* See the important comment by the Encyclopedia
editor in his Foreword,
pp. 10-11. Although most of this paper was prepared prior to March 1994, it was
edited and corrected until just before publication, with some parts written or
updated in the interval.
Contents
1.
Demographics and a Historical Perspective
2.
Basic Sexological Premises
3.
Religious and Ethnic Factors Affecting Sexuality
4.
Sexual Knowledge and Education
5.
Autoerotic Behaviors and Patterns
6.
Interpersonal Heterosexual Behaviors
7.
Homoerotic, Homosexual, and Ambisexual Behaviors
8.
Gender Conflicted Persons
9.
Significant Unconventional Sexual Behaviors
10.
Contraception, Abortion, and Fertility Planning
11.
Sexually Transmitted Diseases
12.
HIV/AIDS
13.
Sexual Dysfunctions, Counseling, and Therapies
14.
Research and Advanced Education
15.
National, Religious, and Ethnic Minorities
16.
Immigrants and Immigration
17.
Glossary
18.
References and Suggested Readings
Demographics
and a Historical Perspective
A.
Demographics
At the eastern end of the Mediterranean Sea, Israel
is a small nation, long and narrow in shape, about the size of the state of New Jersey. Its
western border is the Mediterranean Sea. On all other sides are Arabic,
predominantly Moslem, nations - Egypt, Syria, Jordan, and Lebanon, most of
which are in a state of war with Israel since its declaration as a Jewish state
in 1948. Israel’s 7,847 square miles include a western, fertile, coastal plain,
a well-watered central Judean Plateau, and the arid Negev desert in the south.
Its population was slightly above 5,200,000 as of the
end of 1995. In that year, 83 percent of the population was Jewish, 13.9
percent Moslem Arabs, and 2.5 percent Christian - most of whom are also Arabs
or Druzes - and 1.7 percent other. Ninety percent of the people live in towns
or cities. The age distribution was 30 percent age 14 or younger, 61 percent
between 15 and 64, and 9 percent over age 65. In seventy-five years, Israel’s
population has increased tenfold, while the Jewish population multiplied by
fifty fold from about 85,000 Jews in 1918 to more than 4,140,000 Jews in 1992.
The population density, usually a measure of urbanization and
industrialization, rose from 106 in 1960 to 231 per square kilometer in 1991.
Life expectancy for the Jewish population at birth in 1995 was 76 for males
(second in the world after Japan) and 80 for females. The birth rate was 20 per
1,000 population and the death rate 6 per 1,000, for an annual natural increase
of 1.4 percent. Israel has one hospital bed per 177 persons and one physician
per 345 persons. Infant mortality is 8 per 1,000 live births. The per capita
gross domestic product was $13,350. The literacy rate was 92 percent for Jews
and 70 percent for Arabs.
Israel is the only country where the society is
predominantly Jewish and the Jewish culture dominates. This is a source of
difficulty in understanding sexuality in Israel. First, Western cultures do not
always appreciate the extent to which Christian teachings differ from Jewish
teachings in matters relating to sex and sexuality. (Outside of Israel, large
Jewish communities living within dominant Christian cultures have acquired some
of the host culture constructs.) This problem is aggravated by a methodological
difficulty: Some of the common analytical tools and theoretical frames of
reference used to explain sexual issues, especially gender ones, are somewhat
lacking, because they are anchored in alien, mainly English-speaking, cultures.
B. A Brief
Historical Perspective
In the southwest corner of the Middle East’s ancient
Fertile Crescent, the land of Israel contains some of the oldest evidence we
have of agriculture and the earliest town life. By the third millenium before
the Common Era, civilization had made significant advances in the area. The
Hebrew people probably arrived sometime during the second millenium B.C.E.
Judaism and the land of Judea prospered under King David and his successors
between 1000 and 600 B.C.E. After being conquered by the Babylonians, Persians,
and Greeks, Judea again became an independent kingdom in 168 B.C.E. However,
within a century, the land was occupied by the Romans. Rome suppressed revolts
in 70 and 135 of the Common Era, and renamed Judea Palestine, after the
Phillistines who had inhabited the coastal land before the Hebrews arrived.
Arab invaders conquered the land in 636. Within a few
centuries, Islam and the Arabic language became dominant and the Jewish
community reduced to a minority. During the eleventh to thirteenth centuries,
the country became a part of the Seljuk, Mamluk, and Ottoman empires, although
the Christian Crusades provided some temporary relief from Islamic culture
between 1098 and 1291.
During four centuries of Ottoman rule, the Jewish
population declined to about a third of a million people in 1785. As the
Ottoman empire collapsed in World War I, Britain took over control of the land
in 1917; the Balfour Declaration pledged support for a Jewish national homeland
there as anticipated by the Zionists. In 1922, the land east of the Jordan
River was detached.
Jewish immigration, which began in the late
nineteenth century, swelled in the 1930s as Jews fled the rising tide of Nazi
persecutions. At the same time, Arab immigration from Syria and Lebanon also
increased. Arab opposition to Jewish immigration erupted in violence in 1920,
1921, 1929, and 1936. After the turmoil of World War II, the United Nations
General Assembly voted to partition Palestine into an Arab and a Jewish state.
In 1948, Britain withdrew from the country and Israel declared itself an
independent state. The Arab world rejected the new state, and Egypt, Syria,
Jordan, Lebanon, Iraq, and Saudi Arabia invaded, but were defeated by Israel,
which incorporated new territories. In separate armistices signed with the Arab
nations in 1949, Jordan occupied the Left Bank of the Jordan and Egypt occupied
the Gaza Strip in the south, although neither granted Palestinian autonomy.
An uneasy truce prevailed
until the Six Day War of 1967 erupted when Egypt tried to reoccupy the Gaza
Strip and closed the Gulf of Aqaba to Israeli shipping. The war ended with
Israel taking the Gaza Strip and occupying the Sinai Peninsula to the Suez
Canal, and captured East Jerusalem, Syria’s Golan Heights, and Jordan’s West
Bank.
Egypt and Syria attacked Israel on Yom Kippur of 1973. Israel drove the Syrians back and crossed the Suez Canal into
Egypt. In the disengagement agreement of 1974, Israel withdrew from the Canal’s
West Bank. A second withdrawal followed in 1976, and Israel returned the
Sinai to Egypt in 1982. In 1979, Egypt and Israel signed a peace treaty, ending
thirty years of war. A 1978 terrorist attack from southern Lebanon led to an
Israeli invasion. The violence and terrorism has continued, with Israel
responding to the 1982 wounding of its ambassador to Great Britain by
surrounding and entering West Beirut, a military occupation by Israel of the
West Bank and Gaza Strip, and the 1996 assasination of Prime Minister Yitzhak
Rabin by a fundamentalist Jew opposed to accommodations Israel was planning to
gain peace in the area.
Basic
Sexological Premises
A. Character
of Gender Roles
Judaism paints an ambivalent attitudinal picture in
regard to women. It is certainly patriarchal in nature. The prayer a man
recites three times a day includes a blessing for not being made a woman. On
the other hand, the Shabbat blessing includes a praise glorifying the
woman of valor. She is described in a traditional role of wife, mother, and
homemaker. When a person is commanded to honor his parents, mother and father
are mentioned explicitly and not the general form or the masculine one. A man
is ordered to leave his mother and father and literally “stick” to his wife,
while she is never ordered to leave her parents.
Gender and gender roles are viewed in a more
traditional manner in Israeli sociocultural reality than elsewhere in Europe or
North America. Already mentioned are several unique conditions that contribute
not only to the perception of gender roles and the division of labor that are
the public domain of family life, but also to concepts of intimacy and roles in
sexual relations.
Service in the army reserves also contributes to the
fixation of traditional roles of men and women beyond the military service at
young adulthood. Men serve in the reserve forces a significant part of their
adult life, typically 7 to 8 percent, but some as much as 25 percent of their
time, annually, until they reach the age of 45 to 50. This fact has to be coped
with within the family, and essentially exerts its influence on the balance of
family life emotionally, as well as on the division of labor within the family
balance of power, and the burden of physical and emotional responsibility of
women to the children. Many children grow up with the ongoing worry about the
danger to the life of the father, but also with stories that include macho and
aggressive overtones. The exemption of women from reserve service on their
first pregnancy, understandable as it is, only stresses the role division (see
also Section 5C).
B. Sociolegal
Status of Males and Females
Children
Legally, the rights of male and female children are
fully equal. They inherit equally, are viewed with no distinction in terms of
rights for protection by state authorities, and have the same rights for
education and welfare in case of need.
Another law that has a bearing on sexual and familial
issues is the prevailing legal situation (both in civil code and religious
law), that there is no flaw in the legal status of a child born out of wedlock.
This is sometimes used by religious authorities as an additional argument
against granting abortions for unmarried women.
The only gender difference in the legal status of
children is part of the religious family law that favors giving custody over
girls to the mothers, while favoring fathers in the case of boys over the age
of 6.
Adolescents
During adolescence, the legal status of boys and
girls becomes somewhat different, mainly in regard to age of consent for sexual
intercourse and the legal age of marriage, while their basic sociolegal rights
remain equal.
The differences are in
statutory rape laws - a concept that does not exist for boys. This creates an
anomalous situation when a boy, who is more than two to three years younger
than a girl of 14 or 15, has intercourse with her, opening him to the charge of
rape in strict legal terms.
Despite this, the law does not distinguish between
minors when it comes to sexual intercourse or molestation by an authority
figure such as parents, caretakers, and professionals like teachers,
psychologists, or physicians. Both males and females are considered under the protection
of the law until age 21.
Another difference is the explicit permission to
grant a minor girl an abortion without the knowledge and consent of her parents
(see Section 9C). The practice is an extension of the rule that allows
physicians to give minor girls treatment for preventing abortions, i.e.,
contraceptives, without consent of their parents. This widespread
interpretation of the law is never challenged in the courts.
Adults
The situation becomes more complicated when females
and males reach adulthood. In addition to die complications of family law and
the interaction between a predominantly nonobservant population with
state-enacted and enforced orthodox laws and legal system mentioned above,
there are several other issues of personal standing in which the issues of
gender arise.
Only a few years ago, the income tax laws were
changed so that the designation of “head of family” was struck and married
women acquired independent standing. Prior to that, women’s earning were
treated as a joint income of the family. The term “head of family” was applied
to the husband, unless it was a one-parent family headed by a woman.
An increased percentage of women participate in the
labor force. While in 1967, only about 25 percent of the women worked outside
their household, their number passed 40 percent in 1980 and reached 49 percent
in 1992. Despite their increasing number in many economic branches, and higher
positions, women still suffer from lower wages for equivalent work, and from
lower chances for advancement within a specific area.
The equal opportunity law does not permit
discrimination on the basis of gender, and even demands that advertisements for
work be directed toward both genders.
There is a public campaign now for corrective or
compensatory discrimination. Many men and women object to this proposal because
they believe that women in Israel do have some offsetting advantage because
they do not serve in the reserves, a fact that many employers appreciate.
Another point is the fact that several of the labor
laws, especially those dealing with maternal leave, shorter working hours for
mothers of small children, and the inability to fire pregnant women burden
employers with additional expenses and restrict their ability to compete in an
open market. This seems to be a case where what was perceived to be an advanced
social law less than thirty years ago may be inappropriate in the new political
climate.
Another economic burden and female advantage that
both employers and politicians cite is the differences in the pension laws and
regulations. Women whose life expectancy at birth is 79, 3.6 years longer than
men (75.4), retire five years earlier than men at age 60. In the public
campaign to change the rules, women won the right to choose their age of retirement,
but men still have to work until age 65 in order to earn their pensions. Thus
the time that pension funds expect to pay most women is almost nine years
longer.
This condition is aggravated by the fact that pension
rights to which the surviving member of a couple is entitled are strongly in
favor of women, who can receive up to 40 percent of their partner’s salary,
while in the rarer cases of a men surviving his wife, he can receive about 15
percent of hers. Several advocates of labor reform claim that any such changes
will need to deal at the same time with all the structural differences between
men and women, otherwise the system will not be able to carry the economic
burden, and will also move from one form of discrimination to another instead
of toward egalitarianism.
Religious
and Ethnic Factors Affecting Sexuality
A. Source and
Character of Religious Values
The term “secular Jew” embodies the problematics and
the uniqueness of the Israeli situation. One part of it - Jew - defines the
national sociocultural and historical identity. The second part - secular -
defines a relationship to Judaism as a religion and religious lifestyle, and
the choice of humanistic or secular democratic frame of reference over a
religious one. These two parts can be naturally linked together only within
Israel, the Jews’ national home.
Only about 30 percent of the Jews living in Israel
define themselves as religious. Most of the other 70 percent define themselves
as secular, while about seventeen to twenty-three percent define themselves as
traditional. The latter observe a few selected rules of observance, mainly
ritualistic ones, while living most of their lives according to secular
lifestyle. Despite that, the culture is strongly influenced by traditional
Jewish religious values.
Three examples - (1) Jewish thought and its vehicle,
Hebrew language, (2) the role of religious values in a predominantly secular
society, and (3) religious politics - will illustrate the extent in which
Jewish culture influences sexual constructs.
The Hebrew
Language and Jewish Thought
Language is the vehicle of abstract and analytical
thought and therefore plays an important role in our psychosocial phenomena.
Hebrew, the language of Jewish thought, exerts a very strong influence on
Israeli Jewish thinking about sex and gender. The first expression of the place
and meaning of sex in the world appears in the first chapters of the Old
Testament, in a way diametrically divergent from Christian thought. In Genesis,
the first time intercourse is mentioned in Jewish literature, the root of the
verb used has multiple meanings: knowledge, consciousness, and intercourse. As
far as is known, Hebrew is unique in using one root, and thus overlapping
meanings, for sexual intercourse: knowledge and consciousness. The common root
for knowledge, consciousness, and the verb for sexual intercourse indicates
that sex is highly prominent in Jewish thought, and not necessarily in a
negative way, especially when one recalls that Jews are known as the “people of
the book.”
This influence is apparent despite the fact that
other layers were added over the biblical language and, until this century,
Hebrew was only intermittently used as a spoken language for secular,
nonritual, or nonreligious studies. In modern, largely secular, albeit
Hebrew-speaking Israel, very few people use the biblical term for intercourse
in daily life. Current terminology ranges from the intimate (make love) through
the neutral (to perform sex or sexual relations, to lie with) to the aggressive
equivalents of fuck, screw, shaft, etc.
Thus, unlike many Christian approaches, traditional
Jewish thought views sex as intrinsically neutral. It is a human characteristic
with an extremely strong potential (like knowledge and consciousness), which
can be turned into either good or evil by three humanly determined acts of
choice: the meaning one gives to sex (an act of piety), the context within
which it is practiced (marriage), and the way one practices it (rules of
conduct, including purity laws). In itself sex and the pleasure of sex is not a
sin. The harmony of flesh and spirit, an important tenet of Jewish culture, is
expressed in married heterosexual relations. Its consummation on a regular
basis, not necessarily for procreation, is a mitzvah - a combination of
an obligation and a privilege - and pleasure is an important part of it. Those
who abstain in marriage run the risk of religious sanctions. As role models,
community leaders are to be married with numerous children. There is no
monasticism, and abstinence is frowned upon.
Despite this, one can also find strong ambivalence
about sex and the expression of sexuality in Jewish thought throughout the
ages. Its instinctual nature and extremely high potential for evil needs to be
guarded and curbed at all times. Some strong Christian influences are also
apparent, especially among the Jews living in Europe for the last two
millennia.
Another example of the role of the historical
language’s influencing modern sexual constructs is the fact that Hebrew is almost
a totally genderized language. All the forms of speech - nouns, pronouns, verbs
in all tenses, adjectives, and adverbs - take a genderized form. In contrast,
English, the language of international research, is neutral, except for a few
nouns describing animate objects. A comparative study among children of three
different countries found that the gender prominence and dichotomization was
ordinal according to the gender differentiation within the language,
Hebrew-speaking children having the highest gender awareness. Thus Jewish
children learn with their first abstractions how important it is to identify
the gender of each object/entity and to look for the characteristics that
distinguish one gender from the other.
The Power of
Religious Values in a Secular Society
The Judaic nature of the society is demonstrated by
the role that even secular people ascribe to Judaism in the life of Israel.
While most Jews are nonobservant in terms of Jewish orthodoxy, many of them
define themselves as traditional. Debates on the relations between state and
religion are a constant issue in Israeli politics and public life. Issues like
the definition of the Jew in the law of returning, opening of public places, or
the operation of public transportation on Shabbat (Saturday), support
for religious educational systems, and the exemption of women and men studying
in religious seminaries from army service, are argued regularly.
In many such debates, many secular people defer to
religious demands, not as a surrender to their power politics, but because they
view Judaism as having a special role in the life of the state. One of the
basic tenets of Judaism is that it is a national religion with a role in both
public and private life, with a unique historical role in preserving the Jews
as a cohesive people. Sometimes there is a feeling that in relating to
religious demands in public life, secular people place themselves in an
inferior position. This closely relates to this topic because marital and
gender issues are an important part of the discourse and the complex
relationship between state and religion.
The Political
Power of Religious Parties
The influence of Judaism on family, gender, and
sexual issues is exerted not only through the subtler cultural and indirect
sociocultural forces, but also through the political, social, and economic
power of the religious minority of the population. While the political
platforms of the religious parties are varied, they are united in their
determination to preserve the power and lifestyle of Jewish orthodoxy in the
public life of Israel. Their political leverage is far greater than their
actual electoral power. While the left- and right-wing parties alternated as
dominant political powers and formers of governments, religious elements have held
the balance of power in all coalition governments due to a proportional
electoral system.
In return for support on issues of defense, foreign
affairs, and the economy, the secular parties give in to the demands of the
religious parties on issues of secondary importance to them in many social
areas, including those relating to family, sex, and gender. Thus the judicial
system that determines family matters is religious, although some aspects can
be dealt with also in civil court. The religious influence is obvious in the
reform of laws regarding abortion, homosexuality, and censorship of
pornography.
The combination of religious Halachic canons with a
public that is largely secular creates a conflicted situation. The reason for
this conflict lies in several religious laws that impose great hardship on men
and women, especially on those who do not adhere to the religious lifestyle.
These include the law that forbids men who are descendants of the priesthood
families of the temple from marrying a divorcee or a widow; a law forbidding an
adulterous woman from marrying her partner in sin, even after she is granted a
divorce from the husband; and similar laws.
These situations cause hardship also for religious
people, but they suffer them because they adhere to the basic religious tenets.
For the secular majority who encounter them, they are an imposition. This is
one of the reasons for the strong tensions between the religious and the
secular sectors, but the fear of schism is so intense that most people will look
for compromise solutions instead of cultural war.
Nevertheless while the secular and the religious
parties have officially agreed to a token truce, the preservation of an
ill-defined status quo, in reality there is a constant political war fought in
separate skirmishes on different fronts: in parliament, the courts of law
(especially the Supreme Court of Justice), local governments, and economic
pressures. While many secular people feel that religion is gaining ground in
public life, most of the religious sector feels on the defensive within the
paradox of a secular Jewish state.
B. Source and
Character of Ethnic Values
An Immigrant
Society with Unifying Forces
Israel is an immigrant society with a common
historical background and a melting-pot ethos acting as cohesive forces. The
absorption of repeating masses of immigrants since the early 1950s has had a
considerable impact on sexual behavior, sexual health, and public involvement
in sexual issues. In 1990 and 1991,400,000 people, 10 percent of the total Jewish
population of Israel, immigrated from the former Soviet Union. Issues of
increased rate of induced abortions, relatively low number of children,
one-parent families, an alleged combination of alcohol consumption and sex, and
a seemingly instrumental view of intercourse quickly surfaced.
Also in 1991, 15,000 Jews immigrated from Ethiopia
over one weekend, confronting Israel with issues of traditional medical
practices, ritual isolation of menstruating women, and increased incidence of
infectious diseases including STDs and AIDS.
Unlike other societies where immigration leads mainly
to social fragmentation, indications suggest that social cohesiveness forces
within Israeli society also act in the opposite direction, as integrating
agents even within the span of one generation (see below in marriage and
fertility patterns). The melting-pot ideology is not just a whim. There are
some strong basic and structural needs that contributed to its development: a
belief in the continuity and unity of the Jewish people; a sense of threat of
either political or physical annihilation or both; and, a sense of revival and
modernization of an old culture that was suppressed or dormant by external
conditions. Although many people perceive the melting-pot society not as a domination
of one group over others, but as a continuous process of the evolvement in a
new culture, others espouse a more pluralistic approach, advocating the
preservation and even the development of ethnic characteristics.
In reality, one can see that many factors relating to
dyadic relations and sexual behavior, fertility and fertility regulation, and
other characteristics change in a relatively short time, and different studies
show the emergence of common phenomena.
Israel’s
Political Situation
Israel’s political situation has a strong impact on
sexuality and sexual issues. This small country, with a total population less
than that of New York City, has been surrounded by enemy states and hostile
populations since its founding. Until the 1979 treaty with Egypt, there was no
land border that an Israeli Jew could legally cross. Even in mid-1994 when
ongoing political processes set the stage for reducing the siege, Israel
requires a military service for all citizens that influences sexual and related
issues beyond that requirement.
Siege feelings and the need to keep national unity
make many people accept compromises in striving for change, or at least lower
the tone. This often changes the perspectives about priorities and leads to
personal inner conflict between personal aspirations and internalized
collective ones.
The influence of wars and physical danger on the
sexual behavior of people, their marriages, and their fertility patterns are
understudied. It is proposed here that, in critically dangerous situations, sex
- which is biopsychosocially still connected to reproduction - may serve as a
means to symbolically negate personal death. Such a hypothesis was used in
attempts to explain diverse phenomena, like the frequently discussed increase
in reproduction following military engagement, and the divergence from
normative sexual behavior during times of active warfare.
Recent analysis demonstrates that the first
phenomenon is only a rumor based on impressions and does not exist in reality.
As appealing as the symbolic explanation is, the anecdotally reported departure
from normative behavior during times of peace could alternatively be explained
by feelings of disintegration during wars and irrelevance of social norms in
those times. However, if this explanation were true, one would also expect
widespread occurrence of phenomena like rape of the conquered population, which
did not materialize in the wars in which Israel conquered land and assumed rule
over large Arab populations.
Military
Service
Several characteristics of the general military
service, which is dictated by the political realities, can affect, directly or
indirectly, the nature of Israeli sexual constructs. The role of the Israel
Defense Forces (IDF), both as an institution and as a life event for Israeli
youth and adults, is larger than in other Western societies. Most people would
view it as essential to both their physical and national existence. It is an
existential event in the life of most Israelites, and most families are
immediately involved with its realities and dangers.
(1) Gender Roles and the Status of Women.
Military service in Israel is general and compulsory for both men and women at
the age of 18. Exemptions are granted for physical and mental health reasons,
low educational level, criminal record, and religious reasons, but rarely for
conscientious objections. However, men serve for three years and continue to
serve in the reserves for twenty-five to eighty days annually until they are 50
years old. Women serve for approximately two years and are retired from reserve
service when they bear their first child. This in itself is both a reflection
and an enhancer of the more traditional role still ascribed to women in Israel
(discussed in greater detail below). Other characteristics of the military
service tend to accentuate the traditional gender roles.
Despite compulsory service, there is a strong element
of volunteering in the army, as youth compete, sometimes fiercely, for service
in elite units or prestigious tasks. This entails additional physical and
mental hardship during compulsory service and in many cases an obligation to
serve as many as six additional years. There is a strong element of macho
psychology involved here with both male status and preference by the young women
at stake.
Women do not serve in combat, and their choice of
professions is not only smaller, but also limited to the less prestigious tasks
within the army. Being out of combat service also blocks them from advancing in
the army to the higher levels of general staff commands.
As the IDF retires its generals at between the ages
of 45 and 53, exemplary service in the army and a top-echelon position is one
of the stepping stones to the higher levels of civil service, business, and
political careers. This avenue for advancement is closed to women.
