Daphna Birenbaum-Carmeli

International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers

Several options for cancer prevention are available for women with a BRCA1 or BRCA2 mutation, including prophylactic surgery, chemoprevention and screening. The authors report on preventive practices in women with mutations from 9 countries and examine differences in uptake according to country. Women with a BRCA1 or BRCA2 mutation were contacted after receiving their genetic test result and were questioned regarding their preventive practices. Information was recorded on prophylactic mastectomy, prophylactic oophorectomy, use of tamoxifen and screening (MRI and mammography). Two thousand six hundred seventy‐seven women with a BRCA1 or BRCA2 mutation from 9 countries were included. The follow‐up questionnaire was completed a mean of 3.9 years (range 1.5–10.3 years) after genetic testing. One thousand five hundred thirty‐one women (57.2%) had a bilateral prophylactic oophorectomy. Of the 1,383 women without breast cancer, 248 (18.0%) had had a prophylactic bilateral mastectomy. Among those who did not have a prophylactic mastectomy, only 76 women (5.5%) took tamoxifen and 40 women (2.9%) took raloxifene for breast cancer prevention. Approximately one‐half of the women at risk for breast cancer had taken no preventive option, relying solely on screening. There were large differences in the uptake of the different preventive options by country of residence. Prophylactic oophorectomy is now generally accepted by women and their physicians as a cancer preventive measure. However, only the minority of women with a BRCA1 or BRCA2 mutation opt for prophylactic mastectomy or take tamoxifen for the prevention of hereditary breast cancer. Approximately one‐half of women at risk for breast cancer rely on screening alone.

The predicament of masculinity: Towards understanding the male's experience of infertility treatments

The commonsense notions that associate fertility and femininity are shared by the medical establishment, and have led to the concentration of research on women in the area of fertility. While feminist critics view this state of affairs as a consequence of male domination and emphasize womens predicament, this paper focuses on mens experience in this area. It is suggested that as research and treatment traditionally focus on the woman, therapies offered to the man are relatively scarce and his non-medical part in the process places him in a marginal position. The treatment entails embarrassment and anomie. The availability of sperm donation carries its own threat of mens dispensibility. A male-inspired association of procreation with women has led to the development of female-centered infertility therapies. As a consequence men have found themselves in a disadvantaged position.

In Vitro Fertilisation Policy in Israel and Women's Perspectives: The More the Better?

