ARTICLE 12 Equality in Access to Health Care 1. States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health services, including those relating to family planning. 2. Notwithstanding the provisions of paragraph 1 of this article, States Parties shall ensure to women appropriate services in connection with pregnancy, confinement, and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. 1. Introduction This chapter will examine various curative, preventative, physical, and mental health care services available to Israeli women. In addition, it will examine the relative states of health of men and women in Israel and will focus specifically on reproductive health. There is absolutely no formal discrimination against women regarding health care, nor are there treatments for Israeli women which are contingent upon the approval or permission of their partners or parents, including birth control. It should also be noted that the subject of women's health has recently been the focus of attention, particularly following the Beijing Conference. This is evidenced both by the establishment of a steering committee on women's health needs by the Ministry of Health, as well as by the special appointment of a researcher at the National Center for Disease Control to collect data on women's health. 2. The Legal Framework 2.1. Introduction While foundations for public health care were laid down in the National Health Ordinance-1940, two recent laws relating to public health totally change the framework of health care in Israel. The National Health Insurance Law-1994, which went into effect on January 1, 1995, establishes a universal right to health services in Israel, and the Patient's Rights Law-1996, grants statutory recognition to patients' rights and physicians' duties. These two laws are a source of pride for Israeli society; both are based on the principle of equality and on the dignity and privacy of the individual. 2.2. The National Health Insurance Law The law guarantees the right of every Israeli resident to health care services. The principles of "justice, equality, and mutual aid" provide the basis for its enactment. It obligates sick funds to accept all applicants as members, and to provide them with a "basic basket of services." The government is required to finance this basic basket of services by utilizing the budget allocated to it under the law. The law's main source of funding is revenues generated by health tax payments. The sick funds then receive their funding directly from the government, which distributes it amongst the different sick funds in a socially just manner. 2.2.1. Universal Coverage Under the National Health Insurance Law Previously, membership in a sick fund was voluntary, leaving 200,000 Israeli residents, including many children, without health insurance. The new law makes membership in a sick fund mandatory and allows residents to join the sick fund of their choice. This policy has a dual purpose: it encourages competition amongst sick funds, and ensures that even citizens who are not in good health, or would not otherwise be able to afford the membership in the sick funds, will not be denied membership. An additional feature of the new law is the right to choose the caregiver: patients have the right to be treated by any of the doctors, hospitals, laboratories, or infirmaries with which their sick funds are associated. The new law specifies the services that must be provided in the basic basket of health care. In addition, the law places certain services, such as Mother-Child Clinics, under the direct responsibility of the Ministry of Health. This service, previously provided directly from the Ministry of Health, was to be transferred to the responsibility of the various sick funds, like all other health services. However, when realizing that this could jeopardize the goal of ensuring universal mother and child care irrespective of economic considerations, the law was changed in 1996 in order to maintain the government's direct responsibility for the provision of Mother-Child Clinics. 2.3. The Health Tax Under the new law, every adult regardless of gender is obligated to pay health tax in order to cover the cost of the provision of the basic services. The health tax is a progressive tax and is based on a member's income. However, the law exempts homemakers, or "housewives," from paying the health tax. As explained under Article 13 below, a "housewife" under the National Insurance Law is defined as a "married woman whose partner is insured and only provides domestic provisions for their own household, so that she is neither an 'employee' nor is she 'independent.' "Housewife" exclusion stems from the fact that health taxes are collected and handled as part of the Social Security system. Since "housewives" are not insured according to the National Insurance Law, they are not included in the data base of the Social Security office (See Article 13). While the new law ensures equality between men and women by charging married working women and men equal membership dues, some married women who work outside their homes now pay more for the coverage under the new law than they paid under the old law. This is due to the fact that under the old law, families were charged as single units, with married women receiving a 30% discount on their dues. 2.4. Equality in Health Care 2.4.1. Eligibility The criterion for eligibility is residency in Israel. 2.4.2. Differences in Needs as a Barrier to Equality in Israel Under the new law, most common health care services are included in the basic basket of services. However, it denies coverage for contraceptives, abortions performed on the grounds of extra-marital pregnancy (constituting the major cause for legal abortions), and other various gynecological services. Moreover, the current basket of services does not fully cover pre-and post-natal services. Consequently, women must pay a fee in order to receive services at the mother-child clinics. Another source of inequality in the health-care system is the lack of awareness of gender differences in the symptoms and development of specific diseases, such as heart disease. For example, the director of heart and chest surgery in one of Israel's leading hospitals was reported to have expressed a concern in December 1996 as to the discrimination of women in the provision of health care services relating to heart disease. The tools used to diagnose heart disease amongst men are not effective in the diagnosis of women. In addition, heart disease among women develops at a significantly slower rate than heart disease among men. Consequently, doctors are more reluctant to send women who complain about chest pains to be tested, and fewer women are diagnosed in time. This causes women to be diagnosed at later stages of the disease, when the rate of successful surgery decreases. Currently, the death rate and number of complications from bypass surgery among women is 2-3 times higher than among men (2-7%, as opposed to 1-4% among men). 3. Special Health Services for Women 3.1. Pre/Post Natal Services: Mother-Child Clinics The Health Ministry reported in 1996 that according to a recent survey, 98% of pregnant Israeli women receive pre-natal monitoring. Of those, 20% are monitored by private doctors, and 80% are monitored through Mother-Child clinics. These clinics offer high-quality and relatively inexpensive pre and post-natal care to women on a neighborhood basis. In 1994, 435 such clinics were in full operation. Despite recent attempts to change the focus of Mother-Child clinics from pregnant women to family health, the main focus continues to revolve around childbearing. Most Mother-Child clinics offer pregnancy tests, check-ups, blood tests, nutrition advice, childbirth preparation classes, child's inoculations and developmental monitoring, all at an annual co-payment equivalent to about 35$. The co-payment is per family, and services are never denied for lack of payment. However, as mentioned above, these services are among the few that are not completely covered by the basic-basket of health services. 3.2. Delivery Rooms and Maternity Wards The current number of maternity wards and delivery rooms in Israel does not meet present needs in Israel, due to a sharp rise in the number of births. In 1996 the National Council of Midwives and Gynecology presented the General Manager of the Ministry of Health with a report which exposed serious malfunctions in delivery rooms, particularly overcrowding and shortage of staff (including midwives, doctors, and anesthesiologists). 3.3. Women's Health Clinics In recent years, a number of well-equipped women's health centers have been established to provide special services for high-risk pregnancies, osteoporosis, and various health issues regarding mid-life. 3.4. Geriatric Services Presently, women comprise 57% of all Israelis over 65 years of age, and 70% of all patients hospitalized in geriatric hospitals are women. Thus, geriatric services may be treated as an area of specific concern for women. Currently, hospitalization expenses for senior citizens are covered by the basic basket, but extended hospitalizations of senior citizens are not covered by the basic basket and must be covered by the patients and their families. The National Insurance Law provides a monthly allowance for the elderly (defined as men who are over 65 and women who are over 60) who are in need of a personal caretaker. By September 1996, 67,000 senior citizens, 70% of whom were women, had received this monthly allowance. In 1996 alone, the government paid a total of over 1 billion NIS in such allowances. 4. Family Planning Among Israeli Women 4.1. Legal Abortions The Penal Code - 1977, sections 312-321, permits abortions upon the permission of a designated committee in the following cases: 1. The women is under the legal age for marriage or above 40. 2. The pregnancy is a result of sexual relations forbidden according to the Israeli criminal code, or is a result of incestuous or extra-marital relations. 3. The unborn child will suffer from a physical or mental deformity. 4. The continuation of pregnancy will endanger the life of the mother, or may cause her physical or mental damage. There are no criminal sanctions against women who undergo illegal abortions. The code penalizes doctors who perform the illegal procedures. The Committee for Approval of Termination of Pregnancies is composed of two doctors and a social worker. One of the Committee members must be a woman. No approval for the abortion is needed other than that of the committee, even if the woman seeking the abortion is a minor. Upon applying to the committee, the woman seeking an abortion must meet with a social worker, who is instructed by law to explain the physical and mental dangers of abortion, and is also instructed by the Ministry of Health to attempt to convince her to choose an alternative solution to the unwanted pregnancy. The woman seeking the abortion must also meet with a doctor instructed to explain the medical risks involved. The reports of both the doctor and the social worker must be reviewed by the committee before it makes its decision. The statutory committee may not examine applications for abortions of pregnancies that have developed beyond the 23rd week, rather, such requests must be reviewed by a special committee. The special committee is composed of the director of the medical center (to which the application has been sent), the director of the Maternity ward, the director of the Naonatology ward, the director of a genetics center, and a chief social worker. So far, 6 such special committees have been formed. Abortions performed for medical reasons or where the woman is a minor are covered by the medical insurance as part of the basic basket of health services. 4.2. Abortion rates Since 1980, the number of legal abortions performed in Israel has fluctuated between an estimated 14,000 to 19,000 a year. Chart 1 -Application, Approvals, and Actual Terminations It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Based on regression analysis, researchers have concluded that the level of education has no influence on the tendency to seek an abortion. The number of children before the pregnancy in question has proved to be an influential factor in the decision to apply for an abortion: the probability of application for abortion rose with the number of children a women had prior to the pregnancy in question. A recent study revealed that only 8.4% of married women in Israel sought abortions for health reasons, while the overwhelming majority sought abortions as a form of family planning. Table 1 - Applications to Commissions for Termination of Pregnancy (1995) Marital Status and Religion Total To Age 19 Absolute Numbers Total 16,903 2,318 Married Women 8,760 105 Unmarried Women 6,053 2,193 Religion: Jewish 14,593 2,136 Moslem 744 51 Christian 428 13 Rates per 1,000 Women Total 14 9.7 Married Women 13 9 Unmarried Women 13.2 9.8 Religion: Jewish 15.8 12.1 Moslem 4.4 1.2 Christian 11.1 2.1 Soruce: CBS, SAI 1996 Table 2 - Terminations of Pregnancy in Hospitals, by Cause Source: CBS, SAI 1996 It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Chart 2 -Terminations by Section of the Law (percents) It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. 