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This article talks about statistical information about women’s abortions in the MENA regions. Social factors like social class, gender, and status played a huge role in abortions. There was a protest called the Arab Springs, and that’s when people protested their rights to the government.

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Abortion and Islam: Policies and Practice in the Middle East and North Africa

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This journal article talks about abortions in the Middle East and the North African region. Many of these women are limited to safe abortions, which leads many of these women to have pregnancies that they are forced to have. The use of contraceptives ranges from 10% to 63%. This article also includes a table of abortions and maternal mortality due to unsafe abortions in the MENA region for the time periods of 1995-2000. This table is pretty interesting to look at and to compare the different regions.

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Abortion and Islam: Policies and Practice in the Middle East and North Africa

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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…

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Perception of the Saudi Population on Abortion Decisions in Congenital Fetal Anomalies

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This article talks about Muslim community perceptions on abortions. The abortion decisions from the Saudi community are also talked about in this article. There were a total of 574 people who participated in this study. A little under half were female. The average age of this study was 30.3 years old.

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Monitoring Editor: Alexander Muacevic and John R Adler

Abstract

Introduction

Termination of pregnancy for fetal anomalies is well reported in the literature and accepted by the western and other non-Muslim communities, but Muslim communities' perception is poorly reported and rarely mentioned. This study aims to evaluate the perception of the Saudi community on abortion decisions as a management option in congenital fetal anomalies.

Methods

This is an observational, descriptive cross-sectional study, where participants of Saudi nationality, living in Jeddah, and consenting to participate in the research filled up a self-administrated, structured, close-ended, validated questionnaire. The level of agreement was measured on a Likert scale.

Results

A total of 574 participants were included in the study; 43.3% were female. The mean age of the participants was 30.3 years (SD = 10.6). Undergraduate students were 58.9%, single participants were 56.3%, and participants without children were 61.3%.

The prevalence of abortion was 17.9%. The overall agreement on accepting abortion as an option was 61%. Gender (p<0.001), knowledge level (p=0.003), and religion (p=0.01) were the most important factors that influenced people's perception of abortion. Other factors like participants' age (p=0.09), level of education (p=0.48), marital status (p=0.16), having children (p=0.48), and gender of the fetus (p=0.2) were not significant factors in their decision to choose abortion.

Conclusion

Overall, Saudis were more inclined to accept abortion in case of a confirmed congenital anomaly, yet females were more accepting of the idea than males.

Keywords: abortion in ksa, women, religion, religion and culture, induced abortion, abortion, congenital anomalies

Introduction

Abortion is the act of terminating a pregnancy; it could be either induced or spontaneous. Spontaneous abortion is most referred to as miscarriage, and it occurs with no intention of terminating the pregnancy. On the other hand, the deliberate termination of pregnancy, known as induced abortion, is performed either by surgery or by the usage of certain medications [ 1].

People's perception regarding abortion differs greatly throughout the world. The basis of this variation in decision-making is due to socioeconomic, medical, and religious differences [ 2]. There are several reasons behind the decision to intentionally end a pregnancy, such as potential risk to a woman's life or physical and mental health, rape, and fetal impairment [ 2]. Abortion in Saudi Arabia is a very complex process to go through, especially if the abortion was due to fetal anomalies. Moreover, induced abortion needs to be approved by many authorities such as consultants in the ethical committee of the hospital. Furthermore, the criteria for approval can differ from one hospital to another. In addition, there are no specific clear roles or bylaws regarding abortion in Saudi Arabia. The general rule is "Abortion is prohibited except in critical conditions" and each hospital defines and decides its own criteria for "critical conditions."

Termination of pregnancy for fetal anomalies is well-reported in the literature and accepted by the westernized community, but Muslim communities' perception is poorly reported and rarely mentioned [ 3, 4]. This is mainly because the vast majority of Muslim governments rule by the laws of Shari'a that highly prohibit abortion, except in critical cases that threaten the mother's life. However, some Muslim countries like Turkey and Tunisia have legalized induced abortion [ 2].

The prevalence of fetal anomalies in Saudi Arabia is not very well researched; however, due to increased rates of consanguinity and maternal age, the percentage is expected to be high. In a local study, the prevalence of major congenital anomalies was 46.5 per 1000 live births [ 5].

The recent developments in methods used for the early detection of fetal anomalies, such as ultrasonography, have increased within the last decade [ 6]. Because of the capability of diagnosing congenital anomalies early, the number of abortions has risen compared to the past. About 2% of total abortions according to recent literature are related to congenital fetal anomalies [ 7].

The given cultural context in Saudi Arabia and the current regulations and procedures related to abortion challenge the study of the phenomenon. Our study provides a significant contribution to understanding key facts for abortion in congenital fetal anomalies in Saudi Arabia. It also investigates complementary aspects of the cultural determinants of the phenomenon offering knowledge to the international research community.