The hardships of service, especially in combat units,
promote strong male camaraderie and individual friendships; annual service in
the reserves to age 45 to 50 tends to reinforce them. These almost-exclusively
male interactions can be transferred to civilian life in the form of enhanced
networking and alliances.
It seems that the realities of the military can
foster traditional gender roles in the minds of both men and women, and also
influence their social positions. Other issues discussed below point in the
same directions.
(2) Social Mobilization and Meeting Ground.
Sociologists have noted the IDF’s role as a unifying factor and as contributing
to the relative high mobilization within the Israeli society.
The IDF is involved in absorbing immigrants and in
educational projects for women and men who otherwise would be unfit to serve.
It also serves as a common meeting ground for people from different ethnic
groups, allowing them to mix socially, and in many cases sexually. Many
marriages can be traced to relationships formed in the army.
All IDF officers start as rank and file. There is a
strong emphasis on advancement based on merit and achievement, and excellence
is measured by a combination of mental, physical, and social characteristics. A
meritorious service record is viewed as a strong character reference; in
civilian life, young men from less-privileged strata have another chance for
mobility.
(3) Rite of Passage or Moratorium? It is hard
to appreciate the influence of the IDF on sexual and family issues if one does
not understand the role it plays in the general individual psychosocial
development of Israeli youth, and its centrality in the life of many
individuals. Most Israeli youth leave direct parental control to go into the
army. This is only one factor that ties army service strongly to sexarche,
choice of mates, and other sexual issues (see Section 5C). Developmentally, IDF
service has some definite elements of a rite of passage - the physical and
mental tests, the demand for initiative and resourcefulness judged by peers and
veterans, the formation of group cohesion and social responsibility, the
ability to deal with moral dilemmas in extreme conditions - and these serve to
separate childhood from adulthood.
While not disputing the rite of passage elements in
IDF service, or its positive effects, it was recently suggested that at the
same time the nature of IDF service may also cause a long moratorium on the
tasks of real life, and can even be viewed as causing some elements of
infantile regression. These may have effects on dyadic relationships and gender
roles within them (see below).
(4) Internal Conflicts, Trauma, and Violence.
A possible negative aspect of the military service that may have a bearing on
sexuality and family life involves the nature of military engagement in the
civilian uprising in the disputed occupied territories during the last six
years. This forced the soldiers to confront civilians, rather than enemy
soldiers, in a manner previously unexperienced. These high-risk confrontations
with civilians tend to create strong inner and normative conflicts. Those who
raised the issue hypothesized long-lasting effects, among them proneness to
violence (including domestic violence) and posttraumatic stress disorders.
Claims had been made that in such discussions, it is difficult to distinguish
between political stands and professional opinions.
The possible contribution of these issues on the
actual shaping of sexual and dyadic constructs will be discussed in several
instances.
Sexual
Knowledge and Education
A. Government
Policies and Sex Education Programs
The educational system in Israel is divided between
general educational system and religious ones. This necessitates separate
discussion of the situation in the different sectors. Most of this discussion
will be devoted to the secular educational sector.
The Early
Years (1930s and 1940s)
Early attempts at sex education, in the late 1930s
and early 1940s, were based on local initiatives. Although coming from two
different directions, they converged around the dominant psychoeducational
ideology of that period - the Freudian psychoanalytical thought. The
theoretical concepts, which had little direct field application, were largely
that of mental health hygiene of a “preventive” nature, and were concentrated
around the Psychoanalytical Institute of Jerusalem and the Public Health
Services of a voluntary health service of the Jewish Community (Hadassah).
At the same time, attempts were made to develop sex
education programs at the educational institutions of the left-wing kibbutz
movement “Hashomer Hatzair.” The atmosphere in these institutions was highly
experimental, and the issues of sex, sexuality, gender equality, and the
control of individual urges and wishes - not only sexual ones - as part of
socializing ethos, were central to the life of the movement at that time. For
example, not only was the system coeducational, but boys and girls slept
together in the same room, four to a room, until age 18, and bathed together
until age 12 to 14. Contrary to the expected, this was a society with highly
puritan values, at least when it came to youth, and the key concept of sex
education and youth sexuality was borrowed from psychoanalytical literature - sublimation.
There was high social control over behavior: purity and self-control were
expected, not only in the area of sexuality, but also in areas like smoking and
drinking. It is interesting to note that these two behaviors are clustered with
precocious initiation of intercourse as “problem behaviors” in the modern
research literature.
The 1960s
A revival of interest in sex education came in the
early and mid-1960s, when several sex-education “guidebooks” were published by
concerned professionals. These were not as yet part of an organized
sex-education drive, but their almost simultaneous publication is significant,
as was the foundation of the Israeli Family Planning Association in 1966. It
seems that the main concerns during that period were the apparent increase of
sexual behavior among youth and the alleged contribution of large families to
low socio-economic status (SES) prospects and crime among young immigrants from
Middle Eastern countries.
The 1970s and
1980s
The big organizational change happened in the early
1970s. Dominant among the incentives was the increase in the incidence of
sexually transmitted diseases (STDs) among youth, following a wave of youth
tourism to Israel after the 1967 war. This also coincided with some changes in
the general ethos of the country from communal to individual, which may be
attributed to filtration of the youth movements of the 1960s in Europe and
North America, and with a relative economic boom following four years of
recession.
A national study about sexual knowledge, attitudes,
and practices was mandated and carried out in the early 1970s. The outcome of
the deliberations of a multisectorial committee was an outline for a
comprehensive general curriculum arranged chronologically by content areas and
skill formation, and the formation of a Unit of Family Life and Sex Education
at the Ministry of Education.
The original conceptual framework for this
experimental unit was a mixture of preventive health (implying a high potential
for adverse effects of sexual behavior), a developmental outlook, and normative
boundaries. Its mandate was very wide and flexible and included the development
of educational programs, the training of sex educators, and the implementation
of nonmandatory sex education within the school system.
Two parallel units were formed, one to deal with the
issues within the national-religious sector (which dropped the sex education
out of its name) and the other one to deal with the same issue within the
general (secular) national educational system.
The National (Secular) Sex Education Approach.
The efforts concerning sex education in the secular (general) system developed
in three main parallel directions: (1) the development of programs and
educational materials for different content areas, ages, and skills; (2)
training sex educators/facilitators; and (3) creating the infrastructure for
the implementation of the programs within schools. The development of the
programs and the training of sex educators was influenced by the humanistic
approach to sex education of the Sexuality Information and Education Council of
the United States (SIECUS), American Association of Sex Educators, Counselors,
and Therapists (AASECT), and Society for the Scientific Study of Sexuality
(SSSS) schools. Professionals from the United States of America, most notably
Lester Kirkendall and Sol Gordon, helped with the first training courses and
development programs in the late 1970s and early 1980s.
In 1978, the curriculum for family life and sex
education was formally adopted and the unit ceased to be an experimental one.
After several years of independent (precarious) existence, it was adopted
administratively into the Psycho-Educational Services of the Ministry of
Education. The infrastructure for supporting implementation of sex education
now includes several regional trainers, with whom teachers can consult.
The appearance of AIDS on the Israeli scene in the
mid-1980s was a mixed blessing for sex education. The rise in public interest
in sexual behavior, the perception of youth as an at-risk group, and the
feeling of inadequacy concerning sex education among many parents, acted
together with other factors in 1989 to mandate sex education at least three
times within the formal education span. In each stage, elementary, middle, and
high school, pupils are to be given sixteen hours of sex education.
Unfortunately, this mandate was not accompanied by the necessary budgetary or
time allotment for this purpose, so that its implementation still depends on
local arrangements, the priorities of principals, and the difficulties of the
staff in dealing with the subject.
On the other hand, the public interest in sex
education took a swing from the developmental-humanistic approach back to the
preventive-medical ones. Also, parties less interested in education jumped on
the bandwagon and attempted to lead campaigns by playing on the fears of the
public.
The National-Religions Sector Approach (Excluding
the Ultra Orthodox Approach). This educational system focuses on a
moralistic approach and normative behavior within the boundaries of the
religious framework. An integral part of this framework is the dichotomization
between public and private behavior. While the Jewish practice allows for the
fallibility of the individual and mitigating circumstances, it strongly forbids
the a priori consideration or discussion of alternative behaviors. Thus, an
educational discussion of the forces leading to premarital sexual behavior,
decision making, and alternatives within such situations can be done only within
a judgmental right-wrong framework in which abstinence is viewed as the only
appropriate alternative.
Several religious educators have been dissatisfied
with this approach and expressed their displeasure by participating in training
courses for sex educators in the secular sector, contrary to administrative
directives. They explain this by their wish to respond to the pressing needs of
their pupils beyond the formal and normative guidelines and by a personal need
for developing in this area.
Ultra Orthodox Educational Systems. There is
only indirect and fragmentary knowledge about sex education within the
“Independent Educational System,” run by the ultra orthodox sector, because
this system is not accountable to the administrator of the national curriculum
(see Section 14 on Ultra Orthodox Jews [Haredim]).
B. Informal
Sources of Information
Parents as a
Source of Information
Findings of a national study of youth sexuality from
the 1970s, augmented by some later studies using convenience samples and limited
populations studies, show that between the ages of 14 through 17: (1) parents
in general were viewed as a low source of information on sexual issues; (2)
daughters consulted more than sons with parents; (3) mothers are a much more
common information source than fathers; and (4) both parents were a very low
source of information for sons, although sons also consulted more often with
their mothers than with fathers. Finally, the tendency to view parents as a
source of information decreased with age - youth in the tenth and eleventh
grade were less likely to view their parents as a source of information than
were eighth and ninth graders. This change was bigger for sons than for
daughters. These results are supported by studies of unique populations such as
youth from problem families residing in boarding high schools, kibbutz youth,
and by youth general health studies that included sexuality components. Even
when similar pictures are different in important details, this can be explained
by the unique conditions of the studied populations.
A possible explanation for the findings that girls
interact more than boys with their parents, especially their mothers, on sexual
issues, can be that the interactions are not initiated by the girls but by the
mothers, who are both more concerned with the expression of female sexuality
and more comfortable in approaching their daughters.
This finding that daughters consult parents more than
sons conflicts with the findings that their objective knowledge is lower when
compared to male youth. An explanation might be that the interaction of
daughters with their mothers is more on issues of attitudes and consent than on
information, or that the higher ambivalence of female adolescents about their
sexuality does not allow them to benefit from the higher amount of interactions
with adults.
A recent study using a limited convenience sample
found a different picture that could be very important, if replicated in a more
generalizable form. In a high-middle-class senior high-school sample, parents
were the second most important source of information for girls and third for
boys.
This may indicate that urban middle-class parents are
now finding it easier to talk with their children about sex. This may be part
of the trend of increased acceptance of adolescent sexuality, or a reduction in
the distance between parents and their adolescent offspring.
There is a question whether parents are an
appropriate source of sexual knowledge for youth because of their emotional
involvement and their heterogeneity in regard to reliable information. Popular
sentiments, based on the general assumption that parental involvement in
education is desired, regard as problematic the findings that parents are a low
perceived source of information. Attempts are being made to change this
situation by interventions directed toward both youth and their parents.
However, the effort to increase parental involvement may also reflect adult
ambivalence over youth sexuality and the desire to control it.
Even if one accepts the belief that increased
parental involvement is desirable, these findings are insufficient grounds for
designing interventions; many studies need to be deliberately targeted at more
defined specific subgroups before intervention programs are designed. It may be
worth investing in programs to help parents to increase their role as a
resource for their children and to help fathers talk with and be more available
to their sons, only if the recent findings from the urban middle class are
confirmed and the explanatory assumptions hold.
The findings from the boarding schools may indicate
that in dysfunctional families, a parental substitute may be needed as a
reliable source of information, especially for boys whose fathers are either
physically or mentally absent and whose mothers find it difficult to interact
with male adolescents about sexual issues.
Other Sources
of Information to Adolescents
Concern over parents’ being a low resource is
heightened when other sources of information are viewed. Peers and older
adolescents are found to be the main source of information for both male and
female adolescents. This may increase parental and adult perception of loss of
control as these are potential sexual partners. In addition, the reliability of
this information resource is questionable because of the limited knowledge
among older adolescents and because it is biased by the agenda of the resource
persons.
While information from peers is in many cases
unreliable or incomplete, its language and tone are acceptable to adolescents
and young adults. It may therefore be beneficial to invest more efforts into
developing systems of peer education and peer training.
An important information source is the written and
electronic media. Unfortunately, much of the material directed to adolescents
is sensationalistic, commercial in nature, and/or caters to the lowest common
denominator. Thus questions/answers sections in youth magazines rarely deal
with ambiguities and some questions that have no definite or generalizable answers.
Another source of concern is the fact that more
children and youth report exposure to pornographic videos, especially among
males but also females, a result of cable television networks and the
popularization of video. (Pornography is discussed in Section 8C.)
Extent and
Reliability of Sexual Knowledge
Although knowledge is insufficient to assure healthy
or responsible sexual behavior, it is essential for their attainment. Knowledge
is also essential during puberty and adolescence to help prevent adverse
sequels of sexual behavior, like unwanted pregnancies and sexually transmitted
diseases.
It should be noted that, unfortunately, some of the
studies mentioned above used what is considered unsatisfactory measures of
knowledge, i.e., subjective perception of knowledge rather than measurable
objective ones. Studies by Ronny A. Shtarkshall in convenience samples have
shown a marked discrepancy between objective knowledge and the subjective
perception of knowledge about contraception; e.g., the fact that 90 percent of
adolescents in a large study reported familiarity with at least one
contraceptive did not mean that they really had the knowledge they needed to
use it.
When objective measures of knowledge were used, a low
level of knowledge was found among high school students, many of whom were
either sexually active or on the verge of initiating intercourse. Generally,
male adolescents demonstrated higher objective knowledge. Female adolescents
had higher score on signs of pregnancy and abortions, possibly because of the
personal concern with an unexpected pregnancy.
It is unclear why females who reported more
interactions with adults demonstrate lower knowledge. As was hypothesized
earlier, this could be because their contacts are on issues of conduct, but also
because they and the adults are more ambivalent about female sexuality and
sexual behavior during adolescence. This hypothesis is supported by limited
findings from a high-middle-class study that showed that positive feelings
about sex were positively associated with higher objective knowledge.
Sexual
Knowledge Among Professional Students
A study evaluating knowledge of professional students
in medicine, social work, and law at the Hebrew University in their first and
final years revealed rather alarming findings. First, medical school education
had almost no effect on the knowledge of medical students; only one of five
content areas, the biomedical, showed a positive effect. Second, the level of
knowledge was rather low, especially considering the professional needs of
physicians and social workers. Third, sexual experience was in marked and
significant association with subjective perception of knowledge. Fourth, there
were weak and inconsistent associations between sexual experience during
adolescence and objective knowledge. The combination of the two findings is
alarming. Since it is assumed that awareness of lack of knowledge is better
than perceived knowledge that is erroneous, the finding that medical students
are largely aware of their lack of knowledge was viewed as a mitigating sign.
Finally, even at this stage, age was positively associated with both increased
knowledge and a more adequate perception of knowledge. Extrapolating for a
younger age, this finding supports the hypothesis that older adolescents are
more ready, both cognitively and mentally, to enter into the sexual arena.
Several studies by Shtarkshall evaluated the lack of
knowledge apart from mistaken knowledge, assuming that people who are aware of
their ignorance are in a better situation than those who do not know, but
mistakenly think that they do. The finding that professional students were
largely aware of their lack of knowledge was viewed as a positive sign.
4. Autoerotic
Behaviors and Patterns
There are no known sources that document autoerotic
behavior patterns in the general population in a quantitative way. Even a
publication of a recent general population survey on sexual function and
dysfunction does not fill this gap.
Sexual history interviews with a large biased sample of
help-seeking individuals and couples show the following patterns. Among the
nonreligious, more men than women report masturbating either prior to sexarche
or after it. Also, more men than women report direct manual stimulation, while
fewer report indirect stimulation like rubbing the thighs, or thrusting and
rubbing against objects. These methods are more favored by women. There is a
question whether this is a difference in practice or a reporting bias, but this
question cannot be resolved on the basis of these reports in themselves. Among
the orthodox, and certainly among the ultra orthodox, the issue of reporting
bias is more pronounced, as male masturbation is a serious sin, while female
masturbation is only frowned upon and considered unhealthy.
There are many lay beliefs concerning masturbation
that are expressed mainly by adolescents and youth, either as questions or
comments within sex-education sessions. These are mainly lay beliefs concerning
general or reproductive health, and also the ability to identify a masturbating
person. For men, the beliefs include depletion of the semen, blindness or
shortsightedness, hirsutism on the palms, and an asymmetrical (bent) erectile
penis. Among women, there are admonitions about weak sight and about giving birth
to retarded children as a consequence of masturbation.
5.
Interpersonal Heterosexual Behaviors
A/B. Children
and Adolescents
Pubertal
Rites of Passage
See remarks on IDF service as a kind of rite of
passage for adolescents under Section 1B above.
General Lack
of Data
Attempts to elucidate the patterns of sexuality,
sexual behavior, dyadic relationships, and other sexual issues concerning
adolescents and youth are hampered by sociopolitical restraints. The last study
of sexual knowledge, attitudes, and practices in a national sample of youth was
done in 1970. In 1991, a proposed study of adolescent sexuality was approved by
a review system and then vetoed on educational and moral grounds by the
Director General of the Ministry of Education and Culture, a political
appointment of a religious minister. Even after the change of government at the
end of 1992, a lengthy and tortuous negotiation process about the same study
ended abruptly when the psychological services of the Ministry of Education
“changed its research priorities” and excluded the survey from them.
Most of the available quantitative information is on
secular youth with little on those who define themselves as traditional. All
information about religious youth reported here is anecdotal, although it
represents the cumulative shared experiences of a network of researchers,
counselors, and educators.
Puberty,
Adolescence, and Psychosocial Development
Very little research has been done on pubertal
stages. All studies have used convenience samples of Jewish girls. The normal
range for the onset of breast development in 1977 was from 8.22 to 12.38 years
and the normal (corrected) age for pubic hair development 8.58 to 12.58 years.
The normal range for reaching menarche is 11.09 to 15.49 years.
Several interesting effects associating pubertal
stages and social class or ethnic origin have been observed. Girls from low
socioeconomic class as defined by their fathers’ occupations, whose mothers
were poorly educated and who came from large families, reach the stages of
puberty later than other girls. All three variables are highly and
significantly associated with each other and with Middle Eastern/North African
origin. Sample sizes did not allow a distinction between the contribution of
ethnic origin (genetic) and social conditions (nurture) to this phenomenon.
It is possible that a secular trend is present, since
a comparison of menarche in separate studies of similar populations have shown
a drop of almost five months in mean age from 13.75 in the mid-1960s to 13.29
in the late 1970s. (This is not significant because of a large standard error
in the more recent study.) During this period, there was a large increase in
both the general standard of living and ethnic mixing.
The importance of individual and group differences in
pubertal development in relation to psychosocial sexual development is well
recognized but very difficult to study. Based on observations and anecdotal
information, a hypothesis can be advanced that among Israeli female adolescents
there is an inverted J curve relationship between age at puberty and the time
gap between the onset of puberty and the first sexual intercourse or sexarche,
i.e., girls who develop earlier and later than their peers may go faster
through a scale of the stages of sexual behaviors. (Information about male
adolescents is insufficient even for development of a hypothesis.)
As for social-class differences in puberty showing
that girls of low socio-economic class reach pubertal stages and menarche at a
later age, this may put some stressful pressure on them to act out sexually,
especially in integrated schools, because the influence on psychosocial sexual
development is exerted not through the abstract national norm, but through
interactions with the significant peers. Another pressure on adolescents of low
socioeconomic classes in schools, and especially in integrated ones, is the
need to excel. There is enough information to suggest that low achievement, in
comparison with a significant reference group, is associated with precocious
sexual activity.
Premarital
Sexual Activities and Relationships
This discussion of sexual practices among Israeli
youth focuses on two main issues: premarital intercourse and the context within
which it occurs, and on sexarche or age at first intercourse.
The issue of premarital intercourse during
adolescence is more complex than that of premarital intercourse in general. It
includes adult attitudes toward adolescents’ sexual expression and adolescents’
response to it, the interaction between adolescents, peers, and significant
adults on issues of control, and separation. It is very hard to treat these
different issues separately, and sometimes even to distinguish between them.
In general, studies up to the mid-1980s showed that
attitudes of Israeli youth concerning premarital intercourse, self-pleasuring,
homosexuality, and gender are more conservative than those of European and
North American youth. Attitudes among adolescents towards premarital
intercourse were associated with several independent variables: gender, age,
modernity (socioeconomic status of the family of origin), and religiosity.
Degree of agreement with two extreme attitudes toward
premarital intercourse - “Intercourse is forbidden before marriage” and
“Intercourse is permitted if both partners want it” (not qualified by age,
above 18, or by relationship status, in love or engaged) - are detailed in
Figure 1. In general, younger adolescents are more conservative about
premarital intercourse. Both younger boys and girls are more accepting of the
forbidding message than older boys and girls, while the situation is reversed
for both genders in relation to the permissive attitude.
The findings indicate that, in general, younger
adolescents are more conservative about premarital intercourse. (1) As
expected, acceptance of the permissive message increases and that of the
restrictive message decreases with age for both genders. (2) Comparing genders,
one sees that in various adolescent age groups, more boys than girls accept the
permissive message and more girls than boys accept the restrictive one. (3)
Both boys and girls are more accepting of premarital intercourse if there is an
emotional commitment, and more so if there is a formal public one, i.e.,
engagement. The commitment is much more important to girls than to boys. (4)
The discrepancy between boys and girls that supports a behavioral double
standard is more pronounced when males and females report their attitudes
towards virginity at marriage. Both genders express more permissive attitudes
toward males’ premarital intercourse. More than two thirds of females believe
that girls should be virgins at marriage, while less than half expect this of
their prospective partners. Among males, 10 percent believed that sex is
forbidden before marriage, while 43 percent felt that a woman should be virgin
at marriage. (5) There is also a discrepancy between attitudes and behaviors:
Males are more permissive in their attitudes than their behavior and females
more permissive in their behavior than their attitudes.
Figure 1
Attitudes of Adolescents Toward Premarital
Intercourse
These differences in premarital sex attitudes is more
pronounced if one compares older boys with younger girls. As this is usually
the pattern of pair formation, it can be a source of tension and discontent in
dyadic relationships, prior to initiation of intercourse and after initiating
it.
Mechanisms like denial and externalization used to
cope with these discrepancies can cause difficulties on the individual and
social level, including coercive behavior and problems in contraceptive
behavior. They can also lead to a reporting bias about intercourse.
In the religious sector, public norms are against any
premarital sexual expression, not just intercourse. Many structural and social
controls attempt to enforce these norms because of the common belief that,
while adolescents have natural urges, they lack the self control of adults -
such beliefs are also common among the more conservative elements of the
secular sector. The result is sometimes paradoxical: the constant warnings and
controls make people more aware of the temptation. The results may be dire when
those who transgress do not possess the range of skills that enable them to
protect their own needs while doing so. Those who transgress also have very
little chance of parental or even peer social support.
Trends in
Sexual Behavior, Premarital Intercourse, and Sexarche
Pooling the results of several different studies, one
is able to conclude that the trend from the 1960s to the 1980s is for more
youth to engage in premarital intercourse, and that a larger proportion of
those who do so start at a younger age. The increase in the reported rate for
younger women from the 1960s to the 1980s is three- to sixfold, the highest
increase for both men and women of all ages.
Figure 2 shows the trend to earlier sexarche among
urban women in one study. Caution is needed in using this study, the only one
giving data about premarital intercourse among urban Jewish women prior to
1965. This study has all the limitations of retrospective studies; the time
span between the occurrence of the events and the reporting point varies, and
the reporting may be influenced by a memory bias. In addition, it was limited
to married women in their first marriage, and thus it does not represent the
whole Jewish population. Both nonmarrying and divorce may be associated in more
than one way with the timing of first intercourse.
