Pregnancy and Miscarriage in Qatar: Women, Reproduction and the State 9781838607340, 9781838607371, 9781838607357

Table of contents :
Cover page
Halftitle page
Series page
Title page
Copyright page
Dedication
Contents
Acknowledgements
Introduction
Miscarriage: challenging the trope of silence
1 Qatar: Traditional Modernity
Setting
Anthropology of miscarriage: the project
Contribution and chapter outline
2 Women and State: Reproduction and Arab Modernity
Reproducing the nation: Islam, the state and Qatari mothers
Qatari modernity: innovation, education and international politics
Custom and the contemporary
Conclusions
3 Huda: Marriage, Motherhood and Loss
Reproductive navigations, pregnancy and miscarriage
Marriage and the importance of Qatar motherhood
Conclusions
4 Motherhood Lost: Stories of Miscarriage
Moza
Noora
Conclusions
5 Modern Bodies; Miscarriage Cause
Modernity, women’s bodies and reproduction
Further exhaustions: age, illness and bodily weakness
Blame and culpability
Conclusions
6 (Super)natural Forces and Miscarriage Cause
God gives and God takes
Hit by the eye
Protecting oneself: the art of concealment
Conclusions
7 The Foetus: Burials, Babies, Birds and Imaginings
The miscarried foetus
Zinā babies
Emerging foetal personhood: ensoulment and movement
Birds in heaven
Foetuses in a global world
Conclusions
8 Reproductive Disruptions: Spectrum of Compromised Fertility
Miscarriage unshrouded
Multiple miscarriage: towards infertility
Infertility
Normativity and silence – thoughts on the comparative
Conclusions
9 State Development Discourse: Maternalism and Empowerment
Education and employment: expectations, ambitions and challenges
Professional pregnancy: problematic negotiations, managing tensions and mitigating risk
The role of domestic workers in negotiating professional and maternal roles
Maids, miscarriage and modernity: domestic workers and state policy
Conclusions
Conclusions
Notes
References
Index

Citation preview

Pregnancy and Miscarriage in Qatar

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Sex, Family and Culture in the Middle East Series This innovative series explores the connections and influences impacting ideas about marriage, sexuality and the family throughout history in the MENA region, and until the present day. Individual volumes consider the ancient, early Islamic, medieval, early modern and contemporary periods to investigate how traditions and practices have evolved and interacted across time and countries. Series Editors: Janet Afary, Professor and Mellichamp Chair in Global Religion and Modernity, UC Santa Barbara Claudia Yaghoobi, Roshan Institute Assistant Professor in Persian Studies, The University of North Carolina at Chapel Hill

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Pregnancy and Miscarriage in Qatar Women, Reproduction and the State Susie Kilshaw

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I.B. TAURIS Bloomsbury Publishing Plc 50 Bedford Square, London, WC1B 3DP, UK 1385 Broadway, New York, NY 10018, USA BLOOMSBURY, I.B. TAURIS and the Diana logo are trademarks of Bloomsbury Publishing Plc First published in Great Britain Copyright © Susie Kilshaw 2020 Susie Kilshaw has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work. Cover design: Alixe Bovey All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Bloomsbury Publishing Plc does not have any control over, or responsibility for, any third-party websites referred to or in this book. All internet addresses given in this book were correct at the time of going to press. The author and publisher regret any inconvenience caused if addresses have changed or sites have ceased to exist,but can accept no responsibility for any such changes. A catalogue record for this book is available from the British Library. A catalog record for this book is available from the Library of Congress ISBN: ePub: ePDF:

978-1-8386-0734-0 978-1-8386-0736-4 978-1-8386-0735-7

Series: Sex, Family and Culture in the Middle East Typeset by RefineCatch Limited, Bungay, Suffolk To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters.

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For Scarlett and Annabel for thinking that being an anthropologist is cooler than being a pilot.

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Contents Acknowledgements

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Introduction Miscarriage: challenging the trope of silence

1

1

2

3

4

5

3

Qatar: Traditional Modernity

11

Setting

11

Anthropology of miscarriage: the project

13

Contribution and chapter outline

19

Women and State: Reproduction and Arab Modernity

29

Reproducing the nation: Islam, the state and Qatari mothers

32

Qatari modernity: innovation, education and international politics

38

Custom and the contemporary

43

Conclusions

46

Huda: Marriage, Motherhood and Loss

47

Reproductive navigations, pregnancy and miscarriage

48

Marriage and the importance of Qatar motherhood

51

Conclusions

69

Motherhood Lost: Stories of Miscarriage

73

Moza

74

Noora

89

Conclusions

97

Modern Bodies; Miscarriage Cause

99

Modernity, women’s bodies and reproduction

100

Further exhaustions: age, illness and bodily weakness

107

Blame and culpability

116

Conclusions

119

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6

7

8

9

Contents

(Super)natural Forces and Miscarriage Cause

121

God gives and God takes

123

Hit by the eye

130

Protecting oneself: the art of concealment

134

Conclusions

137

The Foetus: Burials, Babies, Birds and Imaginings

139

The miscarried foetus

141

Zinā babies

149

Emerging foetal personhood: ensoulment and movement

151

Birds in heaven

152

Foetuses in a global world

156

Conclusions

158

Reproductive Disruptions: Spectrum of Compromised Fertility

161

Miscarriage unshrouded

162

Multiple miscarriage: towards infertility

167

Infertility

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Normativity and silence – thoughts on the comparative

176

Conclusions

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State Development Discourse: Maternalism and Empowerment

181

Education and employment: expectations, ambitions and challenges

183

Professional pregnancy: problematic negotiations, managing tensions and mitigating risk

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The role of domestic workers in negotiating professional and maternal roles

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Maids, miscarriage and modernity: domestic workers and state policy Conclusions

Conclusions Notes References Index

197 202 205 211 215 237

Acknowledgements Above all I would like to thank our interlocutors who so generously gave their time and shared their intimate and often difficult stories of pregnancy and loss. I was heartened by how welcoming participants and their families were to us and despite the difficult nature of the subject, I thoroughly enjoyed getting to know the Qatari women whose stories form the basis of this book. The book would not have been possible without the financial support of the Qatar Foundation. This study was funded solely by Qatar National Research Fund (QNRF) (a member of Qatar Foundation), www.qnrf.org, under NPRP grant [5–221–3-064]. (Disclaimer: QNRF did not have any additional role in the study design, data collection and analysis, interpretation of data, decision to publish, or preparation of the manuscript. This publication was made possible by NPRP grant [5–221–3-064] from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the author.) Thank you to the editorial team at IB Tauris, particularly Sophie Rudland, and the anonymous reviewers whose detailed and thoughtful comments improved the book and allowed my ideas to develop. I am indebted to my research team: Co-Lead Principal Investigators, Dr Stella Major (Weill Cornell Medicine-Qatar, Education City) and Dr Kristina Sole (University of Oslo, previous affiliation WCM-Q), both of whom were responsible for overseeing and directing the research in Qatar; Dr Halima Al Tamimi and Dr Faten El-Taher (Hamad Medical Corporation, Doha, Qatar); Ms. Nadia Omar (Medical Research Centre, HMC, previous affiliation WCM-Q) and Dr Mona Mohsen (Interim Translational Research Institute, HMC; previous affiliation WCM-Q). The research upon which this book is based was a collaborative effort and I could not have written it without the team’s dedication. I have benefitted from their expertise, efforts, and insights and am beholden to them for their vital input. Our ongoing discussions have been instrumental to the development this book and so much more. I am ix

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Acknowledgements

proud to call these amazing women my friends. In particular, I would like to thank Nadia Omar and Mona Mohsen who conducted most of the interviews in Qatar, translated them and provided endless information, knowledge, and support. Nadia’s dedication to the project meant she was there at the start and was with us as we ended the project – her tireless efforts kept us on course. I am grateful to Weill Cornell Medicine-Qatar for hosting the research and for the administration team who were always so helpful; in particular, thanks to Tembela Eweje for her work administering the grant and to Darius Walker and Shafnas Kutty for their help in its smooth running. I am grateful to my companion anthropologists in Doha: Tanya Kane and Trinidad Rico for their discussions and friendship. Friends and colleagues at UCL have provided encouragement and a rich intellectual environment to share ideas. Special thanks to Danny Miller, also part of the research team who joined me in Qatar and provided input, particularly on the material culture of loss. Always a generous colleague, a cheerleader and a friend. Paul Carter-Bowman helped to keep my Qatar projects on track and provided relief in times of adversity. I am forever grateful that he helped to make UCL a home for me again. The George Street Social in Oxford and The Crown in Woodstock provided hospitality and a space to write. My Combe sisterhood (Laura, Annie, Martha, Ashley, Jenny, Gloria) have helped in ways they may not be aware – from jumping in to look after a poorly child so I could fly to Doha for a research trip to sharing their insights about pregnancy, miscarriage and working motherhood. Mick and Carl commented on drafts, entertained children whilst I worked, provided commiserations, but most of all insisted on celebrating the successes – thank you. A very special thanks goes Alixe Bovey, who urged me in a particularly bleak time in my life, not unrelated to the subject of this book, to take inspiration from her favourite tattoo – that old sailor’s favourite ‘hold fast’ across the knuckles. Hold fast I did. That the cover image of this book was drawn by one of my oldest and dearest friends is astonishingly apposite. Finally, thanks to my family who have always been encouraging. I am so grateful to my daughters: Annabel whose naissance provided this

Acknowledgements

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anthropologist of reproduction the best participant observation opportunity, and Scarlett whose insistence on learning Arabic swells my heart. Words cannot express my gratitude to my husband, Ed, the reason we went to Qatar in the first place – your adventurous spirit and unwavering support makes it all possible. I don’t even mind that you keep trying to make a cup of tea in my office.

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Introduction Huda1 was pleased when she discovered she was pregnant following an earlier miscarriage. Hoping to expand her family and, in particular, eager to add a son to her brood of three children, the thirty-five-year-old Qatari working mother had felt increasing pressure to conceive from her husband and his family. Upon discovering her pregnancy following a home pregnancy test, Huda immediately made an appointment to see a doctor. During this antenatal appointment at five weeks’ gestation she heard the heartbeat of the growing foetus. Two weeks later she attended another antenatal appointment where it was discovered through an ultrasound that the foetus was measuring smaller than expected and no heartbeat detected. When the ultrasound was repeated a week later, a miscarriage was confirmed. Huda faced this with acceptance, describing her miscarriages as sad, but not particularly uncommon or grave. The mother of three referred to the miscarriage as ‘not a big deal’, ‘normal’ understanding the event in light of the knowledge of other women experiencing similar: I know many women who miscarried recently; my colleague was pregnant at the same time as me and she miscarried . . . My husband’s sister and also my friend miscarried. . . most of the women I know who got married in the last two years had miscarriages.

It would seem that miscarriage is not hidden: Huda was aware of other’s experience, which allows her to understand her miscarriage not as something unusual or about which she should be particularly worried. Instead, Huda focused on conceiving again and remained optimistic about her prospects of having another child. Huda’s strong Muslim faith frames miscarriage as God’s will, part of her destiny and God’s plan for her. This, she explains, helps her to find comfort and allows her to ‘let go’ of the suffering miscarriage may bring. 1

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Pregnancy and Miscarriage in Qatar

Like Huda, miscarriage was something that had touched my life: this book and the research upon which it is based is influenced by my experience. Huda’s account has some similarities with my own, but also has significant differences. At my first routine pregnancy scan at thirteen weeks’ gestation I was informed that the foetus I was carrying had no heartbeat and had likely died a few days previously. Shocked, I realized that whilst I had read and learned a great deal about conception and, later, my developing pregnancy, I was wholly unprepared for what I was to learn was an extremely common event. Approximately 20 per cent of clinically recognized pregnancies end in miscarriage (Royal College of Obstetrics and Gynaecology 2008; Regan and Rai 2000). However, the actual rate of miscarriage is higher since many women have early miscarriages without realizing that they are pregnant (Plagge and Antick 2009, Wilcox et al 1988). The cultural silence around miscarriage meant that I, like many women, was not aware of just how common it was. Equally naïve was I about the variation in possible presentations: I had experienced a ‘missed (or silent) miscarriage’: when the foetus stops developing, but with an absence of signs or symptoms that the pregnancy has ended. I had not experienced bleeding or cramping and was blissfully unaware of the demise of my pregnancy until that moment in the hospital. Following British convention, I had not disclosed my pregnancy beyond my immediate family, planning to wait until after the scan, which coincided with the end of the first trimester. The doctors consistently referred to my loss as a spontaneous abortion, a term that I found upsetting and lacking in compassion. Deciding to have surgery to remove the foetus and pregnancy tissue, the immediate physical experience was over in less than a week and yet my feelings of sadness and loss continued throughout that year. I felt isolated: I had experienced what I felt was a meaningful loss, but one that was left unrecognized by those around me. Most importantly, I was worried that I might not conceive again and that the miscarriage signified some sort of problem with me, my body and my fertility. I was anxious and uncertain that I would ever have a child, remaining pessimistic about my fertility. At thirty-three I was two years younger than Huda, but unlike her, I had no children and this had been my first pregnancy. I couldn’t shake the feeling that I may have done something to cause the miscarriage or that it likely pointed to some sort of reproductive failing. In the aftermath, I observed with interest the cultural silence around miscarriage; I watched as friends who also miscarried struggled to make sense of

Introduction

3

their feelings of loss. Five years after my first miscarriage, I found myself in a clinic in Qatar following a third. After a diagnosis of another missed miscarriage at eleven weeks I decided to fly from the UK to Qatar to join my husband who had relocated for work and wait for the miscarriage to complete naturally. Two weeks later I began to bleed and after a nine-hour ordeal I finally passed the foetus and pregnancy tissue in a temporary apartment in Doha. Informed by my past experience, I went to a clinic to obtain a scan in order to ensure no pregnancy tissue remained. The clinical staff was matter of fact, if perplexed, when I arrived at the primary care clinic: my experience there led me to wonder what the typical procedure was for treating miscarriage. Moreover, I felt curious about Qatari women’s experience of pregnancy loss. This interest was compounded when I met a Qatari obstetrician gynaecologist who explained that Qatari women are not left devastated by miscarriage because of their faith in God and understanding it as part of God’s plan. The doctor explained that miscarriage is seen as acceptable and relatively normal. Perhaps my treatment by clinical staff was informed by this framing of miscarriage. The contrasting experiences of my miscarriages spurred me to study this subject formally and in 2012 I embarked on a four-year project to investigate miscarriage in two of the countries I have called home—the UK and Qatar.2 When my third miscarriage was diagnosed through a scan in the UK, I was vaguely aware that the clinical staff ’s approach was more sensitive than when I was treated for my first, five years previously. Indeed, my experience reflected the beginning of a shift in the social and medical approach to miscarriage and miscarrying women in the UK.

Miscarriage: challenging the trope of silence Silence often surrounds miscarriage. Understanding the societal lack of recognition and its contribution to women’s distress and feelings of isolation, campaigners and scholars have made concerted efforts to dismantle the shame, stigma and silence of pregnancy loss. The slogan of Baby Loss Awareness Week, which began in the UK sixteen years ago, is ‘break the silence.’ Associated with the American Pregnancy and Infant Loss Remembrance Day Campaign,

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Pregnancy and Miscarriage in Qatar

which began in 2002, the week concludes on 15 October each year, a date that marks International Pregnancy and Infant Loss Remembrance Day. Observed annually in the United Kingdom, Canada, the United States, Italy, Norway, Kenya and parts of Australia. The introduction of such awareness days reflect significant shifts in the way miscarriage is framed in these parts of the world. Approaches to miscarriage have changed dramatically in much of EuroAmerica, as evidenced not only by the introduction of awareness days and other public forums to articulate feelings of loss, but also by the growing market for miscarriage memorials; and recent campaigns to provide certificates of life for miscarried foetuses under-24 weeks’ gestation in the UK; and shifts in medical practice, including changes to disposal practices in places like the UK and USA, which now treat pregnancy materials as something needing sensitive disposal (Morgan 2002; Kilshaw 2020a; Kuberska 2020). Miscarriage is increasingly framed as a significant loss of a baby or child for which the appropriate response is distress and grief. Changes in clinical approach and language have been informed by broader societal transformation whilst also reinforcing understandings of miscarriage as the death of a baby. Miscarriage, with its conflation of birth and death, of the beginning of life with the end of it is a topic ripe for analysis and yet there is a historical absence in the scholarly literature, reflecting a broader societal taboo. Positioned amongst the impressive body of work on anthropology of reproduction and, particularly, on reproductive disruptions (Inhorn 2007a and b) this book contributes to the scant scholarship on miscarriage. Mead was one of the few early anthropologists to discuss miscarriage (Mead and Newton 1967): likely informed by her own experience (1973). Following the advent of feminism in the 1970s and 1980 and the subsequent scholarly focus on women’s lives, a small number of anthropological work touched upon miscarriage: Llewelleyn Davies (1978), Shostak (1981), Homans (1982), Reynolds-Whyte (1990) and Caplan (1992), but it was not until the latter half of the 1990s that the first significant anthropological consideration of pregnancy loss, Cecil’s (1996) collected volume appeared. Cecil suggests notions of miscarriage as failure as well as its accompanying mess, blood, pain and embarrassment make it a subject not easily revealed. Linda Layne’s body of work, including Motherhood Lost: A Feminist Account of Pregnancy Loss in America (2003) has been the most influential contemplation of the subject. Revealing how middle-class

Introduction

5

American women grapple with the two affective political forces of foetal rights and a cultural code of silence, Layne notes an absence of a framework to articulate the grief of pregnancy loss. However, this has begun to change during the past two decades, with women insisting on public acts of memorialisation and testimony, eroding the silence of miscarriage in parts of Euro-America. Layne and other scholars have undoubtedly contributed to dismantling the taboo of miscarriage by contributing not only to scholarly, but also public conversations around miscarriage. Yet the scholarly literature also contributed to the dominance of the trope of silence through the focus on particular groups, (mainly white middle-class) EuroAmericans (e.g. Cecil & Slade, 1996; Layne, 1990 2007; 2003; Letherby, 1993; Moulder, 1990 and 1998; Ney et  al., 1994; Woods & Woods, 1997; Van der Sijpt 2017). Craven and Peel (2014, 2017) argued that reproductive loss in a large group of women, including non-heteronormative people and non-traditional families, has been ignored; a gap that the authors have begun to address (see also Berend 2010, 2016). This book contributes to a small but growing body of work that explores miscarriage beyond Euro-America (Abboud & Liamputtong, 2002 and 2003; Varley 2008; Cecil, 1996; Liamputtong Rice 1999; van der Sijpt 2014, 2018 and 2020). Such examinations allow for exploration of whether miscarriage is seen as the loss of a baby or something quite different, as Jeffery and Jeffery (1996) found in North India where local medical models distinguish between ‘“delayed periods” and the “falling baby”’, with only the latter considered to have been a pregnancy (p. 25). Anthropology is perhaps the best discipline to approach miscarriage, as it provides us with the means to explore it as simultaneously a biological, social and cultural event (Cecil 1996; Chapman 2003; Inhorn 2007; Jenkins and Inhorn 2003; Layne 2003; Storeng et al. 2010; Van der Sijpt 2010) and reflect on diversity of frameworks for this globally common experience. The increasing interest in miscarriage amongst social scientists is welcome with a recent publication dedicated to the subject (Kilshaw and Borg 2020) reflecting growing interest. Augmenting the expanding domain of discussions of reproductive loss, the book aims to move beyond the dominant landscape of miscarriage. Whilst the trope of ‘silence’ and ‘taboo’ has dominated the literature on miscarriage, examinations of it in other parts of the world allow us to explore whether such a response is universal. Diverse understandings and presentations provide opportunities to explore approaches that most benefit women. This is

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Pregnancy and Miscarriage in Qatar

particularly timely when we consider how influential a ‘dominant’ language of parenting and reproduction (Faircloth et al., 2013) embedded in what Strathern (1996:38) defines as ‘the largely middle-class, North American/Northern European discourse of public and professional life’. The dominant discourse of miscarriage as the significant loss of a baby that has developed over the past twenty years in Euro-America does not resonate in some contexts where miscarriage is framed more normatively or is approached with pragmatism. Furthermore, such an approach may lead women to feel as though they are not reacting appropriately, ultimately pathologizing certain responses. Thus, there is a need to take into account local configurations that inform reproductive experiences and make room for diverse responses to miscarriage. The book contributes to scholarship about how socio-cultural forces shape the way miscarriage is framed and experienced. The social and political shaping of miscarriage further adds evidence to the way in which reproduction is embedded within larger social, cultural, economic and political relations and forces (Inhorn 2007; see Rapp 1999; Lock 1993; Scheper-Hughes 1992). Through a focus on miscarriage in Qatar the book provides additional information about regional specificity, contributing to limited academic literature on miscarriage and foetal death outside of EuroAmerica as well as scholarship on reproduction in the Middle East. Indeed, it aims to respond to the bias in early feminist research as identified by Mohanty (1984), revealing the diverse responses to and experiences of pregnancy loss and suggests that such responses are flexible and informed by the context in which they are found. In this way, the book emphasises the importance of ‘local moral worlds’ (Kleinman 1992) and how they give rise to local understandings of miscarriage. In particular, I look at the way profound uncertainties about the role of women in a changing society (Newcomb 2009) and navigations of Arab modernity are played out on women’s bodies and their reproductive experiences. Following scholars (i.e. Newcomb 2009) I explore the lived and embodied reality of navigating social roles in a shifting society in particular, in the ways that women navigate tradition and modernization, local and national identities, and gender roles with specific considerations to the tensions between modernity and tradition and global and local identities. As a medical anthropologist, I was familiar with the ways in which illness is culturally contingent. I had spent years studying and investigating how social

Introduction

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and cultural factors affect health, the spread of disease and the treatment of illness. My miscarriages became both personal and professional: my lived experience of the events was shaped by the medical, social and personal framing of miscarriage. It also invited comparison. The trope of silence and taboo throughout British public and scholarly discourse on miscarriage reverberated through my own experience, but when I met with women like Huda, I came to realise that miscarriage may not be approached in this way and not necessarily seen as failure. This book seeks to make sense of Huda’s experiences and those of other Qatari women by exploring how intimate reproductive events are entangled with broader societal and political issues. Women’s reproductive experiences are embedded within the social context of their lives: a miscarriage framed by the wider backdrop of a woman’s past, present, and imagined future. Exploring reproduction and miscarriage as culturally contingent, this book’s main premise is that pregnancy loss is approached, managed and experienced in ways that are impacted by context. The social landscape in which reproduction is surrounded, including: state development discourse, pronatalism and the importance of reproduction, and the centrality of Islam inform the way miscarriage is understood in Qatar. Qatar positions itself as a centre of Arab modernity with Qatari women playing an important role as representatives of this contemporary Qatari nation. State discourse continues to focus on education and increasing women’s presence in the labour market and encouraging their role in politics. Qatari women have taken advantage of such opportunities, seeing them as a means of improvement and emancipation. State development discourse also emphasises moving toward a self-sufficient, self-sustainable Qatari society with improvements to the country’s significant demographic imbalances. The Qatari national population of the country comprises only 10 per cent of the overall population, making Qataris a significant minority in their own country. State anxiety around the growing migrant population, dependence upon and the influence of these outsiders is considerable and informs much of the development plans and strategies. In addition to a large and growing migrant population, concern about demographic imbalances has been further fuelled by a decline in the fertility rates of Qataris. This unease contributes to the active state promotion of fertility amongst its local population. An emphasis on reproduction is scaffolded by that of Islam and its desire to ensure a robust community of

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Muslims. Whilst positioning itself as a modern state, Qatari state discourse emphasizes retaining a strong sense of history, heritage and a respect for traditional customs. Women and reproduction are central to continuity with the past, the state’s development vision and its project of Arab modernity, particularly in light of the country’s demographics. Miscarriage is a lens through which to explore what life is like for Qatari women and ask what a contemporary Qatari woman is supposed to be: what are her ambitions and obligations? Pregnancy loss provides an opportunity to better understand Qatari society. Through women’s stories of pregnancy and miscarriage, the book explores the themes of reproduction, motherhood, family relationships and the changing role of women in Qatari society. Qatar has witnessed rapid economic and social changes. Gender and family relationships are being reformulated and negotiated and, at times, are points of tension. Motherhood is central to woman’s identity and role in Qatari society with a high cultural value placed on having children, thus, infertility poses a significant crisis for men and women, although it is women who primarily bear the brunt of this. It is for this reason that miscarriage, a different form of reproductive disruption, is particularly interesting. I examine the impact of miscarriage on a woman and her role in society and ask what is the cultural response to such events, particularly in light of the stigma attached to infertility. Women’s narratives reveal tensions between expectations and aspirations of motherhood and of those of professional femininity. This book explores these tensions and contradictions. Qatari state discourse and development plans emphasize a balance of modern, traditional, contemporary and custom and these, sometimes competing, policies are mapped onto women’s bodies and their reproductive navigations. Women’s bodies and health is the “site of overt and covert, micro- and macropolitical struggle” (Inhorn 2007a: 26): I explore the way women and their bodies are sites where individual, collective, familial and state forces are played out. I consider the way the body acts as a social mirror, a symbol of society (Douglas [1966] 1984:115; Weiss 2002) with the social regulation of bodies enacted in this particular context and ask what effect this has on women’s experience of miscarriage? The novel contribution of the book is its focus on understanding miscarriage in the context of a selfconsciously changing Qatari society. In particular, I examine the connections between the contemporary lived experience of what might be called Arab

Introduction

9

modernity (following Inhorn 2012) and the values and beliefs surrounding women, gender, marriage, motherhood and, by extension, pregnancy, miscarriage, and foetuses that typically remain unexamined and unarticulated. When I first embarked on this research, I thought perhaps we would uncover something quite different from what the clinician seemed to suggest was a quiet acceptance of pregnancy loss in Qatar. Given the high value placed upon bearing and producing children I thought we might find that miscarriage renders a woman vulnerable to gossip and/or threats of divorce and polygamy. Perhaps women would be blamed for miscarriage along with other reproductive failures. However, miscarriage did not seem to pose the social or personal problem I had anticipated. Towards the end of the project and the writing of this book I was reminded of the doctor’s perspective: I hope the stories contained in this book reveal a complexity of reactions to miscarriage and problematize the doctor’s view whilst also making sense of her comments.

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1

Qatar: Traditional Modernity

Setting Visitors to Doha often express surprise at its state-of-the-art appearance; its skyline dominated by high-rise modern buildings, raised from the ground at an astonishing rate. The city is continuously changing, growing, and evolving; one is overwhelmed by sounds of construction work, which continue into the night, and left confused by suddenly altered roads. Photographs of 1980s Doha show a desert with a few low buildings surrounded by desert sand, the pyramidic Sheraton Hotel stands out as the only building taller than a few storeys. Today, the hotel is dwarfed by the modern steel and glass skyscrapers surrounding it. The city itself is a symbol of Qatar’s rapid social and economic development, representing the country’s ability to change itself and its environment at a rapid rate thanks to its high-income economy. Whilst the striking modernity of its urban built space and the pace of social change characterizes the country, Qatar remains a traditional Muslim society. The state religion is Islam and Sharia a principal source of legislation with the government referring to Islamic law as ‘the moral anchor of Qatari society’ (www.hukoomi.qa/wps/portal/topics/ Religion+and+Community/Religion/islaminqatar). The vast majority of Qataris are devout Sunni Muslims with most adhering to the strict Salafi interpretation of Islam. A constitutional monarchy headed by Emir Sheikh Tamim bin Hamad Al Thani, Qatar is a small country occupying the Qatar Peninsula on the north-eastern coast of the Arabian Peninsula. Gaining independence in 1971 following its status as a British protectorate in the early twentieth century, Qatar has lacked serious challenges to the Islamic legitimacy of its government. An exceptionally wealthy country where the government subsidizes everything 11

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Pregnancy and Miscarriage in Qatar

from petrol to education, it has experienced rapid and dramatic social and economic changes since the mid-twentieth century as the result of the discovery of natural gas and oil in 1940, which transformed its dependence on fishing and pearl fishing, allowing it to become the richest country in the world. Qatar is part of the Gulf Cooperation Council (GCC) a regional intergovernmental political and economic union with other Arab Gulf states (Bahrain, Kuwait, Oman, Saudi Arabia and the United Arab Emirates (UAE)) but excluding Iraq. This membership reflected a complicated but relatively close diplomatic relationship between these states, however, the June 2017 diplomatic crisis with Saudi Arabia, UAE, Bahrain, Egypt, Jordan and a number of other states has led to a growing alliance between Qatar and Iran. The Saudiled coalition cited Qatar’s alleged support for terrorism as the primary reason for the action, insisting that Qatar had violated a 2014 agreement with the GCC members. The population is approximately 2.6 million; with 313,000 Qatari nationals. Qatar’s modern citizenry is composed of Arab tribes of unequal weight, as well as non-Arab groups, including Persians and descendants of slaves. The Qatari population comprises Bedouins, Hadar,1 and those with African origins. Bedouins are descended from the nomads of the Arabian Peninsula; the Hadar, who are often referred to as ‘urban’ Qataris, are mostly descended from Iran, Pakistan and Afghanistan. We most often heard women describe themselves as either Hadar or Bedouin, with the latter sometimes further designated as more traditional and/or conservative. While the overall population has rapidly grown since the late twentieth century, the Qatari population has only marginally increased. Foreign workers, from all over the world, account for 88 per cent of all residents in the country (Ministry of Development Planning and Statistics 2016). The population of men in Qatar greatly outnumbers that of women with 4.91 males (aged twenty-five to fifty-four) to 1 female. This is primarily due to the large numbers of male migrant workers in the country, for the number of Qatari males is almost equal to Qatari females, with a gender ratio of 1:1.04 males to females (Qatar Statistic Authority 2010). Thus, the majority of the population comprises migrant workers, with those from India being the largest community. Nepalis, Bangladeshis, Filipinos and Pakistanis all have significant communities; the rest of the population is drawn from the world’s nationalities (Ministry of Development Planning and Statistics 2018).

Qatar: Traditional Modernity

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The treatment of migrant workers has received a great deal of attention and criticism in recent years, particularly in light of the successful bid to host the 2022 FIFA World Cup. With the world’s attention and scrutiny on the country, the plight of the large migrant population was made known.

Anthropology of miscarriage: the project This book is derived from data collected over a five-year period in Qatar (2010–15) during which time I lived there for two years. During this period, I was first a ‘trailing spouse’, finding myself in Qatar with little notice, I experienced life as a member of the large migrant population in Doha. In the first eighteen months of my time in Qatar I had only limited interactions with Qataris, as is often the experience of temporary migrants in the country. I lived on a small compound, which was shared with families from a variety of nationalities including British, Norwegian, South African, American, Egyptian, Palestinian and Indian and, later, Qatari. In 2011, I began research exploring Qatari understandings of genetic risk in relation to disability and illness, a project funded by the Qatar National Research Fund (QNRF). In 2012, I moved back to the UK, whilst continuing to conduct research. The following year, I began a collaborative four-year QNRF-funded research project focusing on pregnancy and miscarriage. Our research team included clinicians at the main public hospital (Drs Haleema Al-Tamini and Faten El-Taher), a research team at Weill Cornell Medical College, Qatar (Dr Kristina Sole, Dr Stella Major, Dr Mona Mohsen and Mrs Nadia Omar) and Professor Daniel Miller and myself at UCL Anthropology, London. By the time our project commenced I was based in the UK, returning regularly to conduct fieldwork and work with the team. The majority of interviews were in Arabic and conducted by Mona and Nadia whilst I conducted interviews in English where possible, or with the assistance of Mona and Nadia, as I lacked Arabic language skills. The data collection in Qatar was a team effort between Mona, Nadia and myself with constant discussions, shaping of follow-up interviews and reading and re-reading of the notes and interview transcripts. The research upon which this book is based was collaborative and I am grateful to my colleagues, particularly Nadia and Mona who were tireless, enthusiastic, sensitive and provided so many helpful

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Pregnancy and Miscarriage in Qatar

insights along the way. The research and this book simply would not have been possible without the entire team. Whilst our research included informal interactions with interlocutors, the data is primarily derived from in-depth semi-structured interviews. Interviews were conducted in the hospital or at a participant’s preferred location (e.g. their home or a café). Interviews were typically one to two hours in duration and were recorded by digital voice recorder then transcribed and translated into English soon afterwards, whilst retaining key words and phrases in Arabic. I read the interviews immediately and discussed any points for clarification and follow-up questions were developed. Wherever possible, contact was maintained to allow for follow-up and more informal discussions and interaction, allowing for gradual accumulation of data and slow inductive analysis with further interviews and interactions shaped by emerging understandings. Although informed by the QNRF ‘Genetics and Risk’ project and my time living in Qatar more generally, the book is primarily based on eighteen months’ fieldwork in Qatar (for more details of project methods see Kilshaw et al. 2017 and Omar et  al. 2019). The main site was the Women’s Hospital, Hamad Medical Corporation (HMC), the main public hospital in Doha, which serves both the Qatari and the migrant population, delivering an impressive 17,000 babies a year. Since the 1990s, there has been a process of medicalization of pregnancy and childbirth, which has been effective in reducing maternal and infant mortality and morbidity. Maternal mortality rate (MMR) dropped from 49/100,000 in 1990 to 9.02 per cent in 2012 and the rate is comparable to the MMR of many high-income countries, both from the West and East. As part of a process of medicalization, women seek medical assistance in the early stages of pregnancy; the country’s antenatal coverage is 94 per cent (Rahman and Badreldeen 2013). Qatar has a higher stillbirth rate, however, which could be due to higher rates of congenital abnormalities related to consanguineous marriages and low rates of medical terminations (Rahman et al. 2012). Qatari women most commonly give birth in hospital with 99.45 per cent hospital deliveries (Rahman and Badreldeen 2013), as has been documented in other contexts in the region (Green and Smith 2006 in UAE): homebirth is illegal. Close monitoring means that foetal demise is often discovered during regular appointments. Women experiencing pain or bleeding generally present to the hospital and are commonly admitted to undergo monitoring and management.

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Foetuses that are miscarried elsewhere are often brought into the hospital to be examined. This means that both live and dead foetuses are generally managed by the hospital. Sixty Qatari women were recruited from the outpatient department, inpatient rooms and the early pregnancy unit.2 Although primarily interested in miscarriage, unlike in other parts of the world (i.e. see Han 2013; Ivry 2010), little is known about pregnancy in Qatar. We felt it important to develop a foundation of knowledge around the cultural shaping of Qatari pregnancies including understandings about conception, as well as notions of foetal development in order to gain a better understanding of what is lost when a pregnancy is unsuccessful. We interviewed twenty pregnant women. In particular, ideas of what constitutes a ‘good’ or ‘normal’ pregnancy or pregnant body (Kilshaw et  al. 2016) were explored to further our understanding of pregnancy and reproduction more generally. Forty Qatari women, aged eighteen to fifty who had miscarried in the past six months prior to twenty weeks’ gestation were included. Informed by the threshold distinguishing miscarriage from stillbirth, we chose twenty weeks’ gestation, although there was some ambiguity about whether the definition was twenty, twenty-two or twenty-four weeks’ gestation. Women with more than three consecutive pregnancy losses and, thus, considered to be suffering from recurrent pregnancy loss (RPL) were excluded because it is seen as a distinct medical condition with differing medical treatment and is relatively rare. Furthermore, the emotional, physical and psychological toll is likely to be different. For ethical reasons, we decided to exclude these women due to potential harm. The socio-demographic distribution across age, education level and employment status for interlocutors are illustrated in Table 1. All were Muslim Qatari women with an average age of twenty-six years for pregnant participants and thirty-three years for those who had miscarried. They were generally educated: more than 50 per cent had achieved at least undergraduate-level education and the majority (60 per cent) were employed. The sample is somewhat representative, in terms of education levels, with a RAND study of a 1998 cohort which found that 71 per cent of women held a university-level degree (Stasz, Eide, and Martorell 2007). Our cohort was more likely to be employed than the average Qatari women (although only slightly higher than

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Pregnancy and Miscarriage in Qatar

the 36% overall employment rate for women in the country). This could be due to a number of factors including age and the socio-economic demographics of recruitment in the main public hospital. The latter perhaps points to a lower socio-economic cohort with fewer wealthy, higher-status Qataris who are less likely to work and possibly more reluctant to take part because of privacy issues. It is possible working women were more likely to take part and were more open to speaking to strangers. The employment status of interlocutors was 70 per cent of pregnant women and 60 per cent of the miscarriage cohort employed. The majority (73 per cent) of those interviewed had children at the time of participation in the research.

Table 1 Background characteristics of primary study participants (first published Kilshaw et al. 2017). Characteristic Maternal Age (yrs) 20–29 30–39 40–49 Educational Level Illiterate Up to high school Higher education Employment Employed Unemployed Number of Live Births None 1 2–4 ≥5 Total Number of Pregnancies 1–2 3–4 ≥5 Total Number of Miscarriages (none-consecutive) Non 1–3 4–6

Miscarriage (n=40)

Pregnancy (n=20)

15 (37.5%) 21 (52.5%) 4 (10%)

14 (70%) 5 (25%) 1 (5%)

3 (7.5%) 12 (30%) 25 (62.5)

0 (0%) 9 (45%) 11 (55%)

24 (60%) 16 (40%)

14 (70%) 6 (30%)

7 (17.5) 6 (15%) 12 (30) 15 (37.5%)

6 (30%) 4 (20%) 6 (30%) 4 (20)

11 (27.5%) 5 (12.5%) 24 (60%)

10 (50%) 4 (20 %) 6 (30%)

0 (0%) 34 (85%) 6 (15%)

12 (60%) 5 (25%) 3 (15%)

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Qatari women experience multiple pregnancy events (Supreme Council of Health 2014) and thus, are at risk of miscarriage and multiple losses, as is reflected in our findings: amongst our cohort there had been three stillbirths, three neonatal deaths and one death of a one-year-old child due to congenital abnormalities. Forty per cent of the miscarriage cohort had experienced one miscarriage; 30 per cent had experienced two miscarriages; 15 per cent had three miscarriages; and 15 per cent had experienced four or more miscarriages. One third of the pregnant women had experienced a miscarriage, with one experiencing three miscarriages prior to her pregnancy and another experiencing five miscarriages prior to her pregnancy. Despite the lack of concrete statistics, it is likely that rates of miscarriage are increased in Qatar due to the popularity of consanguineous marriages, which have been found to have a significant association with negative pregnancy outcomes in other contexts (Kuntla et al. 2013) and with family clustering of male factor infertility (Inhorn et al. 2009). When we embarked on the research, we were eager to include men’s voices, as men’s experiences of miscarriage are lacking in scholarly and popular accounts. Despite our concerted and continued efforts to speak to husbands, only eight agreed to be interviewed. This was likely due to our recruitment method as well as notions of propriety including what discussions are appropriate between members of the opposite sex. Due to ethics approval stipulations, as well as to ensure sensitivity, recruiting husbands involved asking women if we could meet with their husbands once they had agreed to participate. Interlocutors were reluctant to have their husbands involved in the research. We speculated that this was due to the fact they had shared intimate and personal matters, not only about miscarriage but also about marriage and family life. In their discussions, women sometimes expressed grievances and despite our reassurances, perhaps worried that such information might be disclosed. In most cases, women suggested their husbands were either too busy or would not be interested in meeting with us, some reporting this was their husband’s response when approached. Reproduction is seen as something about which men do not speak; women suggested their husbands knew little about miscarriage. We suspected some felt it would be inappropriate and awkward for their husbands to meet with members of our all-female research team. However, the men we did speak to were helpful in expanding our

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understanding as were the additional interlocutors with whom we met. Fiftyfive further interlocutors provided knowledge about Qatari pregnancy, birth and loss including twenty-nine family members, particularly mothers, mothersin-law and sisters; two religious scholars; we interviewed four Qatari traditional healers and thirteen health professionals. Our research team included three gynaecologists: Dr Halima, Dr Faten and Dr Sole not only helped with project design and access, but were constant sources of information about miscarriage, pregnancy and childbirth generally and in Qatar specifically. From Qatar, Egypt and America (and later Dr Major from the UK), our team was reflective of the composition of the professional staff at the hospital. Qatari hospitals are staffed by health professionals from all over the world. In their research, Hwang et al. (2017: 719) reported that male physicians found working in Qatar challenging because of the difference in ‘nationality, religion, . . . education, tradition and the family’. In particular, patients often refused to be examined by male doctors. Clinicians were commonly US- or UK-trained and the Weill Cornell Medicine, the medical school in Education City, was an American import. This endeavour is part of the broad development strategy of Qatarization, intended to increase the capacity of the national population and reduce the dependence upon and influence of outsiders, such as foreign health professionals. When I gave birth to my daughter in Qatar, I was cared for by an Indian doctor who had been to the UK for some of his training. Nursing staff were commonly from the Philippines, India or Sri Lanka. Whilst truly international, the hospital was governed by Qatari cultural and religious values. Indeed, many of the staff were Muslim and typically shared understandings with their Qatari patients, as shaped by their Islamic faith. During the course of the fieldwork, observations and interactions in clinical and non-clinical sites provided additional information and contextualized interview data. In the hospital these included observing sonogram sessions and attending clinics and meetings; in one case, Nadia attended the birth of an interlocutor. We visited interlocutors in their homes, participated in a Qatari mothers’ group and accompanied women to traditional healers. Observations and informal interviews occurred mainly in opportunistic ways; as the research progressed, we were informed by our interlocutors and followed miscarriage across various locations including the home, the mortuary, the

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mosque, the graveyard, traditional healer’s clinics and religious sites. The basis of analysis was deep familiarity with the data and an ongoing, recursive process of reading, discussing and reflecting on the data as it was collected. Through ongoing discussions and regular team meetings, we reflected on developing understandings and collected additional data as necessary. Emerging understandings and the identification of key knowledge gaps informed further interviews and fieldwork interactions.

Contribution and chapter outline To elucidate and situate the ethnographic material, I have drawn on material from a number of scholarly areas, despite being relatively new to some. As a medical anthropologist with a developing specialization in reproduction, new to the Middle East, I have drawn on material from medical anthropology and scholarship on pregnancy, infertility, childbirth, the foetus, reproduction and reproductive disruption as well as Middle East scholarship. Scholars’ work from the region, particularly those focusing on women, gender and health and those exploring the relationship between modernity, gender and reproduction have been particularly informative. Situated amongst scholarship about the relationship between the state and reproduction, I elucidate the values and beliefs surrounding miscarriage, pregnancy and the foetus, but also women, gender, marriage and motherhood, providing a rich ethnographic example of the interconnections between reproduction and the state in contemporary Qatar. Motherhood is envisioned by the state with reproduction embodying national values (Newcomb 2009 and Newman 2018a, b), which is particularly interesting in the context of changing social and political Qatari landscapes. The book contributes to the ethnographies written by anthropologists about Middle Eastern women (Inhorn 2012: 12), exploring women’s lived experience of Arab modernity. Anthropologists have shown that ethnography is at its best when it gives voice to people’s lived experiences. As Inhorn (2007a: 30) suggests, ‘a great deal about women’s health can be learned by letting women talk – by effectively and compassionately listening to them narrate their own subjective experiences of sickness and health, pain and suffering, oppression and resistance, good health,

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and occasional joy that are part and parcel of women’s health experiences around the globe’. Thus, women’s stories and direct quotations are central components to the text; through women’s accounts of miscarriage and by contextualizing these in the broader context of their lives, I hope to avoid the risk of downplaying differences and defining the subject as ‘the Arab/Muslim woman’ (Mahmood 2005; Falah and Nagel 2005; Abu-Lughod 2016). Although I tease out themes and similarities that tie Qatari women’s experiences together, I also reveal how women’s experience of miscarriage is varied and dependent upon their particular circumstances. Most importantly, I aim to contribute to presentations of the diversity of reactions to pregnancy endings. Before introducing the ethnographic material, Chapter Two provides background on the setting focusing on the larger social, cultural, economic and political relations and forces in which fertility and reproduction are embedded (Inhorn 2007a:10) in Qatar in order to later explore how this social landscape influences miscarriage. For reproduction in both its biological and social interpretations should be placed ‘at the centre of social theory’ and is a particularly useful ‘entry point to the study of social life’ (Ginsburg and Rapp 1995: 1). Local social arrangements within which reproduction is embedded are inherently and often politically contentious (Ginsburg and Rapp 1995). Chapter Three focuses on Huda’s story, contextualizing her miscarriage in her reproductive history and aspirations as well as in the broader context of her life as a Qatari woman. Through Huda’s account the social and political landscape in which reproduction is embedded is further explored. In particular, her story provides for an opportunity to discuss marriage practices and family structure, which limit and influence reproductive negotiations. Her story allows for an exploration of how state approaches to and framing of reproduction and women’s role in society is lived by women. Chapter Four focuses on the accounts of two women, Moza and Noor, to detail how miscarriage is diagnosed, managed and experienced in Qatar. Moza and Noor’s accounts, as well as Huda’s discussions about the causes of miscarriage are then discussed in more depth in Chapters Five and Six. Bodies are experienced to be vulnerable and permeable, particularly during liminal moments of transition in the life cycle (MacPhee 2012), as they interact with the environment (Newman 2018a). Chapter Five focuses on indigenous understandings of pregnancy as a vulnerable state, which puts women at risk

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of infiltration and depletion against which one must protect oneself. Understanding miscarriage and its causes are tied with discourses of Arab modernity and its impact on reproduction. In this way, the book contributes to scholarly work exploring modernity and altered bodies and illnesses, particularly the notion of contemporary women as being less reproductively robust (i.e. Kanaaneh 2002: 211; Fraser 1998; Gottlieb 2004). Chapter Six focuses on supernatural causes of miscarriage including jinn and the evil eye, but also God’s will. The latter provides meaning to loss as well as situating it in the broader context of a woman’s destiny. The chapter explores threats surrounding pregnancies including jinn who can possess, impregnate and enter bodies, indicating an understanding of women’s bodies as being susceptible to infiltration and influence (Newman 2018a). Yet there are methods to protect and fortify the body. The tension between closure and openness and between interiority and exteriority that MacPhee (2012) found amongst Moroccan women’s health behaviour have similarities with Qatari notions of pregnancy and vulnerability. Women protect themselves from harmful spirits and the illnesses they cause. In my exploration of Qatari pregnancies and loss, I contribute an additional ethnographic example of the way concealment of pregnancy may be used as a protective method to avoid shame or embarrassment (MacPhee 2012) or to protect from dangers, such as evil eye (MacPhee 2012; see also Pinto 2008 and Qureshi 2020; Launiala and Hondasalo 2010 in Malawi; Chapman 2006 in Mozambique). Chapter Seven examines the connections between the lived experience of Arab modernity and the beliefs surrounding foetuses. There is scant literature on the foetus: Han, Betsinger and Scott’s (2018) collected volume is a welcome contribution which reflects growing interest (see also Franklin 2013; Pfeffer and Kent 2007; Morgan 2009; Scheper-Hughes 2003; Michaels and Morgan 1999; Mitchell 2001). Scholars have explored the search for the healthy baby and how the ‘imperfect’ foetus is imagined and managed in contemporary Western societies (Rothman 1988; Casper 1998; Rapp 2000; Williams 2005) and how they are represented in anti-abortion propaganda (Petchevsky 1987, Franklin 1991, Duden 1993), but few have specifically focused on what happens after death (Pfeffer 2008; Morgan 2002), although a number of recent works have explored pregnancy remains as cultural artefacts from which we can glean how foetuses were imagined (Kabacinska et al. 2018; Scott and Betsinger

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2018). Research on the disposal of remains (Van der Sijpt 2018; Kuberska 2020) sheds light on the framework of meaning around pregnancy, miscarriage, abortion and wider reproductive politics. Foetuses are cultural accomplishments, the meanings of which are produced within specific historic and social locations (Morgan 2002: 249). There is a great diversity in when a pregnancy is understood as containing a being, human or person (Kulick 1992; Jeffery and Jeffery 1996, Pinto 2008; Cecil 1996); indeed, in some cases this occurs after birth (Scheper-Hughes 2002). Central to Qatari understandings of pregnancy, miscarriage and the foetus is the concept of ensoulment, which impacts how a foetus will be treated in death and whether its death through abortion is permitted. Islamic positions on abortion, ensoulment and notions of foetal development that inform such approaches reveal the foetus as simultaneously authoritative and pliable and a source of bodily knowledge (Newman 2018a). Despite flexibility around understandings of pregnancy and the foetus, interpretations of religious and legal institutions dominate and shape experience (Newman 2018a: 211). Socially, culturally and politically constructed with the structure varying depending on who is attributing the meanings (Casper 1998), knowledge of the foetus may become contested terrain with conflicting claims structuring debates about pregnancy and abortion (Newman 2018a: 201). Chapter Seven explores how tissues, bodies and beings are handled in death revealing what society makes of them (Morgan 2002), contributing to scholarly work on rituals surrounding the end of pregnancy (Hardacre 1997; Harrison 1999; Peelen 2007, Layne 2003; Gammeltoft 2003, 2010; Van der Sijpt 2017, 2018, 2020; Kuberska 2020). The aim of these rituals may be to appease the spirit of the foetus or attend to feelings of guilt (Gammeltoft 2003, Hardacre 1997, Moskowitz 2001; Van der Sijpt 2018), most commonly in the case of aborted rather than miscarried foetuses. In much of Euro-America, what happens to pregnancy remains has become a contentious issue, but Morgan (2002) reminds us that, historically, whatever women’s feelings about miscarriage or abortion, they did not imbue foetal flesh with social importance. Indeed, this focus on remains as the fulcrum of emotion has been a recent phenomenon linked with reproductive politics increasingly focused on material rather than philosophical matters (Morgan 2002). Cultural responses to miscarriage provide an opportunity to examine societal notions of

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personhood and boundaries around person categories. In some contexts, a pregnancy loss, whether through miscarriage or elective abortion, is not necessarily recognized as the loss of a human child or life. In other contexts, the remains are granted full burial rites. Categories of foetal personhood and the mechanisms by which life before birth comes to be understood culturally as the existence of a particular entity with a distinct identity (Michaels and Morgan 1999: 5) impact understandings of miscarriage. The book contributes to scholarly work on women’s experiences of themselves, their bodies and their foetuses and the way these involve embodied medical, legal and religious interpretations: the embodied experience of Arab modernity. Chapter Eight returns to Huda’s story to further reveal the way understandings of miscarriage form part of a wider framework of reproductive experiences and aspirations. In particular, miscarriage is a reproductive misfortune contextualized within a matrix of other disruptions, particularly infertility and childlessness. Medical anthropologists have emphasized the fluidity, uncertainty and limitations of reproduction and the sense of chaos that arises in the face of not meeting expectations and aspirations around reproduction (e.g. Inhorn 2003). The pressures Qatari women face to produce children is relentless; an inability to do so causes anxiety. Reproductive loss and involuntary childlessness have been conceptualized as major disruptions, which potentially cause a crisis in gendered identity, relationships and life plans (Becker 1999). Chapter Eight explores how the nature and severity of the disruption of miscarriage both individually and collectively, is influenced by context. In pronatalist Qatar with understandings of miscarriage as God’s will, with knowledge that unborn foetuses have an enduring presence in the cosmological system, and with infertility holding a particularly problematic position, miscarriage is relatively normalized. Chapter Nine focuses on the tensions arising from the obligations of professional and maternal femininity and how women negotiate these. In particular, it focuses on the domestic worker as both a means to negotiate these tensions and a further symbol of them. Kanaaneh (2002: 241) commented on the way in which gendered and sexed duties to the nation are often key to the formation of nationalisms by citing emerging scholarly literature on nationalism, sexuality and gender (i.e. Mosse 1985; Parker et  al. 1992; Chatterjee 1993; Wilford and Miller 1998; see also Weiss 2002 and Kahn 2000). Women’s bodies are tethered to the nation (Das

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1997) with reproduction bearing profoundly on the ongoing projects of nation-building and subject-making (Krause and DeZordo 2012: 140). In some cases, this involves state policy to reduce fertility and in others promoting it. Reducing birth rates has been part of state discourse of modernity and economic development (Greenhalgh 1995) and ‘raising the quality of the people’ (Anagnost 1995:26) with China a particularly dramatic example. Greenhalgh (2003) showed the devastating effects on parents and children with an unplanned child a ‘sign of backwardness’: an obstacle to modernity and development. Whilst the fertility decline in China was due to draconian government planning, the decline in fertility has been one of the most salient global shifts in the past decades (Krause and DeZordo 2012: 137). Qatar, along with its GCC neighbours, contradicts the ‘demographic transition theory’, which outlines that after a sharp decline in death rates, fertility rates will decrease substantially. During the 1980s, despite a drop in infant and child mortality rates and the rapid increase in life expectancy, the fertility rate of Qatari women declined only marginally: in 1997 total fertility rate (TFR: the average number of children that would be born to a woman over her lifetime) was 5.8, the same as it had been ten years previously (Winckler 2015). However, by the early 2000s, this trend had ended and fertility had declined to 3.6 in 2010 (QSA 2012). Whilst Qatar’s Total Fertility Rate (TFR) remains one of the highest in the Arab Gulf States (QSA 2012), there is a significant anxiety around fertility rates, demographic imbalances and family cohesion which has fuelled pronatalist state policies. Yet such policies are unlikely to have a great effect, in part because of simultaneous expectations about women’s economic activities and development strategies focused on ‘women’s empowerment’. However, the typical explanation that declining fertility rates are due to women choosing work over motherhood does not emerge from explorations into people’s lives, as revealed by Krause (2005) who used ethnographic research to make sense of the extremely low fertility rate in Italy, a momentous and rapid shift in family making which puzzled demographers. The Princeton European Fertility Project’s historical demographers disproved their hypothesis that modernization was one of the drivers of fertility decline (Coale and Watkins 1986 in Krause and De Zorbo 2012; Krause 2005). Instead, smaller families became the norm because of a range of economic, social and morality conditions (Krause 2005, 2012).

