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Abortion and Islam: Policies and Practicein the Middle East and North Africa
Leila Hessini
Senior Policy Advisor, Ipas, Morocco. E-mail:hessinil@ipas.org
Abstract
:
This paper provides an overview of legal, religious, medical and social factors that serve to support or hinder women’s access to safe abortion services in the 21 predominantly Muslimcountries of the Middle East and North Africa (MENA) region, where one in ten pregnancies ends inabortion. Reform efforts, including progressive interpretations of Islam, have resulted in laws allowing for early abortion on request in two countries; six others permit abortion on health grounds and three more also allow abortion in cases of rape or fetal impairment. However, medical and social factors limit access to safe abortion services in all but Turkey and Tunisia. To address this situation,efforts are increasing in a few countries to introduce post-abortion care, document the magnitude of unsafe abortion and understand women’s experience of unplanned pregnancy. Religious fatawa have been issued allowing abortions in certain circumstances. An understanding of variations inMuslim beliefs and practices, and the interplay between politics, religion, history and reproductive rights is key to understanding abortion in different Muslim societies. More needs to be done to build on efforts to increase women’s rights, engage community leaders, support progressive religious leaders and government officials and promote advocacy among health professionals.
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2007 Reproductive Health Matters. All rights reserved.
Keywords:
abortion law and policy, unsafe abortion, Islam, women’s rights, Middle East andNorth Africa region
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HE Middle East and North African (MENA)region,* stretching from Morocco to Iran,is highly diverse in levels of socio-economicdevelopment, political systems, health indicators,women’s status, official interpretations of Islamand individual religious expression. The regionhas some of the world’s lowest and highest popu-lationgrowthrates.Contraceptiveprevalenceratesrange from less than 10% in Mauritania and theSudan to 63% in Tunisia and 74% in Iran.
Totalfertility rates have dropped significantly in Tuni-sia and Morocco (to 2.1 and 2.4, respectively),whereas they are still relatively high in Saudi Arabia (5.2). While reproduction and motherhoodare a source of prestige and identity across MENA countries, only 33% of the poorest women inEgypt and Morocco and 7% in Yemen have accessto a skilled birth attendant.
The need for sexual and reproductive healthinformation and services has never been greater in the region. The biggest cohort of adolescentswill soon be entering reproductive age and mari-tal patterns changing. One-third of the popu-lation is aged 15–24 in many countries in theregion; the cohort aged 20–29 is expected togrowb y 60% in Iraq and 80% in Yemen by 2025.
While age at sexualinitiation is decreasing,average age at marriage has increased, leavinga larger gap for unwanted pregnancies to occur.The number of ever-married women ages 15–1975
*While the MENA region is religiously diverse, this paper limitsitsdiscussiontohowinterpretationsofIslamarebeingused to support or hinder women’s reproductive rights. Ihave therefore only included those countries in the regionthat are predominately Muslim, and excluded Cyprus andIsrael. Afghanistan, Djibouti and Somalia, which are some-times included in the MENA region, were also excluded.
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2007 Reproductive Health Matters. All rights reserved.Reproductive Health Matters 2007;15(29):75–840968-8080/06 $ – see front matter PII: S0968-8080(06)29279-6
www.rhm-elsevier.com www.rhmjournal.org.uk
has dropped from 22% to 10% in Egypt, 10% to1% in Tunisia and 57% to 8%inthe United ArabEmirates in the past 20 years.
While consideredtaboo, premarital sex and unwanted pregnanciesare increasingly common among adolescents and young people in keycountries across the region.
Yet only a few governments – Iran, Morocco andTunisia – support sexual and reproductive healthprogrammes for young people.
Efforts are di-rected towards increasing effective contraceptiveuse especially among unmarried individuals andintegrating sexual and reproductive education inprimary and secondary schools.
Officially,oneinten pregnanciesends inabor-tion
In a 1998hospital-based study in Egypt, one in every fiveobstetric admissions was for post-abortion treat-ment,
This paper provides an overview of the factorsthat serve to support or hinder women’s accessto safe abortion services in the MENA region,underscoring differences across and within coun-tries.ThedataonwhichitisbasedarefromPoplineandMedlinesearches covering the past 20 years;reviews of national newspapers, primarily Egyp-tian and Moroccan; and interviews with key health professionals and representatives of women’s organisations in Egypt, Morocco,Tunisia and Turkey between 2001 and 2006.
Islam, family planning and abortion:different interpretations
Islam is a diverse religion, and its interpretationdiffers across the Muslim world. Individual inter-pretation is a key Islamic principle; Muslims areencouraged to read and analyse traditional reli-gious sources to find solutions to contemporary problems. Four official schools of interpretationexist in Sunni Islam, while Shiites have their own methods of jurisprudence and thought. Theseschools have developed a significant body of
shari’a
(Islamic law), which differs from country to country. In cases where Islamic jurisprudence isunclear, religious leaders will issue
fatawa
Pronouncements on family planning and abor-tion have a long history in Muslim thought. Early Muslim theologians supported contraception aslong as both partners consented. Most scholarsagreed abortions were allowed if pregnanciesended before ensoulment of the fetus, describedas occurringbetween 40, 90or 120 days aftercon-ception, depending on the school of thought.
Usually, a justifiable reason is needed for termi-nating a pregnancy, e.g. to protect a breastfeedingchild,socio-economicconcernsorhealthreasons.