Figure 2 - Cumulative Percentages of Women Initiating
Intercourse at Different Ages, for Women Reaching Age 16 at Three Different
Periods (Cumulative Percentages of Those Who Practiced Intercourse at a
Calendar Year Prior to Their Marriage) - The differences between the three
studied periods are significant at the p = 0.001 level
Figure 2 also demonstrates an interesting phenomenon.
All three groups of women show a rise in the slope of the curve between ages 16
to 17 and 18 to 19. Since most Israeli youth leave home at that age to go to
the IDF, it seems that this is a critical age for the urban women.
In all studies of the urban population, more than 90
percent of the studied population - secular Jewish youth at high school, at any
age more men than women - reported that they had already had sexual
intercourse. However, the trend from the 1970s to the 1980s shows that the
gender discrepancy in decreasing. The ratio of urban men/women reporting
intercourse ranged from more than 8:1 for tenth grade and 3:1 in the twelfth
grade in the 1970s, to 3-4:1 in the tenth grade and 2-3:1 in the twelfth grade
in the late 1980s.
In the middle-late 1980s, between 12 and 30 percent
of urban females and 40 to 55 percent of males had reached sexarche by the end
of grade twelve; 2 to 11 percent of girls and 20 to 35 percent of boys were
sexually active at the end of grade ten.
The discrepancy in proportions between men and women
should be a source of concern. The three most widely used explanations in the
literature are: (1) the presence of a small group of young women who engage in
sex with many young men; (2) The initiation of young men into intercourse by
older women; and, (3) reporting bias. As far as is known, the age gap between
partners in most of the relationships among adolescents and young adults is
either very small or in the opposite direction, the men being older than the
women. There are no indications that there is a small group of women who
initiate many men into sexual intercourse. Also, the tradition of initiation
through sex-for-profit is relatively rare in Israel. It is thus probable that
the normative pressures reported above are acting on youth of both genders to
create reporting bias in the opposite direction: that is, more boys report
having reached sexarche than those who actually do so, with fewer girls
reporting it than those who do. An extensive experience with interactive sex
education programs dealing with normative pressures and sexual behavior lend
additional evidence to support this explanation.
The Context
of Sexarche
In studies of the context within which intercourse is
initiated during adolescence, a high proportion of youth reported that
intercourse is started within a steady relationship. This is more true for
females (95 percent of those reporting premarital intercourse in a large-scale
study) than for males (46 percent in the same study). The same picture is
apparent when comparing the length of relationships: more girls initiate
intercourse in longer relationships. Also, girls who were sexually active
reported higher frequency of intercourse than boys, which would be the case if intercourse
is practiced within a steady relationship.
Despite the general trend of initiating intercourse
within a steady relationship, a phenomenon of initiating intercourse with a
“sex object” is encountered in significant numbers. Youth of both genders report
that they chose a person for the sole purpose of losing their virginity, mainly
because “it was time.” Sometimes the chosen person is a different man or women
from the one they are in a current dyadic relationship with. Sometimes this
happens when they play the role of a sexually experienced person in the
beginning of a relationship and do not find a way out of the role; at other
times, they set out deliberately to find a person “to do it” with. Attention
should be paid to this group even if it is small, as they may be considered an
at-risk group. Because communications may be hampered by conflicting agendas
and pretending experience that is not there, and the commitment between the
sexual partners may be lower, it can be hypothesized that protection within
this group would also be lower.
Experience shows that youth who are able to consult
with parents or other significant adults, more often engage in protected
intercourse. Unfortunately, these are a minority, and those who do talk with
adults are usually older and less in need of this support than the younger
ones.
In looking at the length of relationship within which
intercourse is initiated, a seemingly contradictory picture appears. A higher
proportion of young women initiate intercourse within a steady relationship of
more than thirteen months as compared to the young men - 41 percent and 27
percent respectively.
Several factors, acting separately or in unison,
could contribute to this phenomenon. First, the study was done among high
school youth, and it is possible that the steady relationship of the young
women is with older men who are already out of school. This does not fit with
the higher proportion of males reporting the initiation of intercourse during
adolescence. Second, the study may be dealing with a double-barreled reporting
bias: young women, who feel that it is desirable to initiate intercourse within
a relationship, tend to overreport the duration of the relationship, or those
who start intercourse early in a relationship refrain from reporting it. An
additional contribution to this discrepancy is that a higher proportion of
casual relationships are between younger males and older females.
Premarital
Courtship, Dating, and Relationships and the Prospects of Military Service
The dyadic and sexual relations are highly influenced
by the required military service, even long before they have to enter the IDE
Awareness of this future in the life of each and every youth comes in many
ways, encroaching on the daily life of adolescents. Boys and girls are called
for physical examinations at age 17. Many of the boys and some of the girls
start even earlier on a road leading to one of the elite units or to a
desirable military task. Membership in an elite unit means three things: first,
a very high physical and mental competition requiring intense and long
preparation; second, a much more strenuous and dangerous service; and third, a
longer service, ranging from one to six years beyond the mandatory three years.
Not all Israeli youth actually espouse this lifestyle; those who do are the
pacesetters. The danger of getting killed or wounded in the army is small,
higher in the combat units, and still higher in the elite units where even the
training can be dangerous. The visibility and psychological impact on everyone
are very high and out of proportion to the statistical reality when compared
with road accidents or accidents in the workplace.
Working closely with youth and with facilitators of
sex education, one frequently encounters two ways in which this reality
influences youth in their midadolescence. First, lack of time to grow up and an
unsure future are often brought up as reasons for hastening sexarche, mainly by
boys but also by girls who find it hard to face these realities. Girls bring
these facts up as looming in their mind even when the boys do not raise them.
While it is possible that some young men use these as manipulative arguments,
many of them are also strongly concerned. This effect is also documented in
fiction and films, especially those by young artists. The summer before army
service is part of the cultural terminology that carries with it connotations
far beyond the surface.
Also encountered was an effect acting in the opposite
direction, to postpone initiation of intercourse. Girls from some conservative
environments, especially of Middle Eastern origin, may postpone sexarche in
expectation of the time when the family and social controls will be lowered,
and also out of regard for their parents’ feelings, honoring family values by waiting
until they are out of the home prior to initiating intercourse. Most of these
girls will not go to college, but when they come back home after two years, the
parents are already resigned to their new status.
Age of
Consent: Lowering the Social Controls Over the Sexual Behavior of Youth
In the 1980s, the law of consent underwent a
significant reform. Until then, the uniform age of consent - 16 - applied to
women only. While some interpreted this as an expression of the wish to control
the sexuality of women, others viewed it as expression of male threat to
females’ virtue. Toward the end of the 1980s, a change in the legal age of
consent took into consideration some of the changes in the behavior of youth.
While the age of consent remained 16 - again only for women, intercourse
between a girl aged 14 to 16 and a boy who was older than her by two year or
less would not be considered statutory rape in the context of this
relationship. On the other hand, the age of consent was elevated to 21 in cases
of intercourse with someone under the guardianship or influence of a
professional. The latter section applies to both men and women victims, but it
is still not clear whether it applies to perpetrators of both genders.
C. Young
Adults
Heterosexual
Relations and IDF Service
Life within the IDF strongly influences sexual
behavior, the formation of couples, marriage patterns, and gender issues.
By and large, the IDF is an institution of young
people, outside regular parental and adult social controls, with its own sets
of norms and pressures. Its immediate formal rules, which can be very
restrictive, are usually set and administered by people who are between two to
seven years older than those obeying them. For most youth, the regularity of
military life is highly irregular when compared to their previous lifestyle. On
the other hand, outside of defined training and active military duty, life in
the military leaves them with unregulated and unsupervised time in the
exclusive company of their peers. Despite being a male institution, the IDF
includes a high proportion of young women.
There are no formal or social restrictions on
fraternization between officers and soldiers, and very little emphasis on
military formality and distancing that to outsiders sometimes looks alarmingly
like anarchy. Since most youth serve in the army, and all officers rise from
the ranks, they are essentially of the same class and traditions.
These circumstances that offer many chances for
intimate and sexual encounters, combined with a rite-of-passage situation, tend
to give those who are not sexually initiated a chance to be so. This is
especially true for those who refrain from dyadic or sexual relations because
of external restriction. Many girls growing up in traditional families or communities
consciously postpone their sexual debut until the army, as an act of honoring
their parents. They view sex away from home as less encroaching on the parental
values. It seems that, by mutual consent, the question is not discussed between
parents and daughters. Most of these girls will not go to college, but when
they return home after two years, the parents are already resigned to their new
status.
The conditions and situations within the army service
are conducive not only to sexual relations, but also to pair formation and to
experimentations in relationships (see Section D below). The IDF environment
also creates two specific problems in regard to sexual behavior and gender
roles.
First, the permissive environment can impose a strong
hardship on youth from traditional backgrounds, especially those with lower
educational achievements, who find it very difficult to deal with the
relatively lowering of parental control over sexual behavior, coupled with
increased opportunities and the company of eligible mates. This is especially
true of some young women, mostly from families of Asian/African origin, who put
a great value on virginity, and who, finding themselves in an environment much
more permissive than their home atmosphere, lack the personal, experiential,
and social skills to cope with controlling their own sexual behavior. Add to
this the fact that those behaving permissively, including other women, are the
ones with the prestigious jobs and high social status, and one gets a
problematic situation. To resolve this conflicted situation requires internal
controls and social skills that some of these women do not possess because of
their traditional sheltered upbringing. For some who feel that once they have
lost their virginity they are tainted, the result is promiscuous behavior. For
others, it is a contributing factor to their inability to use contraceptives
resulting from externalizing what they are doing. Internal conflicts regarding
the fact that they are engaging in intercourse are sometimes resolved by the
feeling of being repeatedly subjected to it “unintentionally,” a solution that
also precludes the use of contraceptives. The majority of soldiers applying for
abortions through IDF come from this background.
To counter this, the IDF women’s corps targets women
with low educational achievement as a priority group for sex education
programs. These programs attempt to strengthen their self-image and internal
controls and to allow those who initiate intercourse to preserve both their
self-respect and health.
A second factor is that Israel is a geographically
small country. With very strong family ties, most soldiers in the combat units
get home regularly every second or third week for a long weekend. It is rare
that they will not get home for a month or more. It is thus possible to
preserve dyadic relationships and meet with girlfriends on a regular basis. On
such weekends, the soldiers, who are both tired physically and under a lot of
emotional stress, try to cram in as much eating and sleeping together as they
can. Their girlfriends accept the role of supporters and nourishers, a
traditional motherly role, because they know how much hardship the boys have to
take. There is also a tacit agreement not to raise disagreeable issues. This
creates a situation in which the partners establish a pattern of separate
traditional roles at the early stages in the relationship. It may also create
regressive symbiotic dependence, where one is feeding into the relationship
different components and relies on the other to supply the missing ones.
Cohabitation
Unmarried cohabitation has become more prevalent in
recent years. Its frequency is unclear, but it is certainly much more visible
and acceptable, mostly among middle-class, secular youth, either working or in
higher education. This is a change from a generation ago when fewer couples
cohabited, and then mostly after having decided to get married. Although this
phenomenon has been little studied in Israel, the combination of anecdotal data
and educational experiences suggest several points of interest:
1.
While cohabitation is less binding than marriage
and is often perceived as an experiment in dyadic relationships, the partners
are expected to be monogamous.
2.
Although somewhat more flexible than married
ones, cohabiting couples adhere to traditional gender roles.
3. Cohabitation
sometimes develops through an interim semi-communal stage, as when two or more
boys or girls or a mixed gender group share an apartment for economic reasons.
When one of them forms a liaison, the partner sometimes moves in and shares the
bedroom in that communal arrangement. It is only at a later stage in the
relationship that the couple sets out to find their own apartment. The initial
stage is characterized many times by advertising it only among the peers and
not sharing it with the parents, at least not immediately. The movement to the
private apartment is usually done with parental knowledge and/or consent.
4. Parental
consent, either implied or overt, is no refuge from the feelings of tensions or
ambivalence on both sides. When interviewed, several women in such arrangements
mentioned that either their father or mother had a difficulty in relating to
either the bedroom or the shared bed when visiting their apartment.
5. It
is possible that cohabitation is part of the larger phenomenon of extended
moratorium that Israeli youth take after IDF service. Co-habitation creates an
interim stage between the public announcement of the relationship and creating
a formal commitment.
6. Cohabiting
young adults who eventually marry, although not necessarily with the cohabiting
partner, suggest some ambivalent attitudes to marriage. On one hand, there is
dissatisfaction with the parental model of marriage and reluctance to
perpetuate a similar pattern. On the other hand, the idealization of marriage
and attachment to it as an institution drives them to aspire to an improved
version. This may act against the crystallization of traditional gender roles.
7. There
are anecdotal indications that cohabiting is, for a growing number of couples,
an expression of shunning the rabbinical religious ritual and a rejection of
the legal ramifications that it entails. Resolution comes either by using one
of the tolerated civil arrangements or in postponing the religious ritual until
the last moment when they plan to have children.
8. Breaking
up a cohabiting arrangement seems to be more difficult than breaking up a
noncohabiting relationship, and the phenomenon of feeling entrapped in a
relationship is encountered also by cohabiting couples.
9. When
deciding to marry, couples express it as either taking another step along the
road or as wanting to formalize the relationship in order to have children.
Many cohabiting couples marry when the women are already pregnant.
D. Marriage
Patterns
Legal Age of
Marriage
The legal age of marriage is distinct from the age of
consent. It applies only for women, and currently it is 17. Ronny A.
Shtarkshall was involved as an expert witness in an attempt to apply both age
of consent and legal age of marriage to men also. This was barred in a
parliamentary committee by a representative of a human rights party on the
grounds that this will complicate things and that, while women need protection
from men, men do not need protection from women.
Age at First
Marriage
In comparison to other Western industrial countries,
Israelis marry relatively young. This is true even if one looks separately at
the Jewish population. In 1990, the median age at first marriage for Jewish
brides was 23.2 and for grooms 26.0. It seems reasonable that many marriages at
the younger age were initiated by encounters within the service in the IDE In
1990, roughly 25 percent of all the men who married for the first time did so
between ages 20 and 23, and a third of the women marrying for the first time
did so between ages 20 and 22, the years immediately following the service.
Among the Arabs, Moslem women marry for the first
time at the median age of 20.0, more than 3 years younger than their Jewish
counterparts, while the men marry at 24.4, only about a year and a half younger
than Jewish men. Among the Christian Arabs, the median age is only a year
younger for women, 22.5, but a year later for the men, 27.5.
In Figure 3, we show the changes in age at first
marriage of the Jewish population over four decades. It is evident that between
the early 1950s and mid-1970s there was a drop of more than two years in age at
first marriage of Jewish grooms from 27 to 25. Among Jewish brides the
phenomenon is very similar, but smaller, a drop of about one year (23 to
22). This drop is due to the mass immigration from Moslem countries in the
mid-1950s and early 1960s. The tradition of these Jewish communities favored
early marriage, similar to the Moslem host cultures. This effect on the mean
marriage age of brides is less pronounced - and in the median age even
nonexistent - because traditionally, brides were younger than the grooms and
were married at a very young age, 14 to 16. The Israeli laws forbade such
marriages, raising somewhat immediately the marriage age of brides.
Figure 3 - Age at First Marriage of Jewish Men and
Women
Since the mid-1970s, there is a steady rise in both
mean and median age of first marriage for both brides and grooms. The rise is
larger for women than for men. It is suggested that this rise is the result of
educational changes, especially those affecting immigrants from Islamic
countries that had a greater impact on women who were educationally
underprivileged in comparison to men. It is also possible that the social
acceptance of cohabitation has contributed to the rise in age at first marriage
for both genders.
Marriage
Formation
Among the Jewish population, most first marriages,
especially those that do not deviate by more than a few years beyond the median
age for first marriage, are based on personal choice and attachment. This is
true for the secular, traditional, and orthodox segments of the Jewish
population, the exceptions being the ultra orthodox and small groups of
immigrants from Georgia, Ethiopia, and the Caucasus. Even among the immigrants,
the pattern is changing, and many arranged marriages merely formalize
previously formed attachments. Youths from some immigrant groups explain that
they go through the motions in an attempt to preserve cultural traditions and avoid
conflict within their families. The pattern of marriage formation among the
ultra orthodox Jews and among Moslems, the largest group of non-Jews, will be
discussed in the special sections dedicated to them at the end of this chapter.
At an indeterminate point beyond the median first
marriage, the pressure on the unmarried to conform increases. Participation in
family weddings becomes a burden, as many people use the traditional
well-meaning but stress-generating blessing “Soon at your wedding.” This is
especially stressful to people with homosexual orientation and those whose
self-image keeps them from initiating pair formation. At this point, families,
especially mothers, sometimes turn to matchmakers and the young adults agree.
The young adults themselves sometimes resort to meeting people through
advertising in the newspapers. It seems that these channels are used by a
minority of the population.
Interethnic
Marriages Among the Jews
It is estimated that 15 to 20 percent of the
marriages of secular and traditional Jews are among those who originate from
different parts of the world, mainly Ashkenazi Jews, originating mainly in
Europe, and Sephardic ones, who lived during the last 500 years in Islamic
countries. The rate is somewhat lower among the orthodox and lowest among the
ultra orthodox. The melting-pot ethos, high mobility of the Israeli society,
and the strong mixing effect of the army all contribute to this.
Marital
Variations: Polygamy
Polygamous marriages were prevalent among several
Jewish ethnic groups, especially those immigrating from Islamic countries.
During the peak immigration years of the 1950s, there was a great outrage about
polygynous marriages, mainly from women’s organizations, and they were outlawed
almost immediately. This civil law contradicted both the Jewish Halachic law
(as interpreted in these Jewish communities) and the Islamic law and tradition.
Common Law
and Civil Arrangements
The courts recognize the status of a “common-law
spouse” for the purpose of property division, inheritance, pension rights, and
carrying a name. It also recognizes civil marriages enacted in foreign
countries by citizens of Israel, and cohabitation contracts enacted according
to the civil code, even when the religious courts ban these specific unions. As
a matter of fact, these arrangements evolved in order to solve cases that rise
from the conflicts that have already been referred to between the Halachic
canons and the secular public.
Other patterns of marriage, like homosexual
marriages, are not recognized by Israeli law, and single people find it very
hard to adopt children.
Divorce
The Israeli divorce rate is lower than that of the
U.S.A. and non-Catholic European countries. Still, the rates of divorce per
1,000 ever-married people aged 15 to 49 rose monotonously by 48 percent from
1973 to 1983 from 6.5 to 9.6 respectively for husbands and from 5.3 to 8.2 for
wives. In 1983, the denominator was changed to 1,000 married at all ages;
comparison between the two periods is difficult. Since 1983, the rate has
fluctuated, rising from 5.8 in 1983 to 6.4 in 1991 (new rates), about a 10
percent increase.
A time series analysis of rates of divorce after
specific duration of marriages reveal that the increase in rate of divorce is
due only to increase in rate of “late divorce.” It is the rates of divorce
after nine and twelve years of marriage that are still on the rise. The rate of
divorce after two years of marriage did not rise at all since the early 1960s
and may even have come down slightly. The rate of divorce after six years of
marriage has remained stable since the early 1970s; see Table 1. These findings
are somewhat puzzling as formal marriages are almost universal, the percentage
of secular people is similar to most western European countries, and the Jewish
religion is more tolerant toward abortion than Catholic Christianity. The
relative stability in Israeli marriages supports the claim that the family is a
central theme in Israeli society.
One result of the increase of late divorce is an
increase in the average duration of marriages that ended in divorce - a rise
from 8.3 in the early 1960s to about 11 in the late 1980s and 11.9 in 1991.
However, this increase in the duration of the divorcing marriages by almost 4
years was not accompanied by a similar increase of average age of divorce. For
men, the average age at divorce for the same periods is 40.0, 38.6, and 39.4;
for women it is 35.1, 35.2, and 35.8 respectively.
This means that the proportion of the couples who
marry at a younger age among the divorcing couples is higher than among other
couples. This is a sobering observation regarding marriage at a younger age if
one regards stable marriages as desirable.
Table 1
Couples Who Married in Israel and Divorced, by Year
of Marriage and Selected Periods of the Duration of the Marriage
|
Cumulative Percentages of
Divorcing Couples1
|
||||
|
Elapsed Time:
|
2 Years
|
6 Years
|
9 Years
|
12 Years
|
|
Years Married:
|
||||
|
1964-1967
|
2.7
|
6.0
|
7.5
|
8.9
|
|
1968-1969
|
2.4
|
5.4
|
7.5
|
8.8
|
|
1970-1971
|
2.4
|
5.6
|
7.5
|
9.2
|
|
1972-1973
|
2.4
|
5.8
|
7.9
|
9.6
|
|
1974-1975
|
2.6
|
6.6
|
8.7
|
10.4
|
|
1976-1977
|
2.5
|
6.9
|
8.9
|
10.7
|
|
1978-1979
|
2.9
|
7.2
|
9.4
|
11.0
|
|
1980-1981
|
2.7
|
6.9
|
9.3
|
|
|
1982-1983
|
2.7
|
7.1
|
||
|
1984-1985
|
2.6
|
6.6
|
||
|
1986-1987
|
2.9
|
|||
|
1988-1989
|
2.2
|
|||
1 The formula used is: Number of couples divorcing after the
specified interval from marriage period divided by the number of couples who
married in a specific period times 100.
Extramarital
Relations
Another measure for the quality of marriages is
extramarital affairs. There is no reliable research evidence about the prevalence
of extramarital affairs among married Israeli couples but anecdotal evidence,
the reports in the newspapers about extramarital affairs of celebrities of all
kinds, and the citations in divorce cases lead one to believe that the
prevalence is rather high. Evidence from counseling, and from extensive
education and information work among adults, leads one to believe that
extramarital affairs, even known ones, are not in themselves sufficient to
destabilize marriages.
E. Marital
Law and the Status of Women
The law in Israel gives authority over personal
issues to semiautonomous religious judicial systems of the recognized religious
communities. Cases are tried according to the religious laws of each
denomination. This is one of the reasons why conservative fundamentalist
elements within the non-Jewish religions sometimes support Jewish religious
parties, and even vote for them. Opponents of religious rule over personal
issues sometimes refer to this as the unholy alliance.
Marriage and divorce issues of Jews are therefore
largely determined by the religious Halachic law, although the civil law may
also be resorted to in issues of division of property and custody of children.
For a secular Jew, the patriarchal nature of the Halachic law creates an asymmetrical
and undesirable power balance between the marriage partners.
This situation should not be fully attributed to the
power of religious politics. They have at least the passive support of large
segments of the secular majority. Attempts to create a situation in which
secular civil marriages will be recognized under the law have been defeated
several times under different governments. The claim of orthodox Jews, who are
a minority, that this will create a schism within the nation that will end up
in a disaster, strikes a chord in the heart of many nonobservant Jews. On the
other hand, several developments suggest that the power of the religious
establishment is diminishing (see below).
Jewish religious laws and the practice of the
religious courts place women in a highly undesirable position for those who do
not accept the canonic tenets. They cannot be judges in the rabbinical courts
or even testify officially; they can only present their case. According to the
Jewish religious laws, the men have more sexual freedom, even within a
marriage. The husband is the grantor of a divorce and the wife is the acceptor.
Even the religious courts cannot force a husband to receive a divorce against
his will. On the other hand, there are several reasons why a divorce can be
enforced on a women, one of them being adultery. As the duty to procreate is
placed on the man, he may be granted permission to marry a second wife, when
his first one is infertile and refuses to accept a divorce after ten years of
marriage.
F. The Incidence
of Oral and Anal Sex
Although anal intercourse was proscribed by law until
recently, the restriction was almost never applied to heterosexual couples. A
prosecution dealing with a heterosexual couple did result in a ruling by the
then Legal Advisor and Chief Prosecutor, that strongly restricted the legal
control of sexual issues (see below).
