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Gender Inequity in Saudi Arabia and Its Role in Public Health A.E.H

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Gender Inequity in Saudi Arabia and Its Role in Public Health A.E.H املجلة الصحية لرشق املتوسط املجلد السادس عرش العدد اﻷول Review Gender inequity in Saudi Arabia and its role in public health A.E.H. Mobaraki1 and B. Söderfeldt 2 عدم العدالة بني اجلنسني يف السعودية وتأثريه عىل الصحة العمومية عبد اهلل حسني ُمباركي، بيورن سوديرفلت يف اخلﻻصة:السعودية، يكون للتفسريات املحلية للرشيعة اﻹسﻻمية والعادات املجتمعية تأثري سلبي عىل صحة وعافية النساء. واهلدف من هذه املقالة هو مراجعة ومناقشة عدم العدالة بني اجلنسني يف السعودية وعﻻقة ذلك بالصحة العمومية. وبالرغم من ندرة اﻹحصائيات واملعلومات اخلاصة بعدم العدالة بني اجلنسني يف السعودية، إﻻ أن هذه املقالة حتاول الكشف عن حساسية القضية يف هذا البلد الفريد. وجرى تفقد دور وحقوق املرأة يف املجتمع السعودي، بام يف ذلك التعليم، والزواج، وتعدد الزوجات، واﻹنجاب، وفرص العمل، وقيادة السيارات، وبطاقات اهلوية. ويوىص باملزيد من البحث لتقييم املعرفة والتوجهات واملامرسات حول الرعاية الصحية للسعوديني والسعوديات. ABSTRACT In Saudi Arabia, local interpretations of Islamic laws and social norms have a negative impact on the health and well-being of women. The objective of this literature review was to discuss gender inequity in Saudi Arabia and its relation to public health. Despite the scarcity of recent statistics and information regarding gender inequity in Saudi Arabia, this review is an attempt to explore this sensitive issue in this country. Women’s roles and rights in Saudi society were examined, including education, marriage, polygamy, fertility, job opportunities, car driving and identification cards. Further research to assess knowledge, attitudes and practices towards health care of Saudi men and women is recommended. L’inégalité entre hommes et femmes en Arabie saoudite et ses conséquences sur la santé publique RÉSUMÉ En Arabie saoudite, les interprétations locales des lois islamiques et des normes sociales ont des effets négatifs sur la santé et le bien-être des femmes. L’objectif de cette revue de la littérature était d’étudier l’inégalité entre hommes et femmes en Arabie saoudite et le rapport de cette dernière avec la santé publique. Malgré la rareté des statistiques et des informations récentes sur ce sujet dans le pays, notre revue tente d’explorer cette question sensible. Nous avons examiné le rôle et les droits de la femme dans la société saoudienne, notamment sous l’angle de l’éducation, du mariage, de la polygamie, de la fertilité, des possibilités d’emploi, de la conduite automobile et des documents d’identité. Nous recommandons de poursuivre le travail de recherche afin d’évaluer les connaissances, les attitudes et les pratiques en matière de soins de santé des hommes et des femmes saoudiens. 1Department of Radiation Oncology, Graduate School of Medicine, University of Gunma, Maebashi City, Gunma, Japan (Correspondence to A.E.H. Mobaraki: [email protected]). 2Department of Oral Public Health, Faculty of Odontology, University of Malmö, Malmö, Sweden. Received: 28/05/07; accepted: 26/09/07 113 EMHJ • Vol. 16 No. 1 • 2010 Eastern Mediterranean Health Journal La Revue de Santé de la Médiderranée orientale Introduction roles and rights in Saudi society were ex- 5.9% of the 2006 government budget. amined, including education, marriage, The MOH goal is to provide universal Inequity based on gender exists to a polygamy, fertility, job opportunities, free medical care for Saudi citizens and varying extent in all societies and varies car driving and identification cards. also for the millions of international over time and across social and ethnic pilgrims undertaking the hajj to the holy groups [1]. Within every commu- city of Mecca. The MOH is supported nity, nationality and class, the burden Methods directly by the government and has of hardship often falls disproportion- The PubMed online database and the ately on women [2–4]. “Inequality” and good infrastructures and administra- Google search engine were used for the “inequity” are different concepts; the tive structures. About 60% of health literature review. The inclusion criteria former applies to any variation, while services are provided by the MOH and were based on scope, content, accuracy, the latter applies to both avoidable and 18% by other government hospitals authority, currency, purpose, workabil- unjust causes [5]. There are many dif- ity, searching, connectivity and cost such as universities and military hos- ferent kinds of gender inequity in, for of the chosen journals and web-based pitals which are open to the public. In example, mortality rates, natality rates, information [10]. Most of the sources the last decade more private hospitals basic facilities such as schooling, special were articles in peer-reviewed journals, have been established, financed by opportunities for training, professional websites of reputable organizations and aspects such as employment, ownership some medical companies and by self- national official websites. The WHOIS of property and