4.3. Illegal Abortions It is difficult to account precisely for the number of illegal abortions in Israel, yet the current estimation of the Israel Family Planning Association stands at 4000-6000 abortions per year. Researchers have noted that the numbers have risen significantly following the recent wave of immigration from the former Soviet Union. Many immigrant women are relatively uninformed about birth control and they are accustomed to receiving abortion on demand. 4.4. Pronatalism and Family Planning in Israel Over the last 20 years Israel has witnessed a gradual expansion of family planning services in both the public and private health care sectors. However, despite fairly universal health care coverage and the broad range of medical assistance provided in the basic basket of services, contraceptives continue to fall outside of the basic basket of services offered to women. Israeli sick funds offer contraceptive devices at a fee which varies from 170 NIS for an IUD fitting at clinics operated by the General Sick Fund (which insures approximately 75% of the population) to 400 NIS in the other major funds. Although oral contraceptive pills are offered at a subsidized price (approximately 75% of the actual cost), this fact is not widely publicized and most clinics prefer to dispense the IUD to women after childbirth. Diaphragms are neither encouraged nor subsidized. Other non-prescriptive methods, such as foam, rhythm, and withdrawal are perceived as outside of medical jurisdiction, and are therefore rarely discussed by doctors as alternatives. The Israel Family Planning Association has been actively engaged in performing services not provided by the sick funds or governmental institutions. Since 1981, the association has operated walk-in counseling centers for adolescents facing social, psychological, and gynecological problems. Trained counselors give professional advice concerning contraceptive use, sexual relationships, and pregnancy. Gynecologists give periodic on-site examinations. Currently the association has offices in several pre-dominantly Jewish cities, however, the association plans to open centers in Arab cities like Jaffa and Nazareth, to be staffed by Arab personnel trained by the organization. 4.5. Hysterectomies Sterilization in Israel is performed on a voluntary basis, and the rate of hysterectomies is relatively low. While in the US in the late 1980s some 271 operations of this kind were performed per 1,000,000 women in the populations, in Israel, the rate was only 73 per 1,000,000. 5. Fertility Rates, Treatments, and Services 5.1. Birth Rates and Fertility Rates The absolute number of live births per year has increased from 80,843 in 1970 to 117,182 in 1995. Chart 3 -- Live Births, by Religion (absolute numbers) It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Table 3 - Live births, by Mother's Age Mother's Age Total Jews Moslems Christians Druze & Others Total - Absolute 112,330 79,224 27,705 2,710 2,676 Numbers Total 100 100 100 100 100 Up to 19 4 2.4 8.6 3.2 5.5 20-24 24.7 21.4 32.5 30.4 33.9 25-29 32 32.9 29.4 34.8 30.8 30-34 23.6 25.8 18.5 21.5 19.4 35-39 12.3 14 8.3 8 8.7 40+ 3 3.4 2.1 1.5 1.8 Source: Health in Israel, 1996 Chart 4 -Fertility Rate by Population Group: Live Births per 1,000 Women Source: Health In Israel, 1996 It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. The largest drop in fertility occurred among Druze, while the smallest drop in fertility occurred among Jewish women. However, the average fertility rate among Moslem women still remains much higher than the average fertility rate of Jewish women: while Jewish women were found to have an average of 2.5 children in 1995, Moslem women were found to have 4.7 children on average. Within the Jewish population, the largest drop in fertility occurred among women born in Europe and America (a 21.5% decrease, from 2.8 to 2.2 children on average), and the smallest drop in fertility occurred among women born in Israel (a 10% decrease, from 3.3 children on average to 2.5). From among the different age groups, the largest drop in fertility over the last 15 years has occurred among women in the 15-19 age group, while the biggest rise in fertility rate occurred among women in the 40-44 age-group. The absolute number of live births to unwed Israeli women has not increased significantly in the last 20 years, measured as 1479 births in 1978, and 1490 live births in 1994. However, the number of live births per 1000 unwed Israeli women under the age of 19 has almost halved since 1978, from 1.5 births to 0.8, while the overall number of live births among unwed Jewish women has risen from 732 births in 1982 to 1251 births in 1992. Table 4 - Live Births to Never Married Women It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. 5.2. Fertility Treatments and Services Fertility treatments in Israel are highly developed and well subsidized. Currently, Israel boasts a world record of 20 in-vitro fertilization (IVF) clinics, or approximately one such center for every 285,000 inhabitants. Insurance subsidies cover, on average, 6500 NIS for one cycle of IVF treatment, not including hospital expenses and other costs which are generally covered by the basic basket of services. Currently there is no limit as to how many treatments a woman may receive prior to conception, however, only 7 cycles of treatment, up to the birth of two live children, are covered as part of the basic basket of health services. Although there is no clear definition of infertility in the regulations defining the basic basket, couples are generally eligible for treatment if one year of sexual relations without contraception fails to result in pregnancy. In 1993, 7000 cycles of IVF treatment were performed (some women received more than one cycle of treatment). Moreover, unmarried women are now eligible for fertility treatments with donor sperm in accordance with the same provisions applying to married women. 6. Life Expectancy Table 5 - Life Expectancy Jews Arabs and Others Year Men Women Men Women 1950-1954 67.2 70.1 1960-1964 70.6 73.1 1970-1974 70.6 73.8 68.5 71.9 1975-1979 71.7 75.3 69.2 72 1980-1984 73.1 76.5 70.8 74 1985-1989 74.1 77.8 72.7 75.5 1990-1994 75.5 79.2 73.5 76.3 Excludes war casualties Source: CBS, SAI 1996 While life expectancy for Israeli men was ranked in 1989 as the 2nd highest among 34 developed countries (after Greece), the life expectancy for Israeli women was ranked 18th. According to the WHO Regional Office for Europe, the difference in life expectancy between men and women is the smallest of 20 European reference countries. This pattern remains generally consistent for all the main causes of death. The WHO Europe Regional Office noted Israeli women's high mortality rates as a matter of particular concern in its 1996 Report on Health in Israel. 7. Mortality Rates and Causes of Death 7.1 Infant Mortality Rates The infant mortality rate has almost halved since 1983 and currently stands at 6.8 deaths per every 1000 live births (5.5 deaths among Jewish newborns, and 9.9 deaths among non-Jewish newborns.) Table 6 - Infant Deaths, by Population Group and Cause Rates per 1,000 live births Cause of Death 1970-1974 1980-1984 1985-1989 1990-1994 Jews Total 18.6 11.8 8.8 6.8 Intestinal Infectious Diseases 0.6 0 0 All Other Infectious and Parasitic Diseases 0.4 0.2 0.1 0.1 Pneumonia 1.2 0.3 0.2 0.1 Congenital Anomalies 4.4 2.8 2.3 1.7 Other Causes of Perinatal Mortality 9.9 5.8 4.4 3.6 External Causes 0.3 0.2 0.4 0.2 All Other and Unspecified Causes 1.8 2.4 1.6 1.2 Arabs and Others Total 32.1 22.6 16.8 13.5 Intestinal Infectious Diseases 4.8 0.2 0.3 0.1 All Other Infectious and Parasitic Diseases 1 0.9 0.5 0.3 Pneumonia 4.4 1.8 0.6 0.2 Congenital Anomalies 6.5 4.9 5.4 4.2 Other Causes of Perinatal Mortality 10 7.3 5.3 4.3 External Causes 0.7 0.6 0.8 0.5 All Other and Unspecified Causes 4.7 6.8 4 3.8 Source: CBS, SAI 1996 The mortality rate of Jewish female Israeli newborns has been consistently lower than the mortality rate of Jewish male Israeli newborns and has remained consistently lower than that of their male counterparts during the first year for life, although the gap has been closing. However, while the average mortality rate of non-Jewish female infants was lower than the average mortality rate of non-Jewish male infants between the years 1980-1984, the average mortality of non-Jewish female infants rose above that of their male counterparts between the years 1989-1993, and has remained consistently higher than the mortality rate of non-Jewish male infants between their first month and first year of life. 7.2. Maternal Mortality Rates The maternal rate of mortality has remained generally low since 1985 , and in 1992 stood at 5.45 deaths per every 100,000 live births. According to the WHO Regional Office for Europe, the Israeli rate for 1990-1992 was the 9th lowest among 20 European reference countries. 7.3. Standardized Mortality Rates Table 7 - Mortality Rates of Jews Aged 45 and Over Average 1992-1994 Age Males Females Rates per 1,000 residents Total 25 22.2 45-49 2.8 2.2 50-54 4.5 3.5 55-59 8 6 60-64 14.1 10.7 65-69 22.9 17.5 70-74 36.8 29.3 75-79 60.1 50.4 80-84 97.2 84.6 85+ 189.3 170.2 Source: CBS: SAI 1996 7.4 Causes of Death Table 8 - Deaths, by Cause, Religion, and Sex It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Heart disease is the cause of death for 211.7 out of every 100,000 Israeli women, and 23% of deaths among Israeli women aged 65 and up. While the mortality rate of Israeli women from heart diseases was found to be approximately 30% lower than that of Israeli men, it is placed 27th lowest among the 34 Western countries to which Israel was compared by the International Mortality Chartbook, whereas the mortality rate of Israeli men from heart disease placed 17th lowest as compared to other countries. 7.5. Breast Cancer Among Israeli Women While the incidence of many types of cancers in Israel has generally gone down since the 1960s, Israel has witnessed a constant rise in the incidence of breast cancer over the last 30 years. It appears that Jewish Israeli women, like women in other developed countries, are at a particularly high risk of developing the disease at some point during their lives. A study conducted in 1985 revealed that one of the highest rates of breast cancer in the world is found among Jewish Israeli women, while one of the lowest rates in the world was found among non-Jewish Israeli women. Specifically, Arab-Israeli women constitute the group with the lowest rate of breast cancer in Israel, and the rate of cancer in general among Arab-Israeli women is lower than the rate of cancer among Arab-Israeli men. However, breast cancer still constitutes 1/3 of all cases of cancer among Arab-Israeli women (Avgar, 1996). Breast cancer has become the leading cause of death for Israeli women in the 25-55 age group, and has taken the lives of more Israeli women than all heart diseases combined. The rate of cancer among all Jewish Israeli women has risen since the 1960s from 45 cases per 100,000 women to 81 cases per 100,00 women in the early 1990s. The most dramatic rise in the number of new breast cancer cases occurred among Jewish women born in Israel (from 36/100,000 in the 60s to 92/100,000 in the 90s), as opposed to American, European, African or Asian born Jewish women, or Non-Jewish Israeli women (Avgar, 96). Between the 1987-1989 to 1990-1992 periods, there was a 37% rise in the number of new breast cancer cases. According to the figures compiled in 1995, in 1992 almost 2000 new cases of breast cancer were found among Israeli Jewish women, accounting for a third of the malignant tumors found in Israeli Jewish women during that year. Breast cancer is detected earliest amongst Israeli-born Jewish women (47.7 on average) in comparison with other groups of Jewish Israeli women. As with most malignant diseases, the rate of breast cancer among Israeli women rises with their age, reaching its peak in the 65-70 age groups, which experience outbreaks at a rate of 450/100,000 women (with the exception of American and European born Israeli women, amongst whom breast cancer peaks at later ages) and falling back to a rate of 300/100,000 women in the 70+ age group. 7.6. Mammograms The new Health Insurance Law expressly forbids the discrimination in services on the basis of sex. This has induced the general manager and the director of health services at the Health Ministry to announce in 1996 that by the end of 1997, the sick funds plan to cover all women in the 50-74 age group for a mammography examination once every two years. 