Islam and Abortion: The Diversity of Discourses and Practices Leila Hessini* 1 Introduction most decentralised systems of pregnancy termination One in four world citizens is Muslim and 57 countries (Nashid and Olsson 2007). are official members of the Organisation of the Islamic Conference (OIC).1 Muslims comprise close to The goal of this article is to elucidate examples of half of all Africans, one-fourth of Asians and growing the variations in Muslim belief and practice related to numbers of Europeans and Americans, and represent abortion. I begin by providing examples of abortion- great variation across racial, ethnic, linguistic and related practices and policies in key Muslim countries. geographic lines. While all Muslims share certain core Given the increased use of religion in public policy beliefs, official and practised Islam manifests itself in decisions, positions of religious leaders are discussed, different ways as it intersects with local cultures, followed by examples of strategies to break the traditions, histories and politics. silence around abortion and ensure that women have access to safe abortions. This article ends with The diversity found across the Muslim world is suggestions on future prospects for change. apparent in different countries’ abortion laws and practices. Tunisia, for example, reformed its abortion 2 What are the abortion-related practices and law before France and the USA; services are policies in key Muslim countries? provided free through the public healthcare system Contrary to the image often painted of a monolithic and pregnancy termination is socially accepted. While Islamic position on abortion, great diversity exists it is true that legal restrictions on abortion exist across Muslim countries in terms of pregnancy throughout the Muslim world, most are not due to termination practices and policies. shari’a2 – as some might believe – but to antiquated colonial texts which are the basis for abortion laws in The most recent estimates of induced abortions the majority of countries. worldwide indicate that the countries with the highest rates are the Muslim countries of Central Asia. In Examples from the three most populated Muslim Azerbaijan, women will have on average three countries are particularly revealing of these abortions in their lifetime and abortions are extremely differences. In Indonesia, the most populated Muslim common in Tajikistan, Turkmenistan and Kazakhstan country with one of the highest unsafe abortion (Sedgh et al. 2007). In Indonesia and Pakistan – the rates, several non-governmental organisations (NGOs) two predominantly Muslim countries with the biggest have been working for years to influence a change in populations – close to 5,400 and 2,500 pregnancy the law and have mobilised key Muslim groups in terminations occur, respectively, each day (Utomo et al. their efforts. Pregnancy terminations are so common 2001; Population Council 2004). The first national in Pakistan that on average, each Pakistani woman survey of abortion in Pakistan reveals that there is one will experience one abortion in her lifetime abortion for every five births, resulting in 890,000 (Population Council 2004). Menstrual regulation – abortions per every year (Population Council 2004). which allows for early evacuation of uterine contents Research indicates that without Bangladesh’s after a missed pregnancy – has been an integral part menstrual regulation programme tens of thousands of of Bangladesh’s primary healthcare for close to 30 women would still seek to end their pregnancies and years and as such, Bangladesh has one of the world’s would be forced to undergo unsafe abortions (Nashid IDS Bulletin Volume 39 Number 3 July 2008 © Institute of Development Studies 18 and Olsson 2007). In the Middle East and North Africa ending their childbearing years earlier. Morocco is region, one in ten pregnancies ends in abortion perhaps the Muslim country that has experienced the (UNFPA 2006); in Iran alone, over 1,000 abortions most drastic fertility decline from 7.0 in 1962 to 2.5 in occur every day. The country with the lowest abortion 2004 (Royaume du Maroc 2005). But the proportion rate is the one with the most liberal abortion law: of currently married women with unmet need for Tunisia. These findings corroborate global evidence contraception is also very high, at 24 per cent in sub- that restrictive laws do not lead to fewer abortions Sahara African Muslim countries and 16 per cent in and that conversely, more permissive laws do not the Middle East and North Africa region (Ross and result in more abortions (Sedgh et al. 2007). Winfrey 2002). Women also choose to terminate pregnancies due to social and financial concerns The majority of abortions in Muslim countries are (RRAAM 