Israel offers nearly full funding for in vitro fertilisation (IVF) to any Israeli woman irrespective of her marital status or sexual orientation, until she has two children with her current partner. Consequently, Israeli women are the world’s most intensive consumers of IVF. This 2006 study explored the perceptions of Israeli IVF patients about the treatment and their experiences, probing possible links between state policy and women’s choices and health. Israeli women (n=137), all currently undergoing IVF, were invited to fill out questionnaires. The questionnaires were delivered in five IVF centres by university nursing students or by the clinics’ nurses. Most women were optimistic they would become pregnant, and described the treatment as having modest or no negative effects on their lives. They expressed a sweeping commitment to IVF, which they were willing to repeat “as many times as needed”. At the same time, the majority appeared to have very partial treatment-related knowledge and marginalised side effects, even though they had experienced some themselves. We interpret the observed favourable image of IVF as closely related to the encouragement implied in the extensive state funding of IVF and in the Jewish Israeli tradition of pronatalism, which may account for the virtual absence of critical public debate on the subject. Résumé Israël prend presque totalement en charge le financement de la fécondation in vitro (FIV) pour toute Israélienne, quel que soit son état civil ou son orientation sexuelle, jusqu’à ce qu’elle ait deux enfants avec son partenaire actuel. Par conséquent, les Israéliennes sont les plus fortes consommatrices de FIV au monde. Cette étude de 2006 a exploré leurs perceptions de la FIV et leurs expériences, testant des liens possibles de la politique étatique avec les choix et la santé des femmes. Des Israéliennes (n=137), qui effectuaient toutes une FIV, ont été invitées à remplir un questionnaire. Ce questionnaire a été remis dans cinq centres de FIV par des étudiants en soins infirmiers ou des infirmières du centre. La plupart des femmes étaient optimistes et pensaient qu’elles finiraient par tomber enceintes, et décrivaient le traitement comme ayant peu ou pas d’effets négatifs sur leur vie. Elles se déclaraient extrêmement favorables à la FIV, qu’elles souhaitaient répéter « autant de fois que nécessaire ». En même temps, la majorité d’entre elles semblaient avoir des connaissances très partielles du traitement et des effets secondaires, même si elles en avaient fait elles-mêmes l’expérience. Nous pensons que l’image favorable de la FIV est étroitement liée à l’encouragement implicite que suppose le large financement étatique de la FIV et à la tradition nataliste juive israélienne, qui peut expliquer l’absence quasi-totale de débat public critique sur le sujet. Resumen En Israel se ofrece casi todo el financiamiento necesario para la fertilización in vitro (FIV) a toda mujer israelí, independientemente de su estado civil u orientación sexual, hasta que tenga dos hijos con su pareja actual. Por consiguiente, las mujeres israelíes son las usuarias más intensas del mundo de FIV. En este estudio de 2006 se exploraron las percepciones de pacientes israelíes de FIV respecto al tratamiento y sus experiencias, y se indagó en cuanto a los posibles vínculos entre la política estatal y las opciones de las mujeres y la salud. Se invitó a las mujeres israelíes (n=137), todas ellas sometiéndose actualmente a la FIV, a llenar los cuestionarios. Estos fueron entregados a cinco centros de FIV por estudiantes universitarios de enfermería o por las enfermeras de las clínicas. La mayoría de las mujeres eran optimistas de que quedarían embarazadas, e informaron que el tratamiento tuvo un efecto moderado o ningún efecto negativo en su vida. Expresaron un amplio compromiso a la FIV, que estaban dispuestas a repetir “todas las veces que fuera necesario”. Al mismo tiempo, la mayoría parecía tener un conocimiento muy parcial del tratamiento y efectos secundarios marginados, aunque ellas mismas habían experimentado algunos. Interpretamos la imagen favorable de la FIV como algo estrechamente relacionado con la motivación implicada en el extenso financiamiento estatal de la FIV y en la tradición israelí judía de pronatalidad, que explicaría la virtual ausencia de debate público crítico al respecto.

Thirty-five years of assisted reproductive technologies in Israel

Israel is known as a pronatalist country. Whether due to the Biblical commandment to ‘be fruitful and multiply’ or the traumas of the Holocaust and perennial wars, reproduction is a central life goal for most Israelis. Israeli women bear substantially more children than their counterparts in industrialized countries and view child-rearing as a key life accomplishment. These personal world-view and real-life individual quests take place in a context of equally pronatalist state policies and religious openness to assisted reproductive technologies. In this paper, I outline 35 years of assisted reproductive technologies in Israel by tracing a principal axis in the development of three major technologies of assisted reproduction: the proliferation of IVF-ICSI; the globalization of gamete donation; and the privatization of surrogacy. The paper is based on a policy analysis as well as various studies of assisted reproductive technologies, conducted in Israel over this period.

Contextualizing Nurse Education in Israel: Sociodemography, Labor Market Dynamics and Professional Training

Abstract Background: Motivations for selecting nursing as a career are usually explored through direct questions to candidates and students. Purpose: The present article aims to uncover ties between the demand structure for the profession and broader socio-demographic and economic processes. Method: Data covering a ten year period was retrieved from an Israeli university. It is suggested that the intensity of demographic and economic shifts in Israel allows clearer observation of more general student-related processes that probably take place, if on a smaller scale, virtually everywhere. Findings and discussion: Many of the new recruits to academic nursing programs in Israel in 1996–2004 came from two somewhat marginal sub-populations: immigrants from the Former Soviet Union and Israeli Palestinians. The high, yet decreasing percentage of the former category and the rise in the latter are interpreted in terms of competing forces in the local healthcare labor market, immigrants’ adaptation and economic fluctuations. Conclusion: The demand for nursing studies corresponds to socio-demographic and economic changes. It may be beneficial to consider such links in long term planning and training policies.