8. Hospitalization The hospitalization of Jewish females under the age of 15 is lower then that of their male counterparts. After the age of 15 the hospitalization rate amongst Israeli women exceeds the rate of men, and continues to rise sharply in every age group. By the age of 45, the hospitalization rate of males and females is approximately equal, and beyond the age of 65 the hospitalization rate of men rises above that of women. The above statistics include women hospitalized in maternity wards. Chart 5 -Hospitalized Persons, 1993: Rate per 100 Persons It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Source: Health in Israel, 1996 In 1995, 44% of all psychiatric hospitalizations were of women and 56% were of men. The rate of hospitalized men exceeded the rate of hospitalized women until the ages of 45+. Table 9 - Admissions to Psychiatric In-Patient Care Total-Absolute Numbers Total 16,532 Men 9,293 Women 7,239 Thereof: First Admissions Total 4,111 Men 2,330 Women 1,781 Source: Health in Israel, 1996 9. Violence as a health factorViolence against women is thoroughly discussed under Article 5 above. The National Health Law covers any and all medical expenses incurred as a result of physical or sexual violence against women. The 1996 parliamentary committee whose work is discussed under Article 5 above, has recommended to the Health Ministry that medical teams be trained to identify damage stemming from domestic violence and to ask questions pertaining to family violence (including mental violence) as part of the standard line of questioning during an examination. In addition, the committee has recommended that questions pertaining to violence against women be included in the Israeli Medical Board examinations for doctors, nurses, and paramedics. 10. AIDS The total number of AIDS patients in Israeli during 1995 was 358, 312 of whom were male and 46 of whom were female. 278 of the 358 patients died that year. The number of AIDS carriers in Israel in 1995 was 1386 of whom 367 were women; most were exposed to the virus outside of Israel. Since the first statistical documentation of AIDS in Israel in the early 1980's, the proportion of Israelis infected each year by the HIV virus who are women has significantly increased, especially since 1992. The Israel Family Planning Association has been tackling the issue of AIDS in Israel by printing and distributing educational pamphlets in Hebrew, Russian, Arabic, and Amharic (the language spoken by Ethiopian newcomers to Israel). In addition, the Association offers courses and seminars which emphasize AIDS awareness and education. Table 10 - AIDS in Israel Women Men Exposure Category AIDS HIV+ AIDS HIV+ Patients Carriers Patients Carriers Total 46 367 312 915 Homosexual/Bisexual Males 132 193 Intravenous Drug Users 9 19 54 108 Persons with Hemophilia 1 33 44 Other Blood/Component Recipients 2 7 11 9 Heterosexual Contacts Partners of One of the Above 4 Categories 7 17 4 Persons Presumed: Exposure Abroad 17 198 42 267 Child of At-Risk/Infected Parent 6 23 5 42 Now Known 5 102 35 248 11. Women in Health care 11.1. Women in Medical School The number of women accepted to medical schools in Israel has risen significantly over the last 26 years, from 24% in 1969, to 48% in 1995. Israeli women were found to score comparably to Israeli men in the National Medical Board examinations. 11.2 Women as Medical Personnel By the end of 1993, two thirds of all doctors and dentists were men. Among the specialists, 74% were men. The highest rate of women specialists was in pediatrics (40%) and psychiatry (40%), followed by family-medicine (35%). The lowest rate of women specialists was in general-surgery (5%), followed by obstetrics and gynecology (15%). While 43% of all men-doctors were specialists, only 29% of all women doctors were specialists. The mass emigration to Israel from the former USSR has significantly changed the proportion of practicing doctors who are women in Israel, from 30% to 36% by 1995 (and 35% of all practicing dentists). Twenty percent of all doctors in 1993 were new immigrants who arrived to Israel in 1990-1993. Chart 6 --Medical Personnel It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Currently, 56% of all new immigrants who are doctors are women. Figures from 1992-3 indicate that 49% of medical licenses were given to women, 90% of the whom did not study medicine in Israel. Israeli women doctors tend to work in clinics as opposed to hospitals and are less likely than men to specialize in surgery related fields. While the proportions of Israeli women and US women who specialize in psychiatry and family medicine are similar, the proportion of women in the US who specialize in internal medicine, children's medicine, surgery, and particularly gynecology, is significantly higher than the proportion of their Israeli counterparts. Although gynecology is a specialty predominantly occupied by women in Eastern Europe, the current wave of immigrants from the former USSR did not significantly alter the number of women gynecologists in Israel. 12. Arab Women and Health Services Prior to the enactment of the new health insurance law, health clinics in almost all Jewish cities and villages, while nearly a third of the Arab villages lacked clinics. For example, in the Arab city of Um El Phachem, which housed 27,000 residents, the General Sick Fund provided only one gynecologist for its 18,000 members. In the new law the government adopted the policy of indirectly encouraging the Sick Funds to accept members who live in Israel's peripheries, such as Um El Phachem, by allotting funds in proportion to the number of members in each sick fund, an by specifying that more funds will be allotted for those living in the peripheral areas. Maccabi, the sick fund considered to provide the most qualitative health care services, began establishing branches in Arab villages while the new law was still being discussed in the Knesset. Thus, the new law has in fact brought an immediate improvement in the quantity and proximity of health care services to Israeli Arabs. A recent study conducted to gauge the level of satisfaction with the changes in the health care system brought on by the new law (Berg, 1996) found that the level of satisfaction from the new law was highest in the Arab community: 31% of the Arab residents included in the study felt that health care services had improved as a result of the new law, as opposed to a mere 17% of the veteran Israeli society. Since 1994, the Ministry of Health has joined the active effort to close the gaps in health care between Israel's minority groups and the majority by allotting a proportion of its yearly budget for this express purpose since. In 1995, 5.1 million NIS (roughly 1.5 million dollars) were allotted, which amounted to 2% of the Health Ministry's budget, and by 1996, 9.7 million NIS were allotted this purpose. Most of the funds have been used to employ more care-givers and purchase equipment for the clinics serving minority populations. 12.1 Health Care Services offered to Arab Women As mentioned above, the Minister of Health, through its local public health departments, operates an extensive network of 435 Mother-Child clinics throughout the country that offer high-quality and relatively inexpensive pre- and post-natal care to women on a neighborhood basis. While Mother-Child stations had been set up in all Jewish cities, in 1991 20 Arab villages still lacked Mother-Child clinics. In response, during 1993-1994, the Health Ministry approved the construction of 20 new Mother-Child clinics in Arab towns and villages. In 1995, the Health Ministry approved the construction of an additional 30 mother-Child clinics in Arab towns and villages, and 1996 the Health Ministry approved the construction of an additional 27 new Mother-Child Clinics for Arab towns and villages and spent 6.5 million NIS (roughly 2 million Dollars,) on their construction. A study conducted in 1992 among 320 Arab mothers in seven hospitals in Northern Israel found that Christian Arab women, who tend to be more educated than their Druze and Moslem counterparts, preferred private doctors to the Mother-Child care centers and visited the centers less frequently. Geriatric services for Arab women were virtually non-existent until 1993. No Arab town had institutions with beds for geriatric purposes and geriatric care was provided for the Arab elderly mainly by family members even after the enactment of the Nursing Care Insurance law - 1988. However, caretakers who are not members of the patient's immediate family and do not live in the same household have begun to take collect the allowance provided by the Nursing Care Insurance law as compensation for their services. Presently 12% of all Arab senior citizens receive both a senior citizen's allowance and nursing care allowance, while only 6% of all Jewish senior citizens receive both allowances. In addition, the first old-age home specifically geared for the Arab community opened in 1993 in the Arab town of Deboriah. 12.2. Life Expectancy and Causes of Death Among Arab Women Arab women have a life expectancy of 77.1 years as compared to Jewish women whose life expectancy is 79.5 years. The leading cause of death (47%) among both Arab and Jewish women is heart disease. Cancer is the second leading cause of death among Jewish women, and only the third leading cause of death among Arab women. However, the death rate from cancer among Arab women has been rising, and the difference between the two groups has been decreasing. Strokes have been found to be the third largest cause of death among Israeli women in general, leading to the death of 165 out of every 100,000 Arab women, as compared to 119 out of every 100,000 Jewish women. High blood pressure, which is generally more common among men than women, is particularly common and dangerous to the health of Arab women. 12.3. Infant Mortality Rates among Arab Newborns Despite the general improvement in health services since the establishment of State of Israel, a significant gap remains between the infant mortality rates in the Arab sector as opposed to the Jewish sector. Jews Arabs Table 11 - Health Determinants Stillborns per 1,000 live Births (1991) 3.7 6.5 (Moslems) Infant Mortality (1994) 5.9 11.5 Life Expectancy (1993) Women - 79.5 Women - 77.1 Men - 75.7 Men - 73.6 Source: CBS, SAI 1996 Statistical analysis completed in 1992 found that in the cities included in the study, the 9 cities with the highest infant mortality rates (spanning from 16.8% -24.6%) were cities in which the majority of the population were Arabs. Chart 7 - Jewish and Arab Stillborns and Infant Mortality Rates & Life Expectancy It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Chart 8 - Causes for Infant Mortality, Jewish and Arab Population It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. 12.4. Fertility and Family Planning The birth rate among Israel's Arab Moslems dropped from an average of 9.22 children per family in the 1960s to 8.5 in 1975, and continued to drop dramatically until 1986, when it stabilized at 4.6. Recently there has been a small rise in fertility rates among Moslems (the rate rose to 4.7 in 1995) , but a decline continued among Christian and Druze women. A study conducted in 1996, reveals a negative correlation between the fertility rate and years of education among Arab women, and a positive correlation between the number of years between each birth and the level of education. In addition, the study reveales that the fertility rate among village women is higher than that of city women. Arab women of Jerusalem were found to be exceptional in terms of this correlation, and their fertility rates were significantly higher than the fertility rates in other Arab cities. ARTICLE 13 Social and Economic Benefits States Parties shall take all appropriate measures to eliminate discrimination against women in other aresas of economic and social life in order to ensure, on a basis of equality of men and women, the same rights, in particular: a) The right to family benefits; b) The right to bank loans, mortgages, and other forms of financial credit; c) The right to participate in recreational activities, sports, and in all aspects of cultural life. The discussion under this Article will touch upon several areas relevant to the participation of women in economic, social and cultural life in Israel. As such, it will be divided into a number of parts: aspects of women in the economy; social benefits and the welfare state in Israel in relation to women's social and economic situation; and several aspects of every-day life of women in Israel (time-use and recreation). 1. Women in the Economy 1.1 Women as Members on Boards of Israeli Companies Women's participation in national economic life is a significant feature of full citizenship, which reflects society's willingness to accept women as leaders and decision-makers. In research conducted in 1994, the following data was collected concerning the number of women on the boards of directors in public companies traded on the stock exchange. In 61% of the public companies, there were no women appointed to the board of directors, and in 27% there was only one woman. In addition, research showed that more women serve on the boards of private or family-owned companies than on a public companies traded on the stock exchange. According to the aforementioned research, men have a higher tendency to serve as directors of multiple companies, whereas women have a higher tendency to hold multiple jobs in the same company, in addition to serving as members of the board. Recent data submitted to the Knesset Committee on the Status of Women by the Women Managers in Industry Forum show that the situation did not improve significantly from 1994 to 1996: in both years women constituted less than 9% of the directors in public companies traded on the stock exchange, and in 702 such companies researched, only 322 had women on their boards. 