Our study investigates social aspects of the abortion phenomenon in Saudi Arabia, aiming to interpret significant cultural dimensions of the phenomenon as well as document the perceptions of individuals towards this sensitive case. The key research question for our research approach is "Do Saudis accept induced abortion as a management option in fetuses with congenital anomalies?" Our null hypothesis is that Saudis do not accept induced abortion as a management option in fetuses with congenital anomalies.

The study objectives are to evaluate the perception of the Saudi population regarding abortion decisions in cases of congenital anomalies and to determine the factors that have a significant impact on the mother's decision of rejecting induced abortion despite the presence of fetal anomalies that will result in a poor quality of life for her child.

Materials and methods

Research study design

This is an observational, descriptive, cross-sectional study design, where all participants who fulfilled the inclusion and exclusion criteria have been invited to fill up a self-administered, close-ended, structured, and internally reviewed questionnaire that was available in two languages, Arabic and English, to explore the perception of Saudi society on the usage of induced abortion for congenital fetal anomalies in Jeddah, from 2019 until 2021.

Identification of study participants

The target population was those who fulfilled the inclusion criteria, that is, adults >18 years old, of both genders, Saudi citizens, and those who lived in Jeddah city during the survey period and were willing to participate in filling up the questionnaire after approving the consent form. Through a non-probability, convenience sampling technique, the study population was selected from the assigned criteria of our target population with a preplanned calculated sample size of 389 participants to be included in the final analysis according to the calculation done by a biostatistician at our university based on the population of the city of Jeddah. Initially, Jeddah was divided into three major sections, Northern, Southern, and Eastern. One to two public places have been selected representing each section, with overall six public places included. We approached our target population who were visiting major shopping malls like Red Sea Mall, Alyasmeen Mall, Alsalam Mall, and other public places like the Jeddah waterfront in those pre-selected areas.

Data collection process

All subjects who agreed to participate in our study filled up a self-administered, close-ended, structured, and validated questionnaire. The questionnaire was created by the research team, who validated the construct, and face validity was conducted by experts from KAIMRC (King Abdullah International Medical Research Center) to ensure that it effectively captured the investigated topic and did not contain any errors. The questionnaire is composed of three sections. The first section is about the basic demographic features of our study population. The second section measured the participant's knowledge regarding induced abortion and its related topics. The third section targeted the perception of our participants in selecting abortion as a management approach. The questionnaire was piloted and showed high reliability with Cronbach's alpha calculated at over 0.8.

The participants answered questions on a Likert scale where they chose the degree to which they agreed to specific statements by choosing from the following answers (Strongly Agree-Agree-Neutral-Disagree-Strongly Disagree).

Data analysis

SPSS software (IBM Corp. Released 2020. IBM SPSS Statistics for Macintosh, Version 27.0. Armonk, NY: IBM Corp) was used for data entry, data management, and data analysis. A simple descriptive analysis was performed for qualitative data, frequency and percentage were reported, and for quantitative analysis, mean and standard deviation or median and interquartile range were reported for normally distributed data or skewed data, respectively.

For bivariate analysis, to compare the gender of the participant and the perception of abortion, a chi-square test was used, with the two-tailed and significant level set at 0.05. An independent sample student t-test was reported for other contributing factors on the level of knowledge, the strength of religious beliefs, and age. Logistic regression analysis was performed to evaluate the significance of multiple factors on the agreement of abortion decisions.

A scoring system was done to measure the knowledge of fetal anomalies and abortion and to correlate it with their opinions regarding different aspects of abortion. The scoring system was based on several close-ended questions that explored people's comprehension of the difference between induced and spontaneous abortion, the experience of abortion, people's awareness of current laws of abortion, the types of tests done to detect fetal anomalies in Saudi Arabia, and people's expectations of how common congenital anomalies are in Saudi Arabia.

This study was approved by the Institutional Review Board (IRB) of King Saud Bin Abdulaziz University for Health Sciences, with Approval Study Number SP19/122/J, dated April 24, 2019.

Results

Demographics

In our study, a total number of 574 respondents participated, meeting the inclusion criteria presented in the previous section. In total, 249 of them (43.3%) were females and 325 (56.6%) were males. The mean age of the participants was 30.3 years (SD = 10.6) with ages ranging between 18 and 80 years old. The mean age of male participants was 30.5 (SD = 12.15), and the mean age of females was 30.1 years (SD = 9.26); the difference was not statistically significant (p = 0.66).

Most participants were undergraduates (58.9%; n= 338) followed by secondary/high school graduates (30.1%; n= 173); postgraduate participants represented 7.7% (n=44), intermediate school graduates represented 2.4% (n= 14). and elementary school graduates represented 0.9% (n=5).

