Sex and the Citadel (27 page)

For women across the Arab world, that will cannot come too soon. In Egypt, almost every married woman I know—and several of my unmarried friends—has had at least one abortion. What this means in terms of national numbers is a matter of speculation, since there are few official statistics. One calculation from the mid-1990s put the number of induced abortions in Egypt at 15 percent of pregnancies, roughly on par with rates in Western Europe.
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Such numbers are hard to come by because abortion is against the law in Egypt, although legal wiggle room allows it in limited cases of “necessity”—notably, where a woman’s life is in danger. And
the penalties, on paper at any rate, are stiff: imprisonment for the patient and practitioner.
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This means, at the very least, that thousands of Egyptian women, and their doctors, are breaking the law every year; how they go about it depends on their social standing. Wealthy women can pay a private gynecologist around EGP 3,000 (USD 500) for a safe procedure, usually dilatation and curettage, or D and C, a tidy medical term for scraping out the uterus. Medical abortion, as we saw in Tunisia, is slowly gaining ground; although not quite as profitable for practitioners as surgery, it does have the advantage of plausible deniability, since the drugs needed for the procedure are used in other treatments as well and, in any case, can be procured without a prescription. For the less fortunate, there are doctors who will do a
tandiif
(cleaning) for around EGP 200. It is an unsurprisingly unpleasant experience: of dubious hygiene, offering inadequate pain relief, and perfunctory treatment mainly by male practitioners who, at best, just want to push patients out the door as quickly as possible or, at worst, refuse to treat unmarried women or actively condemn their morals while taking their money all the same; blackmail and sexual harassment can also be part of the service.

Meanwhile, poor women rely mainly on do-it-yourself techniques, including drinking boiled onion tea or soft drinks mixed with black pepper, or inserting the stem of a
mulukhiyya
, a tall weed whose leaves are commonly used to make soup, into the uterus—an organic version of the proverbial coat hanger. Some of these traditional approaches are being replaced by higher-tech versions. So instead of using a plant stalk, a woman who suspects she’s pregnant might go to a clinic and get an IUD, which will stop implantation of the fertilized egg. And rather than taking an herbal concoction, women can improvise by swallowing a couple of packs of contraceptive pills to induce bleeding—a homemade attempt at emergency contraception that is, in fact, available in Egypt but little used by women or medical practitioners there. Much more grisly is the prick-and-stick approach, in which the woman is knocked out with an injection and then hit about the back and abdomen until she
starts to abort. In many cases, these rough-and-ready approaches—either at private clinics or DIY—are not expected to finish the job. Rather they are meant to induce bleeding, which means a woman can then turn up at a public hospital and legitimately seek attention for a “spontaneous” miscarriage or hemorrhage.
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While the law makes getting an abortion a complicated and costly process, it doesn’t appear to do much to deter either women or practitioners. It’s only when a patient dies, or some other scandal erupts, that authorities step in; otherwise, a conspiracy of silence keeps the clandestine abortion business ticking along. It wasn’t always like this. Egypt’s current law dates from the late 1930s, but when my grandmother was a young married woman in the 1940s, abortion was an open part of life. The
daya
, traditional midwife, would come to my family’s apartment, in a lower-middle-class part of Cairo, where there would be coffee and gossip as on any other social occasion; my father, then a young boy, remembers being sent outdoors to play, returning to find the
daya
throwing out an aborted fetus with the other remains of the day.

This laissez-faire approach to abortion reflected a long tradition in Egypt. Like everything else to do with sex, abortion wasn’t something you shouted about, but you didn’t go to great lengths to hide it either; hence the extensive advice on abortion in the books of Arabic erotica through the ages.
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Today, abortion is a trickier affair. Single women, in particular, are caught in a double bind: the taboo of premarital sex not only makes abortion, already a secretive matter, even more furtive for them but, as we’ve seen, also increases their likelihood of having to resort to it in the first place, because of inadequate contraception. And as research shows, the burden of religious guilt weighs heavily on many.
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Most countries in the Arab region have more or less the same position as Egypt when it comes to abortion: technical illegality, tacit practice under most circumstances. All countries in the region permit abortion when a mother’s life is endangered. Half a dozen, including Saudi Arabia, allow it in the case of a threat to a woman’s physical health; Algeria adds the risk to mental health. Kuwait and Qatar also consider fetal impairment adequate grounds. Legislation
in many of these countries is based on that of former colonial occupiers and so tends to reflect Western attitudes of the day rather than local tradition.
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But whereas the United Kingdom, France, and Italy liberalized their abortion laws in the 1960s and ’70s, legislative changes have been far less dramatic in most Arab states. The result is that 80 percent of the region’s women live in countries where abortion is restricted in one way or another.
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Every so often, police swoop down and arrest abortionists, and religious figures inveigh against the practice, then it’s back to business as usual.