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Contextualized in the aftermath of the fascist demographic campaign that encouraged and coerced men and women to increase the birth rate, super-low Italian fertility is linked to being modern (Krause 2005). Complex forces inform intimate experiences leading to fertility decline: family making figured into the process of modern subject formation (Krause 2005: 180). Whilst not specifically focusing on fertility decline, this book contributes to the understanding of women’s lived experience of family construction in the context of decreasing fertility rates in Qatar and state anxiety surrounding this. Through exploring Qatari women’s lived experience of reproduction and loss I contribute to the discussion of women’s embodied negotiations of state policy, nation building and discourses of modernity. I argue that women and their bodies are sites of negotiation of competing state policies contained in development strategies. I explore how women’s bodies are enlisted in nationalist struggles to reproduce new citizens and the entwining of reproduction with statehood. A community’s women are considered to be the ‘bearers of the community’s future generations – crudely, nationalist wombs’ (Enloe 1990: 54). Pronatalism often gains particular emphasis when a community feels under threat, as with Qatari anxieties around demographic imbalances. Women feature prominently as being key to reproducing the nation and swelling the population. Reproductive wars feature throughout the world (Kanaaneh 2002; Kahn 2000). State policies linked to nationalist agendas in the ‘demographic war’ between Israelis and Palestinians have been a focus of scholarly attention (Kanaaneh 2002). Nations’ historical and cosmological ideologies interact with reproductive policies and aspirations, creating unique configurations: enthusiastic pronatalism informs the Israeli embrace of reproductive technology and accounts for the fact that Israel has more fertility clinics per capita than any other country (Kahn 2000: 3; Weiss 2002) and the extreme pressure Jewish women, including single and lesbian women, feel to reproduce. Israel’s pronatalism, Jewish kinship cosmology and rabbinic innovation has constructed a particular case of widespread assisted reproductive technologies (ARTs) used by single heterosexual as well lesbian women with donor Jewish sperm. High rates of genetic screening, testing and counselling; the world record for foetal diagnostics (Weiss 2000); and high rates of abortion even with minor impairments are informed by the social discourse and ideology of the ‘chosen body’ (Weiss 2000: 3). Quality, not just quantity,

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Pregnancy and Miscarriage in Qatar

of reproduction is a further characteristic project of nation building with attributes and features of ‘proper’ or desired offspring indicated. Notions of citizenship and nationhood inform the importance of reproduction and identifies whose reproduction must be harnessed as a resource. Qatari state development strategies emphasize the role of mothers as ‘the principal vehicles for transmitting the whole nation’s values from one generation to the next’ (Enloe 2000: 54). In Conceiving Citizens, Kashani-Sabet (2011) shows how maternity in Iran became tied to patriotic womanhood: motherhood was appropriated for political purposes, spawning a social ideology known as maternalism: ‘an ideology that promoted motherhood, child care, and maternal well-being not only within the strictures of family but also in consideration of nationalist concerns’ (p.  4). At the ‘heart of maternalism lies the paradox of entering the public political arena by reinforcing the traditional female sphere of children, family, nurturance and care’ (Moghadam 2006: 91). ‘Maternalism becomes a powerful organizing principle when it articulates with the maintenance and circumscription of ethnoreligious national belonging’ (Newman 2018b: 53) as in Qatar. Qatar has undergone rapid globalization and social change resulting in anxieties around fertility decline as well as the disintegration of the Khalîjî family (Hasso 2011). The ‘family cohesion agenda’ (Al Malki 2015) has become central to the modernizing vision of the Qatari state sitting alongside the protection of the Islamic identity and scientific development as key to the vision of a contemporary Qatari state (Caeiro 2018). Women play the central role in this vision both as reproducers of children and tradition and as modern, empowered, citizens. Chaterjee’s influential work on postcolonial Indian nationalism as ‘male discourse’ that invested ‘women with the dubious honour or representing’ certain domains of a ‘distinctively modern national culture’ (Chaterjee 1993: 136; 1989: 622) has resonances with the Qatari context. It is difficult to identify with precision the state’s vision of women: does it encourage their empowerment and leadership in society, or does it seek to maintain them at home in order to maintain high fertility rates (Caeiro 2018)? Newcomb (2009: 25) found the image of Moroccan women to be similarly fragmentary but rejects a portrayal the conflict as one between religion/tradition and modernity; instead exploring the ambiguous lived character of enduring ideological binarisms: traditional/modern, religious/secular, private/public,

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and female/male in a shifting social landscape. Expected to hold potentially contrary roles simultaneously, a woman is the guardian of values at home; through being the keeper of traditions and a nourishing mother she reproduces society both biologically and socially and yet she is also to be a promoter of modernity outside the home (Newcomb 2009: 25), her identity inextricably connected to imaginings of the nation (Newcomb 2009: 26). As Abu-Lughod noted, what is ‘so confusing about the calls for remaking women at the turn of the century and into the first half of the twentieth century is that they included advocacy of both women’s greater participation in the public world . . . and women’s enormous responsibility for the domestic sphere’ with nationalism and visions of national development central to both arguments (Abu-Lughod 1998: 8). Abu-Lughod’s seminal edited volume expressed contributors’ suspicions about straightforward associations between modernity, progress, empowerment and the emancipation of women; I also problematize the development discourse, its aims and its impact on women. State discourse and its lived experience are complex and often contradictory. Arguments about the appropriate ‘role of women in the nationalist struggle and in the future nation-state have occurred in virtually every nationalist movement since the eighteenth century’ (Enloe 2000: 54). Qatari women’s bodies, identity and reproduction are similarly sites of tensions within this modernizing vision: they negotiate a requirement to enact performances of the state as modern and embody tradition. This book contributes to discussions around development, statehood and women’s role in society. Informed by a view that bodies are moulded and regulated as part of ongoing construction of national and collective identities (Weiss 2002: 5 see also Kahn 2000), I explore how the abstract social paradigms of contemporary Qatar are articulated through women’s bodies, particularly their reproductive experiences. Thus, this book explores how Qatari women and their bodies are tied to the construction of collective, national Qatari identity, particularly in its vision of Arab modernity.

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2

Women and State: Reproduction and Arab Modernity

The Qatari state and governments of other Muslim Gulf Cooperation Council (GCC) countries have implemented strategies to maintain the high fertility rates of its indigenous population. During the oil boom of the early 1970s and 1980s, GCC countries implemented the most extreme pronatalist measures known worldwide during the second half of the twentieth century (Winckler 2005: 132). The intensity of the measures varied in accordance with the country’s per capita oil revenues with the most intensive being in Kuwait and Qatar, the richest among the GCC oil states (Winckler 2005: 132). With the exception of Saudi Arabia, where contraception is illegal, these were voluntary measures meant to encourage fertility. Despite vast improvements in healthcare and public services, the Total Fertility Rate (TFR) remained largely stagnant in the 1990s; however, by the early 2000s, the fertility rate of Qatari women had declined from 5.8 in 1997 to 3.6 in 2010 (QSA 2012). Despite this decline, the Qatari fertility rate remains one of the highest in the Arab Gulf States (QSA 2012). However, the decreasing fertility of the national population combined with a swelling population of foreign migrants continues to be a cause of state concern. With contemporary Qatari women delaying the birth of their first child and producing fewer children overall (QSA 2010) and with declining marriage rates and increasing divorce rates since 2001, the state had recognized a significant ‘fertility problem’ by 2004. In response, it established the Permanent Population Committee (PPC) to promote higher fertility amongst Qataris to respond to the demographic imbalances and to increase the local population (Gulf Research Centre 2014: 20). Its main objective was to ‘raise the current natural population increase rate for nationals, or at least maintain it to achieve an appropriate balance among Qatar’s total population’ (PPC 2009: 13). The 29

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PPC strategy was to encourage and facilitate marriages among Qatari citizens; the adoption of policies that would reduce delayed marriage, especially of women; facilitate the remarriage of divorcees and widows; provide financial incentives to support housing and have a large family; and recruit religious figures who emphasize the religious duty of marriage and childbearing (Winckler 2015). That reproduction and the need to preserve one’s social group are paramount beliefs in Islam (Tremayne and Inhorn 2012: 18) informs pronatalist state discourses as does concern about population disparities. The focus on families and reproduction has continued in the key state development strategies, the Qatar National Vision (QNV) 2030, and the medium-term Qatar National Development Strategy 2011–16 (QNDS),1 which represents the refined specific initiatives of the former both continued state emphasis on promoting fertility and ‘preserving and protecting family cohesion’. The attitudes and approach of Qatari state institutions are key to understanding the social landscape in which reproduction is embedded because of their influence. The distinction between state and society is particularly thin in the Gulf, not least since, in family matters, the state is construed as benevolent and authorized to act paternalistically (Caeiro 2018). The QNDS and other government institutions, such as the Ministry of Development and Planning Statistics (MDPS) reinforce the normativity of marriage as the single ‘legitimate pillar’ for establishing family life (MDPS 2016: 6), and emphasize the central role that family and, particularly, mothers have in improving Qatari society: The family is the basis of Qatari society, the foundation for all aspects of Qatar’s social structure . . . Qatar’s strong Arab and Islamic identity pervades all aspects of family life and continues to inform the family structure, but changes brought on by external pressures and internal evolution are changing family dynamics. The changes point to a society that is expanding its cultural imprint and progressing in positive ways while staying true to its Arab identity. Women are central to this positive, evolving nature of the Qatari family. Even as they maintain an adherence to valuable traditions, women are adapting to the impacts of modernization. They exemplify the new opportunities available to all Qataris as a result of the country’s rapid economic growth and social transition. QNDS 2011:17

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The QNDS continues the PPC’s strategy of encouraging marriage, particularly early marriage, and the creation of large households. Financial benefits are consistently granted to large families and family allowances increase according to the number of children per couple. With the high divorce rate and decreasing marriage rate attributed to the high cost of marriage, state policies are aimed at reducing the burden of the cost of weddings, and include introducing initiatives to reduce dowries; the government and the Qatar Charity implemented programmes to provide couples with free wedding tents and the construction of wedding halls in a bid to reduce the costs of weddings (QNDS 2011). Mandatory pre-marital counselling and education programmes were planned as part of the strategy in a bid to strengthen Qatari families and reduce divorce. Prominent religious figures were recruited to emphasise the religious duty of marriage and childbearing (Winckler 2015). The QNDS outlines the development of ‘a specialist media unit’ within the ‘Qatar Media Corporation to support key messages on the importance of the family, and a new subject on marriage and family ties will be included in the academic curriculum’ (2011: 168). It should be noted that the majority of these strategies to encourage fertility are directed at men in that men are commonly those in charge of household finances and budgets. State-funded ARTs, such as IVF, are another means to promote fertility. Funded for Qataris, there are no restrictions to access or the use of ARTs in regards to number of cycles, patient’s age, and number of embryos implanted. Whilst the state encourages Qatari fertility, it may indirectly discourage the fertility of migrants. In 2012, the government IVF clinic had 1,304 patients,2 38.4 per cent of whom are Qatari.3 However, during fieldwork, the services were cancelled for all non-Qataris in order to prioritize the reproductive needs of the local population. In this way, these global technologies have certainly aided the creation of ‘local babies’ (Inhorn 2003). Access to ARTs is limited along lines of citizenship. The unevenness of reproduction in Qatar mirrors other inequalities experienced by the migrant population. Reproduction is often unbalanced in society and migrant populations are certainly most affected by such inequalities in Qatar, but ‘stratified reproduction’ (Colen 1986; Ginsburg and Rapp 1995), draws attention to the ‘explicit and implicit ways in which classed, raced, gendered and placed hierarchies intersect with reproduction, meaning that

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some reproductive futures are valued and encouraged, while others are despised and discouraged’ (Faircloth and Gurtin 2017:11). Laws that limit or prevent Qataris marrying foreigners is a way to value certain reproductive realities. The 2006 Family Law confirmed a legal decree on marriage to foreigners adopted in 1989 with legal prohibitions or limits on Qatari citizens marrying foreigners situated within a broader regional trend (Caeiro 2018). The various direct and indirect pronatalist mechanisms, including generous family allowances, high subsidies on housing and state-funded ARTs, are all directed at Qatari nationals. In Qatar, like other prospects, reproductive opportunities and benefits are unevenly distributed, particularly between citizens and migrant workers. The majority of male migrant workers are denied the ability to have children while in Qatar, as most come alone and send earnings home (Gardner 2011; Gardner et al. 2013; Vora 2013) due to economic and state forces. The illegality of sex and, therefore, also pregnancy outside of marriage further restricts those who are able to reproduce. Whilst migrant workers are particularly marginalized in relation to inequalities of reproduction, as will be noted throughout the book, there are additional boundaries around reproductive value.

Reproducing the nation: Islam, the state and Qatari mothers One of the strongest themes in state discourse is the importance of family and, particularly, motherhood, in the development of the country with women’s experience of pressure to bear and mother children a persistent topic in women’s accounts. Having children is indivisible from the role of a Qatari woman: marriage and motherhood are described as simply part of a woman’s life, often described as ‘normal’ or ‘expected’. Interlocutors constantly speak about the expectations and obligations to have children placed upon them, whilst also describing a desire to have children. They are quick to express love for their children who bring them joy and pride. Such desire, aspirations and expectations are typically experienced soon after marriage, which marks the start of a woman’s reproductive life. Marriage ushers in adulthood, womanhood and motherhood. The centrality of motherhood to a woman’s identity, particularly the bearing of sons, is reflected in the common practice of

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teknonymy, that is, the naming of oneself after a first son: Um Hamad, ‘Mother of Hamad’; Um Mohammed ‘Mother of Mohammed’; women gain status when they give birth.

Motherhood in Islam Although not always explicit, women suggest that motherhood is key to one’s religious commitment, reflecting the close relationship between a Muslim woman’s procreation potential and her social status, her dignity and her selfesteem (Serour 1993: 211). Islam emphasizes reproduction as an important element of the faith (Tremayne and Inhorn 2012: 18). Motherhood is important and valued, as reflected in a common aphorism: ‘Paradise lies at the feet of your mother’4 or ‘Paradise is at a mother’s feet’. Although the origins and authority of this saying are questioned,5 this hadith, or saying of the Prophet, is commonly understood to suggest that respecting one’s parents and treating them well, particularly one’s mother, is tantamount to attaining paradise. The saying acknowledges a mother’s influence on her children: she is the source who guides them to paradise by imparting values, education and religious obligations through mothering. Interpreted as either the mother is responsible for her children and their path to paradise and/or that one earns paradise by serving one’s mother, the aphorism embodies sentiments that are found in many parts of the Quran, sunnah, as well as other hadiths. Sunnah, also defined as the path, ‘tradition’ or ‘way of life’ of the prophet that have become models to follow, is the body of literature which discusses and prescribes the traditional customs and practices of the Islamic community, both social and legal. The Quran and the sunnah make up the two primary sources of Islamic theology and law. The Quran stresses that women in their guise of mother, should go through struggles for their children and highlights the need for the child to reciprocate the parent’s sacrifice for them. The prophet Mohammed emphasized the role of a mother: A man came to the Prophet and said: O Messenger of Allah! Who from amongst mankind warrants the best companionship from me? He replied: ‘Your mother.’ The man asked: Then who? So he replied: ‘Your mother.’ The

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man then asked: Then who? So the Prophet replied again: ‘Your mother.’ The man then asked: Then who? So he replied: ‘Then your father.’6 As reported by Abu Horayrah, in Sahih Bukhari (5971) and Sahih Muslim 7/2

Sheikh Abdul-Azîz Ibn Bâz, the Grand Mufti of Saudi Arabia, commented on this hadith, saying: So this necessitates that the mother is given three times the like of kindness and good treatment than the father [Majmoo’ Fataawaa wa Maqalat Mutanawwi’ah] . . . The secret of her importance lies in the tremendous burden and responsibility that is placed upon her, and the difficulties that she has to shoulder – responsibilities and difficulties some of which not even a man bears. This is why from the most important obligations upon a person is to show gratitude to the mother, and kindness and good companionship with her. And in this matter, she is to be given precedence over and above the father.

Childbearing and childrearing are central to notions of womanhood in Islam, which informs and reinforces individual and societal sentiments about the importance of fertility and reproduction. It also informs national discourses around the importance of motherhood for Qatari women.

The Qatari state and reproduction Motherhood, nationalism and citizenship are entwined with obligations to the state filtered through tribe and family influences. Qatar can be seen as promoting the ideology of maternalism, where motherhood, childcare and maternal well-being are emphasized, not only within the family context but also as a nationalist concern (Kashani-Sabet 2011). Women’s bodies are enlisted in nationalist struggles to reproduce new citizens, often in the context of perceived reproductive wars, as other Gulf scholars have illuminated (Kanaaneh 2002; Kahn 2000). Qataris are tasked with creating large families to swell the population and provide manpower, as part of state development plans, which are informed by demographic anxieties and concerns about dependence on the outside. The Qatari state harnesses bodies and activities for nationalist concerns, with a particular emphasis on women’s bodies; promoting and encouraging high fertility and emphasizing mothering as the main site of reproducing Qatari citizens.

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Sexual relationships are governed by law: relationships outside marriage are prohibited, whilst polygamy is sanctioned. Heterosexual marriage is the only means of legitimate kinship in Qatar, which limits the possibilities for reproduction, a policy informed by Sunni Islamic thought. Opportunities for polygyny as well as the structure of citizenship, which travels through men, produces particular configurations in how reproduction is shaped. However, polygamous unions are relatively unusual, and the rate is decreasing, yet women often referred to anxiety around the threat of a husband taking another wife, particularly in cases of reproductive difficulty. Most Qatari marriages are arranged by family members, typically mothers, and commonly with a family of a similar background. Traditionally, Qatari nationals’ households are relatively large; this remains the case, with more than 80 per cent of households comprising five or more people, and 20 per cent comprising ten or more (QNDS 2011: 166). Forty per cent of our participants had six children or more. Whilst many aspects have persisted, there have been significant shifts in Qatari7 family characteristics and formation. Qatari women are marrying and having children later than they did in previous generations: women’s average age on their first marriage has increased rising to 24.1 (Ministry of Development Planning and Statistics 2016). Marriage rates overall have declined in recent years. The divorce rate decreased by 24 per cent. From 2009 to 2015, 807 Qataris divorced (Khatri 2017a): a 71 per cent increase since 2000 (Ministry of Development Planning and Statistics 2016) and one of the highest rates in the region. The TFR amongst Qataris has been decreasing in recent years, from 5.7 in 1990 to 3.6 in 2010, but it remains high compared with other countries and remains one of the highest in the Arab Gulf States (MPDS 2016; Toumi 2011). Consanguineous marriages remain popular: 54 per cent of marriages are within the family; 34 per cent between first cousins (Bener and Hussain 2006). Across the Middle Eastern region, the rates of consanguinity range in most societies from 20 per cent to 55 per cent of all marital unions (Bittles et  al. 1991; Bittles 2012). However, unlike in many parts of the world (Lebanon, Saudi Arabia, Kuwait, Jordan, Israeli Arab communities and the Palestinian territories), the practice is on the increase, as it is in the UAE, Yemen and Iran (Bittles 2011, 62). The increasing rates of consanguinity contradict the assumption that modernization will ‘inevitably reduce the incidence of

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consanguinity’ (Jurdi and Saxena 2003, 2; in Qatar see Harkness and Khaled 2014; Al-Ghanim 2010). I have argued that the continuing preference for consanguineous marriages can be seen as a means to contain global forces (Kilshaw et al. 2015; Kilshaw 2018; Sandridge et al. 2010; Abbasi-Shavazi et al. 2008 on Iran). Attitudes to consanguineous marriages can be seen as ambivalent and differing: the Ministry of Awqâf, the ministry of Islamic affairs and religion, has been resistant towards medical scientific discourses that construe consanguineous marriages as risky; in 2010, national statisticians emphasized the stability of consanguineous unions despite possible medical risks, yet the same statistics authority more recently construed consanguinity as a problem (Caeiro 2018). The risks associated with consanguineous marriages have been reported in the local media with medical doctors and scholars pointing to increased rates of genetic disorders, congenital defects and emotional troubles (Caeiro 2018). Although aware of discourse on risk and consanguineous unions, the Qataris when interviewed, negotiated and replaced these with those of other, often more tangible and immediate risks of marrying one’s daughter to a ‘stranger’. The potential advantages attributed to family marriage include greater autonomy for women, benefits such as familial unity, decreased pressure on the bride in her new home, a stronger marital bond with less risk of divorce, greater compatibility of the bride with her husband’s family, property and wealth retention and effective transmission of the culture from generation to generation (Sandridge et al. 2010; Barth 1953; Khlat et al. 1986; Bittles 1994; Ottenheimer 1996). Such marriages are seen to exhibit greater stability, increase social solidarity and foster tribal cohesion; indeed, analysis of divorce rates reveals that consanguineous marriages are significantly more stable than others: in 2015, only 36 per cent of these marriages ended up in divorce compared to 64 per cent of divorces among Qataris with no blood relationship (MDPS 2016 in Caiero 2018). Marriage in the family increases the likelihood that the couple will share values and traditions, making for a more comfortable union (Kilshaw et al. 2015; Sandridge et al. 2010), as expressed by interlocutors. Qataris spoke of the importance of familiarity with customs and traditions when looking for a potential spouse for their children (Kilshaw et al. 2015; Kilshaw 2018). They hinted at notions of purity and authenticity: familiar customs and practices would allow women to effectively impart them to future

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generations. The process of vetting possible marital partners for one’s family members can be lengthy and complex, thus family marriages provide for a more efficient and effective selection procedure: it reduces the need for clandestine quests for information about family background and reputation since these will be known. Interlocutors of the genetics and risk project also suggested that pre-marital screening gave them confidence in limiting any potential risk of consanguinity (Kilshaw et al. 2015). In 2009, a mandatory premarital screening programme was introduced, similar to many Gulf states, to examine the genetic compatibility between prospective couples. In Qatar, this includes genetic tests for the three most common genetic conditions (Kilshaw et al. 2015). The law restricts the use of the results of medical tests being used to prevent the marriage, although the couple must be informed of potential risks. As Shabana argued,‘results of genetic testing are not always straight forward and they often require expert interpretation and proper counseling’ (Shabana 2017: 200). The medical tests include sickle cell anaemia; thalassemia, testing of the clotting factor to discover haemophilia (if there is a family history or any medical indicators of the disease); syphilis; HIV (AIDS); hepatitis B and C. For most young Qataris, premarital screening represents a formal engagement with genetic risk, becoming a normalized practice of social life (Kilshaw et al. 2015 and Kilshaw 2018). For many couples this begins a process of regulation and control of reproduction. Thus, high levels of medicalization and surveillance begin before a couple weds and continues throughout reproductive experiences through prenatal testing and screening and hospital births. In Qatar, as in Islam generally, tribal and familial connection are inherited through the father, as is Qatari citizenship: children born to a Qatari father, regardless of the mother’s nationality or place of birth, assume citizenship. Jus sanguinis is the basis of Qatari nationality law whereby citizenship is determined not by place of birth but by having a parent who is a citizen of the state. Qatari law allows naturalization of foreigners, but they are rarely granted citizenship even if they have a Qatari mother. There are also a number of attributes that must be met in order for naturalization to be considered including residency for twenty-five years with no gaps exceeding six months and knowledge of Arabic. The rhetoric of biological inheritance and relatedness is not new and has long provided a vocabulary of nationality, nobility and

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purity with DNA seen as a repository of national characteristics (Atkinson and Glasner 2007). The intersection of national and biological identity has been documented in many contexts and is particularly true of Qatar. Nationality law, notions of citizenship and lineage help to explain why the wives of Qatari men are valuable as reproducers.

Qatari modernity: innovation, education and international politics Family cohesion, the protection of Islamic identity, and increasing the population feature prominently in the vision of Qatari modernity. The modernizing agenda also focuses on political involvement on the global scene, demonstrating its commitment to innovation and progress, including through its focus on building a knowledge-based economy and education. Linked to this is an emphasis on increasing the reach and skills of the Qatari workforce, a focus of the QNV. These initiatives are part of the so-called ‘Qatarization’ of the nation, with policies to encourage and support Qatari workers in the public sector and working to extend Qatarization in the private sector (Gulf Research Center 2014). Concerned about their dependence on foreign labour and outside expertise, the Qatari state has introduced a number of governmental initiatives devised to increase the number of Qatari citizens employed in public and private sectors, which has resulted in high employment rates. Whilst this is a broad endeavour, women have figured prominently in state discourses of progress with ‘women’s empowerment’ a central element of QNDS 2011 which aims to increase education and employment levels and opportunities for women being central elements of state development discourse. Such aims are inevitably tied to political positioning. Endeavouring to be an influential link between the Arab world and the rest of the world, Qatar has played an important role in the international political and economic landscape. The country plays host to the Al Udeid air base, the regional home of US Central Command. As a significant player in Arab politics, it supported several rebel groups during the Arab Spring. The Qatari government provided money and diplomatic support to Islamists in Syria, Libya and the Sahel, as well as the Muslim Brotherhood in Egypt. Its political positioning is evidenced

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by its homegrown media network, Al Jazeera, whose independent reporting has occasionally led to diplomatic crises with neighbouring countries and its hosting of the globally televized, ‘Doha Debates’. The BBC and Qatar Foundation-sponsored debates were a forum for free speech intended to provide an opportunity to discuss issues of importance to the Arab world and focused on particularly controversial issues until they ended in 2012. Such projects are intended to foster Qatar’s reputation as a progressive Arab nation, as does its focus on building a knowledge-based economy, education, research and innovation. Women have taken advantage of these increased opportunities throughout the region: ‘it is within the GCC countries that the sharpest rise of educational achievement has been witnessed for women in the whole Arab world’ (Willoughby 2008: 85). In 2012, there were almost twice as many female students enrolled in university as there were males (Walker 2014a). Qatari women outnumber and outperform men academically (Ridge 2014; Walker 2014a). A 2007 RAND report assessing the country’s educational reform stated, ‘the educational attainment is trending in opposite directions for men and women, with women becoming better educated over time while men’s level of education declines’ (Stasz et  al. 2007: 14–15). Qatar’s development plans include initiatives to establish gender equality in the job market, encourage and support women’s participation in the economy and in political life. Women’s employment rates have increased to 36 per cent (MPDS 2016), which are the highest in the Gulf region. However, women are affected by a wage gap, in which they are paid considerably less than men. State discourse encourages women to play a more dominant role in political life, but this has yet to transpire: there are no women on the Majālis Al Shura, the legislative body of the monarchy of Qatar, and there are only two women on the Municipal Council and one female ambassador out of 100 (Al-Tamimi 2016 in Golkowska 2017). Gender stereotypes and cultural mechanisms, such as the emphasis on familial and reproductive responsibilities and lack of pragmatic support make negotiating employment effectively challenging for Qatari women. Qatar’s positioning as a centre of Arab modernity and related development projects have implications for the broader society, particularly for women and reproduction. Increasing expectations and opportunities for women to expand

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their role outside the home has implications for reproductive navigations, including when to marry and, thus, when to have one’s first child and how many children to have. Women consistently spoke about the difficulties in balancing expectations of having large families with those of participating in education and the economy. There has been a tendency to equate tradition with reproduction and domesticity and modernity with economic and public life. However, the way in which reproduction and women’s bodies are enlisted in state development strategies and impacted by them reveals this to be a complex process evading such binaries. Such contradictions are common in discourses around the family in the Gulf with the various aims invoked typically conflicting: ‘to modernize, to redress the “demographic imbalance”, to return to a world shaped by a sense of community, to transition towards a knowledge society, and to integrate more fully into the global structures of neoliberal governance’ (Caeiro 2018: 1). Social paradigms of contemporary Qatar are articulated through women’s bodies and reproduction and yet these paradigms are often contradictory or produce tensions. Whilst emphasizing ‘women’s empowerment’, state discourse articulates a concern about the relationship between women’s advancing educational status and increasing participation in the work force and demographic trends that cause them concern. These include decreasing fertility rates and the disintegration of the family as evidenced by factors such as increased divorce. Qatar’s focus on the education of its citizens has meant the literacy rate has increased dramatically to reach 98.4 per cent (MDPS 2017). University education has become far more commonplace with 30.9 per cent of Qataris holding a university degree in 2012. Indeed, the emphasis on education is evidenced by the state initiative: ‘Education City’, a 14-square-kilometre area in Doha, which houses branch campuses from a number of leading American universities, one British university (UCL) and a public Qatari university founded in 2010: Hamad bin Khalifa University. UCL Qatar, which opened in 2012, is scheduled to close in 2020. Education City merits special mention in discussions of education reform and, particularly, women’s education: an initiative of the Qatar Foundation (QF), it is conceived as a forum for exchange, where universities collaborate with businesses and institutions in both the public and private sector. Sheikha Mozah was the driving force behind its development; her commitment to

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women’s empowerment is embedded in its vision. A key figure driving state development plans and the image of contemporary Qatar, Sheikha Mozah bint Nasser, the present Emir’s mother, was instrumental in encouraging and facilitating the establishment of organizations to serve women, children and the family during her role as consort to her husband, Sheikh Hamad bin Khalifa Al Thani, during his rule from 1995 until 2013 when he handed power to his fourth son. Her influence can be seen in a number of social reform programmes, particularly in the area of health, education and women’s empowerment. She is seen as a role model and as encapsulating the ideal of a contemporary Qatari woman. She was a high-profile figure in Qatar’s politics and society unlike most monarchical wives in the region. Although less visible since her son became leader, she continues to have a role in Qatari political and social life and her influence remains.

Education City: new cosmopolitan space Education City is seen as a cosmopolitan space, where Qataris, other Gulf Arabs and students from other nations mix and are taught by foreign (predominantly American and European) professionals. It stands at the intersection of two sets of interests: being at one with the globalised world while aspiring to stand apart from it (Kane 2013). In her research on medical education on the campus, Kane emphasizes that Qatari leadership did not recruit from the pool of established regional medical schools, but deliberately chose to import one from the US. Although a regional medical college would ‘offer a professional training more in keeping with core Qatari values and culture, the US programme was perceived to be superior both in terms of its quality of training and its capacity to develop a domestic research platform which could communicate at an international level’ (Kane 2013: 101). Diverging from the aims of other seekers of globalized and globalizing education, the Qatari state is: Not aiming to produce neoliberal subjects trained for employment in global knowledge-driven economies. Rather, citizens are being presented with opportunities to equip themselves with specific skills in order to participate in the development of a domestic knowledge-based economy. Kane 2013: 101

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The aim of creating world-class education for Qataris at Education City is predominantly built upon a notion of education as a ‘means of creating marketable, international skill; education is focused on connecting Qatar to the outside world’ rather than inward criticism or reform. It is, ‘not on the issues of governance and society within Qatar itself ’ (Fromherz 2012: 10). Whilst positioning itself as innovative, modern and open to learning from other cultures, Qatar maintains an emphasis on retaining Qatari customs and authenticity. To this end, a number of measures are activated to ensure the maintenance of Qatari values and to nourish a local set of principles of development, including ‘Qatarization’. The goal is primarily to benefit Qataris specifically and Qatar generally and to promote Qatari modernity with its emphasis on the blend of tradition and the contemporary. As a symbol of Qatari modernity, Education City both informs and impacts notions of identity; in the context of a self-consciously changing Qatari society, it has elements of social reform contained within its very structure, particularly in relation to gender divisions and space. The role of women in Qatari modernity are embedded in its campus: Education City is primarily a place where the sexes mix openly, unlike other Qatari domains where sex segregation remains common with public spaces traditionally perceived as exclusively male. Daily life is somewhat divided into two parallel societies in Qatar with minimal interaction between men and women (Bahry and Marr 2005). Public institutions, such as libraries and parks typically maintain gender divisions, having special days for women and children to visit when men are not allowed. Hospitals and clinics, including the Women’s Hospital where our project was based, upholds segregation as does the state university, which has separate campuses for men and women. Many buildings have separate entrances and waiting rooms for men and women; restaurants and cafés often have family rooms; gyms and leisure centres observe ‘ladies only’ hours or activities. Most malls have ‘family days’ on Fridays, banning single men from entering to provide more privacy and comfort for women. Wedding parties are held in separate rooms and often in separate locations, one for the bride and one for the groom. Women are free to be unveiled during celebrations making these occasions opportunities to see and be seen, and to socialize openly in large numbers. Women are not obligated, unlike men, to attend Friday noon prayer in the mosques, but if they attend, they are separated from the men

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(Ludsgaard Ottsen and Bersten 2014). Segregation is extended to the home, where boundaries between public and private space are marked by walls, usually with high boundary walls surrounding the home and garden. Windows face inwards, ‘within Arab Muslim homes, there is a sharper distinction between men’s and women’s spaces as well as transitional spaces in moving from one to another’ (Belk and Sobh 2009: 34). Women’s domain is primarily the household, where they perform their roles of wives and mothers (Golkowska 2017). Within the home there are separations of space, with parts of the house designated for exclusive use of women and men. When we visited interlocutors we were, without exception, entertained in the large sitting rooms of women. By importing Western models of education, different patterns of social life and social space have been transplanted. Newly created physical and symbolic space offers opportunities for women, but they also create potential tension between Western liberalism and local conservative interpretation of Islam (Golkowska 2017). In her exploration of the gendering of new urban spaces in Morocco, Newcomb (2009: 148) writes that disagreements about women and space reveal profound uncertainties and frictions about the interpretation of culture and the role of women in an increasingly mixed society. What is at stake in these arguments is the future and vision of the nation-state (Newcomb 2009). Similarly, women, their bodies and movements are enmeshed with the construction of a national Qatari identity. Restrictions and social norms around women’s movements reveal the social value placed upon them as well as changing notions of women’s identity and role in society.

Custom and the contemporary A general dependence on the outside can be seen throughout Qatar economic, social and political arenas as evidenced in the structure of Education City or the fact that 90 per cent of Qatar’s food comes from overseas. This dependence on the outside has become a preoccupation of Qatar’s political elite (Fromherz 2012: 11), with this anxiety motivating state development programmes and strategies. Qatar ushers in outside influences, but these imports are managed and contained with the main instrument of containment through an emphasis

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on tradition and continuing Qatari identity (Kilshaw 2018). Dress has been a powerful symbol for both containment and emphasizing identity, with an emphasis on national dress but also prescriptions around dress for migrants through various measures. For example, in 2012 the ‘Reflect Your Respect’ campaign, launched by the Qatar Islamic Cultural Centre, which was intended to stop immodest clothing practices of tourists and other foreigners in public spaces, which included the ‘leggings are not pants [trousers]’ rule. Public beaches and parks have also been the focus of restrictions around the dress of foreigners: a strict dress code is enforced for women at the public Katara Beach with clear signs outlining appropriate dress and that women must cover up to the elbows and knees on the beach. Whilst women are generally expected to cover their knees and shoulders and men should wear longer shorts and not go shirtless, the rules of attire are relaxed at resorts and hotels, which are considered more cosmopolitan spaces. Qatar, similar to other GCC countries, actively seeks to create, ‘invented traditions’ in order to maintain and deepen their legitimacy and construct community identity in keeping with the past. This national identity construction and ‘heritage engineering’ is marked by the emphasis on cultural activities and national dress. The state’s obsession with building museums and the renewed interest in historical and heritage sites, such as suqs, Doha’s reconstructed and reimagined Suq Waqif (Cooke 2014) and the redeveloped suq in Al Wakra. Previously destroyed and abandoned, these suqs were subsequently rebuilt and redesigned to appear as a historical site; national identity and tradition are reimagined and rearticulated. There is a constant negotiation between modernization and tradition, as is clearly articulated in state discourse, such as the QNV 2030; the national narrative is modernization with respect for tradition. A distinct amalgam of customary and contemporary is a crucial element of the social projects in Qatar, from higher education to museums’ construction and promotion (Harkness and Khaled 2014) and is conveyed in the new buildings and public spaces that rapidly alter the skyline. Clothing extends gender segregation and the separation of public and private domains in Qatar. The practice of veiling upholds the division between male and female and extends it out into the public sphere. Wearing a veil signals status and modesty (El Guindi, 2003), a prerogative that protects a

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woman’s right to see the world without being watched (Lundsgaard Ottsen and Bersten 2003). Literature about Muslim women has often focused on the veil and contestations around its use (Mernissi 1992; Secor 2010; Ahmed 2012). As ‘the principal vehicles for transmitting’ a nation’s values from one generation to the next, women are veiled to protect them (Enloe 2000: 54). Women almost exclusively wear abaya (a cloak; a simple, loose fitting over-garment, essentially a robe-like dress that covers the whole body except the feet, head and hands) and h.ijāb (a veil) with their bodies and hair being completely covered in loose flowing black robes and materials. Traditionally such clothing is black. All of our interlocutors dressed this way in public spaces, but we were to see them unveiled and without their abaya when we visited them in their homes. By far the majority of women wore the abaya and h.ijāb, with the latter in the shayla (an Islamic head covering worn by women in many Arab Gulf states). Typically a black mask, a form of h.ijāb in the form of half niqāb, with the face still appearing; however, a small number of women wore the niqāb (face; veil; a garment of clothing that covers the face, which is part of a particular interpretation of h.ijāb (modest dress)) to shield their faces from public view. It is widely thought that women began wearing the niqāb during the period of mass infiltration of foreigners into Qatar which coincided with increased wealth. It has been seen to increase the hold of tribal ‘tradition’ (see Fromherz 2012, Gardner 2013, Al-Ghanim 2010) particularly in relation to adherence to traditional dress (Fromherz 2012). Increased use of the h.ijāb in the wake of escalating rates of female employment, education and athleticism in the region (Jawad et  al. 2011) can be seen as a reaction to modernization. Adopting such dress can be seen as a way to establish and reinforce boundaries which separate the private from public, supporting the view that when a society feels under threat from outsiders this is often articulated through an anxiety about or desire to protect body boundaries (i.e. Douglas 1966; Boddy 1989). Clothing is a means to negotiate the social movement of women through public spaces. Gender segregation, including use of certain dress and the veil, can thus be seen as a way to reinforce boundaries between community members and others, as women are most vulnerable to ‘defilement and exploitation by oppressive alien rulers’, and ‘most susceptible to assimilation and co-option by insidious outsiders’ (Enloe 2000: 54).

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Conclusions Social change in the Middle East is sometimes met with forceful conservative reactions (Harkness and Khaled 2014). When boundaries between categories are unclear, contradictory or have broken down, the resulting category confusion is seen as polluting and potentially dangerous (Douglas 1966), requiring containment strategies. Containment is evident in the Qatari approach to outside forces, which are seen as polluting or corrupting Islamic and Qatari values. Such techniques can be seen in the tight restrictions on the sale and use of alcohol, restrictions on the behaviour and movements of certain migrant workers, and in the policy of Qatarization itself. In a plethora of ways, the state limits the ideological influence of others. The delicate balance between tradition and the contemporary pervades most aspects of social life; it informs social roles and establishes the parameters within which gender roles and expectations are being modified. Women and their bodies are inscribed with the values of Qatari society, including the state’s modernizing vision and its negotiations of tradition and modernity. Bodies are sites of articulating tradition through a variety of means including dress, behaviour and movement in social spaces; at the same time, they must enact performances of empowerment and modernity. Discourses of modernity often concern bodies and reproduction; the lived experience of the Qatari state’s vision of contemporary Qatari womanhood and how this is entangled with women’s reproductive lives is the subject of this book. In the first years of my time in Qatar it was common to see women wearing the niqab, abayas and shaylas that were exclusively black; however, during more recent visits I noticed changes in women’s style of dress. Whilst some (more conservative) women continue to wear the plain black abaya and shayla and, more rarely, the niqab, variation and colour (e.g. Swarovski crystals and embroidery) have been added to Qatari women’s traditional dress. Some women, perhaps influenced by Sheikha Mozah, are now confident to show some of their hair, with their shayla sitting back from the hairline. Changes in women’s dress are symbolic of changes in possibilities for and expectations of women: in terms of movement, agency, education, employment and beyond. Such changes in dress are symbolic of women’s empowerment, which is embedded in the state development strategies.

3

Huda: Marriage, Motherhood and Loss It was a warm Doha October morning when we first met Huda in the hospital. University-educated and middle class, Huda spoke English fluently, evidenced by the English words that peppered her Arabic dialogue. Working as a medical technologist, the thirty-five-year-old mother of three is in the minority amongst interlocutors in that she married an unrelated man: 32 per cent of interlocutors are married to their first cousins; 41 per cent married within the family; and 54.5 per cent were married within their tribe, reflecting the national statistics. Generous with her time, Huda shared with us her experiences of pregnancy and miscarriage as well as more general insights about life as a Qatari woman, mother and wife. She spoke about her marriage to her fortytwo-year-old husband, which was sometimes difficult, and her ambivalence about having more children. Huda’s story of reproduction, which includes five pregnancies and two consecutive miscarriages, is embedded in wider discussions of her marriage, family relationships and her life as a Qatari woman. Huda’s story helps to illustrate the way in which reproductive disruptions, such as miscarriage, are embedded in a wider story of reproductive negotiations that are carried out within a framework of cultural expectations and obligations around the role of women in Qatari society. This chapter explores these interconnections by focusing on Huda’s account of marriage, reproduction and her experiences of miscarriage; the accounts of other women provide additional information on the themes introduced by Huda. These stories reveal that women’s experiences of miscarriage can only be understood in the wider context of their lives, including past reproductive experiences as well as their future reproductive aspirations with these acted out in a social landscape that includes arranged marriage, pronatalism, specific models of ideal family size and construct, and expectations of female professionalism, which inform the experience and its aftermath negotiated. Huda’s story 47

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introduces the reader to key themes presented throughout the book, revealing the way in which contemporary Qatari women are to be both (traditional) reproducers whilst also enacting the state as modern. She shows us how notions of motherhood in contemporary Qatar reflect Arab modernity and illustrates how it is lived and experienced by women.

Reproductive navigations, pregnancy and miscarriage Unusually, Huda’s pregnancy was ‘planned’: she had been charting her ovulation and fertile period with the help of a doctor. This was uncommon; most of the women we spoke to do not speak of planning their pregnancies, instead seeing pregnancy as a ‘normal’ outcome of sexual relations with their husbands.1 After a number of months, Huda suspected she might be pregnant and performed a home pregnancy test, whose positive result was delightedly received by her and her husband. She sought medical care to confirm and monitor the pregnancy. When Huda experienced light bleeding, she attended one of the private hospitals in Doha. Huda regularly attends the ‘Police Hospital’, a clinic available only to Ministry of the Interior (MoI) staff and their families; but in this instance her regular doctor was on holiday, so Huda chose to attend a different clinic. The doctor explained that bleeding in pregnancy was normal, but advised her to rest, giving her a sick note to excuse her from work: And he gave me progesterone and every week I would go [to the hospital] to hear the heartbeat. At the fifth week he started to hear the heartbeat, but it was very weak.

The status of Huda’s pregnancy was checked at weekly clinic visits. During one such visit, the doctor prescribed progesterone: a common practice to ‘stabilize’ a pregnancy in cases of threatened miscarriage or when a woman is concerned about the state of her early pregnancy, particularly if miscarriage has occurred previously. Dr Maryam, a clinician interlocutor and Huda’s favoured doctor, further supported the approach of prescribing progesterone and rest: We ask them to rest because they insist on rest, they believe that if they rest the pregnancy will continue even though medically there is no support for

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having rest. But we give them [sick leave documents] because most of them ask for rest, so she will have sick leave and she will have supportive Duphaston [progesterone] and we will refer her to out-patient clinic for follow up with ultrasound.

As discussed in Chapter Five, the common use of progesterone supports discourse around modernity and its impact on reproduction: the increased requirement for medicines and medical care to support fertility, pregnancy and birth. Rest is commonly prescribed and supported by a doctor’s authorization for sick leave, despite Dr Maryam’s assertion that this is patientled, which resonates with our findings about Qatari understandings of pregnancy as a vulnerable state threatened by work and fatigue. Whilst Dr Maryam acknowledged that not all research ‘supports this theory’ of using progesterone to reinforce the luteal phase, women want to feel they are being treated in the event of a threatened miscarriage, so the prescription is seen as psychologically supportive. Reassured, Huda made an appointment to see her favoured obstetrician, I only went for a check up but when she saw the baby, she told me that it looked smaller than it is supposed to at seven weeks. I told her that I heard the heartbeat last week; she said ‘No, he looks smaller and you should do an ultrasound [US].’ When I did the US there was no heartbeat; they told me to wait three days and then do a US again but again there was no heartbeat. They told me that it seemed that the heartbeats had stopped at the sixth week.

Despite any indication, Huda’s pregnancy had ended. As is common practice, the hospital staff instructed her to return for a second ultrasound to allow for a definitive diagnosis of miscarriage. In line with the typical process of miscarriage management in Qatar, Huda was advised to wait a number of weeks in the anticipation that the miscarriage would complete spontaneously. After several weeks and having experienced only very light bleeding and despite her attempts to achieve the miscarriage using herbs, diet and treatment by traditional healers, Huda returned to the hospital: After that they gave me suppositories to open the uterus and pass the baby, but it didn’t work. I was admitted here last week and I took the entire treatment course but nothing happened. They released me and told me to take a break for few days and come back again. This week they started the

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same course of suppositories and again there was no response. I asked them to change the treatment or the strength of the suppositories, but they said this is the only protocol they have. So again they asked me to go home and come back again later. They didn’t recommend the DNC [dilation and curettage (D&C)] because as you know it has side effects, especially as I have done more than one before so I requested to speak to Dr Maryam and she told me in my case the suppositories are useless and I should do the DNC.

Huda underwent surgery to complete the miscarriage and remove the pregnancy tissues from her uterus. Her experience exemplifies the hospital protocol of expectant, followed by medical, followed by surgical management in the event of the failure of previous management attempts. A clot in the placenta; God’s will; evil eye; magic; changes in diet and lifestyle, particularly increased responsibilities around employment, were presented by Huda as possible causes of miscarriage. Her doctor suggested a ‘clot in the placenta’ may have been a cause in her particular case and as a result, Huda was advised to take aspirin as a preventative measure against miscarriage in future pregnancies. If she were to become pregnant progesterone would be similarly prescribed to ‘support’ the pregnancy. Huda understands the main and ultimate cause of miscarriage to be God’s will; she explains her miscarriage as qadar (destiny) and qadar Allah Katboh (that has been decided before by Allah), her miscarriage is ibtila’a (trial or tribulation) from God and something for which she will be rewarded. She describes her faith as strengthened by the experience. Huda believes that changes in lifestyle brought by development had an impact on miscarriage cause and frequency. Such transformations included alterations to diet, such as increased preservatives and contaminates in food, which meant that the Qatari diet is less healthy than in previous generations. Huda sees contemporary life as more demanding, particularly as many women now work outside the home, making them tired and their pregnancies more vulnerable. Huda notes that miscarriage now commonly happens to women who had previously had children. In previous generations, miscarriage generally only occurred in those with compromised fertility: one either had reproductive problems or one did not but, in contemporary Qatar, all women are susceptible to miscarriage. Huda discusses concern about her pregnancy

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being vulnerable to evil eye and magic, a concern that extends to her sister: when newly pregnant, Huda told her sister her news; her sister, a doctor, advised her to conceal her pregnancy until after the first trimester. The act of concealment is a form of protection and illustrates anxieties about the vulnerability of pregnancy to diffuse forces in the environment. Indeed, Huda was particularly concerned that the women who worked in her house posed a risk to her. Domestic workers, she explained, are known to practice magic against their employer. This is an additional aspect of modern life along with other changes in diet and lifestyle that posed a concern for Huda.