Our sample population consisted largely of single participants (n= 323) representing (56.3%) married participants (n=228) representing (39.7%), divorced individuals (n=19) representing (3.3%), and finally, widowed participants (n=4) representing only (0.7%) of the total sample size. Most of our study participants did not have children (n=352) representing (61.3%) while the others who had children represented (38.7%) with a total number of 222. The mean score for their religious beliefs was 7 out of 10 as a maximum score (SD = 2.1).

The prevalence of abortions in our study population was 17.9% (n=103), both spontaneous and induced.

According to the research results, 312 (54.4%) participants agreed on accepting abortion in case of fetal anomalies, 95 (16.6%) disagreed, and 167 (29.1%) were neutral. In the female population, 61.8% (n=201) agreed on abortion in case of confirmed congenital anomalies and 12.9% (n=42) disagreed. However, males' perception was significantly different as only 44% (n=111) of males agreed while males who disagreed represented 21% (n=53). This difference in opinion between genders was statistically significant (chi-square = 17.5, df=2, p<0.0001). Participants' age was not a significant determinant of their agreement on abortion; the mean age for agreement was 29.4 years, 31.3 years for neutral, and 31.4 years for disagreement (analysis of variance (ANOVA), F = 2.34, df=2, p = 0.09). Similarly, the agreement on abortion was not altered by the level of education of our participants (chi-square = 7.5, df=8, p = 0.49). Fifty percent of married participants agreed on abortion in comparison to 57% of single and 63% of divorced; this difference was not statistically significant (chi-square test = 9.3, df=6, p = 0.15). Additionally, participants with a high score on religious beliefs disagreed with abortion more than participants with a lower score (F=4.51, df=2, p = 0.01).

Most of the participants (90.1%; n=517) believed that the gender of the fetus does not play a role in the decision of abortion. A total number of 312 participants (54.4%) agreed that the mother should be allowed to undergo induced abortion while 95 participants (16.6%) did not support the mother's freedom to undergo an abortion. Nonetheless, 167 (29.1%) were indifferent.

In addition, study participants were asked to choose the most fundamental factors that have a significant impact on the mother's decision to undergo an abortion. The results varied, however, the most prominent factors were religious and psychological factors (Table ).

Participants who did not have children are leaning toward accepting the idea of induced abortion more than those with children. However, the possession of children does not impose a statistically significant effect on people's opinions regarding the termination of the pregnancy with a p-value of 0.47 (Table ).

A great proportion of both genders agreed that mothers who have undergone abortions need emotional support, with females representing 80.3% and males 72%. A minority of the population, only 3.4% of females and 5.6% of males, thought that there is no need for emotional support.

A scoring system was created to measure people's level of knowledge of fetal anomalies and abortion, and to correlate it with their opinions regarding different aspects of abortion. Based on the results, a better understanding of congenital anomalies and abortion, including screening tests, procedures, and laws greatly impacted peoples' acceptance of induced abortion of fetuses with congenital anomalies (F=5.9, df=2, p = 0.003).

To evaluate the significant interaction of multiple factors, (gender, level of knowledge, and strength of religious beliefs) on the agreement of abortion decision, a logistic regression procedure (LRP) was performed. Prior to interpreting the results of LRP, several assumptions were evaluated. Assumption testing conducted prior to the analysis did not indicate any violation. The omnibus model for the logistic regression analysis was statistically significant, chi-square (df=3, N=574) = 27.18, p<0.0001, Cox & Snell R2 = 0.046. The Hosmer and Lemeshow test results confirmed that the model was a reasonable fit for the data (chi-square (df=8, n=574) = 12.17, p = 0.144).

Gender (b=0.62, SE=0.17, p<0.0001) and level of knowledge (b=-0.013, SE=0.005, p = 0.007) were the most significant factors that improved the model's predictive capability. The level of religious beliefs did not appear to significantly influence the probability of participants' agreement on the decision of abortion.

Discussion

Abortion (termination of pregnancy for fetal anomalies) is well-reported in the literature and accepted by the westernized community. On the other side, abortion is a controversial and highly sensitive subject, especially in religious communities, such as Saudi society. An extremely scarce number of studies have tackled this topic. In the broad international literature on the phenomenon, various complementary aspects provide significant insights for the justification of the research problem of our study (Table ). The value-based approach to abortion in the literature also covers aspects related to Indicators for therapeutic abortion and understanding the implications of induced abortion. The investigation of attitudes related to abortion was discussed in a recent study in the US and South Africa [ 8, 9]. The main deployed method included the relation of abortion acceptability (in cases of poverty and fetal anomaly) with attitudes about social welfare programs and gender roles. The relevant research also assessed differences by race/ethnicity and education characteristics. In our study, this is a significant determinant of our study problem. We are interested in understanding the attitudes among the Saudi population toward abortion in congenital fetal anomalies. This aspect of the phenomenon is significant since there is a lack of similar studies in KSA.

