The citizenship status of its Arab citizens is the key to Israel's ability to function as anethnic democracy, that is, a political system combining democratic institutions with the dominance of one ethnic group. The confluence of republicanism and ethnonationalism with liberalism, as principles of legitimation, has resulted in two types of citizenship: republican for Jews and liberal for Arabs. Thus, Arab citizens enjoy civil and political rights but are barred from attending to the common good.The Arab citizenship status, while much more restricted than the Jewish, has both induced and enabled Arabs to conduct their political struggles within the framework of the law, in sharp contrast to the noncitizen Arabs of the occupied territories. It may thus serve as a model for other dominant ethnic groups seeking to maintain both their dominance and a democratic system of government.

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BackgroundAlthough the impact of emergency procedures on the childbirth experience has been studied extensively, a possible association of childbirth experience with indications for emergency interventions has not been reported.ObjectivesTo compare the impacts on childbirth experience of ‘planned’ delivery (elective cesarean section and vaginal delivery) versus ‘unplanned’ delivery (vacuum extraction or emergency cesarean section); the intervention itself (vacuum extraction versus emergency cesarean section); and indications for intervention (arrest of labor versus risk to the mother or fetus).Study designA total of 469 women, up to 72 hours post-partum, in the maternity ward of one tertiary health care institute completed the Subjective Childbirth Experience Questionnaire (score: 0–4, a higher score indicated a more negative experience) and a Personal Information Questionnaire. Intra-partum information was retrieved from the medical records. One-way analysis of variance and two-way analysis of variance, followed by analysis of covariance, to test the unique contribution of variables, were used to examine differences between groups in outcome. Tukey's Post-Hoc analysis was used when appropriate.ResultsPlanned delivery, either vaginal or elective cesarean section, was associated with a more positive experience than unplanned delivery, either vacuum or emergency cesarean section (mean respective Subjective Childbirth Experience scores: 1.58 and 1.49 vs. 2.02 and 2.07, P <0.01). The difference in mean Subjective Childbirth Experience scores following elective cesarean section and vaginal delivery was not significant; nor was the difference following vacuum extraction and emergency cesarean section. Interventions due to immediate risk to mother or fetus resulted in a more positive birth experience than interventions due to arrest of labor (Subjective Childbirth Experience: 1.9 vs. 2.2, P <0.01).ConclusionsCompared to planned interventions, unplanned interventions were shown to be associated with a more negative maternal childbirth experience. However, the indication for unplanned intervention appears to have a greater effect than the nature of the intervention on the birth experience. Women who underwent emergency interventions due to delay of birth (arrest of labor) perceived their birth experience more negatively than those who underwent interventions due to risk for the mother or fetus, regardless of the nature of the intervention (vacuum or emergency cesarean section). The results indicate the importance of follow-up after unexpected emergency interventions, especially following arrest of labor, as negative birth experience may have repercussions in a woman's psychosocial life and well-being.