By Christopher Walker
Monday, April 12, 2004
Women seek abortions throughout Egypt, even though religious and civil law bars the procedures. Some 35 percent are done without any medical supervision.
CAIRO (WOMENSENEWS)--Abortion is illegal here and barred by religious authorities. Nevertheless, pregnant women, often at great personal risk, regularly find a way to end unwanted pregnancies.
Ahlam is one such woman.
"It was the worst news of my life," says Ahlam, her eyes filling with tears. "I didn'twant to do it. I knew it was forbidden byGod."
But her doctor said Ahlam (not her real name) and the fetus were infected with toxoplasmosis, a relatively common disease transmitted by house cats or through under-cooked meat. In Ahlam's case, tests of her amniotic fluid showed thatthe disease crossed the placenta wall andinfected the fetus, drastically increasing thechance of birth defects and blindness.
With only three months left in her pregnancy, Ahlam had an abortion.
Women like Ahlam make the choice despite the strong condemnations from local religious leaders. For example, Al-Azhar mosque, Egypt's foremost religious authority, issued a fatwa in January that says that "it is impermissible for the mother to induce abortion if it is proven that the fetus is deformed or suffers from mental retardation . . . It is not a justifiable excuse."
The fatwa only adds to the already existing religious doctrine, supported by Egyptian law, that forbids abortion unless the mother's life is in imminent danger.
The illegality of abortion in Egypt is a relatively recent phenomenon, however. According to the authors of "Planning the Family in Egypt," medieval Muslim texts contain â€œdescriptions of female contraceptive methods and abortificants,â€ suggesting that the practices were once widespread. In addition, there was popular acceptance of abortion in Egyptian society until it was outlawed by Muhammad Ali in the 1830s, reportedly to increase the male population available for his armies.
Current religious rulings and civil law have not stopped abortions in Egypt, however. They have only made them increasingly unsafe.
As governments in North America and Europe clarify their positions on abortion through legislation, scholars of religious law in Egypt have likewise sought rulings that make clear the conditions under which an abortion is permissible under Egypt's Islam.
Most Middle Eastern countries expressly forbid abortion unless the life of the mother is in imminent danger. Tunisia, however, is the exception to the rule and permits abortions on request.
Adding a sense of urgency to the discussions, advances in pre-natal care have made unsafe pregnancies and fetal abnormalities easier to detect. To meet the need, many foreign-trained Egyptian gynecologists now offer abortions in private clinics. However, these relatively safe procedures are not available to most women.
Attempts to reduce the rate of abortion in Egypt or make it safer for women, routinely run up against religious, cultural and sexual barriers.
While there are no exact numbers, there is no question, that abortion rates in Egypt are high. A 1996 study of 1,300 Egyptian women by the Cairo Demographic Center found that one-third had tried to terminate a pregnancy. This is slightly lower than in the United States, where about 40 percent of women have had an abortion at some point in their lives.
A 1998 study by Egyptian researchers and published by the New York-based Population Council extrapolated from the rate of post-abortion treatment in Egyptian public hospitals to find the overall abortion rate. After studying over 22,000 admissions to hospital gynecology departments, researchers found that out of every 100 pregnancies, 15 were ended by induced abortion.
About 35 percent of abortions in Egypt are done without any medical supervision, according to the Population Council study.
A physician who performs an abortion here faces three years in prison. For many doctors, however, the financial gains of performing abortions outweigh the legal and moral risks. A professional and safe medical abortion costs about LE3,000 or about $460 in a private clinic in Egypt.
Ahlam was lucky. Her abortion was done by a doctor under sanitary conditions.
Of course, most women can't afford such a hefty price tag. As a result, most abortions in Egypt are done at home without medical supervision. The average annual income in Egypt is about LE26,000 ($4,000). And the World Bank reports that about 17 percent of families live on less than $2 per day. In addition, husbands often demand a strict accounting of how their wives spend money.
For between LE500 and LE1,000, ($150) doctors or midwives will perform abortions in less than sanitary conditions and with unsophisticated equipment.
Many women try to end their pregnancies by taking overdoses of aspirin or quinine, risking their own lives, as well as harm to the fetuses. Others take herbal douches, including concoctions of mashed onion leaves or moulikhiya, a local plant similar to spinach. They also use cotton stalks, palm fronds or goose feathers soaked in gasoline to dislodge the fetus from the uterine wall.
Only education about contraceptives and reproductive health can reduce these practices and overall abortion rates, says Iman Bibars, the head of the Association for the Development and Enhancement of Women. The association is a nongovernmental organization which conducts health awareness programs for some of Egypt's poorest women.
Bibars adds that women occupy "a traditionally neglected and disempowered segment of Egyptian society," despite their important role within families.
Breaking through the religious and cultural barriers is not easy, however.
"Virginity belongs to the family," she says, not to the woman. "The key question is 'who controls a woman's body?'"
Islam here is founded on the belief that the human body belongs to God and, according to Egyptian tradition, a woman belongs to her father before marriage and her husband after marriage.
"It is this sense of family honor, which comes from our blend of Islam and Arab and African culture that prevents women from understanding their own bodies," says Bibars.
"The problems we have with abortion, the problems with promoting contraception and women's health, these are all symptoms of this obsession with honor. The only way for this to be settled is to have a transparent, open, public debate about what honor means and who ultimately controls a woman's body. Let's ask ourselves these questions," says Bibars.
She adds that when the association holds workshops on women's health, the resistance is fierce--and not only from the target communities. Some of the association's own staff refuse to attend such workshops if they revolve around gynecological health.
There are currently no groups in Egypt that deal specifically with abortion. Bibars says it is impossible for non-governmental organizations to take on the task. "You would be terrorized by everyone and probably shut down in the end."
Instead, groups like Bibars' focus on educating women about contraceptive methods as a way to reduce unwanted pregnancies. Contraceptives are widely available in Egypt, but many in rural areas don't use them properly.
"People say if we make it legal, it will be used as birth control," says Bibars. "But look--it already is and it will be forever."
Christopher Walker is a writer based in Cairo.