Table 3

Additional insights related to factors enabling abortion accessibility [ 10] and sustainability challenge the research design of our study, bringing forward the need to investigate the requirements for a sustainable abortion in the congenital fetal anomalies management approach. This is a key step toward the support of mothers and enhancing the impact on society and sustainable development in KSA.

The relevant literature on abortion considers also psychometric studies for abortion issues and psychological assessment. These studies, together with complementary ones on the relationship of abortion to perceived stigma, constitute a sophisticated psychological background and context for the study of the phenomenon that we want to approach and exploit in our research design. Additional studies related to the study of risk factors associated with abortion and the perspectives of professionals provide indicative aspects for the social aspects and the implications of abortion.

Women's ability to make a decision on abortion is influenced by many factors, such as education level, emotions, and social and religious pressure (modern populations are more open to such a decision unlike traditional and conservative communities) [ 4]. The mere notion of abortion is controversial in Saudi society due to its sensitivity; therefore, most individuals tend to avoid this subject. To the best of our knowledge, there are no studies addressing the perception and acceptability of performing an abortion on fetuses with congenital anomalies in our community. Our study aimed to investigate the perception of the Saudi population regarding abortion in cases of congenital anomalies.

We were interested to evaluate the determinants that impacted mothers' decision to reject induced abortion despite the presence of fetal anomalies that will result in a poor quality of life for their child, and it was found that the greatest proportion of study participants believed religious and psychological factors to have the greatest impact, followed by social and family pressure, complicated official protocols, lack of specialized and authorized abortion centers, cultural causes, and worry about personal reputation. Meanwhile, a study done in 2018 in Mozambique revealed that the most important factors that influence abortion decision-making among young women mainly ranged between 1) lack of women's autonomy to make their own decisions regarding undergoing an induced abortion, 2) their general lack of knowledge, 3) the scarcity of local abortion services, and 4) the powerful influence of healthcare providers on decision- making [ 23].

Interestingly, the results of our study/our study revealed that females are more inclined to accept the idea of terminating a pregnancy in case of confirmed fetal anomalies. Similarly, a study done in Pakistan also found that women had a more favorable attitude toward induced abortion [ 24]. The impact that the level of education has on people's opinions about the most prominent factors that could potentially affect the mother's decision of undergoing abortion varied significantly. Participants with higher educational levels (high school graduates and beyond) tended to choose religious and psychological aspects as the main contributing factors to this decision. Meanwhile, most participants from all educational levels thought that the rest of the factors, including social, cultural, and family pressure, personal reputation, lack of specialized abortion centers, and complicated apportion protocol, played no fundamental role in a mother's abortion decision [ 25].

Policy-making recommendations

It is important to promote some policy-making recommendations and guidelines as a reflective mechanism for the integration of research-based evidence to practice.

In Table , we summarize the key findings of our study, and we also provide initial policy recommendations and aspects of an action plan in KSA.

Prevalence of abortion

Our study, with its given limitations, provides useful data and input for understanding the prevalence of abortion. Without focusing on the absolute number of abortion rates as measured in our study, we need to communicate that abortion is an existing phenomenon with various sociocultural, psychological, and other determinants. As such, it requires a systematic review of policies and procedures related to abortion due to congenital fetal anomalies. This will effectively support the design of new procedures that will allow a value-based approach to abortion due to congenital fetal anomalies. In the same context, fundamental factors with an impact on the mother's decision to take a decision need to be analyzed further and to be the basis for support activities.

Fundamental factors with an impact on a mother's decision to undergo abortion

Our study revealed significant hermeneutic factors for abortion while several of them have also been found in the relevant literature. An initial study of these factors leads to significant propositions for supporting mothers. The first is related to the need for a new educational and awareness campaign for abortion in congenital fetal anomalies. It is necessary to utilize international scientific knowledge with respect to the cultural context in KSA to offer trusted, accurate, and reliable training interventions, including micro-courses, micro-content campaigns in social media, and awareness events in KSA.

Another significant finding is related to the official procedures related to abortion. According to the participants in our survey, these procedures were highlighted as a key determinant of the phenomenon with emphasis on the need for simplification and digital transformation. Our recommendation is a significant refinement and revision of procedures related to abortion in congenital fetal anomalies as a critical step for the support of mothers. We also recommend the utilization of Vision 2030 and its mandate related to Health and Digital Transformation in KSA in the direction of establishing e-channels and electronic workflows for the utilization of the process.

Our survey also revealed the significance of the psychological factors and their impact on the mother's mental health condition. We recommend the establishment of e-psychological support and e-counseling services for mothers with reference to the international standards for relevant services.

Finally, the development of specialized centers with expertise on abortion in congenital fetal anomalies will also provide significant value to a new value-based approach to abortion in KSA.