Four main positions on abortion prior toensoulment currently exist across these schoolsof thought: i) abortion is allowed, ii) abortion isallowed under certain circumstances, iii) abor-tion is disapproved of and iv) abortion isforbidden.
Support for abortion and the belief that life begins at ensoulment is based primarily on the following Qur’anic verse, which discussesthe different stages (semen, blood clot, bones andflesh) of fetal development:
‘‘Man We did create from a quintessence (of clay);thenWe placed himas(adrop of) sperm inaplace
76
*
Fatwa
is the singular and
fatawa
the plural.
L Hessini / Reproductive Health Matters 2007;15(29):75–84
of rest, firmly fixed; then We made the sperm intoa clot of congealed blood; then of that clot We made a (fetus) lump; then We made out of that lump bones and clothed the bones with flesh;then We developed out of it anothe r c reature. Soblessed be Allah the Best to create!’’
Research in Egypt and Turkey demonstrates thatabortions were socially acceptable andwidely available until the late 19th century.
The legaland medical status of abortion then began tochange. Midwives performed abortions until theprofessionalisation of medicine,when the practicewaslimitedtophysicians.
Somehistoriansarguethat women’s rights, including their reproductiverights,diminishedasEuropeanlawswer eincorpo-rated into Middle Eastern legal systems.
In the 1960s, several key meetings broughttogether
muftis
, health professionals and othersto discuss Muslim positions after many nationalgovernments decided to implement family plan-ning programmes. A pan-Islamic conference inCairo in 1965 and another in Kuala Lumpur in1969 approved the use of birth control for eco-nomic reasons, definedasthe inability to sup-portadditionaloffspring.
Thiswasanimportantadvance, as opponents of family planning (andabortion) had often pointed to Qur’anic passagesstating that Allah will provide for all humanbeings. A subsequent international conference onIslam and family planning in Rabat in 1971 con-cluded that Islam permits birth control to spacebirths, forbids sterilisation except in cases of per-sonal necessity and forbids abortion after thefourth month of pregnancy unless the woman’slife is in danger.
In 1992, in a meeting on unsafe abortion andsexual health in the Arab World, the participantsagreed that ‘‘unsafe abortion was a major publichealth problem in almost all countries, and thatgovernments and family planning associationshaveaspecialresponsibilitytofaceuptotheprob-lem, consider reviewing outdated laws where pos-sible, reduce the toll of unsafe abortion by better and more humane treatment and provide better contraceptiveservicestowomenatriskandwomenwho had undergone abortions’’.
Today, positions on abortion continue to vary,though family planning is encouraged in practi-cally all MENA countries. Abortion is generally forbidden after the fetus achieves ensoulmentexcept to save the woman’s life. Interpretationsthatallowforabortionarebasedonfetaldevelop-ment, gestational age and the circumstances of the pregnant woman; they rarely mention fetalrights or when life begins. It is accepted thatmaternal life takes precedence, at least until thefetus achieves the status of person.
The life of existing children is often considered more impor-tant than that of the fetus. If a woman becomespregnant during breastfeeding, it is generally accepted that another infant might put the existingchild at risk. All schools of thought forbid termi-nation of pregnancy that resultsfromillicit sexualactivity, such as an extra-marital relationship.Contemporary
fatawa
have been issued in cer-tain countries that add legal indications to other-wise restrictive laws. A
fatwa
in 1991 in Saudi Arabia allowed for abortion in the first 120 daysafter conception in the case of fetal impairment.
In Iran both the Grand Mufti Ayatollah Yusuf Saanei and the Ayatollah Ali Khameni issued two
fatawa
in 2005 allowing for abortion under cer-tain circumstances. The one provided for abortionin cases of genetic disorder in the first trimester;the other allowed abortion in the first trimester if a woman’s health and life were at risk.
Rape is increasingly recognised by Muslimreligious leaders as a legitimate reason for abor-tion. The Egyptian Grand Sheikh of al-Azhar,Muhammed Sayed Tantawi, issued a
fatwa
in1998, stating that unmarried women who hadbeen raped should have access to abortion.
In2004, he stated that abortion must be provided if the woman’s life was in danger and he approv eda draft bill that included rape as an indication.
In Algeria, the Islamic Supreme Council issueda
fatwa
in 1998, stating that abortions wereallowed in cases of rape, as rape was being usedby religious extremists as a weapon of war.
The Algerian government stated in the UnitedNations that abortion was allowed in cases of rape. However, neither of these
fatawa
wastranslated into law. In contrast, after discussionsabout the rapes of Kuwaiti women by Iraqi sol-diers during the first Gulf War, Kuwaiti
muftis
decided that rape did not justify the needfor legal abortion.
Yet their arguments – thatlife begins at conception and the innocent lifeof the fetus should be protected – had more incommon with fundamentalist Christian viewsthan Islamic jurisprudence.Religious leaders are increasingly playing arole in discussing abortion law reform and more77
L Hessini / Reproductive Health Matters 2007;15(29):75–84
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Abortion and Islam : Policies and Practice
This paper provides an overview of legal, religious, medical and social factors that serve
to support or hinder women’s access to safe abortion services in the 21 predominantly Muslim
countries of the Middle East and North Africa (MENA) region, where one in ten pregnancies ends in
abortion.
to support or hinder women’s access to safe abortion services in the 21 predominantly Muslim
countries of the Middle East and North Africa (MENA) region, where one in ten pregnancies ends in
abortion.
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