Marriage and the importance of Qatar motherhood Huda explains the main reason she and other Qatari women marry is to have a baby and become a mother. Marriage and motherhood are described as being a ‘normal’ requirement of a Qatari woman’s life. Like most Qatari women, it is the story of her marriage which encases her reproductive experiences and provides the framework for her reproductive negotiations. Marriage is key to a woman’s reproductive life, as sexual relations are governed by law: sex is h.alāl (permissible) and legal in Qatar only when it occurs between a married couple. As is typical amongst Qataris, Huda’s was an arranged marriage or, as she describes, ‘done in a traditional way’. As is often the case, it was at a wedding that Huda was first spotted by her husband’s family. Men and women celebrate weddings separately and the venue is carefully guarded meaning that women have no requirement to veil or to wear the abaya once inside, except when the groom and a small number of male guests briefly appear. Large events, weddings are opportunities for women to feast, socialize, dance, celebrate and let their hair down, both literally and metaphorically. Weddings are also a prime opportunity for those seeking a wife for their son or other family member: it was at such an event that Huda’s sisters-in-law first observed her. Huda’s appearance and, most importantly, the reputation of her family was the basis of their interest in her: knowing their brother to be very religious and, thus, not suited to ‘an open lady’; Huda, raised by her conservative, religious family, was deemed an appropriate match with the likelihood of a ‘smooth’ life for the couple. The women approached Huda’s mother who then conferred

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with Huda about the union, presenting her with a picture of her intended. Unimpressed, Huda thought he looked older than his years and that ‘his body shape and style was not too good’. Despite her reservations, Huda prayed, read du’aa (invocation, prayer of supplication or request) and ‘let things go’: in keeping with her faith she explained, One gives oneself to God and allows him to do what is best: if Allah wants this to happen, you will get it and if Allah doesn’t, something will happen to stop it.

Following her prayers, she made the decision to put herself in God’s hands and go ahead with the marriage. According to family tradition, Huda did not see nor speak to her intended before the wedding party and was absent when melkah was performed. Melkah, a small formal family meeting, is the official wedding where details are finalized and the marriage certificate and contract signed, the latter containing details of the marriage agreement. Scholars suggest that young Qatari women’s greater agency is demonstrated in changes to marriage contracts, which may now contain clauses for travel and study (Rajakumar and Kane 2016) and whether she will work following the marriage. The families either attend court or bring a religious scholar to the home to register the marriage. Often, the father is the only member of the family present: in keeping with religious and legal tradition a bride is not required to be present; in Huda’s case, her father attended melkah on the same day of the wedding. The melkah often takes place days, months or even a year before the wedding party. Although legally wed, the newlyweds will not live together nor enter into a close or sexual relationship until the wedding celebration. Thus, the period between the melkah and the wedding is when the couple get to know one another as they may speak on the phone or in person depending on family tradition. There are variations in the aspects of the process of marriage. Some, like Huda, neither saw nor spoke to their husbands until the wedding ceremony; others, like Dana, a happily married twenty-nine-year-old mother of two who had suffered a number of reproductive losses, had more contact with their husband. Whilst their marriage was similarly arranged, Dana and her husband were engaged for eight months during which time he would: ‘Come and see me

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in my parents’ house twice a week and we spoke by phone, so the engagement period was enough for me to know him very well.’ In describing her engagement, Dana reveals that her family is not as conservative as other families we met and reveals herself to be hadar (the descendants of settled town dwellers often understood to be more elite tribes) part of the ‘urban’ Qataris who are seen in contrast to the more traditional and conservative Bedouins, like Huda. We [hadar] are different, he is my husband h.alāl [legally] by the time we had the marriage certificate . . . we can sit together, have dinner, or call each other more than once every day. So, when I got married everything was easy for me.

Dana’s experience differs from Huda’s, whose first meeting with her husband was on her wedding day: It was really scary. I was shocked. Now when I talk to him, I tell him that it isn’t a nice experience, but a scary one. I was waiting for a stranger to come so when he came in and I stood up I dropped the flowers in my hands [laughs]. I was supposed to be smiling but then he came and I was shocked and nervous. He was standing in front of me, but he was not looking at me and [I didn’t look at him], so it was a very horrible situation.

Standing beside her, her new husband did not speak to her because the loud music made communication difficult. Once photographs were taken the couple were told they could leave so they walked in silence through the hotel corridors. The wedding organizer had not covered Huda explaining that it was ‘safe’ and nobody would see her as she guided the couple through the hotel. Her new husband became agitated when he noticed a male member of staff; shouting at Huda to cover her face. Huda sadly notes that the first time her husband spoke to her he had yelled at her; the first time she heard his voice, it was raised in anger. His fury did not abate as he berated the organizer for her mistake. The couple retired to their room: We had a room there and he was shouting for most of the time. He opened the fridge [minibar] and, you know, my husband is religious so . . . when he saw the whiskey he was upset and started shouting. He removed everything. It was really very awful! And when I saw him like that, I told my sister, ‘I don’t want to stay with him; I want to go back home.’

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Finding the situation frightening and upsetting, Huda comments that things continued to go badly: saying he was tired and wanted to sleep, her husband retired to bed. Huda sat on the balcony as laughter, music and sounds of her wedding party floated up to where she sat crying. There she remained all night as her husband, ‘a strange man’ slept in the room inside. Huda describes the first months of marriage as difficult, saying it took her ‘a long time to get along with him’. During this challenging period of her marriage, Huda turned to her mother, Amna, for advice and support. Amna joined us during one interview and explained the advice she gave her daughter. As we sat together and drank Arabic coffee and fresh juice, Amna explained that she had advised Huda that the most important thing is ‘to obey her husband’ and to do ‘what he asks’. Instead of saying no to him, she should say, ʾIn shāʾ Allāh, because no matter what he is a man and the man likes to boss his wife around especially at the beginning of their marriage . . . by controlling her he will prove that he is the boss in the house.

Gradually the relationship began to improve; the couple settled into married life and produced three daughters. Huda’s husband was eager to increase their family and, in particular, to have a son. Although she was uncertain about having more children, Huda became pregnant, a pregnancy later discovered to be twins. Delighted at the prospect of two babies, happiness turned to sadness when Huda miscarried, a sadness impacted by the knowledge that there were two. Had Huda given birth to twins she would have been able to ‘rest’ and delay her next pregnancy. Twins are coveted in Qatar, mainly because of the emphasis on producing a large number of children. A multiple pregnancy means it is more efficient, with some suggesting twin births may lead to the ability to ‘take a break’ from reproductive commitments. The value placed on motherhood and children in Qatari society is evident in Huda’s account, with pressure to produce children felt from numerous sources, which continues throughout a woman’s reproductive life. Wafa, who is twenty-seven and six weeks pregnant with her first baby explains: ‘Every woman wants to be a mother and have kids.’ Wafa describes motherhood as something all women wish for, but continues to articulate other forces steering women towards motherhood:

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It is not good to get married and not have kids, there will be too many stories about you . . . The first thing your husband’s family will say about you ‘Is your wife pregnant?’ ‘God did not give you kids yet?’ And so on. At the beginning it will be in a nice way, but then in the end the problems have no limits. The mother-in-law is not easy, basically: if her son [had been married for] two years and didn’t have children she will insist on him getting married again . . . I am telling you pregnancy at the first year of marriage is very important.

Wafa describes women’s desire to be a mother but immediately links this with negative consequences of not doing so. Women describe a desire to have children, but it is also an obligation with pressure to do so felt acutely. The cultural value placed on children and the entwining of womanhood and motherhood translates into women facing pressure to produce children, with this theme emerging consistently in women’s accounts. The desire, aspiration and expectation to conceive begins immediately following a woman’s wedding, which marks the start of the reproductive phase of a woman’s life, as outlined in Wafa’s account. Such pressures can only be described as relentless and ongoing. A woman’s inability to conceive soon after her wedding makes her vulnerable to gossip and unwanted attention; Wafa explains: ‘from the first month after marriage they will start asking . . . questions start’. Becoming a wife is entirely entwined with reproduction: the expectation is that the couple will not use contraception and that a pregnancy will soon follow (see also Kridli et  al. 2013). Not becoming pregnant soon after marriage signals to others that one might be infertile, a dangerous state for a Qatari woman, making her susceptible to accusations of blame and divorce, isolation and/or polygamy. Wafa’s account illustrates the concern that if conception is not achieved in the first year, a woman is in a vulnerable position and risks having her husband take another wife. If a bride has not produced a child within two years of marriage, the mother-in-law is likely to encourage her son to take another wife to ensure his progeny, identifying the mother-in-law as a key figure in the networks of pressure. The patrivirilocal residence pattern in Qatar, where a married couple lives with or near the husband’s parents after marriage, means that marriage is commonly followed by a move into the husband’s family home with motherin-laws typically guiding new brides about familial practices and norms. The

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daughter-in-law is generally considered subservient to her mother-in-law and, possibly, other female family members. When Huda moved in with her husband’s family for the first five years of her marriage, the influence and involvement of the other female members of the family impacted her marriage: As you know, the family is not the husband and the wife, it is a big family, he is related to his mother, his cousins, his eldest sister and all these members affect the relationship between the wife and the husband in our culture.

Huda reminds us that, in Qatari society, extended families play an important role in a couple’s lives; a marriage influenced by and embedded within a wider web of family relations. The difficulty of the first years of her marriage were mainly due to the women of the family interfering in her relationship and speaking ill of her. In conflict with them, Huda felt they were jealous of her and her position as a new bride. The pressure from her husband’s family to produce children emerges constantly as she speaks about her experience: Huda felt scrutinized, watched and under intense pressure to become pregnant. If a woman does not become pregnant soon after the marriage, she is commonly encouraged or pressured to seek medical help. Fareeda, a thirtyeight-year-old teacher with six children after eleven pregnancies, described the expectation to produce children, recounting the story of her friend who had been pressured to seek medical help for fertility problems despite only being married for four months. Fareeda’s own story was also full of references to the pressure she felt from others. Following her miscarriage at eleven weeks, Fareeda’s mother-in-law visited her in hospital and said, ‘Enough kids you are tired. Why do you want more kids?’ I answered her ‘Sweetheart, go and tell that to your son, not to me! I am only a machine between you both. A machine to bring kids but don’t ask me “Why?” Go ask your son!’ . . . If she [a Qatari woman] is alive she has to produce kids, even that it is difficult nowadays to raise kids.

According to Fareeda, as long as a woman is able, she is supposed to produce children, while acknowledging that this has become more difficult in contemporary Qatar. Much of this difficulty is due to the need to balance family life with the requirements of work. Despite Fareeda’s suggestion that she

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is at the mercy of her mother-in-law and her husband, the former advises her to stop her quest for another baby. However, Fareeda sees herself as ‘a machine’ meant to produce children and suggests she has little choice in the matter. It is her husband who is driving the quest for more children; she laughingly refers to him as ‘the boss’: He wants a baby more than anything. The most important thing is to have a baby. His last child is one-and-a-half so he considers her old now, so there should be a baby at home.

Fareeda’s husband is eager to have a baby in the house and pressures her to have another child to fulfil this aspiration. Huda similarly described insistence from her husband who she explained would like ‘an unlimited number’ of children: [Men] consider having many kids as ezwa (familial support or power) and that their names will not end. The problem is that it has reached a point that they show off how many kids each one of them has. So, someone’s wife has five [children] so you should have six or seven! But they don’t think that each wife is different: his may have different health issues . . . also her circumstances are different: she may be working whilst the other one is not. They don’t think! But these comparisons encourage them: ‘See he has more than you!’

Huda sees competition amongst men to produce children. Interlocutors commonly described a situation in which men aspire to have large families, whilst women wish to limit the size of their family. Women generally suggest they would like four to six children, preferring smaller families than their husbands. In the UAE, only 18 per cent of young Emirati women stated a desire to have six or more children (Broome and Green 2004). Women speak of the responsibility and importance of the role of motherhood, but also about the pleasure it brings. Children are loved, nurtured and a source of joy and pride; they are companions and provide comfort. Mothers describe unlimited love for their children, explaining the love one feels for one’s child is like no other. Twenty-nine-year-old, university-educated Sara had felt like a mother even before she had children because she had helped to raise her younger siblings. However, it was only after she had her daughter that she experienced true motherhood:

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With my daughter it was totally different and my emotions were unlimited! So, motherhood is really a gift from God and it is a loss not being a mother.

This statement was particularly poignant as Sara had just experienced her first miscarriage. Motherhood is, like everything, ultimately a gift from and decided by God. For pregnant Al Mayassa being a mother means everything to her: I feel that I own the whole world. It is like if you are a mother you have everything. [My children add everything to my life]: all the nice things. They cheer you up; you cry for them, you smile for them and you simply live for them.

Al Mayassa describes children being the centre of a woman’s world and whilst they may bring sorrow and pain, they also provide joy and meaning. She would like to have four children; her husband is eager to have ten. Given the discrepancy, we asked how many children she was likely to produce: It is up to him, all the Qatari men are like this. They like to have so many kids . . . if I argue with him he will raise the number to twelve in five years!

Like Al Mayassa, most interlocutors suggested that, ultimately, the decision rests with their husbands and, to some extent, their extended family (findings supported by Kridli et al. (2013)). Men are under pressure to produce children to consolidate their status as a man and to demonstrate their virility, fertility and youth. Children continue their name and strengthen the family, the tribe, as well as the state. Interlocutors suggest that the husband and sometimes the husband’s family ultimately decide the number of children (see also Kridli, Ilori and Goeth 2013), as found in other parts of the Arab Gulf (Hamadeh, AlRoomi and Musuadi 2008), with the number of children higher in families where the husband dictates family size than in those where the decision was reached mutually (Hamadeh, Al-Roomi, and Musuadi 2008). Men and women act within a framework of state pronatalist pressure, which is filtered through family and social networks. Some women attempt to limit their family size either with or without their husband’s knowledge. As Aisha, a twenty-sevenyear-old Bedouin mother of four who had experienced three miscarriages told us, ‘some girls will eat pills’. Contraception is widely available in Qatar and many of our interlocutors report using it at some time. However, there was uncertainty about whether it was h.alāl or not and almost all suggested that a

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newly married woman should not use any form of contraception. Contraception is more acceptable after the birth of the first child and for spacing purposes (see also Kridli et al. 2013), although this is changing due to the pressures of work and women’s increased education.

Boys and balance: negotiations and ideal family construction Huda’s desire to have another child is specifically to produce a son. Whilst at times she does not want to become pregnant again, she explains that knowing it would be best if her family had another male child is what drove her to become pregnant and continues to compel her to try again. Huda’s experiences are informed by obligations, pressures and aspirations to achieve an ideal family in terms of size and balance. This requirement informs her ongoing reproductive navigations, for which she expresses ambivalence. Huda feels the pressure to produce more children, particularly a male child, a pressure which she sees as being directed at her by her husband but influenced by his family. Describing her recent pregnancy as occurring: Almost by force. It is not only from his side but also from his family side; they are putting a lot of pressure on him and as a result he is putting a lot of pressure on me. If I have the choice, I won’t get pregnant again.

Huda describes cascading pressures and influence: her in-laws make demands on her husband to expand the family and he then puts pressure on her. Ultimately, the decision as to whether or not to become pregnant rests with her, she explains, but her husband and his family persist: [He] wants a boy and my plan was to have a baby boy because I don’t want to have a huge number of kids . . . He said that I want to have a boy and of course it is something in our culture so the other members of the family are always complaining and telling him that ‘You have to force your wife to have a boy because soon she’ll be old and she can’t be pregnant again’.

Huda’s husband and his family wish for a son, but so does Huda. However, their motivations are different: Huda wishes for this pregnancy to result in a boy so that she can effectively balance her family, fulfil her perceived obligations to her husband and hopefully end pressure to continue expanding the family. Having a son would allow Huda to successfully cease her reproductive path.

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Huda describes the desire and need for sons as ‘something in [Qatari] culture’. The framework of society establishes the requirement for boys because of gender relations, particularly for protection. Huda’s husband and his family are predominantly concerned with the need for her daughters to have a male sibling; it is a matter of safety and protection: In our culture, girls always need support from the man so that ‘your brother can drive you anywhere’ or ‘your brother can travel with you, be with you as a mah.ram’.

A mah.ram (unmarriageable kin) must accompany a girl; she continues, Boys are responsible for their sisters and their mother. If the husband dies the son will be the man who’s going to take care of the family . . . In our society there are many things that the girl can’t do by herself and if she did they will criticize her and blame her for not letting someone else take care of [it] such as her uncle, and as you know people are busy and don’t have time for others even your brother he may or may not help you so [how could they expect/ask] someone who is not closely related. The whole point is that I don’t want my daughters to ask help from someone else!

Women’s movement outside the household is controlled and restricted: women are seen as bearers of family honour (Sharabi 1988; Barakat 1993). Contemporary Qatari women are ‘encased in gilded cages, their mobility hampered even as their well-adorned bodies must be protected as symbols of familial honour and purity’ (Rajakumars 2014). Women may require permission from appropriate family members and must be accompanied by a family member, most often male, so as not to bring shame on the family; their honour extends to that of the entire family. Under Sharia law, a woman is not permitted to travel the distance of three days (equivalent to forty-eight miles) without her husband or a mah.ram accompanying her. A Qatari woman under the age of twenty-five years (previously fifty years) requires an exit permit to leave the country, which is provided by her father or a male family member (Golkowska 2017). Married women are entitled to travel without permission, but a husband is able to prevent his wife’s journey. Such practices are linked with notions of protecting women, including from the gaze of men, and is entwined with a desire to restrict unacceptable sexual contact. Thus, women’s freedom of movement remains regulated on many levels to differing degrees.

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However, technology has altered Qatari social life and has increased the opportunities to connect with others both nationally and globally, allowing for new possibilities and negotiations of spatial and social boundaries. A preference for sons as a result of their importance in chaperoning female family members was also emphasized by Hanadi, a member of one of the large Bedouin tribes in Qatar. She explained that generally her ‘people like al bezr (offspring)’ and typically produce large families with a preference for sons because they are useful to the other members of the family. Sons are helpful in accompanying female household members, as she and her daughters require drivers/escorts to travel outside the home. We asked Hanadi why not teach her daughters to drive, to which her mother-in-law, who was also present, exclaimed: ‘My dear, we don’t have ladies who drive! Merri people are not the same, in our tribe ladies don’t drive cars . . . for us driving is a’aib (taboo, socially unacceptable).’ Although many Qatari women drive, and others employ drivers, this is not acceptable within Hanadi’s tribe. Sons are not necessarily preferred but required because of the societal configuration which means that women and their movements require protection and support from closely familial men. Although a preference for sons was often denied or minimised, more detailed conversations reveal that sons are necessary for the successful structure of a family. Whilst the motivations behind son preference are largely described in terms of protection; Amna gave another reason: The man always prefers to have boys . . . The son is a continuation of the father, he accompanies him, goes with him to the majālis and helps him when he is old . . . so the son carries his father’s name and is considered a continuation and support for him and the family in case the father is sick or even when he dies.

Amna suggests sons represent lineage, a continuation of the male line. The importance of bearing sons is reflected in a woman’s status, which increases with having children, but particularly sons and the common practice of naming oneself after a first son. Genealogy is determined by male inheritance and paralleled by a genealogy of names; among Palestinians, married adults are often referred to as the father/mother of their firstborn son, the latter

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expected to give his firstborn son the name of the child’s paternal grandfather; recycling names through alternate generations (Kanaaneh 2002: 240). A similar naming practice is found in Qatar, with the first son often named after the child’s paternal grandfather, emphasizing male lines of inheritance. Ultimately, having another son is ‘necessary’, according to Huda, which informs her reproductive negotiations. At times she does not want to get pregnant again because she feels ‘tired’, but when she is ‘calm and relaxed’ she recognizes it would be ‘better for my daughters to have a brother to support them’ and, thus, will continue in her quest to produce a son. Despite not wanting to have a large number of children, if she becomes pregnant with a daughter she will ‘keep trying’ for a boy. Such forces inform Huda’s intimate experience of miscarriage including her request to see the foetus after she had delivered in order to learn its sex: In our culture, they say that if it was a boy it will look like sehleya (a lizard) and it is very white; it is like a white piece of meat with no blood, the blood will be in the sac surrounding it, the foetus will be white and transparent. The girl is different: she is like a piece of red meat and full of blood.

A desire for a son informs Huda and her husband’s post-miscarriage reproductive navigations, leading them to explore methods to increase their chances of producing a boy, including travelling to a hospital in Saudi Arabia where they understood that they could be helped to conceive a boy through IVF with pre-implantation genetic screening (PGD). This is used primarily to diagnose severe genetic disorders in IVF embryos, in order to prevent the transfer of genetically abnormal embryos and the subsequent birth of children with life-threatening heritable diseases (Bhatia 2018; Franklin and Roberts 2006). Since its introduction in the mid-1980s, PGD has quietly gained traction in the Muslim world, particularly in the past decade (Inhorn 2018). PGD is able to select embryos based on sex. Sex selection is conducted to isolate male embryos, in some cases necessary for female-linked genetic conditions, but increasingly it is used solely for sex selection. In this way it can be used as a form of ‘selective reproduction’, as described by Wahlberg and Gammeltoft (2018): although they often overlap with ARTs, ‘what we term selective reproductive technologies (SRTs) are of a more specific

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nature: Rather than aiming to overcome infertility, they are used to prevent or allow the birth of certain kinds of children’ (p.  201). Although ‘Islamic authorities have prohibited the use of PGD to specifically select against the birth of girl children – given the early Islamic injunction against female infanticide (Ahmed 1986) – recent fatwā emanating from Islamic religious authorities and institutions have allowed the use of PGD for socalled “family balancing” ’ (Inhorn 2018: 2). A fatwā (non-binding legal opinion on a point of Sharia (Islamic law) given by a qualified jurist in response to a question posed by an individual, judge or government) in 1980 from Al Azhar University in Cairo specified that Muslim families can use PGD for ‘family balancing’ reasons when a woman has three or four children of the same sex and if it is in the best interests of her and her family that the next pregnancy should be her last, but acceptance varies from schools of thought and nations (Inhorn 2018). Thus, women like Huda, who have daughters, might use PGD for the purposes of ‘son selection’. However, whilst the procedure is common in UAE fertility clinics (Inhorn 2018), it was not available in Qatar during the period of research. Initially excited by the news that the Saudi hospital could help them to produce twin boys, they were left disappointed when further investigations revealed that in Qatar such practice is only h.alāl for particular cases and they did not fulfil the criteria. The clinician they met explained that such procedures are neither acceptable, religiously sanctioned nor available in Qatar where a couple simply prefer to have boys: It is what Allah wants but if there is a very difficult case you can do it and Allah ʾIn shāʾ Allāh will forgive you, but in your situation where you have three kids you should thank God and pray to be given the boy.

The doctor suggested that whether a child is a boy or a girl should be left to God and only in ‘difficult’ cases can PGD be used. In Huda’s case this was not indicated and so they should pray that they were granted a boy. Couples are clearly exploring and using ARTs in order to produce sons, as evidenced by Huda’s story. Sara’s account provides an additional example: a healthcare worker at the hospital, Sara spoke about her colleague, a clinician, who despite being young and having ample opportunities for having children, had decided to undergo IVF in order to select the sex

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of the baby. Sara described the exchange with her colleague who had told her: ‘In the second pregnancy I am going to do an IVF to determine the gender of the baby because I want to choose a baby boy’. I told her, ‘Why? You may have two or three girls and then you will have a boy. Make it . . . open to God and your destiny.’ But she said, ‘No, the first wife has more privilege than me because she has boys, I am not going to wait for a long time to have a baby boy.’ Although she is educated, she is a physician, but still she knows how society is thinking and her husband and family-in-law are thinking so she wants to obtain this privilege by any means.

Sara’s colleague is a second wife who had recently given birth to a daughter. Although she is ‘young and fertile’ she aspires to have a son immediately in order to cement her family status. This had led to her seeking IVF treatment to select a male child. The suggestion is that value and security comes with being the mother of sons, further pointing to mothers of daughters being potentially stigmatized, particularly if their position is uncertain. The importance of producing sons may lead to a wife’s vulnerability or lesser status. According to Huda, women are typically blamed for producing only daughters: They don’t understand that the sex of the baby is related to the man and not to the woman . . . I tell him, ‘It is not me it is you’. One time I was searching on the internet and I showed him that a doctor was saying that the sex of the baby is related to the man. So, he read it and he said, ‘Oh no, it is just his opinion and it is not true’. He gave me an example of a man who was married to a woman and he had all girls with her and then when he married another woman, he had a boy, which means that it is from the woman’s side and not the man; so he told me, ‘If you change your wife you might have a different sex’.

Similar ideas about female responsibility for the sex of the foetus have been identified in other parts of the region (Kanaaneh 2002: 233). Huda and her mother, Amna, pointed out that this is not the only reproductive issue typically blamed on women: Gulf men resist acknowledging their role in fertility problems, explained Amna, as illustrated by Huda’s husband’s refusal to follow Amna’s advice and seek medical help following their second miscarriage.

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Fareeda, one of the very few participants who reported a continuing preference for male children, explained that if a woman only produces daughters it will be ‘another crisis’ for her. If a woman births a daughter, [T]hey will tell her complete [the] forty days after delivery and get pregnant again to have a boy and if she has two girls after each other, then this is a disaster! They will say: ‘this lady only bring girls’.

Birthing a daughter in some families leads to almost immediate pressure to conceive again to produce a son. In light of the fact that many women looked favourably on being able to ‘take a break’, welcoming the, often temporary, respite from relentless pressure to produce, the birth of daughters may not always be welcome. However, Fareeda discussed the pressures to produce a son with resignation: when she gave birth to her fifth daughter, her mother ‘almost had a heart attack’, but Fareeda was bemused and reminded her that she herself had five daughters following the birth of her firstborn son. Yet Fareeda’s account suggests that a woman who ‘brings only girls’ is stigmatized and de-valued in a context where sons are not necessarily preferred but required. Fareeda oscillates between wanting to make her husband happy and feeling too tired to have another child, but she overcomes her reluctance by thinking first of her husband’s happiness and of her desire to produce a brother for her son. With five daughters and one son, she was driven by a need to add another male to the family to ensure her five daughters were appropriately cared for. As a result the fact that the pregnancy she had just miscarried was a boy had greatly upset her. Having abandoned sex selection through IVF, Huda investigated other methods to increase the likelihood of producing a son. After consulting with friends and conducting research on the internet, Huda described a number of things one could do to increase the chances of conceiving a male: If you want a boy let your husband drink a cup of coffee half an hour before and let him have a bath with cold water. I should wash with sodium bicarbonate and there is one position that you can do so you can have a boy, maybe you lay down on your back or on your right side.

For Huda, her desire to seek help in conceiving a boy is, in part, due to the fact that she does not wish to have a ‘huge’ number of children. Thus, she wishes to ensure a boy without a large number of pregnancies to fulfil such obligations. The idea that sons are socially mandatory is widespread and

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producing a son is often deemed compulsory, a requirement that is made more difficult when aspirations are for smaller families (Inhorn 2015). Inhorn (2018) warns that a convergence between a desire for small families and ART-assisted desired sons in the Arab world will lead to a situation where, in the ‘new Arab family’ (Hopkins 2004 quoted in Inhorn 2018), gender composition is no longer left to chance, with the potential for skewed sex ratios becoming a worrying possibility, as demonstrated across many parts of East and Southeast Asia (Bhatia 2018; Croll 2000; Whittaker 2011 in Inhorn 2018). When contraceptives to control family size and reprogenetic technologies to control family gender composition converge, there may be an untoward ‘bioethical aftermath’ (Inhorn and Tremayne 2016), the consequences of which are just beginning to unfold (Inhorn 2018). For balance and the protection of womenfolk, sons are required. State policy discourse, informed by ideas about citizenship and nationality, outlines notions of ideal reproduction and family composition, which impacts reproductive negotiations, including the requirement for sons. Preference for sons or daughters is revealed to be a complex matter, for conversations overwhelmingly reflected a desire for daughters. Whilst Huda’s reproductive navigations are driven to produce a son, the most common preference expressed by the women we met was for daughters: seemingly disputing the stereotype of male preference. Indeed, so dominant was this discourse that it was only upon further analysis that a discourse of underlying son preference emerged. As we continued our conversations with Huda and Amna, they suggest that Qataris prefer daughters, with Amna saying: Yes, they like girls more . . . That’s true, the daughter likes her father more and the son likes his mother more because the girl feels that her father can protect her and the mother feels that her son can protect her. [The father] even believes that she is kinder to him than his wife . . . especially in the Middle East you feel that the relationship between the wife and the husband is not strong, which is opposite to the Western societies where the wife and the husbands are more attached to each other but not to their kids.

Amna suggests that closeness or affection in families is related to protection: family members prefer the opposite sex (daughters prefer fathers and mothers prefer sons) because of the support frameworks of security. Relationships are strengthened by feelings of protection and support. Amna also comments on

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what she sees as differences between family dynamics between Arab families and those in the West where the foremost familial relationship is between the married couple in the latter, but in the former the central relationship is between parent and child. Preference for daughters was at times shared by husbands. Al Mayassa spoke often of her husband’s overwhelming desire for a daughter. During the early stages of her pregnancy she says that if she produced a girl her husband had said she could ‘take a break’ and delay subsequent pregnancies for five or six years. With two children, a boy and a girl, the hope that her pregnancy will produce a daughter does not contradict the requirement for a son, as Al Mayassa has already produced an heir. We were delighted when we heard the news that Al Mayassa had given birth to a much-desired daughter. Pregnant Abeer also spoke constantly about her husband’s and her desire for another daughter, hoping for a sister and companion for their daughter. Such a preference resonates with Abeer’s own childhood experiences: her father, the father of fourteen children from three wives, ‘loves us [his daughters] more than his sons’. Interlocutors suggest daughters cause less trouble than sons, are better behaved, better companions, and are more likely to look after their parents in old age. When Noora was first married, her husband wished only for sons and she agreed, wanting to please him. However, once her sons were older, they caused her trouble and she said: ‘I changed my mind! Girls are quieter and kinder and Subhan Allah nobody takes care of you when you are old except the girls.’ Noora suggests that daughters are better behaved and provide care and companionship, particularly in old age. Daughters are more likely to take advantage of state education and opportunities to better themselves. Through preferring daughters, such preferences may be espousing the state discourse on the central role of women in Qatari national identity. Schaefer Davis (2002) reports that the preference for boys over girls in Morocco had evened out in the past few decades, in part because daughters were seen to be more likely to remain close to their mothers in contemporary society. Whereas daughters would historically reside with their husbands and their families and, as such, be lost to the family on their marriage, sons remained and helped to provide for their natal family. However, in contemporary Morocco, both sons and daughters move out of the family home. With more women working than before, they now contribute to their parents’ income.

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Whilst many expressed a desire for daughters, sons may be seen as less problematic because female family members are considered a threat to family honour (Schaefer Davis 2002: 25). Whilst speaking about her young daughter, Noora describes the difference between the genders in terms of reputation and family honour: We Bedouins say that the man is shayel Aeboh (nothing can affect his reputation because if he does something wrong it will not manifest physically; reputation is not affected by anything) so if he makes mistakes, it is OK, but it is not the same for the girl. My mother used to say that the girl . . . do you know the white scarf for Qatari men al ghutra, we call it qadadah, so the girl is like the white qadadah, anything will dirty her.

A boy’s reputation is robust, unlike girls whose reputation is vulnerable. Slights on her reputation, even those resulting from minor transgressions, may have serious consequences, including for her marriage prospects. Such understandings are linked to the rhetoric of protection, as outlined by Bourdieu (1966: 227). Women are to be protected because their status, safety and morality is entwined with the public standing or ‘honour’ (see Clarke 2009) of the man’s: a man’s honour depends on his duty of protection to his womenfolk. Women’s sexual conduct and reputation reverberates upon their menfolk (Clarke 2009). As Noora suggests, any minor indiscretion will impact her but also her family and their future standing. Thus, women are haram, ‘sacred’, and ‘forbidden’ to others. And from this, derives the ‘covering’ and ‘veiling’ of women (Clarke 2009). Daughters may be desired, but they are also a source of concern and potential harm to family honour. Whilst many long for daughters, the requirement for sons remains. This resonates with Inhorn’s long-term research in the Arab Gulf, which uncovered that men and women are increasingly likely to express a desire for daughters (i.e. 2015). Arab ‘parents say they love their daughters and prefer them as lifelong companions’ (Inhorn 2015:194). However, despite these pronouncements, ‘they still need sons in order to complete their families. This belief that sons are socially mandatory within family life is still widespread; thus, ensuring the birth of at least one son is vitally important’ (Inhorn 2015: 194), a requirement linked to the protection of womenfolk, family reputation but also to state strength. Qataris are thus negotiating discourses of nationalism, modernity and

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reproduction in striving for balanced families, which include sons. Limiting family size means resisting state discourse around maternalism and reproduction as a national duty, which is found in the region. Emirati women aspire to have fewer than six children, despite official pronouncements that it is their national duty to have at least six babies (Nazzal 2004) to help alleviate the ‘acute shortage of national manpower’ (Green and Smith 2006: 267). Children, particularly sons, are important national assets. Son preference is sometimes situated in the modern world in a series of ways including within a framework of nationalism: only by producing boys do women truly become ‘mothers of the nation’ (Kanaaneh 2002:72). Interlocutor’s accounts made little reference to state impositions; however, a small number were explicit about locating state pressure to reproduce, suggesting motherhood was a requirement as a Qatari citizen. Twenty-six-year-old, highschool educated Hessa works for the police department. Pregnant for the second time, she suggests that women ‘give birth to children and build the society’. Hamda explains that Qataris desire to form large families for a number of reasons including: thokher and sanad (to assist and support them) to ‘increase the [Qatari] population’ to ‘increase the size of the community’, and because it is ‘nice to have kids’. Emphasizing the low numbers of Qataris in Qatar, Hamda suggests that one of the reasons Qatari’s aspire to have large families is to swell the national population. The body connects emerging collective identity with traditional identity (Kahn 2000). Qatari women’s bodies, particularly, their reproductive lives, are sites for traditional identity performance, whilst also being implicated in state development policies and aspirations for modernization. State projects mould lives in intimate ways. The emphasis on large families and the importance of childbearing is state incentivized with pressure filtered through family and tribe networks. Reproduction in Qatar must take account of the state’s obsession with the fertility of its citizens; one aspect of this is the importance of producing sons.

Conclusions The meaning given to Huda’s miscarriage and the way it is incorporated into her life is informed by her previous reproductive experiences and future

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aspirations. These negotiations can only be understood within the wider context of a woman’s life including her relationship with her husband. In Qatar, reproductive negotiations involve the wider family, with different motivations, aspirations and obligations filtering down. Huda’s decision to become pregnant again is driven by wanting to produce a son, a desire fuelled by family and societal pressure, yet is cloaked in ambivalence. Producing sons is central to a woman’s role, linked to ideas of citizenship, nationality and a way to create desired families. Son preference has been reported in Qatar (Kridli et al. 2012) and in other Middle Eastern contexts (Hamadeh, Al-Roomi and Musuadi 2008; Kridli and Libbus 2001; Inhorn 2018). Whilst such preference seems to be diminishing (Obermeyer 1999, Schaefer Davis 2002; Inhorn 2012 and 2015; Kanaaneh 2002), there remains a requirement for sons. The desire for sons is most often articulated through a need for daughters to have a male sibling to protect them. Thus, it is important to have one male child for the sake of female children, but sons might be required for further balancing. Son preference enters the negotiations of pronatalism and aspirations for modernization. Whilst the latter manifests as pressure to produce smaller families, such a family must include a male child – heir, protector and hope for the future (Kanaaneh 2002: 229). Huda wishes to limit the size of her family and the number of pregnancies she will endure: she is hopeful for one more pregnancy to produce the required son. Women suggest they would prefer to limit the number of children they will have, which is supported by demographics. Qatari women are, indeed, having fewer children than in previous generations. Like the majority of our interlocutors, Huda is a working mother. Contained in her account is the way in which women navigate their reproductive lives whilst also negotiating the expectations and aspirations of professional femininity. One of the key areas of societal change that women identify are the demands of balancing employment with family life. A trend for smaller families makes producing balanced families and ensuring the presence of a son more problematic. This has led some women, like Huda, to explore the use of ARTs to more efficiently produce sons. Hence a convergence between aspirations for smaller families, requirements for sons, and the availability of ARTs such as PGD. Miscarriage is one of a variety of reproductive experiences and disruptions. Not isolated events, they are intimate experiences interpreted against the

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backdrop of marriage, family life and the broader social and political context. Marriage practices, such as arranged marriage and patrivirilocality, provide a framework within which reproductive navigations can occur. Notions about ideal family construction influence women’s reproductive aspirations and experiences of loss. The role of women in Qatari society, particularly in terms of the interconnection between motherhood and womanhood inform reproductive navigations and experiences. Pronatalist expectations and obligations produce relentless pressures with childbearing and childrearing seen as central to notions of womanhood and national discourses of duty.

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Motherhood Lost: Stories of Miscarriage

Moza’s and Noora’s stories of pregnancy and loss form the basis of this chapter, providing further access into the lives of Qatari women. Moza and Noora’s accounts introduce the processes of miscarriage discovery, diagnosis and management. The way women and those around them attempt to make sense of miscarriage and to understand what caused it emerges, as does the way these are tied to notions of vulnerability, blame and responsibility. Moza and Noora’s miscarriage experiences are presented in depth with other women’s accounts providing additional information around the themes contained in their narratives. These women and their stories reflect the diversity within women’s experiences of miscarriage and of reproduction. Moza and Noora’s accounts of miscarriage are embedded in wider life experiences and trajectories, revealing the way such an event is framed by reproductive experiences, desires and aspirations. Miscarriage is informed by events that go before and temporally extend to that which is planned/ hoped for/feared in the future. The stories contained in this chapter reveal the way in which intimate experiences are influenced by wider social and political forces, several of which, including Islam; societal, familial and state pressure to produce children; the importance of motherhood; the presence and risks of polygamy and divorce; as well as marriage arrangements and patterns are presented in this chapter and developed throughout the book.

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Moza We met twenty-nine-year-old Moza in the main public hospital, the principal site of our research. Having arrived at the hospital, one of the nurses explained that a woman was on the ward who had recently miscarried and suggested that she would be willing to meet with us. After navigating the hospital corridors, we locate the room and knock quietly. A voice calls out and invites us in; upon entering the simple room we are met by a young woman sitting on one of the two hospital beds. She introduces herself and we chat about the research after which time she says she will be willing to talk further with us. Looking frail and fragile, her state is reflected in her voice, as she quietly answers our questions. As she speaks, she slowly begins to describe how she came to be sitting in this hospital bed. Visibly upset, Moza explains that she had just had her second miscarriage. A few weeks previously Moza had learned that her pregnancy was no longer viable and that the baby she was carrying had perished in her womb. The day before we met her, she had been admitted to the hospital for medical management of her miscarriage, which involves administering tablets and/or pessaries of misoprostol. The medications promote uterine contractions, prompting the pregnancy tissue to be expelled. As she describes the experience, she becomes overcome with emotion and has difficulty speaking, we interrupt the interview several times to allow her to gather herself. Despite the difficulty, she explains that she wants to continue to tell us about her experience. Her anguish was striking because it was so different from other interviews. Most of our interactions involved women speaking about their losses in a matter-of-fact way, with conversations moving from subjects of miscarriage to marriage and future plans for reproduction: Moza was different. Perhaps it seems odd to begin this chapter on Qatari women’s experience of pregnancy loss with a story that, in some ways, presents an exception; but despite the fact that Moza’s distress sets her apart, she also shares a great deal with the stories of other interlocutors. The similarities in their stories and, importantly, the differences helped me to better understand Qatari miscarriage. Moza’s interview left an impression on us, as her sadness was so palpable. That we were so struck by it, demonstrates that we had become somewhat used to women discussing their miscarriages in a pragmatic way. Moza’s story is a stark

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reminder of the diversity of women’s experiences of miscarriage and reproduction.

Expectations of fertility and reproduction Moza is Hadar, one of the ‘urban’ Qataris. She is her husband, Khalid’s, second wife; marrying him, after his first wife had died several years into their marriage. After his first wife’s death, Khalid had wanted to marry again and, soon after, a marriage was arranged with Moza, his first cousin. Once married, Moza moved into Khalid’s family home where they lived with his mother, father and siblings. Khalid was eager to have a child as, despite being married previously, he remained childless. Although his deceased wife had become pregnant, she had miscarried. As a new bride, Moza felt pressure from her husband, his family and others to produce a child, but this was likely to be felt more acutely given her husband’s status as a childless widower and his eagerness to have a child. Immediately after the wedding, Moza felt the weight of her husband and his family’s expectations, but she also wished to have a child. As is typical, the couple did not use birth control and so expected a pregnancy would soon follow, but this was not to be. After several months they had still not conceived; people began to constantly check on her status and ask whether or not she was pregnant, expressing concern: When they asked, I used to tell them that Allah is generous and it is all up to him and it is not anybody’s business. And when they used to ask my husband, ‘Is it your fault or hers?’ I told him, ‘Tell them it is not from you, or me, we are both fine alh. amdulillāh but it is God’s will.

Moza felt that she was blamed and judged for her infertility with those around her suggesting the couple’s problems conceiving were her fault: I feel guilty because I don’t have kids yet and I also see that in other people’s eyes. When they ask, ‘Are you not pregnant yet?’ ‘When you will be pregnant?’ . . . This makes you feel guilty or when they tell you that ‘someone already got pregnant and you still haven’t’. This is clear evidence that they are blaming you for not having babies.

Moza was constantly reminded of her inability to conceive; the scrutiny of others was tiresome. At twenty-nine years old, Moza was older than most

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Qatari women trying for their first baby, but the extreme pressure she felt was common throughout women’s accounts regardless of their age. Moza and Khalid sought medical help, hoping that they might uncover a reason and that treatment could be offered for their inability to conceive. That the couple’s quest for conception included seeking medical intervention is typical of Qatari couples. As illustrated in other stories, there is an expectation that conception will occur quickly, very soon after marriage, and if that is not the case the couple, but largely the woman, is required to investigate and/or seek treatment to optimize fertility. The couple underwent a series of investigations, which revealed Moza’s ovarian cyst and Khalid’s low sperm count. Despite the results suggesting Khalid’s sperm was the likely cause of their difficulties in conceiving, Moza continued to feel the brunt of her in-law’s extreme pressure and their suggestions of blame. Moza feels that such judgement extends beyond her family, suggesting women are typically blamed for not producing children: The first thing they will say: ‘Why hasn’t her husband married another woman?’ This is what comes to their minds. They don’t think that she is not having kids because of him and it is entirely his fault. They always say, ‘Why is he staying with her? She is not having babies, he should marry another to have kids.’

Moza’s perception that women are blamed for problems in reproduction, even if difficulties are due to male infertility, emerges repeatedly in interviews. Moza suggests that pressure to produce children means that if a couple is unsuccessful, the man may be encouraged to marry again to produce children with another woman, an anxiety which emerges constantly in discussions with interlocutors. The threat is openly discussed and is a concern for some women, particularly those who fail to produce sufficient children. Most interlocutors spoke about such anxieties not as directly related to them, but instead through stories of other women. Thirty-nine-year-old Luwla, for example, refers to such threats of polygamy in reference to the expectation of producing many children in her Bedouin culture and, relates this to her sister’s experience: One, two or three kids are not enough, we Bedouins like to have a school bus full of kids, Bedouins love kids and they don’t think about the woman. My

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sister had six children and her husband told her if you don’t get more, I will marry another woman.

In referring to her sister, Luwla suggests failure to produce children may result in husbands threatening to marry again. In Luwla’s family, the possibility of polygamy was very real; she describes that many of the men in her life had multiple wives. At twelve years old, a pre-pubescent Luwla became the second wife of a forty-five-year-old man in an exchange that she described as being ‘traded’ by her father. Al mahr1 (dowries) are commonplace in Qatar, so brokering a marriage for his daughter was a means to obtain the necessary finances to fund his own second marriage. He did the same with Luwla’s two younger sisters, marrying them to fund his third and then fourth marriage. Despite being ‘very naïve and knowing nothing of womanhood or motherhood’, Luwla gave birth to her first son at the age of thirteen. Luwla’s marriage was an unhappy union from the outset, but Luwla gave birth to eight more children. Her marriage did not improve; the relationship becoming more strained with every passing year: they argued often with her husband sometimes expelling her from the home or beating her. Eventually, Luwla felt she could take no more abuse and divorced her husband after twenty years of marriage. When we met Luwla she had recently had her third miscarriage. After her divorce she had secretly married a friend of the family, as her new husband was not Qatari and she was certain the marriage would not be accepted. Luwla’s and Moza’s comments reveal the impact of polygamy on women’s reproductive experiences, the expectations placed upon them and the possibilities if these are unfulfilled. Polygyny is religiously, socially and legally sanctioned in Qatar; whilst it remains common among the ruling family, the number of polygynous marriages has decreased. Only 7.9 per cent of marriage bonds registered those who had additional wives, with only 0.7 per cent having more than two (MDPS 2016). The decreasing rate of polygamy is reflected by our interlocutors, only three of whom are members of polygamous households (two as second wives and one as the first wife of a man with two wives). Although the majority are first and only wives, some interlocutors describe polygamy in their family. Twenty-nine-year-old mother of three Abeer’s father has fourteen children from his three wives. The tradition of polygyny is common in her tribe, with men in both her family and her

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husband’s family having a number of wives. Her brothers-in-law had all married multiple times; however, pregnant Abeer remains her husband’s only wife: ‘My husband, no: he wants only me’. She explains, [It] depends on the wife, if she agrees to this then yes . . . my aunt’s husband got married again and she got a divorce immediately . . . it depends on the wife’s character, she is the one deciding how her life is to be.

Abeer describes women as having agency over polygyny, which helps to account for its decline. Women’s increased independence and assertiveness as well as most being unable to afford multiple households has contributed to the decrease in polygyny. A wife can divorce her husband if he takes another wife, and with more education and economic options, women are more likely to do so now than in the past. Similarly, women are making more use of the ability to insert a clause in the marriage contract that restricts her husband from marrying another woman for as long as the contract is valid. As they become more empowered, women increasingly refuse to become a second wife or for their husbands to marry again suggesting, as our findings reflect, that polygamy is not popular amongst women. The most common response to questions about polygamy is laughter: interlocutors chortle when asked whether their husbands have other wives and joke they would ‘kill’ him if he even thought about taking another wife. Although the threat of men taking additional brides was commonly voiced, when discussing their intimate experiences, women most often spoke about husbands who supported them and stood by them in times of infertility and miscarriage. This resonates with Inhorn’s findings as described in The New Arab Man: Emergent Masculinities, Technologies and Islam in the Middle East (2012). Moza is one of these women who, despite concerns that her husband might be pressured to marry again, finds her husband standing by her and supporting her. Following investigations by the hospital, the couple were informed that they would require medical assistance to conceive and IVF treatment was recommended. Such practice is not unusual as ARTs, including IVF, are popular Qatari reproductive tools and are state endorsed and state funded with Qatari patients receiving free treatment. The popularity of and access to ARTs is part of the state’s pronatalist policies. At the time of our fieldwork, the only site for ART services was at the Woman’s Hospital IVF clinic, which was

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established in 1993; however, the private Al-Ahli Hospital opened an IVF clinic in 2016. The couple began their treatment and although not explicitly stated, it is possible the procedure involved ICSI or intracytoplasmic sperm injection, an IVF procedure in which a single sperm is injected directly into the cytoplasm of the egg. During the past decade, ICSI has been applied increasingly around the world to alleviate problems of severe male infertility in patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner. Male factor infertility accounts for 39.8 per cent of the cases seen by the clinic: the high rates of male infertility are likely linked to consanguinity and results in relatively high rates of ICSI being performed in the clinic. Moza was prescribed fertility drugs, which stimulated her ovaries to develop mature eggs for fertilization. When ready, Moza’s eggs were collected using a thin, hollow needle, attached to an ultrasound probe. She was given progesterone to help prepare the lining of her womb and the doctor transferred a number of embryos2 created using Khalid’s sperm and Moza’s eggs, into her womb, the rest frozen for future cycles. Unfortunately, the first IVF cycle failed; a second cycle using one of the frozen embryos followed and the couple were delighted when this resulted in a pregnancy. Sadly, Moza’s pregnancy ended in miscarriage at five weeks’ gestation. Following this second disappointment, Moza and Khalid underwent a third ‘fresh’ cycle, undergoing the whole procedure again during which Moza became pregnant. It was soon after miscarrying this pregnancy at eleven weeks that we first met Moza. Her sadness amplified, she explained, by having heard the baby’s heartbeat during a routine hospital appointment, which had given her hope that the pregnancy was progressing well allowing her to imagine the baby. Learning that it was a boy magnified her sadness in the face of the loss, as she had wished for a boy to fulfil her husband’s desire for a son; something we were able to discuss with Khalid directly. Apologizing that he was very busy, Moza said Khalid would speak to us, but only over the telephone; however we were very grateful for his time, as he was one of the few men to agree to be interviewed. Khalid seemed nervous when Nadia finally reached him after several failed attempts, but said he would do his best to help. Khalid began to relax and as the interview drew to a close, he apologized for being anxious, saying he had never been

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interviewed before and certainly not about such things. Despite his nerves, Khalid was very gracious and provided an additional insight into miscarriage and men’s perceptions and actions around it. Khalid explained that there was social pressure for men to produce children and that it is particularly important to produce a son: Wallah [I swear to God],3 the first thing your son will support you and will help you in your life. He will also benefit his society and his country when he grows up.

Khalid describes sons as providing assistance, helping their fathers in their pursuits and activities. Just as they are productive to fathers and their family, boys will also advance ‘society’ and ‘country’ as they become an adult. Sons are seen as national assets who will contribute to Qatari society with modernization profoundly entangled with reproduction (Kanaaneh 2002: 252). Khalid is one of the few interlocutors who directly links reproduction with development strategies of strengthening the nation.

Miscarriage diagnosis and discovery Close monitoring and surveillance are typical of most women’s experience of pregnancy in Qatar. However, Moza’s pregnancy invited particular scrutiny due to it being the result of ARTs and, thus, close monitoring began prior to conception as part of the treatment regime. Women typically present at the hospital soon after a pregnancy is detected to have it confirmed, often undergoing a scan at this time, beginning a process of monitoring of both the woman and her growing foetus, including ante-natal screenings for common conditions and regular checks to diagnose gestational diabetes. A focused public health initiative to medicalize pregnancy and birth has occurred in Qatar over the past decades which has resulted in women seeking medical assistance in the early stages of pregnancy. The hospital is where miscarriage commonly emerges and is managed, in keeping with the medicalization of childbirth and the illegality of homebirth in Qatar. Here we can see the contradictory results of medicalization: it can be simultaneously empowering and disempowering: ‘new medical technologies that can enhance child survival, improve women’s health and ‘cure’ infertility are also methods of

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surveillance and regulation’ (Ginsburg and Rapp 1991: 314). The medicalization of reproduction has been rapid and comprehensive in Qatar, improving child and maternal survival and women’s health. Yet medicalization has also brought a high degree of surveillance. Indeed, reproductive surveillance can be seen as starting, for all women, before conception, due to mandatory pre-marital screening. During a regular appointment, Moza was told by the clinician that the pregnancy was ‘strong and will last, ʾIn shāʾ Allāh’; at her next appointment a foetal heartbeat was detected. Two weeks later when Moza reported concern with a lack of pregnancy symptoms at a regularly scheduled appointment her doctor suggested an ultrasound: When she did the TV [ultrasound scan], she found that there was no heartbeat. She suggested that I wait two weeks before doing any procedure to confirm.