Public health implication

Our study also contributes to the monitoring of public health policies and procedures. It is an initial input for understanding the impact of abortion on congenital fetal anomalies in KSA. We recommend the establishment of a transparent trusted observatory for abortion figures and facts in KSA as an official monitoring and reporting mechanism aiming to provide value-based insights into the prevalence of the phenomenon in KSA toward enhanced decision-making capability. Furthermore, the redesign of transparent procedures and an integrated strategy for a robust knowledge and awareness campaign are additional initial recommendations from the evidence of our study.

Vision 2030 and digital transformation in health

In another direction, our study is also connected and provides interesting insights into a greater context, such as Vision 2030, and the relevant strategic plan for digital transformation in health. We recommend the digital transformation in abortion procedures as a bold response to the existing prevalence of the phenomenon in KSA. This will secure significant resources and will build trust, transparency, reliability, and responsibility for the various stakeholders. We also recommend the design and implementation of a digital hub for information resources and counseling digital services as a key requirement for a vibrant society and prosperous nation.

Toward this direction, we recommend the development of a senior scientific task force, consisting of physicians, policymakers, and government officers that:

1. Standardize Saudi maternal-fetal specialist guidelines on identifying congenital fetal anomalies and the type of fetal anomalies amenable for abortion currently widely accepted at the ethics committees of hospitals.

2. Standardize the policies and protocols for the promotion of the health of mothers undergoing the phenomenon.

3. Recommend infrastructure developments adopting the latest technological evolution.

4. Propose new systems for psychological support and awareness related to the phenomenon.

5. Set up guidelines for digital hubs and platform-enabled environments that will facilitate the procedure.

Our research is the first attempt and one of the first studies in KSA for the study of abortion in congenital fetal anomalies.

Limitations

This study was limited by the small sample size of participants who agreed to fill up the questionnaire, which increases the chance of selection bias. Participants were reluctant to fill up the questionnaire due to the sensitivity of the topic. Moreover, the study was conducted in one city, and it was not a nationwide survey. During the data collection period, the COVID-19 pandemic restricted the research team to conduct the community survey properly. On the other side, the limitations of the study provide fertile ground for further research as indicated in the previous section. We consider this study as a pilot study with significant findings and value that will be expanded and utilized on a nationwide survey that we will deliver in Fall 2022 aiming to publish the results in 2023.

Conclusions

Our study approached a significant phenomenon related to public health, with sensitive determinants given the sociocultural context in KSA. The study of abortion in congenital fetal anomalies provided significant insights related to the objectives of this study. Saudis were more inclined to accept abortion in case of a confirmed congenital anomaly, but females were more accepting of the idea. However, couples who had children were leaning more toward rejecting the option. The most significant factors that played a role in the decision-making on abortion include gender, religious aspects, educational level, and being a parent of children.

Acknowledgments

The authors would like to express their gratitude to everyone who participated in this research and aided in completing it. We are also immensely grateful for all of the valuable advice, instructions, and constructive criticism that helped us greatly throughout the course of conducting this research. Author contributions: All authors contributed equally.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study. Institutional Review Board of King Saud bin Abdulaziz University for Health Science issued approval Protocol Code: SP19/122/J, date: April 24, 2019. The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of King Saud bin Abdulaziz University for Health Science (protocol code SP19/122/J)

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

References

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Perception of the Saudi Population on Abortion Decisions in Congenital Fetal Anomalies

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Monitoring Editor: Alexander Muacevic and John R Adler Introduction Termination of pregnancy for fetal anomalies is well reported in the literature and accepted by the western and other non-Muslim communities, but Muslim communities' perception is poorly reported and rarely mentioned.

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Where does the Middle East stand on the right to abortion? | WATCH: Where does the Middle East stand on the right to abortion? | By Middle East Monitor | Facebook

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This video talks about peoples thoughts and opinions on abortion and where the Middle East stands on this topic

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Where does the Middle East stand on the right to abortion? | WATCH: Where does the Middle East stand on the right to abortion? | By Middle East Monitor | Facebook

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693 views, 13 likes, 0 loves, 1 comments, 2 shares, Facebook Watch Videos from Middle East Monitor: WATCH: Where does the Middle East stand on the right to abortion?

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Iran death penalty threat for abortion unlawful: UN rights experts

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No one should ever get the death penalty from choices they choose about their own bodies. Iran has a death penalty if they have an abortion

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In a statement released on Tuesday, the experts called on the Iranian authorities to repeal the 'Youthful Population and Protection of the Family' law, which was ratified by Iran's Guardian Council on the first of November.

The law, said the experts, severely restricts access to abortion, contraception, voluntary sterilization services and related information, in direct violation of women's human rights under international law, and contains a provision stating that if carried out on a large scale, abortion would fall under the crime of "corruption on earth" and carry the death penalty.

