٍ عهىيب إَسبَُخ أخشي كبنشَبضُبد وانفهك وانطت وانصُذنخ، وغُش رنك يٍ انعهىو انزٍ رُبست انًشأح، وكٍ يثبال فٍ انزعهى وَشش انعهى ثًخزهف انىسبئم انًزبدخ نهٍ
يكبَخ انًشأح فٍ اإلسالو
حُلٔذ هلل ٝحُقالس ٝحُغالّ ٠ِػ سعٍٞ هللا ٝرؼذ
ؽوخثن حُشؿخٍ، ٝأٜٓخص حألرطخٍ، ٝٓذحسط حُٔشأس ك٢ حإلعالّ ٛٞؿشس ٤ٔػ٘ش، ٝدسس ٌٞ٘ٓٗش، ٝٓخِٞم ُط٤ق ًش٣ْ، كخُ٘غخء حؼُض، ٝكذحثن حُ٘زَ ٝحٌُشّ، ؼٓٝخدٕ حُلنَ ٝح٤ؾُْ، ٖٛٝ أٜٓخص حألطو٤خء، حُٔـذ، ٝفخؼٗخص حُظخس٣خ، ؽٝـشحص حٓشأس، ًَٝ ٓوذحّ خِلٚ أّ كخصٓش، ٝ ًَٝٓشمؼخص حؼُظٔخء، ٝكخم٘خص حأل٤ُٝخء، ٝٓشر٤خص حُلٌٔخء، كٌَ ػظ٤ْ ٝسحءٙ ٝحؼُزوش٣ش، حُطٜش، ٤ٓٝالد حُل٘خٕ ٝحُشكٔش، ؾٓٝشم حُزش ٝحُقِش، ٝٓ٘زغ حإلُٜخّ ٗخؿق ٚؼٓ صؿٝش ؼٓخرشس، كٞٓ ّٖ ٜمغ حُذ٤ٗخ اال رخأل٠ؼٗ حُلٕٞ٘، كآدّ ٚ٤ِػ حُغالّ ُْ ٣غٌٖ ك٢ ٝهقش حُقزش ٝحٌُلخف، كال فالف ُِل٤خس اال رخُٔشأس، ٝال سحكش ك٢ حؾُش٣لخص، رسف ٖٓ أِٜؿٖ حُذٞٓع، هللا ُٚ كٞحء، ٝسعُٞ٘خ ف٠ِ هللا ٝ ٚ٤ِػعِْ ٞٛ أرٞ حُز٘خص حؼُل٤لخص حُـ٘ش كظ٠ خِن رلوٞهٜٖ ك٢ ٤ؼًش ٖٓ حُٔ٘خعزخص، ٝعـَ أػظْ هقش ٖٓ حُزش ٝحإلًشحّ ٝٝهق ألِٜؿٖ ك٢ حُٔلخكَ ٝحُـٞٔع، أرحع .ٝحُظوذ٣ش ُِٔشأس أٓخ ٝأخظخ ٝصؿٝش ٝر٘ظخ ٝحالكظشحّ
رؼذّ حُللخظ ٜ٤ِػخ ٤ِٔػخ ٝطشر٣ٞخ ٝأخاله٤خ، ظِٔض حُٔشأس ػ٘ذ حُـِٜش ٝك٢ حُٞهض حؼُٔخفش ظِٔخ ًز٤شح: عٞحء هزَ صٝحٜؿخ، ؽل٤ق طغِو ٠ِػ ٓخُٜخ ٝكشٜٓخ كش٣ش حُظقشف ك٢ ٓخ طٌِٚٔ، كقخسص ط٘لن ٞٛٝ ،ٚ٤ِػ أٝ رؼذ صٝحٜؿخ ٖٓ صؽٝ رخ٤َ .٣وخرِٜخ رخُلظخظش ٝحُـِظش ٝفٞ٘ف حإل٣زحء، كظِٔض ُٔخ ؼ٘ٓض ٖٓ أرغو كوٞهٜخ
حُـلٞد أسحد إٔ ٣زوٜ٤خ ك٢ ر٤ظٚ ٤ُغظل٤ذ ٖٓ دخِٜخ ٝرغزذ ٓخٍ حُٔشأس ؼُ٘ٓض ح٤ؼٌُشحص ٖٓ حُضٝحؽ؛ ألٕ حألد حؾُشط حٌُٞ٘د .ٝفخسص ػخٗغخ، ال ؾ٣ظٜ٤ٜخ حُشؿخٍ حٜؾُش١، كظ٠ رٛذ ؽزخرٜخ
.ٝحُٔشأس ٓظِٞٓش ػ٘ذ ح٤ؼٌُش ٖٓ حُوغخس حُـلخس حُـِٜش رخؾُشؼ٣ش، ٝحُٔـظؼٔخص حُـخِٛش ك٢ حُوذ٣ْ ٝحُلذ٣غ
حُـز٤ش، ك٢ٜ ػ٘ذْٛ ٖٓ عوو حُٔظخع، طؾظشٝ ٟاٗٔخ ٣لقَ ٛزح حُظِْ ٝحإلهقخء ٝحُظؼ٤ٜٔ ُِٔشأس ك٢ حُٔـظؼٔخص حُـخِٛش .رخعظقـخس حألػخع ٝٓلشٝٓش ٖٓ ح٤ُٔشحع رَ طُٞسع ًٔخ طٞسع حُذحرش، ٣ُٝ٘ظش اٜ٤ُخ ٝطزخع، ٝطٛٞذ ٝطٌظشٟ، ٓلغٞرش ٖٓ
ِٜٞؿٝح حؾُشؼ٣ش، كظزخ ُٖٔ ظِْ حُٔشأس، حُٔظٌ٘شٕٝ ُلوٞم حُٔشأس ظِٛٞٔخ كؤفزلض رال ه٤ٔش ػٝوٛٞخ كؤٓغض رال كن٤ِش، .ٝعلوخ ُٖٔ عِزٜخ كوٞهٜخ
ٓ٘لشف، ٝٓـظٔ ٍغ ٓ٘ـشف، ٤ؿٝ ٍَ ػٖ طلق٤َ ُٝوذ ًخٕ حُظغخَٛ رونخ٣خ حُٔشأس ٖٓ حألعزخد حُشث٤غش ك٢ كقٝ ٍٞحهغ ٍ ٝحُظذ٤ٓش ك٢ حُٔخع٤ٗٞش ٝحؼُِٔخ٤ٗش حُظ٢ طق٘غ حؾُٜ٘ٔ حُز١ ؼٔ٣َ أخطش ؼٓخٍٝ حُٜذّ حُخ٤ش ٓ٘قشف، ٝإ حُٔ٘ظٔش حُخط٤شس ٝحخظالهخً، ٝرُي ًِٚ ُْ ٣ؤص ٓقخدكشً ٝال حػظزخهخً، ٝاٗٔخ ٗظ٤ـش حُٔـظٔغ حإلعال٢ٓ، ًِٚ ٣شًض ٠ِػ حُٔشأس طزشؿخً ٝعلٞسح ً ٝحُٔغِٔخص رؼؾخسح ٍص رشحهش، ٝٓئحٓشس ؽشعش، مذ د٣ٖ حألٓش ِٜؼٓٝخ ٝهَٜٔ٤خ، كظ٠ ُخ ِذع ٤ؼًش ٖٓ حُٔغ٤ِٖٔ طخط٤و ده٤ن، ؽٝشٞٔؿ ٚػدحً ٝس٤ؼؿش، ٝحالٗلالص ٝحإلرخك٤ش؛ كش٣شً ٝطوذٓخ، ٝحالٗغ٤خم ٝسحء ٝدػخ٣خ ٍص ٓنِِش، طَ ؼُ ُذ حالُظضحّ رؾٜ٘ هللا ٝحُلـٞس ٝحالٗلالٍ ك٘خً، ٝحؼُالهخص حٜٞؾُحص سه٤خً ٝطلنشحً ٝٓذ٤ٗش، ٝحُظزشٝ ؽحُغلٞس ٝحالخظاله كش ١َ ََس، ٝحُخالػش ٝحٓظؼخالً ُوٝ ٍٞحُٔغئ٤ُٖٝ ٜ٘ػْ ٖٓ حُ٘غخء ٝحُشؿخٍ، أدح ًء ُلن حُوٞحٓش ٝحُشػخ٣ش، حُٔلشٓش كزخً، ٓٔخ ٣ظطِذ ٣وظش حأل٤ؿخٍ، ػََِ ٜ٤َْخ َٓ َالثِ ٌَشٌ ؿِ َالظٌ ؽِ َذح ٌد َال أَ ْٗلُ َغ ٌُ ْْ َٝأَ ْٛ ٤ِ ٌُ ْْ َٗخ ًسح َٝهُٞ ُدَٛخ حَُّ٘خ ُط َٝح ُْ ِل َـخ َسس ُ حُلن طزخسى ٝطؼخ٠ُ )٣َخ أُّٜ٣ََخ حَُّ ِز٣ َٖ آَ َُٞ٘ٓح هُٞح . أَ َٓ َش٣َٝ ْْ َُٛ ْل ُِٞؼَ َٕ َٓخ ٣ُ ْئ َٓ ُشٝ َٕ( عٞسس حُظلش٣ْ آ٣ش 6 ٣َ ؼْ ُقٞ َٕ َّهللاَ َٓخ ُِٔشأس، ٝكلخظخً ٠ِػ ٌٓخٗظٜخ، كشفخً ٠ِػ اهخٓش ٓخ كشّ حإلعالّ حُظزشٝ ؽحُغلٞس ٝحالخظاله، ؽٝشع حُلـخد اال طٌش٣ٔخ ً حُلغخد، ٝكؼخً ٠ِػ حطخخر حؼُل٤ق، حُز١ ال ط٤ِّٜـٚ حٜٞؾُحص، ٝال طغظ٤ؼشٙ حُٔظـ٤شحص، ٝعذحً ُزسؼ٣ش حُٔـظٔغ حُ٘ظ٤ق، ٝحُـ٤َ ٝرُي ػ ٞٛذٍ حإلعالّ ك٢ ف٤خٗش حُٔـظٔغ ٖٓ حُٔضحُن، ٞٛٝ أٛذٟ عز٤الً حُظذحر٤ش حُٞحه٤ش ٖٓ حُٞهٞع ك٢ حؾُش ٝحالٗلشحف، .حإل٣ٔخٕ، ٝطشكشف ٠ِػ ؿ٘زخطٜخ سح٣ش حُل٤خء حُزؾش٣ش ؼٔؿخء، رٌ َِّ ػض ٍس ٝارخء، ك٢ ٤ػ ؼٍ َخ٤ِّش ٝك٤خس ٤٘ٛجش، ٣ظِِٜخ ُغؼخدس
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كق ٌٖ كق٤ٖ، ِٝٓـؤٌ أ٤ٖٓ، ٝ ِظ ٌَّ ٝحسف، ٞٛ هٞهؼش حُٔشأس ك٢ حإلعالّ عالُش حألًش٤ٖٓ،ٝكل٤ذس أٜٓخص حُٔئ٤ٖ٘ٓ، ر٤ظٜخ ُٜخ ٞٗسٛخ، ٌٕٞ٘ٓٝ حُذسس، طضدحد كٚ٤ ٗنخسسً ٝرٜخ ًء، ٝكغ٘خً ٝم٤خ ًء، ٝك٤ٖ طخشٚ٘ٓ ؽ ٣خزٞ حُـٛٞشس، ٝفذكش حُِئُئس، َٝهَ ْش َٕ ك٢ِ رُٞ٤ُطِ ٌُ َّٖ َٝال طَزَ َّش ؿْ َٖ طَزَ ُّش ٣ٝ – { ؽَظنخءٍ م٤خإٛخ، ٣ٝزٛذ ؿالإٛخ، حع٢ؼٔ ا٠ُ هٍٞ حُلن – طزخسى ٝطؼخ٠ُ .{ح ْأل٠َُُٝ ح ُْ َـخ ِٛ ٤َِّ ِش