2007; Telquel 2006; Seif El-Dawla A et al. unsafe as laws are restrictive and abortions often 1998). Unintended pregnancies may result from take place in clandestine settings by a person lacking sexual violence, especially in countries experiencing the necessary skills or in an environment lacking occupation, war and conflict – such as Iraq, Palestine minimal medical standards, or both (WHO 2003). and the Sudan. Adolescents and young persons – The distinction between unsafe and safe abortions is representing more than 30 per cent of the critical to understanding how lack of access to safe population in many Muslim countries – are at abortion services is an issue of discrimination that particular risk of unsafe sex and unwanted leads to social inequities, widespread illness and pregnancies and few government programmes exist premature death. When services are pushed for this age group (DeJong et al. 2005). underground, women have to pay high prices to access abortions, services are often of a poor quality, 3 Legal status of abortion and governments have no responsibility to provide All Muslim countries allow for abortions to save a them – all factors which serve to perpetuate and woman’s life, in some cases under the ‘defence of deepen discrimination and social inequities. necessity’.3 However, 47 per cent of OIC countries legally permit abortion only for this one indication; Thirteen countries around the world account for another 18 per cent allow for abortions in cases of 67 per cent of all maternal deaths and five of these – physical and/or mental health, fetal abnormality Afghanistan, Bangladesh, Indonesia, Nigeria and and/or rape and incest, and 18 per cent permit Pakistan – have large Muslim populations (WHO abortions on request. Interviews with healthcare 2007). While on average 13 per cent of global professionals indicate that life and health provisions maternal deaths are due to unsafe abortions, this are interpreted quite broadly in some countries; in figure is closer to 50 per cent in the Central Asian others such as Bangladesh and Indonesia, menstrual Muslim republics (Sedgh et al. 2007). Moreover, for regulation is regularly practised. every woman who dies due to an unsafe abortion, the World Health Organization (WHO) estimates Progressive interpretations of Islam, coupled with a that thousands more experience severe and lifelong desire to lower maternal mortality rates, have reproductive morbidities. These include reproductive resulted in laws allowing for early abortion on tract infections, chronic pelvic pain, pelvic request in Tunisia and Turkey,4 which completely inflammatory disease, incontinence, and infertility. liberalised their laws in 1973 and 1982, respectively. In Women’s unnecessary deaths and suffering from the past 30 years, 17 other OIC countries have unsafe abortions are entirely preventable since amended their abortion, health laws, or criminal abortion – when performed by a skilled provider in a codes to increase the legal indications for abortion. clean environment – is one of the safest medical These include: Algeria (1985), Benin (2003), Burkina procedures (WHO 2003). Faso (1996), Chad (2002), Djbouti (1995), Guinea (2000), Guyana (1995), Indonesia (1992), Iran (1991), High abortion rates reflect elevated levels of Kuwait (1981), Mali (2002), Mozambique (1981), Niger unwanted pregnancies. The reasons women in (2006), Pakistan (1990), Saudi Arabia (1990) Sudan Muslim countries decide to terminate a pregnancy (1993) and Togo (2007).5 are manifold. In many countries, the desired family size has decreased dramatically over the past decades The majority of these changes include expanding legal and women are having children at a later age and indications such as: rape/incest, fetal abnormalities, IDS Bulletin Volume 39 Number 3 July 2008 19 Table 1 Origins and current status of abortion laws in OIC countries* Country Source of original Indications under Further developments Current law law original law Afghanistan English Life None Life Albania Communist Life, physical health 1995 On request Algeria French Life 1976, 1985 Life, physical and mental health Azerbaijan Communist On request None On request Bahrain English Life 1976 (new Penal Code) Life Bangladesh English Life None Life (although menstrual regulation is allowed in early pregnancy) Benin French Life 2003 (reproductive Life, health, rape, incest, health law) fetal impairment Brunei English Life None Life Darussalam Burkina Faso French Life 1996 (updated Penal Life, physical health, rape, Code) incest, fetal impairment Cameroon French and English Life 1967 (updated Penal Life, health, rape (2 different laws) Codes) Chad French Life 2002 (reproductive Life, health, fetal health law) impairment Comoros French Life 1982 (updated