1.2. Attitude of Women Directors The research revealed additional differences between the attitude of women and men directors: women emphasize the shareholders' interest, the ability to influence the management and social prestige associated with the job. Men, however, attach strong importance to public interest, the ability to make connections, and their own management experience. These differences reflect important aspects of how directors get appointed: men are usually appointed through friends, network connections, or business associates, while women are appointed mostly due to family connections and public activity. 1.3. Women in Small Businesses Another significant aspect of economic participation is expressed through entrepreneurship, particularly in small businesses. The influence of small businesses in generating employment opportunities has risen greatly in the recent years. Therefore, the participation of women in small businesses should be undestood as a major channel through which women enter the Israeli economy. In a recent national survey conducted under the auspices of the Small Business Authority in Israel, it was found that: 1) 8% of all women aged 22-55 were operating their own business. 2) The life-span of small businesses of women is relatively short: (45% operate 1-4 years, 51% operate 5-7 years.) 3) The major obstacle that women must overcome to be entrepeneurs is lack of experience in financial and marketing strategies. 4) Since women generally own less property than men, it is more difficult for them to provide sureties in order to receive necessary loans. In 1996, the Committee for Promoting Women Entrepreneurship published a report which calls for increasing the number of women in bank managerial positions in order to influence the banks' attitude in favour of women's requests for loans and credit ratings. There is a National Fund for Promoting Small Business from which women can get loans with State guarantees. The Small Business Authority of Israel (hereinafter: "SBAI") is a government agency designed to help, promote and assist small businesses in Israel. The SBAI established a committee aimed at helping women set up small businesses and aiding women entrepreneurs. The SBAI provides courses in business management to women all over Israel. In addition, the SBAI has set up Women Managers Clubs in cooperation with Na'amat (see Article 7). Research done by the SBAI committee on the likelihood of women to open a small business revealed that 1) the average age of women entrepeneurs was 52, 2) their average education consisted of 13.5 years, 3) 70% of women entrepeneurs were married and 85% were mothers. The reasons and methods used for setting up a small business are summarized in the following table: Table 1 - Women's Reasons for Establishing a Small Business Reasons % Alternative to Working as an Employee 24 Desire for Financial Success 26 Reaching a Goal 15.5 Independence 15 Need for Change 13.4 Source: SBAI Committee The following table depicts the various means through which women entrepeneurs obtained the money needed to start their business: Table 2 - Sources of Funding for Intiation of Businesses Source % of Women Almost Didn't Need 30 Private Sources Only 41.1 Family 5.3 Bank Loans 15.5 Non-Private Sources 8.2 Source: SBAI Committee According to this data, in order to get capital most women preferred to borrow from relatives and friends rather than from banks. A small percentage of women reported difficulties in acquiring bank loans due to eligibility problems. 2. Social Benefits and the Welfare State in Israel 2.1 The National Insurance Institute The welfare state in Israel emerged gradually during the 49 years since the state's establishment. Israel succeeded in building a comprehensive system of social protection which encompasses social insurance and social assistance programs. The cornerstone of social insurance was laid soon after the establishment of the state, through the passage of the National Insurance Law- 1953. The social insurance system is extended to include all major contingencies of income loss in modern industrial societies: old age, dependents, disability, child rearing, maternity, unemployment, and work injury. The body responsible for administration of the social insurance programs is the National Insurance Institute (hereinafter: "NII") which operates under the supervision of the Ministry of Labor and Social Affairs. The NII provides welfare services to residents in need. The NII is also responsible for the payment of benefits under the social assistance program, as directed in the Income Support Law- 1980. Employment-related social benefits are described under Article 11. The following sections will describe other relevant social benefits, and will include data on recipients of such benefits. 2.2. Social Benefits 2.2.1. Maternity Grant Women are insured under maternity insurance, which provides a hospitalization grant, a maternity grant (both of which are only for the mother and not for the father) and a maternity leave allowance. Any woman who gives birth at a hospital is eligible for a maternity grant, set as 20% of the average wage, upon the birth of one child, and 100% upon the birth of twins. The conditions for eligibility for maternity leave allowance are detailed under Article 11. During 1996, 56,000 women received maternity leave allowances, constituting 49.1% of all births that year. This means that less than half of the women who gave birth in 1996 were eligible for the allowance, in terms of working the required amount of months prior to the birth, as explained under Article 11 above. 2.2.2. Old Age Pension and Survivor's Benefit 96% of all women over age 65 in Israel receive an old age pension or a widow's pension for dependents. Of those receiving an old age pension, 61% receive the pension after having accrued insurance coverage, while 21% receive pensions in the form of a supplement to the spouse's pension. An additional 18% of elderly women, primarily new immigrants who were unable to accrue pension rigthts in Israel, receive pensions under special arrangements funded by the Treasury (general revenues.) 2.2.3. Longterm Care Insurance All women, including housewives, are insured under long-term care insurance (see Article 12 above), and the conditions of entitlement are identical to that of men with one distinction: the age of entitlement for women is 60 and for men 65. Moreover, the conditions for entitlement to the benefit require at least 50% medical disability for housewives compared to 40% medical disability for other insured persons. 2.2.4. Unemployment Benefits A person who is registered at the Employment Service, who is ready and able to work, and to whom the Service has not offered such work, is entitled to unemployment benefits. The daily unemployment benefit is calculated at rates determined in the law, on the basis of the daily average wage of the unemployed person during the last 75 work days of the qualifying period. In 1996, 45.4% of all women aged 15 or older were part of the work force. The number of women receiving unemployment benefits was only 3.9% of the women's work force. The comparable figure for men was 2.8%. Women's unemployment rate in 1995 was 8%, and men's unemployment rate was 5.1%. 2.2.5. Children's Allowances The NII provides children's allowances to an insured parent under the law, paid to one of the parents for each child (under the age of 18) and to an insured person who supported a child who is not his or her child for at least 12 months. 2.2.6. Alimony Payments The Alimony (Guarantee of Payment) Law -1972 states that any person, regardless of gender, who has received a court decision in his or her favor for alimony and who is an Israeli resident, may receive this grant from the NII according to the court decision. Currently, the sums are 25% of the average wage for the alimony of a woman alone; 39.7% of the average wage for a woman with one child; 49.6% for a woman with two children. This law is a revolutionary law, enabling entitled people who cannot succeed in implementing the court decisions on their own, to receive the sums laid down by the courts. In 1996, 18,283 women received alimony payments. The overwhelming majority (99.3%) were women with children. About one third had one child, one third had two children, close to 20% had three children and about 10% had four children or more. The amount paid increases according to the number of children. Significantly, only 5% of the women received the sum determined in the regulations, since the sum that is decided in the courts is usually lower, and the beneficiary is entitled to the lower sum of the two. Thus, the average sum of alimony payment in 1996 was only 19.9% of the average wage. Other information indicative of the economic situation of women receiving alimony payments through the NII is that of all women who received unemployment payment in 1996 (36,750 women), 52.5% had also received alimony payment. 2.3. Poverty of Women According to the definition of poverty adopted by the NII, a family is considered poor when its standard of living falls considerably below the defined poverty line. The poverty line in Israel is defined as 50% of the median disposable income (i.e. after the various social-security transfer payments and income tax), adjusted to family size. According to the statistics offered by the NII, there are almost no gender-related differences regarding the incidence of poverty among the population, and poverty is documented in equal proportions among both men and women. In 1995, out of 1,447,900 adult women, there were 224,600 earning an income below the poverty line. Out of 1,324,300 adult men, there were 189,300 living below the poverty line. According to these statistics, women constituted 54.3% of the persons having an income below the poverty line, while men constitute 45.7% of the persons having an income below the poverty line. Since women constitute 52.2% of the adult population these figures show that the proportion of women in poverty is only slightly larger than their proportion in general in the population (54.3% vs. 52.2%). Nevertheless, there are specific population groups which are especially vulnerable to poverty, particularly those families that are headed by women. The statistics concerning poverty in families headed by women are as follows: 21.9% of all families headed by women live below the poverty line, 25% of all families headed by elderly women live below the poverty line, and the incidence of poverty in single-parent families headed by women are estimated to be higher, but unfortunately the NII data regarding this group is not sufficient to enable a precise assessment. Regarding two-parent families, the poverty rates are smaller: 13% among families with no children; 7% among families with one child; 11% among families with two children; 15% among families with three children; and the striking figure of 40% among families with four children or more (related to the socio-demographic characteristics of such families). The impression of a higher poverty rate among women-headed families is strengthened by the data concerning income support benefit, discussed below. Much of this information regarding the economic status of women-headed households is the direct result of the earning gaps that exist between women and men, as discussed extensively under Article 11 above. This contention is supported by the breakdown of the incidence of poverty among working men and women, when the analysis is done according to the disposable family income, adjusted by the number of family members. The NII data reveals that 14% of working Jewish women are below the poverty line, while the poverty rate for working Jewish men is only 7%. Interestingly, the opposite is true among working non-Jewish men and women. The poverty rate among non-Jewish working women is 20%, and among non-Jewish working men is 23%. 2.3.1. Single Parent Families In 1995, around 10% of all Israeli households constituted single-parent families (data varies between the Central Bureau of Statistics and the National Insurance Institute). Over 80% of these households are headed by women. According to the NII, poverty among single-parent families is more frequent than among two-parent families. Researchers further contend that almost one third of families with children that are headed by women are poor, compared with 15% of families with children that are headed by men. Unfortunately, neither of these estimations can be presently verified, since the sample used by the NII income-survey is too small to enable statistical analysis regarding single-parent families. One indication of the limitations of these estimates is the disproportionately high rate of single-parent women who received income support benefits in 1995; in this year 41% of all women receiving income support benefits were single-mothers. Overall, the high percentage of single-parent families headed by women living in poverty has been recognized as a serious problem, which is being dealt with in several different ways. The Single-Parent Family Law 1992 entitles single-parent families to income support, and has strengthened the social protection for single-parent families with low income, by increasing the level of their means-tested benefit as well as by awarding them child-education grants and priority in vocational training. The Single-Parent Family Law brought about an equalization of rights among the various types of single-parent families, whether headed by men or by women, under the principle of "equal treatment for families with equal needs." The Law was amended in 1994 and the definition of "single-parent" was broadened to include women or men who are separated from their spouses for at least two years and who have started divorce proceedings, immigrants whose spouses did not immigrate with them, and agunot (women whose husbands refuse to grant them a bill of divorce). According to the Single-Parent Family Law, every single parent is entitled to children's benefits, while those that do not have any income aside from alimony payments are entitled to income support. In 1995 the benefit to deserted wives and mothers whose spouses were in jail was increased by 50% in order to combat the high rate of poverty among these families. In addition, single-parent families are entitled to benefits in income tax, special credit points which reduce the amount of taxes they have to pay, and financial help in paying rent. Moreover, the NII provides a single parent family with a children between the ages of 6-14 with a yearly study grant. 