كخُ٘غخء ك٢ حإلعالّ ؽوخثن حُشؿخٍ، ٝخ٤ش حُٔغ٤ِٖٔ ُوذ سكغ حإلعالّ ٌٓخٗش حُٔشأس، ٝأًشٜٓخ رٔخ ُْ ٣ٌشٜٓخ رٚ د٣ٖ عٞحٙ؛ ح٤ؼُٖ، ػٝٔشس هلُٞظٜخ ُٜخ كن حُشمخع، ٝحُشػخ٣ش، ٝاكغخٕ حُظشر٤ش، ٢ٛٝ ك٢ رُي حُٞهض هشس خ٤شْٛ ألِٚٛ؛ كخُٔغِٔش ك٢ .حُلئحد ُٞحُذٜ٣خ ٝاخٞحٜٗخ
رشػخ٣ظٚ، كال ٣شم٠ إٔ طٔظذ اٜ٤ُخ أ٣ذ رغٞء، ٝال أُغ٘ش ٝارح ًزشص ك٢ٜ حؼُٔضصس حٌُٔشٓش، حُظ٢ ٣ـخس ٜ٤ِػخ ٜ٤ُٝخ، ٣ٝلٞهٜخ حُضؽٝ رؤػض ٞؿحس، ٝأٓ٘غ دحس، رخ٤خٗش، ٝارح طضؿٝض ًخٕ رُي رٌِٔش هللا، ؼ٤ٓٝخهٚ حُـ٤ِع؛ كظٌٕٞ ك٢ ر٤ض رؤرٝ ،ٟال أ٤ػٖ ٝحإلكغخٕ اٜ٤ُخ، ًٝق حألرٜ٘ػ ٟخ، ٝارح ًخٗض أٓخً ًخٕ ر ُّش ٛخ ٓوشٝٗخً رلن ك٢ ع٤ٌ٘ش ٝهشحس، ٝٝحؿذ ٠ِػ صٜؿٝخ اًشحٜٓخ، حألسك، ٝارح ًخٗض أخظخً ك٢ٜ حُظ٢ أُٓش حُٔغِْ رقِظٜخ، هللا-طؼخ٠ُ-ػٝوٞهٜخ ٝحإلعخءس اٜ٤ُخ ٓوشٝٗخً رخؾُشى رخهلل، ٝحُلغخد ك٢ ًز٤شس ك٢ حُغٖ صحدص ٜ٤ِػخ، ٝارح ًخٗض خخُش ًخٗض رٔ٘ضُش حألّ ك٢ حُزش ٝحُقِش، ٝارح ًخٗض ؿذس، أٝ ٝاًشحٜٓخ، ٝحُـ٤شس ٣ٌخد ٣شد ُٜخ هِذ، ٝال ٣ُ َغلُٜ َّٚخ سأ١ رـ٤ش ٓزشس، كوذ ًخٕ حُ٘ز٢ ف٠ِ ه٤ٔظٜخ ُذٟ أٝالدٛخ، ٝأكلخدٛخ، ٤ٔؿٝغ أهخسرٜخ؛ كال .ٝ ٚ٤ِػعِْ ٣غظ٤ؾش حُٔشأس ًٔخ ٣غظ٤ؾش حُشؿخٍ ك٢ هنخ٣خ ٓلق٤ِش ٝأٞٓس ٓق٤ش٣ش هللا
حؼُوٞد، ُٜٝخ كن حُظٝ ،ِْؼحُظ٤ِؼْ، رٔخ ال ٣خخُق ػْ إ ُِٔشأس ك٢ حإلعالّ كن حُظِٔي، ٝحإلؿخسس، ٝحُز٤غ، ٝحؾُشحء، ٝعخثش حٝ رٞ٤ص آرخثٌْ طؼخ٠ُ: ) … ٝال ٠ِػ أٗلغٌْ إٔ طؤًِٞح ٖٓ رٞ٤طٌْ ٖٓ حُ٘قٜ٘ٓٝ ؿٞخ هٍٞ هللا دٜ٘٣خ، ًٔخ ٝسد رزُي ٤ؼًش أػٔخٌْٓ حٝ رٞ٤ص ػٔخطٌْ أٝ رٞ٤ص أخٞحٌُْ أٝ رٞ٤ص خخالطٌْ أٝ رٞ٤ص حٜٓخطي أٝ رٞ٤ص اخٞحٌْٗ حٝ رٞ٤ص أخٞحطٌْ أٝ رٞ٤ص حؼُِْ ٓخ ٞٛ كشك ٤ػٖ ٣ؤػْ كوذ ٗغذ ٤ٌِٓش ُِزٞ٤ص ا٠ُ حإلٗخع ًٔخ ٗغذ ٤ٌِٓش أ٣نخ ُِشؿخٍ، رَ إ ٖٓ .. ( عٞس حُٞ٘س، اال رٔخ طخظـ رٚ ٖٓ دٕٝ حُشؿخٍ، أٝ رٔخ ٣خظقٕٞ رٚ دٜٗٝخ ٖٓ حُلوٞم طخسًٚ رًشحً ًخٕ أّ أ٠ؼٗ، رَ إ ُٜخ ٓخ ُِشؿخٍ .حُظ٢ طالثْ ًُالً ٜ٘ٓٔخ ٠ِػ ٗلٞ ٓخ ٞٛ ٓلقَ ك٢ ٞٓحمٝ ٚؼحألكٌخّ
ٖٓ حألُغ٘ش حُزز٣جش، ٝحأل٤ػٖ حُـخدسس، ٝحأل٣ذ١ ٖٝٓ اًشحّ حإلعالّ ُِٔشأس إٔ أٓشٛخ رٔخ ٣قٜٗٞخ، ٣ٝللع ًشحٓظٜخ، ٣ٝلٜ٤ٔخ .ا٠ُ كظ٘ظٜخ ٝحُغظش، ٝحُزؼذ ػٖ حُظزشػٝ ،ؽٖ حالخظاله رخُشؿخٍ حألؿخٗذ، ػٖٝ ًَ ٓخ ٣ئد١ حُزخهؾش؛ كؤٓشٛخ رخُلـخد
ٝحُلزس ٖٓ ظِٜٔخ، أٝ حإلعخءس اٜ٤ُخ، ٖٝٓ اًشحّ ٖٝٓ اًشحّ حإلعالّ ُٜخ: إٔ أٓش حُضؽٝ رخإلٗلخم ٜ٤ِػخ، ٝاكغخٕ ؼٓخؽشطٜخ، ٝٗلٛٞخ ٗق٤زخً ٖٓ ح٤ُٔشحع؛ كِألّ ٗق٤ذ ٤ؼٖٓ، ُِٝضؿٝش ٗق٤ذ ٤ؼٖٓ، ُِٝز٘ض ُٝألخض حإلعالّ ُِٔشأس إٔ ُٜ َؼؿخ حإلعالّ ُِٔشأس ٖٓ ح٤ُٔشحع ٗقق ٓخ ُِشؿَ، ا٠ُ ٗق٤ذ ٠ِػ ٗلٞ ٓخ ٞٛ ُٓلَ َّقَ ك٢ ٞٓحمٝ ،ٚؼٖٓ طٔخّ حؼُذٍ إٔ ؼؿَ .ٝحُلوٞم، ألٕ حُشؿَ ٣ظلَٔ حُٜٔش ٝطـذ ٚ٤ِػ حُ٘لوش ٝحُشػخ٣ش ؿخٗذ ٓخ ُٜخ ٖٓ حُٜٔش ٝحُ٘لوش
حؼُخ٤ُش حُغٔخ٣ٝش، كخُ٘ظْ حألسم٤ش ك٢ حُزالد حٌُخكشس ٛز٢ٛ ٙ ٓ٘ضُش حُٔشأس ك٢ حإلعالّ؛ كؤ٣ٖ حُ٘ظْ حألسم٤ش ٖٓ ٗظْ حإلعالّ ٛخثٔش ٠ِػ ٜٜؿٝخ طزلغ ًشحٓظٜخ، ك٤غ ٣ظزشأ حألد ٖٓ حر٘ظٚ ك٤ٖ طزؾِ عٖ حؼُخٓ٘ش ؾػشس أٝ أهَ؛ ُظخشؽ ال طش٠ػ ُِٔشأس كغخد حؾُشف، ٝٗز٤َ حألخالم، ٝأ٣ٖ طِي حؼُخدحص ٖٓ ٤ِػخء ػٖ ٓؤٟٝ ٣غظشٛخ، ُٝؤش طغذ ػٞؿظٜخ، ٝسرٔخ ًخٕ رُي ٠ِػ ٓقذس حُخط٤جش، ٝطغِزٜخ كوٜخ ك٢ ح٤ٌُِٔش ُِٔشأس، ِٜؼْ ؿَ ٝخ اٗغخٗخً ٌٓشٓخً كظزخ ٌَُ طِي حألٗظٔش حُظ٢ طؼذ حُٔشأس اًشحّ حإلعالّ ُِٔشأس ٖٓٔ ٝحكظوخس، ٝطؼذٛخ ٓخِٞهخً كوو ُِٔظؼش رلالٍ أٝ كشحّ، ٝأ٣ٖ اًشحّ حإلعالّ ٝحُٔغئ٤ُٝش، ٝطـِٜؼخ طؼ٤ؼ ك٢ ارالٍ ك٢ ػشك ر٤غ حألكز٣ش، كوذ ِٞؼؿح ُألكز٣ش حؾُشف ٣ـِٞؼٕ حُٔشأس عؼِش ٣ظخؿشٕٝ رـغذٛخ ك٢ حُذػخ٣خص ٝحإلػالٗخص؟ رَ ٝحُل٤خء، ؼؿَٝ حؾُخرخص ألؿَ ر٤غ حؼُ٘خٍ! كخُلٔذ هلل حُز١ ػخك٠ حُٔغِٔخص ؽٝشع ُٜٖ حُغظش رـٔخٍ حُـخ٤ٗخص ٝحُلظ٤خص .ؿٔخٍ حُٔشأس رـٔخٍ طٔغٌٜخ رخإلعالّ
ٝك٢ ً٘ق ٝحُذٜ٣خ، ٝسػخ٣ش صٜؿٝخ، ٝرش أر٘خثٜخ، ٛزح ٝٓغ ؾٜ٘ٓ حإلعالّ ٗشٟ إٔ حُٔشأس حُٔغِٔش طغؼذ ك٢ د٤ٗخٛخ ٓغ أعشطٜخ ٛ٘خى ٖٓ طوق٤ش ؽزخرٜخ، أٛ ٝشٜٓخ، ٝك٢ كخٍ كوشٛخ أؿ ٝ٘خٛخ، أٝ فلظٜخ أٝ ٓشمٜخ، ٝإ ًخٕ عٞحء ك٢ كخٍ هلُٞظٜخ، أٝ حإلعالّ-كبٗٔخ ٞٛ رغزذ حُوقٞس حإلٗغخ٢ٗ ٝحُـَٜ ك٢ كن حُٔشأس ك٢ رؼل رالد حُٔغ٤ِٖٔ أٝ ٖٓ رؼل حُٔ٘ظغز٤ٖ ا٠ُ حإلعال٢ٓ كٜٞ رشحء ؽشحثغ حُذ٣ٖ حإلعال٢ٓ، ٝحُٞصس ك٢ رُي ٠ِػ ٖٓ أخطؤ ٝ ،َٜؿٝأٓخ ٝحُذ٣ٖ حُزؾش١، ٝحُزؼُذ ػٖ ططز٤ن ا٠ُ ٛذح٣ش حإلعالّ ٝطؼخٚٔ٤ُ؛ ؼُالؽ حُخطؤ، ٛز٢ٛ ٙ ٓ٘ضُش ٖٓ طزؼش طِي حُ٘وخثـ، ػٝالؽ رُي حُخطؤ اٗٔخ ٌٞ٣ٕ رخُشٞؿع ٤ؿش رُي ٖٓ ٠ِػ عز٤َ حإلؿٔخٍ: ػلش، ٝف٤خٗش، ٞٓٝدس، ٝسكٔش، ٝسػخ٣ش، ٝطٔغي رخُطٜش، ا٠ُ حُٔشأس ك٢ حإلعالّ 93
