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Women's Access to Safe Abortion in Lebanon

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Women's Access to Safe Abortion in Lebanon z. fathallah / abortion in the middle east and north africa, 21-31 Moral Work and the Construction of Abortion Networks: Women’s Access to Safe Abortion in Lebanon zeina fathallah Abstract This study explores the intersectional effects of criminalization on women’s access to safe abortion in Lebanon. Building on 119 original interviews with women who have had an abortion and physicians who offer safe abortion services, the article analyzes women’s experiences through two themes: decision making and accessibility to safe abortion services. The article finds that a woman’s decision to abort is morally conflicted and largely dependent on her partner: in the case of single women, this turns on whether the partner is willing to marry the woman and assume paternity of the future child, while in the case of married women, this turns on the husband’s agreement with the wife’s decision. Women use social networks to gain access to information and to clandestine abortion services. Most of the physicians offering abortion services act as moral gatekeepers, often condemning the woman and preserving certain social norms rather than advocating for women’s bodily autonomy and free choice. This article argues that the right to safe abortion is a privilege rather than a right in the restrictive Lebanese context, since access to services hinges on a woman’s social capital, networks, and ability to negotiate with partners and physicians. Single women from a lower socioeconomic background stand out as the most vulnerable. Zeina Fathallah is a Lecturer at the American University of Beirut, Lebanon. Please address correspondence to the author. Email: [email protected]. Competing interests: None declared. Copyright © 2019 Fathallah. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. DECEMBER 2019 VOLUME 21 NUMBER 2 Health and Human Rights Journal 21 z. fathallah / abortion in the middle east and north africa, 21-31 Introduction literature also emphasizes the fact that criminal- ization puts a huge burden on health professionals. This study explores the intersectional effects of For instance, Thalia Arawi and Anwar Nassar ar- criminalization on women’s access to safe abortion gue that the Lebanese law on abortion should be in Lebanon. Lebanon’s Penal Code, which dates amended to allow for abortions based on prenatally back to 1943, bans abortion except to save the preg- diagnosed fetal malformations because they are nant woman’s life. The article explores how women justified in the interest of the fetus and the child.5 experience abortion across marital status, religion, They note that “obstetricians are confronted with and socioeconomic status and how women who the burden placed on them under the law to refuse seek abortion create a space of autonomy in a clan- termination of pregnancy, or, when performing destine context. Building on 119 original interviews them, to forge records or deny having done them.”6 conducted between 2003 and 2008 with women Furthermore, empirical research on abortion who have had an abortion and physicians who offer in Lebanon, especially within the social sciences, safe abortion services, the article analyzes women’s is not currently available. This study is the first of negotiations with their partners, allies within their its kind to explore women’s experiences and physi- networks, and physicians through two themes that cians’ practices. Unlike other contexts in the Middle emerged from the data material: decision making East and North Africa region where restrictive laws and accessibility to safe abortion services. lead to unsafe abortions, Lebanon’s criminalization Since 1969, there have been no attempts to of abortion is not an insurmountable obstacle for expand the circumstances under which women can lawfully seek an abortion in Lebanon. The absence women who want to safely terminate their pregnan- 7 of liberalization of the law, combined with scant cy under medical supervision. However, the ability research on the effects of criminalization, suggests to obtain a safe abortion is a privilege in the re- that abortion is not a public health issue of concern.1 strictive Lebanese context, where access to services The scant research available has tried to calculate hinges on a woman’s social capital, networks, and the number of abortions at one hospital in Beirut ability to negotiate with partners and physicians. and has explored the attitudes of health profession- Most physicians who offer abortion services act as als more generally. For example, William Bickers moral gatekeepers, often condemning the woman attempts to estimate the number of abortions in and preserving certain social norms rather than Lebanon based on the number of admissions for advocating for women’s bodily autonomy and free spontaneous or induced abortions at the Ameri- choice. Single women from lower socioeconomic can