2.3.2. Poverty among the Elderly Women's organizations have pointed out that, as part of the more vulnerable population, elderly women constitute a higher percentage of persons living below the poverty line. One of the means for dealing with this problem is the Law for the Reduction of Poverty and Income Disparities 1994. Under this law, the benefits paid to the elderly and single-parent families have risen significantly. This law is likely to help more women than men since women generally live longer than men. According to statistics submitted by the NII, however, the situation today is that poverty among the elderly is found in almost equal proportion among men and women. The percentage of elderly women living below the poverty line is 19.2%, and among elderly men is 18.9%. 2.4. Combating Poverty 2.4.1. Income Support Transfer payments play a crucial role in reducing poverty and income disparities. According to the Income Support Law - 1980, Israeli residents over 18 years old, subject to a means test that takes into account the economic situation of the family unit as a whole, are entitled to an income support benefit under certain conditions, including, for example: unemployment; employment at low wages; single-parenthood with a child up to the age of 7; and more. The benefit rates, presented as percentages of the average wage, vary according to the conditions of eligibility. Single parents with children get the highest rate of income support: with one child - 43%, with two or more children - 53%. Income support is given on the basis of a family unit. In 1995, among all recipients of income support benefits 65% were women, of whom 34% were married with or without children, 25% were unmarried, and 41% were single-parents. ARTICLE 14 Rural Women 1. States Parties shall take into account the particular problems faced by rural women and the significant roles which they play in the economic survival of their families, including their work in the non-monetized sectors of the economy and shall take all appropriate measures to ensure the application of the provisions of this Convention to women in rural areas. 2. States Parties shall take all appropriate measures to eliminate discrimination against women in rural areas in order to ensure, on the basis of equality of men and women, that they participate in and benefit from rural development and, in particular, shall ensure to such women the right: a) To participate in the elaboration and implementation of development planning at all levels; b) To have access to adequate health care facilities, including information, counselling and services in family planning; c) To benefit directly from social security programmes; d) To obtain all types of training and education, formal and non formal, including that relating to functional literacy, as well as inter alia, the benefit of all community and extension services, in order to increase their technical proficiency; e) To organise self-help groups and co-operatives in order to obtain equal access to economic opportunities through employment or self-employment; f) To participate in all community activities; g) To have access to agricultural credit and loans, marketing facilities, appropriate technology and equal treatment in land and agrarian reform as well as in land resettlement schemes; g) To enjoy adequate living conditions, particularly in relation to housing, sanitation, electricity and water supply, transport and communications. The issue of rural women is not particularly relevant to the State of Israel, since only 10.4% of the Israeli population lives in rural localities. Two main groups which this Article will concentrate upon are Bedouin women and women in kibbutz. 1. Bedouin Women 1.1. Introduction This chapter focuses on the 100,000 Bedouins who live in the southern Israeli desert regions. Half of the Bedouins who reside in southern Israel live in one of 7 Bedouin towns that were officially founded and recognized by the State (Tel-Sheva, Rahat, Chora, Lakye, Sgav- Shalem, Aroer, and Csype,) while the remaining half are scattered across the desert and live in semi-nomadic clans. The Bedouin community has undergone many changes since its first exposure to Israeli society. The process has had various social, political, and economic effects on the Bedouin community, and has weakened many age-old customs of Bedouin society: particularly those of Bedouin women. 1.2. Family Bedouin society is patriarchal and traditional. Bedouin women traditionally hold all domestic responsibilities, including upkeep of the family tent, and education of children. In addition, women were held responsible for caring for members of the tribe who were in need of communal assistance, like the elderly or the infirm. 1.3. Israel's Influence on the Bedouin Social Structure 1.3.1. The Rise in Polygamous Marriages Historically, Bedouins practiced polygamy, and in recent decades the popularity of polygamy has risen. Exposure to Israeli society has either lead Bedouin men away from their villages, or brought them back to their villages with new expectations as to their future lifestyles there, which include the expectation to marry partners who share their more western outlook and possess a similar educational background. Bedouin women, who are usually not allowed to leave their village for educational or employment purposes, have not been able to meet the expectations of their westernized male counterparts. Consequently, many remain unmarried at relatively advanced ages (late 20s early 30.) . Unmarried Bedouin women remain dependent on their families and are perceived as economic burdens by their fathers, who are traditionally in charge of family finances. In order to remedy the situation, many of these older unmarried Bedouin women are married off as second or third wives. In the Bedouin town Rahat (the largest of the officially recognized Bedouin towns in the south) the average age of legal wives in monogamous marriages is 18.3, and the average age of the first wives in polygamous marriages is 20.5, while the average age of the other wives in a polygamous marriage is 24.24 (Alatona, 93.) In addition, the research indicates that the number of forced marriages was significantly higher among additional wives in polygamous marriages than among the first wives in polygamous marriages or wives in monogamous marriages. Polygamous marriages occur among educated Bedouins men and women as well. Often, an educated woman will be married off as a second or third wife, yet her level of education seems to be a positive variable in her status in the polygamous marriage. In Rahat, while wives in monogamous marriages received an average of 4.4 years of education and additional wives in polygamous marriages received an average of 3.5 years of education, the first wives in polygamous marriages were found to have received only .7 years of education on average. The status of the first wife in a polygamous marriage varies: some of the first wives are all but abandoned by their husbands in favor of the new wives although they are not officially divorced, while others become more prominent in their position as compared to the other wives. Education was found to increase self-esteem among women in monogamous marriages, though educated women in polygamous marriages were found to more frustrated by their marriage arrangements because they were more aware of their educational and professional potential. Israeli law forbids polygamy, though Bedouin men manage to circumvent the law by marrying one wife legally and the rest traditionally, later claiming to the Civil courts that the other wives are strictly maintained as "concubines." However, the Shaaria (Moslem) courts recognize the concubines as legal wives and grant them divorces as well (Alatona, 93). 1.3.2. Modernization as a Bane to the Status of Bedouin women As a result of the government-sponsored transition of the Bedouin community from a semi-nomadic lifestyle to permanent residences, many of the traditional activities of the Bedouin women have been replaced by modern technology and by the Israeli educational system. The abandonment of traditional life has left a vacuum in the lives of Bedouin women that has yet to be filled by new forms of activity; these women are unequipped and unable at this stage in their lives to enter to go into the labor market or pursue a formal education. Thus, they have been left unemployed, although they are not formally recognized as such by the Israeli government. The Bedouin men see the change in their wives role in the nuclear family as a transition from a productive to a consumptive role which leads to a gradual loss of respect for their wives and the roles which they play in the family unit. 1.4. Employment Bedouin men still object to sending their wives and daughters to work outside of their town and villages. At present, Bedouin women are more interested in vocational training which will provide them with skills that can be utilized within their homes or villages. Since Bedouin social code dictates that women must be accompanied at all times and places outside the home, Bedouin men only allow their wives to work outside of the home provided that they are supervised at all times. Bedouins in the Galilee have overcome these societal constraints through the supervision of Raisim, i.e. labor contractors or work supervisors, who assume the responsibility of protecting Bedouin women when they are working outside the home. The Raisim usually organize groups of women to work in factories, agriculture, and as household help, and these women are often paid through the Raisim. While in the past Bedouins were decidedly opposed to women working at night, the Raisim system has created the opportunity for village women to work night-shifts in factories and in hotels. The competition amongst Raisim to manage as many workers as possible ensures that women will not be taken advantage of. Presently, the phenomena of Bedouin women working through the Raisim arrangement is only significant in the Northern Bedouin villages located in the Galilee. 1.5. Education Bedouin children enjoy a public school education comparable to the public school education provided all over Israel. However, only 30% of Bedouin students complete the 12th grade, and barely 3% of the students successfully complete graduation requirements. Currently, Bedouin girls constitute at least 50% of the student body of the recognized Bedouin schools. Many parents expect their daughters to return to their traditional roles in the Bedouin households upon graduation from 12th grade, which often results in irreconcilable differences between the traditional parents and their educated daughters who refuse to return to domestic work which does not allow them to use their education. Furthermore, many girls who are allowed to work must hand their wages over to their parents and often resent their inability to enjoy the fruits of their labor. These irreconcilable differences lead a significant number of Bedouin girls to run away from their homes to shelters and half-way houses. Recently higher education has begun to gain acceptance among some Bedouin parents who realize that in order for their daughters to lead comfortable lifestyles and find suitable husbands (given the rise in demand for educated wives among young Bedouin men) they must have advanced education. Nevertheless, most parents still associate the university setting with decadence, and fear that sending their daughters to university will result in the desecration of their family's honor. 1.6. Ritual Female Genital Operations (Female Circumcision) Ritual female genital surgery (RFGS) has been found to be a normative practice in several Bedouin tribes in southern Israel. Those Bedouin women among whom the custom is prevalent do not refer to female circumcision in anatomic terms, but rather refer to it as "purification." In 1992, Bedouin women from six different tribes were interviewed regarding their circumcisions. The women interviewed were between the ages of 16 and 45. They reported that not only they, but all their sisters and the women in their close and extended family underwent RFGS. The older women who had daughters reported that their daughters had already undergone RFGS or will undergo RFGS when they reach the suitable age. The ages between 12 and 17 are considered suitable for RFGS, since they are after menarche but before the girls reach a marriageable age. Most of the women stated that they will continue practicing RFGS on their daughters, however, two young women aged 16 and 18, who were among the younger and better educated women in the group, said they will not perform RFGS on their daughters. A physical examination of women from the same tribes revealed that the RFGS performed on them did not involve clitoridectomy. However, all of the women recorded bleeding and pain at the time of the RFGS. Three of the women reported that they had required medical attention. All of the women reported pain on intercourse in the months after marriage. None of them felt this to be related to RFGS and many approved of the practice and intended to continue the tradition. 