٤ؽجخً ٖٓ طِي حؼُٔخ٢ٗ، ٝاٗٔخ ط٘ظش ُِٔشأس ٗظشس ٓخد٣ش حؼُٔخ٢ٗ حُـ٤ِٔش حُغخ٤ٓش، أٓخ حُلنخسس حؼُٔخفشس كال طٌخد طؼشف !حُغؼخدس ػ٘ذػٝ ْٛلظٜخ طخِق ٝس٤ؼؿش، ٝأٜٗخ الرذ إٔ طٌٕٞ د٤ٓش ؼ٣زغ رٜخ ًَ عخهو؛ كزُي عش رلظش، كظشٟ إٔ كـخرٜخ
أٝالدٛخ ٝأهخسرٜخ ٠ِػ رشٛخ-ًٔخ عزن-ألٜٗخ أ َّدص حُٔشأس ك٢ حإلعالّ ًِٔخ طوذّ رٜخ حُغٖ صحد حكظشحٜٓخ، ػٝظْ كوٜخ، ٝط٘خكظ حُطخػش هلل عزلخػ ٚٗ٘ذ أر٘خثٜخ، ٝأكلخدٛخ، ٝأِٜٛخ، ٝٓـظٜؼٔخ، ًَٝ ٣وّٞ رلن ح٥خش ٠ِػ عز٤َ ٓخ ٜ٤ِػخ، ٝرو٢ حُز١ ُٜخ .ٝحرظـخء حألؿش، ال ٠ِػ عز٤َ حٌُٔخكؤس كلغذ
م٤خٜػخ ٝطؾشدٛخ ارح ٢ٛ حرظؼذص ػٖ طؼخ٤ُْ ٌٛزح طز٤ٖ ُ٘خ ٗقؿٞ حُٞك٢ ٌٓخٗش ػٝظْ ٓ٘ضُش حُٔشأس ك٢ حإلعالّ، ٝٓذٟ .ٝفٞس ؿٞٓضس ٖٓ طٌش٣ْ حإلعالّ ُِٔشأس ؾٜ٘ٓٝ حإلعالّ، ٛزٙ ٗززس ٣غ٤شس،
ؽخق٤ظٜخ ر٘خء ػظ٤ٔخً كش٣ذحً ، كوخً أهٍٞ: ُوذ ُٝذص حإلعالّ هذ دكٖ أٞٓس حُـخ٤ِٛش ٤ؿٝش ٓـشٟ طخس٣خ حُٔشأس ، ٝفخؽ ر٘خء ألٜٗخ ٓخِٞهش ًخُشٞٓ ٖٓٝ َؿُذحً ؿذ٣ذحً هخٛشحً ، ُوذ سكٜؼخ حإلعالّ ٝفخٕ ُٜخ ًشحٓش اٗغخ٤ٗظٜخ ، حُٔشأس ك٢ د٣ٖ حإلعالّ َٝح ِك َذ ٍس َٝ َخَِ َن ِٓ َْٜ٘خ َص ٜؿَ َْٝخ َٝرَ َّغ أُّٜ٣ََخ حَُّ٘خ ُط حطَّوُٞ ْح َسرَّ ٌُ ُْ حَُّ ِز١ َخَِوَ ٌُْ ِّٖٓ َّٗ ْل ٍظ حُشٝ َؿُِشؿَ عٞحء رغٞحء ًٔخ هخٍ طؼخ٠ُ ” ٣َخ ُ َ ٌُْ ِّٓ ْٖ اِ َّٕ ّهللاَ ًَخ َٕ ػََِ ٤ْ ٌُ ْْ َسه٤ِزخً ، ٝهخٍ طؼخ٠ُ : ” َٝ ّهللاُ َٝ ََ ؼَ ؿَِٗ َغخء َٝحطَّوُٞ ْح ّهللاَ حَُّ ِز١ طَ َغخء ُٞ َٕ رِ َٝ ِٚحألَ ْس َكخ َّ ِٓ ُْٜ٘ َٔخ ِس ؿَخالً ٤ِؼًَشح ً ٣ُ ْئ َٝ َٕ ُِٞ٘ٓرِِ٘ ؼْ َٔ ِض ّهللاِ ُٛ ْْ ٣َ ٌْلُ ُشٝ ، َٕ ٝهخٍ ر٤َِ٘ َٖ َٝ َكلَ َذسً َٝ َس َصهَ ٌُْ ِّٓ َٖ حُط٤َِّّزَخ ِص أَكَزِخ ُْزَخ ِه َِ أَٗلُ ِغ ٌُ ْْ أَ ْص َٝحؿخً ؼَ ؿَ َٝ ََ َُ ٌُْ ِّٓ ْٖ أَ ْص َٝح ؿِ ٌُْ ك٢ِ َرُِ َي ٣٥ََخ ٍص ُِّوَ ْٞ ٍّ ٣َظَلَ ٌَّ ُشٝ َٕ ُِّظَ ْغ ٌُُٞ٘ح اَُِ ٜ٤َْخ ؼَ ؿَ َٝ ََ رَ ٤َْ٘ ٌُْ َّٓ َٞ َّدسً َٝ َس ْك َٔشً اِ َّ ٕ َٝ ِٓ ْٖ آ٣َخطِ ِٚ أَ ْٕ َخَِ َن َُ ٌُْ ِّٓ ْٖ أَٗلُ ِغ ٌُ ْْ أ َ ْص َٝحؿخ ً ‖ : طؼخ٠ُ آٍ ُْٜ سرْٜ أ٢ٗ ال أم٤غ ػ َٔػخَٓ ٌْٓ٘ ٖٓ رًش أٝ أ٠ؼٗ رؼنٌْ ٖٓ رؼل..( عٞسس ” ، ٝهخٍ طؼخ٠ُ : ) كخعظـخد رؼل ٣ؤٓشٕٝ رخؼُٔشٝف ػ ٕٜٞ٘٣ٖٝ حٌُٔ٘ش ػٔشحٕ ٝك٢ عٞسس حُظٞرش هخٍ طؼخ٠ُ: ) ٝحُٔئٝ ٕٞ٘ٓحُٔئٓ٘خص رؼنْٜ أٝ ٤ُخء حإلعالّ هٞ٤د ٣ٝطٞؼ٤ٕ هللا ٝسعُٚٞ أُٝجي ع٤شكْٜٔ هللا إ هللا ؿلٞس سك٤ْ ( ُوذ كي ٣ٝوٞٔ٤ٕ حُقالس ٣ٝئطٕٞ حُضًخس حُلش٣ش ك٢ كذٝد حؾُشؼ٣ش حُظ٢ سعٜٔخ هللا طؼخ٠ُ، ٝطللع ُٜخ حُـخ٤ِٛش ٠ِػ حُٔشأس ٖٓ حإلرالٍ ٝحالعظؼزخد ُٜخ، ٝهذّ ُٜخ ٣٘خُٜخ عٞء أٝ ٌٓشٙٝ ، أٝ طوغ ػخ٤ٗش ٝاٗغخ٤ٗظٜخ، ُوذ فخؽ حإلعالّ ع٤خؿخً ٝهخث٤خً ه٣ٞخً ، ُلٔخ٣ش حُٔشأس ٖٓ إٔ ًشحٓظٜخ ٝأػٞٗظٜخ رخػظزخسٛخ ) خخُوٜخ طؼخ٠ُ، كٖٔ رُي إٔ ًشّ حإلعالّ حُٔشأس طٌش٣ٔخ ػظ٤ٔخ، ًشٜٓخ ك٢ ٞٓحسد حُزٍ ٝحإلٛخٗش ٝحؼُزٞد٣ش ُـ٤ش هللا طؼخ٠ُ، ٝأخزش إٔ حُـ٘ش ػ٘ذ هذٜ٤ٓخ، أ١ إٔ أهشد أُ ّٓخً ( ٣ـذ رشٛخ ٝهخػظٜخ ٝحإلكغخٕ اٜ٤ُخ، ؼؿَٝ سمخٛخ ٖٓ سمخ حُٞحُذ ، هش٣وٜخ ، ٝكشّ ػوٞهٜخ ٝاؿنخرٜخ ُٞٝ رٔـشد حُظؤكق ، ؼؿَٝ كوٜخ أػظْ ٖٓ كن هش٣ن ا٠ُ حُـ٘ش ػ ٌٕٞ٣ٖ .حُوشإٓ ٝحُغ٘ش ٣طٍٞ رًشٛخ ٝأًذ حؼُ٘خ٣ش رٜخ ك٢ كخٍ ًزشٛخ ٝمؼلٜخ ، ًَٝ رُي ك٢ ٗقػ ؿٞذ٣ذس ٖٓ
ا٣َِّخُٙ اِ ْك َغخًٗخ ( حألكوخف/ٝ ، 15هَٝ ( :ُٚٞهَ َن٠ َسرُّ َي أَال طَ ؼْزُ ُذٝح اِال ٖٝٓ رُي : هُٚٞ طؼخ٠ُ : ) َٝ َٝ َّف ٤َْ٘خ ح ِإل ْٗ َغخ َٕ رِ َٞحُِ َذ ٣ْ ِٚ ُ طَ َْٜ٘ ْشُٛ َٔخ َٝهُ َْ َُُٜ َٔخ هَ ْٞال ًَ ِش٣ ًٔخ َٝح ْخلِ ْل َُُٜ َٔخ ح ُْ ٌِزَ َش أَ َك ُذُٛ َٔخ أَ ْٝ ًِالُٛ َٔخ كَال طَوُ َْ َُُٜ َٔخ أ ٍّف َٝال َٝرِخ ُْ َٞحُِ َذ ٣ْ ِٖ اِ ْك َغخًٗخ اِ َّٓخ ٣َ ْزِ ُ َـ َّٖ ػِ ْ٘ َذ َى . َف ِـ٤ ًشح ( حإلعشحء/23،24 حُ ُّز ٍِّ ِٓ َٖ حُ َّش ْك َٔ ِش َٝهُ َْ َس ِّد ح ْس َك ُْٜٔ َٔخ ًَ َٔخ َسر٤ََّخ٢ِٗ ؿََ٘خ َف ٓخ دحّ هخدسح ٓغظطؼ٤خ، ُٜٝزح ُْ ؼ٣شف ػٖ أؼؿ ََٛ حإلعالّ ٖٓ كن حألّ ٠ِػ ُٝذٛخ إٔ ٣٘لن ٜ٤ِػخ ارح حكظخؿض ا٠ُ حُ٘لوش، ٖٓ حُ٘لوش ٜ٤ِػخ، حُٔشأس طُظشى ك٢ دٝس حؼُـضس، أٝ ٣خشٜؿخ حرٜ٘خ ٖٓ حُز٤ض، أٝ ٣ٔظ٘غ أر٘خإٛخ حإلعالّ ه٤ِش هشػ ٕٝذ٣ذس إٔ .أٝ طلظخؽ ٓغ ٞؿٝدْٛ ا٠ُ حؼَُٔ ُظؤًَ ٝطؾشد