There is no collected data on the prevalence of these
practices, but the experience of counselors and therapists point to the fact
that all are practiced by significant numbers of couples. It is interesting to
note that several subgroups in the Israeli population, Jews and non-Jews,
practice heterosexual anal intercourse as a means of keeping an intact hymen
and as a birth control measure, where the loss of one and the appearance of the
other can be highly stigmatizing, damaging, or even dangerous.
The approach of orthodox Judaism is expressed in the
fact that it frowns upon these practices but does not proscribe them. A
Talmudic story illustrates this approach very clearly, although using
metaphorical language. A woman approached one of the sages with a complaint: “I
set a table for my husband and he turned it around.” The sage answered: “What
can I do, daughter, and the scriptures permits him.” There is a question
whether the story deals with the issue of anal sex or with vaginal rear entry,
but at least some of the commentators agree that anal sex is the issue. This
can be perceived on one hand as ambivalence, but on the other as a realistic
view of human nature.
6.
Homoerotic, Homosexual, and Ambisexual Behaviors
A. The Legal
Situation
Until recently, homosexuality - or rather anal
intercourse (sodomy) including heterosexual anal sex - was illegal in Israel.
This was an inheritance of the British colonial penal code of 1936. According
to gay organizations, victimization of homosexuals on the basis of this law was
frequent.
Changes have occurred gradually and evolutionary,
starting in the early 1960s. Despite the illegality of anal intercourse, the
then Legal Advisor to the government and Chief Prosecutor and later Supreme
Court Judge, H. Cohen, ruled that sexual intercourse between consenting adults,
in private, cannot be a basis for prosecution. Since 1972, five attempts had
been made by members of different parties to strike this sodomy statute from
the penal code. In 1988, a political opportunity allowed its revocation. An
amendment to the Equal Opportunity Law passed in 1990 also protects the rights
of homosexuals to employment.
The attempts to change the law were accompanied by
both public campaigns and many changes in public mood toward homosexuals and
homosexuality. Until the mid-1970s, the IDF discharged homosexuals for
psychiatric incompatibility and/or for being a security risk. This was changed
prior to the 1988 legal change, and the IDF made several arrangements that
allow homosexuals to serve without being exposed to undue difficulties.
Currently, several issues are being contested in the
courts, mainly rights of cohabiting males that are usually granted to spouses
under the rulings of common-law marriages. The issue is not as simple as it
looks on first sight, especially when considering the regulations governing the
pension rights of spouses when the principal owner of the rights dies. Male
spouses have smaller pension rights as survivors than females. In the case of
cohabiting gay men, this will give the couple an economic advantage over
heterosexual couples.
B. Public
Atmosphere Concerning Homosexuality
Several factors combine to make issues of homosexuality
very difficult to cope with:
1.
The political power of the orthodox-religious
sector within the Jewish population and the opposition/respect ambivalence of
the secular sector are major factors. While shifting from viewing homosexuality
as a crime to medicalizing it, the orthodox religious still strongly opposes
its public sanction.
2.
The high sex-role polarization in Israel is part
of the perceived centrality of gender differences that have both cultural
origin and social importance. Tolerance of Israelis to homosexuality is
inversely related to their sex-role polarization, and lower than that of
American students living in Israel in proportion to the differences in sex-role
polarization. Homosexuality, especially male homosexuality, threatens the world
picture of two dichotomized genders.
3.
Homosexuality is perceived as incompatible with
the familial structure, which is of central importance within Israeli society.
In early 1993, a gay/lesbian conference was held in
The Knesset (Israeli Parliament), despite strong protests from members of
religious and right-wing parties. Public response to the conference, and to the
personalities who discussed their difficulties, created further changes in both
attitudes and practice.
A still problematic issue is that of open gay
cohabitation. Although possible and prevalent, many people feel uncomfortable
about it, and some express opinions that this is part of homosexual activism
attempting to influence heterosexuals.
C.
Homosexuality in Sex Education
Despite the fact that homosexuality is part of the
sex-education curriculum and several units deal with homosexuality in general
and with homophobia in particular, it seems that both school administrations
and sex educators still find it uncomfortable to deal with the issues properly.
Many youths, therefore, go through school without encountering issues of
homosexuality in sex education, a fact that in itself constitutes a very strong
message, to both homosexual and heterosexual youth, and especially to those who
are still ambivalent about their orientation or wonder about it. Adolescents
uncertain of their sexual orientation or gender identity will hardly find
support within the school system, as there is no systematic training and
recommendations on how to deal with these issues. Normative pressures to
conform are high.
An interesting difficulty in facilitating issues of
homosexuality in the schools was encountered during the training process of sex
educators. Several educators justified their reluctance to deal with homosexuality,
expressing fear of their own biases or stereotypical thoughts. Facilitators
from the Association for Individual Rights, the Israeli equivalent of a gay
task force, supported this position, claiming that only gay people are
sufficiently unbiased and sensitive enough to facilitate educational programs
on homosexuality.
7. Gender
Conflicted Persons
Gender conflicted persons find it difficult to be
evaluated and cared for in an organized and controlled way. There is not one
center that has a comprehensive program for sexually conflicted people, and the
authors know of several occasions that surgical interventions were accomplished
without going through a protocol of evaluation/care/treatment. Other cases,
where the psychiatric and psychosocial questions were resolved properly, had to
go abroad for the surgical procedures. Professionals may be wary to raise the
issues, for fear of invoking restrictive regulations that will even lower the
ability to supply the needs of these people.
8.
Significant Unconventional Sexual Behaviors
A. Coercive
Sex
The categories in the criminal records of the Statistical
Abstracts do not distinguish between subcategories of sexual crime and
include sexual abuse, incest, and rape under sexual offenses. It is agreed by
police, researchers, and activists alike that sexual offenses are probably one
of the most underreported crimes. There is some disagreement as to the extent
of underreporting as well as to the definition of criminal sexual offenses.
Sexual
Harassment
The special circumstances of service in the army may
create a convenient atmosphere and even stimulate sexual harassment. Since most
officers in the three lowest ranks of IDF are not career soldiers, but
extending their compulsory service, they are selected from the general
mainstream of Israeli youth. Because IDF is in active combat, the selection of
male noncommissioned officers (NCOs) and commissioned officers is based on,
among other things, aggressiveness, charisma, initiative, and improvisation.
These same officers, who are also in the closest working relationship with both
men and women of the rank and file, are also older by two to five years, as
compared to the compulsory service women - and in addition, are in a position
of authority. Add to this the fact that IDF is organized mainly around values
that are traditionally identified as male, and one gets an environment in which
women are at a disadvantage. This creates situations that have a potential for
sexual harassment on the one hand and manipulative relationships on the other.
There is another situation affecting older male
officers of higher rank who are usually married. In combat units, the
commanders are in direct daily contact with enlisted soldiers. As one of them
phrased it in a group situation: “We grow older all the time, but they always
remain at the same age, and we have to compete with them all the time.” The
context of this remark clearly indicated that women were part of the
competition. It is unclear whether these officers are only in a power position
or also in a very vulnerable one. Such environments and motivations have high
potential for abuse of power.
The official stand of the army concerning harassment
or misconduct, is strong, with several structural arrangements that attempt to
counterbalance the potential for abuse. First, all women dormitories are out of
bounds for men, including the officers commanding the camps. On any official
supervisory visit, a male officer must be accompanied by an officer of the
female corps. All female soldiers have direct access to an NCO or an officer of
the female corps whose source of authority comes from an independent chain of
command headed by a woman general. Complaints of sexual harassment, or any
other issue of a sexual nature, are dealt with independently by the authority
under which the woman is serving - the female corps - and if necessary, by the
military police and prosecution. A highly publicized case is that of a general
commanding the navy who was dismissed from the IDF for misconduct the day after
he was acquitted in court of rape charges, for lack of supporting evidence.
Despite this, it seems that harassment is prevalent
and is a source of concern to both women and the military establishment. In a
structurally male, aggressively oriented organization, there is strong
ambivalence in treating sexual harassment issues, and there are documented
cases of attempted minimalizing of complaints, especially when they concern
officers with high military potential.
The difficulty lies in what is construed as
harassment in the eyes of male and female soldiers. Moreover, many young women
find it very flattering, even important, that high-prestige men in the
immediate environment are attracted to them. There are also cases where such
situations are used manipulatively by the women, this mainly with younger
officers.
Several educational efforts are now in process to
inform both genders about their rights and about the feelings and points of
view of the two genders on this issue. It is believed that legal as well as
educational efforts are urgent because, beside the individual aspect, sexual
harassment can be used as a means to keep a disadvantaging power balance.
Incest
In Jewish tradition, incest is such a heinous act,
that according to the Halachah, it is one of the only three crimes that
a person should prefer being killed rather than commit. This may explain the
shroud of silence and shame covering the issue of incest. For many years, this
was an unheard-of crime.
In recent years, the changes in public climate, the
establishment of child/youth investigators, and the change in the rules of
evidence, allowing the investigator to testify for the child, have increased
the number of cases in which incest is reported and prosecuted.
Unfortunately, charges of incest (like battering) are
sometime used as weapons in attempts to get vacating orders and/or custody
between divorcing couples.
There are some interesting research questions that
need to be clarified, which will have strong bearings on preventive
intervention and treatment: first, the differences between the legal
definitions of family and of incest in different cultures prevailing in Israel;
second, the contribution of the increase in nonbiological parents or siblings
living together to the increase in the phenomenon.
Rape
A marked change in public attitude in Israel toward
rape and rapists occurred in the 1980s and early 1990s. This is mainly due to
the activities of rape-crisis centers founded by the feminist movement and to
their political and public campaigns. These campaigns resulted in changes in
the rape and sexual assault laws, mainly the abolition of the need for
additional material or other evidence, to that of the victim, in order to
convict a sexual offender, an increase in the punishment range given within the
law, and a redefinition of grave assaults done with the help of a weapon or
gang rape. There were also some changes in the rules of evidence, making it
impossible to bring into the trial the previous sexual behavior of an accuser
or a witness.
There were also changes in the treatment of
survivors. Special examination centers were arranged in emergency rooms in
hospitals in each of the big urban centers in which the staff were trained both
by police, by professionals, and by the volunteers of the rape-crisis centers.
There are special courses for police investigators, and the volunteers of the
centers are allowed to accompany survivors throughout the police
investigations.
These changes, which are by and large positive,
nevertheless raise some problematic points: first, how to maintain the right to
a fair trial and the principle that people are innocent until their crime is
proved beyond reasonable doubt; second, the mixing of political and educational
work aimed at eradicating rape, with prevention work in a society were rape is
still prevalent, with crisis intervention, and with treatment of survivors can
create some confusion and ambivalent messages.
A study presented at an international conference on
victimology found some interesting phenomena that could cause some concern in
this direction. The study compared the attitudes of two groups of professionals
whose job was to treat rape survivors, police investigators, and emergency-room
rape specialists, with those of helping-professions students and those of the
volunteers of the rape-crisis centers. It was found that on several scales, the
rape-crisis volunteers were more likely to take extreme positions, even when
compared only to the women in the other groups. For example, they strongly
disagreed with any assertion that there is a possible environmental involvement
in the probability of rape, an attitude that seems to be problematic for
prevention work. Despite the fact that they were one of the smallest groups,
the standard deviation of their opinion scales was the smallest, indicating a
very uniform norm. There is at least one case in which a woman who confessed in
court that she had made false accusation of rape against a man cited the
pressure by the volunteers as the reason for the filing of the complaint. One
has to be careful with such an allegation, because it may be an attempt to
lighten the personal load.
Another issue of concern, debated in public, was the
slogan that “every man is a potential rapist” proposed for a public service
announcement spot. When challenged, it turned out that the intended messages
were that one cannot distinguish by appearances a rapist from other men, and
that rapists are “ordinary” people. While in itself a political statement open
to argument, this is a far cry from the initial message, which was understood
by many men and women alike as stating that in every man there exists a
potential for rape.
B. Prostitution
The Legal Situation
Israeli law on prostitution is somewhat complicated.
Prostitution itself is not outlawed, but soliciting is, and so are the
operating of an establishment used for prostitution and living off the
proceedings of prostitution.
As a result, there are several arrangements through
which sex workers sell their services and there are “classes” of sex workers.
Lowest on the ladder are the “street” or outdoor prostitutes, many of whom also
perform the sexual act outside. Higher up are sex workers operating in hotels,
especially in tourist hotels, and those operating through some of the escort services
that are currently freely publicized with advertisements on the fringe of
legality. So, also, are massage parlors, which became a euphemism for sexual
services with allusions to “relaxation.”
There have been several media articles describing
another kind of arrangement, which is reportedly limited to students,
professionals, and middle-class women “supported” by a few men who are regular
and exclusive clients. According to the reports, these arrangements are usually
temporary, particularly among students.
Several attempts to change the legal situation by
licensing prostitutes, putting them under medical surveillance, and allowing
them to keep places of business, have failed mainly due to the opposition of
the religious parties in the parliament.
Pimping: The
Exploitation of Female Prostitutes
Although the pimps have traditionally belonged to the
lower echelons of individual male criminals, they get most of the profits from
prostitution. The women under their domination are kept in line by threats and
the use of force.
There were several reports of specialists “hunting”
young, runaway adolescents around the central urban bus stations, befriending
them, and offering them shelter, and gradually moving them into prostitution. A
more recent phenomenon in Israel involves importing women from the former USSR
under forged papers and employing them in prostitution. This operation has many
of the characteristics of organized crime, and the women are totally at the
mercy of their “employers,” as they are in a strange county with no valid
documents.
Homosexual
Prostitution
Several areas in the urban centers are known to be
mainly or exclusively the territory of male prostitutes. Several reports have
shown that, as with female prostitution, many of the sex workers are early or
middle adolescents. Apparently, despite the fact that homosexuality is no
longer a criminal offense, the police are checking constantly on these areas,
and there were some reports of them keeping “pink lists” of male prostitutes.
These reports were denied by the police authorities.
Transvestites
Several reports have revealed that some of the female
sex workers are really male transvestites who are not gay and who do not cater
to a gay clientele. These sex workers, some of whom have undergone hormonal
treatment to grow breasts, pretend to their clients to be female prostitutes.
They mainly provide fellatio; when asked to perform vaginal sex, they depend on
their ability to stimulate the client to orgasm prior to penetration.
C.
Pornography and Erotica
The Legal
Situation
Until recently, Israel had at least nominal
censorship on the theater and cinema. Written and audio materials were
regulated only on grounds of security and not moral ones, and only public
pressure created some restrictions. Abolishing censorship on the theater and
cinema in 1990, part of an ongoing process of increasing the boundaries of
freedom of expression as a basic human right, allows the production and
dissemination of explicit sexual acts, and of violent ones, in print, film, and
video formats.
Currently, despite the fact that there are less
restrictions on moral grounds, there is a relatively recent law about
displaying offensive materials in public that allows people to sue for damages
if their feelings are hurt by specific items. Until now, the attempts to use
this law have been restricted to religious issues. It seems that this does not
include films or otherwise displayed for a fee, especially if the public is
warned about the presence of sexual materials. This is still vague, since
different aspects of the law have to be tried through a full cycle of
litigation before its extent and effectiveness are established.
Restrictions on importing pornographic materials in
commercial quantities by customs control are inefficient, and developments in
satellite television and videotaping make them obsolete. This, combined with
the rise in VCRs during the 1980s and cable television in the early 1990s,
expose much wider segments of the population to both soft and hard pornography.
Another prominent development concerning the public treatment of sexual issues
is the increased commercialization of sex that started in the mid-1980s and
intensified in the early 1990s.
Response of
the Religious Sector
There is opposition to the increase of explicit
materials aired in public from the religious sector. The more orthodox do not
allow TV sets in homes and would shun those who do. Their reactions toward the
treatment of sexual issues in public range from the economic boycotting of
products promoted by what they consider offensive depictions in their
advertisements (including dinosaurs!) to the defacing of commercial display
windows and the burning down of bus stops. Because the glass/plastic walls of
bus stops in Israel are used for displaying advertisements, conservative
religious youths mounted a campaign of destroying bus stops displaying
“offensive” ads. They later managed to persuade both advertisers and
advertising firms, through boycotting, to change their policy and display
different ads in areas where there is a large population of ultra orthodox.
The Response
of the Secular Public
Secular Jews are mainly concerned with two other
aspects of pornography: sexual depictions that are demeaning or threatening to
segments of the population and the effects of pornography on children and
adolescents.
The influence of pornography on children and early
adolescents is a source of concern to some parents, psychologists, and
educators. Because sex is a very private matter, children and adolescents who
are exposed to pornography have no objective criteria to compare it to and may
believe that many or most of the things shown are part of normative behavior of
adults. This may cause some difficulties in their emotional reactions to adult
and parental sexuality. They are also unaware of the manipulations that are
done in making these films, and that can create problems of self-image or fear
regarding the sexual organs. There has been speculation that several cases of
sexual violence among adolescents, especially those involved with group sex,
are related to pornography. Despite the fact that there is no hard evidence to
support this assertion, it cannot be ignored and should be researched
appropriately.
Two issues are at the core of the secular political discourse.
First, which of the following is the most prominent feature of pornography: the
commercialized and dehumanized treatment of the human body, the linking of sex
and violence, or its use by heterosexual males to dominate women and to
perpetuate a sexist and heterosexist society? The second issue focuses on how
to counteract the pernicious effects of pornography and whether censorship or
social control are a remedy, or a worse disease.
Sex Education
and Pornography
Several efforts are being made to incorporate units
dealing more effectively with pornography and its impact within the sex
education programs in schools. The basic approach is that since there is very
little hope of lowering the exposure of children and early adolescents to
pornography unless there is a major social change, it is important to give them
the skills to deal with its potential effects. The concern is focused on the
explicitness of such units and on the claim that they may raise the interest in
pornography or lower the barrier to exposure.
Paid Services
by Telephone
Privatization of the telecommunication monopoly in
1990 brought with it many new initiatives for marketing new services. One of
these was caller-paid telephone (056) numbers offering medical advice,
astrology maps, practical information, and in the sexual area, advice,
introduction services, party lines, and sexual-talk bulletin boards. Each of
these meets the different needs of people with sexual interests.
At their best, sexual-advice services supply minimal
sexual information and a referral service. Callers have no idea of the
expertise, knowledge, or training of the persons who provide advice. Some
services attempt to do counseling, not the crisis intervention of hot lines,
but on a more extensive, sometimes therapeutic level. It is questionable how
helpful these procedures are. The service does supply the very strong need of
some people who suffer from sexual doubts or problems, the need to get advice
without the risk of exposure. If done properly, it could be helpful; however,
it can also postpone the time that people will reach out for needed help. Also,
lay people exposed to easy access and bad practices cloaked in professional
claims may later doubt the ability of any professionals to give help.
Introduction services and party lines, unless they
serve minors, have very little potential for damage. They mainly give an
opportunity for people to create relationships at a safe distance with as many
defenses as they wish. It also allows people some safety measures prior to
creating nonmediated interactions.
The sex talk, fantasy-activated lines operate on a
different level, something that many people are unaware of. These services
allow people to act out their fantasies in a partial manner, while interacting
with a supposedly real person at a distance, allowing the imagination to add
the missing elements of reality. For some people, especially sexually
distressed ones, this could erode the line between fantasy and reality,
creating a few features of virtual reality that may increase the distress
instead of alleviating it. Another problematic feature is that commercial
considerations demand that the service providers play the stereotypical roles,
many of them demeaning and degrading ones, in order to please the customers.
Whether these act as cathartic experiences or add themselves into a positive
feedback loop is still a question.
Commercial sexual services ignore their potential for
harm. They claim they sell a service that no one is forced to buy, and
therefore should not be regulated in the name of freedom of speech. It is
possible that serious studies undertaken jointly by the service providers and
sexuality researchers, followed by self-regulation, will provide an optimal
solution. Strong demands are being made by many organizations to limit the
access to these services to customers who explicitly request it. Legal efforts
are currently being challenged by the industry in courts on the basis of their
rights to free speech.
9.
Contraception, Abortion, and Fertility Planning
A.
Contraception
Modern contraceptives are easily accessible through
several outlets within the health system: mainly the Mother and Child Primary
Health Care (MCH) and ob/gyn clinics of the sick funds, including outpatient
clinics in obstetrics departments. There is no legal restriction on the use of
contraceptives.
Adolescents
Despite the availability of contraceptives several
studies have found that the rate of their use by adolescents at first
intercourse, and in general, is very low. One found that only half of the
sexually active boys and a third of the girls were using contraceptives
regularly. Another reported that only 40 percent of sexually active adolescents
have ever used contraceptives. The level of knowledge, as measured in these
studies, was not a limiting condition, as it was much higher than the rate of
use.
A frequent characteristic of those with early
sexarche is that they either use no contraception or rely on the traditional
methods of withdrawal or rhythm, and that they are also lower contraceptors
later on. Not only do they start without contraceptives, but they also take
longer to achieve adequate protection. Whether there is any causal relationship
at all between the two phenomena, and in which direction, is a very important research
topic, but it seems to be consistent with the view that many of those
initiating intercourse at a younger age do so as acting out or under personal
and social pressures, and are therefore more prone to conflicts and their
sequels. The fact that kibbutz youth with more egalitarian and permissive
attitudes are also better contraceptors adds support to these interpretations;
see Section 14 under Kibbutz for details.
Married Women
Use of contraceptives among married Israeli Jewish
women is given in Table 2 and demonstrates some of our arguments.
Sterilization is frowned on in the Jewish tradition.
While more than two thirds of married Jewish women use medically prescribed
contraceptives, the use of both male and female sterilization is less than 1
percent, very low compared to other industrial countries with comparable health
systems. The demand for sterilization is low because of the importance of
childbearing and other issues. But even when requested, there are many barriers
a man or woman needs to overcome to achieve their desire. The reasons given by
physicians are the irreversibility of the process and distrust of the ability
of people to make irreversible decisions without later regrets.
Professional
Control
The licensing, sale, and fitting of contraceptives
are controlled through medical and medicopharmaceutical regulations. This
highlights another issue, the power struggle between professions over
controlling the availability and use of contraception. While in several Western
industrial countries, IUDs and diaphragms are fitted by paramedical
professionals, in Israel this is still the absolute prerogative of physicians.
Insertion of IUDs is the only invasive procedure that is restricted by
regulation to one type of physician, a gynecologist. Thirty years ago, the
practice in most clinics was that before being fitted for an IUD, a woman had
to have three or four children; later the number came down to two and even to
one. Today, most clinics still refuse to fit an IUD to nulliparous women,
especially unmarried ones, on the basis of good medical practice and the wish
not to endanger their fertility.
Other social restrictions are also exerted mainly
through the medical/health system. A more subtle aspect of the professional
power play is the disagreement about the role of psychosocial counseling in the
fitting of contraceptives and the success/failure of their use.
Table 2
Current Contraceptive Use Among Married Israeli
Jewish Women (Aged 22-44 Years, Exposed Women Only1, 1988)
|
Method of Contraception
|
Number of Women (n)
|
Percent of Exposed
|
Percent of Total
|
|
|
Effective methods
|
794
|
59
|
47
|
|
|
Pill
|
259
|
19
|
15
|
|
|
IUD
|
519
|
39
|
31
|
|
|
Sterilization (male and female)
|
16
|
1
|
1
|
|
|
Less-effective methods
|
138
|
10
|
8
|
|
|
Condom
|
66
|
5
|
4
|
|
|
Diaphragm
|
65
|
5
|
4
|
|
|
Spermicides only
|
7
|
0
|
0
|
|
|
Traditional methods
|
260
|
19
|
15
|
|
|
Withdrawal
|
175
|
13
|
10
|
|
|
Rhythm
|
71
|
5
|
4
|
|
|
Others
|
14
|
1
|
1
|
|
|
No method
|
152
|
11
|
9
|
|
|
Sub-Total (exposed)
|
1344
|
99
|
80
|
|
|
Nonexposed
|
346
|
21
|
||
|
Grand Total
|
1680
|
101
|
||
1 Exposure to contraception was determined by three
independent variables: not-pregnant, not trying to become pregnant, and
currently engaging in sexual intercourse.