"The Iranian Government is taking further steps to use criminal law to restrict the rights of women, for the sake of increasing the number of births, which will effectively force many women and girls to continue unwanted pregnancies to term which would be inherently discriminatory", the experts declared.

Severe restrictions on women's rights

Abortion in Iran is effectively banned, apart from a few exceptions. The new law puts the final decisions on therapeutic abortion - in case of threat to the life of the pregnant woman or foetal anomalies - in the hands of a panel consisting of a judge, medical doctor and forensic doctor, rather than on the pregnant women, supported by the medical doctor.

For the UN experts, the law violates the rights to life and health, the right to non-discrimination and equality, and to freedom of expression by making it illegal to access a range of reproductive health services and share reproductive rights information.

The law also prohibits free distribution of contraceptive goods, and imposes a ban on voluntary sterilizations for men and women, aside from very exceptional cases. The move, said the experts, will disproportionately impact women in situations of marginalization, and victims of sexual violence.

Risk of maternal deaths

In the experts' view, the law will not stop abortions.

They pointed to data illustrating that "criminalizing the termination of pregnancy does not reduce the number of women who resort to abortion".

"Instead, it forces women to risk their lives by undergoing clandestine and unsafe procedures."

According to official data an estimated 300,000 to 600,000 illegal abortions are performed in Iran every year.

Under the law, antenatal screening tests will be restricted, and the health ministry will establish a system to collect information on everyone who goes to a health centre for fertility treatment, pregnancy, delivery, and abortion - a move apparently designed to expand the monitoring of pregnancies and discourage abortions.

"Restricting the access of women to free contraception goods and services will lead to unwanted pregnancies and high maternal mortality", the experts warned.

"We will closely monitor the impact of this law on maternal deaths and ensure accountability for failure to act with due diligence to prevent the death of women and girls with risk pregnancies, or the death of those that undergo unsafe abortions", they added.

Cruel and degrading

The package of measures contained in the law could, therefore, amount to gender-based violence because women denied safe abortions can incur mental and physical suffering, according to the UN experts.

Moreover, the criminalization of abortion can constitute cruel, degrading, and inhumane treatment, and may amount to torture.

"We urge the Government to immediately repeal the law on 'Youthful Population and Protection of the Family' and to take measures to end the criminalization of abortion and to ensure that all women can access all necessary health services, including sexual and reproductive health care, in a manner that is safe, affordable, and consistent with their human rights", the experts said.
Special Rapporteurs and independent experts are appointed by the Geneva-based UN Human Rights Council to examine and report back on a specific human rights theme or a country situation. The positions are honorary and they are not paid for their work. Click here for the names of those who endorsed this statement.

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Iran death penalty threat for abortion unlawful: UN rights experts

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In a statement released on Tuesday, the experts called on the Iranian authorities to repeal the 'Youthful Population and Protection of the Family' law, which was ratified by Iran's Guardian Council on the first of November.

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When abortion is 'haram', women find strategies to claim their rights

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This article is about women who come up with different ways that they can have a potential abortion and the steps to take to do it

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Many women took to the streets worldwide on September 28, the global day of action for safe abortion successes and put forth new demands for women's right to access safe, free and legal abortion.

Right to access safe abortion is under threat in many countries, from the United States to Poland, from Argentina to Ireland where women are still fighting for it. Religion, specifically Catholicism, has often been stated as the main obstacle to birth control and abortions. As such, many Catholic majority countries have strict abortion laws. Most remarkably among those, Andorra, Dominican Republic, El Salvador, Malta, Nicaragua and Vatican come to fore with complete abortion bans.

But what about Muslim-dominant countries?

Nearly 80% of women in the Middle East and North Africa live in countries where abortion laws are restricted (PDF,989Ko). Among those, 55% live in countries where abortion is prohibited except to save the mother's life and 24% live in countries where abortion is permitted only to preserve women's physical or mental health. Today, only Turkey and Tunisia allow elective abortions (abortion on demand). Although, there are no countries in the region with complete abortion bans, abortion restrictions narrow the grounds for women's access to safe abortion.

Just like elsewhere, abortion appears to be a highly controversial topic for the Muslim-majority countries, as well as for the Islamic jurisprudence. Even in countries where it is legal, as in Turkey, abortion regime is constantly challenged and attacked by opposing political and religious discourses (TR). Similarly, in Tunisia, despite the legal framework, women still report being judged (FR) by the medical personnel and society for obtaining abortion.

What does Islam say about abortion?

In general, Muslim authorities consider abortion as an act of interfering the role of Allah (God), the only author of life and death. However, different Islamic schools have different views on abortion. According to the Hanafi School, which is predominant in the Middle East, Turkey and central Asia, and that constituted the main body of law during the Ottoman Empire, abortion was conceptualized as ıskât-ı cenîn, which can be translated as the expulsion of the fetus.