1.7. Organizations for the Advancement of Bedouin Women Currently, there are no organizations specifically run by Bedouin women. The Bedouin community itself does not provide a social framework for women outside of infrequent social gatherings under religious auspices. Some Bedouin women have shown a great deal of interest in the formation of such organizations. The social workers in the town Csyfe were the first to open a women's recreational center in a Bedouin town. Some of the activities provided by the center are workshops for learning Hebrew, classes to complete the basic requirements for a high-school diploma, and social gatherings. 1.8. Health The new Health Insurance law has been changing the face of health care for Israel's Bedouin residents. For example, before the enactment of the new law, 20,000 residents of the Bedouin town of Rahat (about half of the city's population) were uninsured. The remainder of the residents who were insured belonged to the General Sick Fund, which only maintained one infirmary in the entire city. The new law, which has guaranteed coverage for all of Israel's residents, has led two additional sick funds to open branches in Rahat. In addition, the Health Ministry has approved the construction of 6 new infirmaries in officially recognized southern Bedouin towns. However, the Ministry's southern district currently lacks the necessary funding and labor-force to provide the full basic basket of services for the Bedouin community. The shortage of doctors to fill the needs of the Bedouin community has been estimated at 50% and the shortage of nurses has been estimated at 30% (Belmeker, 1996). The Health Ministry has attempted to respond to the problem by appropriating approximately 200,000 NIS each year since 1995 specifically for the Bedouin sector, which have been expended on training seminars for nurses to serve the Bedouin community. An additional problem in applying the new law concerns the 40,000 Bedouins of the south who live in areas where there are no permanent health services. They are currently forced to walk at least 5 kilometers, or wait for traveling doctors provided by the sick funds, in order to enjoy the services now included in the basic basket of services. Presently, the government maintains two traveling medical teams, and uses the services of an additional private traveling medical team. Under the new law, infirmaries providing basic services must be within a "reasonable distance" from the residence of the insured. Therefore, in order to maintain the law's instructions, more infirmaries must be erected closer to Bedouin villages. More attention should also be given to those health services where the Bedouins' need is greater, such as obstetrics and pediatrics; while 20%-25% of the population which makes use of the Soroka hospital in Be'er-Sheva are Bedouins, over 45% of the births in that hospital (11,000 in 1995) are those of Bedouin women. 1.9. Violence Against Bedouin Women Social workers who work in Bedouin communities maintain that they manage to prevent 20-30 girls each year from being murdered on account of having "desecrated their family's honor," and have minimized the occurrence of such murders altogether. The social workers use relatively unconventional methods to prevent the murders, such as secret abortions. Although the notion of "family honor" is deeply ingrained in the Bedouin ethos, the social workers explain that parents are reluctant to react to their daughters' promiscuous behavior unless it becomes publicly known and they are pressured to react by their community. 2. Women on the Kibbutz 2.1. The Myth of Equality Kibbutz movement ideology strives to create and maintain equality between the sexes. This ideological emphasis on equality however, has failed to compensate for the reality of female kibbutz member's inferior status, a problem which has existed throughout kibbutz history. The Associated Partnership Statute (categories of associations) - 1995, defines a kibbutz as an organization which is its own settlement based on joint ownership of property, independent work, equality and joint production, consumption and education. According to this definition, women are entitled to the same rights and responsibilities as any kibbutz member. In other words, from a legal standpoint there is equality between men and women on the kibbutz. 2.2. A Woman's Role in the Kibbutz 2.2.1. Education During the past 25 years the right to higher education has been provided to both male and female kibbutz members. Statistical studies show that 69% of kibbutz men and 74% of kibbutz women, age 31- 40 have at least 13 years of education. This gap narrows in poles taken of younger people, though more men have advanced degrees. Fields of study are often divided by gender, with most women studying social sciences, psychology and art; and most men economics, earth science and technical vocations. Table 1 - Fields of Study Men Women Total Subject Absolute Absolute Absolute Numbers Percents Numbers Percents Numbers Percents Economics, 4252 75 1389 25 5641 100 Engineering, Sciences Art Education, 1457 23.5 4736 76.5 6193 100 Humanities Source: TKM Statistical Division, 1994 In other fields of study this gender division is less extreme, for example in economics and engineering. Chart 1 - Students of Economics Source: The Institute for Kibbutz Research, Haifa University 2.3. Employment Most female kibbutz members are employed in education, domestic work or public service, whereas most men are employed in agriculture, industry or production management. In kibbutz industries, few women are employed as "blue collar" workers, most are in secretarial positions. This division can be found in executive positions as well, where most senior positions are filled by men. Table 2 - Areas of Employment on Kibbutzim, by Gender 1978 1986-87 1994 Branch Women Men Women Men Women Men Agriculture 1 31 3 22 5 23 Industry, Crafts and Tourism 8 30 6 38 21 34 Public Services 37 10 30 6 26 16 Education 30 5 38 40 26 5 Secretarial 8 8 12 14 12 15.5 Other 7 16 11 16 10 6.5 Total 100 100 100 100 100 100 Source: The Institute for Kibbutz, Research, Haifa University, 1996 Table 3 - Level of Skill Required for Job percents Level of Training Women Men Low 40 31 Medium 27 35 High 33 34 Total 100 100 In sum, it can be concluded that there is a clear division of labor based on gender in kibbutz society. This division dictates which positions are to be allocated to women and which to men. 2.4. Appointment of Men and Women to Public and Political Positions on the Kibbutz In the past twenty years, only 16 women have been appointed to management positions on kibbutzim; today 5.7% of those in office are women, which does not show a substantial increase from 1973. Over this same period, 34.5% of those holding the position of kibbutz secretary were women, though the number of women in other significant kibbutz management positions, such as treasurer, has remained low. The following table shows that the number of female chairpersons of committees in male dominated fields is statistically insignificant. Table 4 - Women Supervisors of Committees Committee % Women Education 80 Health 77 Budgeting 36 Workforce/Manpower 21.3 Money 8.5 Planning, Building 7.8 Sport 6.4 Kibbutz Economics 2.8 Auto Pool 1.1 Security 0 Source: The Institute for Kibbutz, Research, Haifa University, 1996 In sum, contemporary statistics about the division of labor on kibbutzim tend to reflect that which was reported by researchers more than twenty years ago. Men and women are active in fields which are an extension of their traditional roles; men in fields of economy and economics related to sources of livelihood and resources, and women in roles of care-givers. ARTICLE 15 Equality Before the Law and in Civil Matters 1. State Parties shall accord to women equality with men before the law. 2. States Parties shall accord to women, in civil matters, a legal capacity identical to that of men and the same opportunities to exercise that capacity. They shall in particular give women equal rights to conclude contracts and to administer property and treat them equally in all stages in courts and tribunals. 3. States Parties agree that all contracts and all other private instruments of any kind with a legal effect which is directed at restricting the legal capacity of women shall be deemed null and void. 4. States Parties shall accord to men and women the same rights with regard to the law relating to the movement of persons and the freedom to choose their residence and domicile. 1. Legal Capacity of Women As explained under Article 1, complete formal equality between men and women before the law is entrenched in Israeli law, except in matters governed by religious law. Women hold complete legal capacity to conclude contracts and administer property. Women have the same rights as men to make contracts in their own name, including those relating to credit, real estate and other property, as well as to make other commercial transactions, notwithstanding their personal status. The Women's Equal Rights Law-1951 specifically relates to the issue of marriage, providing complete legal capacity for a married woman with regards to property "as if she were not married." This provision abrogated the power of religious law which designates husbands as administrators and proprietors of their wives' property. 2. Gender-Specific Legal Concepts Two particular Israeli legal concepts apply to women and not to men: one is in the area of social benefits, namely the concept of the home-maker, or rather its gender-specific label of "housewife," which only applies to women and not to men. The other is in the area of defenses under criminal law, namely the defense of post-partum-syndrome which applies to rare cases where a woman who suffers from severe depression after giving birth, consequently kills her newborn baby. Section 303(a) to the Penal Law-1977 states that in such cases, where the baby was under 12 months of age, the maximum punishment of the mother is 5 years imprisonment. Section 303(b) makes clear that this special defense does not preclude the possibility of an absolute immunity for reason of insanity. 3. Equal Participation of Women in the Courts-System Women are treated equally and participate equally in the civil-courts, both as litigants, witnesses, lawyers and judges (qualifications to this formal equality are discussed in the following section). The situation, however, is different with respect to the religious courts system, which is part of the national judicial system, and has exclusive jurisdiction in matters of marriage and divorce, and concurrent jurisdiction in other matters of family law. Under Jewish law, women are not qualified to be witnesses. However, halachic (Jewish law) authorities throughout the ages have found various solutions and means to accept women's testimony, and in practice, rabbinical courts accept their testimony and accord it the same evidential weight that is accorded to men's testimony. An interesting development had taken place with respect to the representation of clients in rabbinical courts. Certified attorneys, whether men or women, can represent clients in rabbinical courts (or in other religious courts) in any and all matters. However, both rabbinical and Moslem courts recognize the competence of rabbinical or sharia advocates to represent clients only in the relevant religious courts, without being certified attornies. The Rabbinical Advocates Law - 1955 originally applied to men alone, since it required graduation from a yeshiva (an institute of higher learning of religion and religious law, traditionally for men alone) as a primary condition for qualification as a candidate to the profession. The law was amended in 1991 to include graduates of other educational institutes of higher learning that are recognized by the Chief Rabbinical Court as eligible candidates for the profession. However, no regulations or other directives were passed to establish the criteria for such recognition. Only in 1994, after an institute for higher Torah learning for women petitioned the High Court of Justice, did the Chief Rabbinical Court decide upon the criteria for its recognition. The High Court of Justice reviewed those criteria, and found that some of them, such as the requirement of full-time everyday studies for full two years, were intended to make it impossible for women students to qualify for candidacy, and were therefore discriminatory. Several dozen women have since passed the examinations and are now functioning as rabbinical advocates; they primarly represent women clients. 