Family
Planning
Fertility and family size are mainly a personal and
familial decision shaped by normative forces, but also part of the public
domain, and strongly dependent on policy decision, laws and regulations,
authorizations, and financial support or constraints. Family planning and
contraception in Israel can be viewed as part of a multidimensional domain
built of several axes, of which the most important ones are: modernity,
nationalism, and religiosity. While some people view religiosity as belonging
to the axis of modernity, this is not always the case in Israel. While among
Moslem women, high fertility is inversely associated mainly with modernity
(women’s education being a major component), in the Jewish population it is
mainly associated with religiosity. Among Jewish women, one finds a defined
group of highly educated, professional women, who espouse a combination of
religiosity with nationalistic ideology and pride themselves on having more
than five or six children.
It is important to note here that while the
commandment to “be fruitful and multiply” is taken almost literally, Jewish Halachah,
which strongly opposes family planning, allows the use of contraceptives on the
basis of individual need within the rather wide Halachic formulation of Pikuach
Nefesh (“danger to the soul”). Moreover, some features of Jewish religious
law create unique situations. The fact that many commandments, including “do
not spill your semen in vain,” bind men only, and allow women to use
contraceptives, provided there is no direct damage to the men’s sperm. Thus
while vasectomy, withdrawal, condoms, and spermicides are almost universally
forbidden, pills, IUDs, and even diaphragms can be used within boundaries.
Apart from the personal position and family decision
making, the public stand of Jewish orthodoxy has always been against organized
family planning and the development of fertility control and contraceptive
services.
Public Policy
and the Family Planning Movement
The movement for birth control or birth planning, and
the utilization of modern contraceptives as an integral part of it, are
relatively recent in Israel. The Israeli Family Planning Association (IFPA) was
founded in 1966. Mother and Child Primary Health Care clinics (MCH), the
mainstay of public health in Israel, received an official mandate to deal with
birth control issues only in 1972.
The predominant approach to birth control and family
planning in the late 1960s and 1970s was a mixture of demographic and health
approaches with social/ethnic ideology. The main features concerned the
national melting-pot ideology regarding immigrant groups, and the wish to
better the situation of the groups with a low socioeconomic status through the
control of their family size. From today’s perspective, the latter component
was not only flawed in its premises, but also parentalistic in its nature
(Ronny A. Shtarkshall has coined the term parentalistic, as opposed to
paternalistic, because of its less-sexist connotations). This approach was in
conflict with two other important axes that strongly influenced family planning
- the religious and nationalistic, both of which were pronatalist.
Nevertheless, the strong medicalized approach to health in general and pride in
medical professionalism resulted in one of the first field studies that
heralded introduction of IUDs for worldwide use.
Professionals in several disciplines, including
health professionals, were dissatisfied with the medical/demographic framework
and favored adoption of a human/family-rights approach. Implementation of this
new approach has minimized the authority of the professionals, and focused on
enabling the clients to take charge of their own needs and on adapting the
counseling process to the need of specific groups. However, responses to recent
immigrants from the former USSR and Ethiopia have shown that old habits die
very slowly and can be resurrected easily when some service providers decide
that they “know better” and intervene without appropriate preparation and
adequate concern for sociocultural factors.
Client-Oriented
Services
The initiation of special counseling services for
youth by the IFPA was also a step toward developing services adapted to the
clients’ needs. These are not only more accessible services that meet the
unique needs of this population, but also a declaration that the sexual
experiences of youth are not intrinsically negative. The informal approach, the
environment, and the mode of counseling in these advisory centers aim at
minimizing the feelings of adult social control of youth sexual behavior.
Currently, many municipal services, sick funds, and other NGOs have established
such services, so that the IFPA is phasing out direct service to youth and
going into an advisory training role for developing such services.
Groups at
Risk for Unplanned Pregnancies
Some service providers and organizations view the 19
percent of the couples who want to postpone or terminate fertility, but use
traditional, inefficient methods, as one of the main targets for family
planning education. Several studies have shown that most of the married couples
belonging to this group really want more effective contraception, but are
hindered from using it by lack of knowledge, suspicion, fear, and subjective
difficulties in accessing services.
Unmarried adolescents and
young adults, including soldiers in the service, students, and recent
immigrants from the former USSR, are also the foci of family planning efforts,
because of underuse or misuse of contraceptives and the high rate of unwanted
pregnancies. (See Section 14 for issues of family planning and contraception
among Moslem women and couples, and among Russian and Ethiopian immigrants.)
As much as the contribution of the family planning
services is appreciated, it cannot be ignored that the convergence of fertility
rates among the second-generation immigrants was largely achieved, not through
their action, but rather through intermarriages of Jews of different ethnic origin,
the action of a universal, largely egalitarian, educational system, the
unifying force of the IDF, and entry of women into the paid workforce.
B. Unmarried
Motherhood
Looking at the development of never-married mothers
in the recent years, one concludes that, in Israel, for an increasing number of
women, the drive toward childbearing is stronger than the convention that
motherhood is only accepted within marriage.
The rate of live births per 1,000 never-married women
aged 15 to 44 rose by 70 percent from 2.3 per 1,000 in the early 1970s to 3.9
per 1,000 in 1989. But the crude rates are not as informative as the
age-specific rates: while the rate for the two younger age groups, 15 to 19 and
20 to 24, actually dropped (from 1.4 to 0.8, down 43 percent, and from 3.4 to
2.9, down 15 percent, respectively), the rates for the older aged groups
increased significantly in the last two decades. In the two decades between
1970 and 1989, the rate has more than doubled for the 25 to 29 age group, from
4.1 to 9.1 per 1,000, tripled for the 30 to 34 group from 6.8 to 20.3 per
1,000, and more than quadrupled for the 35 to 39 group, 5.2 to 21.9 per 1,000.
The drop in the rate of birth of unmarried young
women is probably the result of Article 2 in the abortion law that allows legal
termination of pregnancy to unmarried women (see under Abortion below). Most
abortions of unmarried women are concentrated in the 15 to 24 age group where a
sizable proportion of the sexually active women are still not only unmarried,
but also in unfavorable conditions to marry or give birth. Since abortion is
also available to unwed older women, the lower rate of abortion and higher rate
of unwed motherhood among older women reflects the need of older unmarried
women to exercise their right to childbearing.
By Jewish law, a child born to an unwed mother is
legal, and there is no stigma attached to his/her birthright. It is the mother
who carries the burden of shame, according to the religious ruling and much
popular belief, and not the child. Obviously, an increasing number of women are
willing to pay the price or do not feel the stigma.
There is no available information on the proportion
of unwed women who choose to become pregnant by sexual intercourse or
artificial insemination. Some institutions perform artificial insemination by
donors with no requirement that the recipient be married, but several court
cases reveal that at least some of women prefer impregnation by intercourse.
The issue came into public attention when women sued
the fathers, some of them public figures, for child support. Several such cases
included signed contracts waiving child support as part of the agreement by the
men to impregnate the women. These contracts were declared void by the courts
because the court is bound to decide in the best interests of the child even if
both parents agree otherwise. In several cases, there were claims that the
women misrepresented either their fertility status or the fact that they were
using a specific contraceptive. The courts declared this argument to be
irrelevant because, even if proven true, it had no bearing on the interests or
the legal status of the child.
Several such involved fathers have formed an
organization, “Fathers Not by Choice,” and now lobby for the rights of fathers.
They contend that the prevailing situation, giving them no custody rights in
such cases, and in many cases no other rights, constitutes sex discrimination.
C. Abortion
Several times in the short history of Israel,
abortion has been a major public and political issue with highly emotional and
ideological arguments that embody tensions between different segments of the
society, and a discrepancy between public policy and private practices. While
playing a prominent role, the element of women’s rights to their bodies was not
as dominant as in some other countries. This may be because the issue of
abortion touches on other issues highly important to the Israeli public:
relations between religion and state, national identity and aspirations, and
the collective memory of the annihilation of more than half of the Jewish
people of Europe in the Holocaust.
Jewish religious laws, the Halachah, give precedence to the
life of the mother over the life of the embryo/fetus until that moment of
delivery when the head is fully out. An abortion because of danger to the life
of the mother can be accepted by religious authorities, but only after
consulting a Halachic authority. All other abortions are perceived to be
murder. Abortion is presented by its opponents as the ongoing denial of life of
its future children to a society that had lost one third of its people, 1.5
million of whom were children, and continues to suffer loss of young life by
warfare and terrorism.
It has not helped that the professional view of
family planning efforts within certain organizations providing abortions was
predominantly biomedical. As a result, women seeking abortions were sometimes
looked down upon as ignorant or failing to use medically available
contraceptives properly. There was a feeling that they should have known
better. This view is encountered mainly toward young unmarried women, though in
the past it included women of low socioeconomic status who had already had
several children. Recently, this attitude was revived in public discussion by
the increased demand for abortions from the former USSR immigrants.
It is also possible that some vested economic
interests were involved in the opposition to legalizing abortions. Some
professionals objected to providing abortions in public hospitals as a waste of
public money, while they or their colleagues were performing them privately for
a fee.
During the abortion debate, reproductive health data
was frequently misused. Those who objected to abortions exaggerated the health
risk of abortions - both mortality and the risk to future fertility - as an
argument against it. This was mainly done by comparing the mortality and
morbidity rates from induced abortions to the successful prevention of
pregnancy by contraceptive use, instead of comparing abortion mortality and
morbidity with the risk incurred by carrying the pregnancy to term and its
delivery. This argument is also facetious because, despite the fact that Israel
has a very low perinatal morbidity and mortality, these are still much higher
than the risks of abortions performed according to accepted medical standards.
Legally, abortion is still defined as a felony in the
criminal code. As with most laws in Israel, abortions continue to be regulated
by British colonial laws. For almost thirty years, 1948 to 1978, the only legal
reasons for the performance of legal abortions were purely medical.
Nevertheless, illegal abortions were widespread. Oddly enough, almost all the
illegal abortions were performed by licensed gynecologists or general surgeons
under accepted medical standards. Extremely few cases were prosecuted, and
these only in cases where a woman lost her life.
Since the mid-1960s, several organizations, mainly
human rights activists, the Israeli Family Planning Association, the women’s
segment of the Histadrut, the labor union, the feminist caucus, and
organizations seeking to decrease the political power of the religious over
individuals, have united in uncoordinated efforts to change the law. The fact
that there was a vast difference between the law and the practice, and that the
main barrier to seeking abortion was economic, has played a psychological role
in paving the way to the change.
In 1977, the Knesset changed the abortion law
(enacted January 1978). The main change was the establishment of hospital
committees that could allow the performance of induced abortions under five
clauses: age (women under 17 or over 40); pregnancy resulting from
out-of-wedlock, adulterous, or unlawful relationships; medical conditions
relating to the embryo (genetic or developmental malformations); medical
conditions endangering the mother physically and/or mentally; and social or
economic hardship.
The law stated explicitly that parental consent is
not a condition for performing an abortion on a minor and that seeking abortion
is free of regional restrictions on the dispensation of medical services. On
the other hand, no physician is required to perform an abortion, even a legally
authorized one. The establishment of committees in public and private hospitals
that were medically authorized to perform abortions was at the discretion of
the hospital management. Several hospitals did not establish such committees
because of religious or other ideological reasons. The fact that permission for
abortion is granted by a hospital committee does not mean that the hospital is
required to perform the abortion. The committees are autonomous in determining
their procedures and regulating their activities, provided that each committee
includes at least one gynecologist, one social/mental health professional, and
one woman. In most committees, the woman was also the social worker, thus
combining two functions in one person who also has lower status in medical
institutions. Some committees demand that the petitioning woman appear before
the committee in person and answer questions; others only review a file
prepared by the social worker. Some committees convene only once a week, others
meet daily; some are known to be “liberal,” while others are “hard.”
This differentiation became highly important in 1980,
only two years after enactment of the new law, when religious parties succeeded
in striking out Article 5 allowing abortions for social or economic hardship.
Since then, because there are no regional administrative restrictions on where
women can seek an abortion, women have preferred to approach the more liberal
committees. Thus the demand for legal abortions among married women, and their
performance, has not changed much in the years following abrogation of Article
5 (Table 3). Only the reasons for which these abortions were granted have
shifted. There was a fourfold increase in granting abortions for physical or
mental medical reasons (from 8 to 36 percent).
Table 3
Induced Terminations of Pregnancies Performed in
Hospitals in Israel (1979-89)
|
Year
|
Total Number of Abortions
|
Rates per 1000 Women
(Ages 15-49) |
Rates per 1000 Live Births
|
|
1979
|
15,925
|
17.7
|
17.0
|
|
1980
|
14,708
|
18.0
|
15.6
|
|
1981
|
14,514
|
17.4
|
15.6
|
|
1982
|
16,829
|
19.8
|
17.4
|
|
1983
|
15,593
|
17.9
|
15.8
|
|
1984
|
18,984
|
19.1
|
19.2
|
|
1985
|
18,406
|
18.1
|
18.3
|
|
1986
|
17,110
|
16.8
|
17.2
|
|
1987
|
15,290
|
16.0
|
15.4
|
|
1988
|
15,255
|
15.6
|
15.2
|
|
1989
|
15,216
|
15.2
|
15.1
|
|
1990
|
15,509
|
14.9
|
15.0
|
|
1991
|
15,767
|
15.1
|
14.9
|
As of late 1994, privately performed, illegal
abortions are still performed largely by physicians under medically accepted
conditions. The latest estimate by knowledgeable sources is that their number
is 5,000 to 7,000 annually, about 25 to 33 percent of the total number of
abortions performed. This estimate is for the period prior to the arrival of the
large 1990/91 immigrant wave from the former USSR (see Section 14 below).
In 1990, there was an attempt by religious parties to
restrict abortions further by reducing the number of hospitals authorized to
have committees and perform abortions, and to limit them to public hospitals
only. Since the right-wing government at the time was favorable to this attempt
for both ideological and political reasons, a coalition of family planning and
health professional organizations, the feminist lobby, and human rights
activists was needed to defeat this attempt.
Antiabortion organizations are active, especially
among youth and among women seeking abortions. Their propaganda disregards the
data and claims that every second or third pregnancy is willfully terminated, while
the actual number is less than one in five, even if one counts the illegally
performed abortions.
The IDF’s attitude toward abortions is consistent
with the wider tolerance toward premarital sex in late adolescence. In the
past, a pregnant soldier was discharged whether she carried the pregnancy to
term or terminated it. This caused many female soldiers who wished to continue
their service to hide their pregnancy and have illegal abortions. This rule was
changed, and currently a pregnant soldier can seek an abortion through the IDF
and stay in the service. The rules still give the IDF an option to discharge a
woman on the basis of incompatibility. As far as is known, this option is used
only in the case of repeat aborters and if other adverse conditions exist.
As noted in Section 9B on unwed mothers, it seems
that the decrease of unwed motherhood in the younger age groups is due mainly
to the availability of legal abortions to unwed women. It would have been very
interesting to be able to estimate how many “forced marriages” are avoided
because of the availability of legal abortions to unmarried women. Research in
Israel has shown that among marriages that suffer from abusive patterns, the
rate of premarital conceptions is by far the strongest associated variable
marking the difference between them and divorcing marriages that do not suffer
from an abusive pattern.
A significant aspect of abortions in Israel is their
cost. Prior to the 1978 law, abortions were very expensive, creating additional
hardship for less-well-to-do women. Since 1978, the prices are between $250 and
$600, between 40 to 100 percent of the minimal legal monthly wages. Only
abortions performed for medical reasons in one of the public hospitals are
covered by the sick funds; the foundation for children run by the Ministry of
Welfare pays for abortions for women under 17; all abortions performed on
soldiers are covered by the IDF. In all, an estimated 65 percent of all
abortions are paid for by public funds.
Most abortions in Israel are first-trimester
abortions by suction and curretage. Most hospitals use general anesthesia
during induced abortion in order to minimize the psychological effects on the
woman. Very few institutions perform second-trimester abortions (evacuation),
mainly because of staff objections. Mortality and morbidity from induced
abortions in Israel is very low.
The large immigration from the former USSR starting
in 1989 and peaking in 1990/91 changed the demand for induced abortions and,
possibly also, the conditions under which some abortions are performed. First,
it is estimated that these immigrant Jews will increase the demand for
abortions by about 10 percent (over their proportion in the overall
population). Second, since most Russian women seeking abortion are married, and
the cost of out-of-hospital abortions, privately performed by a licensed
physician is rather high, there is both statistical and anecdotal evidence
indicating these women seek abortions from USSR-immigrant physicians who are
unlicensed to practice medicine or surgery in Israel. They charge less for
abortions, are highly proficient in their performance, but sometimes perform
them in medically problematic conditions.
D. Population
Trends
Uniqueness of
the Jewish Population
The Jewish population of Israel has the highest Total
Fertility Rates (TFR, i.e., the average number of live children expected to be
born to a woman during her lifetime as calculated from the age-specific
fertilities) among the Western industrial countries - 2.6 for 1991. This fertility
is far above that of other major Jewish communities, including Eastern Europe
and Latin America, even though both populations are descendants of survivors of
the Holocaust (as is a large segment of the Israeli population). This is well
above the replacement value and reflects the importance of children in the
Israeli-Jewish lifestyle, including but not limited to the orthodox and ultra
orthodox sectors. Among secular Jewish couples in Israel, it seems like the
birth of the first two children is taken for granted and family planning
considerations are usually reserved for timing and for additional children.
Also, the second generation of Jews immigrating from
different parts of the world to Israel change markedly in less than a
generation, so that their fertility patterns resemble the Jewish-Israeli
pattern more than the patterns in their countries of origin.
Time Sequence
of Fertility Changes
Despite the just-mentioned facts, the fertility
patterns over the last three decades do show a general drop in fertility among
all the national and most ethnic groups in Israel, concomitant with
modernization and the rise in both economic and educational level (Table 4).
Closer analysis of the TFR in various Jewish ethnic
groups reveals a more complete picture. While there is a consistent drop in the
TFR for Jewish mothers born in Asia and Africa, for mothers born in Israel, and
those born in Europe and America, there is a rise in the TFR until the first
half of the 1970s and then a decline. The overall the rate of increase for both
latter groups was similar, 0.3 to 0.4 child per mother. If these trends - the
rise in age at first marriage, the delay of age at first birth, and the
lowering of the desired number of children - continue, the result can be a
continuous decrease of the TFR among Jews in Israel. It is hard to predict to
what levels and what will be the forces acting to speed, slow, or reverse this
trend. Whatever the situation, the TFR of orthodox and ultra orthodox Jews will
be a factor.
Table 4
Total Fertility Rates of Jews and Non-Jews in Israel
(1965-1989)
|
Period
|
1960-1964
|
1965-1969
|
1970-1974
|
1975-1979
|
1980-1984
|
1985-1989
|
1990
|
1991
|
|
Jews (total)
|
3.39
|
3.36
|
3.28
|
3.00
|
2.80
|
2.79
|
2.69
|
2.58
|
|
Mothers born in Israel
|
2.73
|
2.83
|
3.05
|
2.91
|
2.82
|
2.82
|
2.76
|
2.70
|
|
Moslems
|
9.23
|
9.22
|
8.47
|
7.25
|
5.54
|
4.70
|
4.70
|
4.70
|
|
Jews (mothers born in Asian and African countries)
|
4.79
|
4.35
|
3.92
|
3.40
|
3.09
|
3.14
|
3.09
|
3.271
|
|
Christians
|
4.68
|
4.26
|
3.65
|
3.12
|
2.41
|
2.49
|
2.57
|
2.26
|
|
Jews (mothers born in Europe, America (N&S), Australia, and Southern
Africa)
|
2.38
|
2.59
|
2.83
|
2.80
|
2.76
|
2.66
|
2.31
|
2.052
|
|
Druze and others
|
7.49
|
7.30
|
7.25
|
6.93
|
5.40
|
4.19
|
4.05
|
3.70
|
The Total Fertility Rate (TFR) is the total number of live children
born to a woman throughout her fertile period. It is based on the sum of age-specific
fertilities for women between the ages of 14 to 49 and assumes that women of a
specific group have the specific age fertility appropriate for their group when
they are at that age.
1 The rise in TFR among Jewish women born in African countries in 1991 is probably due to the wave of immigration of Jews from Ethiopia.
2 The rather sharp drop in TFR in 1990 and 1991 among women born in Europe/America is probably due to the large wave of immigration from the former USSR where the TFR among Jewish women is below 2.
1 The rise in TFR among Jewish women born in African countries in 1991 is probably due to the wave of immigration of Jews from Ethiopia.
2 The rather sharp drop in TFR in 1990 and 1991 among women born in Europe/America is probably due to the large wave of immigration from the former USSR where the TFR among Jewish women is below 2.
Factors
Shaping Israeli Fertility
Forces shaping Israeli fertility changes in the last
forty years include: modernity, mainly women’s education; changes in economic
status and perspectives; entrance of women into the labor force; a general downgrading
of the collective/national elements within the prevailing ethos; and a
concomitant rise in the individualistic achievement-orientation components.
Immigration was also a factor: Jewish women from Ethiopia contributing to a TFR
rise in 1991; Russian immigrants to a drop in 1990 where the TFR among Jewish
women is below 2.
The pronatalist attitude prevalent in modern Israel
explains the socialization toward marriage and parenthood that Israeli adults
feel ill at ease to defy. Willed childlessness is not presented as a viable
option and childless couples are considered to be in need of help.
Fertility
Services
A direct consequence of this cultural climate is the
demand for fertility services, and especially in vitro fertilization (IVF), as
aids to married biological parenthood. In 1993, there were roughly one IVF
clinic for every 30,000 Israelis, more than in any other country over the
world, and lower by more than a factor of magnitude than the per capita rate in
the U.S.A. The research in fertility, and especially in IVF, in Israel is
disproportionately high and several improvements on the methods originated
here. Other fertility services are also highly developed in Israel, but the
focus is mainly on the biomedical service, with minimal resort to accompanying
psychosocial interventions. Several attempts in the latter direction report a
marked increase in success rates of the biomedical interventions if they are
done in conjunction with the psychosocial ones. Surrogate motherhood is still
very rare and complicated by unresolved legal issues.
Adoption
Married couples who go down the fertility road to its
limits without success resort to adoption. In an effort to protect the rights
of the adopted children, adoption procedures in Israel are slow and cumbersome.
These efforts sometimes backfire as children drag for years through
institutions, foster homes, and the courts without stable environment and the
ability to form lasting attachments. The processes are somewhat easier when
older children or physically or mentally challenged children are involved, but
in these cases the adoption process can be much more difficult.
From the side of the petitioning couples, the waiting
and procedures are sometimes intolerable, creating a large market in adoption
of foreign children. Romania was a source until government corruption and news
of HIV infection in orphanages blocked this option. In several South American
countries, what was a legal if costly process turned into illegal trade in
forged documents, kidnapping, and extortion.
Sexually
Transmitted Diseases
The public awareness of STDs in Israel in low.
Syphilis, chlamydia, gonorrhea, and herpes genitalis are reportable diseases,
but this regulation is not strictly enforced and not fully observed. A structural
reason for this may be that Israel does not have STD clinics, specializing in
both care and prevention.
In the late 1960s, an apparent doubling in reported
STDs, believed to be caused by the influx of volunteers after the “Six Days’
War,” caused the ministries of Health and Education to recommend the study of
sexual knowledge, attitudes, and behavior. This study, carried out in the early
1970s, also recommended the introduction of a sex-education curriculum into the
schools.
The current prevalence of STDs in Israel for 1993 in
annual rates of preliminary notifications were 1.1, 0.0, and 0.3 per 100,000
for syphilis, genital chlamydia trachomatis, and gonorrhea respectively. This
is believed by researchers to be below the actual rate. For example, some estimates
of chlamydia infection are as high as 10 percent of the women of 15 to 49 (2
percent of the population). Estimates of the prevalence of herpes genitalis are
also quite high.