At the outset, this terminology was obscure as it made no distinction between miscarriage and abortion (TR). Moreover, within the Hanafi school, it was argued that ıskât-ı cenîn is mekrouh, meaning unwanted rather than haram (prohibited), before the fetus is 120 days old, given that the fetus would not be ensouled until then (TR). Yet, even if it is mekrouh, termination of pregnancy was entrenched to husband's approval and it did not constitute a right or decision on women's part.

At the same time, other Islamic schools have diverging opinions on abortion. Shafi school, which is dominant in Southeast Asia and parts of Africa, majorly permits termination of pregnancies up to 40 days and opinions diverge within the school as per the foetal development advances.

Some Shafi imams even tolerated abortion up to 120 days. Although the Hanbali school that is dominant in Saudi Arabia and United Arabic Emirates does not have a unified stance on abortion, some opinions permit abortion until the 120 days. Finally, the Mailiki school, dominant in North Africa, affirms intermediate status of fetus as the potential of life and prohibits abortion entirely. As a matter of fact, all Islamic schools consider fetus to be ensouled by 120 days of conception and none of them permit abortion after this stage.

New socio-political concerns

In many Muslim-majority countries, Islamic jurisprudence influenced abortion legislations. However, as new socio-political concerns emerged across time, abortion legislations have been reformed. In the case of the Ottoman Empire, the relative "free medium" offered by the Hanafi school was challenged by a new pro-natalist and modernist agenda emerged toward the late eighteenth-century. As the empire was moving toward decline, modernization and population growth was seen as a remedy to ensure military, economic, and political stability. Inspired by Europe, Ottomans aimed to achieve a breakthrough via a vast reformation and codification process.

In 1858, the Imperial Ottoman Penal Code - modelled after the French Penal Code of 1810 (Code Pénal 1810)- was adopted. The new Penal Code officially prohibited and criminalized abortion through a unique harmonization of the French Penal Code with the Islamic jurisprudence. Henceforth, abortion was declared haram (prohibited) legally across all Ottoman territories. Nonetheless, in the Ottoman jurisprudence, abortion was conceptualized exclusively as a social phenomenon. The recorded prosecutions which followed the implementation of the Penal Code illustrate this point, as they criminalize abortion practitioners, as in doctors, nurses, pharmacists, etc., rather than women themselves (TR).

Following the Ottoman jurisprudence, many ex-Ottoman territories kept up with abortion restrictions. However, when we look at Muslim-majority countries, we also witness a diversity in abortion laws as they allow and prohibit abortion on different grounds. Today in many of those countries, abortion is often only allowed when women's life is under danger, when the fetus is malformed or when the pregnancy is a result of a criminal act, such as a rape. Though these grounds allow some women to obtain abortion, they still reinforce medical supervision and legal proceeding, leaving no room for elective abortions.

Restricting abortion drives it underground

It is widely and scientifically known that restricting abortion does not efface the practice. On the contrary, it drives abortions underground and gives birth to clandestine and unsafe abortions, as well as maternal mortality. As women use dangerous methods to terminate their unwanted pregnancies, they risk their health, fertility and even lives. Every year, 47,000 women die from complications related to unsafe abortion. Middle East and North Africa, following Sub-Saharan Africa and South Asia, looms large as the third region with severe maternal mortality rates.

Moreover, abortion restrictions hit women from lower economic background the most. Often women who can afford might find the possibility to travel to access safe abortion elsewhere. Some women also manage to negotiate with local medical staff to receive service. For some others, the black market is the only resort. Many women become victims of scammers who sell fake abortion pills at high costs. Even in cases where women manage to access to reliable services or medicines, they seldomly access to reliable information and relevant care. This leads to isolation in their abortion experience, as well as increased pain.

Wind of change on apps

Nevertheless, with the advent of medical abortion and telemedicine abortion, safe abortion alternatives flourish despite legal restrictions. Many women living in the Muslim-majority countries, or elsewhere with restrictive abortion laws, consult to online telemedicine services to receive help and information on the self-administration of medical abortion pills.

Studies have proven that self-administration of medical abortion pills obtained through telemedicine services is safe and effective in early pregnancies.

Being one of such telemedicine services providing safe abortion in restrictive settings, Women on Web (WoW), helps around 60,000 women every year. Their website is available in 16 languages, including Arabic, Persian and Turkish.

However, in some countries like Saudi Arabia and Turkey, Women on Web website is banned. In this case, to circumvent the censure, women use an app on their smart phones to ask for help.

Today abortion appears to be haram, illegal and clandestine in large parts of the Muslim world. Despite this, women continue to challenge the status quo and archaic laws through their daily practices and activism.

