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Abortion in the
Middle East
The bare bones of every country’s abortion policies are available on the United Nations website:
http://www.un.org/esa/population/publications/2007_Abortion_Policies_Chart/2007_WallChart.xls
This table shows the situation in those countries which are the heart of the Middle East . Using the 2007 update of a chart originally published by the UN in 1999, there are two changes. Fetal impairment was included as grounds for abortion in Jordan, and removed in Iraq.
|
Grounds on which abortion is permitted:
|
Egypt, Iran, Syria, Yemen, Oman, Lebanon, UAE. |
Iraq |
Saudi Arabia |
Jordan |
Qatar |
Kuwait |
Israel |
Turkey |
|
To save the life of the woman |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
|
To preserve physical health |
x |
x |
√ |
√ |
√ |
√ |
√ |
√ |
|
To preserve mental health |
x |
x |
√ |
√ |
√ |
√ |
√ |
√ |
|
Rape or incest |
x |
x |
x |
x |
x |
x |
√ |
√ |
|
Fetal impairment |
x |
x |
x |
√ |
√ |
√ |
√ |
√ |
|
Economic or social reasons |
x |
x |
x |
x |
x |
x |
x |
√ |
|
Available on request |
x |
x |
x |
x |
x |
x |
x |
√ |
I am including three other Mediterranean countries because they are of special interest. NZ is included for comparison.
|
Grounds on which abortion is permitted:
|
Tunisia |
Cyprus |
Greece |
New Zealand |
|
To save the life of the woman |
√ |
√ |
√ |
√ |
|
To preserve physical health |
√ |
√ |
√ |
√ |
|
To preserve mental health |
√ |
√ |
√ |
√ |
|
Rape or incest |
√ |
√ |
√ |
√ |
|
Fetal impairment |
√ |
√ |
√ |
√ |
|
Economic or social reasons |
√ |
x |
√ |
x |
|
Available on request |
√ |
x |
√ |
x |
The reality is not always the same as these UN tables would suggest. Communities may adopt practises which are different from what the laws decree
For example the Israel report states that in 1977 the law provided for a low cost, and in some cases free, legal abortion for any woman who fills one of four criteria:
- She is under 18 or over 40. (cost to those in between $US 370)
- She is carrying a fetus with a serious mental or physical handicap
- She claims that the fetus results from forbidden relations such as rape or incest (free) or. In the case of a married woman, that the baby is not her husband’s (not free). Single women also come under this clause, and they too must pay.
- She shows that by continuing the pregnancy, her physical or mental health would be damaged (free).
In 1980, a fifth criterion that allowed abortions for women living in economic hardship was abolished due to pressure from religious political parties.
There is an elaborate network of abortion committees operating in private and public hospitals throughout the country. In 1999, 19,674 applications out of 20,581 were approved and 18,785 pregnancies were terminated. In addition 16,000 abortions were illegally performed in private doctors’ clinics at a cost of many thousands of shekels. There were just over 7 million people living in Israel and the total abortion rate was thought to be 40,000 in 2001(Jewish Virtual Library, 2001).
Thalassaemia
In the rest of the Middle East abortion policies are often closely related to the important hereditary disease thalassaemia, more particularly thalassaemia major. This is inherited as a recessive genetic trait and when two carriers marry, one in four of the resulting fetuses will be affected. A baby with thalassaemia major requires repeated blood transfusions for the resulting anaemia and this has to be continued until transfusions are no longer tolerated due to the accumulation of iron in the major organs.
West Bank and Gaza
A report, from the Makasssed Islamic Charitable Hospital, Mount of Olives, Jerusalem, describes a survey carried out in Gaza where 130 couples who were carriers of the trait were identified and 25 of them had affected fetuses. All the couples with affected foetuses opted for abortion (Ayesh et al., 2005).
Since the Israel attack on Gaza medical access to Gaza has been blocked.
Interestingly the report was printed in Saudi Arabia where abortion on the grounds of fetal abnormality is not permitted.
Saudi Arabia
In December 2006 a Royal Proclamation authorised pre-marital screening of engaged couples for the carrier trait of thalassaemia major. A survey of one district of the country disclosed a carrier rate of 3.4%
Abortion is authorised to save the life of the mother or to preserve her physical or mental health. Abortion is not permitted in cases of rape or incest nor is the presence of a fetus with a disability recognised as legal grounds. The abortion has to be authorised by three medical specialists appointed by the hospital director. Consent must be signed by the patient and her husband or guardian.