In 1988 a Society for the Study and Prevention of
STDs was formed under the auspices of the Israeli Family Planning Association,
with the aims of joining biomedical and behavioral efforts, integrating
prevention with proper early detection and care, and for increasing the
awareness of STDs and their risk to health among health professionals. It holds
professional orientation and awareness meetings and formulates guidelines for
better detection and care of various STDs. Its educational and public
activities are conducted within the general framework of the IFPA.
HIV/AIDS
A. Situation
Report
Currently HIV/AIDS has a low prevalence/low incidence
in Israel. The documented number of AIDS cases for May 1994 was 292 -
cumulative incidence of 56/million - 69 of which, 24 percent, are currently
alive in Israel. As of June 1994, there were 1,152 people reported as
HIV-seropositive who are not ill with AIDS, a cumulative incidence of 256 per
million or 0.026 percent. It is believed that the reporting of cases is
accurate. Tables 5 and 6 summarize the published data about both AIDS and HIV
in Israel for June 1993.
The authorities cite the fact that incidence of new
AIDS cases within Israel is flat as a support for their claim that the
situation is under control. They also claim that since half of the new AIDS
cases are previously known as HIV cases, the actual number of HIV cases is
probably twice the number of AIDS cases reported from all sources.
However, it may be that this perception is only the
short-sightedness of politicians and policy makers who do not realize that this
may be the lower flat part of an atypical hyperbolic curve, below the threshold
of doubling. Several facts apparent in these tables can be a cause for concern.
First, the progression from HIV to AIDS may represent the transmission
situation in the past five to ten years. Second, 30 percent of the HIV cases
are of unknown risk factor, and almost 10 percent of all the people identified
as HIV-seropositive are also of unknown gender; among those of unknown risk
factor, 25 percent are of unknown gender. Since HIV testing in Israel is mostly
voluntary, and there is no summarized and/or analyzed data about the people who
have been tested for HIV, there is no information about over- or undertesting
in important subpopulations like age groups or genders. This results in a puzzle
with more holes than picture.
Table 5
Cumulative Adult (Age 15+) HIV+ Cases in Israel (June
1993) Presented by Transmission Category (After Slater P. Sutton’s Law and
AIDS Prevention in Israel)
|
Males
|
Females
|
Unknown
|
Total
|
|||||
|
Transmission Category1
|
N
|
%2
|
N
|
%2
|
N
|
%2
|
N
|
%3
|
|
1. Gay & Bisexual Men
|
153
|
100.0
|
-
|
-
|
-
|
-
|
153
|
16.6
|
|
2. IV Drug Users4
|
97
|
78.2
|
14
|
11.3
|
13
|
10.5
|
124
|
12.6
|
|
3. Hemophiliacs
|
47
|
97.9
|
1
|
2.1
|
0
|
0.0
|
48
|
4.9
|
|
4. Transfusion Recipients
|
7
|
53.8
|
5
|
38.5
|
1
|
7.7
|
13
|
1.3
|
|
5. Heterosexuals
|
199
|
58.0
|
139
|
40.5
|
5
|
1.5
|
343
|
34.7
|
|
Subtotal (known risk group)
|
503
|
73.9
|
159
|
23.3
|
19
|
2.8
|
681
|
68.9
|
|
6. Unknown Transmission
|
173
|
56.3
|
58
|
18.9
|
76
|
24.8
|
307
|
31.1
|
|
Total
|
676
|
68.4
|
217
|
22.0
|
95
|
9.6
|
988
|
100.0
|
1 RS would have preferred the use of risk practice or risk
behavior to the use of transmission category or risk group. This would have
changed the structure of this table. For example, the use of anal sex as risk
practice (with subdivision for gay or heterosexual groups) could have clarified
the relative role of this practice in heterosexual transmission in Israel,
without loss of the ability to calculate the risk to encounter an HIV+ partner
in sexual encounters within specific groups.
2 % of the total number of cases in this specific category.
3 % of this category in the total number of HIV+ in Israel at that date.
4 Including drug users with additional risk factors.
2 % of the total number of cases in this specific category.
3 % of this category in the total number of HIV+ in Israel at that date.
4 Including drug users with additional risk factors.
B.
Sociopolitical Issues
There are several troubling questions that relate to
HIV/AIDS being a biopsychosocial construct, interlocking with sexuality and
other social, political, and cultural issues.
The responsibility for dealing with all the aspects
of AIDS has been allocated to the Ministry of Health with its mainly biomedical
outlook. The decisions of the National AIDS Steering Committee, which is always
headed by a physician, are only recommendations to the director general of the
ministry. Thus, decisions to implement policies or actions that may have a
strong psychosocial component can be taken up only from its biomedical end,
resulting in a distinct bias with serious and unpredictable results.
A second issue is more pervasive. On the one hand,
there is the perception that HIV/AIDS and infected persons are marginalized and
stigmatized.
Table 6
Accumulative Adult (Age 15+) AIDS Cases in Israel
(June 1993) Presented by Transmission Category (After Slater P. Sutton’s Law
and AIDS Prevention in Israel)
|
Males
|
Females
|
Total
|
||||
|
Transmission Category1
|
N
|
%2
|
N
|
%2
|
N
|
%3
|
|
1. Gay & Bisexual Men
|
110
|
100.0
|
-
|
-
|
110
|
45.6
|
|
2. IV Drug Users4
|
43
|
84.3
|
8
|
9.8
|
51
|
21.2
|
|
3. Homophiliacs
|
28
|
100.0
|
0
|
0.0
|
28
|
11.6
|
|
4. Transfusion Recipients
|
7
|
87.5
|
1
|
12.5
|
8
|
3.3
|
|
5. Heterosexuals
|
26
|
74.3
|
9
|
25.7
|
35
|
14.5
|
|
Subtotal (known risk group)
|
214
|
92.2
|
18
|
7.8
|
232
|
96.3
|
|
6. Unknown Transmission
|
9
|
0
|
9
|
3.7
|
||
|
Total
|
223
|
18
|
241
|
100.0
|
||
1 RS would have preferred the use of risk practice or risk
behavior to the use of transmission category or risk group. This would have
changed the structure of this table. For example, the use of anal sex as risk
practice (with subdivision for gay or heterosexual groups) could have clarified
the relative role of this practice in heterosexual transmission in Israel,
without loss of the ability to calculate the risk to encounter an HIV+ partner
in sexual encounters within specific groups.
2 % of the total number of cases in this specific category.
3 % of this category in the total number of HIV+ in Israel at that date.
4 Including drug users with additional risk factors.
2 % of the total number of cases in this specific category.
3 % of this category in the total number of HIV+ in Israel at that date.
4 Including drug users with additional risk factors.
This perception influences the ways in which people
with AIDS or HIV and HIV/AIDS issues are treated. On the other hand, there is a
proneness in the responsibility for public health to avoid discussing the fact
that, in different situations and under different conditions, it may not only
be responsible, but essential to undertake unpleasant or even restrictive
measures. (In accordance with the traditional Judaic approach, the application
is highly dependant on unique situations that need to be weighed from all sides
and in relation to all those who are involved, even though the laws are general
and cover everyone.) This chain of bias-guilt-avoidance is hardly suitable to
deal with the sensitive issues of HIV/AIDS. It may also be responsible for the
fact that Israel has yet to form a midrange plan to deal with the disease.
Another issue is the influence of organizational
structures and vested interests on the nature of the efforts to stem the
disease. Such phenomena affect the definition of prevention and the perception
of appropriate behavioral interventions; they are also the source of the
phenomenon that policies are formulated, and interventions designed and
implemented, prior to ascertaining the behavioral patterns, psychological,
social, and cultural determinants of behaviors involved in this disease.
Vested interests come into play, especially when
dealing with allocation of budgets, human resources, control, and research
opportunities. Thus, the AIDS centers that are located in eight hospitals, and
that are treatment-oriented and medically controlled, strive to retain the
overall responsibility for prevention, even of interventions that are
community-oriented and those in which the behavioral, and even cultural
components, are predominant.
Most of the HIV tests are done on these sites in
which precounseling and postcounseling to the people who test seronegative is
limited to printed brochures. The people who test seropositive receive a
mixture of medical and social counseling with little organized support and few
educational programs. Attempts to alleviate the situation, even with the help
of volunteer services, meet with suspicion on the one hand, and financial
constraints on the other.
C. Priority
Groups for Preventive Interventions
The prioritization of groups, and development of
educational interventions, have been done without prior behavioral and
psychosocial studies or any organized decision-making process. Recently, the
topic was discussed in an article with several published commentaries
recommending the use of epidemiological data to determine priorities for
interventions. This proposal would not be a step forward, because it does not
give any consideration to behavioral patterns. It also does not distinguish
between risk-group, at-risk group, and risk behavior. Thus, it did not consider
hemophiliacs, the highest HIV-seroprevalent risk-group, and failed to notice
that they are currently at a very low risk for passing on the infection, that
most of them are under constant medical supervision and counseling for their
primary disease, and that the at-risk group for infection are their sexual
contacts.
The commentaries revealed deep differences between
people who deal with AIDS, bordering on a communication gap. Thus, the head of
the National AIDS Committee declared a commitment to implement a general AIDS
education effort among adolescents in schools, while another commentator
pointed out that there were still no behavioral data pointing towards that
need, and suggesting that the existing epidemiological data, although scanty,
favored the targeting of educational efforts to limited priority subgroups
within youth.
The establishing of targeted priority groups is
important not only because of the scarcity of financial and human resources,
but also because of the need to target the educational messages to the specific
needs and conditions of subgroups, if one is to expecting to make an impact
(see below in AIDS Education Versus Sex Education). The general intervention
efforts aim at the common denominators and, therefore, maybe too diluted and
unfocused.
The balance between targeting priority groups for
interventions to lower the transmission within those groups, and support for
those who are already HIV-seropositive, and stigmatizing these same groups, is
very delicate, especially if the groups are marginalized or stigmatized to
start with.
Recently, this issue raised its head when the
educational and counseling efforts within an immigrant population suffering
from high prevalence and incidence rates, and from a heterosexual pattern of
transmission, were sensationalized in the media. The fear and shunning
reactions of small segments of the population, combined with the sensitivity
and shame within this traditional community, triggered reactions toward the
professionals who were in close association with them, and set back some of the
preventive efforts.
D. Contact
Tracing and Educational/Counseling Programs
Epidemiological follow-up and notification, support
for people who are HIV-seropositive, and counseling interventions could be
highly effective, if implemented professionally, compassionately, and
discreetly. This was possible in Israel as no anonymous testing is available,
only confidential ones. Unfortunately, the system did not manage to make the
essential accommodations to implement such policies.
In one case, when a whole group of immigrants from a
country with a high prevalence of HIV was screened on entry, the recommendation
for combined supportive and preventive interventions by case managers working
within the community was postponed for more than two years. As transmission
within the community continued, while people did not come in readily for
voluntary testing, it is questionable whether the intervention can be as
effective as if it had been implemented nearer to the screening date.
This immigrant community also posed the challenge of
developing culturally appropriate educational programs and training personnel
to deliver them. It also challenged the system with the necessity for cultural
bridging, and the training of cultural mediators between professionals whose
beliefs were embedded in biomedical models, and clients who used a combination
of traditional lay beliefs and biomedical models.
This was achieved by creating an alliance between a
group of professionals and a group of veteran immigrants who trained to become
both educational agents and mediators while they also acted as cultural
informants and consultants.
E. AIDS
Education Versus Sex Education
This question, although general in nature, is
especially relevant in Israel, a low-prevalence country in which adolescents
can be defined by their moderate prevalence of heterosexual risk behaviors when
compared to the U.S.A. and European countries, and very low prevalence of
individuals being at-future-risk for HIV infection and not at-immediate-risk.
While today’s adolescents do not face the probability
of HIV infection, they do face a much more tangible risk of pregnancy and STD
infection. In this context, attempts to motivate youth by fear of the small
risk of HIV/AIDS or by fear of the future may backfire.
On a more theoretical basis, it is questionable
whether it is appropriate to introduce youth to the issues of sex through risks
of either a deadly disease, other diseases, or a pregnancy. It is proposed that
early sex education, focusing on communication and decision-making skills, on
responsibility for one’s actions and health and also for the health and welfare
of one’s partner, and on alternative, noncoital sexual expressions, would be
both more appropriate for adolescents and, in the long run, more efficient in
lowering the transmission rates.
It is also important to note that the differences
between cultures are not limited to “esoteric” immigrants, but can also be
between “similar” industrial countries. Thus the concept of “safer sex,” which
is embedded in the basic premises of a society that is highly individualistic
and sometimes adversarial, may be insufficient or inappropriate in a culture
that puts more emphasis on the sense of community and cooperation between
individuals.
It is also questionable whether egoistic motivations,
which are at the roots of safer sex, are sufficient in boundary conditions,
where altruistic or secondary motivations are needed to augment the egoistic
ones. Such considerations will call for alternative educational approaches.
Dealing with issues of mutual protection and responsibility need a much more
elaborate educational approach than focusing on barriers to condom use or on
the mechanical skills of its use. These should be discussed in the wider scope
of sex education.
The decision-making, communication, and protective
skills learned in sex education are very similar and can be easily applied to
protection against HIV/AIDS.
It is somewhat disappointing that the need for a
comprehensive approach to sex education and the urgency of such implementation
are wasted because the interests of some politicians meet with those of
educational entrepreneurs. The latter promote the use of shelf programs aimed
at the largest possible populations and designed to offend as few people as
possible. They are thus focusing on “clinical,” nonoffensive, and non-sexual
aspects of HIV/AIDS, demand minimal training of the implementers, and minimal
hours for delivery. The interest of educational and health politicians is in
“magic bullet” interventions that can be put in place speedily and with minimal
fuss and objections from vocal political minorities.
Such ready-made AIDS education programs allow them to
shirk their responsibility, while pretending to fulfill it. It is only fair to
say that some of these politicians do not know better and believe in what they
are doing. The responsibility of the entrepreneurial professionals seems to be
graver.
Sexual
Dysfunctions, Counseling, and Therapies
A. Concepts
of Sexual Dysfunction and Therapy
Despite the fact that several of the founders of
modern sexology in Germany had either passed through or settled in Israel after
the rise of the Nazi regime to power, sexology did not emerge in Israel as a
discipline until the early and middle 1970s. Treatment for sexual dysfunctions
was limited either to medically oriented interventions or to analytically
oriented psychodynamic therapies, which were imported by members of Freud’s
Psychoanalytic Institute who immigrated to Israel and founded a similar
institute with his blessings in the late 1930s.
The medical approach focused on functional symptoms
alleviation as a means to solving the sexual dysfunctions, e.g., the use of
dilators for vaginal spasms or numbing creams for early ejaculation. While the
psychoanalytic approach recognizes dysfunctions and issues like orientation and
gender confusion as separate diagnostic categories, and is interested in deep
causes and their transformation, psychoanalysts did not treat them with the
same methods and under similar basic assumptions as medical practitioners.
The development of sex therapy in Israel occurred
mainly after Masters and Johnson and is, by and large, an import from the
U.S.A. Most of the Israeli therapists are trained there rather than in Europe.
Currently, there is a pluralism of approaches to the treatment of sexual dysfunctions,
ranging from the purely medically oriented through the combined biopsychosocial
approach, and couple-oriented systemic approach to the psychodynamic.
B.
Availability of Diagnosis, Counseling, and Treatment
A World Health Organization (W.H.O.) report counted,
at the end of 1988, thirteen centers offering sex therapy, across the country.
This list was not exhaustive even for that date, and since then more services
have opened up in different locations.
Most of the clinics are still located in public
hospitals or specialists’ clinics of the sick funds. Significantly, few of them
have a free-standing status, and most are annexed to departments like
Gynecology, Psychiatry, or Urology, depending on the medical training of the
head of the clinic or on political considerations. These arrangements are
typical of a situation in which sexology and sex therapy are still not
considered a full-fledged, professional and/or academic enterprize.
The clinics, even those in the public hospitals and
sick funds, are very heterogeneous. A few have several staff members from
different disciplines working full- or part-time with a wide range of services.
These can offer a full biomedical and psychosocial evaluation and a variety of
therapies. Usually, they will also treat orientation- and gender-confusion
issues, including evaluations for sex change, e.g., the sexual function clinics
at the Hadassah Medical Organization in Jerusalem and the Sheba Medical center
in Ramat-Gan. Most clinics focus on fewer aspects of the sexual functions or
offer a smaller variety of services. Several sex-therapy clinics evolved in
nonmedical family and marriage services. These offer mostly psychosocial
evaluations and interventions. One of these clinics started in the early 1990s
also offers surrogate therapy as part of its services. The male and female
surrogates are selected and trained by the staff of that clinic.
Two centers specialize in rehabilitative sexology:
Sheba and Beit-Lewinstein Rehabilitative Center. These offer both posttrauma and
postdisease treatment of sexual concerns and functions.
A relatively recent development is the appearance of
specialized private-enterprize sex clinics that use aggressive publicity and
cater mainly to men with erectile dysfunctions. These clinics offer mainly
treatment by medication, mostly penile injections. There are several reports
that they offer rather poor psychological and dyadic evaluations and
interventions, and at least one of them is under investigation by the Ministry
of Health.
A national association of sex therapists (ITAM) was
formed in the late 1980s in expectation of the therapy-licensing regulations.
This is a rather loose association that did not take a public initiative in
dealing with defending potential clients against exaggerated publicity claims
or misconduct.
Research
and Advanced Education
A.
Sexological Research and Advanced Education
There is not one academic department or academic
program that focuses on sexual issues or sexology. All the research and
training is done under the names of different “professions” with very little
integration and/or interdisciplinary approach. One attempt to form an
interdisciplinary group ended when the person who initiated it did not receive
tenure and moved to Canada. Despite that, several studies concerning sexual
function and dysfunction have been carried out in clinical and limited
nonclinical populations. Other studies, in the educational, psychosocial, and
health fields have included issues of sexuality, sexual behavior, and attitudes.
The rise of interest in HIV/AIDS issues has focused some attention to what is
defined as sexual risk behaviors.
Only one of the four medical schools includes a
course on sexuality and sexual behavior in their regular curriculum. The other
three do so only as an elective or intermittently. It is possible to be board
licensed in gynecology and urology without any course or internship in the
psychosocial and behavioral aspects of sexuality. The only specialization that
includes some issues of sexuality in requirements for board certification is
Family Practice. As a result, at least one of the postgraduate courses in this
specialty offers a thirty-two-hour unit on sexuality and sexual issues in the
family practice and a sixteen-hour unit on family planning and contraception.
Several of the universities and colleges offer
scattered academic courses on sexual issues within various faculties, schools,
or departments. Such are the courses at the School of Social Work of the
University of Tel-Aviv; sex education courses at the Kibbutzim
teachers-training college, and others.
The Hebrew University of Jerusalem has several
academic courses in Family Planning in various departments. One of them is an
interdisciplinary course to train counselors in family planning, contraception,
and sexuality-related issues. Although part of the MPH curriculum, this course
is considered to be an intervention course in the School of Social Work, and a
skills course in educational counseling and psychology. Other courses there are
those focusing on the biological, social, and psychological bases of gender
differences.
Several courses in sex education are offered within
university schools of education. These are nonacademic, in-service training
courses held in cooperation with the Unit of Family Life and Sex Education of
the Israeli Ministry of Education and Culture. Nonacademic courses, mainly in
sex education and family planning, are offered by the Ministry of Education and
the Israeli Family Planning Association (IFPA). These take the form of annual
courses or concentrated workshops on general issues, on specialized populations
(e.g., immigrants and challenged youth), or special issues (e.g., dealing with
rape and coercive sex in the educational system, new methods in sex education,
and cross-cultural issues).
Recent developments may herald some changes. First,
one of the courses in sex education, which is coheaded by Ronny A. Shtarkshall,
is currently considered for inclusion in the master of arts degree program by
the School of Education of the Hebrew University of Jerusalem. This is a
168-hour course for training facilitators for interactive experiential work in
sex education. The 56-hour, theoretical-academic component of this course will
give, if approved, four annual credits at the graduate level. Second, the IFPA
has initiated within the Post-Graduate Training Program of the Sakler Faculty
of Medicine of the University of Tel-Aviv an interdisciplinary program in
population, family planning, sexual health, and counseling. Third, the IFPA board
of directors and council approved criteria for the training and recognition of
Sex Educators. These include academic studies, skills training, sensitization
and desensitization to sexuality issues, and supervised experience. It is
expected that these developments will create some change in the attitudes
toward professionalism is sexual issues.
B.
Sexological Organizations
Institute for Sex Therapy, Sheba Medical Center, Tel
Hashomer, Israel; Phone: 972-3/530-3749; Fax: 972-3/535-2888
Israel Family Planning Association, 9, Rambam Street,
Tel-Aviv, 65601, Israel; Phone: 972-3/5101511; Fax: 972-3/5102589
Ministry of Education & Culture, Psychological
and Counseling Services, 2 Devorah Hanevia Street, Jerusalem, Israel; Phone:
972-02/293249; Fax: 972-02/293256
National,
Religious, and Ethnic Minorities
A. The
Moslems
Moslem Arabs, the large majority of Arab citizens in
Israel, constitute 14 percent of the population of Israel. Their situation is
unique: a minority within a Jewish state and culture that has been at
continuous war with its neighboring Moslem countries since its founding.
Despite that, some sense of group autonomy that
transcends individual rights is recognized by the state, as matters like
marriages, divorce, and family law are in the jurisdiction of the Moslem
religious courts.
While the national and political aspirations of
Moslem Arabs in Israel may be at odds with the mainstream of Israeli society,
it is interesting that both the Moslem establishment and the population approve
of the Israeli system that allows the religious courts of each denomination to
govern its own population.
The religious courts are bound by the civil code,
which takes precedence in matters in which the religious courts are at odds
with it, like the ban on polygamy and the legal age of consent for marriage.
Only recently, the supreme court ruled that the religious courts cannot ignore
the rulings concerning division of property between husband and wife, which
give women more rights than under the religious canons.
This indigenous control also gives the traditional
establishment power over younger “upstarts.” If there is a movement striving to
free the Moslem society from the strong hold of the religious establishment, it
is much less visible than among the Jewish segment of the population, perhaps
as a result of tile value placed on a uniform stance as a minority.
There are several other factors that affect sexual,
marital, and familial issues in which the Arab-Moslem society differs from the
Jewish mainstream. The Jewish majority is largely urban with an industrial and
service-based economy, with high measures of modernity including women’s
education and their participation in the workforce. The starting point of
Arab-Moslem society is largely rural, its economy is based on farming, and the
determinants of modernity are rather low. This is rapidly changing, but there
is still a wide gap. In recent years, both academics and some small activist
organizations have broken the unified front by publishing studies about marriage
patterns, sexual violence, and other disputed issues, and waging public
campaigns against phenomena like murder for the honor of the family. These
reports provide a good background for discussion of such issues.
Marriage as a
Public Transaction Between Families
The traditional view of marriage in the Arab, mainly
Moslem, society is of marriage as a transaction between families, concerned
mainly with strengthening the economic and political power of the extended family/tribe,
the Chamulah. Love and sexual satisfaction have very little to do
with marriage, but procreation is very important. This is typical of rural
societies, depending on land for wealth and prestige and on unity for its
preservation. Marriages are arranged between families, sometimes against the
will of the bride or the groom.
Bride payment, Mohar, is paid according to the
desirability of the bride and the purity of the name of the family daughters
and the status of her family. The collection of appropriate Mohar,
especially for a highly desirable bride from a prestigious family, is a very
heavy burden on young men, if they do not have the support of their well-to-do
families or if they are poor. Thus the practice of arranged marriages with high
Mohar has acted not only to preserve the wealth, but to keep the younger
men in line and preserve the social status quo. The payment of the Mohar
has also represented symbolically the fact that the bride’s family was losing a
labor force, while the groom’s family was gaining one as well as a potential
mother of children. Therefore, the fertility of the bride’s mother, her aunts,
elder sisters, and cousins has been a factor in her desirability and her Mohar.