land, and household payment. These private hospitals cover tool was used to check the ownership of duties [6]. Gender inequity is usually the remaining 22% of health services the domain names. translated into a power imbalance with which are monitored by the MOH [7]. A PubMed database search were women being more vulnerable. This Due to the rapid increase in the popula- made using the phrases “gender inequi- vulnerability is more precarious in tradi- tion, the government has planned to tional patriarchal societies. ty”, “Saudi women” and “Muslim wom- en”. The search was limited to English adopt a health insurance policy [11] Saudi Arabia has a population esti- language articles and the period from to reduce its financial burden and to mated to be about 23 million in 2006 1985 to the present. A Google search was improve health standards [12]. including 27.1% foreigners [7]. Of the made for “Saudi women health” and out Saudi citizens, 90% are Arabs and all In 2006, the ratio of doctors in Saudi of 16 000 hits, the top 50 items were Arabia was 20 and of dentists was 2.14 are Muslims. Annual per capita income scanned. Related books were accessed per 10 000 inhabitants [7]. In compari- is about US$ 13 600 [8]. The system of through the general library at the Uni- government in Saudi Arabia is a mon- versity of Lund, Sweden. The Islamic son, the ratios of doctors and dentists in archy, with the constitution governed holy book, the Quran, was an important Sweden in 2003 were about 44.4 and by a strict interpretation of Islamic law source for this review. To draw some 15.6 per 10 000 inhabitants respectively [9]. The Council of Ministers is nomi- comparisons with a European country, [13]. The infant mortality rate in Saudi nated by the King. The media (print and a Google search for “Swedish health” Arabia was high in the early 1980s, with visual) are government owned. Policies found 99 900 hits and the top 150 items are formulated and implemented by an estimated 118 deaths per 1000 live were scanned. Unpublished data, pre- births [14]. By contrast, based only on the government. There are no people’s dominantly theses, were searched at deliveries of infants in hospitals of the representatives or independent interest the University of Lund, Sweden, the groups to represent health concerns to University of Leeds, United Kingdom, MOH, the infant mortality rate was the government. The government ran and the University of Gunma, Japan, but 18.6 per 1000 in 2006 [15]. Despite the municipal elections for the first time no relevant information was found. dramatic progress in health care in the in 2005, although women were not al- last 3 decades, the high birth rate [7] lowed to vote [8]. and other factors have left Saudi Arabia In this unique country, local interpre- Health care in a country where only 70% of females tations of Islamic laws and social norms Saudi Arabia are literate [8] and the child mortality can have a negative impact on the health and well-being of women. The objective The health care system in Saudi Ara- rate was 20 per 1000 children in 2006 of this literature review was to discuss bia is mostly owned and handled by [7]. In comparison, Sweden had an esti- gender inequity in Saudi Arabia and the Ministry of Health (MOH), and mated child mortality rate of 4 per 1000 its relation to public health. Women’s health care expenditure accounted for children in 2005 [16]. 114 املجلة الصحية لرشق املتوسط املجلد السادس عرش العدد اﻷول Women’s education Marriage Abortion is forbidden according to the Saudi Arabian interpretation of Although at present there are more In Saudi Arabian personal status law Islamic law and is only allowed when a female graduates than males in Saudi an unmarried adult woman is the ward medical committee decides there is a Arabia [9], statistics reveal that about of her father, a married woman is the risk to the mother if she continues her 30% of Saudi women are still illiterate ward of her husband and a widowed pregnancy [22]. Therefore, although ge- [8]. This might be because opening woman is the ward of her sons. In a male- netic haematological disease is common schools for girls initially met with strong dominated and tribal community with due to consanguineous marriages, ante- opposition in some parts of Saudi Ara- a high social coherence, it is not unu- natal screening programmes for incur- bia, where nonreligious education was sual for a woman to be forced to marry able genetic diseases have no practical use. Consequently primary prevention regarded as unsuitable for girls [17]. a relative. More than 50% of marriages programmes such as premarital genetic Moreover, coeducation is not allowed in Saudi Arabia are consanguineous [22]. The infant mortality rate is high screening tests are the only option [23]. and the curriculum in girls’ schools has (18.5 per 1000 in 2006) despite good A study has shown that a majority of long been a less comprehensive version health care facilities and an effective Saudi Arabian mothers were unaware of that taught in boy’s school [9].
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