3.1. Gender Bias in the Courts 3.1.1. Special Study of Gender Bias in Israeli Courts In the early 1990s the Israeli Women's Network initiated a study on gender-bias in Israeli courts. With the support of the Ford Foundation and the academic backing of the Jerusalem Institute of Israel Research, the study was designed to determine if and how gender bias was manifested in Israeli courts. The study began in 1992, and concluded toward the end of 1996. 3.1.2. Main Findings of the Study Some of the main findings of the research are as follows: 1. Judges seem to accord greater credibility to men than to women, both as defendants and as lawyers. Women lawyers were significantly less successful in persuading judges than were men lawyers, regarding both sentence length and the ratio between prison term and maximum sentence. Lower sentences were imposed when women were the prosecutors and higher sentences were imposed when women were the defense attorneys. Furthermore, men prosecutors were most persuasive when the defense attorney was a woman. 2. When the accused was a stranger to the woman victim, the prison term he was sentenced to was almost double the sentence as when the accused was a family member of the woman victim. 3. Women acting as sole judges (i.e. when not ruling as part of a panel of judges) declare lighter sentences than their male counterparts. For example, the average jail sentence in sex crimes, passed by a sole woman judge, stands at 9.5 months, as compared to 23 months passed by sole male judges, for the same crimes. Women judges tend to cite the negative characteristics of the victim. On the other hand, in cases where judgment is passed by a panel of three judges, when the panel includes a woman judge, the punishment is heavier than when it is an all male panel. 4. It was further found that the rate of convictions in "crimes against life" is lower when the victim is a woman, and that the period of imprisonment for crimes against the lives of women is significantly lower than imprisonment for crimes against the lives of men. The length of a jail sentence is approximately 2 years shorter when the victim is a woman. A summary of the study was submitted to Justice Barak, the Chief Justice of the Supreme Court, who decided on the establishment of a committee to investigate the results of the report and its implications. 3.1.3. Workshops on Gender Bias for Judges The researchers recommend, among other things, that continuing educational programs for judges be instituted that will raise the issue of gender bias (as well as other forms of bias in the courts). Experimental programs in that direction were already initiated prior to the study by Judge Rotlevi of the Tel-Aviv District Court. However, according to her report, those seminars were not very successful, and attendance was low. ARTICLE 16 Equality in Marriage and Family Law 1. States Parties shall take all appropriate measures to eliminate discrimination against women in all matters relating to marriage and family relations and in particular shall ensure, on a basis of equality of men and women: a) The same right to enter into marriage; b) The same right freely to choose a spouse and to enter into marriage only with their free and full consent; c) The same rights and responsibilities during marriage and at tits dissolution; d) The same rights and responsibilities as parents, irrespective of their marital status, in matters relating to their children; in all cases the interests of the children shall be paramount; e) The same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education, and means to exercise these rights; f) The same rights and responsibilities with regard to guardianship, wardship, trusteeship and adoption of children or similar institutions where these concepts exist in the national legislation; in all cases the interests of the children shall be paramount; g) The same personal rights as husband and wife, including the right to choose a family name, a profession, and an occupation; h) The same rights for both spouses in respect of the ownership, acquisition, management, administration, enjoyment, and disposition of property, whether free of charge or for a valuable consideration. 2. The betrothal and the marriage of a child shall have no legal effect and all necessary action, including legislation, shall be taken to specify a minimum age for marriage and to make the registration of marriages in an official registry compulsory. 1. Introduction This article is one of two that the State of Israel has ratified with reservations, due to the fact that religious law governs family law in Israel, insofar as the legal issues in question are classified as "matters of personal status," and are not qualified by territorial legislation (i.e. civil laws that specifically apply in both religious and civil courts). The scope of the legislation termed "matters of personal status," which covers all personal laws (except for Islamic laws), has narrowed over time, and currently includes only marriage, divorce, alimony and child support. The scope of this legislation regarding Moslems in Israel is broader, and includes child-custody and paternity matters as well. Until 1995, jurisdiction over family matters was divided between the religious and the civil courts, and within the civil judicial system itself. This was changed by the Family Court Law - 1995, which established a new family-law division within the magistrate courts which was responsible for all family matters under the jurisdiction of the civil system. The establishment of the family-courts system, however, has not affected the jurisdictional split between the religious and the civil judiciaries. 2. Reservations to Article 16 The maintenance of religious law in matters of family and divorce is perceived to be one of the most vital components of Israeli law, since it ensures that the State of Israel is the state of the Jewish people. It is thus considered a foundational aspect of the sensitive relationship between religion and state in Israel. Due to the reservation that the State of Israel entered with regard to this article, insofar as the laws of personal status affect the laws of various religious communities in Israel which do not conform with the provisions of this Article, the following sections will not discuss the legal situation in matters of marriages and divorce, nor in matters of spousal support. 3. Some Demographic Data Israel is a very family-oriented society. The desire to raise a family has always been ranked highly in studies of Israeli Jewish high-school students, although girls tend to rank it higher than boys. The family-oriented nature of Israeli society is illustrated by the following data, which details rates of marriage and percentages of non-married and never-married men and women in different age-groups: Table 1 - Population Aged 15 and Over, by Religion, Marital Status and Age Source: CBS, SAI 1996 It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. Table 2 - Median and Average Marriage Age Source: CBS, SAI 1996 Marriage ages for both women and men have risen over the years, while the gaps in the average and median ages of women as compared to those of men remain more or less unchanged. The low marriage age of Moslem and Druze women is particularly striking. Divorce rates are considerably higher in the Jewish population than in the Moslem population: Table 3 - Persons Divorcing by Religion, Age and Year Source: CBS, SAI 1996 It was not possible at this time to reproduce the chart or table which appears here in the text, but you may obtain it by contacting the Division for the Advancement of Women directly. It is important to note that the Central Bureau of Statistics (CBS) presents the number of marriages as they appear in the official marriage and divorce registrar records, which means those marriages and divorces that are conducted in Israel in accordance with Israeli law. 4. Non-Marital Cohabitation The Israeli legal system recognizes the state of non-marital cohabitation or partnership, and extends rights and obligations to such unions. Thus, for example, economic rights of non-marital partners have been equated to those of married couples for purposes of pensions, social security entitlements, resident's protection against eviction, damage awards under torts law, and more. In the context of inheritance, an additional specification requires that "no prior marriage exists" (i.e. a marriage that has not been terminated) for either of the partners. In addition to bestowing many economic rights to non-marital partnerships there is a more substantive level of recognition given to such unions. The Names Law-1956, and its 1996 amendment is an example. The amendment confirmed a 1993 case, Efrat v. The Registrar, which directed the Ministry of Interior to register the change of name of a woman who wanted to change her family name to that of the man who was her non-marital partner. Justice Barak, who deliberated on the case, went into a lengthy discussion about the legal and social attitudes toward non-marital partnerships, and concluded that it is in the public interest to encourage them as forms of family life which are as equally important to society as "formal" families. Another illustration of the more substantive level of recognition given to non-marital unions can be found in legislation that imposes the same obligations and duties upon both non-marital and marital partners. These include obligations and duties regarding family-violence and duty of care toward minors. The legislature has not gone as far as imposing mutual positive obligations upon the unmarried partners toward each other, thus there is no statutory obligation of support, but case law has held that such an obligation could be construed as an implied commitment under the circumstances. Similarly, case law has held the rule of community property which was developed by the Supreme Court to regulate the area of matrimonial property before the enactment of the Spouses (Property Relations) Law - 1973, applies equally to non-marital partners. Notwithstanding the broad scope of recognition, there still are some areas in which such relationships are not equated to those of formal marriage. Such areas include the provision of immunity from spousal testimony in criminal proceedings, the right of spousal entry to Israel according to the Entry into Israel Law-1952 , and the right to adopt a child together. On the level of relationships between non-marital partners and their mutual children, as far as they are determined according to civil law, the lack of formal marriage between the parents has no significance whatsoever upon their duties and rights toward their children. The situation is different with respect to Moslems, who are governed by religious law in this area. 5. Minimum Marital Age The Marriage Age Law-1950, states that the minimum marital age for all women in Israel is 17. No minimal age for men is set. Since the substantive law that applies in matters of marriage is derived from the individual's religious law, the minimal age for men would be drawn from religious law. The minimal age requirement is accompanied by provisions that make the arrangement of under-age marriages a criminal offense punishable by up to two years imprisonment. The possible offenders include the person who arranges the marriage, the person who conducts the marriage, and the marrying man himself. The under-age woman is excluded. The law also provides that the mere fact that a marriage was conducted in violation of this law is a ground for divorce. Article 5 of the Marriage Age Law-1950 provides for two alternative grounds for judicial permission of under-age marriage. The first one relates to circumstances in which the under-age woman is pregnant from or has given birth to the child of the man whom she asks permission to marry. No age limit at all is attached to this ground for exception. The second relates to unspecified "special circumstances" that would justify immediate marriage, provided the woman is over 16 years old. Since the legislature has left those "special circumstances" unspecified, the Supreme Court has taken it upon itself to provide instructions as to the substance of those circumstances. In one of the leading cases, then Justice Barak firmly stated that a community's custom and tradition do not justify marital exception, since it is those traditions and customs that the Marriage Age Law-1950 was set to abolish. Criminal sanctions contribute to the reduction of the phenomenon of marriages involving minors. However, it has not been eliminated altogether, as can be seen from the following tables, which contain data of marital ages in Israel. Table 4 - Marriage of Minors Up to Age 17 Jews Moslems Year Brides Grooms Brides Grooms Up to 16 17 17 Up to 16 17 17 Average 1975-1979 12.3 48.4 1.2 19.6 133.1 2.2 Average 1985-1989 2.4 17.4 0.3 15.4 140.2 1.7 1991 0.9 13.9 0.1 10.1 179.1 0.7 1992 0.7 11.4 0.5 179.7 1993* 0.6 10.6 0.2 *Statistics are note available for this year for Moslims. Source: CBS, SAI 1996 Table 5 - Marriage of Young People Up to Age 19 Age Jews Moslems Christians Druze Grooms Total 26,680 7,857 795 703 Total to age 19 652 540 5 53 Up to 17 18 16 18 166 186 5 16 19 468 338 37 Brides Total 26,680 7,857 795 703 Total to age 19 3,258 3,845 149 386 Up to 16 27 15 4 2 17 397 1,558 28 157 18 1,147 1,207 45 117 19 1,687 1,045 72 110 Source: CBS, SAI 1996 6. Bigamy Since questions of marriage and divorce are determined by religious law alone, the secular legislature cannot decree bigamous marriages invalid, when such marriages are recognized by the relevant religious laws, but can only operate against them through criminal law. Section 176 of the Penal Law-1977, makes bigamy a criminal offense punishable by 5 years imprisonment. Sections 181-182 prohibit forcing divorce upon one's wife with no judicial decree of divorce, and makes the arrangement of such prohibited marriages or divorces a criminal offense as well. Sections 179-180 provide exceptions for the rule against bigamy. Section 180 applies to all individuals whose religious affiliation is other than Jewish, and indicates that incapacitation of one's spouse or 7 years absence theerof may justify marriage to another person. Section 179 applies only to Jewish people, providing immunity to a person whose second marriage was permitted by a rabbinical court's judgment that underwent the specific Halachic procedure to make it religiously valid. Since religious law accommodates bigamous marriage, further legislative intervention must be made in particular areas of law where the interests of the two wives may conflict. Such accommodations were developed in response to certain population groups who immigrated to Israel. For example, the Successions Law - 1965, specifically states (in section 146), that when the man who dies was married to two women, both of them share in the estate, where ordinarily the estate is given to the sole wife of the deceased. 