This contributes to the fact that the pregnancies and childbearing of each
woman in the Chamulah is the business of every other woman. Women move
into the husband’s extended family, but her family of origin is still
responsible for her proper conduct.
Inbreeding
Several mechanisms exist to facilitate keeping the
wealth, especially land ownership, within extended families. One is reciprocal
marriages: families exchange two pairs of their offspring, one male and one
female from each family. These male-female pairs are often a brother and sister
or first cousins. This saves the dowry payments for both families, but also
creates double-kinship lines. A second mechanism is the marriage of first
cousins, second cousins, uncle and niece, or aunt and nephew, although this is
not as common today as in the past. The result is that 45 percent of all marriages
in the Arab society in Israel are between relatives; 25 percent are of
first-degree kin.
This happens despite the decrease in arranged
marriages and their transformation into ritual formalization of voluntary pair
formation. This seeming paradox can be explained by the fact that, despite
modernization, the Arab society is still a closed one with low mobility. The
available choices for marriage are limited and usually come from the same
village built around extended families.
The health implications of these phenomena can be
dire. Several villages, which are socially or geographically isolated, suffer
from an extremely high incidence of specific genetic defects. Efforts are being
made to lower the rate of genetic defects, even among the married relatives, by
appropriate genetic counseling.
One such defect within the domain of human sexuality
is the existence of a large number of pseudohermaphrodites of the
dihydrotestosterone (DHT) or 5-alpha reductase deficiency. First reported and
studied in the Dominican Republic, this recessive gene mutation has been traced
to one family that migrated from the Syrian mountains about 150 years ago and
continued to intermarry. A brief attempt to study these people and their
environment, while extending them medical help, was cut short by the realities
of the Israeli-Arab conflict. It was ascertained that the extended family is
aware of the situation and of the peculiarity of these children. Yet it was
never clear whether this is an internal familial terminology or a public one.
They almost invariably strive to become men because of the dominance of males
in the Arab society. The very few individuals who live as females are servants
within their own families.
Polygyny
Another aspect of marriage among Moslem Arabs in
Israel is polygyny. The Islamic religion allows a man four wives and as many
concubines as his household can support. In reality, it was very rare that a
man had more than two or three wives. One of the customs was for the older and
dominant wife to choose a younger one for the husband, usually one that she
could dominate.
Polygamy is banned by Israeli law. This ban was
enacted mainly as a measure affirming women’s equality, as a reaction to the
custom of Jews who immigrated from Islamic countries. Acceptance of the law by
Moslem Arabs in Israel was almost universal until 1967 when it became possible
for men to have another wife either from or in the West Bank or Gaza district.
Despite this, most Moslem Arabs obey the law and there are very few prosecuted
cases of polygamy.
Perceptions
of Male and Female Sexuality
In Islamic cultures the sexuality of men and women is
perceived as moving in different directions during a lifetime, a picture
somewhat in accordance with some modern sexological descriptions of the early peaking
of male and later peaking of female sexual prowess.
According to this Moslem view, men’s sexuality is
uncontrolled in their youth before they marry. This is the time to keep guard
on them, but also to allow them to fool around with women of ill repute. This
is also the time to go to war or to forage (where women are seen as the spoils
of war). After marriage, as men grow older, their appetites, while
undiminished, become more controlled because of their added wisdom. In men,
wisdom, cunning, and cool control over situations is usually associated with
age.
The sexuality of a women is believed to be low in her
youth and she is perceived as innocent. It is only after losing her virginity
that the sexuality of women will grow and may get out of control. Therefore,
married women are to be guarded at all times. A man’s inability to satisfy his
woman or to keep her in line is a very bad reflection on the husband’s manhood,
in addition to bringing shame to the woman’s family of origin.
Family Honor
Two concepts are strongly associated with family
honor. The first is the public proof of intact female virginity at marriage;
the second is punishment for its defilement. In a traditional wedding ceremony,
the family of the bride, usually the mother and/or aunts, are expected to
receive the sheet with the signs of hymen blood on it and exhibit it in public.
Contrary to popular belief, this is not only a sign for the intactness of the
bride’s honor, but also proof of the groom’s virility.
Sex therapists working with Arab populations
encountered the male fear of slighting one’s own manhood and family honor by
failing to perform. On the other hand, there are reports that the literary
description of shyness and reluctance, signifying a virginal nature, that are
expected to be conquered by force are part of the construct of women’s
perception of the first intercourse. The emerging picture is that of a ritual
choreography where each partner has to play his/her traditional role in order
to bring it to its full destiny and honor both families.
Even in rural and highly guarded societies where
marriages are arranged, young people find their ways to associate with each
other. In recent years when schools became coeducational, when there is greater
freedom of movement, and when Arab youth are attending universities together
with a majority of Jewish students at the age of 18 - they do not serve in the
army - it is much harder to avoid romance and a certain amount of sexual play
between youth. As already mentioned, family arrangements are many times a
formalization of self-selection.
Despite this change, the symbolic meaning of
virginity is still important. Two sexual practices help young people to keep
the hymen intact while engaging in sex: interfemoral and anal intercourse. The
first is more risky to the woman as she may become pregnant, and also the man
may catch her off guard and penetrate the hymen. The second avoids both, but in
the area of HIV/AIDS may be inadvisable. No research has been published on this
subject among Israeli Moslems, although there is enough anecdotal information
to say that both practices are prevalent.
“When the family honor is shamed, it has to be
cleansed with blood.” This is true not only of issues of honor relating to
women, but also in other cases of honor, including blood feuds and ritual
revenge. Both the annals of the courts and fiction are filled with such
stories.
In case of sexual honor, there are some revealing
features. First, when family honor is shamed in matters of sex and marriage,
the women carries the main burden of punishment and men rarely are blamed. One
possible reason for this is that killing a man will touch on another matter of
honor and start a blood feud that may last for generations. Second, when a
transgression is made public, it is the woman’s family that carries the burden
of cleansing it with blood and killing the alleged transgressor. It was found
that in many instances, the women of the family either incite the men to
action, or even actively participate in its preparations or the actual deed.
This is understandable in the light of the fact that an unpunished
transgression reflects mainly on the good name of the women of the family, thus
reducing the chances of the unwed ones to marry or to receive a good Mohar.
In 1992, a group of Moslem women activists publicly
agitated against this practice for the first time. They even demonstrated in
public against it, an unprecedented action. It is still unclear whether Jewish
female and male activists, by joining in this campaign, will strengthen or
weaken it. There is certainly strong expressed sympathy from Jews toward this
campaign.
Unlike the practice in some Islamic countries, the
courts in Israel do not accept the honor of the family as a mitigating
circumstance. On the contrary, they have expressed their lack of sympathy for
such customs and followed it with the maximum punishment under Israeli law,
which is a life sentence.
Fertility
Patterns and Their Secular Trend
The Total Fertility Rates (TFR) of Moslem Arab women
in Israel (4.65, 1993), is the highest among the national-religious groups
composing its population. Still it has also undergone the most marked decline
in the last three decades (see Table 4). The drop in TFR from 9.23 to 4.65 in
thirty-five years is proportionally lower than that of the Christian Arab women
(50 percent and 52 percent respectively), but in terms of absolute family size,
it is much greater. Christian women are having, on the average, only 2.6
children less as compared to thirty-five years ago, and their TFR is the lowest
among the studied groups (2.09, 1993), while Moslem women are having on the
average 4.6 less children.
An attempt to study the contribution of different
independent variables to this fertility change has revealed an interesting
picture involving cumulation of seven independent variables. At the time of the
study (1988), the independent variables that were the most strongly associated
with both the desired and achieved number of children were the mother’s age
group, her education, and a traditional arranged marriage with payment of a Mohar.
Two other independent variables were associated with only one of the studied
variables: Urban or rural locality was associated only with the desired number
of children, while participation in the workforce was associated only with the
achieved number of children.
Education seems to be the strongest of the associated
variables, the difference in desired fertility between the two extreme
educational categories being almost 2 children, and between the achieved
fertility at a relatively young age (28.5) by one child. The type of marriage
is variable showing the second strongest association. The differences in the
desired and achieved fertility between the two types of marriages being 0.6 and
0.5 children respectively. The other variables, even when significant, showed
much smaller differences. Prominent in their lack of association with either
the desired or achieved fertility were religiosity and marital lifestyle (who
gives up aspirations for the sake of the family).
The combination of the independent variables together
show a better overall explanatory power for desired fertility than it did for
the achieved fertility. One possible explanation of this discrepancy is the
fact that the analysis was done with relatively young women who were still at
an interim stage of achieving their fertility aspirations. Another explanation
is that the study was dealing with cognitive conscious variables that
associated with the verbal desired fertility, while achieved fertility is more
associated with unconscious factors that are not available for this kind of
analysis.
Contraceptive
Use
Several studies have demonstrated that the
availability and use of contraceptives, in themselves, were only weakly
associated with the achieved fertility, the use of contraceptives, as an
intermediate variable mediating between the desired fertility and the achieved
one, being the behavioral means to space pregnancies or to terminate fertility.
Table 7 compares the use of contraceptives among the Jewish population and
Moslem Arabs. In order to get a better analysis, the study distinguished
between women who do not use contraceptives because they are currently not
exposed to additional pregnancies, and those who do not use them for other reasons.
The former are pregnant women, women who try to conceive, infertile women, or
those who do not practice sexual intercourse.
The first significant fact, in terms of fertility
rates, is that the proportion of “nonexposed” women among the Moslems is much higher
than among the Jewish women, 29.4 percent as compared to 20.6 percent of all
the women respectively. The bulk of the “non-exposed” are pregnant women and
those trying to conceive. This means that at any one time, roughly 40 percent
more Moslem women were in the process of having children (Table 8).
The number of “nonusers” among the “exposed” is also
very significant, 21.3 percent of the “exposed” Moslem women compared with 11.3
percent among the Jewish women - 15.1 percent as compared to 9 percent of the
total number of women respectively. This number is very important because it
marks the percent of women among the “exposed” who do not want to conceive, but
do not use means of protection from pregnancy. Therefore, these women may be a
potential audience for family planning efforts. Another such group not shown
here is the women who actually attempt to avoid conception, but who are using
inefficient methods. Their percentage is also higher among the Moslem than
Jewish women. The conclusion is that when looking only at the women who do not
desire conception at a given moment, there is a strong need for family planning
efforts among the Moslem Arabs in Israel in order to allow them to realize
their desires.
Table 7
Comparison of the Use and Non-Use of Contraceptives
Among Married Jewish and Moslem Israeli Women (Aged 22-44 Years, 1988)
|
Number of Women
|
Percent of Total
|
Percent of Exposed
|
|
|
JEWISH WOMEN
|
1192
|
70.6
|
88.8
|
|
Users of contraceptives
|
|||
|
Non-users of contraceptives
among exposed
(non-use for reasons of fear, reluctance, principle, family
opposition, no intercourse, or ill-defined)
|
152
|
9.0
|
11.3
|
|
Subtotal exposed
|
1344
|
(80.0)
|
100.1
|
|
Non-exposed non-users of
contraceptives
(non-use because pregnant, want to become pregnant, recently
delivered, infecund, or no intercourse)
|
346
|
20.6
|
|
|
Total non-users of
contraceptives
|
29.6
|
||
|
Total number of women
|
1680
|
100.2
|
|
|
MOSLEM WOMEN
|
258
|
55.5
|
78.7
|
|
Users of contraceptives
|
|||
|
Non-users of contraceptives
among exposed
(non-use for reasons of fear, reluctance, principle, family
opposition, no intercourse, or ill-defined)
|
70
|
16.1
|
21.3
|
|
Subtotal exposed
|
328
|
(70.6)
|
100.0
|
|
Non-users non-exposed
(non-use because: pregnant, want to become pregnant, recently
delivered, infecund, or no intercourse)
|
137
|
29.4
|
|
|
Total number of women
|
465
|
100.0
|
Table 8
Use and Non-Use of Contraceptives Among Married
Israeli Moslem Women According to Exposure/Non-Exposure to Pregnancy and the
Reason Given for the Exposure/Non-Exposure (Aged 22-44 Years, 1988)
|
Number of Women
|
Percent of Total
|
Percent of Exposed
|
|
|
Users of contraceptives
|
258
|
65.5
|
78.7
|
|
Non-use on reasons of principle
|
25
|
5.4
|
7.6
|
|
Non-use because of reluctance, fear, ill-defined
|
45
|
9.7
|
13.7
|
|
Non-users of contraceptives
among exposed
(principles, opposition of family, reluctance, ill-defined)
|
70
|
15.1
|
21.3
|
|
Subtotal exposed
|
328
|
(70.6)
|
100.0
|
|
Fertility-targeted non-use
(pregnant, want to become pregnant, or delivered recently)
|
115
|
24.7
|
|
|
Infecund or no intercourse
|
22
|
4.7
|
|
|
Non-users non-exposed
|
137
|
29.4
|
|
|
Total number of women
|
465
|
100.0
|
Fundamentalist
Islam and Women’s Status
In the last ten years, the
fundamentalist Islamic movement has gained power among the Moslem Arab
population. The change is evident in both social phenomena and in the rise to
power of the Islamic movement in the local elections. More women are seen
wearing the traditional chador covering a woman from hair to toe at both
high schools and universities. In previous years, such garb was limited to
older rural women. Many mosques are being build in communities, boys and girls
are separated in the schools, and there are overt attempts, some of them not so
delicate, to bring women “back to their place,” ban alcohol, permissive
dresses, erotic films, etc. The Islamic fundamentalists, who are politically
most antiIsraeli, are similar in several respect to some Jewish ultra orthodox
groups.
Sexual
Violence Against Women and Children: The Deep Silence
The issue of sexual
exploitation, coercion, and violence against women and children in the Arab
sector has only recently been discussed in public; a first study has been
published on the matter and crisis centers have been opened.
Because several
characteristics of Arab society, especially in the sexual arena, make it
against the self-interest of women, children, and concerned caretakers to make
public accusations or seek help in situations of abuse, crisis support is
mainly provided by telephone hot lines that allow the caller complete
anonymity. A virgin woman who loses her virginity, for whatever reason, has a
lower value in marriage and a taint on the ability of the family to guard the
virtue of its daughters (which may reflect on the marriage value of other
female members of the family). If a married woman is raped, the perception of
nonvirgin women as tempters may cause people to blame her for what happened and
not the man (over whom women may have sexual powers). A raped boy or man may
keep quiet in order not to raise doubts about his manhood, which is highly
valued in that society, and therefore in his ability to marry. Thus, the rape
crisis centers that have counseling, intervention, and hot line programs in
Arabic report that their contacts in the Arab sector are predominantly by
phone, and that fewer callers will agree to identify themselves, make contact,
or press charges, as compared to the Jewish sectors.
B. Ultra
Orthodox Jews
The ultra orthodox, or Haredim, have an ambivalent
existence as non-Zionist Jews, recognizing only divine rules yet living within
a Jewish state. In some sense, it is more difficult for them in Israel than in
the diaspora, under the rule of non-Jews. Judaism, as a national as well as an
individual religion, prescribes rules of conduct not only within the private
domain, but also in the public one. These rules do not apply to non-Jews, so it
is only among Jews of differing practice that many conflicts arise about public
observance of certain rules.
Many of the ultra orthodox live within a defensive
spiritual perimeter, trying to isolate themselves and their children from the
encroaching influence of secular temptations. They have a separate educational
system that, although Financed by the government, is totally outside of its
educational supervision. Most of their youth do not go to the army, a highly
significant experience in the life of secular and orthodox Israeli youth, which
has an impact on dyadic, gender, and sexual issues. They also often feel
strongly that secular Jews do not understand the importance of their way of
life and, being in conflict with them over their own needs, hate or ridicule
them. They therefore shun strangers, even the ultra orthodox who belong to
other sects or communities. As their communities are very closely knitted,
their life revolving around the synagogue, the ritual bath, and other public
functions, it is very difficult to penetrate into their life.
It is even more difficult to penetrate into issues of
sex and marriage that are not discussed in public. A very few windows have been
opened into these areas in both fiction and nonfiction written by people who
were formerly ultra orthodox, in a study by a woman anthropologist among
religious women, and in sexual counseling and therapy.
Arranged
Marriages: Potential, Yichus, Health, and Money
Marriage in the orthodox tradition is one of the most
revered institutions. Many if not most of the religious rituals are familial,
and it is assigned a most important role in transmitting the Judaic values from
one generation to another. Although Judaism allows divorces, they are highly
stigmatizing; striving for the intactness of the family and keeping the peace
within it are highly valued.
In the ultra orthodox tradition, marriages are
arranged, either through marriage brokers, or through interested parties in
large family circles, or among friends. Four factors are highly important in
arranging marriages. They are not necessarily the same for men and women, but
they interact in more than one way. First, and probably the most important
factor for a man, is his potential in Halachic scholarship. As marriages are
arranged around the age of 18 to 20 for men and 16 to 18 for women, a realized
potential is rare. The heads of the religious academies or seminaries - the yeshivas
- will be looking for a suitable match for their most promising students.
These will be decided by the second and third qualities: Yichus, for
which the nearest translation is lineage and financial security. The first yichus
concern focuses on finding a woman who is herself from a family of Halachic
scholars, and thus will not only literally support her husband in his struggle
for scholastic excellence, but also increase the chances of bearing and raising
children who will be such scholars. This set of yichus issues also
includes all the qualities of the lineage, not only the hereditary ones, but
also ones like the “name” of the family, past divorces of other family members,
and other such factors. The second yichus concern looked for in women is
the ability of her parents to support the continuing studies of the husband in
the yeshivah for years to come. Such support is contracted for in
marriages and may place a heavy burden on the parents, as they can last for
three, five, ten, or even more years. During that time, the parents can expect
to support not only the young couple, but between three to six children. The
quality of yichus is also a determinant in the men’s eligibility, but
not the financial one, if they are scholars. The financial status is important
in men who are not scholars and who are in business or in trade.
Another highly valued factor is health, that of the
bride and groom, and the health of their families. Thus, families strive to
hide any “problematic” health problems like mental health, developmental
disabilities, genetic disorders, or subfertility. They may hide such a
son/daughter, even to the point of denying full care because of denial
mechanisms.
Many things can detract from the value of a person in
marriage, even having a brother or sister who has become less religious. Thus,
gossip can be very harmful, and whisper campaigns pernicious. The admonitions
against disqualifying gossip about brides and grooms are severe, which attest
to the importance of the issue.
Sons and daughters of the big rabbinical families
usually marry only within “proven” lines. Sometimes three or four such families
remarry for several generations. Such marriages acquire the proportions of
almost royal events.
Thus, marriages are viewed mainly not as an issue of
the heart, but rational arrangements whose main purpose is to establish a
viable, socially, and financially secure unit with a good potential for
reproduction, continuations, and excellence.
Rules of
Conduct Regulating Intercourse
As stated before, in Judaic tradition, sex is an
entity that intrinsically is neither good nor bad, but has a high potential for
both. The nature of sex is dependent on its meaning, context, and practices.
For orthodox people, and certainly for the ultra
orthodox, the context and practices are highly important and intermingled. The
central role of intercourse is procreation in the spirit of the blessing
“Procreate and multiply and fill the earth,” although the Halachic basis for
the rules and regulations covering the mitzvah to procreate are anchored
elsewhere. On the other hand, it is important to note that sex is practiced as
one of the marriage obligations of the husband, not only for procreation. Thus,
contraception may be allowed either for spacing or for ending pregnancies, if
one of several reasons recognized by the Halachah occur, even before the proscribed number of
children is reached. During such periods, when procreation is not its reason,
sex continues to be a mitzvah.
In terms of meaning, sex, as most other things,
should be practiced for the glory of God and his creation. There are several
degrees of elevation in practicing it, but if striving for a higher step
disturbs one from fulfilling the mitzvah itself literally, then that
person is really sinning and should change his or her ways. This sometimes has
meaning in sex therapy, as the therapist encounters a phenomenon in which sexual
dysfunction is explained by the need to strive for an elevation of the sexual
act.
The context of practicing sex is restricted to the
boundaries of marriage and to the prescribed period of the month that is
determined by the woman’s menstrual period (see below). The rules of conduct
governing the actual act of intercourse are numerous, from the amount of light
which is allowed into the room (only indirect), through the place of religious
books during the act, through positions that are recommended and acts that are
proscribed, to mention just a few. A most proscribed act is, of course, the
spilling of semen in vain, which determines the fact that condoms and
withdrawal are religiously banned. There is a discussion whether, if in the
course of transgressing other laws, the use of condoms is allowed for
protection against AIDS. Another rule of conduct that is perfectly natural and
understandable to those practicing Judaism in its ultra orthodox variation is
that women are prohibited from direct verbal initiation of intercourse,
although they are allowed other means of initiation, including indirect verbal
ones.
It is important to note that pleasure is considered
an integral part of the act, and it is the duty of the husband to “please” his
wife. This raises several interesting issues, some of which have a meaning in
sexual counseling and therapy. First, what is the meaning of pleasing or
pleasure in the differing minds of men and women? This will determine if at
all, what, when, and how, they ask for something in practice. This also poses a
problem for a nonorthodox therapist who may interpret pleasure either in a
culturally nonappropriate manner, or neglect to include individual variations
and needs within the stereotypical interpretation. A second question is what
proportion of the couples practice intercourse strictly according to the rules,
how prevalent are the private variations to the public norms and how far they
go?
Purity Laws:
Periodic Abstinence, the Public-Private Dualism of Sexual Intercourse, and the
Social Control Over Fertility
Purity laws restrict the period in which a couple can
practice intercourse to about half of the month. The cessation of not only
intercourse, but any direct or indirect physical contact between husband and
wife is determined by the onset of menstruation; this is called the Nidah
period. Toward the end of her menstrual period, but not less than five days
from its onset, the woman has to check with white cloth at the external opening
of the cervix, whether she is still bleeding. When there are no signs of
bleeding any more, she has to count seven “clean” days; at the evening of the
last day, she has to cleanse herself in the “mikveh,” literally a pool, which is the
public ritual bath. On that same night, her husband is to approach her
for intercourse.
This emphasis on purity and the high visibility of
the dualism between impurity-purity in women’s life, raise several issues that
can be viewed from different aspects.
Writings by religious people directed mainly at
nonobservant people argue in a mixture of apologetic and aggressive modes that
these laws protect the health of women in the time when her body is most
vulnerable to infections through sexual intercourse, that the periodic
abstinence creates a healthy sexual tension between husband and wife, and not
only increases the bond between them, but also puts some meaning into it. There
are also claims that restriction on intercourse, and the timing of the first
intercourse after the abstinence, act not only to increase fertility, but also
to the lowering of birth defects. Little evidence has been compiled that will
be accepted as supporting the biomedical claim, in fact, and some of the
evidence is cited wrongly or out of context. As for the psychological and
dyadic claims, this may be true for some couples, but may be totally the
opposite for others. Ronny A. Shtarkshall observed in a biased population of
help-seeking couples that the purity laws were sometimes the focus of strong
suffering on the side of women and a cause for conflict. Some women, for
example, complained that the ban of touching was unbearable, especially when in
a low or depressed mood or when one is ill or suffering. This was also true
when the husband or an adolescent child is suffering. Women also complained
that intercourse at the end of the Nidah period had a “mechanical”
aspect to it, which causes both individual and interpersonal difficulties. The
fact that this mechanical aspect of the intercourse - fulfilling a mitzvah -
may have been only perceived or partially true is unimportant here. The
important aspect is that it could cause difficulties and that it has to be
addressed.
A highly important point of view is the feminist
discourse that includes these laws as one of the determinants of the status of
women in the Jewish religious society. Despite the fact that this discourse
totally ignores the fact that purity laws also apply to men and to sperm
emission, in a highly elaborate way, they point to some very important issues.