Our first “IVF baby”: Israel and Canada’s press coverage of procreative technology

Provides a comparison of the press coverage of the introduction of IVF in different contexts, giving a vantage point for examining the variability and the context‐dependence of the issue. Sheds some light on the cultural‐political‐social problems that the new technology entails. Contrasts the differences between Canada and Israel, showing that both countries endorse modern technology in the field of medidine: in both countries, IVF was imported about the same time and both used the US and Britain as a frame of reference and model rather than local developments. Shows the cultural differences of how each culture embraced the new technology.

Hegemony and Homogeneity: Donor Choices of Israeli Recipients of Donor Insemination

This article explores the relevance of hegemony theory to choices of sperm donors made by Jewish Israeli recipients of donor insemination (DI). The context is the objectification of ‘the Natural’ through hegemonic images of mass consumption. The study, which was conducted in a major Israeli hospital, examined physiological features (height, eye colour, skin colour) of the most popular donors. In the highly familistic society of Israel, recipients’ choices conformed to images of their own ‘natural family’. Within the limits of the family’s looks, choices revealed a convergence of specific type of physiognomy - that of the hegemonic Ashkenazi man. While recipients tended to reproduce their own appearance they often ‘compromised’ it towards the kind of looks constructed as desirable in the mass media. The choice of donors by DI recipients presents an extreme case in which people construct their own family by incorporating hegemonic ideals of mass consumption.

Between individualism and collectivism: the case of a middle class neighbourhood in Israel

Cites collectivism as an element within Israeli culture from its inception. Explores the intricate mosaic of individualism/collectivism as expressed in a middle class Tel‐Aviv neighbourhood. Uses a three years of fieldwork and a neighbourhood survey to describe the residents as active individuals, aiming to advance their private interests and eager to interact with each other and participate in organized local activities. Shows how some modes of collectivist action were directed towards individual interests. Shows the collectivist tendency as still strong and influenced by the dominance of social parties in Israel.

Your faith or mine: a pregnancy spacing intervention in an ultra-orthodox Jewish community in Israel