The UN population division issues updated study on abortion policies reports: “Induced abortion is generally illegal in Saudi Arabia under non-codified principles of Islamic law. A person who performs an illegal abortion is subject to the payment of blood money to the relatives of the aborted foetus. However, under article 24 of the Rules of Implementation for Regulations of the Practice of Medicine and Dentistry, Ministerial Resolution No. 218/17/L of 26 June 1989, an abortion may be performed to save the pregnant woman’s life, and if the pregnancy is less than four months old and it is proven beyond doubt that continued pregnancy gravely endangers the mother’s health. Written consent of the patient and her husband or guardian is required.
Article 24 is based on Resolution No. 140 by the Committee of Senior Ulema, which is reproduced in the above Rules and provides that a pregnancy cannot be aborted at any stage except when legally (according to Islamic Laws) justified and within very narrow limitations.
Resolution No. 140 refers to three stages of pregnancy. Within the first 40 days of pregnancy, an abortion may be allowed if it is deemed necessary to accomplish a legal benefit or to prevent an expected harm. It is not allowed, however, for fear of hardship in child upbringing or inability to secure the cost of living, education, or future, or if the parents decide that they have enough children. At the embryo stage, an abortion is not allowed unless an approved medical committee decides that continuation of the pregnancy endangers the woman’s safety and could possibly lead to her death, and if all means to eliminate the danger have been exhausted. After four months of pregnancy, abortion is not allowed unless a panel of approved specialists states that continuation of the pregnancy will cause the woman’s death and all means to eliminate the danger have been exhausted. Resolution No. 140 provides that under these conditions, abortion is allowed “to avoid the gravest of two dangers and to accomplish the better of two benefits”.” (United Nations, 2002)
Many Arab countries have high rates of cousin marriages, and this leads to many genetic defects as well as thalassaemia. I could find no references to any discussion about widening the grounds for abortion in Saudi Arabia
Iran
This country provides the most interesting example of what was, at least for a time, a hugely successful public health policy aimed at eradicating thalassemia major. The British Medical Journal described the policy as “a model for both developed and emerging nations”
In a paper in the BMJ the head of the Genetics Office of the Ministry of Health in Teheran, and the Emeritus Professor in Health Informatics and Multiprofessional Education at University College, London describe the success of the programme:
“In Iran, the development of primary health care over the past 20 years has greatly reduced infant mortality and crude birth rate. Accordingly in 1991 prevention of non-communicable disease was added to the primary health care programme, and a department for the control of non-communicative disease, including a genetics office, was established within the Ministry of Health and Medical Education. Thalassaemia, which is an important health problem in Iran, was chosen to test the feasibility of preventing non-communicative disease in primary care.” (Samavat and Modell, 2004).
Pre-marital testing and counselling of engaged couples was started in 1996. Over a period of five years testing has been done on 2.7 million couples followed by genetic counselling of more than 10,000 couples who were found to be positive. This resulted in a 70% reduction in the expected annual birth rate of affected couples. Without any interference about 1200 cases would be expected per year but in 1998 there were 480 cases and by 2002 this had dropped to 78 cases. The cost of testing is a handful of dollars per couple.
This situation appears to have changed:
According to Pew Forum, “In 2005, the Iranian parliament passed a measure allowing abortions within the first four months of pregnancy in cases of fetal impairment that would result in economic burden; the measure was ultimately blocked by the Iranian Guard Council.” The UN chart at the beginning of this article supports this statement (Pew Forum, 2008).
United Arab Emirates
Ali Shakar, a senior spokesman for the Ministry of Health was reported in the Gulf News (October 2007) as saying that the government is working to draft a law allowing therapeutic abortions as part of the country’s prevention programme for reducing genetic disorders such as thalassaemia and Down’s syndrome. Abortion is currently illegal in the UAE unless it is to save the life of the mother, but “some Islamic scholars argue that abortion of a diseased foetus is allowed so long as it is younger than 120 days.”
Although the following countries are not strictly speaking in the Middle East their various abortion policies are of interest
Tunisia
This is by far the most liberal of the Arab nations – the only one with women judges and the only one with abortion on request. These human rights have been established by President Ben Ali.
According to Pew Forum, “however in more traditional communities, doctors may be less willing to perform abortions in situations that are considered taboo, such as pregnancies resulting from extramarital affairs or premarital sex. As a result, women often resort to illegal abortions.” (Pew Forum, 2008).
