Palestine’s Abortion Problem

HALHUL, West Bank — Kalila was 14 years old when she married her 32-year-old second cousin. She was also 14 when she became pregnant. Neither her marriage nor her pregnancy were her decision; ashamed and embarrassed, as well as afraid of giving birth, she decided to get an abortion. It was a harrowing decision, and one she told no one about. At five months pregnant, Kalila — whose name has been changed — climbed atop a 9-foot stone wall in this Palestinian city and tossed herself off of it, belly first.

The pain and bleeding began immediately, and her contractions lasted three days. Finally her mother brought her to the family doctor, who told Kalila that she would have to deliver her dead fetus at home, without any medical assistance. Abortion, after all, is illegal under Palestinian law; while it is technically legal in order to protect the life of the mother, in practice, according to experts, it is impossible to get such a procedure. Especially for those like Kalila, who might want an abortion without the knowledge of their husbands.

After three agonizing days, Kalila went to the bathroom and out came her dead baby, followed by heavy bleeding. She lost consciousness until the next morning. Her mother brought her to the same doctor, who performed a surgical procedure in which the cervix is dilated and the uterine lining is scraped with a spoon-shaped instrument to remove abnormal tissues.

“It was a very harsh and painful experience,” said Kalila, now a 40-year-old woman with six children. With her achy joints and wrinkled face wrapped in a red hijab, she looks more like 60.

Kalila’s story is quite common among Palestinian women. While abortion is outlawed by the Palestinian government, there is no punishment for women who end their own pregnancies: This has led to the spread of at-home abortion methods, such as jumping off of staircases or inserting sharp instruments into the body. Last November, a woman in Nablus died from internal bleeding after she tried to end her pregnancy by having her young son jump on her belly, according to Ali Shaar, a Palestinian physician who works as the national program officer for reproductive health at the U.N. Population Fund’s assistance program for the Palestinians.

Abortion is illegal in most of the Middle East, but what sets Palestinian women apart from those in other Arab countries is that they live just several miles — sometimes less than one mile — from a country where abortion is completely legal, easily accessible, and even government-funded.

“The Palestinian Authority is basically encouraging unsafe abortions,” says Amina Stavridis, director of the Palestinian Family Planning and Protection Association (PFFPA), a Jerusalem-based non-profit organization.

Israel, despite its religious, right-wing government, is among the world’s most liberal countries when it comes to abortion. Women must apply to a medical committee in order to obtain a surgical abortion, but 98 percent of requests are approved. Palestinian women who live in East Jerusalem and are not citizens of Israel are also part of the Israeli health care system, and thus have access to abortions through the Israeli system.

Bashira, a 31-year-old woman whose name has also been changed, lives in East Jerusalem, in the Old City, close to al-Aqsa Mosque. She prays every day and has four children, the oldest of whom is six. Yet for the past few years, she and her husband have had a rocky marriage. He is unemployed, and she stays home with their kids. Due to their economic situation and her hopes of divorcing him, she decided that she didn’t want to have any more children.

When Bashira discovered she was three weeks pregnant with their fifth child, she didn’t tell her husband. She went straight to her Israeli doctor, who gave her a prescription for Cytotec, a pill that can be taken to induce abortion up to 12 weeks into a woman’s pregnancy. It cost her just 20 shekels, or about $5.

“I feel very lucky to live here,” said Bashira, referring to Israel. Like most Palestinians, Bashira wants there to be an independent Palestinian state. Yet for the sake of her rights as a woman, she said, “I prefer to live in Israel under the Israeli government.”

While such procedures are technically against Palestinian law, several Palestinian organizations are aiding women in obtaining safe, albeit illegal, abortions. In 2014, the PFPPA served more than 70,000 women, of whom more than 10,000 received abortion-related services. Virtually no data exists about abortion in Palestine. A 2007 study conducted by the PFPPA and the U.N. Relief and Works Agency (UNRWA) found that 40 percent of 333 women surveyed in West Bank refugee camps had undergone an abortion, but the study also stated that some of those women said their abortions were spontaneous and involuntary.

The staff at the PFPPA, which includes social workers and nurses, do not administer abortions themselves. Instead, the organization refers women to clinics and doctors who are willing to take the legal risk of performing confidential surgical abortions. No trace of their procedure is left behind in medical records or elsewhere, so it is impossible to determine how many Palestinian women undergo abortions.

“The government knows that organizations like ours are helping with abortion,” said Stavridis, the organization’s director.