ؾػشطٜخ، ٝأخزش إٔ ُٜخ ٖٓ حُلن ؼَٓ ٓخ ُِضؽٝ ًشّ حإلعالّ حُٔشأس صؿٝشً، كؤٝف٠ رٜخ حألصٝحؽ خ٤شح، ٝأٓش رخإلكغخٕ ك٢ أكنُِْٜ طؼخٓال ٓغ ُٔغج٤ُٞظٚ ك٢ حإلٗلخم ٝحُو٤خّ ٠ِػ ؽجٕٞ حألعشس، ٝر٤ٖ إٔ خ٤ش حُٔغ٤ِٖٔ اال أٚٗ ٣ض٣ذ ٜ٤ِػخ دسؿش، ػَ َٝخ ؽِ ُشُٛٝ َّٖ رِخ ُْ َٔ ؼْ ُشٝ ِف ( حُ٘غخء/ٝ ، 19هََُٜٝ ( : ُُٚٞ َّٖ ) : صؿٝظٝ ،ٚكشّ أخز ٓخُٜخ رـ٤ش سمخٛخ، ٖٝٓ رُي هُٚٞ طؼخ٠ُ . َد َس ؿَشٌ َٝ َّهللاُ ػَ ِض٣ ٌض َك ٤ٌِ ٌْ ( حُزوشس/ؼْ ِٓ 228 َُ حَُّ ِز١ ػََِ ٤ْ ِٜ َّٖ رِخ ُْ َٔ ؼْ ُشٝ ِف َُِِٝ ِّش ؿَخ ٍِ ػََِ ٤ْ ِٜ َّٖ
. (ٝهُٚٞ ف٠ِ هللا ٝ ٚ٤ِػعِْ : ) ح ْعظَ ْٞ ُفٞح ر ِخُِّ٘ َغخ ِء َخ ٤ْ ًشح ( سٝحٙ حُزخخس١ )ٝ )3331ٓغِْ )1468
َخ ٤ْ ُش ًُ ْْ ألَ ْٛ ٢ِ ( سٝحٙ حُظشٓز١ )ٝ )3895حرٖ ٓخٝ )1977( ٚؿهُٚٞ ف٠ِ هللا ٝ ٚ٤ِػعِْ : ) َخ ٤ْ ُش ًُ ْْ َخ ٤ْ ُش ًُ ْْ ألَ َٝ ِٚ ِ ْٛأََٗخ . حألُزخ٢ٗ ك٢ فل٤ق حُظشٓز١ ٝفللٚ
حُز٘خص أؿشح ػظ٤ٔخً ، ٖٝٓ رُي : هُٚٞ ف٠ِ هللا ًشٜٓخ ر٘ظخ، ٝأ٠ِػ ٌٓخٗظٜخ ار كغ ٠ِػ طشر٤ظٜخ ٝطٜٔ٤ِؼخ، ؼؿَٝ ُظشر٤ش َٝ َم َّْ أَ َفخرِ ٚؼَُ ( سٝحٙ ٓغِْ )ٝ. )2631سٟٝ حرٖ ٓخؿَ ٚؿخ ِس٣َظَ ٤ْ ِٖ َكظ٠َّ طَ ْزُِ َـخ ؿَخ َء ٣َ ْٞ َّ ح ُْو٤َِخ َٓ ِش أََٗخ ٝ ٚ٤ِػ َٞ َُٛٝعِْ : ) َٓ ْٖ ػَخ ٍَ ػََِ ٤ْ َٝ ِٚ َعَِّ َْ ٣َوُٞ ٍُ : ) َٓ ْٖ ًَخ َٕ ػ ََُُٚال ُع رََ٘خ ٍص ، ْر َٖ ػَخ ِٓ ٍش سم٢ هللا ٚ٘ػ هخٍ : َع ِٔ ؼْ ُض َس ُعٞ ٍَ َّهللاِ َف٠َِّ َّ هللاُ )ػُ ٖػ )3669 ْوزَش َ 94
حرٖ ٓخٝ ٚؿفللٚ حألُزخ٢ٗ ؿِ َذطِ َُٚ َّٖ ًُ ُِٚ ِك َـخرًخ ِٓ ْٖ حَُّ٘خ ِس ٣َ ْٞ َّ ح ُْو٤َِخ َٓ ِش ( سٝحٙ كَ َقزَ َش ػََِ ٤ْ َٝ ، َّٖ ِٜأَ ْه َٝ َّٖ َُٜٔ ؼَ َعوَخَٝ َّٖ ُٛ ًَ َغخُٛ َّٖ ِٓ ْٖ . ك٢ فل٤ق حرٖ ٓخؿش. ٝهؿِ ٖٓ( : ُٚٞ َذطٚ( أ١ ٖٓ ؿ٘خٙ
ٝكشّ هطؼ٤ظٜخ ك٢ ٗق٤ؼً ؿٞشس، ٜ٘ٓخ: هُٚٞ ًشّ حإلعالّ حُٔشأس أخظخ ػٝٔش ٝخخُش ، كؤٓش رقِش حُشكْ، ٝكغ ٠ِػ رُي، َٝ ِفُِٞح حألَ ْس َكخ َّ ، َٝ َفُِّٞح رِخَُِّ ٤ْ َِ َٝحَُّ٘خ ُط ٤َِٗخ ٌّ، أُّٜ٣ََخ حَُّ٘خ ُط ، أَ ْك ٞؾُح حُ َّغال َّ ، َٝأ َ ْه ُٞٔ ؼِح حُطَّ ؼَخ َّ ، ف٠ِ هللا ٝ ٚ٤ِػعِْ : ) ٣َخ فل٤ق حرٖ ٓخٚؿ أ٣نخ. ٝسٟٝ حُزخخس١ )ػَ )5988 ْٖ طَ ْذ ُخُِٞح ح ُْ َـَّ٘شَ رِ َغال ٍّ ( سٝحٙ حرٖ ٓخٝ )3251( ٚؿفللٚ حألُزخ٢ٗ ك٢ .( َٝ َفَِ ِي َٝ َف ِْظَٝ ،ُُٚ َٓ ْٖ هَ َط ؼَ ِي هَ َط ؼْظػَ ُ َُِٚ ٤ْ َٝ ِٚ َعَِّ َْ أٚٗ ه َخ ٍَ: هخٍ َّهللاُ طؼخ٠ُ – ػٖ حُشكْ- : ) َٓ ْٖ حَُّ٘زِ ٢ِّ َف٠َِّ َّ هللاُ هذ طـظٔغ ٛزٙ حألٚؿٝ ك٢ حُٔشأس حُٞحكذس ، كظٌٕٞ صؿٝش ٝر٘ظخ ٝأٓخ ٝأخظخ ػٝٔش ٝخخُش، ك٤٘خُٜخ حُظٌش٣ْ ٖٓ ٛزٙ حألٚؿٝ .ٓـظؼٔش
ٝر٤ٖ حُشؿَ ك٢ أؼًش حألكٌخّ، ك٢ٜ ٓؤٞٓسس ٝ ِٚؼٓرخُـِٔش ؛ كخإلعالّ سكغ ٖٓ ؽؤٕ حُٔشأس ، ٝأ٠ِػ ٖٓ ٌٓخٗظٜخ ٝعٟٞ رٜ٘٤خ حٌُٔ٘ش، ٝطذُٚ ٞػ ك٢ ؿضحء ح٥خشس ، ُٜٝخ كن حُظؼز٤ش ، ط٘قق ٝطؤٓش رخؼُٔشٝف ٝط٠ٜ٘ ػٖ رخإل٣ٔخٕ ٝحُطخػش ، ٝٓغخ٣ٝش ٝطٜذ ، ٝال ٣ـٞص ألكذ إٔ ٣ؤخز ٓخُٜخ رـ٤ش سمخٛخ، ُٜٝخ ا٠ُ هللا، ُٜٝخ كن حُظِٔي ، طز٤غ ٝطؾظش١ ، ٝطشع ، ٝطظقذم .طلظخٚؿ ك٢ دٜ٘٣خ ال ؼُ٣ظذٜ٤ِػ ٟخ ، ٝال طُظِْ . ُٜٝخ كن حُظ٤ِؼْ ، رَ ٣ـذ إٔ طظؼِْ ٓخ كن حُل٤خس حٌُش٣ٔش،
ٝحُضؿٝش حُقخُلش، ٝحألخض حُلخمِش، ٝحُز٘ض ٝال ؿشٝ ك٢ رُي ألٕ ٛزٙ حُٔشأس ٢ٛ أعخط حُٔـظٔغ، ك٤غ ٢ٛ حألّ حُلٕٞ٘، حُٔـظٔغ أٝ ٣ظخشؽ حألرطخٍ، ٝطظشر٠ حأل٤ؿخٍ، ك٢ٜ حُٔلٞس حُلو٤و٢ حُظ٢ ٜ٤ِػخ فالف حُزخسس، كٖٔ ٓذحسعٜٖ حُلو٤و٤ش .كغخدٙ
ؼ٣ٝض ر٤ُالً ، ٣ٌٝشّ ػض٣ضحً ، ؿخء حإلعالّ ٤ُشكغ ؿخء حإلعالّ ٤ُلون أٓ٘خً ٞؾ٘ٓدحً ، ؼ٣ٝزض كوخً ٓغِٞرخً ، ٣ٝ٘قش ٓظِٞٓخً ، ؽؤٜٗخ ، ؼ٣ٝض سأٜ٣خ ، ٞؿٝدٛخ ، ٣ٝلظشّ رحطٜخ ، ٣ٝشد ُٜخ حػظزخسٛخ حُز١ عِزٚ أػذحء حإلعالّ، ٣ٌٝشّ ُِٔشأس هذسٛخ ، ؼ٣ٝزض هِزٜخ رزًش سرٜخ ، ٣ٝض٣ٖ ػٔشٛخ رٜذ١ خخُوٜخ، ؿخء حإلعالّ كخػظشف ٣ٝض٣َ ظِٜٔخ ، ٣ٝن٢ء ك٤خطٜخ رطخػش سرٜخ ، ٣ٝغؼذ كؤهشأ ٜ٤ِػخ حُغالّ ٖٓ سرٜخ ― كؤسعَ ُٜخ حُغالّ سرٜخ ، ٝٗضٍ ؿزش٣َ كوخٍ ٣خ ٓلٔذ رؾش خزد٣ـش رٔخ ٣غشٛخ رٞؿٞدٛخ ، كٝ ٚ٤ال ٗقذ “، ٝحٛظْ رؤٓشٛخ ، كغٔغ فٞطٜخ ، ٝأٗضٍ هشآٗخً ك٢ ٢٘ٓٝ ، ٝرؾشٛخ رز٤ض ك٢ حُـ٘ش ٖٓ هقذ ال فخذ حُلذ٣غ ” حُ٘غخء ؽوخثن حُشؿخٍ عٔغ هللا هٍٞ حُظ٢ طـخدُي ك٢ صٜؿٝخ ” ،سكغ ؽؤٜٗخ ، ٝأ٠ِػ رًشٛخ ، هخٍ ك٢ ؽؤٜٗخ ، ” هذ ‖
حألرقخس ، ” هَ ُِٔئ٤ٖ٘ٓ ٣ـنٞح ٖٓ أرقخسْٛ فخٜٗخ ػٖ حألٗظخس ، ٝكلظٜخ ػٖ حألؽشحس ، كضٜ٘٣خ رخُلـخد ؿٝل ٜ٘ػخ ُِٔئٓ٘خص ٣ـننٖ ٖٓ أرقخس٣ٝ ٖٛللظٖ كشٝ ) .ٖٜؿٝهخٍ ” ٣خ أٜ٣خ حُ٘ز٢ هَ ٣ٝللظٞح كشٜؿْٝ ” ا٠ُ هٝ ( ُٚٞهَ كال ٣ئر٣ٖ “. كَٜ كوٚ حُٔغِٕٞٔ ٓشحد هللا ألصٝحؿي ٝر٘خطي ٝٗغخء حُٔئ٤ٖ٘ٓ ٣ذ٤ٖٗ ؿ ٖٓ ٖٜ٤ِػالر٤زٜٖ رُي أد٠ٗ إٔ ؼ٣شكٖ عٞسس حُ٘غخء آ٣ش (وهللا َشَذ أٌ َزىة عهُكى وَشَذ انزٍَ َزجعىٌ انشهىاد أٌ رًُهىا يُال عظُب ) !ٝ ُْٜٓشحد أػذحء هللا؟ 27