The scan, which was repeated two weeks later, confirmed the absence of a heartbeat. Although aware that it was likely routine, Moza was distressed at having to wait for two weeks to confirm the baby’s death. Two ultrasounds carried out two weeks apart are intended to confirm the absence of a heartbeat and to verify that no further development of the foetus has occurred allowing for a definitive diagnosis of miscarriage to be made. Women sometimes have a number of scans over a period of weeks to confirm the death of the foetus, due to concerns about terminating a viable pregnancy and the proscriptions around abortion. Moza was aware that there can be uncertainty about the date of conception, making it unclear how developed a foetus should be; however, she emphasizes her pregnancy ‘is not a normal pregnancy . . . this is an IVF pregnancy, it is known when it was done’: the date of conception was known, providing certainty around gestation. Having not had any pain or bleeding indicating a miscarriage, Moza experienced an ‘incomplete abortion’,4 when the foetus dies in utero with the absence of vaginal bleeding. This type of miscarriage is most often diagnosed during an ultrasound: cardiac activity should be expected on ultrasound imaging whenever the embryo measures more than 7 mm: at that size, if a sonographer does not detect a heartbeat a diagnosis of miscarriage is made (NCE 2012). A number of interlocutors’ miscarriages were discovered in this way and in these

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cases the pregnancy materials remain in the body, requiring the miscarriage to be managed.

Miscarriage management Miscarriage is often not an instant event. Instead, the physical experience may extend over days, weeks and sometimes months, as was the case with Moza. Instructed to wait for the miscarriage to complete naturally, the advice given to Moza reflected the common medical practice in Qatar, which prioritizes so-called ‘expectant’ or ‘conservative’ management involving waiting for the onset of bleeding and cramping to expel the pregnancy tissues from the uterus and the miscarriage to conclude spontaneously. However, after two weeks with no bleeding or signs of the miscarriage progressing, she returned to the hospital: I went to the Emergency and I told them that I want to get rid of the dead baby, so I was admitted yesterday and I did the evacuation . . . They started giving me suppositories, one every four hours, the last one was at 9:45 pm by 11:30 pm I went to the bathroom and it all came down.

Moza describes how, following the medical management of her miscarriage, the baby ‘came down’ and exited her body and refers to it as ‘tasqueet’. In Arabic, miscarriage is defined as ‫’ﺇ‬iijhad (miscarriage, termination, failure, washout, setback, deadlock, loss, damage, wastage, injury, disadvantage). Interlocutors most commonly refer to miscarriage in Arabic as isqat or tasqeet, with the former being more formal. The two words originate from the same word source saqat (to miscarry), which means to ‘drop something from up to down’. The language denotes a drop or a fall, similar to that found in Urdu ‘a baby falls’ (Shaw 2014; Quershi 2020) and amongst the Hmong (Liamputtong-Rice 1999). The root saqat is also used when someone fails a test or to describe something that has been put to an end, such as in the case of a revolution or the overthrowing of a regime. Saqat al janeen (the foetus fell down before completion): miscarriage, understood as mis-completion, but also as falling. Interlocutors used ijhad (abortion) interchangeably with miscarriage. In some contexts, the linguistic distinction between spontaneous and induced pregnancy endings may be unclear with terms distorting underlying intentions; moral

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associations of ambiguous labels around terminations may generate complex navigations from miscarrying women trying to disprove their culpability (Erviti et  al. 2004; Van der Sijpt 2017). Women may attempt to restrict resulting uncertainty by choosing particular language or description of events in an attempt to alleviate arising ambiguities. In the UK or US there is typically an insistence on distinguishing miscarriage and abortion. Ambiguities around the term ‘spontaneous abortion’ for miscarriage in the UK, for example, has been addressed by no longer using the term in medical contexts. In 1997, a Royal College of Obstetricians and Gynaecologists study group recommended that the word abortion be avoided in cases of spontaneous early pregnancy loss. As abortions in the UK are legal and common, with one in three British women undergoing an induced abortion of a pregnancy, it was noted that abortion was associated in the public mind with planned termination of pregnancy (Royal College of Obstetricians and Gynaecologists 33rd Study Group 1997); the cultural associations deemed the term inappropriate for those undergoing the loss of a wanted pregnancy (Oakley et  al. 1984; Moulder 1998). The recommendations were adopted as guidelines in 2006, with the note that many women found ‘historical terminology [. . .] distressing’ (Royal College of Obstetricians and Gynaecologists 2006). ‘Miscarriage’ or ‘pregnancy loss’ has now become the favoured term in both public and medical settings. In Qatar, such ambiguity is not common, as legal and religious prohibitions make abortion uncommon. When Moza’s miscarriage did not complete naturally, medical management was provided at the hospital; her experience is typical of the hospital protocol of managing miscarriage: expectant management followed by a second procedure if that is unsuccessful: the administration of misoprostol. The drug prompts the cervix to open and the uterus to contract, expelling pregnancy tissues, a procedure Moza refers to as an ‘evacuation’. In her account, Dana mentions that when her bleeding did not reduce, the doctors were preparing for a ‘DNC’ referring to a dilation and curettage (D&C). This third management procedure, surgical management, involves the dilation of the cervix followed by removal of tissue from inside the uterus, under general anaesthetic or, sometimes, local anaesthetic.5 Surgery is a last resort, in part due to the strain on the hospital’s very busy gynaecology surgical ward. To assess whether the miscarriage was complete, the staff measured Dana’s hCG (human chorionic gonadotropin) levels. An hCG blood test

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measures the level of the hormone produced by the placenta during pregnancy. Levels drop in a non-viable pregnancy, inducing the spontaneous opening of the cervix, bleeding and expulsion of the contents of the uterus. Such levels are measured at two or more different stages to ascertain whether the levels are lowering, which would indicate that the pregnancy remains have been expelled from her body. In Moza’s case, the management of her miscarriage was successful and completed in the hospital, but the period between the discovery of the miscarriage and its end was a difficult time for Moza who says during our second meeting: ‘I couldn’t take it; it is very difficult to feel that you are carrying something in your tummy that won’t be a baby later on.’ Although relieved that the procedure successfully ‘cleaned [her] up’, Moza was tired and sad afterwards: ‘Wallah, I am very tired but alh. amdulillāh . . . I am tired from everything and very sad that I didn’t complete my pregnancy, also my husband is very sad.’ Indeed, Khalid was upset as we soon discovered when we spoke to him. Like his wife, Khalid found that people were ‘supportive’, ‘considerate’, and ‘sympathized’ after miscarriage, with people saying, ‘You have to be patient and God will compensate you with a better one’; ‘You should always thank God’. Khalid describes the past months as ‘a tough time’ and explains that they were both ‘sad and upset’. He emphasizes that his focus was not on the lost pregnancy, but on his wife: ‘I wasn’t upset for the lost baby, I was upset for my wife because this happened to her and she was very disappointed’. This sentiment resonates with the comments of other men and the stories of other interlocutors. Husbands were disappointed following a miscarriage but were primarily concerned with their wives’ happiness and well-being. Men were described as not being overly concerned or sad about the miscarriage, but instead upset for their wives and concerned about risks to their health. Women commonly describe husbands as being supportive, reminding them that their health is of primary concern and that they will become pregnant again: men encounter miscarriage with acceptance and look forward to future pregnancies.

Pregnancy, vulnerability and miscarriage risk Pregnancy is seen as a vulnerable state. Like all interlocutors, Khalid understands the ultimate reason for his wife’s miscarriage, in particular, and

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miscarriages, in general, to be due to God’s will: ‘I think there is no reason behind miscarriage except God’s will. It is destined for us and it is what Allah decided and we should accept.’ Khalid understands miscarriage as part of God’s plan for himself and Moza; outside his and, indeed, anyone’s control. In this way, a miscarriage is something that one must accept as part of one’s faith in God. Moza agrees with her husband’s account of the primacy of God’s will, but also considers other causes: Maybe [the woman] does not take care of herself or [she] became exhausted by going out or doing housework. I know one of my relatives was five months pregnant; she became pregnant naturally, but she didn’t seek any medical care or take any medications and she miscarried. It is all because of her carelessness . . . My sister miscarried once and it was due to stress: a woman talked about her so she got upset and angry and the same day she miscarried.

Moza presents a number of possible factors that cause miscarriage including exhaustion and stress; she suggests that miscarriage may occur if a woman is careless and not protective. Pregnant women are expected to care for themselves, avoid strenuous activity and exhaustion and seek appropriate medical care. Moza emphasizes an additional risk: pregnancies achieved through ARTs; maintaining that such pregnancies are more vulnerable than ‘natural’ pregnancies, a belief held by other interlocutors. Moza emphasizes this susceptibility in her discussions about working whilst pregnant: In normal pregnancy, yes she may work but not in IVF pregnancy. In my first pregnancy I went to work while I was pregnant and by the end of the week I miscarried.

Moza suggests that working during pregnancy is acceptable for typical pregnancies, but that work may be too great a risk for vulnerable pregnancies, such as those conceived through IVF. Work emerges as a significant concern for women.

After miscarriage: faith and reward Moza was tearful when we spoke to her, her pain evident. Two months later she invited Nadia to accompany her to her follow-up appointment at the

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IVF unit. The women sat in a small room in the busy clinic, the doctor reassuring Moza that her fertility problems were ‘not very bad’ and that ‘fertilization can be achieved easily by IVF’. Despite Moza not being classified as suffering recurrent miscarriage, having miscarried only twice, the doctor refers her to the recurrent miscarriage clinic for investigations, including genetic tests, to ensure there are no identifiable problems prior to embarking on another IVF cycle. The clinician explains that the miscarriage was likely due to a chromosomal abnormality. Moza asks if it would be better if she undertook the next IVF cycle in Jordan. To this, the doctor responded that if the tests she had just ordered determined that the miscarriage was due to genetic factors then it would be advisable to seek treatment in Jordan where pre-implantation genetic screening (PGD) is conducted and could screen for severe genetic disorders. However, Moza did not travel to Jordan for such treatment. As her story affected us, we were delighted upon receiving the news a few months later that Moza was pregnant. Moza and Khalid’s son was born in the same hospital where we had met her, where she had undergone IVF treatment and where she had miscarried. It was a much happier occasion when Nadia, following an invitation, met Moza and her new-born son, Abdullah, who had been named after Moza’s husband’s father, as is traditional naming practice. Her head covered, Moza was wearing a simple long-sleeved sleeping gown. The baby’s cot, clothing and hat all matched: white, with a thin ribbon with the same red stitching pattern seen on Qatari men’s ghutra. Women often described the care and attention they took in choosing a theme or colour scheme to coordinate the baby’s clothes and other items, often travelling outside Qatar to source them. Moza’s father and Khalid quietly and discretely left the room when Nadia arrived, leaving the group of women to visit. Moza, her mother Reem, and Nadia chatted for a few minutes before two other female visitors joined them. It is common for women to stay in hospital with their babies for a period of five days and this is an opportunity for the new mother to rest, away from the demands of home life and domestic responsibilities, with nurses on hand to help care for the baby. During this period, they accept a large number of visitors, mostly female relatives and friends; it is an opportunity for visitors to see the new baby, offer congratulations and bring gifts. Refreshments and food are offered in rooms adorned with large floral arrangements and displays

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of chocolates or sweets. A number of such arrangements and an impressive display of small baskets filled with blue chocolates were in Moza’s room. The latter were given to guests as they departed as a memento of the baby’s arrival. It is common for guests to be handed such a gift, which might be sweets, a frame, a box with baby toiletries, or perfume. As the women admired the baby and chatted about motherhood, Moza describes how the minute she saw her baby she forgot all the suffering she had experienced. The infertility, the treatment and miscarriages receded from her thoughts. Filled with feelings of happiness and of gratitude, she explains she never lost hope: ‘[I] was sure that Allah will compensate me because I prayed a lot and thanked him no matter what happened.’ Throughout her experiences of reproductive difficulties, Moza was comforted by her faith in God and her confidence in the likelihood of a successful pregnancy: those around her supported this conviction. Despite her feelings of liability for the problems in conceiving, she did not feel blamed for her miscarriage. Instead, her family and her in-laws were supportive and reminded her that she had become pregnant. This narrative of miscarriage as a demonstration of fertility and, thus a positive, if sad, event emerges throughout our fieldwork. Moza’s story reflects the complexities of notions of blame and culpability that emerge from women’s accounts of miscarriage and reproductive disruption. Her story also reveals the impact of miscarriage on the extended family. Moza’s in-laws had very much wanted her to produce a child: they were excited when they found out she was pregnant and devastated when she miscarried. She decided not to disclose her second pregnancy to avoid any further disappointment in the event of another loss whilst also anxious that additional miscarriages would lead to gossip and cast further doubt on her fertility. Khalid, his family, and Moza’s family were sympathetic and emphasized that there was nothing wrong with her, reminding her that she was able to conceive, saying, ‘One time it will happen and the pregnancy will continue’. Her miscarriages are seen as a demonstration of her fertility. Moza is comforted by the knowledge of women who had miscarried but had gone on to have children. Her sister conceived as the result of fertility treatment and had miscarried before having twin boys and was pregnant again with twins. Moza’s awareness of the miscarriages of others allows her to see her loss as not particularly rare,

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unusual, or worthy of anxiety. Reem laughs at the blessing of her two daughters making her home busy for the time being: Moza’s pregnant sister and her twins are staying in Reem’s home so she can care for them. Once Moza leaves the hospital she will join the household, staying for forty days, as is traditional for new mothers in the Middle East (Kridli et al. 2012). This period, nifass (postnatal bleeding; also childbed, childbirth, parturition), sees women returning to their natal home to rest and be cared for. Mothers and other female relatives play a primary role in supporting the young mother and helping provide care for the new-born, particularly in this period (see also Kridli et al. 2012), which coincides with a time of risk and vulnerability to illness for the new mother and baby (Kridli et  al. 2012). The interlocutors suggest that in previous generations women were not supposed to leave the home, but many no longer feel restricted in this way. After forty days passed, Moza and her son returned home to Khalid. We were able to get a glimpse into their lives with their son, as we spoke to them once they had settled into life as new parents. Khalid’s difficult path to becoming a father had involved two marriages, the death of his first wife and three miscarriages, but perhaps this had resulted in a greater appreciation for this son; for Khalid is the only Qatari father who reports changing nappies and waking in the night to look after and ‘cuddle’ the baby. Delighted with his son, Khalid is clearly devoted to him and his wife. Explaining how the couple share responsibilities, Khalid suggests a woman’s role as mother is greater, but: ‘Wallah, the father’s role is big; he raises the children, teaches them and provides [for them] so they can have a good life. The father’s role is important and is a big one.’ Moza’s experience of miscarriage is informed by her previous reproductive experiences, including previous loss and problems conceiving. It is also influenced by her husband’s previous marriage and his reproductive experience. Through Moza and Khalid’s story, a number of themes emerge including miscarriage discovery, procedures for management, notions of cause and miscarriage as a demonstration of fertility. Expectations, aspirations and obligations to produce children impact women’s experiences: miscarriage is best understood as embedded in a woman’s life, including her past reproductive experiences and anticipated future ones.

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Noora We first met Noora in the hospital out-patients department where she had come for a follow-up appointment after her miscarriage three months previously. Very friendly, Noora eagerly agreed to take part in the research. Forty-two years old and a housewife, Noora would be considered part of the Qatari middle class. Originally from Saudi Arabia and part of a Bedouin tribe, her Qatari nationality was conferred through her marriage to her Qatari first cousin. Noora’s experience illustrates the way miscarriage and reactions to them are embedded in complex reproductive aspirations and obligations and influenced by multiple factors. Similar to others, Noora’s pregnancy was not planned but, unlike the other interlocutors’ pregnancies, it was not expected. During our many conversations, the layers of hope, aspirations and disappointment were revealed, as were shifting motivations. With six children, three boys and three girls, Noora had been advised not to become pregnant again due to her health and the risk of a seventh caesarean section. It was somewhat of a surprise when a home pregnancy test to rule out pregnancy prior to a medical treatment for arthritis revealed her to be pregnant, much to her husband’s delight: I saw my husband’s reaction after I got pregnant and how he was taking care of me because I was pregnant. He was happier than he was with my first baby. To be honest, he cared a lot about me, so I prayed to God that I have this baby for him.

Her husband’s happiness and the resulting care he had for her strengthened her resolve to have the baby. However, despite her prayers, it was not to be: four weeks after the positive pregnancy test, Noora began to bleed. In the event of bleeding, pain or concern, pregnant women commonly seek medical attention typically presenting at the hospital emergency department. At the hospital, Noora was examined and told that ‘everything was OK’ and bleeding during pregnancy was common. Not satisfied, Noora sought another opinion at a private clinic, where the doctor surmised that ‘maybe the placenta is separated’, causing her to bleed. From here Noora went to yet another clinic where she was told the heartbeat was present but ‘weak’. Faced with conflicting

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information, Noora ‘went from clinic to clinic but each said something different’. Accessing a number of medical practices in this way is not unusual, with residents making use of the public hospitals and primary care clinics as well as the large number of private hospitals and clinics.

Pregnancy, miscarriage and surveillance During her short pregnancy, Noora had undergone six sonogram scans, the first of which was when she presented to the emergency department with bleeding. At that time the baby was too small to be visible, but subsequent scans revealed the baby and its heartbeat, a moment that Noora later describes as impacting her experience of loss: ‘Especially when I heard his heartbeats, I developed a relationship with him. It is over now subh. ānallāh (Praise be to God).’ Noora’s experience is typical: women undergo monthly monitoring ultrasounds from an early stage of their pregnancy. More frequent scans are common: if a pregnancy is deemed high risk it will be more closely observed. Ultrasounds at the public hospital are often supplemented by additional investigations at private clinics. The sonography sessions I observed had a clinical atmosphere. Women ask simple questions about sex and foetal size, but otherwise there was little discussion between those present. There was an absence of narration around the development of foetal personhood, which is so familiar in Euro-American contexts, as described by Lisa Mitchell (2001). Ultrasonography has become a key tool in the medical surveillance and management of pregnancy and there is an important body of work exploring its social, cultural, and political implications (Mitchell 2001 and 2004; Mitchell and Georges 1997; Roberts 2012a, 2012b; Roberts et al. 2015a; Roberts et al. 2015b; Sandelowski 1994; Taylor 1998 and 2008; Thomas 2015). In Qatar, the high rate of diabetes means that women are often concerned about foetal size, as the condition can result in growth restriction, growth acceleration and foetal obesity. Foetuses emerging in the ‘scanning room’ were often at risk, risky or problematic: they are observed, diagnosed; their fate considered. In each instance, the sonographer, the woman and myself were the only people in the room. Women rarely attend with friends or family members and certainly not their husbands! As the main hospital is segregated, men are not allowed in the area where women are treated.6 During fieldwork, I was struck by the

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absence of foetal images, or at least a lack of emphasis on them. In EuroAmerica anti-abortion propaganda has been central in presenting images of foetuses to the public (Michaels and Morgan 1999), but foetuses have also become familiar features of the public landscape including in science journalism, consumer advertising (Taylor 1992) and on social media. However, in Qatar, due to an absence of pro-life propaganda and the rarity of representations of the human form, foetal images are uncommon. Pregnant women are familiar with foetal images through sonograms, but these are largely clinical interactions with an absence of narration: the focus is on diagnosis. Noora found herself back at the main hospital, still uncertain about the status of her pregnancy. It was only when she went on to visit yet another private clinic that she was told the baby (I refer here to ‘baby’ as this was the way in which Noora referred to it) had died. Noora had lost confidence in the main hospital, so went instead to ‘the Cuban Hospital’ where they performed another scan that confirmed the absence of a heartbeat. When finally told that the baby had died Noora was ‘shocked’ and ‘extremely disappointed . . . I wished to have the baby, but Allah didn’t wish for this to happen’. With the pregnancy no longer viable, Noora faced the process of eliminating the pregnancy remains from her body. After being given ‘suppositories to induce abortion’, as described in Moza’s account, she began to bleed. Bleeding continued for several days after which Noora underwent a scan which revealed retained pregnancy tissue in her uterus: ‘half the baby passed down and the other half is still in my womb’, she explained. Surgical intervention was performed, but despite undergoing surgery in September, Noora was still experiencing bleeding in December. Noora returned to the main public hospital for further investigation, which revealed retained pregnancy tissues, requiring further treatment. These frequent hospital appointments and admissions had resulted in ‘everyone’ knowing about her miscarriage despite her reluctance to disclose her pregnancy.

After a miscarriage: treatment and cause During the process of the miscarriage and in its aftermath, Noora, like many interlocutors, sought help beyond the hospitals, by visiting traditional healers.

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Um Abdullah, al massada (masseuse), found that Noora’s uterus was full and so provided treatment to cleanse it. Women describe the management of their miscarriage as a process of ‘cleansing’ or ‘making themselves clean’. Tissue and blood must be expelled in order for the woman to be clean and her miscarriage complete. Al massada uses massage and oils, in the case of miscarriage; massage relieves pain, particularly in the stomach, uterus and back, and cleanses the uterus. Interlocutors describe using a variety of methods including herbs and massage to cleanse their bodies. Such practices relate to those which are undertaken following birth where vaginal discharge places mothers in a state of ritual impurity. Similar to that described by McPhee (2012: 126–7), aesthetics of purity contributes to the logic of childbirth customs where women ritually cleanse their bodies after giving birth. Interlocutors commonly describe seeking the services of al massad for miscarriage, but also other illnesses including infertility, headache, infections, hepatitis and back pain. Noora also sought help from a practitioner for the bleeding and because she was ta’banah (tired) following the miscarriage. The woman, who Noora had seen for previous ailments, diagnosed her with a ‘fallen down’ uterus (uterine prolapse) and retained pregnancy tissues, a diagnosis later confirmed at the hospital. The practitioner, Um Jassim, explained to Noora that her ‘rahem (uterus) is not clean yet’, providing herbs and herbal suppositories that she dutifully took. Um Jassim, a moaligeh (general healer), was popular with interlocutors, treating a variety of conditions. Her services are particularly popular for those suffering from infertility, pregnancy complications, and problems associated with children. The first time Noora visited her following the miscarriage she performed ruqyah sharea, a common treatment relayed by the Prophet Mohammad for afflictions such as sihr (magic), masaha (possession) and ayn (evil eye). The treatment consists of reading certain verses of the Quran to treat harm caused by magic, possession or evil eye. Um Jassim and Um Abdullah’s craft can be seen as an example of how women around the world ‘produce’ health, often through their formal and informal roles as traditional healers (i.e. Boddy 1989). The use of herbs and plants is common in the region, particularly by women (i.e. Gerber et al. 2014 in Qatar) and often persists in relation to pregnancy, birth and miscarriage (Green and Smith 2006: 271 in UAE; Reiss 1991 in Israel; McPhee 2012 in Morocco) and may also play a role in ‘retrieving lost periods’, which may be linked to ending unwanted

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pregnancies (Newman 2018a). The endorsement and avoidance of certain plants and herbs during pregnancy, the popularity of medicinal herbs (Kilshaw et al. 2016; Newman 2018a) and traditional healers reveal that miscarriage is embedded in cultural matrixes of local healing frameworks and knowledge systems about illness. During subsequent meetings, Noora spoke about what she thought caused miscarriage, both in general and in her specific case. Whilst being confident that her miscarriage was due to God’s will, she considers other possible causes including carelessness, such as not heeding medical advice about taking progesterone and resting. In discussing her continuing desire for another pregnancy, Noora later reveals that she had not entirely dismissed her role in the miscarriage: It is a gift and compensation from Allah I will take care more because after God’s will I think what happened was fifty percent because of my carelessness. I worked a lot at home because I didn’t have a maid though I had a bleeding. They told me that you should take rest with the progesterone but I didn’t listen.

Having been without a maid for a number of months, Noora was doing more work around the house than usual. Her account reveals tensions: Noora expresses concern that she did not adequately care for herself and her pregnancy, but also emphasizes that ultimately miscarriage is out of her hands and due to God’s will, resisting suggestions of blame. Speaking generally, Noora suggests that lifting something heavy, having ‘too much work to do in the house’, stress, tiredness and overwork are all commonly understood causes of miscarriage. Noora also mentions possession and the influence of jinn: ‘We say maybe she is possessed or we may say it is the qareen [ jinn] settled in the uterus’. Noora also suggests her age was potentially a cause for her miscarriage: ‘Age plays a role. It was risky for me to get pregnant at this age. I asked the doctors before I decided to get pregnant and they all said: ‘it is not recommended’. According to Noora, what people think is the cause of miscarriage ‘depends on the mentality and the society she is living in’ and how ‘civilized’ they are. Maternal age, notions of vulnerability along with other causes of miscarriage, such as working too hard and God’s will are the focus of the following two chapters.

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Following the miscarriage, Noora continued to pursue another pregnancy despite being warned by medical professionals that this was not advisable, due to her age and the prospect of having a seventh caesarean section. Noora consulted three clinicians in the hope that one might re-assure her or suggest management strategies if she were to become pregnant. During a visit to Noora’s home we met her husband, Mohammed, who endorsed the clinician’s view that she should not expose herself to risk through another pregnancy, adding that if he wished to have more children he could do so by marrying another wife. Mohammed’s suggestion that he might take another wife contributes to Noora’s reproductive aspirations, as she clearly does not want this to happen. Her eagerness to become pregnant is motivated by a desire to fulfil her husband’s reproductive ambitions and to prevent him marrying again, but also by her own desire for a baby. Producing children is an obligation that continues throughout women’s reproductive years, often leading to ambivalence about the relationship between maternal age and increased vulnerability. Noora does not keep anything to remember the pregnancy or the baby she lost, which is typical of Qatari women. For Noora, like most interlocutors, when asked about this she explains that God did not mean for this pregnancy to continue and for this baby to be born and, so, ‘I like to put an end to everything’. This does not mean that women do not remember the baby or feel sad about the loss; Noora explains that a dress bought in anticipation of a developing pregnancy hangs in her closet in the hope it will be used: I went to Saudi Arabia and I bought maternity dresses from there and every time I open the closet and I see them I feel nafstea ta’abaneh (depressed). Allahom la Ietirad (Oh God no objection! No objection to God’s will).

She suggests that she does not keep anything so as not to cause upset or remind herself of the loss, but it is also to accept God’s will: there is a complex interaction between loss, sadness, acceptance and faith. As Noora herself suggests: Allah was generous with me and he gave me kids and getting one more child means to me that I own the whole world. I wished that this pregnancy had lasted but I can’t reject God’s decision, alh. amdulillāh for everything.

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Not dwelling on the loss is linked with accepting God’s plan but Noora sometimes struggles with this. She says she cannot help but think of the baby she lost, particularly when she sees the children of women who were pregnant around the same time as she was: Honestly, I feel very disappointed, I mean no matter what you believe about destiny and God’s will and how much faith you have, you will have a moment of weakness and it is when the Shaitan (Satan) will play in your head and I will say; “if I was in her position, . . . if, . . . if, . . .”

She explains that she immediately returns back to God and asks for his forgiveness during these moments: ‘I am afraid that this may be considered that I am not accepting God’s will.’ Noora was disappointed, but also aware that the miscarriage is part of God’s plan, perhaps the baby would have been disabled or ‘make trouble’. A few months after the miscarriage, Noora’s daughter-in law’s new-born baby died at four months leading Noora to ‘thank God for what happened to me’. She is grateful that her miscarriage at two months’ gestation was less upsetting than having to face the loss of a newborn. We met with Noora several times and were delighted to be invited to her home on a number of occasions where she would invite us into her majālis (place of sitting; sitting room); offering tea and coffee whilst explaining that Qataris serve tea first, whilst Saudis serve coffee first. As per tradition, she stood until we, her guests, were served and then she settled on one of the sofas arranged around the perimeter of the room. During one meeting, Noora spoke about her motivation for having another child. She suggests that her husband wants more children and ‘pesters’ her; his eagerness driven by a desire to prove his virility and youthfulness. She also is driven by her own desires: ‘I missed having a baby and I don’t work and I had nothing to do, also my husband starts nagging, as you know!’ With her youngest child now eight, she misses having a baby in the house. At various times she describes her feelings of maternal instinct to have more children and her own aspirations to have more children, which have been strengthened after the miscarriage. However, in our discussions she focuses on her husband’s eagerness to have more children and her anxiety that this will not be with her, something which became clear during one of these visits.

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When we arrived, we noted that the furniture in her majālis had changed. Noora explained that the furniture was old and her husband was having thoughts about marrying again, so by spending money on new furniture and redecoration she was ‘clipping his wing so he won’t fly to someone else’. We were able to meet with Mohammed, Noora’s husband, during this visit. Very friendly and happy to chat, he explained that they had not expected or planned a pregnancy but was thrilled when Noora became pregnant. Mohammed says it was Noora who wanted to become pregnant: Wallah, we don’t limit and what comes from Allah, we accept it . . . and I don’t care whether it is a boy or a girl . . . she should have stopped after the fourth pregnancy because she gives birth caesarean, all her deliveries were caesarean and it is high risk to have this surgery again because when you have a surgery after a surgery the tissues of the tummy become weak. So, it is destined! OK . . . but now, we should stop because it is dangerous, right? And I am not ready to gamble on Um Sultan’s life because this is a big adventure; she is my partner and I can’t gamble on her, so we were pleased to have four, but Subhan Allah, God meant for the fifth child to come, so that’s it! We had no power over that, with the contraceptives, and all the precautions . . . but Allah destined for the fifth child to come, though we wanted to stop but then the sixth child came too.

Whilst Mohammed thinks it too dangerous for Noora to conceive again and discourages her, he also points out that all conceptions are in God’s hands. He is aware of the risks of having a seventh child and does not wish to ‘gamble’ on Noora’s life. This, however, does not mean he is not eager for more children: If she doesn’t mind, I will marry again, I have no problem [laughs] . . . I will marry again and have more children for her, she can raise them if she wants.

During another meeting, five months later, Noora looked particularly happy and relaxed when she came into her garden to greet us. Wearing a lovely purple dress, we noticed her hands were decorated elaborately with henna: we asked if she were attending a wedding over the weekend, as that is the usual reason for such decoration. Noora pulls up her dress to reveal a large henna design on her back, explaining that it is the final day of her menstrual period and she and her husband are staying in one of Doha’s luxury hotels for two nights. The couple had recently been doing so on her husband’s suggestion: they enjoyed

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taking time out of their regular routine and do something special together. Her husband encouraged her to have henna because he finds the look and smell appealing. The discussion quickly turned to the subject of attraction, sex and love. It seems apparent that the relationship between Noora and her husband is a happy one, but the possibility of another wife loomed large. I was reminded of Noora’s discussion of her husband’s reaction in the immediate aftermath of her miscarriage, when she felt his concern was only for her, not the lost pregnancy: It was obvious that the most important thing for him, is me, but I am sure he was upset . . . He told me ‘You are the most important and alh. amdulillāh we have kids’ . . . God is so generous and we are mankind so greedy . . .

Her husband had been intent on reminding her that they are blessed with children already and that her health is his primary concern. Noora continues to hope that she will become pregnant and have another child. She focuses on moving past the experience and tries not to dwell on the memory or any sadness she might feel. She remains hopeful that she may become pregnant again and hopes that this time God will see fit to protect the pregnancy. Noora, like other interlocutors, finds faith in God and remains confident that the miscarriage is part of God’s plan. To this end, women focus on cleansing their body of the miscarriage and preparing themselves for future pregnancies.

Conclusions Women’s discussions of reproduction speak to gender, familial hierarchies and perceptions. Noora and Moza’s accounts of their miscarriages are embedded in the broader context of their lives, particularly their reproductive aspirations and experiences. Their stories reveal the way miscarriage is commonly discovered, diagnosed and managed, and what women do in the aftermath with their focus on cleansing the body and looking toward future conceptions. Explanations of what causes miscarriage are touched upon in these discussions and will be expanded in the following chapters. Moza and Noora describe the importance of pregnancy and the pressures placed upon them to have children by husbands and their family whilst also describing a desire to have children.

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The importance of motherhood and producing children emerges as a key theme in women’s accounts. Not producing children and not fulfilling the role of wife and mother puts a woman in a potentially vulnerable position, with the possibility of divorce or polygyny, although the latter is less a threat than with previous generations. Cultural, religious, and familial obligations are played out on women’s bodies and their reproductive activities, with these linked to state expectations.

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Modern Bodies; Miscarriage Cause

Qatari pregnant bodies are framed as vulnerable; concerns revolve around danger, cleanliness (Kilshaw et al. 2016) and depletion. Pregnancy is typically viewed as a susceptible state, where women are susceptible to various and diffuse threats. In most cases the cause of miscarriage remains unknown, leaving room for conjecture about cause and accusations of blame. The accounts of Huda, Moza and Noora introduce notions of miscarriage causation: Qatari knowledge systems include theories of mystical1 causes; problems with the foetus, such as chromosomal abnormalities; and foetal environment. Pregnancy is seen as a time of vulnerability with concerns for the safety of the woman and her developing foetus. Moza, Noora, Huda and those around them understand miscarriage to be the result of God’s will; Noora introduces jinn to the discussion of cause and Huda points to magic and evil eye as causes of miscarriage and fertility problems. Supernatural forces play a dominant role in discussions of what may cause miscarriage, as will be discussed in the following chapter. This chapter focuses on the most commonly discussed causes of miscarriage, particularly those around ideas of depletion and vulnerability, as conveyed by both the pregnant interlocutors and women who had recently miscarried. In particular, activities that put a physical strain on a woman, which may result in exhaustion are deemed problematic. Lifting something heavy is connected to concerns about exertion, but so commonly cited, with one quarter of all interlocutors referring to it, that it demands particular attention. Stress was commonly reported as a possible cause of miscarriage with women talking about work-related stress as well as those related to personal and family difficulties. These causes revolve around the woman, her body and her activities and their possible role in the demise of a pregnancy. Exhaustion, exertion, physical movement and stress are often 99

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discussed in association with the demands of work. Discourses around pregnancy, vulnerability and miscarriage reveal tensions contained in Arab modernity. Understanding what causes miscarriage and what might threaten a pregnancy reveal how women negotiate modernity and how it is embodied and experienced in relation to their reproduction. In particular, discussions around the causes of miscarriage reveal anxieties around women’s role in society and its impact on reproduction.

Modernity, women’s bodies and reproduction The perception that miscarriage is more common in contemporary Qatar than in the past as a result of changes in lifestyle emerges as a dominant theme in discussions. Younger women are seen as less robust than in previous generations. Women’s bodies are perceived as weaker and somehow reproductively challenged, particularly by the older generation with a similar discourse reported in other contexts (i.e. Kanaaneh 2002; Fraser 1995; Gottlieb 2004) with modern bodies seen as different, as are the illnesses that ail them. In particular, women’s bodies are deemed more delicate, less robust and more vulnerable to reproductive problems including infertility, miscarriage, problems with the foetus, and difficulties in giving birth. Noora’s husband, Mohammed, explains, Now, when a woman gets pregnant, we don’t know whether she will complete her pregnancy or not, we don’t know many things. Years ago, women used to work hard and get tired, but they eventually give birth to a healthy baby. My grandmother gave birth to my father in the desert [What do you think had caused this difference between nowadays and before?] As you know, our time is different than theirs; the wife nowadays doesn’t work a lot and doesn’t get tired as before. As you see we have maids, instead of one maid there are two or three and also after the wife has the baby, she has a babysitter for the baby, so what is her role? She doesn’t have a role! But in the old generation, the mother raises and feeds her children, and works in her house.

Mohammed describes contemporary pregnancies as more tentative and uncertain. He suggests that Qatari women do not work as hard as previous generations as a result of having more domestic help. He associates this with an

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eroding of the role of women in the domestic sphere. This seemed to contradict the widespread understanding that those with strenuous jobs or who worked excessively were more at risk of miscarriage. With this in mind, should we not expect miscarriage to be more common in previous generations when women ‘worked hard’ and were more likely to tire, as he suggested? He responded, As you said, there was a lot of pressure on them before but they didn’t miscarry as much as they do now, even before we didn’t hear about caesarean; all the deliveries were normal and sometimes the woman gives birth when she is in the desert or in the car while she is going to the hospital and then she will not continue her way to the hospital, she will go back home . . . what I mean is that though miscarriage exists now it is more because the food is not healthy, they exaggerate a lot in every aspect of their life; they are very protective about everything to the extent that their bodies’ may have lower immunity. The frozen chicken that people eat now plays a role; using the car to go from one place to another, also plays a role . . . They used to walk long distances even if they were tired or pregnant. It was normal that a pregnant woman did her house chores from the early morning at 6 am till the end of the day; she’d wake up her kids early in the morning to prepare them for school and she used also to feed the cattle in her house. May I ask where you are from? [I am Palestinian]. OK, Palestinians are the most hardworking women, I am sure that your mother or grandmother worked a lot, they even used to work in the farm. They only eat onion and tomato and work until the afternoon and they sleep by 6 pm, so what I mean is that they used to be healthier, stronger and more energetic than now; but now, they don’t have energy, they are bored all the time, they have aches and because of the humidity nobody walks. So, if someone walks for an hour on the Corniche ‘beach’ it is like he has done an impossible mission. Before they used to walk daily for several kilometres, therefore, from my point of view, I think that this is one of the reasons of why miscarriage is more common now.

Through suggesting miscarriage is more common in today’s Qatar, he suggests that women now are less reproductively robust. Mohammed articulates a widespread belief that women were more effective child-bearers/birthers in previous generations, suggesting that there was no need for caesarean sections: women delivered ‘normally’, typically not requiring medical intervention. He

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refers to women giving birth in the desert, linking nostalgia for the Qatar of the past with the romance of nomadic life in the desert. Contemporary bodies and birth are more medicalized and requiring of medical help. Mohammed acknowledges that miscarriage was present in the past, but it is more frequent in today’s Qatar. He links this to changes in the diet, which makes food less healthy. Thirty-five-year-old mother of three, Huda, whose story opens the book, also reports miscarriage as occurring more frequently in contemporary Qatar as compared to previous generations, linking this to changes in lifestyle, particularly diet: Now many things have changed; the preservatives that are added to the food, radiation, also the way they store the food and the methods of preparation, all these things have been changed . . . hormones are added to the eggs and to everything, so our food is not healthy any more.

In later discussions, Huda repeats these concerns about the contemporary Qatari diet and adds anxiety about ‘radiation that is emitted’ from new, but now commonplace technology such as iPhones and iPads. Radiation as the result of X-rays was mentioned by a small number of interlocutors. Women indicate that pregnant women should not be exposed to radiation or take medications, particularly in the first trimester (Kilshaw et  al. 2016). Huda detects a difference in those affected by miscarriage with it being more common in those who had previously achieved successful pregnancies: ‘Now young women are having abortions after they had babies.’ In previous generations, once a woman had a child she would rarely have subsequent difficulties producing children: according to Huda, women either have damaged reproduction or are reproductively ‘normal’. Modern bodies are more uncertain. Huda understands her own miscarriage as unusual because it followed three uneventful and successful pregnancies. According to Mohammed, women’s ‘protectiveness’ means that their immunity is lowered, making them more susceptible to miscarriage and illness. Women no longer walk and no longer use their bodies for household chores and tasks. Mohammed paints a picture of women who are careful, protective, who limit activities, do little and ‘exaggerate’: the suggestion is of delicate women who are no longer as robust as their ancestors. Women and their bodies were ‘healthier’, ‘stronger’, more ‘energetic’ than in contemporary Qatar due to better

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diets, more exercise and a need to work hard. Mohammed’s response reflects a widespread perception that miscarriage is more common today than in previous generations and links it to lifestyle changes that deplete the role of women, their bodies and their reproductive capabilities. He presents this discussion soon after explaining that miscarriage is very common and that his mother miscarried repeatedly. In her case, he explains, she miscarried male foetuses. However, despite acknowledging the commonality of miscarriage in known times, Mohammed emphasizes that contemporary Qatari women are more vulnerable to miscarriage, citing their protected and coddled lifestyle; in his view, their lack of activity makes them less robust.

Modern depletions: exhaustion, stress and work With the pregnant body seen as vulnerable, behaviours, activities and substances that further deplete or strain a woman are perceived as threatening to her and to the growing foetus. Exhaustion is a particular concern, appearing frequently in women’s discussions about pregnancy and danger. Activities that cause stress, either physical or emotional, may cause miscarriage. Activities, behaviours or external threats that negatively impact the woman’s body and, thus, the environment in which the foetus is developing are deemed as potentially threatening. Undertakings and movements associated with ‘work’ are seen as particularly threatening to vulnerable bodies, mainly through their ability to fatigue. ‘Work’ includes both housework and paid employment. However, professional women, particularly those with long working hours or whose work involves excessive movement, exertion and/or travel are more vulnerable to miscarriage. Travel is seen as potentially perilous for pregnant women because it may cause fatigue or exposure to unknown elements. Interlocutors commonly suggest that a pregnant woman should rest, sleep and avoid strenuous activities (Kilshaw et al. 2016). Lifting heavy objects was cited by 25 per cent of our pregnant interlocutors and was the second most common cause reported by women who had miscarried (25 per cent); however, none of these women suggest it as a possible cause of their miscarriage, instead it is identified as a general risk rather than a specific cause. Noora suggests carrying something heavy is a central feature of Qatari explanations of miscarriage cause:

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In Gulf region countries we always say that a woman miscarries because she lifted a heavy object: this is the most common theory. She carried something heavy or she overworked or slept with her husband. We don’t consider the medical or biological reasons . . . They asked me when I had the miscarriage, ‘Did you carry something? What did you do?’ Even though the woman doesn’t do any work at home.

Noora’s description of women as having little housework was common and at times was a focus for accounts of how women’s lives had changed, as revealed in Mohammed’s account above. Household tasks are typically performed by domestic workers in contemporary Qatar, meaning women and pregnant women, in particular, are relieved of strenuous or tiring domestic activities. Primarily mothers and grandmothers of interlocutors emphasized lifting heavy objects as a key concern, suggesting generational differences about miscarriage cause related to lived experience. However, some women may be at risk due to obligations of household labour. Noora suggested that her miscarriage may have been the result of her undertaking housework in the absence of a maid. She subsequently delayed further pregnancies until she had hired a new maid (see Chapter Nine for discussion about maids and miscarriage). Although housework did not feature as a prominent concern, unlike the demands of professional employment, a small number of interlocutors did emphasize the role of excessive housework in causing miscarriage. The mother of a woman who had recently miscarried listed ‘domestic abuse’ as a risk for miscarriage: Domestic abuse is also one of the reasons; they give her so much work, more than she can afford. I know a woman who got married young and her mother-in-law was abusing her by letting her do a lot of housework, such as carrying buckets of water from one floor to another while she was pregnant.

‘Domestic abuse’ here refers primarily to patrilineal family members, usually the mother-in-law, burdening a woman with excessive and strenuous household tasks, including heavy lifting, which may lead to exertion and ultimately to miscarriage. Three interlocutors refer to domestic abuse in this way and suggest it as a possible cause of miscarriage. In such cases, blame is attributed not to the woman, but to those around her. Qureshi (2020) reveals

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how culpability for miscarriage in rural Pakistan is passed from a woman’s natal families to their marital families, who directly influence her workload, diet and care during pregnancy. Such rhetorics of blame reflect common faultlines of conflict in marriages that are typically patrivirilocal. Whilst in these cases abuse refers to abuse of power and in placing excessive demands on a pregnant woman, it should be said that domestic violence is not unusual in Qatar: female students at Qatar University reported that 23 per cent of Qatari women and 22 per cent of non-Qataris experienced domestic violence including verbal and physical abuse and marital rape (Al-Ghanim 2009) with a significant lack of legislation to protect victims. Concerns about professional work featured heavily in women’s accounts of miscarriage and reproduction. This discourse is associated with a wider discussion of modernity’s effect on women, their bodies and reproduction. Interlocutors commonly point to changes in Qatari lifestyle, and particularly that of women. In describing her long hours as a medical technologist, Huda explains that women have more demands on them in contemporary Qatar, including those of education and employment. Such expectations and responsibilities risk fatiguing women, which causes miscarriage. Maybe life has changed and the woman has more responsibilities now. She goes to her work and then comes back and sometimes she is tired. Many things have changed; the lifestyle has changed.

Huda reflects on the transformation in expectations and responsibilities placed on contemporary Qatari women. Lifestyle changes, including women’s increased role outside the home, make women tired and more vulnerable. In recent government initiatives of women’s empowerment women are central to state development plans (QNDS 2011), particularly through an increased role in social and economic life; expectations that conflict with family responsibilities and reproduction. Concerns about the impact of work and associated physical activity, stress and tiredness on pregnancy reveal the way such state initiatives influence women’s lives and their experience of reproduction. Excessive or exhausting physical movement is commonly seen as threatening to a pregnancy. Fatigue and exertion further deplete vulnerable pregnant bodies. Awatif, a thirty-six-year-old woman with five children following nine pregnancies, explained that fatigue may cause miscarriage: ‘They say if the

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woman worked a lot and got tired, she may miscarry, so [it is] all about moving a lot’. Having recently miscarried, Awatif was conscious that excess work activities or physical movement were possible causes of miscarriage, particularly by causing fatigue. Wadha, a thirty-four-year-old teacher with five children, attributes her miscarriage to exhaustion: ‘It is because of tiredness . . . I think having rest is important, maybe if I rested I wouldn’t have miscarried’. Thirty-three-year-old Najah attributes the loss of her first pregnancy to the demands of work: I blamed myself, maybe my work rhythm is fast and I didn’t slow down . . . I work in communications; we have too much work . . . we move a lot . . . we have a lot of movement and pressure.

As suggested in both Naja and Wadha’s accounts, women sometimes blame themselves in the aftermath of miscarriage, particularly ascribing it to tiredness, overwork or stress. Wadha wonders if she had rested more, perhaps she would not have miscarried. Naja describes a busy and stressful work environment, which leads her to worry that she may have caused the miscarriage. Women commonly suggest that pregnant women should ‘take it easy’ and rest, with the movement and activity associated with domestic or professional labour contrary to this guidance. Whilst most interlocutors suggest that pregnant women can continue to work, it was clear that there was a great deal of anxiety about working whilst pregnant, which was part of broader concerns about the conflict between the demands of work and those of family responsibilities. Most women who suggested combining work and pregnancy was possible, advocated that this was possible by reducing the demands of employment. Thus, avoiding or reducing work, particularly in the first months of their pregnancy (Kilshaw et al. 2016) is commonly recommended as a protective measure. Activities and substances that impact the body, pollute or weaken it, are understood to make a woman vulnerable to miscarriage. Pregnant bodies are seen as susceptible to depletion, but certain bodies and pregnancies are seen as particularly so. Older women and those suffering from illness are seen to be more in need of protection and of rest, as are women whose pregnancies are seen as ‘weak’ or the result of fertility treatment. According to twenty-nine-yearold Kareema, who remained childless after two miscarried pregnancies, women may continue to work whilst pregnant, ‘but not if the pregnancy was “weak” ’ and not if the woman’s job was particularly demanding or required a lot of

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effort. Noora, mother of six children, suggests that young women and those with good ‘general health’ may continue to work, but not those whose pregnancies are vulnerable such as those of older mothers. As a forty-two-year-old woman, Noora sees herself as particularly susceptible to potential dangers of the work environment when pregnant: the combination of advanced maternal age and the demands of work threaten to deplete and exhaust her, making the pregnancy unsustainable. Noora explains that some women can work: ‘If she is young and her uterus is ready to have the baby, it is different than if she is at age of forty or forty-two, like me; so it depends on the woman and her general health.’ Age and associated pregnancies make women’s bodies weaker resulting in more vulnerable pregnancies, as illustrated by Noora who suggests women can continue to work when pregnant, but only if their age and health allow. Thus, older pregnant women are more vulnerable to the demands of work, which puts their bodies under strain and may lead to miscarriage. Pregnancies resulting from fertility treatment are deemed particularly vulnerable. Moza understands IVF pregnancies as particularly weak meaning women pregnant after such treatment should avoid work: In normal pregnancy, yes she may work; but not in IVF pregnancy. In my first pregnancy I went to work while I was pregnant and by the end of the week I miscarried.

Moza had become pregnant following IVF treatment, but her pregnancies did not last. Pointing out that she had miscarried ‘by the end of the week’, Moza suggests that her work activities had potentially contributed to the miscarriage. Certain pregnancies, such as those arising from IVF treatment or those in women of advanced maternal age are more vulnerable than others. Work activities place additional strains on women and their bodies, particularly those deemed vulnerable. Some women suggest the most effective strategy for protecting oneself and one’s pregnancy was by reducing work activities or avoiding them altogether.

Further exhaustions: age, illness and bodily weakness Whilst advanced maternal age and the demands of work as forms of depletion are discussed above, age appears as a more general concern in relation to miscarriage. Thirty-three percent of miscarriage interlocutors reported a link

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between advanced age and miscarriage. Noora suggests that age played a role in her miscarriage, and that it was ‘risky’ for her to become pregnant at her age, particularly because she had undergone six caesareans, which had weakened her body. She links this to her vulnerability to work, described above. Indeed, age is by far the largest independent risk factor for early pregnancy loss, the likelihood of miscarriage is significantly higher in women aged thirty-five years or more. After the age of forty, the miscarriage rate rises exponentially: around 30 per cent of pregnancies will miscarry in women aged forty and 60 per cent at age forty-four (De La Rochebrochard and Thonneau, 2002; Dunson, 2002; Lean et al. 2017). Only one of the twenty pregnant interlocutors mentioned age as a possible risk factor for miscarriage or pregnancy complications. Discussions about age and miscarriage are linked to broader discussions around bodily states of weakness and vulnerability, particularly in relation to weak uteruses. Awatif, who recently had her fourth miscarriage considers multiple pregnancies as the cause of such weakness: ‘Because when the lady gets pregnant many times, this will weaken the uterus. I think this is the most [common] cause of miscarriage.’ The older a woman is, the more likely she is to have experienced multiple pregnancies, thus uterine weakness is linked to another risk: advanced age. Multiple previous pregnancies may also be associated with the additional strain, weakness or damage caused by multiple experiences of childbirth, as is the case with Noora. The fact that she had undergone six caesareans was an additional concern. There is ambivalence about advanced maternal age and the associated risks with many indicating age has no effect on pregnancy outcomes, providing anecdotal evidence in support, as pregnant Rahaf did. The thirty-nine-yearold diabetic mother of six children had been advised to undergo tubal ligation to avoid future pregnancies following two miscarriages and a stillbirth; but Rahaf refused, citing examples to minimize the association between age and problems in pregnancy: My mother-in-law was two-and-a-half-months pregnant at my wedding . . . she was over forty-five-years-old, maybe forty-eight . . . Bedouins will still have children even if they are old.