Turkey
Turkey is not an Arab state, but it too has abortion on request and genetic testing for thalassaemia. There is a long tradition of secularism dating back to the time of Kemal Attaturk (1881-1938) first President of the Republic of Turkey.
Again, according to Pew Forum (Pew Forum, 2008) : “A 1983 law makes abortion legal in Turkey in all circumstances within 10 weeks of pregnancy. After 10 weeks, abortion is legal if the mother’s life is at risk, if her physical or mental health is in danger or if her pregnancy involves fetal abnormalities. Parental and spousal consent requirements are in effect, but they can be waived if the risk to the mother’s life constitutes an immediate danger.”
Cyprus
Cyprus is unique because the north is Turkish and the south is Greek.
Movement on thalassaemia started in 1976 after a seminar organised by the Turkish Haematology Association. The programme began with improved treatment facilities but screening of high risk patients began in 1979 and compulsory pre-marital testing began in 1979. The Greek Orthodox population in the south of the island have also adopted compulsory pre-marital testing and in the south as in the north abortion has become legal in pregnancies diagnosed with thalassaemia (Catlin, 2003).
No affected babies have been born in the last five years.
Greece
In common with most European countries with the exception of Ireland and Poland, Greece has a totally liberal attitude to abortion.
Egypt
“The Egyptian penal code of 1937 bans abortion in all circumstances, but criminal law allows flexibility on grounds of “necessity”. Physicians rely on that principal to justify performing an abortion when they believe the mother’s life or health is in danger or in cases of fetal abnormality. A committee of physicians must agree that the abortion is acceptable within the law.” (Pew Forum, 2008).
Cystic fibrosis
There is an interesting contrast between the pro-active policies of the Middle East in relation to thalassaemia major and our lackadaisical approach to the disease cystic fibrosis in New Zealand. One in 25 of our population are carriers of this recessive gene and the chance of two carriers marrying is one in six hundred and twenty five (Cystic Fibrosis New Zealand, 2009).
This is close to the rate found for thalassaemia major in many Middle East populations. With modern treatments cystic fibrosis is not as devastating a disease as thalassaemia major, but it does lead to chronic ill health and a lower life expectancy and infertility.
One serious objection to all types of genetic testing in NZ is that insurance companies can require those taking out life insurance or mortgage insurance or loss of income insurance to disclose the results of any tests of this sort. Couples may be best advised to avoid genetic testing until the government introduces laws to protect our population from genetic probing by insurance companies.
Further reading:
A liberal-leaning organisation Gynuity Health Projects summarises the situation in an article by Rasha Dabash and Farzaneh Roudi-Fahini “Abortion in the Middle East and North Africa”(Dabash and Roudi-Fahimi, 2008) . http://gynuity.org/downloads/MENAabortion_brief_sep08.pdf
The article is strongly recommended for those wishing to go further into these issues as it includes material on the use of contraceptive methods, maternal mortality, and much data on the dangers of unsafe and illegal abortion methods.
Pew Forum: Abortion Laws Around the World provides a deliberately objective look at the issues.
References:
Ayesh, S. K., Al-Sharef, W. A., Nassar, S. M., Thawabteh, N. A., & Abu-Libdeh, B. Y. (2005). Prenatal diagnosis of beta-thalassemia in the West Bank and Gaza. Saudi Medical Journal, 26(11), 1771-1776.
Catlin, A. J. (2003). Thalassemia: The Facts and the Controversies. Pediatric Nursing, 29(6), 447-449.
- Retrieved 14/06/09, 2009, from http://www.cfnz.org.nz/about-cystic-fibrosis
Dabash, R., & Roudi-Fahimi, F. (2008). Abortion in the Middle East and North Africa. Retrieved. from http://gynuity.org/downloads/MENAabortion_brief_sep08.pdf.
- Retrieved 14/06/09, 2009, from http://www.jewishvirtuallibrary.org/jsource/Health/abort1.html
- Retrieved 14/06/09, 2009, from http://pewforum.org/docs/?DocID=167#middleeast
Samavat, A., & Modell, B. (2004). Iranian national thalassaemia screening programme. BMJ (Clinical research ed.), 329, 1134-1137.
- Retrieved 14/06/09, 2009, from http://www.un.org/esa/population/publications/abortion/doc/saudiarabia.doc
Written by Dr Jim Hefford who in 1989 spent 12 months as a medical practitioner in Saudi Arabia.