She and others have lobbied the Palestinian government to make abortion legal, at least in early stages of pregnancy, as is the case in other Muslim countries such as Pakistan and Tunisia. The government, she said, knows exactly what she’s doing — but has waved her away by saying that the law is not going to change, and that the PFPPA is doing a good enough job containing the problem.

“The Ministry of Health just tells us, ‘That’s your role,’ or ‘You’re doing a good enough job with it.’ But no, that should be their role,” Stavridis said. “We need to be able to help women publicly, and we don’t have enough resources.”

According to Stavridis, most of the Palestinian women who undergo abortions — whether at home or with the help of the PFPPA — are married. The main factors behind their desire to end their pregnancies, she says, are that they have too many children already, live under poor economic conditions, or have conflicts with their husbands and are in the process of divorce. Birth control also remains taboo in much of Palestinian society, making unwanted pregnancies even more prevalent.

“It starts with family planning, and many women don’t use family planning because it’s not their choice,” said Dr. Umaiyeh Khammash, head of UNRWA’s health program in the West Bank. “What often happens is that the man wants a baby and the woman doesn’t, and then she wants an abortion and that’s her only option for family planning.”

According to a 2013 study on family planning conducted by UNRWA and al-Quds University, “The prevailing culture in Palestine views the subordinate status of women to men as the ideal social construction,” and contributes to an environment where a husband’s opposition to contraception is the final word.

Palestinian women who are early enough in their pregnancies benefit from the fact that medical abortion is so easily accessible in Israel, because medication that’s available just over the Green Line is available to them as well.

Atiya, a health educator at the PFPPA whose name has been changed, said that she’s gone to her own Israeli doctor at least five times requesting Cytotec. Each time, she said, it wasn’t for her, but for Palestinian women in the West Bank, for whom she crossed the Green Line to deliver the medication.

“He knew it wasn’t for me,” Atiya said of her doctor, who understood that she was helping women in need.

On one occasion, Atiya brought Cytotec to a woman in the West Bank who had been impregnated by her boyfriend. “He didn’t want to marry her because he wanted to marry a virgin,” said Atiya. “He left her, pregnant, and she knew if her family found out they would kill her.”

In fact, honor killings — when a woman’s own relatives kill her to protect the family’s reputation — are among the factors that lead women in the Palestinian Territories to seek abortions. Stavridis, the PFPPA director, told me a similar story of a woman who was engaged to her now-husband when she became pregnant. Her husband’s parents told her and her fiancée that if she didn’t abort her baby, they would have her killed. That night, she tried several at-home methods, including jumping off of the staircase of her home. After a week, she went to the bathroom and the dead fetus came out. She suffered such severe medical complications that she and her husband, who were married one month later, were not able to conceive for another five years.

Stavridis often grows angry when speaking about the Palestinian government, which she believes uses the conflict with Israel as an excuse to ignore women’s rights.

“Giving us our rights as women is under the Palestinian Authority’s [PA] control,” she says. “They can create a solution. This is at least one thing they do have control over.”

Drinking is also against Islam, she points out. “Yet the PA has public programs for people with drinking problems,” she said. “Probably because most of the alcoholics are men…. Sure, they passed a law last year to make punishment for honor killing the same as murder, but in practice it hasn’t been implemented.”

The PFPPA is a highly nationalistic organization, which like any Palestinian entity is determined to see a Palestinian state come to fruition. Yet despite her devotion to the Palestinian cause, Stavridis, like many Palestinian women I spoke to, believes that as women, they have more rights living under the Israeli government. This is often difficult for them to come to terms with.

“I hope that Palestine will reach statehood, but also that it will reach the state that Israel has reached regarding women’s rights,” says Stavridis. “Now, it feels like we as Palestinian women are under another occupation — one of our bodies.”

Photo credit: David Silverman/Getty Images

*Corrections, Jan. 25, 2016: A 2007 study by the PFPPA and UNRWA found that 40 percent of 333 women surveyed in West Bank refugee camps had undergone an abortion and also stated that some of those women said their abortions were spontaneous and involuntary. An earlier version of this article incorrectly said in its subheading and body that approximately 40 percent of Palestinian women in the West Bank had undergone an abortion and also said that 26 percent of those abortions had been conducted through unsafe, at-home methods. The study was unclear about whether 26 percent of the abortions were through unsafe, at-home methods or whether 26 percent of women reported knowing of someone who had experienced an unsafe, at-home abortion.