However, one third of the entire cohort of women mention age as a potential risk of pregnancy complications; yet women accompany such comments with

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evidence of those who had successful pregnancies later in life seemingly dismissing risks. Whilst age is a concern for some women and is communicated as a risk by health care providers, the obligations and aspirations of having children often makes women minimise such concerns and instead emphasize other possible causes. Advanced age is understood as making women and their bodies more vulnerable and is part of a broader understanding of conditions that do so. Aspects of a woman’s bodily state such as illness whilst pregnant, uterine abnormalities (e.g. fibroids and overstretched uterine cavity), a ‘clot in the placenta’, blood-type incompatibility, are linked to miscarriage. Sixty-three per cent of interlocutors listed a problem with the woman’s body as a possible cause of miscarriage. Uterine abnormalities, such as endometriosis or a misshapen uterus may cause miscarriage; a uterus may be ‘weak’, causing pregnancies to fail. Some women discussed illness, ‘diseases’ or ‘viruses’ in general; others were more specific and referred to particular conditions such as urinary tract infections, high blood pressure, toxoplasmosis and diabetes as possible causes. The latter condition was widely cited, reflecting its high prevalence in Qatar (16.7 per cent in adult Qatari population) (Bener et al. 2009). A number of interlocutors report previous diabetes-related pregnancy complications and/or losses. Jameela, a thirty-three-year-old diabetic woman who had experienced two consecutive miscarriages explains the link between miscarriage and diabetes: ‘Diabetes has a big role. My previous miscarriage was because of diabetes . . . and my pregnancy ended’. Diabetes is, indeed, a risk factor and something of concern to women. Ongoing screening during pregnancy includes monitoring for both diabetes and gestational diabetes making women familiar with potential risks. Diabetes is a condition tied to modernity, as is found in other parts of the region (Parkhurst 2018 in the UAE) and is often thought to be a product of changes brought by development and outside influences. In such accounts, Euro-American immigrants to the country are seen as agents of disease because of their association with foreign influence and the conditions for change (Parkhurst 2018). Diabetes, then, is seen as a ‘sudden product of “modernisation” ’ (Parkhurst 2018: 72–3) a perception ‘made complicated by discourse that links Western material and social imports to cultural pollutants, if not direct agents of disease. American designed fastfood industries, expensive villas, sport-utility vehicles, mass media, and even

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increased longevity become objects vacillating between desire and danger’ (Parkhurst 2018: 73). Diabetes is associated with changes in diet and the introduction of fast- and prepared foods; there is a more generalized concern about the consumption of these types of foods and their link to ill-health and pregnancy risks. There were concerns about the consumption of caffeine, fatty foods and ‘junk’ foods as well as discussions about the risk of taking medications when pregnant. Concern about what pregnant women consume is common and found in numerous cultural contexts. Certain plants and herbs (Kilshaw et  al. 2016), such as red seed, cinnamon, ginger, thyme, fenugreek, black seed, sage, papaya and pineapple, are to be avoided by pregnant women, as they are used as uterine stimulants and, thus, cause miscarriage. Commonly used to induce labour or to cleanse the uterus following birth or miscarriage, these herbs and plants are to be avoided in all but the very final stages of pregnancy. The use of such herbs is part of a wider practice in which Qataris, particularly women, use traditional herbs, medicines and practices for a variety of ailments (Gerber et al. 2014; Kilshaw et al. 2016). McPhee (2012) similarly found prohibitions against certain herbal medicines (those that are har (humorally hot)) for pregnant Moroccan Saharans. The emphasis on the right kinds of foods that pregnant women are to eat emerges from ideas and practices regarding food, health and morality (Brandt and Rozin 1997). The ‘right kinds of foods provide the right kinds of resources for healthy bodies, the reasoning goes, and choosing health is the moral – in other words, the appropriate, proper, and correct – decision’ (Han 2013: 119). Discussions about diet and medications further emphasize the link between ill-health, reproductive problems and changes in lifestyle brought on by modernity. Concerns about a change in Qatari diets combine with other concerns about contemporary Qatari life including a sedentary lifestyle; pollution; radiation caused by technology, such as smart phones and tablets. Such changes in lifestyle, brought on by development and globalization, mean that miscarriage is more frequent but also are thought to be more diffuse and far-reaching impacting bodies and reproduction more broadly. Bodies, particularly those of women, are seen to be less robust and their reproduction compromised. The idea that women’s bodies are weaker and somehow reproductively challenged emerges from interviews, particularly

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with discussions with members of the older generation who often spoke of their memories of pregnancy and birth being relatively straightforward. In these accounts it was often suggested contemporary Qatari women had more problems in producing healthy children. Similar discourse has been found elsewhere with contemporary bodies perceived as weaker, with more deformities and new illnesses emerging (Kanaaneh 2002: 211 in Galilee; Fraser 1995 in African American communities in the American South; Gottlieb 2004 in West Africa). Associated with this discourse is that modern bodies are different as are the illnesses that affect them: bodies, particularly those of women, are more medicalized and require more help from doctors. In particular, modern women were seen as reproductively weaker than their ancestors. Gottlieb describes old people describing people as being sicker, with more women dying in childbirth, and breast milk being less abundant (2004: 274). Modern bodies require modern medicine, which is perceived to be stronger in order to treat contemporary illness (Gottlieb 2004; Fraser 1995). In her work on the destruction of the African American midwifery tradition in the American south in the first half of the twentieth century and its replacement by medicalized, hospital-based births, Fraser found an ongoing dialectic between the acceptance of modernization and all it entailed and the assertion that ‘things were better back then’ (1995: 48). This discourse captures a variety of subjects including diet and medicines: store-bought foods are not as strong and are less potent, as are home remedies. Contemporary bodies are immune to home remedies; older medical rituals, treatments and forms of knowing no longer have the power to influence or heal (Fraser 1995). Gottlieb (2004) similarly describes indigenous medicines as no longer as effective. Fraser’s participants spoke of material changes in the female body that had rendered midwifery practice obsolete (1995: 57). Just as the community had changed, becoming more modern, so too had minds, sensibilities, bodies and the illnesses affecting them. Whilst lamenting such changes, which are seen as at the community and corporal level, the older generation suggests that such change is inevitable and not unfavourable (Fraser 1995). Modernity and change are not always welcomed, however, for old people in Beng village in the Cote d’Ivoire, the ‘collective envisioning of the past as a safer time and as a place where all was right with the world constitutes a discourse through which contemporary adults express their own current sense of loss. That

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loss revolves around a widespread conviction that, in general, life is far worse today than it was long ago’: what is significant is the broadly-held perception that Westernization and modernization have produced a deterioration rather than an improvement in the quality of daily life (Gottleib 2004: 274). In Qatar, changes in lifestyle brought on by modernity and the introduction of outside (Western) influences causes bodies to become weaker and less robust leaving contemporary Qatari women more likely to experience reproductive problems. Qatari women are seen as cossetted, less likely to move around and with fewer demands on their bodies, which is seen as negatively impacting their ability to produce children (see also Kanaaneh 2002).

Maternal influence Theories of miscarriage causation rely on notions of vulnerability of the pregnant body, but also its permeability. They also centre around notions of influence between mother and foetus and permeability between the two. Indigenous knowledge systems of conception, foetal development and inheritance are key to understanding notions of maternal influence. Whilst few Qataris suggest that all genetic material comes from fathers (Kilshaw et  al. 2015), a model of shared genetic contribution is most common. However, an emphasis on male contribution at conception is typical, with the father seen as dominant, providing the template for traits with the mother influencing. Parkhurst (2013) found similar in the UAE where a child’s traits were thought to be derived primarily from the father with others ‘picked up’ or absorbed from the mother in utero (see also Delaney 1991 in Turkey). Such understandings of inheritance have relevance for ideas about citizenship and nationality: tribal and familial connections are inherited through father and Qatari citizenship passed from father to child. Such models of inheritance, including social and biological, which are seen as tracking primarily through men, have parallels outside this region (Prager 2015; Shaw and Hurst 2008; Shaw 2015). A woman’s environment, her behaviours and activities influence her foetus, an understanding based on notions of maternal influence, which is used to explain reproductive problems, but also attributes in children once born, such as disabilities, behavioural problems, or in relation to temperament (Kilshaw et al. 2015). Miscarriage is commonly attributed to forces that may negatively

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impact a woman’s state of wellbeing or impede her state of calm or rest. Whilst strenuous activity or stress related to work may cause miscarriage, so may emotional stress or distress, as Moza describes: Yes, my sister miscarried once and it was due to stress. A woman started talking rubbish behind her back, so she got upset and angry and the same day she miscarried.

Being agitated, angry or distressed is potentially damaging to a pregnancy. In Moza’s sister’s case, the upset was due to another speaking ill of her and gossiping about her. Family stresses, such as divorce or worries about a loved one may make a pregnancy vulnerable. More commonly, interlocutors speak of distress caused by bad news or a shocking event, in particular, the death of a loved one. Sara, a twenty-nine-year-old mother of two children, attributes her miscarriage as well as that of her sister to deaths in the family: My sister and I went through a similar situation: our uncle passed away recently and I was very sad for his loss . . . My aunt had a heart attack and died immediately. She visited us a day before her death, so when my sister heard the news, she was shocked . . . Immediately after my sister heard about my aunt’s death, the baby died. I don’t know if this has scientific evidence but these were two situations that we both experienced.

The sisters’ miscarriages are associated with deaths in the family and the sadness and/or shock which they felt as a result. In Sara’s case, her miscarriage was associated with the distress of losing a beloved uncle and for her sister it was the shock of losing her aunt suddenly having just seen her. Sara expresses uncertainty about the ‘scientific’ nature of this connection but outlines the causal relationship between the stress and shock and the miscarriages. Similarly, the husband of a woman who had recently miscarried attributes his wife’s miscarriage to similar distress: She probably had the miscarriage because she was under emotional stress. Her eldest sister passed away when we were in London during our summer vacation.

A woman’s emotional state is thought to impact the safety of her pregnancy: stress, shock and upset, particularly that associated with shocking or upsetting news such as a death of a loved one can cause miscarriage.

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Understandings of maternal influence inform understandings of children’s health and temperament once born. Qatari notions of disability and genetic risk reveal that a woman’s physical and emotional state during pregnancy took priority over other forms of explanation for disability in children (Kilshaw et al. 2015; Kilshaw 2018; see also Panter-Brick 1991 in Saudi Arabia). Thus, we see men provide a template, which is assumed to be constant and women’s influence may shape and change, often to the detriment. Research from around the world has found that women are commonly blamed for reproductive problems (see Inhorn 2007); Shaw and Hurst (2008) found that British Pakistanis reported that problems in a pregnancy or a child were blamed on the mother’s actions during pregnancy (see also Rozario 2013). A child’s temperament is associated with a mother’s activities whilst pregnant. Fareeda, a thirty-eight-year-old teacher with six children after eleven pregnancies, explains that a mother’s mood affects the baby in utero, as does her wider environment: I was studying at the college when I had my daughter and thus she is the only smart one I have in the family. Whenever she hears something, she memorizes it. For my second daughter, I was in Al Hajj so I used to pray a lot and it was Ramadan too, so I feel she is totally different from her sisters and brothers, she is more religious and she follows me in my prayer steps and these things . . . The last two daughters are anxious because I am a teacher and always anxious, so I feel that has affected them.

Fareeda explains that reading the Quran and praying not only calms the woman but also the baby, whereas noisy environments, such as a wedding, can agitate a baby. A woman’s experiences whilst pregnant influence her child’s temperament and attributes: Fareeda’s daughter is clever because she was influenced by her mother’s college environment in utero. Her second daughter’s religiosity is influenced by her mother’s pilgrimage to the Hajj, the frequency of her mother’s prayers whilst pregnant and because she was gestating during Ramadan, the holy month. Such notions of influence can also be found in birthmark beliefs, which suggest that ignored pregnancy cravings will result in a birthmark, typically one reminiscent of the unmet want. As Newman describes in Morocco ‘the woman’s experiences during pregnancy and the community’s treatment of her have tangible impacts on the foetal bod. . . . Birthmark beliefs highlight

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a sense of the woman’s body as a substrate for other kinds of social and moral interactions with the foetus’ (2018a: 208). Such understandings of the maternal and foetal body depend on notions of permeability and influence between the two. Interlocutors’ most common discussions about maternal impact on children is in reference to asabeya, which can be translated as ‘agitation’, ‘irritability’, ‘nerves’ – the opposite of calm; calm being the ideal state of a pregnant woman (Kilshaw et al. 2016). Thirty-year-old pregnant Fatima explains how a mother’s emotional state can affect her growing baby: If the mother was asabeya and so on the baby will cry and be irritable . . . with my first baby I was asabeya and my baby was also asabeya: [she would] cry and cry.

Fatima’s irritated, agitated state during her pregnancy resulted in her daughter being an agitated, restless and upset baby. Her mood and state whilst pregnant influenced her daughter’s mood once born and likely her temperament. The risks of the pregnant woman’s emotional state to her pregnancy is common and found in other contexts, both historical and contemporary: In much of Euro-America it is commonplace to link a mother’s mood to foetal health, particularly stress and depression (i.e. Giscombé and Lobel 2005 and O’Connor et al. 2014) and is a recurrent theme on public forms, such as the popular UK website Mumsnet: i.e. [I] ‘was really worried that depression in pregnancy would affect the baby’s temperament’. In the British Victorian era pregnant women were advised to avoid strong emotions for fear of affecting the temperament and physical constitution of the child (Lupton 1999). Pregnant Amna discusses asabeya and the influence of a mother’s emotions on her children in utero, providing further insight into notions of influence: I believe if you get angry . . . sadness will affect the foetus and they said he will take his mother’s mood, yet when the baby becomes asabey . . . in my pregnancy with my daughter I was at the eighth month when my brother died Allah erhamu (God forgives him) – and truly I was severely affected . . . I thought with the amount I cried that my daughter will be . . . moody, but she is the quietest person in the house . . . even my mother was saying ‘God help this girl she breastfeeds from you and with this amount of sadness she will be very moody.’

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Amna explains that a woman’s emotional state affects the baby, but in her case her daughter was not affected by her shock at the death of her brother and her subsequent sadness. Amna’s refers to a widespread caution against breastfeeding when one is sad or upset, in order to avoid negative emotions transferring through breast milk to the nursing child. Similar understandings are found in Morocco where emotional state is one variable most associated with breast milk quality and women who are seen to be suffering from a spirit attack or illness are not to nurse (McPhee 2012: 133 and 139). Women are told not to breastfeed when tired, asbeya, angry or sad so as not to transmit these emotional states to the baby. There is, however, divided opinion about whether this is a valid concern or not. Breast milk is a powerful substance due to its importance for milk kinship, as first reported by Altorki (1980). Clarke states ‘Islamic law divides “kinship”, “qarabah” (“closeness”), into three parts: “nasab” (relations of filiation, “consanguinity” in anthropological terms), “musaharah” (relations through marriage, “alliance”) and “rida” (relations through breastfeeding, “milk kinship” in the anthropological literature). Regarding “rida”, kinship-type relations are instituted by suckling at the same breast, relations that include a prohibition on marriage . . . So an otherwise unrelated boy and girl, suckled by the same nurse, become milk brother and milk sister and cannot marry. Nor can the nurseling marry his or her nurse’ (2009:14; see McPhee 2012 for milk kinship in Morocco). Breast milk is important in terms of kinship and is linked to notions of maternal influence. Thus, influence is felt in utero but also through a mother’s role in raising children, including through breastfeeding.

Blame and culpability There is ambivalence towards blame and culpability related to miscarriage. This is due to the fact that it is often difficult to attach specific behaviours and activities to a miscarriage event, but also the cause of miscarriage typically remains unknown. Despite ambiguity, discussions of cause sometimes contain moral discourses concerning agency and culpability with the emergence of a narrative of others’ responsibility (see Omar et  al. 2019 for full discussion). Qatari women most commonly suggest that they are indirectly blamed for

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miscarriage with direct accusations being relatively rare. Women suggest that in explorations of cause, they might be asked about and indirectly accused of doing something that might have caused their miscarriage, such as not resting properly or carrying something heavy. Halima, Dana’s mother described that her daughter was accused by her husband’s family ‘in an indirect way’. In some cases, accusations are more direct. Thirty-year-old mother of two, Amna, reported that she had been blamed for her miscarriage: In my first miscarriage, everybody blamed me. They were sure that I did something wrong. I told them that the doctor said it was not my fault, but nobody believed me. They insisted that I had lifted something heavy or did something that caused the miscarriage.

Amna felt accused of doing something to harm her pregnancy. In her defence, she refers to the clinician who emphasized that she was not to blame. Whilst Amna suggests quite direct allegations, most women report more implicit and vague suggestions of responsibility. Women are able to employ religious and medical frameworks to defend themselves from such allegations. Both Moza and Noora’s accounts include references to ‘carelessness’. When Moza refers to carelessness she does so in discussion of general causes for miscarriage: a woman who does too much housework, becomes exhausted and does not take adequate care could be seen to cause her miscarriage. Both also suggest that women who do not seek and follow medical care may also be perceived as careless and responsible for their pregnancy ending. Noora suggests that perhaps she might be partially responsible because she tired herself by doing excessive housework in the absence of a maid, particularly when she had some bleeding. Not taking progesterone, as recommended, is similarly linked to careless behaviour. Her husband associates her miscarriage with her ‘carelessness’ in tiring herself. However, Noora deflects such feelings of responsibility and suggestions of blame by recourse to God’s will as the ultimate cause of miscarriage, but also with indirect suggestions that ultimately, she had no ability ‘to take it easy’. Narratives of blame and culpability are minimized by the knowledge that, ultimately, God determines their fate, granting health, illness or pregnancy loss, as when Noora responds to her own feelings or responsibility and accusations of carelessness with: ‘It is God’s wish for this embryo to implant in my womb; he destined that he won’t continue.’

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Concerns about carelessness were typically contextualized in terms of impossible expectations or lack of choice in undertaking the work, housework or activities in question. Theories of carelessness give Noora license to ‘take care more’ and be sure to rest and relax in future pregnancies as a preventative measure. Similarly, twenty-eight-year-old Ameena expressed concern to her clinician that she may have caused her first pregnancy to end in miscarriage: I even asked them if I have miscarried because of walking or moving or being exhausted. If it is because of walking or climbing the stairs, then, I have to be more careful next time, rest, take care of myself and relax.

Such concerns give her the resolve to rest and avoid certain activities in future. Such understandings reinforce cultural ideas about women needing to avoid strenuous and stressful activities when pregnant and to provide support for women who choose to do so. As there are certain responsibilities about self-care during pregnancy, those who felt they had not taken due care to rest and remain relaxed allude to concerns that they may have caused their miscarriage. Such sentiments of selfblame emerge mainly in discussions about work and the resulting tiredness as well as diabetes. Women who felt they had not followed medical and other diet advice about managing diabetes and minimizing its impact were vulnerable to feelings of guilt and concern that they had contributed to their miscarriage. Twenty-nine-year-old mother of one, Sara, a diabetic, was one of the few women to clearly articulate feelings of guilt in this way. Sara blamed herself for not following the strict medical guidance: I have a feeling that I caused the death of this baby; this is a secret that I didn’t tell to anybody before! [Why?] Because they said that the high glucose level is the cause and I wasn’t taking Insulin regularly.

However, instances of self-blame such as this were relatively unusual. Again, understandings of God’s will as the ultimate cause of miscarriage helped to quiet feelings of culpability. Discourses linking pregnancy loss with changes in lifestyle further dissipate notions of individual blame. Instead, culpability is placed on modernity for weakening bodies, particularly women’s bodies and their ability to reproduce; responsibility rests not with individuals, but with a

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changing society, as well as outside influences. Indigenous knowledge systems about inheritance, conception, foetal development and maternal influence are linked to notions of blame and responsibility for reproductive problems, including miscarriage.

Conclusions Pregnant bodies are perceived as vulnerable and permeable with threats revolving around dangers such as cleanliness, pollution and notions of depletion. Pregnancy is a susceptible state, where women are vulnerable to various and diffuse threats. Interlocutors speculate about what causes miscarriage both generally and in their specific case, but the reason often remains unknown, which creates ambiguity and ambivalence not only about cause but also responsibility. Advanced maternal age may be seen as a risk and may be similarly linked to ideas concerning depletion. However, the strains of age may also be difficult to avoid due to the expectation and obligation of producing large families. Women express concerns about their husbands acquiring additional wives to fulfil their reproductive aspirations and may wish to conceive despite concerns about their advanced age to avoid polygamy. Experiencing societal, marital and extended family pressure to have more children as well as their own desire to do so meant women seemed to minimize concerns about the link between age and reproductive problems, often referring to cases of older women they knew who had successfully conceived and given birth. Interlocutors speak about the importance of a woman’s emotional, psychological and physical state when pregnant. Women are to be vigilant against activities and experiences that might strain or deplete the pregnant body, particularly those that exhaust or exert it. Stress emerges as a primary cause with women speaking about work-related stress as well as those related to personal and family difficulties. In light of the escalating emphasis on education and employment, avoiding the risks associated with work can be difficult for pregnant women. Bodies are to be protected from the dangers threatening it: these may be linked with modernity, such as unhealthy diets and the demands of professional life. Exhaustion, exertion, physical movement and stress, particularly those related to professional activities, are commonly

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associated with miscarriage and point to frictions contained in the lived experience of Arab modernity for Qatari women. Interlocutors suggest that miscarriage is more common in contemporary Qatar and suggest several reasons for this. References to changes in daily life and how this may be impacting rates and incidence of miscarriage reflect concerns about modernity. Interlocutors discussed environmental changes such as pollution, X-rays and the impact of radiation from new technologies as well as changes to diet and a move towards a more sedentary lifestyle. There is a theory that women’s bodies are weaker and somehow reproductively challenged. Qataris spoke about their memories of pregnancy and birth being relatively straightforward and understood contemporary Qatari women as having more problems in producing healthy children. Previous generations were more reproductively robust and less likely to experience miscarriage, suggesting that contemporary Qatari bodies are negatively affected by developments in Qatari life. Associated with this discourse is the idea that modern bodies, particularly those of women, are more medicalized and require more help from doctors. Women are seen to be cossetted, which is seen as negatively impacting their ability to produce children. In this way, discourses of miscarriage, pregnancy and risk as well as altered reproduction can be interpreted as a critique of modernity (see Kanaaneh 2002 for similar arguments in Galilee). In particular, discussions about miscarriage reveal anxieties around women’s role in society, the pressures of balancing family and professional demands and the impact of such on reproduction. In this chapter I have briefly touched upon understandings of God’s will in relation to miscarriage, particularly in relation to its ability to protect one from accusations or feelings of culpability. The central role of God’s will in understanding what causes miscarriage will be more fully discussed in the next chapter, along with other mystical beings and forces.

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(Super)natural Forces and Miscarriage Cause Pregnant bodies are thought to be vulnerable and permeable, thus women are to be vigilant against activities and substances that might deplete, pollute or enter it. Body boundaries are to be monitored and protected from dangers that threaten; these threats may be linked with modernity, such as unhealthy diets and behaviours, but also include more diffuse dangers such as evil eye and jinn, which appear frequently in women’s accounts of reproductive difficulties. Ultimately, however, miscarriages are understood to be part of God’s will, just as God is responsible for all that happens in one’s life and the world. This understanding is linked to the broader role of Allah and Islam in Qatari daily life, which is omnipresent and the guiding principles of life and anchor one’s orientation to the future. Thus, God is also a means of protection from diffuse threats. Conversations are saturated with references to such influences; Islam governs the path Qataris take through the world and the afterlife, guiding daily life. Religion is ever-present in Qatar, with the world populated by heavenly, mystical and hidden forces, which inform understandings of miscarriage and other forms of illness and misfortune as well as their cure. Islam means ‘active submission to the will of God’, the religion teaches that Allah controls absolutely everything and, when making plans, you often hear the response ʾIn shāʾ Allāh (God willing). You will also hear La ilaha illa Allah, Mohammadun rasulu Allah (There’s no God but God, and Mohammed is his Prophet). Public worship is incredibly important: five times a day, the public call to prayer is broadcast from minarets throughout the city. The sound punctuates the rhythm of daily life in Qatar. If you are shopping on a Friday, guards will hurry you out before midday to ensure the doors are closed for Friday prayers. Although many large supermarkets only close for an hour, the requirement, by a new law passed in 2015, which introduced greater fines for those who do not, 121

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is for all commercial outlets to close for ninety minutes during Friday prayers. Our interviews were sometimes interrupted by the call to prayer and the woman would excuse herself to pray or they were arranged around prayer schedules. Islam also sets the yearly rhythms with a number of festivals and holidays observed. The annual observance of Ramadan is considered one of the five pillars of Islam and alters daily life in Qatar during this period. During Ramadan, it is illegal to eat or drink in public from dawn to sunset. Religious proscriptions also extend to other practies around consumption: Drinking alcohol in public is illegal, although it is possible to consume alcohol in the larger hotels and in the privacy of your home if you have obtained a license to do so. Whilst pork is available, its sale, like alcohol, is strictly controlled by the state and, indeed, can only be purchased at the same government-run outlet. Although considerably more liberal than many of its neighbours and one of the least conservative emirates in the region (Clinton, 2011), Qatar is the only country other than Saudi Arabia to espouse Wahhabism as its official state religion, distinguishing it religiously from other Gulf states, and resulting in an uneasy alliance with Saudi Arabia, which has recently become damaged. Less strictly enforced in Qatar, Wahhabism is an orthodox Sunni Muslim sect founded by Muhammad ibn Abd al-Wahhab (1703–92). It advocates a return to the early Islam of the Quran and Sunna, rejecting later innovations. Like Qatar, the ruling families of Qatar’s neighbours Bahrain, Kuwait and UAE favour Sunni Islam, but follow different schools of Islamic law. Whereas Qatar and Saudi Arabia follow the Hanbali school, their neighbours follow the Mālikī school, the latter of which has also retained its dominance throughout North and West Africa, including Morocco. The Mālikī madhab differs from the other three major Sunni schools of law most notably in the sources it uses for derivation of rulings. Like all Sunni schools of Sharia, the Mālikī school uses the Quran as primary source, followed by the sayings, customs/traditions and practices of Muhammad, transmitted as hadiths; but unlike the others, it also considers the consensus of the people of Medina to be a valid source of law. In the Mālikī school, this tradition includes not only what was recorded in hadiths, but also the legal rulings of the four rightly guided caliphs – especially Umar. Despite being of the same Wahhabi and Hanbali branch, the role of religion at a political level in Qatar and Saudi Arabia differs markedly. Referring to Baskan and Wright (2011: 96), Caeiro (2018) reflects that, politically, Qatar has

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a secular character more comparable to Turkey than Saudi Arabia, a difference due mainly to the lack of an indigenous Ulama class within Qatar. The leading religious scholar in the country, Yusuf al Qaradawi who was granted Qatari nationality, was originally from Egypt. Qaradawi hosts a popular show, “Shariah and Life”, on Al Jazeera, to which interlocutors sometimes referred. Religion is ever present with religious references and writings found everywhere. However, there is no religious police force, unlike in Saudi Arabia, where the mutawwa’in (religious police) are tasked with making sure that men and women comply with Islamic dress code, behave morally in public and close all businesses during prayer times (Baskan and Wright 2011: 97 in Caeiro 2018). The government arm responsible for ‘ensuring that all areas of modern life comply with the principles of Islam’ and which sets religious policy is the Ministry of Awqâf, the country’s ministry of religious endowments and Islamic affairs, which was created in 1993. Attached to this is Qatar’s Centre for Religious Da’wa and Guidance, which establishes fatwā and provides people with direct guidance and advice. The world’s largest online fatwā bank, Islamweb, is attached to the ministry and is Qatar’s only authorized fatwā body (Caeiro 2018).

God gives and God takes God plays the central role in explanations of illness and misfortune, with miscarriage being a part of this broader framework. During my time in Qatar, I heard people refer to the well-known hadith, ‘Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically, but use nothing unlawful’ (Abu Dawud): this informs Qatari understandings of illness. Hwang and colleagues explored how such understandings impacted perceptions and behaviours around breast cancer. They found that ‘both breast cancer and the cure are given by Allah’ was a prevalent understanding in Qatar (2017: 718) and informed women’s engagement with screening programmes. In some cases, such knowledge was constraining, but in others it facilitated screening and/or treatment, depending on women’s interpretations. Whilst some might not seek medical interventions, leaving it instead in God’s hands, others interpret the hadith as God’s will in causing the disease, but also providing the specific cure by such medical

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intervention (Hwang et al 2017). Women’s responses to miscarriage are similarly derived from these understandings: God caused the miscarriage and it was meant to be, but medical care and treatment may be required to rectify it. God would also ensure a cure, leading women to be optimistic about their future reproduction. God knows why a particular condition occurred and it is God who decides whether someone is healthy or unwell, lives or dies (Shaw and Hurst 2008). Pragmatic or scientific explanations are held simultaneously with attributions of a misfortune to forces beyond human understanding, something not unique to Muslims (Shaw and Hurst 2008; Panter-Brick 1991; Foster 1976; Evans-Pritchard 1976). God’s will is the ultimate cause, whilst other natural or immediate causes may also be considered. Interlocutors were unanimous in their understanding of God’s will as the ultimate cause of miscarriage. In her considerations of what caused her miscarriage, Noora returns to the one cause about which all interlocutors agree: Our religion makes us accept what happened to us. I mean, my husband was telling me: ‘You were careless, you tired yourself ’ and I always tell them, ‘It is God’s wish for this embryo to implant in my womb; he destined that he won’t continue, khalas (that’s it)’. Though I wanted this baby, I am totally convinced that God meant good for me: maybe if the pregnancy continued the baby will be born abnormal or may cause harm to me. The minute I got pregnant I was praying for this pregnancy to continue if the baby is good for me and therefore, I was completely sure that the loss of this baby was for my best, alh.amdulillāh.

Noora is certain that the miscarriage was due to God’s will; the baby she was carrying was not meant to be. The loss is part of God’s plan for her, protecting her from future and more considerable harm. She emphasizes this to her husband and others when they suggest she may have been responsible for the miscarriage. The centrality of God’s will in miscarriage cause provides a way of deflecting accusations or feelings of blame. Forty-two-year-old mother-of-one Khoulood who had recently miscarried explains that there is meaning behind God’s decision to end her pregnancy: Allah’s decision is always good. Allah knows his people and what is good for them and what is not. Allah saw that this baby is not good for me, so he took it back . . . He may have been meant to be abnormal or disabled or may grow

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up to be a tyrant and will kill me or kill his father or he may grow up to be a corrupted person. There must be wisdom of his death. I believe in Allah and I accept whatever comes from him.

Knowing what is best for the person, God bestows and withdraws. Khoulood sees wisdom in God’s decision to prevent the pregnancy from continuing and sees it as for her benefit. She explains that if the baby had been born, perhaps he or she would have been born with disabilities or cause strife within the family; in this way the miscarriage is seen as protecting her and her family from future heartache or misfortune. In this specific way, or by referring to a more general sense of the miscarriage being part of God’s overall plan, the miscarriage is understood as having meaning which is ultimately for the good. Her faith leads to acceptance of ‘whatever’ comes from God, including the end of her pregnancy. Interlocutors refer to qadr, a decree or preordainment of God, as Huda does in describing her miscarriage as qadar (destiny) qadar Allah Katboh (that has been decided before by Allah). Such a framework provides meaning in the loss and situates it in the broader context of their lives, which is ultimately determined by God. Huda explained that her faith has been strengthened by the experience. For some, miscarriage and other reproductive losses are interpreted as proof of God’s love for them, for He only tests those He loves, as was articulated by Dana. When the twenty-nine-year-old, stay-at-home mother-of-two underwent a scan during a routine appointment at twelve weeks’ gestation, she was shocked to receive news that the baby had stopped developing at seven weeks and that a heartbeat could not be detected. The clinician who diagnosed her miscarriage advised Dana to wait for the miscarriage to complete naturally. Twelve days later she began to experience light bleeding and cramping; when the pain became more intense that evening, she returned to hospital: I came to the ER . . . the doctor asked me if I saw anything, but I was scared; there was so much blood everywhere. There were pieces of tissue, but I didn’t know what it was. When I came here the doctor examined me and removed some blood clots so the bleeding became normal. They were planning on doing a DNC but the bleeding decreased and they were very busy with other urgent cases so they decided to send me to the ward. They did an ultrasound again and everything was normal so they told me that they will release me soon.

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Dana had avoided further intervention beyond the clinician manually removing tissue. As she describes her experience, she burst into tears, explaining that before she was very happy, but her life seemed so perfect that it made her wonder if God was shunning her: I thought Allah didn’t like me because he is not testing me and he is giving me everything: my husband loves me a lot and I am very happy with him and mā shāʾa llāhu1 (God has willed it) I have two lovely kids, a boy and a girl. They are very polite, very obedient and very smart so I told myself, ‘Certainly Allah doesn’t like me because he is not testing me’ and when this happened to me I realised that it is a test from Allah, alh.amdulillāh.

Feeling blessed by a good life with a loving husband, a happy marriage, lovely and well-behaved children and a balanced family, Dana had worried that her fortunate position pointed to a lack of love from Allah. It would seem He was not testing her and it is known that God tests those He loves the most. When she experiences her miscarriages, Dana initially wondered why she was so unfortunate, particularly in addition to the loss of her son; she worried that something was wrong with her. However, she then realized that her misfortune was a test from God, allowing her to find meaning in the loss. Miscarriage is an ordeal set by God; Huda similarly describes her miscarriage as a trial: ʾIn shāʾ Allāh it is all ibtila’a [a trial, a tribulation] from God that we will be rewarded for later on and Al mo’min (the believer) if he encounters disasters will become closer to God and pray to him.

Samia, a thirty-three-year-old woman, the mother of four sons, had recently experienced her first miscarriage. When a scan revealed that Samia’s foetus no longer had a heartbeat she was shocked: after five previous uneventful pregnancies, she was not anticipating any adversity. Demanding a reason for the miscarriage, she questioned the doctor, who replied: ‘This is from Allah’, to which Samia angrily replied: ‘Doctor, I know that everything is from Allah, but there must be a reason and you have to tell me what is the reason?’ Samia shared with her doctor the religious framework of God’s will as the cause of ‘everything’, including her miscarriage, but Samia was seeking understanding of the specific, immediate or natural cause. Understanding of God’s will as the

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ultimate cause does not preclude an interest in other causes with both typically being held simultaneously. In the immediate aftermath of the miscarriage, Samia was angry and sought to know the reason for it, but she said that her anger soon abated, she ‘calmed down’ as she accepted God’s plan; her doctor’s reminder that her miscarriage was ‘from Allah’ was helpful in finding comfort. Asking Allah to forgive her, she read prayers, which helped to relieve her worries and ease her anxieties, ‘and then I relaxed. I felt joy and peace’. Acceptance and acknowledgement of God’s hand in her miscarriage and that it was part of a wider plan for her life brought Samia consolation. Many women reported their faith had strengthened through the experience of miscarriage, describing themselves as feeling closer to God, their faith bringing them comfort. The knowledge that this is part of their destiny and of God’s wisdom for what is best for them allows for acceptance and provides reassurance. The role of God also provides a means to assuage feelings of culpability. Some women report ‘foetal abnormalities’ (10 per cent) or ‘genetic or chromosomal abnormalities’ (15 per cent) as causing miscarriage, with such cause entwined with discussions of God’s will. Interlocutors who refer to foetal or chromosomal abnormalities commonly refer to information received from clinicians, a hospital flyer, and/or from the internet. Most early miscarriages are caused by genetic abnormalities (Choi et  al. 2014; Romero et  al. 2015; American Pregnancy Association 2016; Phillipp et  al. 2003), something commonly communicated to women by health professionals, as illustrated by a clinician interview: International studies prove that 60 per cent of miscarriages are due to abnormalities and, for me, I believe that this is from God because if all the 60 per cent didn’t abort, imagine how much the number of abnormal human beings would be living on the Earth. Once I tell the patient this, she becomes quiet and she thanks God.

This Muslim clinician emphasizes foetal abnormality but entwines this with knowledge of God’s will as the ultimate cause of miscarriage. His statement is illustrative of the biomedical perspective, which views miscarriage as a healthy response to a faulty embryo whilst also reinforcing religious understandings of miscarriage as Allah’s will. Furthermore, his explanation is indicative of the way in which God’s role in such misfortune is merciful.

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The issue of foetal abnormality in Qatar is complicated by the prevalence of consanguinity and the public health discourse around its potential risks (Kilshaw 2018; Kilshaw et  al. 2015). However, cousin marriage does not appear as a concern amongst interlocutors. Previous research (Kilshaw et  al. 2015; Kilshaw 2018) revealed that the foetal environment and God’s will are more influential in explanations for illness and disability in children than the risks associated with consanguinity. As one interlocutor explains: We believe that it is all from God and whether the baby is normal or not is God’s decision at the end! We see people who are not relatives and their children are abnormal.

Working in a school for disabled children, this woman is familiar with discussions of risk and consanguinity and is the only interlocutor to discuss cousin marriage as a possible risk of miscarriage. She explains that ultimately it is God’s decision and that abnormalities may occur in those who are related, but also in those who are unrelated. Discussions reveal that it is God’s will as to whether a foetus will have or develop a disability, but also God who decides whether such a pregnancy will continue. In cases of miscarriage, God is merciful by preventing a disabled or ill foetus from being born, as Fatima, a thirty-nine-year-old university educated mother of four who had recently had her third miscarriage suggests: ‘Maybe there is abnormality with the foetus for example . . . it is . . . from God, God didn’t want him to live.’ Understanding God’s will as the ultimate cause, Fatima remains uncertain about the specific cause of her miscarriage particularly because she did not do anything known to cause miscarriage. Stating that she ‘didn’t feel tired’ during her pregnancy, Fatima had avoided known risks such as strenuous activity and exhaustion and, thus, she remains uncertain as to what could have caused her miscarriage. She speculates that her age may have contributed to the miscarriage. The major factor underlying chromosomal anomalies leading to miscarriage is, indeed, the effect of maternal age (Dunson et al. 2002; Kroon et al. 2011), but the cause is typically unknown in the vast majority of cases. Such uncertainty leads women to consider a range of possible pragmatic and natural causes, whilst remaining certain of the central role of God’s will.

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Jinn possession Jinn are common suspects in events of reproductive misfortune. Often referred to in relation to infertility and other pregnancy complications, three interlocutors spoke about jinn in relation to miscarriage. In Islamic cosmology, a jinn (pl. jnun) is a supernatural being that exists in the eaalam al-ghaib (the invisible world), that is closest to ad-dunia (the material realm of the universe where humans reside) (McPhee 2012: 43). Although jnun are neither good nor evil by nature, they act as pathogenic agents when humans disturb or offend them. In Arabic and Islamic mythology, they are creatures known to cause mischief and misfortune. Meaning ‘concealed’ or ‘hidden’, jinn are associated with both physical and metaphorical darkness as well as the inability to see, for example, jinn allayl (darkness of the night) (Parkhurst 2013: 66). The notion of ‘concealment’ leads to a ‘cascade of vocabulary’ that is relevant to the subject of miscarriage, in that janoon (foetus) indicates a ‘concealed’ or ‘secret’ human, but also hinting that the sex of the child remains unknown, so the foetus remains a mystery (Parkhust 2013:69). When interlocutors spoke about jinn, they were quick to point out that they are mentioned in the Quran and the Sunnah, providing religious legitimacy for belief in their reality. ‘Indeed, we created man from dried clay of black smooth mud. And We created the Jinn before that from the smokeless flame of fire’ (Surah Al-Hijr 15: 26–7). In 2017, jinn gained a media presence when a correspondent from Al Arabiya, the Saudi-owned pan-Arab television channel based in Dubai accused Qatar of hiring sorcerers to conjure jnun to end the Gulf crisis. Whilst Twitter erupted in humorous memes and responses, in reality it was a serious accusation given that practising sorcery is a serious offence in the Gulf, punishable by a prison sentence of three to fifteen years and/ or a maximum fine of QR200,000 in Qatar (Khatri 2017). Jinn may enter a human to cause mischief, as was the case with thirty-threeyear-old Haleema, who recently suffered her second miscarriage. She claimed an amorous jinn visited her in her dreams and caused the death of her baby to alienate her from her husband. There are a number of possible conditions under which a woman may become possessed or impregnated by a jinn; in most cases, it is due to a woman’s failure to observe particular norms, protective rituals or activities regarding nudity and the openness of the body, including

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saying bismillah (in the name of God) before removing her clothes or bathing (Newman 2018a: 209), which renders her vulnerable to possession by enamoured jinn. According to her sister, Khoulood’s miscarriage occurred when she stopped reciting the Quran and rubbing her belly with blessed oil. Ceasing these practices allowed a jinn to enter her womb and remain there: If a jinn is settled in the uterus it will prevent pregnancy. Many people are possessed and this possession causes them to miscarry so they seek help from religious leaders and from Quran . . . Possession means jinn controlling the person either by magic sihr or by the eye . . . sometimes the jinn that possessed you is caused by evil eye.

Herbalists and religious healers provide treatment for women suffering jinn possession and reproductive problems, including ‘lost’ and irregular periods (Newman 2018a: 209) or infertility. In the same way that beliefs stress the permeability of pregnant bodies and their interaction with the environment surrounding them, jinn possession indicates an understanding of women’s reproductive bodies as susceptible to infiltration and influence (Newman 2018). Problems in a pregnancy or in a child once born are commonly blamed on the mother’s actions during pregnancy (see also Rozario 2013), particularly in relation to attracting jinn as a result of some bad or careless behaviour in a variety of Muslim contexts, including amongst British Pakistanis (see Shaw 2000: 209–212; Shaw and Hurst 2008). Pregnant women are particularly vulnerable to jinn and should protect themselves by reciting prayers, remembering Allah and not behaving in ways that might attract them.

Hit by the eye As Khoulood’s sister outlines, there are connections between jinn, possession, magic and evil eye. Indeed, a common cause of miscarriage is evil eye, with 33 per cent of interlocutors referring to it. Evil eye is cast, often by women, ‘who may be jealous, envious or simply wicked, and who intentionally or unintentionally harm’ by a glance (Panter-Brick 1991). Belief in evil eye is prevalent throughout the Middle East (Spooner 1997; Ibrahim and Cole. 1978; Meleis and Sorrell 1981) and the eye is a particular concern for fertility and

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reproduction. Pregnant women are vulnerable by their very nature: their pregnancy illustrates their fertility, which because of its high value may attract the envy of others less fortunate. This pattern fits anthropological descriptions of how lines of spiritual accusation follow lines of social tension, as with EvansPritchard’s (1976) discussions of Zande witchcraft whilst also reflecting the centrality of reproduction in Qatari society (see Qureshi 2020). Saharans in Morocco worry about the dangers caused by social imbalance at the time of a child’s birth, for expressions of admiration and envy have the power to cause harm through evil eye (McPhee 2012). Primarily concerned with issues of vulnerability and protection, Saharans in Morocco were particularly vigilant around liminal moments of life transition, as we would expect (McPhee 2012: 42). Protective devices were used around these events, such as pregnancy and birth, but there was a sense of ever-present liminality because of the constant presence of the evil eye. A sheikh, a religious scholar, we spoke to who specializes in reproductive issues, confirms the prevalence of evil eye in illness causation, including miscarriage: The eye is real and it has been narrated in ‘hadiths’ that the eye may lead a man to the grave or the camel to the pan (it may cause the death of someone and make the impossible things possible) . . . But definitely, a woman with many births could be cursed especially if another woman who is infertile looked at her belly, so she may eventually miscarry. Absolutely, the evil eye is like an arrow that comes out of the eye of the jealous person.

The sheikh acknowledges the role of evil eye in miscarriage, noting that fertile women attract evil eye, re-iterating what other interlocutors report: envious, but often unaware, infertile women are the most common source of evil eye. The husband of Khadeeja, a twenty-eight-year-old mother of six, who had miscarried, concurred: ‘the evil eye is from an infertile woman’. Khadeeja added: Yes, from an infertile woman. Nowadays infertility has increased and the chances to become pregnant have decreased, therefore, someone who is not getting pregnant may yeseeb bel ain (hit by the eye) a pregnant woman.

Khadeeja asserts not only that infertile women are the source of evil eye and, thus, a danger, but also that infertility is more common now and contemporary Qatari women are less likely to conceive. She reiterates the link between

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modernity and diminished reproduction and, by association, an increase in evil eye and risks to pregnant women. Not only is evil eye central to miscarriage causation, but it is also implicated in other reproductive difficulties, such as infertility, pregnancy complications and difficult labour. Forty-one-year-old pregnant Hamda works full time as a manager in a hospital. Eager to add to her brood of seven children, she worries about the threat that evil eye presents to her pregnancy, particularly as she had miscarried previously: The only thing that scares me is evil eye . . . People always talk. They say, ‘she works and gives birth to more kids and she is also taking care of them’. Honestly, I worry a lot.

Hamda is concerned that her fertility, as demonstrated not only by her pregnancy but her large family, attracts jealousy and gossip, which may result in evil eye. Her success as a working mother makes her vulnerable. After six previous ‘very easy’ deliveries, Hamda’s most recent birth experience was protracted and difficult, something she attributes to evil eye caused by jealousy over her record of straightforward births: I had contractions for three days before I gave birth to my last baby and it is all from other people’s eyes . . . I always say if it weren’t because of the evil eye and how difficult it is to raise children and take care of their studies these days, I would get as many children as I can because I love children. I believe that I had troubles in my last pregnancy because of the evil eye.

The third time we met with Hamda she was in hospital with pregnancy complications, which she understood to have been caused by evil eye: Hamda’s ability to become pregnant easily, her large family and her ability to care effectively for her children despite working and travelling attracted jealousy, which resulted in evil eye, as did her large house and wealth. Keeping her children close and well provided for made her vulnerable to the envy of others. Demonstrations of success and of surpassing expectations and ideals of Qatari womanhood left her exposed. Her fertility, her reproductive success, her accomplished mothering and affluence made her vulnerable to evil eye. To prevent evil eye, upon seeing someone or something that pleases, one should say maa shaa-Allah (God wills it) and then pray to Allah to bless that person or thing. Women try to prevent envy as a form of protection: McPhee (2012:

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111) found Moroccan pregnant women employed a strategy of interiority to prevent social imbalance that may result in envy, not sharing good news and/ or downplaying are forms of protection. Whilst evil eye is prevalent, a small number of interlocutors suggested inconsistency of belief, including forty-four-year-old mother of six Sameera who explains miscarriage is often attributed to evil eye: Yes, they say it is evil eye . . . but in general, people are educated now, and they know that there must be a reason that has caused the miscarriage. They suggest ruqyah to treat evil eye. Old people believe in evil eye; they worry more.

Ruqyah, a cure or protection from evil eye, involves the recitation of certain verses from the Quran either by themselves or with treatment from a religious person, a motawa or sheikh. The words may be spoken or written for the purpose of protection or cure and may be accompanied by other action, such as wiping or blowing over the object/ body part to which it is applied. Qataris wear amulets and protect themselves from evil eye by ruqyah. Whilst pregnancy is highly medicalized, the use of traditional and religious healers and medicine was commonly used. A bricolage of modernity where medical science is highly fetishized and pursued while traditional medicine continues to be tolerated has been reported in other parts of the region and seems particularly evident in practices around reproduction (i.e. Kanaaneh 2002 in Galilee). Reiss notes ‘traditional practice was evidently most persistent with regard to pregnancy and birth’ amongst Arab peasants in Israel (1991:47 in Kanaaneh 2002: 226). Noting that people turn to traditional ways when modern medicine does not help, Kanaaneh describes Galilee healers reading prayers and writing amulets to ward off the evil eye, cure diseases, help women conceive and have successful pregnancies (2002: 225). Sameera, who had recently experienced her second miscarriage, implies that as individuals become more educated they see ‘reasons’ for miscarriage other than evil eye. She suggests her mother and the older generation are more anxious about it. The sheikh introduced above similarly suggests that people sometimes ‘exaggerate’ the pervasiveness of evil eye: They refer any problem that happens to them to the eye, though it may be due to other reasons. For example, maybe it is our unhealthy food that is causing the problem.

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The sheikh, Sameera and a small number of interlocutors suggest that some people, especially older people or those who are uneducated overlook other possible causes of ill health, an association, which is part of a wider discourse around the perception of such beliefs as old fashioned. As a result of these associations, discussions about evil eye can be sensitive despite its prevalence. The complexity of such discourse is reflected in an incident that occurred during a presentation by our research team at an international medical conference. Focusing on explanations of miscarriage cause amongst Qataris, the presentation included the key points contained in this chapter. In the audience were a small number of Qatari health professionals who were critical of the presentation: their main disapproval was that they felt it portrayed Qataris as backward in emphasizing the role of evil eye in explanations of cause. As a nation intent on presenting itself as modern, traditional ideas such as evil eye can be treated with ambivalence. In light of this, the ease with which women speak about evil eye in relation to miscarriage and infertility and the widespread concern about it is noteworthy.

Protecting oneself: the art of concealment Once a pregnancy becomes known it is vulnerable and at risk from evil eye, thus women may choose to protect themselves by not disclosing their pregnancy, particularly in some social environments. Qatari women may choose not to reveal their pregnancy, but there was a wide degree of variation in this practice. This may be due to variations in terms of vulnerability, as McPhee (2012: 111) found in Morocco: the interpretation of when a mother was socially and physically (i.e. in terms of gestation) vulnerable to the danger of envy could fluctuate over the course of the pregnancy. Thus, the art of concealment might relate to intensity of vulnerability or to the social interactions themselves. Huda refers to ‘the eye’ as a cause of miscarriage, describing her sister’s warnings to protect herself from such dangers. When Huda disclosed her pregnancy to her sister, a doctor, she advised her to refrain from telling anyone about her pregnancy: ‘Keep silent till you are sure that everything is fine’, she said. At first, it appears as though perhaps her clinician sister was merely

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recommending that she refrain from announcing her pregnancy until after the tentative first trimester. However, we asked Huda why her sister suggested such non-disclosure, Huda responded: It is just a belief among us, as you know about evil eye and these things. They also say that fazat al qalb [the sudden response] from other people when you inform them that you are pregnant and al shahqua (gasping in awe or surprise) is not good . . . it is considered a bad luck, subh.ānallāh (God is perfect). After three months they consider that you have passed the risky period and that your pregnancy is stable; but at the beginning you shouldn’t tell that you are pregnant to avoid being cursed by other people.

The ‘risky’ and uncertain period of the first trimester, when miscarriages are more common, is associated with a period of increased vulnerability, particularly to evil eye and the actions of others. Huda includes in this the impact of the sharp intake of breath that sometimes accompanies a response to surprising news. Once the pregnancy ‘is stable’, after the first three months have passed, it is less vulnerable and, thus, its disclosure is more prudent. Sameera was similarly told, ‘Don’t tell anybody!’ by her mother upon learning of her pregnancy, which Sameera attributes her mother’s antiquated ideas about the prevalence and severity of the risk of evil eye. In her discussion of concealment, Huda refers to being cursed by others and later in the conversation she speaks about the power of magic. Explaining that it is ‘common knowledge’ that maids are known to perform magic and are sources of harm for their employers. Discussions of domestic workers as being threatening, particularly in relation to magic and pregnancy, is linked to wider national anxieties about the influence of outsiders, as discussed in Chapter Nine. Awatif, a thirty-six-year-old with four children, reports that her miscarriage occurred immediately after her parents and in-laws came to know about her pregnancy: The problem is if people know that I am pregnant, something wrong will happen to me, if anyone talked about my pregnancy I am sure something bad will happen to me.