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ٌعد العنؾ ضد المرأة امتهانا للكرامة االنسانٌة وخروجا وخرقا لكل المواثٌق الدولٌة والشرابع السماوٌة،فهو هدر لحقوق االنسان التً ضمنتها الكثٌر من الشرابع والسنن ،ودافع عنها االنسان وضمنها فً مدوناته القانونٌة ،اال ان هناك بعض الظروؾ السٌاسٌة واالجتماعٌة والسٌاسٌة افرزت بعض العوامل التً صعدت من وتٌرة العنؾ بشكل العام السٌما العنؾ الموجه ضد المرأة ، رؼم سعً المرأة وجهادها ووقوفها الى جانب الرجل وحاجة المجتمع الى دورها فً الحٌاة السٌاسٌة واالجتماعٌة واالقتصادٌة. وٌظهر العنؾ ضد المرأة فً مختلؾ قطاعات المجتمع بؽض النظر عن الطبقة والدٌن والثقافة او البلد وتخلفه وتقدمه،وكثٌرا ماتتنوع دوافع العنؾ والٌمنع حدوثه تقدم البلد او انخفاض نموه او كون المجتمع من المجتمعات المتحضرة او المتخلفة ، وان تعددت تعارؾٌ العنؾ اال انها تعنً معنى واحد هو استخدام القوة المادي او المعنوٌة ضد االخر، وتشٌر الموسوعة العلمٌة )Universals( أن مفهوم العنؾ ٌعنً كل فعل ٌمارس من طرؾ جماعة أو فرد ضد أفراد آخرٌن عن طرٌق التعنؾٌ قوالً أو فعالً وهو فعل عنؾٌ ٌجسد القوة المادٌة أو المعنوٌة.• ذكر قاموس )Webster( أن من معانً العنؾ ممارسة القوة الجسدٌة بؽرض اإلضرار بالؽٌر وتعنً بمفهوم العنؾ هنا تهمد 95
اإلضرار بالمرأة أو الطفل، وقد ٌكون شكل هذا الضرر مادي من خالل ممارسة القوة الجسدٌة بالضرب أو معنوي من خالل تعمد اإلهانة المعنوٌة للمرأة والطفل بالسباب أو التجرٌح أو اإلهانة.• وهو سلوك أو فعل ٌتسم بالعدوانٌة ٌصدر عن طرؾ قد ٌكون فرداً أو جماعة أو طبقة اجتماعٌة أو دولة بهدؾ استؽالل وإخضاع طرؾ آخر فً إطار عالقة قوة ؼٌر متكافبة اقتصادٌا وسٌاسٌاً مما ٌتسبب فً إحداث أضرار مادٌة أو معنوٌة أو نفسٌة لفرد أو جماعة أو طبقة اجتماعٌة أو دولة أخرى. الجهد الدولً فً مواجهة العنؾ أعت َب ر مٌثاق األمم المتحدة الذي اع ُت ِمد فً سان فرنسٌسكو فً العام 5945 أول معاهدة دولٌة تشٌر، فً عبارات محددة، إلى تساوي الرجال والنساء فً الحقوق. وانطالقاً من إٌمان المنظمة الدولٌة بالمساواة فً الحقوق بٌن الجنسٌن،واكد االعالن العالمً لحقوق االنسان)5948( رفضه التمٌٌز على اساس الجنس فً مادته الثانٌة ورفضه لالسترقاق واالستعباد فً المادة الرابعة،والتعذٌب والمعاملة او العقوبة القاسٌة فً المادة الخامسة،واشار فً المادة)56( على سن الزواج الذي هو سن البلوغ،والتساوي فً الحقوق لدى التزوج وخالل قٌام الزواج ولدى انحالله. ونصت المادة الثانٌة عشر من اإلعالن العالمً لحقوق اإلنسان : ال ٌعرض أحد لتدخل تعسفً فً حٌاته الخاصة أو أسرته أو مسكنه أو مراسالته أو لحمالت على شرفه وسمعته، ولكل شخص الحق فً حماٌة القانون من مثل هذا التدخل أو تلك الحمالت فقد بدأت المنظمة الدولٌة ومنذ وقت مبكر، أنشطتها من أجل القضاء على التمٌٌز ضد المرأة، فأنشأت لجنة مركز المرأة فً العام 5946 لمراقبة أوضاع المرأة ونشر حقوقها. وفً إثر شٌوع مبدأ المساواة فً العالم وفق ما نصت علٌه الشرعة الدولٌة لحقوق اإلنسان واستمر الجهد الدولً ثابر من اجل إنصاؾ المرأة ورفعها من حالة الدونٌة واالرتقاء بها الى مستوى المساواة وعدم التمٌٌز، عبر اإلعالن العالمً لحقوق اإلنسان )5948( والعهد الدولً الخاص بالحقوق االقتصادٌة واالجتماعٌة والثقافٌة )5966( واتفاقٌة القضاء على جمٌع أشكال التمٌٌز ضد المرأة )5979( والعهد الدولً الخاص بالحقوق المدنٌة والسٌاسٌة )5966(،.ٌفاصدرت الجمعٌة العامة لالمم المتحدة اعالنا بشأن حماٌة النساء واالطفال فً حاالت الطوارئ والنزاعات المسلحة بموجب قرارها المرقم 3358 فً 54 كانون االول 5974 دعت فٌه جمٌع الدول واالعضاء الى االلتزام بمبادئ القانون الدولً:المرأة المنتمٌة لألقلٌات وحقوقها: منظمة العمل الدولٌة اسهمت بتحسٌن مستوٌات العمل وعلى جمٌع الصعد، فأبرمت االتفاقٌة رقم 59 لسنة 5952 بشأن المساواة بالمعامالت )حوادث العمل( واالتفاقٌة رقم 51 لسنة 5955 بشأن المساواة باالجور.عدم اجراء الزواج تحت السن القانونٌة وعدم االجبار على الزواج، واصدرت الجمعٌة العامة لهٌبة االمم المتحدة فً قرارها المرقم )516/52( لسنة 5995 اتفاقٌة الطفل، ومن حقوق الطفلة: الحق فً الحٌاة وفً عدم تمٌٌزها عن الذكور وفً التعلٌم والسالمة البدنٌة والحماٌة من االعتداءات. وفً 58ـ كانون األول / دٌسمبر 5979، اعتمدت الجمعٌة العامة لألمم المتحدة اتفاقٌة القضاء على جمٌع أشكال التمٌٌز ضد المرأة "سٌداو CEDAW"، ودخلت االتفاقٌة ح ٌّز التنفٌذ فً 3 أٌلول / سبتمبر 5985 كاتفاقٌة دولٌة بعد أن صادقت علٌها الدولة العشرون. وبحلول الذكرى السنوٌة العاشرة لالتفاقٌة عام 5989، كان ما ٌقرب من مابة دولة قد وافقت على االلتزام بأحكامها.