Cultural pathways to health inequity: perceived life course impact of endometriosis among Jewish and Arab women in Israel

Endometriosis has been widely examined from a biomedical perspective, but its cultural and ethnic dimensions have received far less attention. The aim of this study is not to provide nationally representative prevalence estimates or prevalence figures, but rather to examine associations and differences in Perceived Life Course Impact (PLCI) and social support among women diagnosed with endometriosis across ethnic groups. A cross-sectional study was conducted among 747 Israeli women aged 18–50 years, including 535 Jewish (267 with endometriosis, 268 controls) and 212 Arab (58 with endometriosis, 154 controls) women. Participants completed validated questionnaires assessing PLCI (intimate relationships, education, employment), social support, social negativity, and perceived mental health. Analyses of covariance and hierarchical regression models were used to examine ethnic and diagnostic group differences, controlling for demographic and health-related covariates. Women with endometriosis (regardless of ethnicity) reported significantly higher PLCI in all life domains, poorer mental health, lower social support, and higher social negativity compared with controls ( p < .001). Arab women reported higher PLCI regarding education than Jewish women, and better social interaction patterns were reported by Jewish than Arab women., Jewish women with endometriosis reported worse mental health and higher pain levels than their Arab counterparts. Regression models showed that, for the whole sample, social negativity was the strongest social predictor of PLCI, with social support and menstrual pain joining it for the most part. Social negativity was the strongest predictor of PLCI, among women with endometriosis as well, with social support, menstrual pain, and driving time to the health care clinic, joining it for the most part. Endometriosis imposes a substantial life-course burden among women across cultural groups; the ways this burden is experienced and interpreted are shaped by ethnicity, culture, and social environment. Our findings highlight the need for culturally sensitive interventions that address both clinical symptoms and social and cultural determinants of health.