Hospital of Beirut.2 However, there is still no backgrounds are particularly vulnerable in these accurate information on the number of legal and negotiations, given that premarital sexuality is still illegal abortions in Lebanon. (The total number of prone to stigmatization. Thus, marital status and legal abortions, including spontaneous abortions, socioeconomic background shape the possibility of reported by hospitals to the Vital Data Observatory accessing safe abortion care and the kinds of expe- at the Ministry of Public Health was 10,913 in 2014.3) riences women have. L. Zahed, M. Nabulsi, and H. Tamim assess the at- titudes of health professionals in Lebanon toward The criminalization of abortion in Lebanon prenatal diagnosis and termination of pregnancy for a series of genetic, non-genetic, and non-med- The Lebanese Penal Code established in 1943 both ical conditions, finding that the highest percentage outright prohibits abortion under all circumstanc- of positive attitudes toward abortion (90.5%) relates es and bans the selling of substances used to induce to abortions following pregnancies resulting from abortion (arts. 539–546). Under article 541, a woman rape, while the lowest percentage (20%) relates to having an abortion is subject to imprisonment of abortions sought by pregnant married women six months to three years, and the person perform- without their husbands’ knowledge.4 The prevailing ing the abortion is subject to imprisonment of one 22 DECEMBER 2019 VOLUME 21 NUMBER 2 Health and Human Rights Journal z. fathallah / abortion in the middle east and north africa, 21-31 to three years. Nonetheless, article 545 stipulates • article 16(1)(c), (d), (f), and (g) (equal rights, di- that a woman who has an abortion to “save her vorce rights, parenting, custody of children, and honor” would benefit from an attenuating excuse. the “same personal rights as husband and wife, Although the circumstances under which an abor- including the right to choose a family name, a tion is considered to save one’s honor are not stated profession and an occupation”); and in the Penal Code, they include various situations, • article 29(1) (administration of the convention such as pregnancy among unmarried pregnant and arbitration in the event of a dispute between women and pregnancy resulting from rape. The state parties). benefit of an attenuating excuse also applies to the person contributing to an abortion in order to save In its concluding observations submitted to the the honor of a family member or a relative with or Lebanese state in 2015, the United Nations (UN) without the woman’s consent. Committee on the Elimination of Discrimination Presidential Decree No. 13187, dated October against Women called for the decriminalization 20, 1969, reaffirms the prohibition of abortion but of abortion, at least where the pregnancy poses a modifies the Penal Code by permitting it if need- threat to the pregnant woman’s life or health and in ed to save the pregnant woman’s life (therapeutic cases of rape, incest, and severe fetal impairment.10 abortion). Therapeutic abortions are currently al- In 2018, the United Nations Population Fund, lowed based on the conditions specified in article United Nations Development Programme, and UN 32 of Medical Ethics Law No. 288 of February 22, Women issued a joint recommendation calling on 1994, which indicates that the attending physician, Lebanon to develop a national human rights strate- before performing an abortion, must consult with gy related to sexual and reproductive rights, as well two other physicians who have also performed a as to regulate abortion in line with the laws of some medical examination, and they all must agree that states, such as Tunisia.11 the woman’s life can be saved only through an Abortion in Lebanon cannot be studied with- abortion. out first understanding the country’s political and The government of Lebanon voted for the socioeconomic conditions. Since the end of the civil Universal Declaration of Human Rights and has war in 1990, Lebanon has been highly characterized ratified a number of international instruments by political crises, systematic public corruption, dealing with health and human rights, including and governmental disengagement from social prob- the International Covenant on Economic, Social lems. The population’s most basic human rights and Cultural Rights and the Convention on the (medical care, food and shelter, education, and em- Elimination of All Forms of Discrimination against ployment) are not being met, and social and gender 8 Women. Lebanon’s ban on abortion is part of a inequities are commonplace. This is the context in legal architecture that limits women’s rights gener- which women’s rights organizations currently op- ally in the country. For example, Lebanese women erate in Lebanon. These organizations’ main aims do not have the right to pass on their nationality to have been to protect women against gender-based their children or to a foreign husband.
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