وبلػ عدد الدول التً انضمت إلى االتفاقٌة 575 حتى تارٌخ 28 تشرٌن الثانً 2112.أعلنت الجمعٌة العامة ٌوم 25 تشرٌن الثانً/نوفمبر الٌوم الدولً للقضاء على العنؾ ضد المرأة، ودعت الحكومات والمنظمات الدولٌة والمنظمات ؼٌر الحكومٌة إلى تنظٌم أنشطة فً ذلك الٌوم تهدؾ إلى زٌادة الوعً العام لتلك . العنؾ ضد المرأة ٌعرؾ العنؾ فً اإلعالن العالمً للقضاء على العنؾ ضد المرأة والذى وقعتة األمم المتحدة سنة 5993 بأنه) أي فعل عنؾٌ قابم على أساس الجنس ٌنجم عنه أو ٌحتمل ان ٌنجم عنه أذى أو معاناة جسمٌة أو جنسٌة أو نفسٌة للمرأة، بما فً ذلك التهدٌد باقتراؾ مثل هذا الفعل أو اإلكراه أو الحرمان التعسفً من الحرٌـة، سواء أوقع ذلك فً الحٌاة العامة أو الخاصة ( .وتشٌر الوثٌقة الصادرة عن المؤتمر العالمً الرابع للمرأة فً بكٌن 5995 "أن العنؾ ضد النساء هو أي عنؾ مرتبط بنوع الجنس، ٌؤدي على األرجح إلى وقوع ضرر جسدي أو جنسً أو نفسً أو معاناة للمرأة بما فً ذلك التهدٌد بمثل تلك األفعال، والحرمان من الحرٌة قسراً أو تعسفاً سواء حدث ذلك فً مكان عام أو فً الحٌاة الخاصة. وربط المؤتمر العالمً لحقوق اإلنسان والذي صدر عنه ما ٌعرؾ بإعالن وبرنامج عمل فٌنا )5993( بٌن العنؾ والتمٌٌز ضد المرأة، الفقرة )38( على أن مظاهر العنؾ تشمل المضاٌقة الجنسٌة واالستؽالل الجنسً والتمٌٌز القابم على الجنس والتعصب والتطرؾ وقد جاءت الفقرة ما ٌلً" ٌشدد المؤتمر العالمً لحقوق اإلنسان بصفة خاصة
96
على أهمٌة العمل من أجل القضاء على العنؾ ضد المرأة فً الحٌاة العامة والخاصة والقضاء على جمٌع أشكال المضاٌقة الجنسٌة واالستؽالل واالتجار بالمرأة والقضاء على التحٌز القابم على الجنس فً إقامة العدل وإزالة أي تضارب ٌمكن أن ٌنشأ بٌن حقوق المرأة واآلثار الضارة لبعض الممارسات التقلٌدٌة أو المتصلة بالعادات والتعصب الثقافً والتطرؾ الدٌنً".أن التعذٌب ٌتؽذى على ثقافة عالمٌة ترفض فكرة المساواة فً الحقوق مع الرجال والتً تبٌح العنؾ ضد النساء.أظهر تقرٌر أصدرته األمم المتحدة فً عام 2115 أن واحدة من بٌن كل ثالث نساء فً العالم تعرضت للضرب أو اإلكراه على ممارسة الجنس أو إساءة المعاملة بصورة أو بأخرى، وؼالباً ُُ ما تتم هذه االنتهاكات لحقوق المرأة بواسطة إنسان ٌعرفنه. أشارت العدٌد من الدراسات المٌدانٌة لمنظمات إنسانٌة ؼٌر حكومٌة أن امرأة واحدة على األقل من كل ثالث، تتعرض للضرب أو لإلكراه واإلهانة فً كل ٌوم من أٌام حٌاتها. كما ذكرت منظمة الصحة العالمٌة بأن قرابة 71% من ضحاٌا جرابم القتل من اإلناث ٌُقتلن على أٌدي رفاقهن الذكور. وتمثل النساء واألطفال قرابة 81% من القتلى والجرحى من جراء استخدام األدوات الجارحة واألسلحة ، حسبما ذكر األمٌن العام لألمم المتحدة. وفً كل عام تتعرض مالٌٌن النساء والفتٌات لالؼتصاب على أٌدي رفقابهن الذكور، أو أقاربهن، أو أصدقابهن أو أشخاص ؼرباء، أو على أٌدي أرباب العمل أو الزمالء، أو الجنود، أو أفراد الجماعات المسلحة.
اشكال العنؾ ضد المرأة
وتصنؾ االتفاقٌات الدولٌة العنؾ الى: أــ العنؾ البدنً والجنسى والنفسً الذي ٌحدث فً إطار األسرة بما فً ذلك الضرب والتعدي الجنسً على أطفال األسرة اإلناث ، ، وختان اإلناث وؼٌره من الممارسات التقلٌدٌة المؤذٌة للمرأة ، والعنؼ ؾٌر الزوجً والعنؾ المرتبط باالستؽالل . ب- العنؾ البدنً والجنسً والنفسً الذي ٌحدث فً إطار المجتمع العام بما فً ذلك االؼتصاب والتعدي الجنسً والمضاٌقة الجنسٌة والتخوؾٌ فً مكان العمل وفً المؤسسات التعلٌمٌة وأي مكان آخر ، واالتجار بالنساء وإجبارهن على البؽاء. ج- العنؾ البدنً والجنسً والنفسً الذي ترتكبه الدولة أو تتؽاضى عنه، أٌنما وقع. وٌدعو صندوق األمم المتحدة للسكان إلى األخذ بنهج ذي أربعة فروع ٌتمثل فٌما ٌلً: ـ تعزٌز القوانٌن والسٌاسات العامة بما ٌتمشى مع االتفاقات الدولٌة.
مواجهة العنؾ
