Abortion in the Arab world

Rasha Gaddah, Saturday 3 Aug 2019

Abortion is highly restricted in the Arab world, with a woman’s right to choose being something that is still largely decided by men


In the Arab world, there are few if any safe ways to have an abortion if a woman wants to terminate a pregnancy, even if this is the result of rape. In many cases, all she can do is resort to unqualified practitioners, unsafe clinics, or traditional remedies, all of which may put her at risk of death or prosecution.

Medically, abortion is not viewed as a risky procedure, but the law in the Arab world makes it so. According to the World Health Organisation (WHO), only one in four abortion procedures are safe in countries where it is outlawed, while in normal circumstances the figure is nine in 10.

Some 56 million women have abortions around the world every year, 45 per cent of which are unsafe and mainly in developing countries in Africa, Asia and Latin America. Stiffer laws in these countries may be accompanied by government negligence in providing effective family-planning services. Some 214 million women in developing countries lack access to birth control, which results in 89 million unplanned pregnancies and 48 million abortions every year.

Not every country elsewhere in the world allows abortion. In Europe, abortion is possible notably in cases where there are questions about the health of the foetus, while other countries allow abortion in cases of pregnancies resulting from rape or incest or for mental or physical health reasons.

In the UK, abortion is allowed until the 24th week of pregnancy if there are risks to the mental or physical health of the mother or baby. The Republic of Ireland, Malta and Poland have the strictest abortion laws in the EU, and in Poland and the Republic of Ireland, abortion is only allowed if the mother’s life is at risk.

In Egypt, more attention began to be drawn to abortion in September 2017 on Global Safe Abortion Day when the Egyptian Initiative for Personal Rights and the Global Alliance for Realising Sexual and Reproductive Justice (RESURJ), both NGOs, issued a joint statement noting that Egypt’s abortion law “is among the most restrictive worldwide”. The law does not allow abortion even if a pregnancy is the result of rape or incest, and it punishes women who seek abortions with imprisonment.

In the working-class district of Matariya in eastern Cairo, Al-Ahram Weekly met Hassan (not his real name) who is in his 30s and works as a doorman in the area. Local charity workers explained that his wife Abeer had died during an abortion procedure in a private medical clinic since the government hospital had refused to operate on her since the pregnancy did not pose a risk to her life, as stipulated by the law. Hassan described the reasons why he and his wife had sought an abortion.

“I have two daughters and a son between the ages of five and one. We lived in one room under the stairs in the building where I worked at the time. My wife was weak and found herself two months pregnant while still nursing our youngest child. Life is hard, and we didn’t feel we had the money to have another child. So, we decided to seek an abortion for the baby’s sake and ours.”

Hassan did not know that the law criminalises doctors who perform abortions and pharmacists who sell medications that induce miscarriage. According to lawyer Ashraf Abdou, the law in Egypt lists abortion as a violation of the right to life that could carry with it a sentence of three years in prison, though judges have some discretion when sentencing. The government hospital where Hassan took his wife refused to perform an abortion because the foetus did not present a risk to the mother, forcing the couple to seek other options.

“People told us about a private clinic. But after the doctor there performed the abortion, Abeer’s temperature spiked. The doctor said this was normal, but she worsened and later died,” Hassan said. She was only 21 years old at the time, and Hassan feels that she died because the law denied her the right to safe medical services, even though it did not prevent her from getting married at the age of 16.

UNSAFE PRACTICES: Such strict anti-abortion laws can cause women to seek unsafe abortions in private and unlicensed clinics, sometimes called “stairwell clinics”, or to risk their lives by seeking to bring about a miscarriage through physical means or by drinking traditional concoctions to terminate unwanted pregnancies.

It is still the case today that women around the world die as a result of unsafe abortions. In Egypt, the law is based on Islamic Sharia Law and only allows the procedure if the mother’s life is at risk. “This is why doctors must focus on promoting birth control, sex education, and early pregnancy testing if the menstrual cycle is even one day late. At this point, it may still be possible to prescribe medical means to prevent conception, whether for women who do not wish to become pregnant or for those who are sexually active out of wedlock,” said Amr Hassan, a professor of obstetrics and gynaecology at the Qasr Al-Aini Hospital in Cairo.

Terminating a pregnancy in its earliest stages can be done by using two types of medications, mifepristone and misoprostol, with a 97 per cent success rate, according to the website Women on the Web. Hassan said that these medications cause contractions and the uterus lining to detach before the foetus has developed. “The medicines are issued by prescription only, though sometimes they are found through other means,” he added. However, many women around the world may be unable to access them, causing them to resort to unsafe practices carrying serious risks instead.

 “There may be monetary blackmail by the physician who performs the procedure, for example, and the latter may be carried out in a stairwell clinic using instruments that may not be properly sterilised. The doctor may be inexperienced and may even puncture the uterus during the procedure, resulting in haemorrhaging. The abortion may be incomplete, causing sepsis. Excessive curettage may result in the adhesion of the front wall of the uterus to the back, preventing future pregnancies. All of these things carry very serious risks,” Hassan said.