Awatif associates her miscarriage with other’s knowledge of her pregnancy. It is not uncommon for women to resist publicizing their pregnancies. Whilst

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there is the suggestion that some people over-emphasize the role of evil eye, particularly the older generation, it emerged as a dominant concern for many interlocutors and led some women to not disclose early pregnancy for fear of attracting it (Kridli et  al. 2013). In her explorations of the art of household protections undertaken by pregnant women and their infants amongst Saharans in Morocco, McPhee (2012) found that young brides in the past were afraid to say they were pregnant, middle-aged and senior women had disguised their pregnancies under loose clothing. The explanation given for such concealment was because they were ashamed to reveal a pregnancy to in-laws (and by extension any more distant relatives or others) despite the high value placed on children (McPhee 2012:110). Such shame was derived from the association between pregnancy and sexual relations, a subject that transgressed principles of purity, social respect and modesty but it was also strongly associated with protecting vulnerable pregnancies from the diffuse threats of evil eye. The shameful connotations of pregnancy and, by association miscarriage, was also linked to non-disclosure and concealment amongst Qatari women, particularly in certain social environments. Whilst there was variation in relation to disclosure and concealment of pregnancy related to levels of vulnerability as well as social environment, there was one environment where Qatari women commonly did not disclose their pregnancy: the workplace. Cultural norms dictate that women do not talk about sex and sexuality openly with men. Due to practices linked to modesty and shame, in certain contexts such as work environments, pregnancy and miscarriage were not commonly disclosed or discussed. Thus, the practice of non-disclosure and concealment of pregnancy and miscarriage is due to various negotiations of vulnerabilities and tensions including principles of modesty and shame: Concealment and delicate revelation of pregnancy can be less about modesty and privacy and more – or as much – about the dangers of too much visibility. Good and auspicious things are attractive to threatening gazes, to the power of nazar [the evil eye]. Pinto 2008: 160

Pinto’s exploration of pregnancy loss reveals that whilst concealment and layered disclosure of pregnancy may be related to modesty and privacy in

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Northern India, it is just as much about the dangers of visibility and pregnancy as a state attracting the envious gazes of others. This sense of vulnerability during pregnancy in Northern India prompts women, in the face of the threat of spiritual malevolence, to hide their pregnancies (Pinto 2008). Qureshi (2020) takes forward Jeffery and Jeffery (1996) and Pinto’s (2008) observations of precarity of early pregnancy and the practice of concealment but notes changes in the recognition of pregnancy associated with an increasingly medicalized diagnosis. However, she highlights the continued precariousness of pregnancy and the importance of acts of concealment, in contexts such as Northern India and Pakistan where women’s menstrual cycles are surveilled and diffuse malevolent dangers are ever present. Concealing pregnancies to protect the mother and foetus from the harmful gaze of an envious neighbour or visitor has been reported by anthropologists in countries including Malawi Mozambique (Chapman 2006), Malawi (Launiala and Hondasalo 2010) and Morocco (McPhee 2012). Pregnancies might be concealed because of the dangers of conspicuousness (Pinto 2008; McPhee 2012). Whilst Qatari women often choose not to discuss or disclose their pregnancies or miscarriages in some (mixed) environments, Qatari miscarriage is otherwise dealt with relatively openly: women report being aware of others who have miscarried and may speak to other women about their loss, a finding which contradicts those of Kridli and colleagues (2012). High fertility rates mean that women and those around them have greater exposure to unsuccessful reproductive events, with miscarriage being understood as not uncommon. Whilst pregnancy makes one vulnerable because of the envy it may attract, women who miscarry are not vulnerable in the same way – there is no longer a pregnancy to be protected from diffuse threats.

Conclusions Although women did not directly speak of blame or responsibility in relation to evil eye or jinn there is a complex interaction with such causes and notions of culpability. Careless or immodest behaviour may attract jinn, which then may cause miscarriage. However, interlocutors were not explicit about this and discussions around evil eye focused on suggestions that women were

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innocent targets, typically due only to their fertility and very state of being pregnant. Of course, narratives of blame and culpability are minimized by the knowledge that, ultimately, God determines whether a pregnancy ends. Body boundaries should be monitored and protected, particularly during vulnerable states such as pregnancy. Pregnant bodies are understood to be vulnerable and permeable and must be protected from dangers that threaten them: these dangers may be linked to modernity, such as unhealthy diets and behaviours, but also associated with diffuse and ever-present supernatural perils such as evil eye and jinn. Miscarriage or other reproductive problems may arise when boundaries are traversed by evil eye or other dangers. Boundaries involve body boundaries, but also those around social networks and borders around groups and may represent lines of tension or networks of care (Qureshi 2020; Kilshaw 2020a). Causes of miscarriage are numerous and speculative. Whilst the previous chapter focused on notions of maternal influence and the threats to vulnerable pregnancies such as physical and emotional exertion or stress, this chapter has focused on the invisible forces beyond human understanding that play a dominant role in making sense of illness including reproductive problems. Whilst possession by jinn and magic are associated with infertility and recurrent miscarriage, evil eye is more commonly associated with miscarriage. Pregnancy makes a woman vulnerable to evil eye, for it demonstrates her fertility and may attract the attentions of a jealous, possibly infertile, woman. Thus, pregnancies may not be advertised and may be concealed so as not to attract negative attention. Interlocutors most often refer to the role of God in explanations of cause. Miscarriage is commonly understood as caused by God: it happened for a reason and may be part of a process of trial through hardship, pointing to the centrality of faith and Islam in Qatari explanatory models. God’s will is the ultimate cause with additional possible causes: a common philosophy of attributing cause to illness and misfortune (Shaw and Hurst 2008; Panter-Brick 1991; Evans-Pritchard 1976). Understanding miscarriage as part of God’s plan helps to minimize feelings of blame and also helps to make sense of the loss.

7

The Foetus: Burials, Babies, Birds and Imaginings

We met Nouf on the day after she miscarried. Quietly describing how a routine scan had detected that her baby had died she said she waited for the miscarriage to complete naturally, but when no bleeding had occurred after a few weeks, she was admitted to the hospital and given a combination of pills and vaginal pessaries to stimulate her uterus to expel the pregnancy tissues. As she passed tissues and blood, she saw the foetus, which was quickly dispatched to the histopathology lab. After speaking to Nouf, I was curious about the path foetuses travel after they leave a woman’s body (see Kilshaw 2017). We began following the journey a miscarried foetus takes by walking through the hospital corridors to the histopathology lab where we were welcomed by women in white coats who removed a foetus from a white plastic container and laid it carefully out on a blue mat. As they handled the grey entity, they explained how they examine the body and look for signs of deformity or pathology in an attempt to uncover the reason for its demise. When a woman miscarries, the products are taken to the lab for examination before continuing on their journey, but where does the foetus travel after the investigation here had been completed? We were directed to walk a few yards to the mortuary. Here we meet Dr Ali who takes us to the mortuary. As he explains the procedures for handling bodies and body parts, including pregnancy remains, he shows us a number of small, neatly wrapped, blue and white plastic encased packages, labelled with a woman’s name (the mother) or ‘baby of ’ and the woman’s name. Those labelled ‘baby of ’, foetuses of over twenty-two weeks’ gestation, require official documentation: a birth and death certificate, as well as a burial request (Kilshaw 2017a). The family are required to name it, claim the body and take responsibility for burial. Describing the contents of the other packages, 139

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Dr Ali explains: ‘The foetus was not a living thing so it is sent as a sample or tissue of the mother’. If the remains are not collected within a few weeks the hospital will bury them. The materials are taken to the graveyard, accompanied by an official hospital request form, which says: ‘Kindly bury the dead foetuses and the remnants of body parts that are listed in this letter’. A list accompanies the consignment, which includes details of the individual contents. The body parts, tissues and materials are listed with the name of the person to which it belonged and a separate list details the foetuses: ‘baby of ’, the gestational age and sex, if known. Foetuses, regardless of gestational age, will be buried, just as all other tissues and body parts are buried. We were intrigued to explore more about the treatment of pregnancy remains and observe how they were disposed of, along with other understandings of foetuses in various contexts. This chapter focuses on foetuses in different contexts to better understand pregnancy loss. During fieldwork we encountered living and dead foetuses in different places, imaginings and materialities: in bodies (both pregnant and miscarrying), in plastic containers, on TV screens in the sonography suite, as images on smart phones, on dissection mats. ‘The way these are represented or imagined is informed by the ways they are “located”: in the womb, on a scan, being prayed over in the mosque’ (Kilshaw 2017a:192). ‘The foetus is made into certain realities by its specific location in the body, in the social world and in the cosmology’ (Kilshaw 2017a:192). How do women and their family members perceive the foetus and how are they informed by legal, religious and medical discourses? A foetus is made into being by the different practices around it. Medical, religious, legal and personal definitions inform the production of the thing (i.e. baby, tissue, no-thing). Categories of foetal personhood and notions of existence of a particular entity with a distinct identity (Michaels and Morgan 1999: 5) impact understandings of miscarriage. How life before birth is perceived informs experience of the end of such life. The specific nature of miscarriage is shaped by definitions and categories of what has been lost and the meaning ascribed to them. The foetus is uniquely symbolic and yet innately fluid and flexible: attempts to create categories to contain it may be contradictory or create tensions. The miscarried foetus is a source of the profoundest ambiguity: the way the material of pregnancy, specifically in the aftermath of miscarriage, is handled, managed

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and disposed of provides insight about how society perceives pregnancy loss. The way these entities are considered subsequently informs how they are interacted with and yet the practices around their preservation or disposal subsequently informs how we view them and their value, impacting experiences of their loss. Classifications are informed by context and also by time: remains of pregnancy are handled and managed in ways that are informed by duration in the body of their mother. This chapter explores the connections between the lived experience of Arab modernity and the beliefs surrounding foetuses and the relationships with them.

The miscarried foetus Eager to continue our investigation into the path the pregnancy remains travel following a miscarriage, we sought approval to conduct further explorations. A few months later, permission was granted for us to visit a graveyard; soon after, Dr Ali contacted us to let us know that an ambulance containing remains was preparing to go there. We drove to the hospital mortuary where we were greeted by Dr Ali who explained that the ambulance was taking a number of body parts, including an amputated leg and pregnancy remains. We were told to cover ourselves with abayas and our hair with shaylas and to avoid attention. We sped through the city, trying to follow the ambulance closely. At one point some confusion about a reconstructed road led to us becoming lost and we lost sight of the ambulance. However, the driver of the ambulance guided us by phone and we were soon reunited with the vehicle and its contents at the graveyard. Our attempt to keep a low profile was quickly undermined when our presence attracted the attention of a group of men who were bemused by the sight of four women. We came to learn through discussions with interlocutors, that any involvement in burial was typically conducted by husbands and that women did not go to the graveyard. A curious but friendly sheikh approached us and explained that he was responsible for the mosque and was happy to explain burial practices. We learned that a foetus of 120 days or more gestation is handled in the same manner as an adult. According to Sharia, in preparation for burial, a body is washed with water, cleaned with kafour (camphor) and then rinsed with water

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scented with sidr (ziziphus). It is then dried and perfumed with oud and rose scents before being enshrouded in clean white sheets called kafan. D’ah (prayer) takes place and the body is buried in a hole, leaning to the right side and covered with a layer of strips or rock tiles and soil (Kilshaw 2017a). A foetus of less than 120 days’ gestation is treated as tissue and is not covered with a shroud or prayed over before burial (Kilshaw 2017a) in an area of the graveyard reserved for body parts and tissues. A small number of interlocutors reported that if the remains were less than four months’ gestation they could be buried anywhere; one interlocutor buried remains in her backyard. Formal burial practices are not a public ritual and, importantly, typically does not involve the woman. Women are absent from the preparations and burial, whilst her husband may or may not be present. Following the burial, acts of memorialization are largely lacking with women and those around them encouraged not to dwell on the loss as part of an acceptance of God’s will. During a visit to Qatar’s Religious Da’wa and Guidance Authority we spoke to a sheikh who was an expert in fertility and reproduction. Speaking at length about pregnancy, miscarriage and reproduction, he explained the importance of the 120-day threshold, which determines whether a foetus is considered ‘alive’ and ‘a human’: In Qatar we follow madhab al hanbali and so the borderline between living and non-living human being is four months. In other madhabs [schools] this is not the case, a foetus or baby will not be treated like an adult unless he came out screaming and shouting.

He suggests here that the Hanbali school of Islam dictates the boundary between human and non-human is 120 days, whereas other schools observe different thresholds, (e.g. if the foetus is born alive). Such definitions give rise to different realities and impact their possibilities. The sheikh quotes from a well-known hadith (Hadith 6390, Book 33, Muslim): Verily the creation of each one of you is brought together in his mother’s belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether happy or unhappy.

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Based on this hadith, classical scholars theorise that the ruh (soul) is breathed into the foetus at 120 days’ gestation: at this point it is a human being. This central Islamic belief is pivotal to the treatment and management of foetuses and informs certain practices, such as legal abortion, as will be discussed below. Han (2018) points out the centrality of the dilemma of what to call ‘it’ in the first place: our choice of term (foetus, baby or child) is to refer not only to its material existence but also to the social relations that surround it: to define a foetus also defines a pregnancy and a pregnant woman. In biomedical terms, ‘foetus’ only comes into effect after the eighth week of gestation (Maienschein 2002); however, the term is often used for earlier gestational ages. A number of interlocutors describe pregnancy remains as qetat lahem (piece of meat): Fareeda, a mother of six, was one of these women, describing her most recent miscarriage in this way. When she describes the aftermath of her pregnancy, she refers to it as ‘a piece of meat’, explaining that at less than 120 days’ gestation it is not prayed over during the burial process, reflecting the religious and medical categorization as being non-human and without a soul. Fareeda had experienced five miscarriages at differing gestational ages, something which impacted her approach to pregnancy loss and perception of their materials. Noora’s husband, Mohammed, also refers to her miscarriage in this way: God gave and then God took back what he gave us . . . God destined for this pregnancy to happen and then he destined to take it back. Why do I have to feel sad? Oh, please excuse me but it is a ‘piece of meat’ and it is gone and what is important is that my wife is fine, she should thank Allah that she is fine and that she had no complications.

Referring to miscarriage as God’s will and what God destined for them, Mohammed dismisses a need to feel sorrow for the end of the pregnancy, for it was a ‘piece of meat’ not worthy of sadness. He emphasizes that his main concern is for his wife, which he sees as far more important. Whilst some interlocutors refer to early pregnancies in this way, the majority refers to tifl (baby) or janeen (foetus), suggesting that their reality was not of tissues or flesh, illustrating that medical and religious categories do not necessarily match experience. Nomenclature neither maps neatly onto clinical gestational stages nor correlates with clinical, physical, legal, religious and cultural distinction.

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Categories of humanity, the foetus and abortion Islamic jurisprudence goes into great detail about foetal development, providing nuanced guidelines regarding paternity, abortion and foetal personhood (Newman 2018a: 202). The permissibility of abortion varies between the four schools of Sunni Islam, but all share an understanding of foetal development rooted in Greek or Yunani medical knowledge (Newman 2018a). Referencing Musallam (1983: 54), Newman (2018a: 202) outlines the four stages of foetal formation: ‘1) as seminal matter . . . 2) as bloody form . . . 3) the foetus acquires flesh and solidity . . . and finally 4) all the organs attain their full perfection and the foetus is quickened’ with this framework informing Islamic bioethical debates on abortion. ‘Quickening’ refers to the moment when foetal movement can be detected and is seen as indicative of ‘ensoulment’, which is key to the treatment and management of pregnancies and the foetuses they contain, including the permissibility of abortion. Ensoulment represents the moment at which the divine spirit enters the foetus, making it a member of the umma, or community of believers (Newman 2018a); at the final stage of development it then acquires personhood and becomes a Muslim. Determining the timing of ensoulment is of the utmost importance for differentiating abortion from murder (Newman 2018a). Inconsistencies can in part be attributed to the diversity of Islamic jurisprudence and bioethical opinions regarding the moment of ensoulment. Rather than representing a set of monolithic rules and prohibitions, opinions regarding the moment of ensoulment and the permissibility of abortion should be understood as a dynamic and rigorous scholarly and religious debate (Bowen 1997; Katz 2003; Musallam 1983 referenced in Newman 2018a). Debates about abortion ‘are fraught with epistemological nuances because the Quran, on which Islamic jurisprudence is based, does not explicitly discuss abortion’ (Newman 2018a: 203). Historically, abortion was only allowed in Qatar if the pregnancy was deemed to endanger the mother’s life. In 1971, Qatar’s penal code ratified this convention by legalizing abortion in cases where the mother’s life would be saved. In 1983, abortions performed on pregnancies of fewer than four months duration became legal if the pregnancy were to cause serious harm to the mother’s health, or if there was evidence that the child would be born with severe untreatable mental or physical deficiencies

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and both parents consented to the abortion (Department of Economic and Social Affairs, United Nations 2001; HMC legal law number 17). There can be some debate about what constitutes severe and permanent disabilities and there is not always agreement between the medical, legal, religious and personal views of those involved. For an abortion to legally proceed it must be recommended by a medical commission comprising three specialists, including at least one obstetrician, and must be performed in a government hospital. The medical context gives rise to a being that is tissue and flesh and thus, disposable, but this does not necessarily resonate with the categories in other frameworks. Irregularities exist between medical, religious and legal perspectives, which inform differing understandings of foetuses and their status in some circumstances. There can be dissonance between the categories that construct foetuses as social, legal and religious entities. An individual’s knowledge of the foetus is sometimes at odds with the medical perspective, often influenced by religious knowledge or information and/or by somatic and emotional knowledge, as illustrated by Dana. Dana’s experience of miscarriage is embedded in her previous experience of pregnancy and loss and her future reproductive aspirations. She describes her previous pregnancy and the discovery that the baby she was carrying had a severe defect. Told by her doctors that she could abort the baby given that the abnormality was so severe, Dana refused to do so and instead travelled abroad to seek further diagnoses and treatment. In an attempt to correct the baby’s abnormality, doctors in the host country performed in utero surgery on the foetus, but the surgery was unsuccessful. Having travelled back to Doha, Dana was again offered a termination, but she decided instead to continue with the pregnancy; her son died soon after birth. This experience affected Dana greatly and subsequently informed her experience when she miscarried twice in the year following her son’s death. Dana ‘badly wanted to get pregnant’ after the loss of her new-born son, a desire, in part, to try to ease the pain of his death. Newman (2018a) reveals further examples of incongruity between religious bioethical scholarship and women’s experiences of their pregnancies and reproductive bodies. A Moroccan woman who has not sensed the movement of the foetus until after forty days, could theoretically make the case that it has not yet been ensouled.

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Hamda, a pregnant mother of seven, experiences her pregnancy as particularly vulnerable due to her age: I am old and as you know the chances that a woman may give birth to an abnormal baby increases after the age of thirty-five. I am honestly scared and if it happened that my baby has any problems or deformities, I will terminate my pregnancy . . . I saw many Mongolian children when I was working in [the hospital] and I know how much they and their parents suffer. This is why I think it is better to get rid of the baby in this case rather than watching him or her suffering.

At forty-one years old, Hamda expresses concern that her age makes her more likely to have an ‘abnormal baby’, referring to a baby with birth defects. Here she seems to conflate ‘abnormal’ with ‘Mongolian’ (Mongoloid)1 children, suggesting a conflation of these with Down Syndrome, the most common chromosomal birth defect. Although the term is outdated and unacceptable in many contexts, it was not unusual for Down Syndrome to be referred to in this way. Age does increase the chances of having a child with Down Syndrome: at the age of twenty a woman’s likelihood is 1 in 1,500; at the age of thirty-five this rises to 1 in 270; at the age of forty-five this rises to 1 in 50. Hamda’s status as diabetic was also a concern, as the condition increases the likelihood of a baby developing health problems, such as breathing difficulties or heart problems, shortly after birth and/or developing obesity and diabetes in later life. Mothers with diabetes have increased chances of their baby being born with birth defects, particularly of the nervous system or heart abnormalities or being stillborn. The risks of neonatal death are slightly elevated in mothers with diabetes. Diabetes is prevalent in Qatar and women are exposed to surveillance and public health warnings throughout their pregnancies. For Hamda, her concerns about increased risk have led her to conclude that she would seek a termination, explaining that if she were to have an affected child, she would consult a sheikh to obtain a fatwā to allow her to do so in order to avoid suffering. Foetuses are investigated and diagnosed to reveal whether their termination can be legally and/or religiously sanctioned. Having met with the head of the medical commission, the body which determines the permissibility of abortions on a case-by-case basis, we also

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discussed the issue of abortion with the sheikh at the Centre for Religious Da’wa and Guidance. He concurred with the head of the medical commission in discussions about the prohibition of post-ensoulment terminations except in cases of maternal risk: They have to differentiate between before and after the soul is blown, after that she can’t abort the baby because he is considered as a human being . . . So, if the pregnancy reaches four months, it is not allowable to abort him. [He can be aborted] only if he threatens the mother’s life.

A 2002 letter from the Islamic court of appeal to the medical commission further clarifies the religious position on abortion. The letter outlines that the Sharia law on abortion states that abortion is forbidden after 120 days and is considered a crime. The only exception is if the foetus is endangering the mother’s life or if she was raped: the latter is considered as suffering in terms of her emotional and mental state. All four schools of Sunni Islam require abortions to be performed before 120 days as these procedures would be ‘permitted as technically not constitutive of abortion: although the product of conception has been expelled, no soul is being killed as the foetus is not yet animated’ (Bowen 2003: 560 in Newman 2018a: 204). The 2002 letter was a fatwā regarding the position on abortion in response to a query about a couple seeking an abortion ‘of their own reasons and not necessary for medical reasons’. After beginning in the usual way with the greeting Al Salamoalykom wa rahmato allah wa barakatoh (Peace be and blessing upon you); it continues: God has created beings till a certain time and he protected them from harm, so he has forbade killing in any manner that is not allowed. God also has protected the baby while growing before it became whole/complete so he forbade killing the fetus because it is considered a soul/living being that God has value the most, and forbade its killing and if it wasn’t for protecting the fetuses in their mothers’ wombs and forbidding their harm they would not have a chance to exist and that will be going against God’s will and against his reason for creating people and bringing life to Earth.

The author, the president of the Islamic court of appeal, made it clear that some religious scholars (e.g. hanabelah (the Hanbali School of Jurisprudence) and some scholars from other madhabs (Islamic schools of jurisprudence)

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allow abortion before forty days’ gestation. Other scholars permit abortion after forty days and before 120 days, but only with good reason, while others forbid it. The author concludes that abortion is allowed if forty days have not passed and with the consent of both spouses. If forty days have passed, but 120 days have not yet passed, an abortion is not permissible except in two cases: a. If continuing with the pregnancy greatly harms the mother’s general health and may cause unbearable harm that may continue after delivery. b. If it is proven that the foetus will be born with congenital defect(s) or mental retardation that can’t be cured Ensoulment at conception or within forty days’ gestation is espoused in the Mālikī school (Bowen 2003; Brockopp 2003, Musallam 1983). While the Mālikī school sets a strict limit within which ensoulment may take place, other schools have more pliable understandings of this phenomenon and connect it to the quickening of the foetus later in pregnancy (Newman 2018). The Mālikī school is the most restrictive and does not take into account a woman’s detection of foetal movement. Newman (2018a) found divergent opinions suggesting that a physician’s, woman’s or religious leader’s understandings of a foetus may come into conflict in cases of unwanted pregnancies. The division of foetal development into equal forty-day segments is based in the hadith rather than the Quran (Musallam 1983: 54 in Newman 2018a) meaning that Islamic bioethical opinions on abortion are a ‘soft “no but” rather than an adamant “never” ’ (Bowen 2003: 51). We also spoke to the sheikh at the Centre for Religious Da’wa and Guidance about the permissibility of abortion following a diagnosis of severe abnormalities. He said: Many times we face such cases. [The hospital asks] about our fatwā . . . our fatwā says that we should not abort him: leave him until he is out then we will deal with him. Where is mercy? God has created him and chose this for him, so we leave it for God.

The sheikh explains that the hospital commonly seeks guidance on specific cases for requests for terminations following the diagnosis of problems with the foetus. He suggests that, according to the religious perspective, such a foetus should be left. The sheikh and the head of the medial commission explain that the hospital commission seeks advice from the religious leaders,

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but suggests that his response is that abortion should not be performed in the case of abnormalities. We were told that whilst it seeks advice, the commission itself is made up of medical rather than religious experts. In a number of cases, women who were advised that termination was possible and recommended chose to continue with their pregnancy and referred to religious knowledge and advice to support their actions. For the sheikh, once a foetus becomes a human being it should be left regardless of the potential for death or disability. However, the sheikh then introduces a category of foetus whose emergence, by definition, potentially allows for its termination: that of zinā (all forms of illegitimate sex).

Zinā babies Under Qatar’s penal code, a woman who induces an abortion or consents to an abortion that is not conducted legally, as outlined above, faces up to five years’ imprisonment. Individuals who perform an abortion on a woman face up to five years’ imprisonment if done with her consent and ten if she does not consent. Prior to ensoulment, the termination of a foetus is allowed in medical and legal discourse if it is known to have abnormalities incompatible with life. The sheikh emphasizes, and medical and legal discourse agree, that once ensoulment takes place a foetus should be left to develop and can only legitimately be aborted if it threatens the life of its mother. However, the sheikh also refers to a particular circumstance where an exception may be made: if the foetus is that of an unmarried woman. Pregnancies and foetuses take on divergent values when located outside of the heterosexual marital union: the foetuses of single pregnant women are proof of extramarital sexual behaviour, taking on shameful connotations (Newman 2018a: 214). Pregnancy is illegal for unmarried women in Qatar and, thus, such a foetus is neither legitimate nor acknowledged. An unmarried pregnant woman risks jail or deportation and may receive physical punishment. Access to maternity care is dependent upon producing a marriage certificate. So the foetus of an unmarried woman is problematic. Hospital personnel are required to alert the authorities if an unmarried pregnant woman presents at the hospital. The sheikh explains:

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Women are of two types: a married woman and a single woman. The married woman should not abort her baby only in exceptional cases . . . she is the origin and the baby is the branch, so if the branch is threatening the origin we have to sacrifice the branch to protect the origin, not the opposite and not for other reasons such as having many children.

He then continues to say that an unmarried woman’s foetus is haram, and, thus, Some scholars allow [abortion] before he turns into a human being and before having a soul. [Because the foetus is created] by shame [this baby will] remain a zinā baby . . . if the soul is not yet blown, then she is allowed to abort the baby because of the shame that will follow her.

The sheikh suggests that a married woman’s pre-ensouled foetus is legitimate and sacred and must not be destroyed unless its presence threatens the life of its mother; according to some scholars, an unmarried woman’s foetus is not legitimate and can be aborted prior to ensoulment. Abortions are sometimes performed on women who are pregnant out of wedlock as a direct result of the illegality of giving birth to such a child (Doha News, 27 August 2013). The reason for this distinction is the strict taboo Islamic law has on sexual relations outside wedlock (zinā): the taboo is designed to protect paternity (i.e. family), which is designated as one of the five goals of Islamic law (Clarke 2009: 3). Zinā threatens the entire framework of Islamic society because it confuses the lines of nasab (lineage), which is the foundation of the system. Nasab accrues to those conceived within a union of marriage; it is that which gives one full membership in society (Clarke 2009: 96). Thus, these foetuses are particularly liminal, practically invisible, and are not accorded legitimacy. There is some disagreement about the permissibility of abortion in cases of zinā. As Newman (2018a) clarifies: Medical ethicist and historian Kiaresh Aramesh asserts that all four schools of Islam forbid abortion in cases where pregnancy results from ‘illicit sexual behavior such as an extra-marital relationship’ (2007: 30). Conversely, drawing on Muslim theologian and ethicist Abu Hamid al-Ghazali (d. 1111 CE), who stipulated,‘if the zygote is the result of adultery, then the allowance of abortion may be envisaged,’ medical anthropologist Donna Lee Bowen states that ‘adultery can be considered a valid reason to allow abortion’. 2003: 57

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Newman (2018a) notes the simultaneous moral and medical character of the foetus in Al-Ghazali’s opinion.

Emerging foetal personhood: ensoulment and movement Ensoulment at 120 days is a fixture in the way foetuses were defined by all interlocutors; as a threshold it was consistent. However, despite this clearly defined boundary there may be ambiguity. At times one could not be certain that a foetus was 120 days, leaving clinicians, mortuary staff or the sheikh at the graveyard to make a judgement call, often considering information about suspected gestation combined with weight. There was ambiguity in terms of how this equated to developing personhood in the foetus. Despite knowledge about the time of ensoulment, most interlocutors report that a foetus becomes ‘a baby’ at five months’ gestation (Kilshaw 2017). Pregnant for the ninth time, thirty-eight-year-old Noor explained that the foetus becomes a person, From the fifth month . . . because he starts moving . . . you feel there is a spirit in your tummy. There is a big creature that exists. When he is small you feel there is something, but you don’t know what . . . . [M]y feeling about the baby starts when he starts moving. Whenever he moves or jumps I put my hand on my tummy and mention God’s name, I feel there is a soul.

Similarly, pregnant with her eighth child, Houda thought of the foetus as a ‘baby’: From the fifth month, subh.ānallāh, because you feel that it is complete Maa shaa-Allah [Does it have to do with the soul is breathed into it?] No, because the soul is breathed into it from the fourth month . . . When it starts to move, subh.ānallāh, I felt that the soul was blown into it.

Both Houda and Noor began to think of the foetus as a ‘baby’, a person separate from them, once they detected its movement at around five months’ gestation, its individual existence mediated by its movements. Detecting foetal movement has been linked to a shift to women’s self-identification as mothers (Newman 2018a: 215). Shaw (2014) found that women also focused on foetal movement as an important threshold of personhood in her research with British Pakistani women, but movement was seen to be animated by the moment of ensoulment.

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Miscarriages prior to this are described as ‘lost’ or ‘wasted’ pregnancies; women refer to lost pregnancies, a loss of blood or tissue, rather than lost babies (Shaw 2014). The moments when a woman first begins to perceive foetal movement is sometimes referred to as ‘the quickening’ in Canada, the US and the UK. Historically, this was sometimes considered to be the beginning of the possession of ‘individual life’ by the foetus, with the word being epistemologically linked with ‘quick’ meaning ‘alive’ (Han 2013). According to Christian tradition this equates with the moment of ensoulment, in which a human spirit comes to animate the human body (Duden 1999). However, in Qatar, women did not report ensoulment as being simultaneous with movement. Women typically do not feel foetal movement with certainty until the fifteenth or sixteenth week of pregnancy at the earliest. Emerging foetal personhood is informed by religious categories as well as women’s somatic experiences. A further aspect of foetal personhood is informed by the religious framework of the ongoing cosmological presence of these beings.

Birds in heaven The most common way miscarried foetuses are spoken about is as ‘birds in heaven’: doctors, religious leaders, women and their family members refer to them in this way (Kilshaw 2017). Fareeda, describes an exchange with her doctor immediately after the surgical management of her most recent miscarriage: The doctor in the operation room told me, ‘You have four toyoor fe al janah (birds in heaven)’. I said, ‘I hope I will see them in heaven’. She said, ‘No they will make you enter heaven’ . . . When I tell them I had four miscarriages they say, ‘You are lucky, there is someone who will protect you in the judgement day’. I told them my first miscarriage was about forty days only. They say, This bird will come alone in heaven and hold your hand and say to God, “this was my mother” ’ . . . It should be this way because we are suffering a lot in miscarriage . . . It relieves the pain, alh.amdulillāh.

Fareeda’s comment reveals the way in which knowledge of miscarried foetuses as birds in heaven is shared throughout society, including in the medical

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context of the hospital. Fareeda had experienced four miscarriages; she explains to the doctor that her first miscarriage occurred at ‘forty days only’ referring to its status as a pre-ensouled entity. Fareeda is comforted by the doctor’s reference to her foetus as a ‘bird’, suggesting that, despite it not having a soul, it has a presence in the cosmology. In most cases, women and those around them understand miscarried foetuses to become birds in heaven regardless of their gestational age. The doctor confirms that Fareeda has four birds in heaven, as all her lost foetuses are understood to be such. This exchange also reveals the comfort women find in the understanding that their babies have some place in the cosmological system, that these beings will protect them, aid them in their entrance to heaven and that they will see them again. In general, the content of miscarriages is referred to as ‘birds in heaven’, but some suggest that this category is reserved for later gestations, as Noora suggests: When we say a bird in heaven, this doesn’t include the babies that are lost during miscarriage, I mean when they are still at two months or three or four of gestation. It should be seven months and more, and then you can say that it is a bird in heaven . . . because at this gestational age [seven months] the soul will be breathed into it, or if the child was born and then died very young, like what happened with my daughter in law; she lost her son when he was four months, subh.ānallāh when he is like this we call him a bird in heaven because he is pure and free of sins . . . he will be a mediator, Allah says that this child can protect seventy of his family from going to hill, but the word ‘bird’ is what is known among people but the right one should a ‘mediator’ . . . it brings a sense of relief. I went through this experience where the woman feels very weak and vulnerable and she is stressed out because she lost something. Once the woman gets pregnant she develops a relationship between her and her baby, subh.ānallāh even if he is still very young, ‘a piece of meat’ as other people may call it but for the mother it is her child and there is already a relationship between them, subh.ānallāh! [When you had the miscarriage, did you imagine that the lost baby is a bird in heaven?] No, I was only two months pregnant.

Noora is relatively unusual in suggesting that only late gestation miscarriages are considered as producing ‘birds in heaven’. Samia, the mother of four sons who had recently experienced her first miscarriage, describes initially being upset when the miscarriage was diagnosed:

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When they informed me . . . I cried and I didn’t accept it . . . the doctor said, ‘This is from Allah’. So, though I was shocked at the beginning, but being a Muslim and our faith that whatever happens to us is God’s will . . . God rewards. My baby will be a bird in heaven and he [will act on behalf] of his parents.

Samia’s initial reaction is to cry and not to accept the death of the foetus, but she is comforted by the doctor reminding her that it is due to God’s will and she remembers that her baby will act on her behalf as a bird in heaven. Interlocutors commonly express comfort in this knowledge which helps them to accept the loss. Rouda, a pregnant mother of a six-month-old daughter, spoke about her previous experience of miscarriage, stillbirth and loss. She explains that her lost babies were with prophet Mousa in heaven. Our Prophet said any child that dies will be with our Prophet Mousa until his family comes to the heaven . . . so this is reassuring . . . They will be birds with Prophet Mousa in heaven, I don’t know if they will be in the form of birds or children until their family dies and comes to heaven.

Rouda had given birth to a stillborn baby girl and later gave birth to a son with Down Syndrome who died when he was sixteen months old. Rouda’s experience illustrates that children who die before the age of puberty are understood as innocent and, thus, are seen to go immediately to paradise. The miscarried foetuses we encountered are similarly conveyed. These beings and her miscarried foetus have a presence in the cosmology, which brought her comfort: ‘You feel if you believe in God you will let it go, we don’t guarantee how long we will live for a year or two, at least if we die someone will be there for us’. Rouda is consoled by the knowledge that she will see her children and the miscarried baby again. She explains that they will protect her and ask God to forgive her on judgement day: ‘This is what we get from these situations’. Thus, these are ethereal beings and are rewards for fertility and suffering whilst also providing company in heaven. When thirty-one-year-old mother of three Haleema discovered she was miscarrying for the third time she became very upset and shouted at the hospital staff. The clinicians tried to calm her; a nurse said: ‘It’s OK, ʾIn shāʾ Allāh, he will be an intercessor for you to paradise.’ Haleema found the knowledge that her lost babies would be in heaven comforting:

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I think that I will meet the babies again in the afterlife and they will be my intercessors. I don’t think that I want them to come back again to me. I just think that they will seek forgiveness for me in the judgment day.

Interlocutors consistently reflect on the way in which hospital staff refer to their miscarried foetuses as birds in heaven. Interviews and interactions with health professionals revealed this to be the case. As one clinician explained: Because in Qatar we are Muslims: we believe God gives and God takes, and we believe that this will be a bird in heaven. [For] any mother that loses a baby; this will be a bird and she will see him in the afterlife, so she will not be very depressed that she lost that baby.

The majority of doctors we met were Muslim and, thus, shared their patients’ understanding of God’s will as the cause of miscarriage and the status of birds in heaven. Nurses are often Muslim, but those who are not, such as the large Filipino population, often shared understandings of miscarriage as God’s will. Interlocutors overwhelmingly suggested that medical staff shared their understandings and often reminded them of God’s will as the cause of miscarriage and comforted them with references to birds in heaven. This was supported by my own experience and those of European friends/ acquaintances who were surprised and, at times, unsettled by clinical staff referring to their miscarriage as ‘from God’. Foetuses are ultimately gifts from God; the loss is destined as part of God’s plan. Women are reminded that the foetus is in heaven and they will see them again when it acts as their intercessor. The foetus plays a role in a woman’s future cosmological status. Forty-three-year-old mother of one, Kholoud, explains the afterlife and the role that deceased children play in this: We believe in Allah subhanahu wa ta’ala (The most glorified, the most high) and we work for the afterlife. This life is transient and what we do in this life should be intended for the afterlife. I kept my baby with Allah and ʾIn shāʾ Allāh I will meet him later . . . On the day of judgment (this child) will hold his mother and father’s hands and pass them to heaven. He will be a mediator for his parents . . . You don’t know what your child will grow up to be: he may grow up to be disabled or a corrupted person or disobedient or he may kill his parents. So, Allah didn’t want him to be born because he wants the best for you. We believe in this and this is why we stay strong when we have such experience.

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Married to her thirty-year-old cousin, who is her second husband, Kholoud is eager to have another child, but had recently experienced her fourth miscarriage. She remains convinced that these ‘children’ would wait for her in paradise. Importantly, Kholoud is further comforted by the knowledge that these miscarriages were God’s way of protecting her from further heartache, for had the child been born it may have been ‘disabled’, ‘corrupted’ or ‘disobedient’. This knowledge gives women strength in the face of miscarriage.

Foetuses in a global world Categories and practices around foetuses travel internationally and, thus, consideration must be paid to the globalization of the foetal subject (see Mitchell and Georges 1997; Ortiz 1997). Qatar is embedded in global flows of people, clinicians, doctors, policy, research and, thus, hegemonic discourses and global policy initiatives around reproduction and foetuses are relevant. These discourses are predominantly influenced by what Strathern (1996: 38) defines as ‘the largely middle-class, North American/Northern European discourse of public and professional life’ and have included a ‘dominant’ language of parenting and reproduction (Faircloth et  al. 2013a). Thus, miscarriage in contemporary Qatar is likely to be informed by such discourse and we may very well see changes in the way embryos, foetuses, ‘pieces of meat’ and the loss of these beings/ tissues are understood. In light of global entanglements and influences it is relevant to ask what happens to pregnancy remains in Euro-America. Historically, foetuses would be discarded as waste with little interest in how this was done with this perception relatively stable for nearly a century in the USA (Morgan 2002: 267), yet embryos and foetal remains are now ‘speaking more loudly’, as they escape those ‘long-standing jurisdictional confines and enter a wider civic domain’. Increased levels of public scrutiny and discomfort around the issue of embryo and foetal remains disposal in these contexts has led to legislation or formal guidance being issued. A 2004 Dispatches TV programme in the UK which focused on the routine incineration of pregnancy remains as clinical waste led to public outcry, prompting the UK Human Tissues Authority (HTA) to develop guidance on the disposal of the remains of pregnancy (March 2015).

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This guidance, which influences national policy, outlines that women should have access to a range of disposal options (burial, cremation, incineration2), that remains be ‘sensitively’ disposed of and the woman’s wishes carried out. In Texas, USA, a 2017 senate bill requiring hospitals and clinics to bury pregnancy remains (miscarried, stillbirth and aborted as well as those from ectopic pregnancies) regardless of the woman’s wishes was passed and it appears that other states may follow suit. Whilst the responsibility rests with the clinic, not the women, the bill will impact the availability of abortion (and other early pregnancy care) providers, as they may not be in a position to fulfil the required disposal services. This law would, in effect, prevent clinics from providing abortions if a disposal/burial pathway was not established whilst placing additional financial burdens on the clinics. The bill was blocked and taken to trial in July 2018 where it remained opposed, although in September 2019 Texas attorneys asked the courts for it to be revived. The values attached to remains are ‘politically and socially constructed by women, clinicians, the state, entrepreneurs, religiously motivated groups’ (Morgan 2002: 252). Such shifts in the treatment of these materials have been informed by broader societal changes about pregnancy loss in these contexts and, in turn, loops back to impact how women experience a pregnancy ending. The way these entities are considered subsequently inform the nature of interactions with them. The historical record is almost entirely silent on the subject of what is done with miscarried foetuses (Morgan 2002): outside of ‘the medical realm, the products of miscarriage were virtually invisible, in the social sense. Whatever women’s feelings about miscarriage or abortion, they did not imbue foetal flesh with social importance. They did not vest their emotions in the remains or accord them special treatment’ (p.  256). This is a very different situation to contemporary Euro-America where reproductive politics increasingly centres on material rather than philosophical matters (Morgan 2002) placing foetal remains in the centre of discourses around pregnancy loss. Miscarriage has increasingly been framed in Euro-American contexts as the significant loss of a baby or child that is likely to be met with distress, grief and potentially resulting in post-traumatic stress and depression (Farren et  al. 2016). The foetus is often at the centre of acts of memorialization and commemoration, making the disposal of foetal remains a central aspect of the process and approach to care and the remains imbued with value.

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Conclusions Social scientists have shied away from the foetus: an unsurprising reluctance given the political nature of the questions involved. The meanings ascribed to human foetuses and the history of efforts to grant social identities to them is a problematic topic in current feminist thought (see Michaels and Morgan 1999). Such scholarly reluctance is compounded with unsuccessful pregnancies, for the miscarried foetus is a source of the profoundest ambiguity. As Rapp (2018: xiv) articulates: The foetus, a foetus, and the differential life chances of foetuses everywhere constitute a perfect storm of what the feminist theories Donna Haraway would call ‘material-semiotic objects’. Liminal in the most profound sense, foetuses serve as lightning rods for any ontology you’d care to imagine, providing our meaning-making species with a continually self-reproducing nature-culture, a biosocial or material-vitalistic entity to which every generation must necessarily address itself.

Uniquely symbolic, yet innately fluid and flexible, they matter in so many dimensions of our experiences and expectations because it is, both materially and metaphorically, a product of the past, a marker of the present, and an embodiment of the future (Han et  al. 2018). The ambiguity of the foetus informs the silence around it: living but not yet alive; betwixt ‘human or nonhuman’ (Casper 1998) and person or human tissue (Squier 2004); such ambiguity leads to difficulty in articulating exactly what these beings or materials are, making them problematic subjects of scholarly analysis. Categories may be in flux and continually negotiated and they may be contested. Despite a desire to define the boundaries, categories are messy; boundaries overlap and are always context dependent. Negotiations between individuals, medical, religious, legal, and social institutions help to shape understandings of these entities and impact how people experience them, but categorization may not be coherent. The meanings attached to embryos, foetuses and pregnancy materials are constructed by negotiations (Morgan 2002) amongst women, clinicians, the state and religious authorities. These are tangled relationships, which produce contested ground through which various forces jostle for authority (Morgan 2002), as Newman (2018a) documented in

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Morocco where knowledge of the foetus becomes contested terrain with conflicting claims structuring debates about pregnancy and abortion (p. 201). Classifications are informed by context. These may be around time: gestational age informs treatment, particularly as it relates to ensoulment, or around the legitimacy of union which produced it. The way such materials are handled reveals how they are viewed by society. In Qatar, all foetal and pregnancy remains are buried, as are all other bodily tissues. Remains of fewer than 120 days’ gestation are handled as though they were a body part or tissue of the woman. Some interlocutors refer to them ‘pieces of meat’; however, most refer to them as tefel or janeen, revealing categories which did not necessarily match womens’ experiences. What impact does a miscarried foetus have on a woman’s social position? Despite not producing a live child, a woman who miscarries has demonstrated her fertility and thus, secures her position, albeit temporarily. Women who had miscarried suggested they had been awarded the opportunity to become a mother. An aspect of this is the being maintains a position in the cosmology as a bird in heaven. The foetus is made into a certain reality by its specific location, in this case in the social world and in the Qatari cosmology. Beliefs surrounding foetuses are interrelated with the lived experience of Arab modernity and women’s experience of their loss.

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Reproductive Disruptions: Spectrum of Compromised Fertility

Women’s stories reveal the influence of social and political forces on intimate experiences of conception, pregnancy and miscarriage, and how reproductive negotiations are embedded in wider familial relationships, which are themselves influenced by Qatari social structures. The interconnection between motherhood and womanhood informs women’s reproductive navigations and experiences. As a result of the high value placed upon having children, women typically have numerous reproductive events with miscarriage as part of a broader spectrum of reproductive disruptions. Furthermore, because of the significance of fertility, miscarriage is interpreted in light of a woman’s ability to conceive. It is for these reasons that miscarriage is, on the whole, neither stigmatized nor surrounded in silence. Qatari pronatalism impacts women’s reproduction and shapes miscarriage as a normative event. Such an approach is in stark contrast to what one finds in the UK and, indeed, in other parts of northern Europe and North America. Public discourse and scholarly work on miscarriage have focused on the silence surrounding it, framing it as ‘the last taboo’ whilst also emphasising understandings of pregnancy loss as failure. However, the silence has eroded and it is increasingly being spoken about in public forums, in part to overthrow notions of miscarriage as failure and reduce feelings of culpability. Over the past two decades not only has pregnancy loss become more visible, but the dominant narrative is that of a significant loss that should be acknowledged and memorialized (Kilshaw 2020a). This chapter considers how miscarriage is understood in Qatar and reveals the diversity of expressions of pregnancy loss and undermines assumptions about miscarriage as failure.

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Miscarriage unshrouded Women commonly described miscarriage as ‘normal’, ‘no big deal’, something not particularly unknown or unusual, as Huda did at the opening of this book; her interpretation informed not only by her own experience of five pregnancies and the birth of three children, but also her social context. Huda interprets her experience in light of an understanding of reproduction as inclusive of suffering and difficulty, with particular attention to other women’s experiences of reproductive disruption. When speaking about her view of miscarriage and her own experience, Huda refers to the ways in which other women’s pregnancies have ended. Thus, miscarriage is a sad, if commonplace occurrence. Such an understanding helps women to approach miscarriage with acceptance, as Huda did, realising it is not indicative of reproductive failing. Huda understands her miscarriage event in the context of the shared experience of other women: I know many women who miscarried recently; my colleague was pregnant at the same time as me and she miscarried. It was her first miscarriage after three successful pregnancies. My husband’s sister and also my friend miscarried last year, most of the women I know who got married in the last two years had miscarriages.

Huda’s knowledge of ‘many’ other women who miscarried, allows her to contextualize her experience with those of others and as something not particularly unusual. In particular, she focuses on recent cases of miscarriage, further reinforcing commonality. Indeed, ‘most’ of the newly married women she knows have experienced a miscarriage suggesting that it is a normal event in women’s reproductive negotiations. Huda reports that her colleague miscarried at the same time as she did and that this followed a number of successful pregnancies, indicating that miscarriage is something that happens to fertile women and those who are able to produce children. Huda’s awareness of the pregnancy losses of other women meant that hers is not interpreted as unusual or necessarily worrying and does not signify reproductive inadequacies. Women are aware of the miscarriages of others, suggesting that it is discussed relatively openly (Kilshaw et  al. 2017), at least in some social

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environments. Jameela, a thirty-eight-year-old interlocutor who miscarried at the same time as her sister describes miscarriage as: Something normal, I saw that lots of women miscarried this month. Also, my sister, just yesterday, she miscarried. The heartbeat also stopped. I saw a lot [of miscarriages] this month. Many women miscarry.

Describing miscarriage as ‘normal’, Jameela refers to other women she was aware of who had similar experiences. Interestingly, similar to Huda, Jameela refers to other women who had miscarried recently and by so doing emphasizes commonality: this is something that happens to women like her, in the immediate time frame and to contemporary women. Indeed, Huda explains: ‘The first miscarriage was normal for me because my mum miscarried and many women who I know also had miscarriages and then they had kids.’ Previous knowledge of her mother’s pregnancy loss meant that when Huda first miscarried there was a developed framework for seeing such disruptions as normal. This knowledge provides a context where miscarriage is not seen as indicative of damaged fertility. Of particular relevance, was that her mother and other women known to her had gone on to have children despite previous miscarriages. In fact, Huda’s mother-in-law comforted her following her miscarriage by focusing on the likelihood of future pregnancies: ‘My motherin-law told me that it always happens with women because of tiredness and once you had children before you will have again so it is not a big deal.’ Huda’s mother-in-law focuses on the commonality of miscarriage and minimizes it, particularly by reminding Huda that she had already produced three children. Her mother-in-law focuses on Huda’s demonstrated fertility. That Huda has had children previously suggests that the miscarriage is an unfortunate event, likely caused by tiredness, but it means she is fertile and will have more children despite this pregnancy ending. Her miscarriage is not seen to impact future reproduction or suggestive of reproductive failure. These accounts and anecdotes reveal a focus on miscarriage events as embedded in wider reproductive careers: women have miscarriages before or after successful reproductive events and, thus, a miscarriage does not reflect on women’s overall fertility. Instead, it is seen as a common pregnancy complication, a not unexpected event in the typically lengthy period of reproduction activity that is common to Qatari women. In general, women experience numerous

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reproductive events during their reproductive years and often have complex reproductive experiences. In light of this, miscarriage is often interpreted as one possible adverse experience in a range of reproductive disruptions or complication, but one that is somewhat anticipated. As Huda’s account reveals, following a miscarriage, women are typically reminded by those around them that future pregnancies are possible and, indeed, likely. There is no reason to think subsequent pregnancies will not be successful. That a pregnancy had occurred in the first place is emphasized, which reinforces the woman’s status as fertile. Noora, the forty-two-year-old mother of six, introduced in Chapter Three, explains: They usually stigmatize the infertile woman. People say she is like ‘an unplanted Land, ard bour (a land where plants do not grow)’, not like the woman who had babies or at least gets pregnant: this woman is not stigmatized even if she lost her pregnancy twice or even three times. It is not a problem at all, but they always stigmatize the woman who didn’t get pregnant at all.

Noora explains that a woman who has become pregnant but lost pregnancies ‘twice or even three times’ is not stigmatized; the emphasis is on her ability to conceive, which demonstrates her fecundity. Exhibiting fertility in this way separates her from barren women who are likened to land where nothing grows. Noora’s husband, Mohammed, agreed: When the woman doesn’t get pregnant and doesn’t have kids at all, we call her aqueem (infertile), but when the woman miscarries once or twice, we consider her healthy and fertile.

