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Women’s reproductive health is a major determinant of a nation’s health and the health of its future generations, as studies have shown that it is a central feature of human development (such as how a mother’s health has been shown to have intergenerational impacts on the health and well-being of her children). Priority attention is needed to understand the interplay of biological and social determinants in women’s health to ensure that women are provided with comprehensive, quality healthcare tailored to their needs. Furthermore, enhancing and reframing the narrative around reproductive health should be an even more urgent priority, to not only lead to effective preventative strategies and care, but also to empower women to lead their healthiest life possible.

Here in the Arab Gulf region, research on women’s reproductive health is widely under-represented and poorly understood. Investigating the environmental and genetic factors impacting local women’s reproductive health will improve the holistic healthcare of women in the Arab Gulf, broader MENA region, and for the global Arab diaspora. Given the potential effects of these factors on the personal lives of women and their families, as well as on their country’s economies and development, women’s reproductive healthcare should be a strategic focus so that we can advance our understanding of the complex pathways leading to diagnosis, prevention, and early detection of chronic reproductive health diseases.

This is especially true in the Unites Arab Emirates (UAE), as Emirati women have been suggested to have among the highest prevalence rates of reproductive health issues and infertility in the world. This is possibly due to obesity rates, first cousin marriages, vitamin D deficiency, lack of awareness among adolescence on reproductive health, cultural traditions that inhibit health education and routine check-ups, and environmental toxins from pollution and chemical agents. Each of these factors is outlined below.

• The UAE has ranked among the highest in the global obesity statistics, with 70-75% of the population being obese or overweight, where women have a 50-100% higher risk of obesity than men. This could be attributed to lack of physical activity, cultural barriers for women participating in sport teams, as well as the lack of physical education in the curriculum of most public girl’s schools.
• First cousin marriages account for approximately 50% of marriages in the Emirati population, leading to loss of function mutations and higher frequency of genetic disease occurrence.
• Despite abundant sunshine, 90% of the UAE population suffers from Vitamin D deficiency, leading to hormonal imbalance, increased risk of miscarriage, and infertility.
• A survey of 1000 Emirati women found that 91% lacked sufficient knowledge of reproductive health and potential diseases, not aware that these diseases relate to infertility and potentially other life threatening complications. In addition, culturally a gynecology clinic in the UAE remains the realm of mostly married women that then seek regular check-ups. This means that young woman of reproductive age may suffer from chronic pain on a daily basis or have menstrual irregularities that may be a symptom of larger issues, but this lack of sufficient knowledge, coupled with inhibitive cultural traditions and taboos surrounding women’s healthcare, will prevent her from discussing it and visiting a specialist for care.
• Environmental toxin exposures from pollution or chemical agents, such as mercury in fish, may alter risk by changing circulating hormone levels and affecting the immune system of exposed women.

Due to these factors, as well as potentially others, the fertility rate has dropped by nearly 77% in the Emirati population since 1985. By the next decade, it has been estimated that there may be double the number of infertile couples if no progress is done to improve women’s reproductive health.

Another implication is that these reproductive health issues can have varying degrees of side effects that have overarching consequences for women’s health in a holistic sense. Some effects of reproductive health issues are infertility, chronic pelvic pain, and menstrual irregularity, and may lead to other life-threatening conditions, such as cancer, cardiovascular diseases, and diabetes. These symptoms and associated diseases lead to significant absenteeism in school and work, poor academic results, poor social relationships, increased risk of depression and anxiety, and potentially death.

It is important to detect and treat symptoms at an early age to addresses the underlying imbalances that perpetuate the illness, which will take a shift in policy, practice, and thinking at the governmental level, as well as in schools, doctor’s offices, and the home. Late diagnosis of reproductive health conditions will exacerbate the problem, making it more difficult to manage which otherwise could have been an easily-treatable issue. Thus, it is critically important that young women are educated, comfortable discussing their body, and supported in seeking care preventatively and for their symptoms so that they can make a healthy transition into adulthood and decrease their risk of infertility and chronic, life-threatening conditions.

As policymakers consider the broad range of health policies and effective regulation, it is crucial to explore the opportunities to improve women’s health. Innovative opportunities must be available in the UAE to address unique health challenges and behavioral determinants of women’s health. Introducing bi-annual gynecological visits, a fuller range of gynecological education, and health promotion to increase awareness can influence and encourage women to seek diagnosis for specific symptoms that otherwise may have a negative impact on their daily health activities. In addition, by improving health literacy, preventing and reducing chronic health conditions, and promoting wellness, this will significantly decrease the risk of women losing the chance of motherhood.

The Middle Eastern Women Research Association (MAR’A) Project, a collaboration between the University of Oxford, Harvard University, and the World Endometriosis Research Foundation that is supported in part by the Al Qasimi Foundation, is the first to explore public health issues in women that will result in a better understanding of the prevalence, risk factors and symptoms of women’s health patterns in the UAE. By learning more about environmental, biological and genetic factors related to Emirati women, we will be more educated to make thoughtful decisions to invest in health information systems to better identify risk factors, help set targets for policymaking, increase public awareness, and enable formal program educational and evaluation strategies.

Mira Mousa is a PhD candidate in the Women’s and Reproductive Health Department at the University of Oxford whose research focuses on women’s health awareness and education. She is collaborating with Harvard University and the World Endometriosis Research Foundation to be part of a worldwide study the epidemiological and genetic factors of women’s health conditions, increase awareness among the public and medical professionals, provide support for patients and families, and promote education to girls and women to increase reproductive health literacy.