Backstreet abortions carried out in the shadows always leads to such risks, he said. “In cases where scans have revealed disfiguring of the foetus, with the mother asking for an abortion, we ask her to seek permission from Al-Azhar in order to operate. However, whether or not this is available depends on the individual sheikh’s beliefs,” Hassan added, referring to the Sunni Muslim institution in Cairo which can make decisions in such cases.

ARAB COUNTRIES: Other Arab countries have laws on abortion similar to those in force in Egypt.

The law in Iraq, for example, is similar to in Egypt, and it only allows abortions if a pregnancy poses a risk to the mother’s life. According to Iraqi Law 111/1969, a woman who undergoes an elective abortion in other circumstances can be punished with imprisonment or a fine. Rasha Khaled, an Iraqi lawyer, commented that the “religious authorities [in Iraq] banned abortions of pregnancies resulting from rape by terrorists and members of Islamic State group gangs, though they also banned any harm being done to women who had become pregnant as a result.”

In Iraq, some women resort to unsafe abortions using smuggled medicines or unlicensed midwives, she said. Religion is a key factor, since Sharia Law bans abortion once the foetus has a soul and heartbeat, and it gives very restricted licence to abortions being carried out before that takes place. The only exception is if there is a risk to the mother’s life, and this will make it too difficult for her to carry the pregnancy to term.

“Even in such cases, the approval of a government medical committee is necessary before an abortion is carried out,” Khaled said.

In Syria, abortion is illegal unless there is a risk to the mother’s life in continuing with the pregnancy. Under other circumstances, there is a penalty of between one and three years in prison under Article 528 of the Syrian Penal Code. Even a woman who agrees to an abortion can be imprisoned for six months to three years, according to Article 227.

Nadia (not her real name) is a 19-year-old Syrian girl who is the mother of a seven-year-old daughter. “They married me off when I was 11, and I was married for two years. During that time my husband often beat me,” she said in comments to the Weekly. “When I became pregnant, my husband beat me even more and threw me out of the house, so I went back to my parents. I didn’t have an official marriage certificate because I was underage, and my husband told me that the baby was not his. I tried to have an abortion as a result, and one of my relatives gave me a special tea to drink. However, the pregnancy was not terminated,” she said.

Syrian law is patriarchal and limits a woman’s right to take decisions about her body. Fathers can pass on citizenship to their children, but mothers cannot, for example, the only exception being if a child is born to a Syrian mother by an unknown father.

Under Syrian law, a wife who commits adultery is punished more severely than a husband. Whereas a wife can be sentenced to three months to two years in prison, a husband’s sentence is between one month and one year. A husband can also only be convicted if he commits adultery in the marital home, though this does not apply to the wife, said Mona Salloum, a member of the Syrian Women’s Initiative for Peace and Democracy, an NGO.

Laws denying women their rights in Syria include a ban on abortion, whether the pregnancy has lasted one day or four months. “The penalty for a physician or a pharmacist helping to carry out an abortion can reach life in prison, and something similar applies to anyone selling medicine that induces a miscarriage,” Salloum said.

In a 2006 study by the Syrian Ministry of Health in collaboration with a team from Damascus University on unwanted pregnancies, a sample of Syrian women were asked if they had ever had an abortion. Four per cent of married women between the ages of 15 and 49 said they had had at least one deliberate miscarriage.

In 2012, the university’s Journal of Health Sciences published a study drawing on data from its Hospital for Obstetrics and Gynaecology on the misoprostol medicine Cytotec. Out of 126 abortions between July 2009 and March 2010, 5.6 per cent had used misoprostol to deliberately terminate a pregnancy, signaling a rise in abortion rates.

The study said that natural birth-control methods were the most commonly used in Syria, though these could be ineffective and result in unwanted pregnancies and women seeking abortions. It said that campaigns on reproductive health and modern contraception methods would help to replace such older methods and reduce the number of unwanted pregnancies.

SUDAN, JORDAN AND TUNISIA: In Sudan, Penal Code articles 135, 136 and 138 allow abortion when necessary to save the mother’s life or where pregnancies are the result of rape and less than 90 days.

The penalty for an abortion that does not meet these criteria is imprisonment for up to three years and/or a fine, though this does not abrogate the sometimes still-demanded right to blood money.

Sudanese lawyer Ahlam Ahmed told the Weekly that “four years ago, a girl from a remote part of Om Durman came to Khartoum to study. She met a young man who deceived her and began a sexual relationship with her. She became pregnant, but he refused to marry her and took her to a midwife’s house where she had an abortion. The girl suffered complications and began to haemorrhage, and her family found out. They were going to kill her to save their honour, but she recovered, and they then married her off to a 70-year-old man.”