A woman who loses a pregnancy is ‘healthy and fertile’; she has successfully conceived and the miscarriage does not imply an impairment in her reproductive status. Miscarriage is a normal event in a range of reproductive possibilities; it is acceptable, unlike infertility. Even those women who experience a number of miscarriages will likely be understood to be reproductively healthy. Miscarriage is not damaging to fertility or perceptions of the woman as a fertile woman, she is expected to conceive again. Indeed, miscarriage is viewed as a positive demonstration of fertility. This is reflected in women’s accounts, as they typically express optimism about future reproduction; they appear confident in their ability to conceive again, as do those around them. Huda’s

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miscarriage is not a challenge to her fertility; she expresses confidence in her ability to achieve her reproductive aspirations, although such navigations are met with ambivalence. Huda expresses uncertainty about having another child, but despite her reluctance, she decides to try to conceive again: Look, I myself didn’t want to have more kids because I feel that my health is not like before, I mean it takes a lot from the woman’s health: pregnancy and raising the kids takes a lot . . . I say alh. amdulillāh but I wish to have a boy for his sisters. My husband plans to have many kids but to please him and please myself I say, ʾIn shāʾ Allāh, we will have one son.

Despite her reticence, in time Huda becomes more certain of having another child, or, more specifically, a son. She explains that this is to please her husband, but also herself and to provide a protector for her daughters. To this end, her attentions turned to cleansing her body of the miscarriage and preparing for conception. She sought advice from medical professionals and conducted research on the Internet, to learn how best to complete the miscarriage and ‘get rid of the dead baby’. Advised to eat pineapple and drink pineapple juice, Huda resorted to her knowledge of herbs and foods and undertook a protocol to expel the pregnancy tissues. Her use of herbs and diet was supplemented by the skills of traditional healers whose treatment Huda sought. Qatari women commonly use herbs and foods to aid menstruation and birth or cleanse the uterus in their aftermath. Al hess, also al hasow and al hesow, a common Arabic sweet dish, similar to custard, is used in the aftermath of a miscarriage to rid the body of retained tissues and blood. The mixture, containing sugar and flour with the addition of al haba al hamra (also hab al Rashad), red seed or garden cress (Latin: Lepidium sativum) is also consumed by postpartum women, those suffering from heavy periods or at the end of menstruation. It ‘cleanses the uterus and cause[s] bleeding’, clearing the uterus of blood and tissues. Due to the way it acts on the uterus, it is referred to most often as a food to be avoided by pregnant woman (Kilshaw et al. 2016). As Huda explains, Qatari women, Take it after delivery and after miscarriage. It cleans the uterus because it has laxative effect and it reduces the uterine contractions.

One of the traditional practitioners that Huda called upon to help her ‘pass the baby’ and avoid ‘the induced labour’ or the medical management of her miscarriage was al massada. The masseuse conducted a series of massages

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using oils, in order to relieve pain and to encourage the expulsion of tissues and blood to cleanse the uterus and return it to its previous state. However, despite conducting ten sessions with Huda, al massada was unsuccessful in stimulating the completion of her miscarriage and Huda ‘had no choice but to seek medical help’. As described previously, Huda returned to the hospital to have her miscarriage managed, at first through a series of medications, but it eventually required surgical intervention. Like most interlocutors, Huda focuses on moving forward from the miscarriage. Related to this is not dwelling on the experience; she describes not saving anything to remind herself of the pregnancy: No, I didn’t keep anything because if it is abortion, I don’t like to keep anything because every time I see it, I will feel atab nafseyan (emotionally unwell).

By far the majority of interlocutors do not keep mementos of the pregnancy, such as scan pictures of the foetus or items bought in preparation for the birth. Some women who had bought items of clothes or other goods for the baby say they might keep them, but with the intention of using them for subsequent pregnancies and babies, not as a form of commemoration, suggesting they are not imbued with meaning linked with that particular pregnancy. Most women say they will give them to charity or to someone they know who is having a baby. Huda suggested that keeping items will cause upset and make one ‘emotionally unwell’. Remembrances are unwanted or inappropriate, with women suggesting that, instead, one must accept the miscarriage as part of God’s plan. The framework for finding meaning in miscarriage as part of God’s will and an understanding of the being as a ‘bird in heaven’, who maintains a presence in the cosmology provides comfort. Dwelling on the lost pregnancy implies not accepting it as God’s will. This approach to miscarriage is markedly different from many women in Euro-America who, in part and in response to societal silence, now eroding, insist on public displays of commemoration to acknowledge their loss. There are growing opportunities to do so, such as International Pregnancy and Infant Loss Remembrance Day, which closes with a day of remembrance ceremonies and candle lighting vigils including the global Wave of Light, where participants light a candle in memory of babies lost through miscarriage, stillbirth and infant

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death, illuminating social media platforms with images. Women often keep baby items, pictures and other objects to remember and memorialize a pregnancy that ended in miscarriage (Layne 2000, 2003; Kilshaw 2020b, 2017b) or the imagined child contained within. The temporal shift backwards to pre-pregnancy and even pre-conception in the context of anxious reproduction (Faircloth and Gurtin 2017) leads to an emphasis on each pregnancy as containing a child whose loss must be acknowledged and grieved. This is likely linked to lower fertility rates, meaning women experience fewer pregnancies, delayed reproduction, what has been termed ‘anxious’ reproduction (Faircloth and Gurtin 2017) as well as increasing expectation of medicine. The normativity and lack of sensitivity around miscarriage in Qatar was reflected by our research experience in that whilst IRB approvals were rigorous, but relatively straightforward in Qatar, in England there was a great deal of concern about asking women to speak about what is deemed as such a sensitive and distressing topic.

Multiple miscarriage: towards infertility Huda was not particularly worried about her first miscarriage, seeing it as a relatively common event, which did not threaten her fertility. However, when she experienced her second miscarriage, those around her became concerned that there was something wrong and her fertility was questioned. For Huda, it was her second miscarriage that attracted concern but, in most cases, a small number of losses was not seen as cause for alarm. One, two or three miscarriages is typically seen as acceptable and unlikely to be seen as indicative of reproductive failure. However, each miscarriage seems to have a cumulative effect, adding to potential concern. The woman’s specific situation will also be taken into account as those around her consider reproductive possibilities and aspirations. Numerous miscarriages result in dwindling confidence in a woman’s fertility moving her through the spectrum of perceived fertility toward suspected infertility. In this way a miscarriage, if it follows a number of previous miscarriages is problematic not so much in itself, but when considered in relation to previous disruptions, may be interpreted as an indication of infertility. A miscarriage does not indicate reproductive failure, but numerous miscarriages accumulate concern, which may be seen as reproductive

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inadequacy and failure. Reem, a thirty-five-year-old woman with five children who had recently miscarried for the first time describes, ‘For us [miscarriage] is normal, but for someone who miscarries a lot they feel sorry for her’. This indicates that multiple miscarriage is seen as deviating from the norm and is worthy of pity; thus, whilst miscarriage is relatively normalized, it may be potentially problematic, particularly with each additional loss or reproductive failure. Additional losses accumulate apprehension, placing a woman in dangerous proximity to a wholly negative category: infertility. Multiple reproductive losses place a woman in a vulnerable position as it casts doubt over her reproductive status, moving her across the spectrum towards deficient fertility. This resonates with Varley’s findings that miscarriage in Gilgit, Northern Pakistan, is proof of a woman’s ability to conceive – ‘half the battle won’: two or three miscarriages over a woman’s reproductive life were viewed as normal, but more than five was ‘ “too much,” and signaled cosmological imbalance or “black magic” ’ (2008: 313). Similarly, whereas miscarriage in Qatar was likely to be seen as caused by evil eye or other factors, infertility might be attributed to possession or black magic. Challenges to a woman’s ability to reproduce may put her in a vulnerable position and leave her open to threats of divorce or polygamy, as Mohammed explained: Most women worry that if she miscarries once or more, her husband may marry another woman, even if the idea is not present in his mind, the people around him will make him think of it. [Who are those people?] His family, his mother, his brothers and sisters, and his friends . . . This is the most fearful thing for women. I mean even if she has children; no matter how many one or two or three and then she miscarried once or twice or more, she will assume that her husband is still young and nothing can prevent him from getting married again.

Despite previously suggesting that a small number of miscarriages should not cause concern, Mohammed recognizes that women who miscarry may worry that such an event leaves them susceptible to their husband marrying again. Even if the husband is not thinking of responding in this way, he argues that those around him may encourage him to marry again to ensure more children. This, he suggests, is ‘the most fearful thing’ for Qatari women. The fact that they have already produced children does not necessarily protect

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them from worry. Mohammed’s description of women’s anxieties in relation to polygamy is reflective of what we found in other conversations. Women often spoke about the possibility of their husband taking another wife in the guise of having more children, but this was most often associated with problems conceiving rather than miscarriage. Indeed, women do have cause for concern. Statistics show 95.9 per cent of divorces occur between childless couples often within the first four years of marriage (MDPS 2016: 25). Feelings of vulnerability in the face of not fulfilling reproductive aspirations and expectations informs women’s experience of miscarriage. The threat of polygyny certainly impacted Noora’s experience of miscarriage, as she was particularly worried that Mohammed would take another wife when it was no longer advisable or possible for her to produce more children. Noora confirms Mohammed’s assertion that miscarriges make a woman vulnerable: Definitely a woman who miscarries will be scared because this is considered a weakness, if I miscarry it means I can’t have children, so definitely I will be scared.

Whilst Noora and Mohammed previously suggest miscarriage is not a cause for concern and is a demonstration of health and fertility, further discussion reveals that they suggest that miscarriage may be regarded as ‘weakness’, casting a woman in a vulnerable position. This apparent contradiction is likely informed by Noora’s particular situation: she is forty-two years old; her miscarriage occurred towards the end of her reproductive years. She miscarried after becoming pregnant despite medical advice warning her not to due to her age and health. Of course, the pregnancy and its ending occurred against the backdrop of Mohammed’s continuing desire for more children and his admission that in order to fulfil this desire, he will marry again with Noora’s permission. Noora feels she is running out of time, thus, a miscarriage is more likely to suggest the end of fertility. Whilst most women spoke about miscarriage as not something particularly worrying or shameful and many suggested it was spoken about somewhat openly, others suggested that concealing miscarriage is common practice in Qatar. Dana explained: I think [women] avoid talking about it, to avoid being a topic of conversation because people feed on gossip like this. Miscarriage is usually a good topic of

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gossip and they would avoid it, they don’t want to be a topic of gossip. And whether it happened again . . . and they count how many times it happened to someone. People, some people, tend to collect and analyse even add some spices to it, so to avoid this we do not want to share.

According to Dana, women avoid disclosing miscarriages to avoid being the subject of gossip. Dana refers specifically to the risk of others knowing that one has experienced numerous miscarriages. Women may not discuss their miscarriage for fear of future reproductive disruptions and others noting their accumulation. The suggestion is they keep miscarriage secret to avoid future miscarriages being tallied by others, which may lead them to be labelled infertile. According to Dana, gossips also ‘add spice’ to stories, perhaps intimating more reproductive difficulties. Twenty-eight-year-old mother of two Khadija also suggests miscarriage is something about which others gossip. Having recently experienced her second miscarriage at twelve weeks’ gestation, Khadija thinks miscarriage attracts ignominy: They say: ‘This woman always miscarries’. For example, you may be sitting in a place with your friend and your friend points at a lady and says, ‘This lady has no children because they always die’ or ‘She always get pregnant but her babies die in her stomach’, – like this.

Khadija explains that some women are known to lose pregnancies and may be pointed out as such. Khadija’s husband adds: There is another social stigma; for example, if a woman always miscarries, men don’t propose to her sisters because they think it may be genetic.

Khadija’s husband suggests that there is a stigma associated with a woman who ‘always miscarries’ and that this may impact a woman’s family members, as recurrent miscarriage extends the stigma to the woman’s female relatives. However, what these quotations reveal is that whilst the speakers are reporting that miscarriage is seen as shameful, in fact, they refer to multiple miscarriages. A woman ‘who has no children because they always die’ is suffering from miscarriage, but the emphasis is on her inability to produce children at all. Whilst able to conceive, she remains unable to continue a pregnancy and, thus, she moves along the spectrum towards infertility.

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One or two miscarriages do not reflect negatively on a woman’s fertility and, thus, does not typically impact her social or marital standing. However, individual circumstances may result in a woman’s position being more or less vulnerable in the face of miscarriage. In Huda’s case, her miscarriage at advanced maternal age and in light of her husband’s eagerness for more children mean that her marital standing may be impacted. Despite previously speaking about how her mother-in-law minimized her miscarriage in light of her having three children, Huda feels that, after her second miscarriage, her past demonstrations of fertility were forgotten: Look, abortion is very common now . . . once you miscarry, oh my God! You have a problem and they start telling the husband ‘What are you going to do now?’ So they ignore that you had babies before. My husband’s parents are waiting for a baby boy . . . No, but also abortion! ‘You are facing a new problem’ . . . They make things worse. Unfortunately, we have so many wrong beliefs and our men believe in this even if they are well educated.

Not fulfilling expectations of producing a son puts her in a difficult position, but when she then miscarries a ‘new problem’ appears. Huda complains that her previous successful pregnancies have been discounted in the face of her recent miscarriages. The requirement to produce a son had been the focus of concern, but the miscarriage creates ‘a new problem’ in the eyes of her in-laws, which lead her to ‘feeling emotionally unwell’. Reproductive disruptions of different forms accumulate vulnerability.

Infertility Miscarriage, as the premature ending of a known pregnancy, primarily demonstrates fertility and, thus, does not necessarily place women in a problematic position. Pregnancy loss, when seen in a broader context of women’s reproduction and what is deemed ‘normal’, does not automatically make a woman vulnerable. Experiencing a miscarriage sets a woman apart from those who are barren, for it shows that she is able to conceive. Unlike those who experience miscarriage, infertile women emerge constantly in discussions as targets of stigma and anxiety. Infertility and, particularly,

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infertile women are seen as anathema. With the emphasis on pronatalism and on women’s role in producing children, those who are unable to do so are seen as failures. With womanhood and motherhood being so entwined, those who are unable to become mothers may be seen as not fully women. Despite remaining childless having recently experienced her second consecutive miscarriage, twenty-nine-year-old Kareema feels blessed in comparison to her sister-in-law who has never become pregnant in her seven years of marriage. Unlike her sister-in-law, Kareema feels secure in the knowledge that she can become pregnant and thus is fertile. Achieving pregnancy is positive, as conception, even one that ends in miscarriage, provides protection from concerns about her fertility, if only temporarily. It is those who have not conceived, like her sister-in-law, who are truly vulnerable, for it is more likely that they will not produce children. Seven years without conceiving demonstrates a lack of reproductive health and suggests the woman is barren. For this reason, Kareema thanks God for the opportunity to experience pregnancy even if it ended prematurely. She feels she has ‘tasted motherhood’. Wafa describes infertile women as the source of gossip: ‘Because she can’t have kids and she is not useful . . . they will talk.’ A woman’s ‘use’ is tied to her ability to produce children. Those who are unable to do so will be objects of derision. Wafa explains that such women are viewed negatively. With reproduction being central to a Qatari woman’s status, social standing and identity those who are unable to produce a child are considered inadequate and lack value in society. Infertility presents a threat to social norms of reproduction. A barren woman is particularly problematic as she is unable to fulfil her role as reproducer. As a result, a newlywed woman is the source of intense interest, with those around her awaiting evidence of her fertility. Interlocutors describe the first months of marriage as a tense period during which they experience scrutiny, particularly by their husband’s family, with whom they now live. Newly married women feel pressure to conceive immediately; if they do not do so, concerns about their fertility swiftly develop. Her fertility is of interest, to the extended family with observations and remarks made about her reproductive status, particularly by the motherin-law. At times, passive commenting becomes more active: women describe being instructed to seek medical intervention, often after only a few months of marriage. Typically, these stories feature anxious mothers-in-law. Women

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are encouraged and cajoled to seek assistance from medical practitioners to improve their chances of becoming pregnant. Women are held responsible for their fertility and are expected to be proactive in seeking investigations and enhancements, if necessary. The aforementioned hadith, which informs understandings of illness ‘Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically, but use nothing unlawful’ (Abu Dawud), extends to infertility. Women’s responses are derived from such framing: God caused the misfortune and it was meant to be, but medical care and treatment may be required to rectify it. God ensures a cure, leading women to be optimistic about their future reproduction. This means that women experiencing reproductive problems seek treatment – both biomedical and alternative therapies. Indeed, particularly with infertility, it was seen as a woman’s responsibility to seek treatment whilst maintaining faith in God as the ultimate arbiter of cure. Pregnant Abeer describes how in the first months of her marriage her mother-in-law had been concerned that she was infertile; the absence of pregnancy heightened by a comparison with her sisters-in-law who produced children soon after their weddings. Despite only being married for two months, Abeer’s mother-in-law escorted her to the hospital where she underwent investigations into her fertility. Her mother-in-law also arranged for al massada to come to their home to provide fertility enhancing treatments. In Abeer’s case, her marriage had not been in the family, making the relationship with her mother-in-law distant. With pressure mounting on her, Abeer fell to the floor in front of her husband and cried. Seeing her crying on the floor, her husband assumed the worst and thought tests must have revealed a problem with her ability to conceive. Abeer explained to him that she was not upset over the status of her fertility, but instead her distress was due to her treatment at the hands of his family: ‘you people make me feel that I have a problem’. This seemed a turning point for the couple, as her husband, who Abeer often refers to as kind, honest and loving, realized how much pressure she was under and how upset it was making her. Indeed, despite the family making her feel as though there was something wrong with her, medical investigations revealed no physical problems that might indicate reproductive problems. This was further demonstrated by the fact that Abeer soon became pregnant. Delighted by the news, her husband bought her a generous gift of gold.

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Infertile women hold a problematic and liminal status, as they transgress social roles and expectations. They are a the source of anxiety and concern and, thus, it is unsurprising that they are also most common source of evil eye. This is particularly relevant for discussions of miscarriage, for evil eye is seen as a common cause of pregnancy loss. Thus, not only are infertile women to be pitied and seen as failing in their duty and role as a Qatari woman, they are also to be feared. They are doubly stigmatized: unable to produce children themselves, they are also sources of risk for other women’s pregnancies. The sheikh introduced in the previous chapter explains: But definitely, a woman with many births could be cursed especially if another woman who is infertile looked at her belly, so she may eventually miscarry. Absolutely, the evil eye is like an arrow that comes out of the eye of the jealous person.

A specialist in reproductive issues, the sheikh echoes the comments of other interlocutors: pregnant women are not only vulnerable to evil eye but also likely to attract it. Those who are jealous of their fertile state are most likely to be infertile women. Due to the importance of reproduction, a barren woman is likely be jealous of another’s pregnancy and, thus, should be feared. Khadeeja leaves us in no doubt as to the source of evil eye: [Evil eye is] from an infertile woman. Nowadays infertility has increased and the chances to become pregnant have decreased, therefore, someone who is not getting pregnant may be yeseeb bel ain (hit by the eye) of a pregnant woman.

Infertile women, jealous of another’s fertility may cause harm. With contemporary Qatar facing decreased fertility, according to Khadeeja, women are more likely to suffer infertility and, as a result, cases of evil eye in pregnancy are increasing. Barren women are to be pitied, but also feared, for they can impact the pregnancies of women and cause them to miscarry. Infertility is a problematic state for a society that prizes fertility so highly. Childbirth and childrearing are key elements of the role of women in Qatari society. Motherhood is entwined with women’s role in Qatar: women are reproducers of children and of society and thus, it is unsurprising that women who fail to produce children espouse an ambiguous and problematic status.

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Government discourse makes the ‘Qatari family’ the basis of Qatari society and the heterosexual family as the ‘reproductive unit’. This creates a liminal character, which has become the focus of state anxiety: the single woman. As sources of societal anxiety, barren married women are related to single women for they are both seen as reproductively useless. The state’s concern with the ‘sharply rising proportion of Qatari women who never marry and steadily increasing divorce rates’ (QNDS 2011:166) is acute. The local press has anxiously reported that a quarter of marriageable Qatari women remain single with Arabic newspapers publishing articles about the negatives of the ‘spinster problem’ (Rajakumars 2014). As sex and reproduction are only legal and sanctioned when they occur between a married man and his wife, the wombs of single women are unproductive. The QNDS 2011–2016 (165–77) provided detailed ‘targets’ to ‘Implement a programme to strengthen family cohesion’ including to ‘reduce the proportion of Qatari women who are unmarried by ages 30–34 by 15%’. The wombs of single women, unable to reproduce legitimately (at least for the time being) and barren women are wasted: they are not available for the state’s mission to swell the Qatari population. These women are the source of anxiety, their value for population enhancement and reproduction of Qatari society is limited; they problematize the interdependence of the role of women and motherhood. Stigma associated with infertility has parallels in other societies and is particularly acute in pronatalist contexts, such as Israel where infertility is seen as a tragic fate for a woman (Inhorn 1996). The barren woman is an archetype of suffering in the Israeli/Jewish imagination and particularly problematic for religiously observant Jews for whom reproduction is understood as an imperative religious duty that is foundational to their entire way of life (Kahn 2000). Similarly, procreation is part of one’s religious duty and entwined with one’s role as a Qatari woman. One’s religious obligations around reproduction reinforce national expectations to become a mother. Due to the high value placed on reproduction, infertility produces significant difficulties for Qatari men and women, but it is particularly devastating for women. Infertile women may be subjected to adverse consequences such as abuse, coercion, pressure, divorce, polygamous remarriage or abandonment, and are more likely to be the recipients of social stigma and ostracism by the community (Van Balen and Inhorn 2002; Inhorn 2007b: 186). Women are

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particularly concerned about divorce or their husband taking another wife if she is unable to conceive. If a couple has problems conceiving, it is likely the woman will be seen as responsible, regardless of where the difficulties lie. Indeed, throughout the world, women typically bear the burden of infertility, often blamed for any reproductive problem regardless of source. In Qatar, like most of the Arab world, reproduction is seen as a woman’s domain leading to women being held responsible for any related problems. As Fareeda explains, infertility is ‘always’ blamed on the woman: No one will admit that the problem is from their son! The mother-in-law will say that the problem is from the wife if she didn’t get pregnant: this is the tragedy.

Culpability is often placed on the woman and she typically bears the brunt of stigma. For a couple having difficulty producing a child there are options available: ARTs are readily accessible and commonly used. Yet these technologies are not ‘immune to culture’ but are adopted in complex ways (Inhorn 2006; see also Inhorn 2005; Inhorn 2007b), often with ‘patriarchal paradoxes’ surrounding them, particularly in certain cultures (Inhorn 2003 in Faircloth and Gurtin 2017). In Qatar, as with other Sunni branches of Islam, such patriarchal paradoxes include a ban on third-party donation, which limits possibilities for infertile women. Whilst ICSI has helped to alleviate problems of severe male infertility in patients, providing greater options for infertile men who previously would not be able to produce ‘biological’ children, this technology only further increases infertile women’s vulnerability (Inhorn 2007b: 191). Polygyny provides opportunities for men who can take another wife in an attempt to produce children. Adoption is not socially sanctioned, so for Qatari women, the only means to produce a child and fulfil societal expectations is by giving birth to her husband’s child. If she does not do so, she faces social stigma and is at risk of divorce or her husband marrying another woman.

Normativity and silence – thoughts on the comparative Whilst the dominant trope surrounding miscarriage is its ordinariness and something not entirely hidden, a small number of interlocutors refer to

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miscarriage as ‘taboo’ and something to be kept private. According to Nada, one should not speak to others about one’s miscarriage: There are some people who hide this and don’t talk about it. In our society they hide miscarriage, however, in other societies such as in USA they sympathize with the woman. Here in Doha, it is a (taboo) aeb! The woman who miscarries shouldn’t talk about it and shouldn’t tell anybody.

Twenty-three-year-old Nada’s opinion that miscarriage should be kept private is possibly informed by her status as a new bride whose first and only pregnancy had ended in miscarriage. Having not produced a child, Nada’s position is more vulnerable than other interlocutors who have more fully demonstrated their fertility by producing children. Recently married, Nada is likely unfamiliar with discussions of pregnancy and reproduction in keeping with Qatari social mores, which dictate that sex and sexuality are not appropriate topics for the unmarried and amongst certain groups. Nada has only recently moved into the realm of womanhood and has likely not experienced open discussions with other women about pregnancy. Her comments are striking in that most suggest that miscarriage isn’t something particularly taboo, particularly in comparison to infertility. Nada’s comment that other societies, like the USA, are more sympathetic to miscarrying women and her suggestion that miscarriage is taboo in Doha unlike in other contexts is particularly interesting. As Nada acutely notes, miscarriage is typically responded to with sympathy in North America (also the UK), however, this is a relatively recent development. Historically, miscarriage has garnered little attention let alone sympathy. Scholarly work on miscarriage (i.e. Cecil 1996, Layne 2003, van der Sijpt 2017) has focused on the trope of silence surrounding it. Notions of miscarriage as failure as well as discomfort with its associations with blood, mess, death, and pain (Cecil 1996), or ‘matter out of place’ (Murphy and Philpin 2010) has made miscarriage a silenced subject. In more recent years, this absence has been challenged with more public spaces opening for women to document and articulate feelings of loss and grief. Accounts of miscarriage in much of Euro-America have focused on its social silence and how this emphasizes feelings of inadequacy, isolation and shame.Yet the sheer volume of discussions around pregnancy loss demonstrates that there is silence no more. Women are actively and publicly sharing

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experiences of pregnancy loss, thus dismantling silence, shame and stigma around all forms of pregnancy endings; as the ‘break the silence’ slogan of British Baby Loss Awareness Week so clearly articulates. Approaches to miscarriage have changed dramatically in much of Euro-America, as evidenced not only by the introduction of awareness days and other public forums to articulate feelings of loss, but also the market for miscarriage memorials, and shifts in medical practice, including changes to disposal practices, which now treat pregnancy materials as something needing sensitive disposal (Morgan 2002; Kilshaw 2020a; Kuberska 2020). Such activities frame miscarriage as a significant loss of a baby or child for which the appropriate response is distress and grief. Informed by broader social transformations and understandings, updated clinical approaches reinforce understandings of miscarriage as the death of a baby. Women in many parts of Euro-America have reported silence about miscarriage and typically understand it to be rare, unusual and indicating more serious reproductive problems (Kilshaw 2020b, 2017b; see also Bardos et al. 2015); remaining pessimistic about their future fertility and concerned a miscarriage points to damaged fertility (Kilshaw, 2020b). ‘Uncertainty’ appears repeatedly in their accounts: miscarriage results in ambiguity, particularly over one’s reproductive future (Kilshaw 2020b), reflecting the milieu of ‘anxious reproduction’, which emerges as new reproductive choices, burdens, responsibilities and accountabilities increases anxiety (Faircloth and Gurtin 2017). Miscarriage in this context is typically understood as failure and is accompanied by feelings of personal guilt particularly in neoliberal and technologically advanced settings where a sense of responsibility, accountability and agency dominate reproductive experiences (Kilshaw 2020a and b; McCabe 2016; Rapp 2000; Thompson 2005). The emphasis on individuality, choice and agency contributes to an assumption that women may be responsible for their miscarriage much as they are held responsible for infertility (Layne 1997). Miscarriage as failure may be particularly acute in the context of ARTs (Berend 2010, 2016; Mitra 2020). However, miscarriage is not always viewed as failure, but instead evidence of health because of its demonstration of conception and/or the body acting as it should by preventing the ongoing development of an unviable or undesirable foetus. Such a framing of miscarriage as the body operating as it should rather than pathologically is found in biomedical

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interpretations (Layne 1997: 291; Melo and Granne 2020), where miscarriage is a natural process of quality control. Qatari miscarriage suggests fertility and, thus, a (partial) success; there is optimism about future reproduction. Qatari women retain confidence in their fertility and a sense that their life is mapped in a way that is somewhat beyond their control. Qatari women’s lives are lived within a religious and cultural framework, which limits notions of choice, including about reproduction, and, as a result miscarriage is seen as ultimately outside their control. Exposed to more reproductive events, miscarriage is normalized. Exploring miscarriage in a range of contexts, such as Qatar, provides opportunities to question commonly held assumptions around the experience. Although the discourse of miscarriage as significant loss of a baby is a recent development in Euro-America, it has become part of the ‘dominant’ language of parenting and reproduction (Faircloth et  al. 2013a), itself informed ‘the largely middle-class, North American/Northern European discourse of public and professional life’ (Strathern 1996: 38). Yet such a framing of pregnancy loss may be at odds in some contexts, where miscarriage is framed more normatively or is more likely to be approached with pragmatism. Indeed, the influence of such dominant discourses may impact Qatari women’s experience of miscarriage, particularly in light of global flows of knowledge in this cosmopolitan context. Increasing individualization of Qatari society may make such interpretations of and reactions to miscarriage more persuasive.

Conclusions Miscarriage is a sad, if relatively commonplace, occurrence. Awareness of other women’s reproductive experiences mean that it was not interpreted as unusual or necessarily a worrying event, reflecting the biomedical view of miscarriage. In biomedicine, miscarriage is understood as a natural process of quality control through which the body recognizes an abnormal pregnancy (Benagiano et al. 2010); a view which resonates with the understanding of miscarriage as God’s will to end a pregnancy that would have ended in disability or some future problem. Following a miscarriage, women are reminded of their fertility and typically remain optimistic about future reproduction. The focus is on

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cleansing the body often with the help of traditional healers. A small number of miscarriages does not necessarily damage a woman’s status or call her fertility into question; however, numerous miscarriages become a source of anxiety and concern. Women who suffer multiple miscarriages evoke damaged fertility, moving them on the spectrum towards the state of an infertile woman. Deviations from the expectation that women will become pregnant easily, soon after marriage; will continue to regularly conceive; and will produce a son places the woman in a difficult position. Her status will only worsen with each additional loss or reproductive failure. With the centrality of fertility and reproduction in Qatari society, those whom are unable to produce children fall short of social expectations. Infertility presents a threat to social norms of reproduction, with the infertile woman being the cause of anxiety, pity but also fear. Qatari interlocutors see miscarriage (in small numbers) as a demonstration of fertility and, thus, it is compared favourably against infertility and an absence of conception. Women and those around them interpret miscarriage by using knowledge from other women as well as from their own reproductive histories. Qatari women often spoke of other women they knew who had miscarried and saw their experience from this perspective, interpreting their experience as not particularly unusual. Because of the specific social landscape in Qatar, which includes extreme pronatalism, high fertility rates, polygyny, accessibility of ARTs but without third-party donation there is a particular configuration of reproductive problems and stigma. Women who are unable to conceive and/or produce children are highly stigmatized; those who have hope of conception and/or who have demonstrated their fertility are protected from this stigma. This differs from much of Euro-America where, in the era of anxious reproduction, any stigma around miscarriage and infertility seems to be collapsing.

9

State Development Discourse: Maternalism and Empowerment

Encouragement and obligations to produce children are felt at the individual and also at the societal and state level, with women’s reproduction embedded in national values and pronatalist measures. Feminist anthropologists have shown ways in which bodies and women’s bodies, in particular, are sites for social inscription (i.e. Martin 1987). Women’s bodies are sites of state influence, with reproduction embedded in local social arrangements, which are inherently and politically contentious (Ginsburg and Rapp 1995). Motherhood, nationalism and citizenship are interlinked with obligations filtered through tribe and family networks. Lines of power, communication and influence, often with the husband and the mother-in-law as central figures, exert pressure on women and their bodies, influencing reproductive negotiations. The Qatari state encourages high fertility amongst its citizens through various direct and indirect pronatalist mechanisms including extensive social welfare programs, such as generous family allowances (UN Dept. of International Economic and Social Affairs 1990), full subsidies of public services, including healthcare and education (Winckler 2015) and high subsidies on housing, food and energy products. The absence of income tax, national employees’ high salaries and relaxed work conditions support and encourage large families. Ready access to state-funded ARTs are further pronatalist mechanisms, all of which are meant to increase the national population. Motherhood outside of marriage is not legitimately possible; pronatalist measures are directed at the heterosexual family as the ‘reproductive unit’ in Qatar. Considerable subsidies and benefits are targeted at families and, thus, both men and women, yet decisions about family size rest primarily with the husband. However, enticements to have large families often ‘come up against other structural 181

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factors: discrimination that many women encounter in the job market, the inability of women to count on a strong Welfare State or on state policies supporting the reconciliation of family and work, and gendered divisions of labour in which many women struggle with deep gender inequalities in the division of domestic work’ and care responsibilities (Krause and De Zordo 2012: 145). Development strategies, such as the QNDS 2011 emphasized the ‘continuity of cohesive families and large households’ as ‘crucial to the national vision’ (p. 166). Women are key reproducers of the state through conceiving and producing children. The family is ‘the first and most influential educator and inculcator of values’ (QNDS 2011: 165), and government discourse takes the ‘Qatari family’ as the basis of Qatari society; yet it is the role of women as mothers who are the targets, as it is they who are seen to impart moral and religious values to their children. Women, as mothers, are crucial to the continuation of traditional values and practices including Arabic language skills: they reproduce Qatari society. Maternalism features in state projects of development, linking motherhood with the nation. The Qatari state harnesses bodies for nationalist concerns with the Arab modernity project enacted by/through bodies, particularly those of women. Qatari women’s bodies are sites of articulating tradition, or conventions of tradition, through a variety of means including dress, behaviour and movement in social spaces, and through bearing and raising children. Women and their bodies are inscribed with the values of Qatari society and to this end reproduction is managed. State mechanisms promote and encourage high fertility and emphasize mothering, which are seen as essential to a women’s role in society. Reproduction is one of the primary means through which bodies, particularly women’s bodies are sites of development strategies. Government discourse, including documents and policies, such as the Qatar National Vision 2030 (QNV), the state communicates a clear message about what a Qatari woman is supposed to be. A category of ‘Qatari woman’ emerges in the reform discourse (following Le Renard 2014) where she has become the object of development and modernization policies. Development strategies emphasize women’s empowerment, education and employment whilst simultaneously stressing their role as reproducer of tradition and continuity with the past. As Caeiro (2018) observes, it is difficult to identify with precision how the state views the family and women’s role in society: does it encourage women’s

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empowerment and leadership in society, or does it seek to maintain them at home to maintain high fertility rates (see Newcomb 2009 for similar discussion of contradictions and multiple pressures for contemporary Moroccan woman)? Women negotiate these contradictory nationalist values, being asked to perform and embody Arab modernity and its distinct fusion of customary and contemporary. Tensions are played out on women’s bodies, their reproductive aspirations and experiences. Miscarriage and reproduction are experienced against a backdrop of state development strategies of pronatalism, maternalism and women’s empowerment and the frictions that emerge as a result. An exploration of these strategies and their lived experience help us to understand miscarriage, including theories of causation, notions of culpability, desire to conceal pregnancies and/or loss, and the overall normative approach to miscarriage in light of the stigma of infertility.

Education and employment: expectations, ambitions and challenges Qatari women’s opportunities for higher education and employment have increased substantially in recent decades. Women’s education has seen significant growth in the last century, with women increasingly outnumbering men in attendance rates at Qatari universities. Empowering women through education and employment has been one of the emerging narratives of the previous leadership, particularly through the influence of Sheikha Mozah. Indeed, one cannot speak about the role of women in contemporary Qatar without speaking of the Sheikha’s visible and influential role in state politics. The second wife of the former Emir and mother of the present leader, she is a rare exception in that she exerts a discernible public role, ‘crossing boundaries for Qatari women and exerting significant influence at a key moment of modernisation in Qatari history’ (Rajakumar 2014: 127). She embodies the delicate balance between modernization and tradition and espouses a ‘plural, liberal interpretation of Islam, which focuses on the religion’s emphasis on education, the role of the individual in society, and the betterment of the world’ (Rajakumar 2014: 127). As the mother of seven children, she represents the values of Qatari motherhood and is a role model for many. Whilst overwhelmingly admired in Qatar, her influence and

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profile has attracted criticism in other parts of the region: ‘Sheikha Moza is the object of lurid, often misogynistic insults in the Saudi, Emirati and Egyptian media, where she is portrayed as a power-hungry manipulator of weak men’ (Walsh 2018). In this way, her influential role has been a means for those nations involved in the diplomatic crisis with Qatar to criticize its government and their vision for society. The Qatari state began to invest in education in the 1950s and 1960s. The first school for girls was opened in 1955 and women began receiving formal education in increasing numbers during this period. Sixty per cent of interlocutors were engaged in or had completed higher education. All but three women had achieved a high school education, reflecting the gains made by the state’s emphasis on improving access to education and opportunities for all Qataris, but particularly for women. The investment in education has had remarkable results: the literacy rate has increased dramatically to reach 96.3 per cent (QSA, 2010) and university education has become far more commonplace with 30.9 per cent of Qataris holding a university degree in 2012. The first university, Qatar University, was opened in 1973; as a homegrown initiative, it provided gender-segregated education with a men’s campus and a separate women’s campus. In the first year, 40 per cent of the students were women, and they continue to be a significant presence: in 2012 there were almost twice as many women students enrolled as men. Indeed, this trend can be seen throughout the higher education campuses, including in gender-mixed Education City. Concerned about dependence on foreign labour and outside expertise, the state introduced a number of governmental initiatives devised to increase the number of Qatari citizens employed in public and private sectors, as part of the ‘Qatarization’ of the nation. Such initiatives are seen in reform discourses throughout the region: ‘Saudization’ began in Saudi Arabia in the 1990s, and included the nationalization of jobs and the development of the private sector. In the early 2000s, Saudi women’s role in social development became one of the main themes of governmental reform discourse (Le Renard 2014) and is at the core of a new national rhetoric. Similarly, in Qatar, women began to take on a central role in state development plans, particularly in their inclusion in the nationalization of jobs and, more broadly, in the Arab modernity project.

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The QNDS 2011 emphasized women’s role in society through empowering women to participate more fully in the political and economic spheres (QNDS 2011: 17), referencing international norms and conventions in seeking to improve work-life balance for women and increase the presence of women in leadership positions (Caeiro 2018). Women were encouraged to enter paid employment with the state eager to reduce barriers (QNDS 2011: 166). The document detailed ‘targets’ for advancing the women’s empowerment agenda including ‘put in place measures that support working women, including revising the current human resources law and maternity leave policy’; ‘increase the number of women in leadership positions by 30 per cent’; ‘establish a civil society organization that promotes women’s issues’ (2011: 165–77). The aim and expectation was that by 2016, Qatar’s rising female labour force participation rate would stand at 42 per cent (QNDS 2011). By 2015, 51 per cent of women over fifteen in the country were economically active; however, the rate of Qatari women’s employment was 36 per cent (MPDS 2016; Walker 2016) compared to the 64 per cent employment rate of Qatari men. The employment rate of Qatari women is the highest in the Gulf region, but it is still disappointing considering 88 per cent of Qatari women pursue higher education (Al-Tamimi 2016 in Golkowska 2017). Despite the efforts of the government to increase opportunities for women and to reduce barriers, women are affected by the significant wage gap, in which they are paid 25–50 per cent less than men. The generous social allowances, such as housing allowances, are commonly given to male employees, but less likely to their female colleagues. Women’s choice of professions is also limited; some professions are seen as inappropriate or not family friendly. Medicine, teaching and social work are typical professions for women. For these reasons and because of uneven developments in gender equality and women’s lack of involvement in political life, Qatar has recently been ranked one of the most unequal societies in terms of gender (Scott 2017; Chan 2016). Forty-six per cent of economically inactive Qatari women are stay-at-home wives and mothers and 38 per cent are students. ‘Cultural reasons’ were cited by 44 per cent of women as an obstacle to pursuing professional goals (Walker 2016). Government initiatives regarding education, employment and ‘empowerment’ promote a model of Qatari womanhood. Women must participate in ‘national development’ through professional employment and become productive, ‘active’

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members of society (Le Renard 2014: 43). The promotion of the model of professional femininity resonates with ‘reasonable change’: the rhetoric of change while respecting customs, Islam, and specificities of society (Le Renard 2014). However, an important aspect of professional femininity is that it is seen as supplementary and not replacing a model of femininity based on reproduction (Le Renard 2014: 73). Whilst education and employment initiatives for women have been heralded as an overwhelmingly and progressive example of Qatari leadership, it has not been free from controversy. Women’s education has been seen to affect marriage practices, such as increasing age at first marriage, which now rests at 24.1 years (QSA 2014) and contributes to decreased fertility as well as high divorce rates. Thus, we see that development strategies of empowerment help to produce state anxiety around demographic imbalances and decreasing fertility.

Professional pregnancy: problematic negotiations, managing tensions and mitigating risk Many women welcome education and employment initiatives, for they present opportunities for empowerment and independence both financial and social. Women speak of financial gains, access to state support, independence and feelings of fulfilment as reasons for education and employment, as well as reporting social expectations to do so. Sameera told us that women work because it brings ‘freedom and prestige’. However, the narratives contained in this book make it clear that such opportunities also produce expectations, obligations and aspirations which must be negotiated alongside the demands of reproduction in a pronatalist environment, which emphasizes their role as wives and mothers. Women’s narratives of reproduction are saturated with tensions of balancing professional and family duties: women feel pressure to produce many children, mother them effectively whilst simultaneously embodying a role as a professional modern Qatari woman. They express anxiety about working whilst pregnant, with such activities seen as a threat to vulnerable pregnant bodies. How does a woman negotiate motherhood at the same time as undertaking employment or education?

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Delaying employment or pregnancy, limiting family size There are a number of strategies that women employ to manage competing expectations and aspirations. Reproductive navigations include delaying pregnancies and striving for smaller families. This somewhat contradicts women’s suggestions that they have little control over their reproductive lives and that they don’t ‘plan’ pregnancies, pointing to pregnancy timings being managed either through avoidance or birth control. Birth control is widely available, although there was some uncertainty as to whether it was permissible. Women suggested one should seek a husband’s permission to use birth control and it was typically seen as unacceptable for new brides or women who had yet to conceive a child. Coitus interruptus was often referred to as a means to manage pregnancy. Krause (2012: 368) has discussed the way demographic transition theory assumptions about the binary between ‘controlled’ and hence ‘modern’ fertility practices and ‘uncontrolled’ and thus ‘backwards’ ones are often challenged by reproductive practices. Hessa, a pregnant twenty-six-yearold working woman with a five-year-old child, waited five years before trying to expand her family because of the expectations upon her and her own career ambitions: I had to finish my university education and after that I started to look for a job. After I was employed, I had to wait for one year to prove myself before I became pregnant.

Hessa manages reproductive navigations in light of her professional and personal life. After finishing her education, she focused on securing a good job and subsequently felt she required time to demonstrate to her employer her worth. Only once her career had progressed did she feel able to have another child. It is likely that Hessa’s decision impacted the size of the family she was to create. Others more directly suggest that their expectations of employment impacted their projected family size. As Samia, a thirty-three-year-old working mother of four sons said: I don’t have a definite number [of children] in my mind because of modern life responsibilities and not being available all the time to play the role of the mother. Our mothers used to have many kids because they were available all the time for their role as mothers. Nowadays, because of the variety of the tasks and the responsibilities that the woman has, in addition to her role as a

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wife, an employee, a mother and a sister . . . she also has responsibilities toward her parents. Therefore, it is difficult to have lots of kids. I can have ten kids, but I want to be available for them and I won’t be able to give them the time and the attention that they need. So, if Allah wants, I will have five kids.

Samia expresses a sentiment reiterated by many: contemporary life involves multiple and often conflicting roles for women. Ultimately, these demands make it difficult to fulfil individual, familial, religious, cultural and state expectations to produce a large number of children. For Samia, ‘modern life responsibilities’ make it difficult to be ‘available’ for children and mother them effectively, which is particularly acute in large families. In some cases, negotiating these conflicting obligations involve aspirations to have fewer children, as with Samia and indirectly, Hessa who navigates reproduction around education and employment goals. Like Hessa, Dana delayed pregnancy to complete university, however, such delays were unusual, with the majority of interlocutors suggesting that delaying pregnancy in this way was not a viable option due to the expectations and pressures of conceiving soon after marriage. In Dana’s case, her desire to finish university before having a child was formalized in her marriage arrangement. Once married, the couple used condoms for the first year of their marriage, choosing this form of birth control so as not to impact her fertility with hormone-based birth control. Dana became pregnant during her final semester at university. After she gave birth to her son she decided not to work mainly due to the fact that her mother was already caring for her sister’s children and her mother-in-law was unable to help because of her own career. Not wanting to leave her children in the care of a maid for long periods, Dana decided not to work, or at least delay for the time being. After the birth of her son, Dana soon became pregnant again and gave birth to a daughter. Wishing to concentrate on being a good mother to her two children whilst also having devoted time to pursue her own interests and hobbies, Dana ‘took a break’ after her daughter’s birth. However, she later regretted this decision in light of a series of reproductive losses and disappointments. She worried that a large family now evaded her: she and her husband had fifteen siblings between them and want to continue the tradition of large families. ‘I always wished to have a big family’, Dana explained and described her relationship with her family as very close and supportive of one

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another; a large family meant more companionship and support. Having seen his wife’s distress at losing a baby and then miscarrying, Dana’s husband, Qaseem, was content with their two children. When I met with him, he explained that it was Dana who was driven to have more children, citing her very close and large family, which had been such a support to her during her recent losses. Indeed, I witnessed her close relationship with her sisters and mother as I met with them several times. Dana and Qaseem had a close and loving relationship: Dana described Qaseem as very caring of her in general, but particularly through her miscarriage and the loss of their son. Qassem was one of the only men whose wives reported that they had accompanied them to the pregnancy scans. When Dana speaks about motherhood, the words she uses are ‘responsibility’ and ‘sacrifice’, describing motherhood as preventing one from having freedom. Some of Dana’s friends had delayed marriage, instead deciding to embark on careers after graduating from university: Most of them didn’t get married but instead they [secured jobs] and after a while occupied a high position. I am not regretting being a mother because I consider raising my kids an achievement, but you give up some things when you become a mother.

Dana describes her friends as ‘living life to the full’ and having fun in comparison to her life, which is full of the responsibilities of motherhood and being a wife. Dana’s friends are representative of a demographic trend of Qatari women delaying marriage and the birth of their first child (QSA 2010). Women’s reproductive navigations are influenced by their professional activities, with women delaying marriage or pregnancy, if possible. Thus, they are illustrative of the demographic trends that so concerns the Qatari state. Some women may attempt to space pregnancies to allow for effective reproduction and mothering whilst fulfilling educational and career aspirations and obligations. In this way, the expectations of professionalism and empowerment impact women’s reproductive choices and may result in delayed marriage and fewer children, contributing to state anxieties about decreasing fertility rates. Indeed, the state, by way of the Ministry of Development Planning and Statistics, identified women’s education and participation in the labour market as one of the main reasons for the ‘remarkable decrease’ in Qatar’s general marriage rate (MPDS 2016: 6), shifting the responsibility towards women and foreclosing any

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examination into the distribution of rights and duties in Qatari marriages (Caeiro 2018:10).

Reducing and avoiding work as pregnancy health negotiations Whilst some women negotiate reproduction and professional expectations by attempting to avoid their simultaneous occurrence, the majority of women are unable to avoid doing so throughout their lives. Many women find themselves negotiating pregnancies in educational or professional environments. Work features significantly in women’s narratives of pregnancy and vulnerability. Overwork, excessive movement, stress and fatigue are commonly discussed pregnancy risks with the majority of interlocutors suggesting a link to miscarriage. Narratives about pregnancy and the work environment as being damaging reveal tensions around contradictory models promoted for women. Certain pregnant women are more vulnerable because of age, certain health conditions, or if their pregnancy is ‘weak’, or the result of fertility treatments. Tiredness and excessive physical movement are commonly seen as threatening to a pregnancy. As fatigue depletes the pregnant body, working too much or excessive physical activity is damaging and may result in miscarriage. Women commonly suggest that pregnant women should ‘take it easy’: movement, activity and stress associated with professional activities prevent this ideal state of calm (Kilshaw et al. 2016). Women may thus avoid or reduce professional responsibilities to protect pregnancies. Fouz, a twentynine-year-old administrator who recently suffered a miscarriage following IVF treatment, suggests that work may be damaging to pregnancies: In my first pregnancy I was working in a school and everything was fine. However, I recommend that the woman takes rest for the first three months and after that she can resume her life as before. I suggest that they reduce working hours for a pregnant woman so she can start her work at 10:00 or 10:30 in the morning.

Whilst she worked during her first pregnancy, which produced her now threeyear-old son, conceived following IUI (inter-uterine insemination) fertility treatment, Fouz remains concerned about the working environment and suggests that rest is desirable and protective for pregnant women, with particular emphasis

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on the first trimester. Pregnancies are commonly seen as more vulnerable in the early months, with Fouz advising that women are able to return to ‘life as before’ and work following that period. However, Fouz subsequently argues that pregnant women should be privy to reduced employment hours. A concern about the impact of professional activities on pregnancy consistently emerges. Whilst Fouz advocates women continuing to work, possibly in a reduced capacity, others suggest work should be avoided altogether. A woman’s individual situation including the nature of her work or the particular vulnerability of her pregnancy influenced negotiations of workplace responsibilities. One of the main strategies that women employ in negotiating their working life whilst pregnant is through a series of ‘sick leaves’. ‘Sick leave’ refers to the document, signed by a clinician, which is formal exemption from work, typically for a two-week period. This document would be shown to an employer in order to excuse the woman from her responsibilities. Samia who had recently suffered her first miscarriage explained: At the end it is all God’s will and if the woman has a high chance to miscarry, she should take rest and stay away from stress, particularly at work either by reducing the number of working hours or taking sick leave.

As Samia explains, ultimately whether or not a woman will miscarry is God’s will, but if her pregnancy is vulnerable, she should rest and avoid stress. Samia emphasizes the association between stress and work and recommends women should reduce their hours or avoid work through obtaining permissions through sick leave documents. Such exemptions were common; it was not unusual to bump into pregnant interlocutors at the hospital as they obtained such documents. Indeed, women would often seek such permissions numerous times throughout their pregnancies. However, such requests could themselves be a source of negotiation as some women would not want the reason behind the absence made explicit, in order to not disclose their pregnancy to their employer.

Concealing pregnancy Women not wishing for sick leave documents to divulge pregnancy raises a related issue about work as a problematic environment. Many women do not

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reveal their pregnancies to work colleagues until it is necessary to do so. This tendency relates to wider cultural practices of modesty. Some employment and education environments are mixed-gender spaces, challenging practices and sensibilities of gender segregation. The state’s commitment to develop a knowledge-based economy and associated development initiatives has meant importing Western models of education and different patterns of social life, presenting new challenges for Qatari women who are to navigate between modern and traditional codes of conduct and spatial practices (Golkowska 2017). Professional and higher education environments expand women’s social/public sphere and increase opportunities for interactions, creating more instances of coming into regular and close contact with non-kin men and women. Gender segregation, intended to limit interaction between men and women who are not close blood kin, is an important aspect of life in Qatar and other Arab Gulf states. Whilst not legally required in Qatar, unlike in Saudi Arabia where it is actively enforced, gender segregation is common. This segregation is in place ‘to regulate women [and to] prevent other men from encroaching on the male honour of the family’ (Al-Munajjed 1997). Indeed, this practice is linked to the broad and central requirement of ‘modest self-presentation for Muslims in public, particularly women’ and the underlying attribute for privacy is respect (Sobh and Belk 2011), which is common in much of the region. Modesty is challenged by pregnancy in the workplace. When we first met Amal she had been admitted to the hospital for complications with her pregnancy. However, despite her obvious absence, her employers were unaware of her pregnancy and related hospitalization, as Amal had simply reported being ‘unwell’. In previous pregnancies, Amal delayed disclosing her pregnancy to colleagues until she was in her final month. Having not gained a great deal of weight, she was able to conceal her growing bump. She chose not to reveal her pregnancy to work colleagues because: I am ashamed! Because I am their manager and most of the employees are men and they are older than me, so I feel ashamed to tell them that I am pregnant. In my first pregnancy I didn’t tell anybody in my workplace till the sixth month. They thought that I had just put on some weight because I didn’t have a big belly until the ninth month . . . Then they started feeling pity for me and I don’t like this feeling.

