Religion guides views of fertility treatment in Middle East

February 14, 2004

SEATTLE---Among Muslims, reproductive technologies can clash with deeply held religious beliefs about the importance of biologically based kinship, family life and parenthood.

U-M researcher Marcia Inhorn has used medical anthropology methods for the last 20 years to study infertility and in vitro fertilization in the Middle East---where Israel and Lebanon are home to some of the highest per capita numbers of in vitro fertilization (IVF) centers in the world.

Inhorn, an associate professor of health behavior and health education and of anthropology, presents a talk titled "Finding 'Culture' in Science and Biotechnology: Perspectives From Medical Anthropology" at the annual meeting of the American Association for the Advancement of Science Feb. 14.

In qualitative, ethnographic interviews with nearly 400 patient couples, Inhorn has identified major differences in cultural attitudes toward reproductive technologies between Shi'ite Muslims in Lebanon and Sunni Muslims in Egypt. Results of her work in Egypt are part of a 2003 book, "Local Babies, Global Science: Gender, Religion, and In Vitro Fertilization in Egypt."

Egypt's first fatwa, or religious proclamation, on medically assisted reproduction came in 1980, not long after the first IVF baby was born in England. More than 90 percent of Egypt's citizens practice Sunni Islam.

Sunni religious rules state that IVF is allowed, but that since marriage is a contract between a husband and wife, no third party should intrude into procreation, thus prohibiting such things as sperm or egg donation.

Most leaders of Shi'a Islam, the minority branch of Islam found in countries including Iran, Iraq, Lebanon, Afghanistan and India, concur with Sunni religious authorities about the strict prohibition on third-party donation.

But in the late 1990s, an Iranian leader issued a fatwa stating egg donation "is not in and of itself legally forbidden." Inhorn notes that Shi'ites practice a form of individual religious reasoning called ijtihad, in which various Shi'ite religious leaders come to their own conclusions.

Shi'ites who are strict in their interpretation of a third-party donation in IVF believe the couple should get approval from a religious court first, and the husband needs to do a muta'a, or temporary, marriage with any egg donor so the child is not born out of wedlock. However, since a married Shi'ite Muslim woman cannot marry another man sperm donation from a man other than her husband is akin to adultery.

Middle Eastern societies expect all married couples to produce biological children, since legal adoption as it is practiced in the West is prohibited in both Sunni and Shi'a Islam. In the absence of adoption and gamete donation, infertile Muslim couples in countries such as Egypt have no choice but to turn to in vitro fertilization using their own gametes.
Inhorn serves as director of the Center for Middle Eastern and North African Studies, part of the U-M International Institute.

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