7. Parents and Children 7.1 Child Custody The Capacity and Guardianship Law - 1962, which regulates the issue of child custody, is a territorial act. Thus, it applies to all individuals notwithstanding their religious affiliation. The act provides for equal responsibility of both parents toward their children, and directs them to act "in the best interest of the child." Recognition of both parents as equal, natural guardians of their children was also codified in the Women's Equal Rights Law-1951. Confirming the equality of both parents' guardianship over their children, the Capacity and Guardianship Law-1962 sets a "tender years presumption," which imposes a rule of maternal preference whenever children under six years old are involved. Loss of maternal preference can occur under very rare and extreme circumstances when the mother is considered unfit. In general, most courts tend to favor maternal custody, even when older children are involved. It is important to emphasize, however, that the rule of the "best interests of the child" is the governing norm in all cases, and the maternal preference is simply an implementation of this rule, since it is usually perceived to be in the best interests of the child - especially during infancy - to remain within the custody of the mother. 7.2. Paternity and Unwed Mothers Marital ties between the parents or their lack thereof do not affect the relationship between the parents and the children, as far as civil law is concerned. Due to the differences in the jurisdiction and scope of Moslem law in Israel, matters of paternity are under exclusive jurisdiction of sharia courts and are governed by Moslem law. A major change recently occurred in this area, when a Supreme Court precedent removed paternity suits and child support claims concerning children born out of marriage from the exclusive jurisdiction of the sharia courts to the jurisdiction of civil law. 7.3. Child Support Family Law Amendment (Maintenance) - 1959 refers to the individual's personal (religious) law as the law governing questions of child and spousal support. A 1981 amendment to the law provides that the child support obligation of both parents shall be determined relative to each parents' income. In order to deal with the problem of non-payment, the Alimony Law (Security Payment) - 1972, provides assurance of payment by the National Insurance Institute (NII) upon request by the custodian parent, once the indebted parent defaults on his or her payments. This revolutionary mechanism thus releases the creditor from tedious legal proceedings through the Executor's Office, and transfers them to the NII who will take the necessary legal actions against the recalcitrant spouse. The NII in the meantime pays the creditor the amount that was set in the regulations. This is an important expression of Israel's commitment to provide a security net to prevent dependents from falling below the poverty line. Through this mechanism, Israeli law manages to avert some of the unfortunate economic consequences of marital-breakdowns for women and children, which are often enhanced by paternal evasion of economic responsibilities. 8. Married Women's Legal Status with Respect to Property Acquisition and Division of Marital Property upon Marital Breakdown Following the Women's Equal Rights Law-1951, the Supreme-Court's case-law removed the issue of property distribution from the rule of religious law, and ruled that this subject is to be governed by civil-secular law alone. The governing principle regarding distribution of marital property under Israeli law is the principle of community property. This principle has developed in the Supreme Court's rulings since the early 1960's, and was incorporated into a specific law in the Spouses (Property Relations) Law - 1973. The law applies to all couples who were married after 1973, and designates their community property unless the couple contracted otherwise. The judicial "community property rule" applies to all couples who were married before that, and to non-marital cohabitants as well, and works as a presumption that the partners have an equal share in the property, provided there was a "joint effort" by both partners in the accumulation of the family assets. In principle, the rule of community property, whether embedded in the case law or in the 1973 act, dictates equal sharing not only of property assets and rights, but also of debts and obligations, when these have accrued in relation to the communal property and are not personal in nature. So far the trend in the case law has been to make it rather difficult for creditors to prove the communal nature of the debts. . 9. Law of Inheritance The Successions Law - 1965 treats men and women with complete equality. Husbands and wives are equally entitled to each other's estates, and sons and daughters are equally entitled to the same share in their parents' estate, and so on. There is, however, one exception in favor of women, and that is the widow's right to alimony payments from her deceased husband's estate and the right to remain in the home in which they lived together, while no such rights exist in relation to male widowers. 10. Names law The law relating to the selection of family names has undergone a major change in the past year. Until then, section 6 of the Names Law - 1956 stated that as a rule, a married woman takes her husband's family name upon marriage, although she may keep her own name or add it to her husband's name. Practically, however, women who wanted to retain their own names discovered that their names were automatically changed upon registration of their marriages, without asking for their preferences. In February 1996 the law was amended, and section 6 now refers to both men and women, stating that upon marriage, a person may retain his or her former name, choose the spouse's family name, add the spouse's family name to the person's former name, select a new family name identical to a new one chosen by his or her spouse, or add it to the former name. In any case, the person shall notify the marriage registrar of his or her choice, making it clear that marriage does not automatically lead to a change of names. In addition to this reform, a provision that mandated that any change in the family name of married couples must be made by the husband and wife together was removed. As to family names of children, section 3 states that a child acquires his or her parents' family name. If parents have different family names, then, as a rule, the child acquires the father's family name, unless both parents agree that the child would acquire both names. This provision was not changed in the 1996 reform. 11. Single Mothers The Israeli legal system recognizes the growing phenomenon of single-parent families headed by women and accords them a variety of social benefits and aid. The Single Parent Family Law-1992 guarantees these social benefits to single mothers. For example, in recent decision of the Haifa district court, the court voided a decision taken by kibbutz members not to include a single-mother with her minor child among the eligible member-families for a new family housing unit, notwithstanding her seniority, since she and her child were not considered a "family." In rejecting the kibbutz's internal decision, the district court asserted that the single-parent family is equal to that of the two-parent, normative family. Moreover, in February 1997 a decision of the Supreme Court voided regulations that compelled unmarried women to undergo psychological and social worker evaluations before they could receive fertility treatments, such as artificial insemination and ovum donation. The regulations are to expire in 6 months, and the Ministry of Health pledged that within a month an internal directive that guarantees equal access to reproductive health services, regardless of marital status, will be issued. 12. New Reproductive Technologies and Surrogacy There are more fertility clinics per capita in Israel than in any other country in the world. Moreover, all Israeli residents are entitled to up to seven rounds of in-vitro fertilization treatment, up to the birth of two children, as part of their basic basket of health services. Israel has become the first state to positively sanction and regulate surrogacy, as evidenced in the March 1996 legislation: Surrogate Motherhood Agreements (Approval of Agreement and Status of Newborn) Law - 1996. This law was the result of a long process that included both the recommendations of a public-professional committee (the Aloni Committee, appointed by the Ministers of Justice and of Health in 1991), and several appeals to the High Court of Justice. The law sanctions full surrogacy (where the carrying mother is not genetically related to the resulting child), under very specific conditions. The whole procedure is legal only if done through the prior approval of the surrogacy agreement by a statutory committee composed of seven members of relevant professions (physicians, social-workers, psychologists, attorneys, with mandatory representation of three members of each gender) and a religious official of the contracting couple's religion. The conditions for approval of surrogacy contracts are: 1) That all parties be adult residents of Israel; 2) That the carrying mother be unmarried (with possible exception under extenuating circumstances); 3) That there is no family-relation between the surrogate and the designated parents; 4) That the surrogate's religion is the same as the designated mother's religion, and; 5) That the sperm used is the designated father's sperm. The petition for approval must be accompanied by a psychological evaluation of the parties and a medical evaluation as to the inability of the designated mother to become pregnant or carry a pregnancy. The Committee may approve monthly payments to the carrying mother to cover actual costs in addition to compensation for suffering, loss of time, income or earning capacity, or any other reasonable compensation. Any payment the carrying mother receives beyond the amount approved by the Committee is illegal, and subjects all the parties of the agreement, including the carrying mother, to criminal sanctions. If there is a brokerage involved, the Committee needs to see the brokerage agreement as well, but there is no provision for its approval or any restrictions on the brokerage fees. The third chapter of the law deals with the status of children born as the result of such agreements. In principle, the law designates the contracting couple as the child's legal parents. In order to formalize this principle, within a week of the child's birth the designated parents must apply for a "parenthood order," which the court shall grant, unless convinced it is contrary to the best interests of the child. Prior to the issuance of a parenthood order, the carrying mother may ask to withdraw from the agreement, and the court may grant her petition if convinced that a change in the circumstances justifies her retraction, and the child's best interests will not be jeopardized. In such a case, the court will issue an order which decrees that the carrying mother is the child's legal mother, and may order restitution of expenses. No retraction is possible after the issuance of a parenthood order. The law contains further provisions dealing with other possible complications. As of January 1997, the Committee has examined 10 applications and has approved 3 agreements. According to the Committee's administrative assistant, there are presently 50 couples seeking surrogacy agreements. Some couples apply through brokerage agencies, but most apply to the Committee independently. 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