The difference between Sudanese law and those of the other countries mentioned is thus largely superficial. The facts on the ground are the same regarding the laws and a woman’s right to safe abortions, namely that access to abortion is still widely seen as opening the door to extramarital sexual relations and “destroying the values of Arab societies.”

 “A woman who becomes pregnant out of wedlock in Sudan cannot argue for an abortion, because this requires many conditions. Since the mother is seen as having deliberately created the problem, and since she is seen as having committed an act that is scandalous, she becomes legally at risk herself,” Ahmed said.

Sometimes the law in Sudan does not allow abortion even if the pregnancy is the result of rape. The law requires a proportionality between the act and the risk involved. “There is no proportionality between a woman’s right to honour which she wants to protect by having an abortion and the right of the baby to life. Not every danger that puts the mother at risk is seen as a justification for abortion,” she added.

In Jordan, according to figures from the Jordanian Ministry of Justice 48 women were found guilty of having sought abortions between 2009 and 2016. Jordan’s Law 16/1960 and amendments to it deal with abortion in articles 321-325, describing an abortion as a crime whether committed by the mother herself or another person. The law does not allow for any exceptions, unless the mother’s life or health are at risk, Moral or criminal reasons such as rape do not justify abortion, and neither does foetal deformation.

Yet, the constitutions of most Arab countries claim that all citizens are equal in front of the law regarding rights and duties regardless of their ethnicity, religion or gender. Clearly, this is not yet the case, since women are still discriminated against economically, socially and politically, and, as here, in accessing healthcare that prioritises their needs.

Jordan is more forthright than many other countries in the Arab world in declaring such equality, since Article 6 of its constitution states that “Jordanians are equal in front of the law. There is no discrimination between them in rights and duties irrespective of their ethnicity, language or religion.” However, this statement omits gender, which means that equality between men and women is far from being guaranteed.

Some Jordanian women may bear children against their will due to ineffective family planning and laws that do not allow any exceptions for abortions. The law punishes women who undergo abortions even if the pregnancy is the result of rape, and this causes women to seek unsafe abortions that expose them to psychological and health risks and even death.

However, against this background Tunisia is the great exception. Tunisian law allows any legally adult woman, married or not, to terminate an unwanted pregnancy without restriction as long as the gestation period is no more than three months, according to a law passed in 1973. Since the mid-1950s, Tunisian women have won one right after another, including banning polygamy, raising the marriage age to 17, having the right to initiate divorce, equality in the workplace and the political sphere, the right to safe abortion, and, most recently, equality in inheritance.

In 1965, Tunisia adopted safe abortion laws to ensure the well-being of mothers who already had children and did not want any more, as long as the gestation was no more than three months. “In 1973, abortion was allowed without a given reason in the first three months at a public or licensed private hospital to protect the lives of mothers,” explained Haitham Mahfouz, a member of Tunisia’s Mother and Child Association, an NGO.

LAW AND SHARIA: Anti-abortion laws still discriminate against women in most Arab countries and go hand-in-hand with political and social circumstances that include corruption, injustice, and human-rights violations.

Since women are often viewed as the weaker sex in the Arab countries, they are often discriminated against in ways that cite religious teachings. Such laws have always ideologically used the bodies of women to serve special interests. Sometimes, they insist on covering the female body to pander to the Islamist current, and at other times they insist on uncovering it to appease the liberal one. All too rarely do they give women the freedom to do what they please with their bodies.

Anti-abortion laws were often promoted in the 19th century to control the sexuality and lives of women, though in other societies, such as pre-modern China and ancient Egypt, abortion was not unusual. Modern laws thus do not do justice to women and violate their rights, and the existence of anti-abortion laws rarely result in a drop in abortion rates. Instead, they make the procedure riskier in countries that already suffer from poor healthcare and a lack of modern and effective contraceptives for women that are also appropriate and free.

Moreover, the anti-abortion laws remain strict even though religious opinion is divided. Scholars differ in their religious rulings on abortion if the foetus is less than 40 days old. The Malaki School of Islamic jurisprudence prohibits it, but Hanbali and some Hanafi scholars allow it even without the need for a reason. The Shafei School allows abortions. In many cases, clerics from the Hanafi and Shafei schools allow it before a baby is thought to breath, and it is also true for some Hanbali and Malaki clerics. Others say life is breathed into a baby 120 days after conception.

Perhaps the time has come to end the legal guardianship over women and let them make their own decisions depending on their own psychological and physical needs. The state should also be encouraged to play a fuller role in changing unsafe abortions to safe ones and provide healthcare and post-procedure care for elective abortions.

Yet, even before it does this, it should provide modern and effective birth control methods for free and launch further awareness campaigns about contraception. Laws against women in the social, economic and political domains should be changed such that childbearing does not impact a woman’s social, professional or financial status. Above all, women should be allowed to feel that they are also full citizens who are not harmed by giving birth.

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