ولمواجهة العنؾ والحد منه وضعت عدت الٌات: ـ تفعٌل دور القضاء والحد من ظاهرة اإلفالت من العقاب، والتسلٌم باحتٌاجات الضحاٌا والتجاوب معها، وتعزٌز التعببة االجتماعٌة والتحول الثقافً. ـ ٌجب إنفاذ القوانٌن والسٌاسات وتطبٌقها، وتخصٌص المٌزانٌات، وتتؽٌر االتجاهات والممارسات الضارة. و تعلٌم األطفال وهم ما زالوا فً كنؾ أمهاتهم أن العنؾ ضد المرأة والفتاة خطأ. وتلعب المدارس دورا فً تعزٌز المساواة بٌن جمٌع البشر، ذكوراً أو إناثاً، فً القٌمة والكرامة األصٌلة. ـ تنشط وتروٌج ثقافة عدم التسامح مع العنؾ ضد المرأة فً االسرة والمدرسة وفً المجتمع. ـ عدم جواز أن تتذرع دولة أو سلطة تحت أي ظرؾ من الظروؾ بدواعً العرؾ أو الدٌن أو التقالٌد تبرٌراً للعنؾ المرتكب ضد المرأة. آثار العنؾ ضد المرأة تترتب على العنؾ الممارس ضد المرأة آثار جسمٌة ونفسٌة واجتماعٌة ،تصٌب المرأة وتكون لها اثارها على االسرة والمجتمع: - أضرار جسدٌة ونفسٌة - شعور المرأة بالخوؾ وانعدام األمان - الحد من إمكانٌة حصولها على الموارد - منعها من التمتع بحقوقها كإنسان - ٌعرقل مساهمتها فً التنمٌة 97
- تضخم الشعور بالذنب والخجل واالنطواء والعزلة وفقدان الثقة بالنفس و احترام الذات العنؾ ضد المرأة... أطره الثقافٌة واالجتماعٌة والقانونٌة تعد العادات والتقالٌد والقٌم االجتماعٌة من اهم االطر الثقافٌة التً تقدم سندا وتبرٌرا للعنؾ ضد المرأة،فضال عن القٌم العشابرٌة والثقافة الذكورٌة التً تعلً من شأن الرجل وتعامل المرأة بدونٌة واحتقار وتضعها فً الدرجة الثانٌة من السلم االنسانً. وٌدعم هذا بعض النصوص الدٌنٌة التً تفسر فً الكثٌر من االحٌان لصالح الرجل فتتمخض عنها احكام فقهٌة تنال من المكانة االنسانٌة للمرأة،او تسلبها حقوقها ودورها فً الحٌاة االقتصادٌة والسٌاسٌة واالجتماعٌة،ماٌدعم سلطة الرجل وٌعطٌه التبرٌرات فً ممارسة العنؾ. وبقدر تعلق االمر باالسرة العراقٌة فان وجود المادة الدستورٌة)45( التً تعد احد مصادر العنؾ القانونً ضد المرأة النها تسلبها بعض الحقوق واالمتٌازات التً ثبتها قانون االحوال الشخصٌة )588( لسنة 5959 وتنظٌم حٌاة االسرة السٌما المرأة على وفق المادة )45( سٌفتح المجال واسعا امام اهواء الفتاوى الطابفٌة والمذهبٌة واجتهادات رجاالتها، فضال عن ما ٌتضمنه قانون الخدمة المدنٌة وقانون السفر وقانون العقوبات من مواد تعد من مصادر العنؾ القانونً ضد المرأة،اذ انها تمنح تسوؽٌا وتبرٌرا للعنؾ الموجه ضد المرأة ، كالمادة )45( من قانون العقوبات العراقً التً تنص على حق الزوج فً تأدٌب زوجته)الجرٌمة اذا وقع الفعل استعماال لحق مقرر بمقتضى القانون وٌعتبر استعماال للحق : 5 ـ تأدٌب الزوج لزوجته ....الخ( العنؾ ضد المرأة الوطن له أما األرقام فمنها تشٌر إلى العنؾ الذي تواجهه المرأة فً بعض الدول: -ففً فرنسا، 95% من ضحٌا العنؾ هن من النساء، 55% منهن نتٌجة تعرضهن للضرب من قبل أزواجهن أو أصدقابهن. -فً كندا، 61% من الرجال ٌمارسون العنؾ، 66% تتعرض العابلة كلها للعنؾ. فً الهند، 8 نساء من بٌن كل 51 نساء هن ضحاٌا للعنؾ، سواء العنؾ األسري أو القتل. فً البٌرو، 71% من الجرابم المسجلة لدى الشرطة هً لنساء تعرضن للضرب من قبل أزواجهن. أن زهاء 61% من النساء التركٌات فوق سن الخامسة عشرة تعرضن للعنؾ أو الضرب أو اإلهانة أو اإلذالل، على أٌدي رجال من داخل أسرهن، سواء من الزوج أو الخطٌب أو الصدٌق أو األب أو والد الزوج(! وأشارت الدراسة إلى أن )51%( من النسبة اآلنفة ٌتعرضن للضرب بشكل مستمر، وأن )41%( منهن ٌرجعن السبب فً ذلك لظروؾ اقتصادٌة وتناول الكحولٌات وأن )25%( فقط من أولبك النساء الالتً ٌتعرضن للضرب ٌقمن بالرد على العنؾ بعنؾ مماثل، فً حٌن أن )51%( فقط منهن ٌتركن المنزل احتجاجاً على العنؾ الذي ٌتعرضن له..( والؽرٌب: )أن )71%( من هؤالء السٌدات الالتً ٌتعرضن للضرب ال ٌحبذن الطالق حفاظاً على مستقبل األوالد، فً حٌن أن ) %( 55فقط منهن ال ٌطلبن الطالق بسبب حبهن ألزواجهن(. -وفً الوالٌات المتحدة: ٌعتبر الضرب والعنؾ الجسدي السبب الربٌسً فً اإلصابات البلؽٌة للنساء. االسالم والعنؾ ضد المرأة ٌتهم الدٌن االسالمً ونصوصه وتفسٌراتها وبعض احكامه الشرعٌة بانه احد مصادر العنؾ ضد المرأة ،اال ان لبعض الفقهاء والمتنورٌن منهم راي مختلؾ ، جاء فً القرآن الكرٌم ، اذ ٌتخذون من بعض النصوص مصادرا ومراجعا لمواقفهم المعتدلة من المرأة)ومن آٌاته أن خلق لكم من أنفسكم أزواجاً لتسكنوا إلٌها وجعل بٌنكم مودة ورحمة(. وورد فً حدٌث للنبً األكرم )ص( )إن النساء شقابق الرجال(وكذلك قوله )استوصوا بالنساء خٌراً(. وٌقؾ على رأس الفقهاء المجددٌن المجتهد اللبنانً محمد حسٌن فضل هللا الذي تمٌزت مواقؾ بروح التجدٌد واالبداع التً ٌتسم بها فكره االجتماعً ، والذي امتد الى فتاواه الشرعٌة وقد ثارت ثابرة المؤسسة الدٌنٌة والكثٌر من رجال الدٌن ضده حٌن أصدر بٌاناً شرعٌاً لمناسبة الٌوم العالمً لمناهضة العنؾ ضد المرأة، والذي افتى فٌه )ٌجوز للمرأة الدفاع عن نفسها ض ّد عنؾ الرجل(فٌقول محمد حسٌن فضل هللا وهو ٌتحدث عن العنؾ ضد المرأة )ال ُعنؾ النفسً الذي ٌه ّدد فٌه الزوج زوجته بالطالق أو بؽٌره، أو عندما ٌتركها فً زواجها كالمع ّلقة، فال ُتعامل كزوجة، أو الذي ٌستخدم فٌه الطالق كعنصر ابتزا ٍز لها فً أكثر من جان ٍب، فتفقد بالتالً االستقرار فً زواجها، م ّما ٌنعكس ضرراً على نفس ٌّتها وتوازنها.