Abstract Ultra-orthodox (haredi) Jews in Israel have an exceptionally high fertility rate of 7.7. As most fathers spend their days studying the Bible, the women struggle to support their large families under severe economic pressures. Some women experience maternal exhaustion coping with this life situation. Contraception for pregnancy spacing raises myriad dilemmas in the haredi community, however, many of which apply to promoting family planning in religious settings more generally. In a health promotion course for 23 haredi registered nurses at the University of Haifa in 2006–2007, pregnancy spacing was selected as the subject of the class project, the main aim of which was to convey an influential health message in a culturally acceptable manner. As the issue was debated, it was agreed the project should also address a range of women’s health problems as well as pregnancy spacing. Thus, maternal nutrition, pelvic floor tone, dental health, maternal exhaustion and competition over number of children were added. A brochure was prepared and widely distributed in the haredi community, where it was well received. This paper describes the classroom dynamics during the planning and application of the project. It illustrates the importance of cultural awareness when addressing sensitive issues and communities with particular cultural dispositions. Résumé Les Juifs ultra-orthodoxes (haredim) en Israël ont un taux exceptionnellement élevé de fécondité de 7,7. Comme la plupart des pères passent leurs journées à étudier la Bible, les femmes peinent pour élever leur famille nombreuse dans des conditions économiques difficiles. Cette vie conduit certaines femmes à développer un épuisement maternel. Néanmoins, la contraception pour l’espacement des naissances soulève une multitude de dilemmes dans la communauté haredi, dont beaucoup s’appliquent plus généralement à la promotion de la planification familiale dans des contextes religieux. Dans un cours de promotion de la santé pour 23 infirmières haredi à l’Université d’Haïfa en 2006–2007, l’espacement des naissances a été choisi comme thème du projet de classe, dont le principal objet était de transmettre un message influent de manière culturellement acceptable. Au cours des débats, il a été convenu que le projet devait aussi aborder plusieurs problèmes de santé des femmes, en plus de l’espacement des naissances. Par conséquent, la nutrition maternelle, la musculation du périnée, la santé dentaire, l’épuisement maternel et la concurrence sur le nombre d’enfants ont été ajoutés. Une brochure a été préparée et largement distribuée dans la communauté haredi qui l’a bien accueillie. Cet article décrit la dynamique de classe pendant la planification et l’application du projet. Il montre qu’il est important d’avoir conscience des enjeux culturels lorsqu’on traite des questions sensibles et des communautés à dispositions culturelles particulières. Resumen Los judíos ultra ortodoxos (haredi) en Israel tienen una tasa excepcionalmente alta de fertilidad de 7.7. Dado que la mayoría de los padres dedican sus días al estudio de la Biblia, las mujeres luchan por mantener a sus amplias familias bajo enormes presiones económicas. Algunas mujeres sufren agotamiento materno lidiando con esta situación. La anticoncepción para el espaciamiento de embarazos plantea diversos dilemas en la comunidad haredi; sin embargo, muchos de estos se aplican a la promoción de la planificación familiar en ámbitos religiosos más generalmente. En un curso de promoción de la salud para 23 enfermeras diplomadas haredi, en la Universidad de Haifa en 2006–2007, el espaciamiento de embarazos fue seleccionado como el tema del proyecto de la clase, cuya finalidad principal era transmitir un mensaje influyente sobre la salud de una manera culturalmente aceptable. Según se fue debatiendo el tema, se acordó que el proyecto también debería tratar varios otros problemas de salud de las mujeres. Por tanto, se añadieron nutrición materna, tono del piso pélvico, salud dental, agotamiento materno y competencia por el número de hijos. Se preparó un folleto y se distribuyó por toda la comunidad haredi, donde fue bien recibido. En este artículo se describen las dinámicas de la clase durante la planificación y aplicación del proyecto. Se ilustra la importancia de la conciencia cultural al tratar temas delicados y dirigirse a comunidades con determinadas disposiciones culturales.

Masculinity and Marginality: Palestinian Men's Struggles with Infertility in Israel and Lebanon

Male infertility, which contributes to roughly 60–70% of infertility cases in the Middle East, is especially agonizing in this region, where fatherhood is crucial to achieving masculine adulthood and community standing. In this paper, we compare the infertility experience of two groups of Palestinian men, one living in Israel and the other in Lebanon. The study is based on ethnographic interviews conducted with 24 men between 2003 and 2007. The findings cluster at three levels of daily experience. At the subjective level, men express a sense of “asynchronization,” namely, feeling as if they are lagging behind or deviating from the normal masculine life trajectory. At the community level, men vary greatly in their disclosure practices, but all are preoccupied with monitoring the flow of infertility-related information. We attribute the centrality of this gate-keeping activity to the stigma of infertility and related treatments. At the societal level, the state’s role acquires heightened significance, owing to the marginalized minority status of Palestinian men in both countries. Our comparison reveals two contrasting situations: In Lebanon, the high cost of treatment places it beyond the reach of many Palestinians, thus epitomizing their civil marginality and poverty. In Israel, where fertility treatment is state-funded, eligibility on the grounds of one’s Israeli citizenship comprises a relatively positive experience for Palestinian men, who are otherwise routinely discriminated against in crucial life domains. More generally, the study illustrates how advanced fertility treatments, in their global spread, serve to entrench ideas of reproductive normalcy, individuality, and citizenship.