Achieving Sexual and Reproductive Health Equity in the Arab Region: A New Role for the Health Sector

The sexual and reproductive health landscape in the Arab region is a manifestation of the success of the development discourse and the international consensus in impacting positive change. This chapter demonstrates how the strategy and performance of the health sector in the Arab region have positively changed and contributed to the improved reproductive health of women. The chapter also discusses a number of shortfalls in the progress achieved. In particular, we highlight the inequity shortfall and argue that addressing this shortfall requires departure from “business as usual” approach. Such a departure demands a significant paradigm shift as well as knowledge and action shifts. The nature of the departure needed was articulated by the Commission of Social Determinants of Health, but has not received the attention it deserves in the Arab region. The positive achievements on the reproductive health front provide an opportunity to address the reproductive health challenge to ensure leaving no one behind and can serve as a gateway of reform of health policies. The health sector particularly should spearhead a major policy reform movement

Who to Test for Hepatitis C Virus in the Middle East and North Africa?: Pooled Analyses of 2,500 Prevalence Measures, Including 49 Million Tests.

Expanding hepatitis C virus (HCV) treatment coverage is challenged by limited testing and diagnosis. This study assessed the risk of exposure, for the Middle East and North Africa, by population, yields of testing, and program efficiency of testing strategies. A standardized and systematically assembled database of 2,542 HCV antibody prevalence studies on 49 million individuals was analyzed. Random effects meta-analyses were conducted to estimate pooled measures for risk of exposure, risk ratio (RR) of exposure, and yields of testing. Program expansion path curves were calculated to assess program efficiency. Countries clustered into two patterns: generalized versus concentrated epidemics. In generalized epidemics (Egypt and Pakistan) relative to general populations, RR of exposure was 6.8 for people who inject drugs (PWID), 6.7 for populations with liver conditions, and 5.0 for populations with high-risk health care exposures. In concentrated epidemics (remaining countries), corresponding RRs were 97.2, 45.1, and 22.2, respectively. In generalized epidemics, the number of tests needed to identify a chronic infection was 2.5 for PWID, 2.4 for populations with liver conditions, 2.7 for populations with high-risk health care exposures, and 14.2 for general populations. In concentrated epidemics, corresponding numbers were 2.8, 8.6, 5.1, and 222.2, respectively. Program expansion path curves demonstrated major gains in program efficiency by targeting specific populations. Risk of exposure varies immensely by population and shows a distinctive hierarchy, particularly in concentrated epidemics. Testing strategies can be much more efficient through population prioritization by risk of exposure. General population testing is not programmatically efficient in concentrated epidemics

Couple Relationships in the Arab Region: Changes and Renegotiations

This chapter investigates the potential impact of two competing forces on the positioning and dynamics of marriage in the Arab region. It also investigates the level of satisfaction and the possible emergence of a new framework of conscious choice. The first type of forces support individual control. They foster informal unions and equitable dynamics. The expectations are that these relationships are governed by individual choices and are characterized by more closeness and romantic emotions. The second type of forces include the centrality of marriage, as well as a traditional division of gender roles. These forces sustain the institution of marriage, as well as a patriarchal separation of roles. The expectations are that these latter relationships lend themselves to pressured or even forced marriages and are characterized by uneven power relationships and less closeness and romantic ideals. This chapter demonstrates that couple relationships, particularly among the young generations, are caught between two opposing forces. Transformations are occurring, but the speed and degree of change vary widely among countries, as well as between males and females. The role of love and intimacy in shaping couple relationships is also shifting. The current evidence depicts a level of practicality in partner selection, as well as a degree of tension within marriage. It suggests that power relationships remain dominant. It also points to a transitional phase where women are more assertive in claiming their rights and exercising them in different formats