First is the issue of fear of contact with a Nidah
woman unknowingly, which governs the rules of conduct of many orthodox men who
will refrain from any casual touch or shaking hands with women. Thus, every
woman is suspected to be impure unless proven otherwise. This may be the explanation
for grandmothers sometimes being more “touching” than mothers when boys are
concerned, and the readiness of the adolescent boys to accept this physical
contact.
Second is the heightened awareness of adolescent
girls of their bodies, its potential for impurity, and the need to examine it
regularly. On the other hand, adolescent boys are introduced to the female
issues from a totally “impersonal” point of view, through learning about it in
their Halachic studies. The fact that boys also become aware of their own
bodies through the need to keep a constant watch over themselves as not to
spend semen in vain (which include nocturnal emissions), and thus be in danger
of defiling the religious scrolls, is not alleviating the potential harm that
such awareness may impose on the development of girls.
It is important to emphasize that this discourse is
mostly limited to nonreligious circles and to religious women of North American
origin. Writings about these issues from this point of view, or from related
ones, by orthodox women are generally not available.
An important point that is raised by both religious
men and women, sometimes from different perspectives, is the public nature of
intercourse and of fertility that is dictated by the use of the mikveh.
Some recent ethnographic/anthropologic literature describe the feelings of
women who go back home after visiting the mikveh, feeling in the look of
every person in the street, especially the men, the knowledge of the expected
intercourse. Thus a very private act acquires a very public aspect. Both men
and women in therapy for either lowered fertility or for sexual issues
frequently comment on the fact that going to the mikveh is a public
proclamation of the failure to conceive in a society where both internal familial
and external pressures for procreation are very high, especially on young
couples. Men and women commonly comment on the fact that it is public knowledge
even before that, when people, especially parents and in-laws, can tell when
they refrain from touching each other or making contact, even indirectly,
through a dish. This may have several implications (see discussion of
therapeutic issues below).
Fertility
Patterns
Although the high number of children born to ultra
orthodox families is obvious and an accepted fact which influences both
perceptions and politics, there is little hard data on the fertility patterns
of the ultra orthodox. This results from a combination of administrative
restrictions and reasons embedded in the ultra orthodox culture. While the
religion of the parents is noted on the birth certificates of newborns, there
is no notation of religiosity on documents that are the basis for all the
statistical calculations of birthrates, age specific birthrates, and TFRs. Thus
secular, traditional, orthodox, and ultra orthodox Jews are in the same
category. As the ultra orthodox tend to live in geographically cohesive
communities, it is possible to get a handle on their fertility through
statistical regions. The TFR for Jews in the city of Jerusalem, which has a
high proportion of ultra orthodox (30 percent by municipal elections), is
almost two children higher as compared to the TFR for Jews in the two other big
urban centers - Tel-Aviv and Haifa - 3.72 as compared to 1.86 and 1.91
respectively.
It is apparent even to naive observers that the
fertility pattern is totally different both in spacing and in TFR, as it is
common to encounter families with six to nine children and not uncommon to
encounter families with ten to fourteen children. Young couples usually aim at
having the first child as soon as possible, within the first year of marriage.
Studies have shown that this is such a prevalent and internalized norm that
couples rarely discuss this issue. As a woman’s menstruation and pregnancy are
public knowledge, loving and concerned pressure is brought to bear on couples
early in the marriage. Parents and in-laws are sometimes unaware that such
pressures can be devastating both to the fertility and to the sexual
functioning of the young couple.
Even in a fertility survey, it was difficult to look
at the ultra orthodox separately, because their women tended to avoid being
interviewed and were therefore underrepresented. The reasons for refusal,
especially when the interview touched on issues of children, fertility, and
family planning, are perfectly understandable from inside their cultural
environment. First and foremost, children and fertility are one of the most
precious things in the life of women. In a society where the future and
planning for the future are the prerogative of God, any tampering, even a
verbal one can be construed as tempting fate or courting punishment. Second,
there is the fear of being misunderstood and/or stigmatized by outsiders,
especially nonreligious Jews. Third, there is the fear of the evil eye
resulting from jealousy.
Contraception
vs. Family Planning
Despite the strong emphasis on procreation, the Jewish Halachah allows
contraception on the basis of individual needs and circumstances. As the
principles of the Halachah do not recognize general rulings, each
individual case has to be decided by a Halachic authority on the advice of
medical opinion. On the other hand, there is a very strong public opposition to
family-planning services. The delicate differentiation between family planning
and the use of contraceptives lies in the realm of purpose. While family
planning as such is a transgression, the use of contraceptives for religiously
recognized purposes is allowed.
The religious rules govern not only the use of contraceptives,
but also the types of contraceptives to be used. As already mentioned, two
types of contraceptives are almost totally banned: male contraceptives and
nonreversible contraception, whether male or female. Among temporary female
contraceptives, currently the most acceptable ones are combined birth-control
pills (for women with breakthrough bleeding), IUD, and diaphragm. Again there
are personal variations and medical opinions are sought and listened to.
The public opinion against family planning and
contraceptive services is such that ultra orthodox women, even those with
strong need that will probably be acceptable to the Halachic authorities,
refrain from seeking help. The tip of the iceberg was seen when women listeners
started writing to a weekly radio program, “Not a Children’s Game,” devoted to
reproductive health and family planning issues. A psychosocial analysis of the
letters revealed that about half of the women writing in were from the ultra
orthodox community. Half of those were vociferously and almost violently
against the program as promoting promiscuity and being antinatal; the other
half were women desperately seeking help in dire situations. Religious
authorities consulted by the producers assured them that these women could and
should receive help according the Halachah. It was also evident that
these women will be able to accept help only if it will be within the religious
tenets. They were confidentially referred to both medical and religious
authorities in the relevant geographical area. This public-private dichotomy is
sometimes typical of the religious community.
Transgressions
The fact that people adhere to many religious rules
and live within a religious community does not mean that they do not transgress
on any of its laws and rules. Transgressions on an individual basis are varied
and should be only recognized and not discussed in such a paper. On the other
hand, when cultural, ethnic, or other traditions within a religious community
are in contrast with religious rules, or are in contradiction of the rules that
these same people profess, these should be looked into.
One such example was mentioned above, when public and
spousal pressure prevented women who probably deserved contraception within the
Halachah from seeking and receiving help.
Another example that relates to contraception was
noted in a study that examined the family-planning practices of a very orthodox
community of immigrants from Yemen. While the women complained about unwanted
pregnancies and the number of children, the husbands claimed that
family-planning services should not be approached because of religious reasons,
A study by family physicians revealed that the most prevalent family-planning
practice in this community, one that the majority of couples used, was
withdrawal - a grave sin according to the religious rules.
One can only conclude that, as strong as religion
rules are among orthodox groups, cultural traditions sometimes modulate them in
unexpected ways.
Issues in Sex
Therapy
Nonobservant therapists working in areas with a
concentration of ultra orthodox must resolve several therapeutic, ethical, and
personal/professional issues.
First is the difference between the therapeutic
paradigm and the basic tenets of the client(s) and their subculture. In essence,
one can say that the place of sex in the worldview of the clients differs in
some important points from that of the therapist and the therapeutic approach.
While the basic approach of sex therapy to sex is
individual- and couple-oriented, hedonistic, and present-oriented, the approach
of many of the clients is certainly different. While pleasure and fulfillment
are not excluded from the constellation, they are certainly not at its center.
The central themes of sex among the orthodox are its function in procreation
and the preservation of the family; despite the strong shroud of secrecy and
privacy, sex has several “public” aspects to it, especially within the extended
families; through the centrality of procreation, sex acquires a strong future
aspect to it.
In this domain, one can also include the egalitarian
approach of sex therapy, implicit in many of its tenets and interventions. In
the ultra orthodox point of view there is a strong asymmetry in terms of
initiative, responsibility, and the duty of husbands for the sexual act and the
fulfillment of their wives.
A second issue can be viewed as environmental. While
one of the basic means of sex therapy is to lower the burden of performance
from the partner who carries it and the introduction of nonperforming sex,
among the ultra orthodox, who view procreation as a central aim of intercourse,
there is not only an objective criterion for performance, but also a regular
almost public viewing of it, at least to other women - the visits of the wife
to the mikveh.
A third issue is a more individual one. The use of
exploration, inventive-ness, and flexibility is an important part in the
therapeutic intervention. Here the therapist encounters various degrees of
rigidity/flexibility as in any other population. The uniqueness is the
connection that the clients are making with the religious rules of conduct, a
very powerful barrier to possible change. An approach that is embedded in their
belief system is that transgression is a matter of choice, and it is an individual
choice between sins.
The resolution of these issues lies in the
recognition by therapists that any therapy cannot buck the basic belief system
of the client and that changes can mostly be affected within that system. In
the case of working with ultra orthodox persons, the therapist must adhere to
some self-imposed rules and restrictions. Some of these are harder than others.
Such is the agreement to consult rabbinical authorities on issues within the
therapy, when the client demands it, and to abide by their specific decision in
working with the specific client for which the question was asked. This raises
issues like divided or shared authority and the use of consultations as escape
routes. Other issues are the specialized knowledge needed even to ask Halachic
questions and the use of the therapist’s own rabbinical authority in phrasing
them.
The basic rule seems to be the ability to feel true
respect from outside and to grasp meanings from inside of a culture that is
basically alien to the therapist’s worldview.
It is difficult and inadvisable to talk about
prevalence of sexual problems, not only because there are no adequate
statistics, but because the reasons for seeking help may be totally different
from that of the general population. The main complaint is subfertility, which
is later diagnosed as a primary sexual dysfunction or the wish to have more
children in the case of secondary ones.
C. The
Kibbutz Movement
The kibbutz movement comprises 2 to 3 percent of the
Jewish population of Israel, a seemingly smallish part of the population to be
dealt with separately. But this movement of collective communities, the first
of which was founded eighty years ago, played an important role in the
development of Israeli society. Several features of this subculture are highly
important for the discussion of sexuality of youth, fertility patterns, and
contraception. The first is that, even with the current changes in lifestyle,
and the fact that most kibbutzes have changed sleeping arrangements so that
children sleep at their parents’ apartments instead of the children homes,
kibbutz youth live a life much more independent of adult control in general,
and parental control in particular, from early adolescence on than any other
group of Israeli youth. Second, despite the fact that the kibbutz society is
not as egalitarian as people used to think, it is apparently very much so in
many aspects. Third, the kibbutz society emphasizes self-reliance and internal
locus of control in many aspects of life by minimizing economic secondary
motivations. It is therefore not surprising that people take charge of their
life in many aspects, including sexual responsibility and sexual health.
On the other hand, in a seemingly contradictory vein,
social pressures to conform are very high within the kibbutzes. It seems that
the strongest effects occur when social pressures and the powers of the
individual act in the same direction.
Intercourse
During Adolescence and Young Adulthood
When comparing urban to kibbutz youth, it is apparent
that beyond tenth grade (age 16) both kibbutz men and women report more
premarital intercourse than others; they also start at a younger age. This
difference is more pronounced for women than for men - the rate of reported
intercourse for kibbutz men is either similar or slightly higher than that of
urban young men. In contrast to urban youth, the ratio of kibbutz men and women
reporting intercourse, among those who initiated it, was about 1:1 for all
grades. Whether this is an egalitarian norm of reporting, or of initiating
intercourse or both, needs further studies. These results have been verified in
several independent studies over a period of about twenty-five years.
As reported earlier, it seems that since the
mid-1960s, the age of sexarche in Israel is going down for those who practice
premarital intercourse (see Figure 2). This is true for both youth in both
social settings, and is especially marked for urban women. However, there is an
interesting difference between urban and kibbutz women (Figure 4). In all three
cohorts of urban women, there is a break in the curve and a rise in the slope
between ages 16 to 17, and 18 to 19. Among kibbutz women, this is true only for
the older cohort, those who reached age 16 between 1965 and 1969. The two younger
cohorts of kibbutz women, who reached age 16 in 1970 through 1975 and 1976
through 1982, show a straight line between ages 14 to 15 to 18 to 19
(significant at the 0.01 level for all three cohorts).
Figure 4 - Comparison of Sexarche Between Urban and
Kibbutz Women Who Reached Age 16 at Different Time Periods
The “break” in the curve for urban women can be
explained by the lowering of parental/social control for women who leave for
the army at the end of twelfth grade. There are several possible explanations
for the fact that for the kibbutz women the curve is straight: first, kibbutz
women may be relying more on internal locus of control and, therefore, are less
influenced by the parental/social controls; second, less parental control being
exerted on kibbutz youth than on urban youth; and/or more accepting and
egalitarian norms of sexuality among kibbutz youth that allow more women both
to practice intercourse and to report it. Several indications in the data and
in the general structure of kibbutz life indicate all of these factors may be
acting together.
Fertility
Patterns
A superficial analysis shows similarities between
fertility patterns of urban and kibbutz women; closer analysis reveals a much
more interesting picture. First, when comparing the TFR of kibbutz women to the
segments of the population closer to them in composition, those of
American-European origin, one finds that kibbutz women have more children.
Second, when controlling for religion and comparing secular urban women with
secular kibbutzes and religious (not ultra orthodox) urban women with religious
kibbutzes (a small minority), one can see that in each sector, the kibbutz
women have 0.5 more children. Third, the patterns of fertility are different.
Kibbutz women marry older, give birth at a later age, and lag behind the urban
women in number of children until about age 30, although they continue to have
children until a later age.
Another difference is that the interval between
giving birth is longer for kibbutz women, when controlled for religiosity,
education, ethnic origin, age, stillbirth, and natural or induced abortion.
Kibbutz women had intervals two months longer between the first and second
child, and three months longer between the third and fourth child. The two
latter differences point to a relatively high degree of planning and control of
fertility.
When looking at the differences between various types
of kibbutz ideologies and diverse lifestyles that emerged during recent years -
like young children sleeping at home instead of at communal children’s homes -
it was found that the personal differences between women within kibbutzes
contribute to the differences in TFR, much more than the differences between
kibbutz movements.
Contraception
Does the fact that the kibbutz society supplies all
the material needs of its members, including health needs; shows high
prevalence of egalitarian attitudes to sexual behavior of men and women; and
puts a high value on planning and control, in fact lowers some of the barriers
to family planning and to efficient contraception that are so prevalent among
many other groups? If this is the case, then the use of contraceptives among
kibbutz women, married and unmarried alike, should be consistently higher than
for urban women across all other variables like religiosity, educational level,
ethnic origin, and birth order of the children.
As early as first intercourse, kibbutz women show a
different pattern from urban youth: 43 percent of secular kibbutz youth used
some kind of contraceptive at sexarche, about half of them - 21 percent of all
the women practicing premarital intercourse - used the pill on first
intercourse. This number is much higher than the rate for secular urban youth:
27 percent and 13 percent respectively. The significance of this difference
becomes more pronounced if one notes that it was already demonstrated that
kibbutz women reach sexarche at a younger age than urban youth, and that age at
first intercourse is a strong determinant of the ability of youths to protect
themselves.
When comparing nonorthodox kibbutz women and urban
women during their married life, it is clear that kibbutz women are more
efficient and more consistent contraceptors. Only 15 percent of kibbutz women
did not use any contraceptive prior to the first pregnancy, compared to 40
percent of the urban ones. During that period, only 12 percent of the kibbutz
women relied on withdrawal as compared to 19 percent of the urban ones. The
rates of pill use are reversed, 50 percent compared to 26 percent respectively.
After first pregnancy, the differences are even more
pronounced: 90 percent of kibbutz women contracept and only 8 percent use
withdrawal or rhythm, compared to 28 percent noncontraceptors and 26 percent
withdrawal or rhythm contraceptors among urban women. These differences remain
pronounced in higher birth order intervals. Among variables that might explain
differences in contraceptive use prior to first pregnancy within the kibbutzes,
the only ones with significance were the birth cohort - older cohorts using
less contraceptives and less-effective ones prior to the first pregnancy, and
ethnic origin - women of Asian-African origin using less effective
contraceptives.
When comparing contraceptive use in 1987-88, kibbutz
women progress from 79 percent efficient contraceptors prior to the first
pregnancy, through 81 percent after the first and second pregnancy, to 89
percent after the third pregnancy. Urban women progress from 24 percent through
62 percent to 64 percent respectively. Not only is there a difference, but the
pattern is different. It seems that urban women contact agencies that help them
use efficient contraceptives only after giving birth to the first child, while
the majority of kibbutz women do so prior to the first pregnancy.
Juxtaposing the patterns of contraceptive use with
the patterns of fertility, and taking into account that kibbutz women who start
having children at a later age and with longer birth intervals end up with more
children over a longer fertile period, it seems that the group is very close to
that of the ideal contraceptors - women who use contraceptives effectively to
have as many children as they want at the time that they choose. This is also
supported by information about much fewer reported unplanned pregnancies, most
of which seem to be while using very safe methods.
Immigrants
and Immigration
Israel is, as indicated, an immigrant society, albeit
with some strong internal and external cohesive forces. There are some
indicators that demonstrate that these forces are acting toward creation of a
common meeting ground, in which some unique characteristics develop.
Nevertheless, two groups of recent immigrants give us
the opportunity to look at issues and processes that both immigrants and the
host society undergo when faced with the phenomenon of people from an alien
culture transplanted into an established one.
One can claim that the
immigrants from the former Soviet Union (USSR) and those from Ethiopia have
nothing in common. The Ethiopian immigrant group is small even by Israeli
standards, the recent wave arriving since 1991 being 20,000 people and the
whole community numbering 50,000. More than half a million immigrants, 10
percent of the total population of Israel, have arrived from the USSR since
1989. The “Russians” came from a midindustrial, European country with a high
literacy rate, mainly from urban areas, having a high rate of academic
professionalization and with many family ties with the established old-timers’
society. As a matter of fact, the Mayflower founding parents of the Israeli
society and state immigrated from Tzarist Russia and its environments at the
end of the last century and the beginning of this one. The immigrants from
Ethiopia came from a country with a rich but isolated culture, nonindustrialized,
with low literacy rates, mainly from rural-agricultural areas with low
mobility, an extended family structure, and very little family ties with the
old-timers’ establishment.
On the other hand, both groups had undergone, through
the dual process of emigration/immigration, being uprooted from one’s original
culture and transplanted into a new alien one. But the similarities may even go
deeper. Both groups came from societies that had very strong external social
controls. While among Jews in Ethiopia, the controls were mainly familial and
“tribal” - the forces of tradition within a small, isolated, and sometimes
persecuted group - those of the USSR were political and institutional. Also, at
the time of their immigration, both original societies were undergoing some
very strong processes of disruptive transitions. So one is faced with a unique
chance of looking at two groups of immigrants undergoing a very similar
process, but with somewhat different starting points and cultural contents.
Interest in the immigrants from Ethiopia and the
former USSR is not one of explorers observing exotic cultures with mixed
emotions, nor of amateurish anthropologists whose hidden aggenda is asserting
their own cultural superiority. We are involved and vested participant-observers,
with a strong interest in ameliorating the difficult process of immigration and
acculturation. Ronny A. Shtarkshall is already an intervener-observer involved
in the study and development of integrating interventions.
Because these immigrations are quite recent, the
initial processes of cultural integration, some of which are very painful, are
still going on. Sensitivities are high and the potential for stigmatization is
frightening. Hence one cannot do more at this time than indicate that careful
and sensitive work with these immigrant groups may well in the future provide a
rich source for major new insights into the principles and functioning of a
cross-cultural sex education program.
Glossary
Some Hebrew and Arabic words that are frequently used
in the text, mainly for lack of an appropriately equivalent term in English
(Some of these terms are italicized throughout the text).
1.
Halachah: The accumulated body of religious laws, discussions, rules of
conduct, interpretations, judicial decisions, and precedents that govern the
life of an orthodox religious Jew. Generally the Halachah covers all the
aspects of life of a religious Jew from birth to death, religious and secular,
public and private. The more orthodox a person is, the more strict is the
adherence to the Halachic rules and the more involved are the interpretations.
2.
Haredim: A general name given to ultra orthodox communities by secular
people. Most people who use this name do not distinguish even between the major
variations of ultra orthodox Judaism.
3.
Mikveh: Literally a place were flowing water will collect, the name of
the ritual bath that serves for ritual purification of both women and men when
this is required according to religious regulations. It is mostly discussed,
especially by the secular population, in relation to the purification of women
at the end of their impure period - Nidah. It should be noted that men
should also purify themselves if they spill semen, and that many religious
rituals require that men purify themselves in the mikveh.
4.
Mitzvah: A combination of a religious law, personal obligation, and a
privilege. The Hebrew name for the religious rules. The original biblical ones
numbered 613 (not a small number in itself), but their development and
interpretation in the Talmud increased their numbers several folds.
5.
Mohar:
Bride payment. Traditionally paid by Moslem grooms to the bride’s
father. Mohar can be paid in money or cattle. It is almost never paid
with land.
6.
Nidah:
A period determined by the menstrual period and seven days after it,
during which women are impure and untouchable. The root of the word also means
ban or banishment.
7.
Shabbat: The seventh day. Among orthodox and ultra orthodox, it is
strictly kept. Not only no work is allowed, but things like lighting a fire or
an electric instrument, driving or riding in a car, picking a flower, writing
or tearing paper are banned. Although very holy and strictly observed, one is
allowed to do most of the things if the purpose is to save lives. One of the
things that is not only allowed but recommended on Shabbat night is
intercourse.
8.
Yeshivah: A high religious academy or a seminary.
9.
Yichus: lineage.
References
and Suggested Readings
1.
Antonovsky, H. 1980. Adolescent Sexuality.
Lexington, Massachusetts: Lexington Books.
2.
Arieli, Y. 1992. “Being a Secular Jew in
Israel.” In Arieli Y. History and Politics. Tel Aviv: Am-Oved
3.
Birenbaum, M. 1993. Survey of Sex Education
in General National Education Schools, 1991-1992. Jerusalem: Unit of Family
Life and Sex Education, Ministry of Education and Culture. (Hebrew).
4.
Central Bureau of Statistics. 1993. Statistical
Almanac, 1992. Jerusalem: Governmentís Press (Hebrew & English).
5.
Herz, Fredda M., and Elliott J. Rosen. 1982.
“Jewish Families.” In M. McGoldrick, J. K. Pearce, and J. Giordano, eds. Ethnicity
and Family Therapy. New York: Guilford Press.
6.
Keysar, A. 1990. Demographic Processes in the
Kibbutzes of Israel. A doctoral dissertation. Hebrew Univesity of
Jerusalem.
7.
Nathan, M., and A. Schnabel. 1975. “Changes in
the Attitudes of Kibbutz Children Toward Friendship and Sexual Relations.” Studies
in Education (Iunim Bechinuch). 6:117-32 (Hebrew).
8.
Peritz, E., and M. Baras, eds. 1992. Studies
in the Fertility of Israel. Jerusalem: The Hebrew University of Jerusalem.
9.
Sabatallo, E. 1992. “Estimates of Demand for
Abortion Among Soviet Immigrants in Israel.” Studies in Family Planning,
23(4):268-73.
10.
Sabatallo, E. 1993. “The Impact of Induced
Abortion on Fertility in Israel.” Social Science in Medicine,36(5):703-07.
11.
Sabatallo, E. 1993. Continuity and Short Term
Changes in Patterns of Fertility and Abortions Among Immigrant from the
Former USSR. Jerusalem: Social Security. (in press; Hebrew).
12.
Shtarkshall R. A. 1990. “Formen und Trends im
Sexualverhalten israelischer Jugendlicher.” In W. Melzer, W. Ferchhoff and G.
Neubauer, eds. Jugend in Israel und in der Bundesrepublik. Weinheim und
München: Juventa Verlag.
13.
Shuval. J. T. 1992. Social Dimensions of
Health: The Israeli Experience. Westport, Connecticut: Praeger.
14.
Sketchley, J. M. 1991. Psychosexual Services
in Selected European Countries. Copenhagen: World Health Organization,
European Region.
NOTE: A more extensive list of references that were
utilized in the preparation of this article can be obtained by writing to the
first author: Ronny A. Shtarkshall, Ph.D., 15 Yasmin Street (Box 1116),
Mevasseret-Zion, Israel 90805.
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