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Amal raises an important issue about the tensions for Qatari women working in professional environments. Women report feelings of shame when disclosing pregnancies to male co-workers. Discussions of pregnancy compromise practices of modesty and threaten women’s respectability by referencing their sexuality to (unrelated) men. In a society where women are unlikely to speak about pregnancy, reproduction or sexuality even with close family members (Kridli 2013), having to discuss pregnancy or miscarriage with (male) work colleagues, is extremely transgressive. To negotiate such a social transgression and delay the public presence of their pregnancy in the work environment, women often disclose their pregnancy to superiors or colleagues only once it becomes necessary to do so or once the pregnancy is impossible to conceal. A husband whose wife had recently miscarried provides insight about this practice: speaking from his experience as an employer, he indicates that he only learns about employees’ miscarriages from their medical reports when they claim sick leave: Pregnancy and miscarriage are two things that women here are shy to talk about in front of men. Not only that, but they hide it from most people. I am a manager in a bank and many of my employees are women and I don’t know if one of them is pregnant until she is in the last months or even until she gives birth to her baby. Wearing [the] abaya makes it easy for them to hide their pregnancy so nobody will notice and the same thing regarding miscarriage. I only got to know that one of my employees had miscarriage from the medical report that she submitted with the sick leave. I wonder why do they do that? Why do they hide their pregnancy? . . . It is not only me, other colleagues don’t know, only one or two of her close friends will know about her pregnancy and that’s it.

As an employer, he remains ignorant of his employee’s pregnancies; Qatari women wear the loose-fitting abaya, thus, a pregnancy may not be detected until the final months. In Amal’s case, she delayed revealing her pregnancy until it became impossible to conceal. In other cases, such as Kareema’s, a woman might feel required to disclose a pregnancy as a means to explain sickness or an absence or because her appearance began to change noticeably. Kareema felt obliged to notify her superior about her pregnancy because after her previous pregnancy, which had also ended in miscarriage, her manager thought she had fabricated the pregnancies to avoid work:

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He thought that I had created all this to get sick leave . . . Therefore, when I miscarried the second time, I told the doctor in Hamad Hospital, ‘Please write it in Arabic and English, “Miscarriage” ’ because in my first medical report I was shy to write miscarriage, so to make him understand I asked for it to be written clearly.

Kareema felt compelled to disclose her pregnancies and miscarriages in order to protect her reputation at work. Her workplace accepted the sick leave, but she felt uncomfortable about the incident. She was embarrassed to have her manager know ‘personal matters’ about herself; that these ‘matters’ indicated sexuality further impacted her discomfort. However, her desire not to be seen as a liar or malingerer compelled her to disclose the intimate information of her miscarriage. Concealment of pregnancy is linked to protection from threats that might harm, including evil eye, or from gossip, but it is also related to modesty. Revealing a pregnancy or miscarriage either through a visible swelling body or by declaration transgresses social norms of not discussing private and intimate matters. This is particularly problematic with male colleagues or employers, as pregnancy is suggestive of sexual behaviour. Whilst women often choose not to discuss or disclose their pregnancies or miscarriages in some, particularly in mixed-gender environments, Qatari miscarriage is otherwise dealt with relatively openly. Women employ a variety of strategies to navigate between professional and reproductive aspirations and obligations, and to manage the tensions that may arise. Delaying marriage and the birth of their first child is a means for women to negotiate expectations. For many Qatari women, further negotiations are required to manage reproduction alongside professional demands. In some cases, women may wish to delay further pregnancies or limit family size to lessen the frictions arising from negotiating family and professional responsibilities. Women who find themselves navigating pregnancies whilst working employ strategies such as reducing and avoiding work, particularly through the use of sick leaves to limit vulnerabilities and impact on pregnancy. Not disclosing or concealing pregnancies and/or miscarriage is a common strategy to reduce anxiety about the social transgressions that occur when pregnancy is revealed in public spaces. But how do women negotiate the practicalities of combining work and motherhood? I now turn to one major strategy of women’s negotiations of balancing the obligations of family and careers: the

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domestic worker. Yet, whilst making professional motherhood possible, domestic workers maintain a particularly problematic status in household and state discourse.

The role of domestic workers in negotiating professional and maternal roles The Qatari state is eager to increase women’s participation in economic and political life, but given that childcare is overwhelmingly seen as a woman’s role, how do women balance work and home life? This is particularly problematic when one considers the long hours in a typical Qatari workday, the often lengthy travel time caused by the dreadful Doha traffic, and limited maternity and family leave policies. One of the key concerns for family life in situations of dual-earner family models is childcare. Cross-cultural variations in welfare regimes (Esping-Anderson 1999) reveal that a dual-earner family model is in tension with childcare as the responsibility of the family. In some contexts, the state takes a role in responsibility for childcare thus allowing parents to fulfil expectations of employment, but in Qatar responsibility remains with the family and primarily with women. Maternity leave entitlement is fifty days with full pay if the woman has been employed for a year. Upon returning to work there are a number of options for childcare including help from extended family. However, the key to managing the work/home balance in Qatar is through employing domestic workers who literally support the reproduction of Qatari families. However, anxious about the role of foreign workers in Qatar in general and their influence in Qatari homes, specifically, the dependence on foreign domestic workers is being curtailed by the state. The significant role of domestic workers in Qatari homes is reflected in their frequent appearance in women’s discussions; conversations often touched on, and at times revolved around, maids. Almost all interlocutors employed maids – some employed several – in addition to other domestic workers, such as drivers. Always migrant workers, these employees are key figures in Qatari domestic arrangements with maids playing a central role in how households are managed, enabling women to negotiate their responsibilities whilst also providing opportunities for leisure. Often portrayed as problematic characters,

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maids are both necessary and potentially threatening. Discussions about domestic workers are often rife with frustration and anxiety; at times they are directly implicated in reproductive disruptions. Conversations about maids, often the source of ambivalence and anxiety, most commonly revolved around concerns and complaints. Women sometimes speak affectionately about their maid, but most often discussions were tinged with exasperation. Domestic workers require directing and managing, as Huda explained: I should have more than two eyes. I should have six eyes: one on the driver, one on each maid, one on the kids and one on the husband. You should be very aware of everything . . . So controlling the maid is important because many problems happen when the mother is not here.

Employing domestic workers meant they had to be organized and managed. ‘Problems’ occur when the woman is absent from the home, thus, a woman must maintain control and oversee household matters from afar. Interlocutors speak of maids needing to be watched and controlled and suggest that they add a complexity to household dynamics, expressing anxiety about having an outsider in the home who interacts freely with family members. Some women are concerned about maids seducing or acting inappropriately towards their husbands, whilst one woman reported that her husband had sex with their maid on several occasions. Qatar only recently (August 2017) approved a law outlining certain basic employment requirements for domestic workers, including limiting the working day to ten hours and the working week to six days. Abuse of workers, such as domestic and construction workers, is systemic, in part as a result of niz.ām al-kafāla (sponsorship system) or kafāla; a sponsorship system used to monitor migrant labours, primarily those working in construction and domestic workers. The system requires all unskilled labourers to have an in-country sponsor, usually their employer, who is responsible for their visa and legal status. It dictates that workers are unable to leave the country or change jobs without the employer’s permission leaving domestic workers vulnerable to abuse. The practice has been criticized by human rights organizations for creating an environment in which exploitation of workers thrives, as many employers take away passports and abuse their workers with little chance of legal repercussions. Qatari women most often

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disregarded such dynamics and, instead, expressed anxiety about domestic workers as potential risks. Although some women speak with concern about the interaction between adult family members and domestic workers, anxieties focus on interactions with children. Huda’s concerns about managing her maid are linked to concerns about their influence on her children: Most of the time I don’t like to have two maids because the controlling becomes difficult. And it means that they have a lot of time to sit with the kids and I want my kids to depend on themselves and not to stay in contact with the maid for a long time. If she is the only maid and I help her most of the time she will only focus on the house work; but if there are two maids, they will clean and finish everything early in the morning and for most of the time they will be just sitting, chatting with the kids and playing with them and this may affect my kids because they may transfer bad beliefs to my kids. So, I don’t want this close contact between my kids and the maids.

Huda explains that a mother looks after her children, but she is also responsible for managing the household, including domestic workers. Part of this control is to ensure that one’s children learn self-sufficiency and to minimize excessive contact between one’s children and domestic workers. As Huda continues, such contact could result in children being influenced by unsavoury beliefs. These concerns emerged often and are linked to notions of motherhood and continuation of family, tribe and cultural traditions and values.

Maids, miscarriage and modernity: domestic workers and state policy In some cases, maids may be implicated in miscarriage: if a woman understands that her miscarriage was caused by overwork or fatigue, this may be blamed on the absence of or lack of effectiveness of a maid; or if witchcraft is suggested. Fromherz (2012) argues that Saudi maids are feared for their powers of traditional ‘black magic’, an indication of an externally projected anxiety, and points to scandals over their hiring as reflective of this as well as complicated unease about Qatari modernity. Domestic workers feature in discourses of modernity and its impact on reproduction. Women from older generations

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comment upon changes in Qatari social life with contemporary Qatari women being more pampered, more requiring of leisure time, less active, and their bodies less robust; a narrative of contemporary women’s reproductive inferiority emerges. In addition, contemporary women are seen as less focused on childrearing. Domestic workers, particularly maids, appear frequently in narratives of change and are emblematic of modernity and its critiques. Contemporary Qatari women are understood to be more likely to miscarry and less fertile than their predecessors. Maids are incriminated in the demise of women’s robustness and at times directly implicated in miscarriage. Twentyeight-year-old Hanadi’s mother-in-law spoke about the causes of miscarriage: This is something only God knows about . . . before in our day and our mothers’ day we didn’t have maids and alh.amdulillāh everything was good, very few will have miscarriage or isqat (abortion) nowadays the girls are relaxed and will have miscarriage . . . I don’t know maybe from work, but the Indian maids are doing everything, and she is not doing anything.

Hanadi’s mother-in-law suggests that the presence of and dependence on maids means that women are less active and less likely to perform physical tasks, resulting in weakness and increased vulnerability to miscarriage. Dana’s mother, Halima, touches on a similar narrative in describing how her daughter felt she was subtly blamed for her miscarriage by her in-laws: [Dana] was telling us that her husband’s family accuse her for [her miscarriage] in an indirect way . . . but nowadays it is not due to lifting something heavy or doing something wrong, as you know now nobody does anything, they all have maids, so women’s life is very easy and relaxing. But for example, her mother-in-law said, ‘What’s wrong with women nowadays? We used to have our babies without having any problems!’ Although she had a miscarriage before; she gave birth to a baby girl without an eye so whether the baby will be born normally or will be lost or born abnormal, it is all from Allah and we had nothing to do with it even if she worked in her house and then she lost the baby it is still not her fault.

In defence of her daughter, Halima introduces the notion that miscarriage could not be due to ‘doing something wrong’ or heavy lifting, because women no longer perform such activities and their lives are ‘easy’ due to the presence of domestic workers who perform the physical and demanding household tasks. Thus,

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Halima emphasizes that a miscarriage is not the fault of the woman. One of the most common explanations for miscarriage, lifting something heavy, would seem to be less of a risk in contemporary Qatari women’s lives. Or perhaps women are particularly blamed for such activity, as it is an unnecessary activity in light of the presence of maids. Children are relatively heavy objects that are often lifted, but interlocutors were silent about this potential risk. Halima points out that despite the fact that Dana’s mother-in-law had produced a child with a birth defect, the suggestion remained that the older generation experienced more successful and straightforward reproduction. Both Halima and Dana’s mother-in-law suggest that contemporary life and bodies are different. Halima suggests that life used to be more difficult and more physical. Dana’s mother-inlaw suggests that something is ‘wrong’ with contemporary women who no longer find pregnancy and childbirth as straightforward as their predecessors. The implication is that pampered Qatari women are reproductively challenged, their bodies weak. In this way, modernization makes women more vulnerable. During our conversations, Halima often spoke about how life in Qatar had changed, suggesting an increase in women’s expectations and opportunities for leisure time and the presence of domestic workers as facilitating this. She suggests that the role of maids has also changed, with more household responsibilities being allocated to them: [Before] we used to have maids but only to clean the houses and they were not involved in taking care of the children. We didn’t have nannies while nowadays they do. [What is the role of the maid in the house nowadays?] She has a major role especially if the mother works and she has children. When the mother is at work the maid will be responsible for the children and also when the mother is back from work, she will be tired and wants to sleep or have some rest. When the mother goes out, she leaves the children with the maid. Unfortunately, this is not good but she has no other choice.

Halima remembers that in previous decades, maids would be responsible for cleaning whilst the mother retained responsibility for childcare. However, the suggestion is that the role of maids has expanded, and now incorporates caring for children, particularly in light of women’s professional and educational obligations, but also their desire for leisure. Halima and other interlocutors from the older generation suggest that maids conduct more intimate childcare

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tasks than in previous times. Modernity has brought wealth and maids, but it has also meant that women are no longer able to, required to, or, in some cases, no longer desire to perform the intimate tasks of mothering. Dependence on maids has increased and subsequently, they have greater contact with and influence over children, which appears to be a source of anxiety. Women often declare they limit the role of domestic workers in their own homes and seem eager to emphasize their insistence on performing key childrearing and intimate mothering acts. This was often contextualized in reference to other families who depended upon maids and were at risk from their influence. Whilst Halima clearly articulates a shift in dependence on domestic workers in Qatar in general, she emphasizes that her daughters limited the role of domestic workers in their own homes. Her daughter Dana is eager to present herself as a hands-on mother who restricts her maid’s role in the household: I think it is my job to change the child’s diaper and change the clothes and give him a bath, I think the intimate things are the mother’s job to do, she can just sit with him while he is playing but the main things are the mum’s job but I see different ladies in my society: it is fine with them if the maid changes the baby’s diaper or feeds him and she will just stay with her baby when he is happy [she laughs].

Dana emphasizes the importance of conducting the intimate acts of motherhood and is critical of Qatari women who do not do so. Indeed, Dana frames her decision to be a stay-at-home mother as arising from concerns about childcare and leaving her children with a maid for long periods. Women prefer to have children cared for by family members, with mothers and mothers-in-law playing an important role in childcare arrangements, but this is not always possible: Dana’s mother and mother-in-law were both unavailable. Thus, Dana decided to be a stay-at-home mother with her maid supporting her household. Women often speak anxiously about the possibility of maids imparting undesirable traits, customs or beliefs to their children. This is particularly problematic if the maid is not a Muslim and/or if she does not speak Arabic. Presence in the home is key to limiting such influence, but with women having more opportunities for socializing outside the home, leisure activities, as well

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as work and family commitments, this is not always possible. As Huda explains, interaction between her maid and her children was controlled, but at times such restriction is impossible: Because some of the maids try to talk with the kids about their religion or she may talk about her way of praying: things that kids shouldn’t learn because it is different from our religion . . . So, yes, the maid affects the house but the mother’s control is important . . . But [if] the mother is outside of the house most of the time and she is not concentrating: the maid can do many [bad] things.

Women hold the responsibilities for the majority of emotional work and intimate labour in families, including family visits, attending numerous celebrations, and taking care of younger siblings and sick or elderly family members (Golkowska 2017) as well as those of motherhood. Women often report difficulty in balancing these requirements. In many cases, women delegate responsibility for some intimate labour to domestic workers, but there is a desire to limit this. Interaction between children and domestic workers is problematic, but difficult to avoid by mothers, particularly working mothers. The concern about the influence and dependence on maids expressed by interlocutors is also found in state discourse. For a society that has tightly controlled interactions between strangers, it is unsurprising that the presence of maids and their intimate activities in the home are met with anxiety. The QNDS (2011: 168) strategy for advancing family cohesion directly targeted domestic workers: There are concerns about the expanded role of domestic helpers in Qatari households, particularly those engaged in childcare. Most have limited education and difficulties communicating in Arabic. Heavy dependence on domestic helpers is leading to weakened family ties, affecting traditional family values and child well-being. This reality raises three key impact concerns: weakened bonds between parent and child, adverse impact on child safety and development, and negative effects on Qatari heritage and culture.

Detailed plans included strategies for minimizing and controlling the use of domestic workers including reducing the average number of domestic workers

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per household by half, implementing regulatory guidance on the recruitment and management of such workers (pp. 165–77) and strengthening parental roles. Concern over the influence of non-Arab, non-Muslim domestic workers on Qatari children has resulted in the emergence of a new domestic helper role: the nanny. In December 2012, Sheikha Mozah launched the Qatar Nanny Training Academy, which trains a small number of Arabic-speaking female students with the first intake from Mauritania and the Comoros. The course includes hygiene, first aid and nutrition as well as promoting Arabic in the home and ‘upholding Qatari Islamic culture and values’ (Walker 2014b). At the academy’s launch, founding committee member Amal Abdullatif Al-Mannai said that the aim is to ‘protect children from other cultures that diffuse into the society through Asian nannies in particular’ (Walker 2014b). Associated with this initiative, a new category of visa, for the ‘professional nanny’ has been established to differentiate them from other household staff. The state has tried to professionalize and, thus, control the use of domestic workers for childcare and childrearing in an attempt to constrain the influence of the outsiders on Qatar, specifically Qatari children. Concern about the role of domestic workers is symbolic of broader state anxiety about migrant workers and dependence on the outside more generally. Dependence on the outside has become an obsession of Qatar’s political elite (Fromherz 2012: 11) with concerns about the influence of external forces on Qatari identity, culture and values.

Conclusions Understanding of miscarriage causation reveals tensions created by contradictory development models: the work environment is perceived as problematic for women and their pregnancies leading women to develop strategies to navigate between roles and the frictions they produce. This may be through delaying pregnancy, aiming to limit family size, concealing pregnancies, reducing work obligations and/ or refraining from participating in professional activities either temporarily or altogether. Balancing professional roles with those of reproduction is typically negotiated with help from family members, but primarily through employment of domestic workers. Domestic workers provide a means to balance

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the requirements of domestic and intimate care as well as fulfilling aspirations and expectations in regard to education and employment. However, state discourse expresses concern about a dependence on maids making women’s negotiations fraught. When women are offered or vie for more public roles, often no allowance is made for their continued – and perhaps enhanced – domestic responsibilities and nurturing roles, placing them under enormous strain, causing tremendous grief (Hatem 1998). A good, modern Qatari woman is one who is educated and works but who does not overly depend on a maid for childcare. If she does, she should limit their contact with her children or such a helper should be a properly trained nanny who can impart Qatari and Islamic values and traditions. Women internalize state anxieties about the influence of outsiders. Domestic workers are central figures in discourse and criticism about social change: dependence upon them is seen as key to women’s declining reproductive success and threatens Qatari mothering and the continuation of Qatari society. Poor and vulnerable migrant workers are asked to absorb the anomie of change, but they are also blamed for being a threat to authentic heritage and culture (Fromherz 2012). At times, domestic workers are directly blamed for reproductive disruptions: their magic and mischief a cause of a miscarriage or infertility. Migrants are blamed for a range of social ills including children’s lack of mastery of Arabic, Islam, and Qatari culture. Their presence is implicated in the unravelling of the Qatari family and, hence, has become a focus for family cohesion policy. Parenting has long been understood as central for the continuation of kinship, household, family; as well as the more general reproduction of social norms and communities (Faircloth et al. 2013). In Qatar, motherhood is seen as central for the continuation of community, religion and Qatari culture and values. State discourse emphasizes the importance of reproduction and presents ideal models of families and motherhood to which women are expected to conform. State development plans also focus on women’s empowerment and participation in economic and public life, creating tensions and contradictions for women’s role in society. The dual emphasis on maternalism and empowerment entwines women’s identity with that of the nation. The state communicates a clear message about what a Qatari woman is supposed be: a modern traditional

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woman. Similar contradictions, multiple possibilities and pressures have been eloquently described by Newcomb where the state-held vision of Moroccan women has them occupying potentially fractious roles simultaneously: Modern and traditional, vocal yet silent, present yet somehow absent . . . She is the guardian of values at home; she perpetuates life and cements identity, mainly through being the keeper of traditions and nourishing mother and yet she is also to be a promoter of modernity outside the home: in this way, her identity is ‘inextricably connected’ to that of the nation. 2009: 25–6

State policy impacts reproductive navigations and informs women’s reproductive experiences, including miscarriage. Women’s bodies are sites of tensions arising from the development policies of Arab modernity.

Conclusions

Miscarriage is a common women’s health experience with approximately one in four pregnancies ending in miscarriage globally. Whilst it is a biological event, a miscarriage is also a social one. Categories and definitions applied to pregnancy, and the thresholds of humanity, life and death all impact the way miscarriage is understood, managed and experienced. Societal understandings about motherhood, parenthood, kinship and foetal personhood influence the way miscarriage is perceived and lived. In this book I have explored how miscarriage is defined, diagnosed, managed and experienced in Qatar. By placing women’s stories at the forefront, I have revealed the importance of ‘local moral worlds’ (Kleinman 1992) and how they give rise to local understandings of miscarriage. Led by these stories, I explored the particular configuration of Qatari miscarriage. Stories reveal how intimate reproductive events are embedded in wider social landscapes and entangled with broader societal and political issues. Through discussions of miscarriage, women communicate matters relating to their wider life experiences: they speak of marriage arrangements, relationships with husbands and extended families and their reproductive aspirations. Through these stories we understand contemporary Qatari women’s experiences and how their lives may differ from the lives of their mothers and grandmothers. Since the mid-twentieth century the breathtakingly rapid pace of economic and social transformation has been difficult to fathom. New opportunities, responsibilities and expectations for Qatari women have emerged. Gender and family relationships are being reformulated and negotiated and, at times, are points of tension. Reproduction has been a key site of change: with the dramatic shift in medicalization of pregnancy and childbirth, the embracing of fertility treatments, and changes in family formation. Reproduction is an area where lines of state policy intersect 205

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with those of individual, family and tribe obligations and aspirations. Reproduction ‘provides a terrain for imagining new cultural futures and transformations’ (Ginsburg and Rapp 1995: 2) and in this way miscarriage provides a lens through which to explore how women’s reproductive lives are changing in response to social transformations in Qatar as well as to gain an understanding of contemporary Qatari society and the role of Qatari women. Miscarriage, including notions of vulnerability, threat and culpability, as well as normativity can only be understood against a backdrop of state development strategies, which emphasize maternalism and pronatalism as well as women’s education, employment and empowerment.Women experience pressure to produce many children and mother them effectively whilst fulfilling the role of a professional and modern Qatari woman; they express concerns about difficulty in balancing these expectations. Rhetorics of cause reveal social tensions and concerns, including friction between contradictory models promoted for women and concerns about the impact of modernity. Discourses link miscarriage and reproductive weakness to modernity with domestic workers implicated in such criticisms. They are a source of anxiety, reflecting wider concerns about foreigners and the influence of outsiders. Symbols of such angst, they threaten mothering, the reproduction of Qatari citizens and are seen as responsible for the disintegration of the family. At times, domestic workers take a more direct role in the blame around reproductive disruptions. Professional femininity creates tensions with the work environment being perceived as problematic for women and their pregnancies. Women remain concerned about the risks posed by work, including stress and exhaustion. The work environment is problematic for a pregnant or miscarrying woman because of issues around modesty, leading women to conceal their pregnancies in this setting. The most common way women navigate working whilst pregnant is through sick leave, which allows for absences and opportunities for rest. Such friction arises from the overwhelming pressure to produce children whilst performing Arab modernity with its emphasis on women’s empowerment. The importance of motherhood in Qatari society emerges again and again: its influence on reproductive experiences is profound. Producing a child improves relationships and increases status. In light of the pressure to produce children, what impact does a miscarriage have on a woman’s social position?

Conclusions

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A woman who miscarries has demonstrated her fertility and thus, has secured her position albeit temporarily. She has been awarded the opportunity to become a mother, again temporarily or partially: the being maintains a position in the cosmology as a bird in heaven who will be met again and provides a reward by mediating for her entrance to paradise. Miscarriage is relatively normalized. Medical, religious and social institutions speak of miscarriage as something common, due to God’s will, a demonstration of fertility and of the body working in a healthy way. Women are likely to experience numerous pregnancy events and are aware of miscarriage and possible reproductive disruptions. Such familiarity means that miscarriage is typically understood as a disappointment and a sad event, but not something particularly unusual or malign. A miscarriage is commonly interpreted as evidence of health and fertility, with a focus on the ability to conceive even if the pregnancy ended. A small number of miscarriages does not necessarily damage a woman’s status or call her fertility into question: optimism about a woman’s fertility is maintained. Miscarriage is not an event expected to be met with grief or despair. Women’s experience of reproduction, particularly, reproductive loss, is influenced by discourses of motherhood, modernity and development. Reproduction, nationalism and citizenship are entwined with obligations to the state filtered through tribe and family influences. Motherhood and childcare are emphasized within the family context but also as a nationalist concern (Kashani-Sabet 2011) with women’s bodies being enlisted in nationalist struggles to reproduce new citizens. Abu-Lughod’s reflections on the postcolonial Middle East context where women became ‘potent symbols of identity and visions of society and the nation’ (1998: 3) resonates with contemporary Qatar. Women have been made symbols of identity and their proper roles debated in light of specific visions of the nation and society (i.e. Chatterjee 1993; Newcomb 2009). Women play a key role in the development plans of Qatar: their professional efforts strengthen the economy, moving towards the further Qatarization of the workforce, and embodying Arab modernity and a vision of Qatar as a cosmopolitan and progressive Gulf state. However, the second QNDS de-emphasized both the family cohesion agenda and women’s empowerment. Indeed, family cohesion and women’s empowerment disappeared from the 2018 strategy with no explanation (Caeiro 2018). Tellingly, this was the only major component to have been

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deleted from the first strategy: the ‘voluntarism that characterized family policy under the “Father Emir” has not been continued under Sheikh Tamim’s reign’ (Caeiro 2018). Published in 2018, the document may have significant implications for women’s lives and may suggest a reframing of women’s roles in relation to state identity and its vision; however, this remains to be seen. The body articulates abstract social paradigms; it acts as a social mirror, a symbol of society (Douglas [1966] 1984: 115; Weiss 2002) with social regulation of the body impacting women’s experience of miscarriage. Not wishing to construct the typical dichotomy that opposes tradition to modernity, with women relegated to the realm of the traditional and its association with reproduction and domesticity, I have explored how state discourse and development has established categories of modern, traditional, contemporary and custom. These sometimes competing categories are mapped onto women’s bodies and their reproductive navigations. Women, through reproduction and childrearing, produce continuity with tradition whilst they enact a role as professional and economic actors. There is a complexity between the categories of tradition and modernity and, informed by Abu-Lughod, binary opposition cannot be assumed between them. Women’s bodies and health is the ‘site of overt and covert, micro- and macropolitical struggle’ (Inhorn 2007a: 26); they are the sites where individual, collective, familial and state forces are played out. Obligations, expectations and aspirations as outlined by the state combine with those of family, tribe, community and religion. In this way, women’s bodies can be read as a text upon which the most fundamental values of a society are inscribed: in this case the nationalist values, sometimes contradictory, of professional and maternal femininity. This book shows how Qatari women experience these tensions, how they attempt to negotiate them and how they impact reproductive experiences. Women are expected to occupy all positions simultaneously: modern and traditional, professional and maternal, custom and contemporary, they are caught in a liminal space between numerous binarisms; they are inextricably connected to the way the Qatari nation is imagined. A key theme throughout the book is that Qatari social life is experiencing a period of transformation and one site of this is in the performance of motherhood. Scholars exploring the redefinition of women’s domesticity in the Middle East in the late modern period reveal that a ‘modern’ wife and

Conclusions

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mother is a very different woman to those before her (Najmabadi 1998 in Iran; Shakry 1998 in Egypt; Abu-Lughod 1998b) and part of the role of the ‘new’ wife and mother was to rear and train future citizens of the modern nation (Najmabadi 1998; Shakry 1998). In Qatar, motherhood is where notions of identity, nationhood and ideas around tradition and modernity are negotiated. In her work on motherhood, Faircloth (2013a) noted that French women were able to resist the penetration of intensive mothering because of the state’s ethos of taking partial responsibility for childcare, which leads to the absence of guilt (Warner 2006). However, Faircloth points out that France is on the cusp of change with women likely to begin to experience rising tension between their working and domestic lives. It would seem that women in Qatar are already experiencing such tensions. Given that other global and globalizing forces and discourses are negotiated, re-interpreted and contained in Qatar (Kilshaw 2018) it remains to be seen how parenting and, specifically, mothering models will be re-negotiated and transformed in the coming years. Importantly, the embracing and/or negotiation of such models will impact the way miscarriage is understood and experienced. Will reactions like Moza’s, which involved intense upset and sadness, become more commonplace? By providing examples of the diverse responses to and experiences of pregnancy loss, I argue that such responses are flexible and informed by the context in which they are found in order to move beyond the dominant landscape of miscarriage, which is primarily populated by the perspectives of white, middle-class Western woman. Whilst teasing out commonalities in Qatari women’s experiences of reproduction to understand the social forces that influence them, the diversity within these experiences also emerges. Women’s experiences of miscarriage are embedded in their individual life course and, whilst shaped by cultural forces, their unique situation influences novel configurations. I hope these stories of miscarriage, reproduction and motherhood help to populate the landscape with a diversity of voices.

210

Notes Introduction 1 All names have been changed along with any identifying information. 2 The overall research project was intended to be comparative and included twelve months’ ethnographic research in England, which included interviews with forty British women who had miscarried in the previous six months. The two sites provided opportunities to probe lines of enquiry to tease out similarities and differences between the two contexts. Whilst the British fieldwork informs this work, the book focuses on the Qatari fieldwork and material.

1 Qatar: Traditional Modernity 1 The Hadar’s ancestors were settled town dwellers and most are descended from migrants from present-day Iran, Pakistan and Afghanistan. They are sometimes referred to as Irani-Qataris. There are two other groups: the Bedouin and Abd. Alabd means ‘slaves’ and this group are descendants of slaves brought from East Africa. All three groups identify as Qatari and retain citizenship, but subtle sociocultural differences between the groups are recognized. 2 Ethical approvals were granted from Weill Cornell Medicine-Qatar (IRB number: 13–00074), Hamad Medical Corporation-Qatar (IRB number: 11345/11) and University College London, London; UCL Research Ethics Committee (Project ID: 1020/001). Verbal informed consent was obtained. Signature was waived to protect the confidentiality of the participants (in accordance with the code 45 CFR 46.117(c)(1)). Consent was obtained from participants for anonymous quotes to be published in publications.

2 Women and State: Reproduction and Arab Modernity 1 The Qatar National Vision (QNV) 2030 is a development plan launched in 2008 by His Highness Sheikh Hamad bin Khalifa Al Thani to provide a clear roadmap of Qatar’s future and to ‘transform Qatar into an advanced society capable of achieving sustainable development’ by 2030 (www.gsdp.gov.qa/portal/page/portal/ 211

212

2

3

4

5 6 7

Notes

gsdp_en/qatar_national_vision). It is ‘based on the guiding principles of Qatar’s Permanent Constitution’ the primary catalyst driving change and growth across Qatar and ‘reflects the aspirations of the Qatari people and the resolve of its leadership’. The strategy outlines the state leadership’s development plan that involves human, social, economic and environmental growth, expansion and/ or improvement. This long-term development plan is honed into more specific initiatives in the Qatar National Development Strategy 2011–16 (QNDS). The QNDS is a medium-term plan formulated upon QNV 2030, which outlines a ‘carefully designed programme’ to help to fulfil the QNV 2030 aims during the period of 2011–16; it intends to provide ‘social protection and employment opportunities in a prosperous, stable and secure society that nurtures its members and preserves and protects family cohesion’. The QNDS was widely circulated and influential to public, scholarly and government discourse. The next QNDS was launched in spring 2018 and significantly, family cohesion and women’s empowerment has disappeared from the project (Caeiro 2018). The rate under for non-Qataris is 10,000 QR (or roughly £1,700), which is well under half of the cost that one expects to pay in the UK, for example. In addition to the relatively reasonable cost of treatments, the lack of restrictions on practices opens up opportunities for the non-Qatari population that may not be possible in their home countries. Thus, when we began fieldwork the clinic served a considerable number of the ex-patriot population who took advantage of the opportunity to use ARTs when it might be financially difficult or logistically impossible in their home countries. However, services for non-Qataris was cancelled in 2014 due to the pressures placed on the IVF clinic by the demand from Qataris seeking treatment for infertility. The statistics found here and in the rest of this section have been collated by Nadia Omar, research specialist, through personnel communication with health professionals at HMC. Further statistics presented are derived from H. Burjaq, personal communication, 2014. Islamic scholars have generally stated this hadith as being beyond da’eef, but rather fabricated. However, they suggest that its meanings and virtues are correct because these are found in numerous references in the Quran and Sunnah. Musnad Ahmad, Sunan An-Nasâ’i, Sunan Ibn Mâjah narrated by Anas and mentioned in Musnad Al Shehab book 119. This hadith is a well-known narration. It was narrated by ‘Abu Horayrah’ and mentioned in Sahih Bukhari (5979) and Sahih Muslim (1003). In this section I specifically focus on Qatari nationals and Qatari households, rather than the more general population in Qatar.

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3 Huda: Marriage, Motherhood and Loss 1 Contraception is available and made use of, however, most women expressed ambivalence about its use with some saying it was haram (prohibited) and others suggesting it was only allowable with their husband’s consent. Many said it was only acceptable after the woman had given birth and for the use of birth spacing or in the case of illness. A small number of women suggested that they, or women they knew, ‘ate pills’ without the knowledge of their husband to avoid unwanted pregnancies.

4 Motherhood Lost: Stories of Miscarriage 1 Refers to money paid by the proposed husband to the wife and her family prior to the wedding. This varies according to the socioeconomic level of the families in Qatar. 2 As will be discussed briefly in Chapter Eight, Qatar has few regulations with IVF beyond the strict ‘no third-party donation’ rule in line with Sunni Islam; this means that several embryos may be transferred to increase the chances of success. 3 [I promise] by God – this term is very commonly used in Arabic to denote ‘I swear’ or ‘really’. As it is so commonly used I will not translate each time. Throughout the text some Arabic terms have been left. These are denoted in italics and then explained in brackets immediately following. 4 In the UK this is more commonly referred to as ‘missed miscarriage’, although the medical terminology may use either ‘missed miscarriage’ or ‘incomplete abortion’. 5 In Qatar, surgical management is often referred to as a ‘DNC’ or a ‘D&C’. Sometimes referred to as a ‘D&C’ in the UK, it is more commonly referred to as an ERPC (evacuation of retained products of conception). However, in the past few years this term has been replaced with SMM (surgical management of miscarriage) in response to complaints from women and advocacy groups that the former was insensitive. In the UK, this most often involves dilation of the cervix followed by manual vacuum aspiration (MVA) or suction to remove the contents of the womb. 6 When I was pregnant with my daughter, I found requests to allow husbands to attend sonogram sessions were possible, in keeping with attempts to ensure sensitivity to the needs of the diverse client population. Whilst the hospital staff attempted to be accommodating, ultimately the needs and requirements of insuring gender segregation in such an intimate space dominate (see also discussion Chapter Two).

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5 Modern Bodies; Miscarriage Cause 1 Some may refer to these as ‘supernatural’ forces, but jinn, evil eye and God’s will are natural forces, known if not always knowable. They may be hidden, but they are ‘natural’ parts of life in Qatar.

6 (Super)natural Forces and Miscarriage Cause 1 ‘God has willed’, ‘God willing’ or ‘as God willed’, used to express appreciation, joy, praise, or thankfulness for a person or an event that mentioned immediately before the utterance. The expression is often used in the Muslim world to wish for God’s protection of something or someone from the evil eye.

7 The Foetus: Burials, Babies, Birds and Imaginings 1 Due to his perception that children with Down syndrome shared facial similarities with those of Blumenbach’s Mongolian race, John Langdon Down used the term ‘mongoloid’. However, in 1961, scientists suggested the term was embarrassing and misleading, leading the WHO to stop using the term. The term is understood to be unacceptable, incorrect and is no longer in common usage in most contexts. 2 This is the case excepting Scotland where incineration is not allowed.

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Index Headings in italics are Arabic terms. Page numbers followed by n refer to a note with its number. Abeer 67, 77–8, 173 abortion 81–3, 144–9, 157 adoption 176 African Americans 111–12 age (maternal) 93–4, 107–9, 119–20, 128 Aisha 58 Al Jazeera 39, 123 Al Mayassa 58, 67 Amal 192–3 Ameena 118 American attitudes. See Euro-American attitudes Amna 54, 61, 64, 66, 115–16, 117 anxious reproduction 167, 180 Arab modernity 6, 11, 100, 212 Qatar 7–8, 30–2, 38–46, 48, 100–7, 120, 182–6, 207 Arab Spring 38 asabeya 115–16 assisted reproductive technologies (ARTs) 25–6. See also infertility access to 31–2, 176, 181, 212 n.3 IVF treatment 62–4, 78–9, 85–6, 213 n.2 for sex selection 62–6, 70 vulnerability of pregnancy 84–5, 106–7, 190 Awatif 105–6, 108, 135 Bedouins 12, 53, 61, 76–7, 89, 108, 211 n.1 ‘birds in heaven’ 152–6 birth 80, 85–8, 154 birthmarks 114–15 blame. See culpability boys (sons), importance 59–70, 80 breastfeeding 115–16 Caeiro, A. 26, 36, 122–3, 182–3, 207–8 carelessness 85, 93, 117–18

Centre for Religious Da’wa and Guidance 123, 142, 147, 148 children childcare 174, 195–7, 199–203, 208–9 disabled 114, 128 Down syndrome 146, 154, 214 n.1 cleansing 92–3, 97, 110, 165–6, 180 clothing. See dress, traditional concealment of pregnancy 51, 134–7, 191–4 conception 58, 161, 171–2. See also assisted reproductive technologies (ARTs) indigenous knowledge 112 soon after marriage 55–7, 75–6, 172–3 consanguineous marriage 14, 17, 35–6, 47, 75, 79, 128 contraception 58–9, 187, 188, 213 n.1 Cote d’Ivoire 111–12 cousin marriage. See consanguineous marriage culpability 113–14, 124 birth of daughters 64–5 infertility 75–6, 175–6 miscarriage 83, 87, 104–6, 116–19 Dana marriage 52–3 miscarriage 83, 117, 145, 169–70, 198–9 religious faith 125–6 reproductive navigation 188–9, 200 daughters 63, 66–8 demographic transition theory 24 diabetes 90, 109–10, 118, 146 diet 50, 102, 110, 118 disability 114, 128 divorce 31, 77, 78 rates 35, 36, 175, 186 threat of 168–9

237

238

Index

DNC 50, 83, 213 n.5 doctors 3, 86, 126, 127, 134, 155 domestic abuse 77, 104–5 domestic workers. See maids Down syndrome 146, 154, 214 n.1 dress, traditional 44–5, 46, 193 education 39, 183–5, 187–9 Education City 40–3, 184 employment 38, 39, 183–5, 187–90 ensoulment 141–5, 148, 151, 159 Euro-American attitudes conflicting pressures on women 209 to the foetus 90–1, 115, 152, 156–7 miscarriage 4, 6, 155, 161, 166–7, 177–9 Euro-American immigrants 109 Euro-American influences 112, 179 evil eye 99, 121 infertile women as source 174 miscarriage 130–4, 137–8, 168 protection from 136–7, 194 exertion 99, 103–6, 113, 117 exhaustion 103, 105–6, 117–18, 190 families 35, 66–8, 201. See also households balancing 63, 66, 69, 70–1 extended families 55–6, 58, 59, 87, 104–5, 117, 172 government policies 26, 30, 175, 181–2, 201–4, 207–8 mothers-in-law 55–7, 104, 163, 172–3, 198–9 Family Law (2006) 32 family marriage. See consanguineous marriage Fareeda 56–7, 65, 114, 143, 152–3, 176 fatherhood 57, 58, 59, 88, 95–6, 112, 189 Fatima 115, 128 fertility 162–5, 167–8, 207. See also assisted reproductive technologies (ARTs); infertility Qatari fertility rates 7–8, 24, 26, 29, 35, 186 foetuses 139–41 abnormalities 127–8, 146, 148 ‘birds in heaven’ 152–56 ensoulment 141–5, 148, 151–2, 159

images of 91 movement by 151–2 remains of 21–3, 139–41, 156–9, 178 symbolism 21–2, 140, 158 Fouz 190–1 France 209 Fraser, G. 111 gender segregation 42–3, 44–5, 51–2, 90, 121–2, 184, 192 girls (daughters) 63, 66–8 government policies families 26, 30, 175, 181–3, 201–3 foetuses 139–40 reproduction 19, 24–6, 29–32, 34–8, 179–80, 181–3 women’s empowerment 105, 189–90 graveyards 141 Gulf Cooperation Council (GCC) 12 Hadar 12, 53, 75, 211 n.1 hadiths 33–4, 122–4, 131, 142–3, 148, 173 Haleema 129, 154–5 Halima 117, 198–200 Hamda 69, 132, 146 Hanadi 61, 198 Hanbali school 122, 142, 147–8 health professionals 18, 155 doctors 3, 86, 126, 127, 134, 155 Hessa 69, 187 hijāb. See dress, traditional Houda 151 households. See also families size 31, 35 women outside 60–1 housework 93, 104–5, 117–18, 198–9 Huda 1 and the evil eye 134–5 importance of a son 59–60, 62–6, 165 maids 196–7 marriage 51–2, 53–4, 56, 171 miscarriage 47–51, 162, 164–66, 167 pressures on women 102, 105 husbands 17, 58, 193. See also marriage and maids 196 supportive 78, 84, 173, 189, 213 n.6 immigrant workers. See migrants India 137

Index infertility 55, 75–6, 138, 167–71. See also assisted reproductive technologies (ARTs); fertility male 79 stigma of 8, 164, 171–76 Inhorn, M. 8–9, 19–20, 33, 62–3, 66, 68, 114, 176 Iran 12, 26 Islamic perspective 11, 121–3. See also religious faith; traditions abortion 144–49 families 30 foetuses 63, 141–5 motherhood 32–4 Islamweb 123 Israel 25–6, 175 IVF treatment 62–4, 78–9, 85–6 Jameela 109, 163 jinn 93, 99, 121, 129–30, 137–8, 214 n.1 Jordan 86 Kanaaneh, R. 23, 25, 69, 133 Kareema 106, 172, 193–4 Khadeeja 131–2, 174 Khadija 170 Khalid 75, 79–80, 84–5, 86, 88 Kholoud 155–6 Khoulood 124–5, 130 language, use of 82–3, 143 Le Renard, A. 182, 184, 186 lifestyle changes 105–6, 110 loss, feelings of 6, 94–5, 138, 157, 161, 166 Luwla 76–7 magic 51, 99, 197 maids 93, 100, 104, 117, 195–7, 198–203 causing miscarriages 51, 135, 197, 203 Mālikī school 122, 148 marriage 51–2, 186. See also husbands arranged marriages 35, 52–4 consanguineous 14, 17, 35–6, 47, 75, 79, 128 contracts 52, 78 to foreigners 32, 77 rates of 35, 189–90 massage 92, 165–6

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medical treatment 56. See also assisted reproductive technologies (ARTs); monitoring pregnancy commission on abortion 145, 146, 149 early pregnancy 48–9, 50 infertility 76 miscarriage management 49–50, 74, 83–4, 91–2, 139 pregnancy 80–1 and religious faith 123–4 mementos 87, 166–7 men 60, 79–80 fatherhood 57, 58, 59, 88, 95–6, 112, 189 husbands 17, 78, 84, 173, 189, 193, 196, 213 n.6 Qatari citizenship 37–8 midwifery 111 migrants 155, 195–6, 203, 206 access to ARTs 31 population 7–8, 12–13, 29 milk kinship 116 miscarriages awareness of 3–4, 177–79 causes 84–5, 91–2, 93–4, 99–100, 103, 105–8, 190 concealment 169–70 demonstration of fertility 87, 163–5, 171, 178–9 diagnosis 1, 49, 80–2, 90–1, 125–6, 140 framing 3–4, 6–7, 125–7, 178, 179 frequency 2, 100–3, 108 linguistic description 82–3 management 49–50, 74, 82–4, 91–2, 139 multiple 167–71 normalization 162–3, 179 stigma 169–71, 176 taboos 4–5, 177 misoprostol 74, 83 modernity 110–111 and diabetes 109 Qatar 7–8, 11, 26–7, 30–2, 38–46, 100–7, 182–6, 207 tensions with tradition 100, 120, 132, 198 modesty 44, 136, 192–3, 194, 206 Mohammed 94–6, 100–3, 143, 164, 168–9 monitoring pregnancy 48–9, 79, 80–1, 90–1, 146

240

Index

Morocco attitude to foetuses 114, 145, 159 herbal medicines 110 preference for sons 67 role of women 27, 183, 204 supernatural forces 131, 133, 134 motherhood 8, 54–5, 57–9, 161, 172. See also women importance of 19–21, 32–3, 183–4, 203, 206–7 maternal risk 147 modernity 208–9 unmarried 149–51 Moza 113, 117 IVF treatment 78–80, 86, 107 miscarriage 73, 74–6, 80–4 Mozah bint Nasser, Sheikha 40–1, 46, 183–4, 202 Muslim faith. See Islamic perspective; religious faith Nada 177 Najah 106 nationalism contradictory values 182–3 motherhood 19, 24, 25–6, 27, 34, 207 Noor 151 Noora 107, 108, 117–18 attitude to infertility 164, 169 and daughters 67, 68 housework 104 miscarriage 73, 91–4, 153 pregnancy 89–91, 95–7 religious faith 94–5, 124 Nouf 139 Pakistan 105, 168 Palestinians 25 Permanent Population Committee (PPC) 29–30, 31 permeability 112–16, 119 polygamy (polygyny) 35, 64 rates of 77–8 threat of 76–7, 94, 96–7, 119, 168–9, 176 pregnancy 89–91, 190–1. See also reproduction indigenous knowledge 112–13 monitoring 48–9, 79, 80–1, 90–1, 146

planning 48, 97 soon after marriage 55–7, 76, 172–3 pre-implantation genetic screening (PGD) 62, 63, 86 pre-marital screening 37, 81 progesterone 48–9, 50, 79, 117 pronatalism 24–6, 29–32, 175, 181–3 impact on women 58, 161, 172 protection of women 60–1, 66, 68 al Qaradawi, Yusuf 123 Qaseem 189 Qatar 11–13. See also government policies citizenship 37–8, 112 economic dependence 43–4, 184 fertility rates 7–8, 24, 26, 29, 35, 186 illegal pregnancies 149–51 modernity 7–8, 11, 26–7, 30–2, 38–46, 100–7, 119–20, 182–6, 207 penal code 144, 149–51 Qatar National Vision (QNV) 30–1, 38, 182, 185, 211–12 n.1 religion 122–3, 142–3 stillbirth rate 14 Rahaf 108 Reem 168 Religious Da’wa and Guidance Authority 123, 142, 147, 148 religious faith 114, 121–2. See also Islamic perspective commitment to have children 32–3, 175 framing miscarriages 1, 85, 87, 94–5, 123–8 Quran 33, 92, 122, 144, 148 will of God 1, 50, 84–5, 93, 118, 121, 123–8, 143, 155 reproduction. See also pregnancy government policies 19, 24–6, 29–32, 34–8, 180, 181–3 medicalization 14, 37, 80–1 navigation of 40, 47–8, 51, 59, 62, 66, 70–1, 161–2, 181, 187–91, 204, 208 pressures to have children 54–5, 70, 75–7, 80 research methods data collection 13, 14–15, 167, 211 n.2 ethnographic approach 19

Index men’s perspective 17–18 sample characteristics 15–17 research team 13–14, 17–19 Rouda 158 Sameera 133–4, 135, 186 Samia 126–7, 153–4, 187–8, 191 Sara 57–8, 63–4, 113, 118 Saudi Arabia 122–3, 184, 192, 197 screening pre-implantation genetic screening (PGD) 62, 63 pre-marital screening 37, 81 segregation of genders 42–3, 44–5, 51–2, 90, 121–2, 184, 192 selective reproductive technologies (SRTs) 62 sex selection 62–6, 70 sexual relationships 35, 149–51 Sharia law 11, 60–1, 63, 122, 149–51 foetuses 141–2 sick leave 191–2, 193–4 silence, social 2, 3–5, 158, 161, 166–7, 177–8 single women 149–51, 175 social inscription 46, 181, 182, 208 sons, importance of 59–70, 80 sponsorship system 196 state policies. See government policies stigma infertility 8, 164, 171–6 miscarriages 169–71 producing girls 65 stillborn babies 14, 15, 154 stress 99, 103, 113, 119 Sunnah 33 Sunni Muslims 11, 122, 144, 147, 176 supernatural forces 99, 121 evil eye 99, 121, 130–4, 136, 137–8, 168, 174, 194 jinn 93, 99, 121, 129–30, 137–8, 214 n.1 magic 51, 99, 197 surgical management of miscarriage 50, 83–4, 213 n.5 surveillance of pregnancy 48–9, 79, 80–1, 90–1, 146 taboos 4–5, 161, 177 Tamim bin Hamad Al Thani, Emir Sheikh 11, 208

241

technology 61, 102, 110, 120 TFR (total fertility rate). See fertility traditions 11, 42, 44–5, 69, 182, 208. See also Islamic perspective herbal medicines 49, 92–3, 110, 111, 130, 133, 165–6 naming practices 33, 61–2, 86 traditional dress 44–5, 46, 193 travel 60–1, 103 twins 54 UK Human Tissues Authority (HTA) 156 ultrasounds 1, 49, 79, 81, 90–1 university attendance. See education unmarried women 149–51, 175 veils. See dress, traditional vulnerability of pregnancy 99–100, 103, 107–9, 118–19, 137–8 social vulnerability 55, 168, 172, 176–7 to supernatural forces 130–1 Wadha 106 Wafa 54–5, 172 Wahhabism 122 weddings 31, 51–2, 53–4 Westernization. See Euro-American influences women 17. See also gender segregation; motherhood concealment of pregnancy 51, 134–7, 191–4 conflicting pressures on 40, 57, 182–3, 185–8, 193–7, 206–9 education 39, 42–3, 183–5, 187–9 employment 38, 39, 185 influence on foetus 112–16 perceived weakness 100–1, 107–9, 110–11 protection of 60–1, 67–8 reproductive navigations 187–91 roles of 7–9, 26–7, 39–40, 46, 183–6, 201 unmarried women 149–51, 175 vulnerability through work 84–5, 100, 105, 106, 119, 190–1 zinā babies 149–51

242

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244