In 2012, in response to a planned legislation to restrict abortion in Turkey, thousands of women organized a pro-choice rally in Istanbul. Taking streets to claim their right to safe abortion, women claimed for their bodily autonomy: "Abortion is a right, decision belongs to women" Kürtaj haktır, karar kadınların (TR).

Cet article est republié à partir de The Conversation sous licence Creative Commons. Lire l' article original.

Hazal Atay, Ph.D candidate, INSPIRE Marie Skłodowska-Curie Fellow at Sciences Po Paris, Sciences Po - USPC

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When abortion is 'haram', women find strategies to claim their rights

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Many women took to the streets worldwide on September 28, the global day of action for safe abortion successes and put forth new demands for women's right to access safe, free and legal abortion. Right to access safe abortion is under threat in many countries, from the United States to Poland, from Argentina to Ireland where women are still fighting for it.

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IPAs is helping out with abortions

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In Bangladesh, Ipas-trained community health workers and religious leaders reached 14,989 individuals with information on family planning, including abortion.

In the Democratic Republic of Congo, Ipas-supported community groups ran online "Let's Talk Abortion" campaigns that reached 116,306 people .

In Bolivia, a program to dismantle toxic masculinity and its harms on reproductive health, including abortion access,

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WHO issues new guidelines on abortion to help countries deliver lifesaving care

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WHO is helping countries out with abortion

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The World Health Organization (WHO) is releasing new guidelines on abortion care today, in a bid to protect the health of women and girls and help prevent over 25 million unsafe abortions that currently occur each year.

"Being able to obtain safe abortion is a crucial part of health care," said Craig Lissner, acting Director for Sexual and Reproductive Health and Research at WHO. "Nearly every death and injury that results from unsafe abortion is entirely preventable. That's why we recommend women and girls can access abortion and family planning services when they need them."

Based on the latest scientific evidence, these consolidated guidelines bring together over 50 recommendations spanning clinical practice, health service delivery, and legal and policy interventions to support quality abortion care.

New recommendations to improve access to high quality, person-centred services

When abortion is carried out using a method recommended by WHO, appropriate to the duration of the pregnancy and assisted by someone with the necessary information or skills, it is a simple and extremely safe procedure.

Tragically, however, only around half of all abortions take place under such conditions, with unsafe abortions causing around 39 000 deaths every year and resulting in millions more women hospitalized with complications. Most of these deaths are concentrated in lower-income countries - with over 60% in Africa and 30% in Asia - and among those living in the most vulnerable situations.

The guideline includes recommendations on many simple primary care level interventions that improve the quality of abortion care provided to women and girls. These include task sharing by a wider range of health workers; ensuring access to medical abortion pills, which mean more women can obtain safe abortion services, and making sure that accurate information on care is available to all those who need it.

For the first time, the guidelines also include recommendations for use where appropriate of telemedicine, which helped support access to abortion and family planning services during the COVID-19 pandemic.

Removing unnecessary policy barriers facilitates safe abortion access

Alongside the clinical and service delivery recommendations, the guidelines recommend removing medically unnecessary policy barriers to safe abortion, such as criminalization, mandatory waiting times, the requirement that approval must be given by other people (e.g., partners or family members) or institutions, and limits on when during pregnancy an abortion can take place. Such barriers can lead to critical delays in accessing treatment and put women and girls at greater risk of unsafe abortion, stigmatization, and health complications, while increasing disruptions to education and their ability to work.

While most countries permit abortion under specified circumstances, about 20 countries provide no legal grounds for abortion. More than 3 in 4 countries have legal penalties for abortion, which can include lengthy prison sentences or heavy fines for people having or assisting with the procedure.

"It's vital that an abortion is safe in medical terms," said Dr Bela Ganatra, Head of WHO's Prevention of Unsafe Abortion Unit. "But that's not enough on its own. As with any other health services, abortion care needs to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgement. No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care."

Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal.

"The evidence is clear - if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care," Dr Ganatra added.

Following the launch of the guidelines, WHO will support interested countries to implement these new guidelines and strengthen national policies and programmes related to contraception, family planning and abortion services, helping them provide the highest standard of care for women and girls.

Quality abortion care is care that is effective - delivered by health workers with the right skills, resources, and information; safe; accessible to all those that need it; timely, and respectful of women and girls' needs and rights.

The WHO abortion care guideline updates the former edition, released in 2012, and consolidates existing and new recommendations. The digital version is available at https://srhr.org/abortioncare

An interactive online database containing comprehensive information on the abortion laws, policies, health standards and guidelines for all countries is available at https://abortion-policies.srhr.org.

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WHO issues new guidelines on abortion to help countries deliver lifesaving care

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Alongside the clinical and service delivery recommendations, the guidelines recommend removing medically unnecessary policy barriers to safe abortion, such as criminalization, mandatory waiting times, the requirement that approval must be given by other people (e.g., partners or family members) or institutions, and limits on when during pregnancy an abortion can take place.