إلى العنؾ المعٌشً الذي ٌمتنع فٌه الزوج أو األب من تح ّمل مسؤول ٌّاته الما ّدٌة تجاه الزوجة واألسرة، فٌحرم المرأة من حقوقها فً العٌش الكرٌم، أو عندما ٌضؽط علٌها لتتنازل عن مهرها الذي ٌم ّثل ـ فً المفهوم اإلسالمً ـ هد ٌّة رمز ٌّة عن المو ّدة والمح ّبة اإلنسان ٌّة، بعٌداً عن الجانب التجاري.إلى »العنؾ التربو ّي « الذي ُتمنع معه المرأة من ح ّقها فً التعلٌم والتر ّقً فً مٌدان التخ ّصص العلمً، بما ٌرفع من مستواها الفكري والثقافً وٌفتح لها آفاق التط ّور والتطوٌر فً مٌادٌن الحٌاة؛ فتبقى فً د ّوامة الجهل والتخ ّلؾ؛ ث ّم تح ّمل مسؤول ٌّة األخطاء التً تقع فٌها نتٌجة ق ّلة الخبرة والتجربة التً فرضها علٌها العنؾ. إلى العنؾ العملً الذي ٌُم ٌّز بٌن أجر المرأة وأجر الرجل 98
من دون ح ّق، مع أ ّن التساوي فً العمل ٌقتضً التساوي فً ما ٌتر ّتب علٌه، علماً أ ّن المجتمع بأسره قد ٌمارس هذا النوع من العنؾ عندما ٌس ّن قوانٌن العمل التً ال تراعً للمرأة أعباء األمومة أو الحضانة أو ما إلى ذلك م ّما ٌخت ّص بالمرأة، إضاف ًة إلى استؽالل المدراء وأرباب العمل للمو ّظفات من خالل الضؽط علٌه ّن فً أكثر من مجال.لقد وضع اإلسالم للعالقة بٌن الرجل والمرأة فً الحٌاة الزوج ٌّة واألسرة عموماً قاعد ًة ثابتة، وهً قاعدة »المعروؾ ، «فقال هللا تعالى فً القرآن الكرٌم: } َو َعا ِش ُرو ُه َّن بِا ْل َم ْع ُرو ؾِ{، وقال تعالى: }فإمسا ٌك بمعرو ؾٍ أو تسرٌح بإحسان{، حٌث ٌُمكن ً أن تش ّكل قاعد ًة شرع ٌّة ٌُمكن أن تنفتح على أكثر من ُحك ٍم شرع ًّ ٌُنهً الزواج إذا تح ّول ض ّد »المعروؾ«. خامساً: اعتبر اإلسالم أ ّن المرأة ـ فً إطار الزواج ـ كاب ٌن حقوق ًّ مستقلّ عن الرجل من الناحٌة الما ّدٌة؛ فلٌس للرجل أن ٌستولً على أموالها الخا ّصة، أو أن ٌتد ّخل فً تجارتها أو مصالحها التً ال تتع ّلق به كزوج، أو ال تتع ّلق باألسرة التً ٌتح ّمل مسؤول ٌّة إدارتها.سادساً: إ ّن اإلسالم لم ٌبح للرجل أن ٌمارس أ ّي عن ؾٍ ًُ على المرأة، سواء فً حقوقها الشرعٌة التً ٌنشأ االلتزام بها من خالل عقد الزواج، أو فً إخراجها من المنزل، وح ّتى فً مثل الس ّب والشتم والكالم القاسً الس ٌّ ا، وٌم ّثل ذلك خطٌب ًة ٌُحاسب هللا علٌها، و ٌُعاقب علٌها القانون اإلسالمً.سابعاً: أ ّما إذا مارس الرجل العنؾ الجسد ّي ض ّد المرأة، ولم تستطع الدفاع عن نفسها إال بأن تبادل عنفه بعنؾ مثله، فٌجوز لها ذلك من باب الدفاع عن النفس. كما أ ّنه إذا مارس الرجل العنؾ الحقوقً ض ّدها، بأن منعها بعض حقوقها الزوج ٌّة، كالنفقة أو الجنس، فلها أن تمنعه تلقاب ٌّاً من الحقوق التً التزمت بها من خالل العقد. ثامناً: ٌؤ ّكد اإلسالم أ ّنه ال والٌة ألحد على المرأة إذا كانت بالؽ ًة رشٌد ًة مستق ّلة فً إدارة شؤون نفسها، فلٌس ألحد أن ٌفرض علٌها زوجاً ال ترٌده، والعقد من دون رضاها باطلٌ ال أثر له.تاسعاً: فً ظلّ اهتمامنا بالمحافظة على األسرة، فإ ّنه ٌنبؽً للتشرٌعات التً تن ّظم عمل المرأة أن تلحظ المواءمة بٌن عملها، عندما تختاره، وبٌن أعبابها المتع ّلقة باألسرة، وإ ّن أ ّي إخالل بهذا األمر قد ٌؤ ّدي إلى تف ّكك األسرة، ما ٌعنً أن المجتمع ٌُمارس عنفاً مضاعفاً تجاه تركٌبته االجتماعٌة ونسقه القٌمً.عاشراً: لقد أ ّكد اإلسالم على موقع المرأة إلى جانب الرجل فً اإلنسان ٌّة والعقل والمسؤول ٌّة ونتابجها، وأ ّسس الحٌاة الزوج ٌّة على أسا ٍس من المو ّدة والرحمة، م ّما ٌمنح األسرة ُبعداً إنسان ٌّاً ٌتفاعل فٌه أفرادها بعٌداً عن المفردات الحقوق ٌّة القانون ٌّة التً تعٌش الجمود والجفاؾ الروحً والعاطفً؛ وهذا ما ٌمنح الؽنى الروحً والتوازن النفسً والرق ًّ الثقافً والفكري لإلنسان ك ّله، رجالً كان أو امرأة، فرداً كان أو مجتمعاً.
The End يع رًُُبرً نكى ثبنزىفُق وانُجبح
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