If, as in Egypt, women manage to get the job done anyway, does it really matter whether abortion is largely against the law? Of course it does, say health experts and reproductive rights advocates. Aside from arguments on the right to bodily autonomy, there is plenty of practical fallout from criminalizing abortion, safety being one of the main casualties. The burden of unsafe abortion hits poor women hard; according to some estimates, up to 10 percent of maternal deaths in Egypt are due to abortion, both natural and induced.
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And then there is the cost to the health service of mopping up after so many crude terminations. This is not a uniquely Egyptian situation: across the Middle East and North Africa, the World Health Organization estimates, there are around 1.7 million unsafe abortions performed a year.
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Given that so many women are running so many risks, why is there so little public debate about abortion in Egypt and neighboring countries? The heavy hand of patriarchy, strengthened by the rise in recent years of Islamic fundamentalism, hardly encourages free and frank discussion of women’s sexuality. Many women’s organizations in the region have yet to engage on questions of sexual and reproductive rights, abortion among them, in part because they are busy fighting other battles and in part because of the “patriarchal bargain” some of them strike, trading off gains in certain areas for concessions in others, like sexuality.
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And then there is the vested interest of a powerful medical profession reluctant to lose a steady source of income from a clandestine, and therefore lucrative, practice.

If Egypt is to change its laws on abortion as part of a broader
platform of political and social reform, one country marking that trail is Morocco. The law on the books allows only for terminations in the case of danger to a woman’s health or life and requires a husband’s consent or, failing that, approval from a provincial medical authority. As in Egypt, the penalties for infractions can be severe. And as in Egypt, illegal abortions are commonplace—at least six hundred a day, according to some sources.
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One man out to change all that is Chafik Chraibi. As head of gynecology and obstetrics at a major maternity hospital in Rabat, he’s seen enough complications from botched abortions to last a lifetime. “You cannot imagine how many women are doing abortions,” he told me. “Here, every day, every day, I receive women, married or not, they are four to five months pregnant, they have ruptured their uterus, they are in a mess and they don’t know what to do. Yet they don’t want to admit it. But we know … they took something.”

In 2007, Chraibi decided to shift course, from mopping up to leading the charge. He is president and founder of AMLAC, the Moroccan Association for the Fight Against Clandestine Abortion. Its name speaks volumes about how social change happens in the Arab region. “It would be shocking [for society] if I said the name of the association was for the liberalization of abortion,” says Chraibi. “Maybe [in] the future generation, not mine.”

Today’s goal is already ambitious: a “softening” of Morocco’s laws on abortion to allow terminations up to eight or ten weeks in certain cases: rape, incest, minors, fetal malformation, for women with psychiatric disturbances or caught in “dramatic” social situations (a housemaid seduced in her employer’s family and thrown out on the street, for example). But Chraibi is also advocating for sexual education in schools and easier access to contraception, not only out of principle—this will reduce the need for abortion in the first place—but also out of pragmatism: it makes the association more socially acceptable if it’s seen as promoting prevention rather than just abortion.

Chraibi’s group isn’t the only one pushing for change; Morocco has an active civil society and several organizations with an interest
in these issues. But it’s Chraibi who has become the identifiable face of this particular battle—and the man journalists at home and abroad call when they want to talk abortion. It’s easy to see why. Chraibi is charming, confident, and urbane, with a dramatic voice and a lively manner. This is not a man who takes life lying down. When we met, he was juggling a uterine cancer surgery, staff meetings, a briefing for politicians, and a couple of media interviews with the local press and French and Italian TV.

Chraibi has been touring the country to raise awareness and stir public support. As far as he’s concerned, the main obstacle to change isn’t religion but politics. “Every month, I go to one or two towns in Morocco where I am invited by an association [of] doctors, women, etc. There are always two or three people who speak: a religious leader, a lawyer—the local magistrate—and me. I start, I pose the problem, and then we discuss. The religious guy is always flexible. He says until forty days, the fetus doesn’t have a soul so abortion is authorized in the case of need. He distinguishes between forty days and four months in the case of necessity. The majority of religious leaders are in the same direction. But the lawyer, the local magistrate, he only talks about the law. Religion is a lot more supple than the law.”

Unlike many others in the region, Morocco has been able to galvanize a public debate around abortion. This is, in part, because its greater freedoms of expression and civil society not only push such issues forward but also create a climate in which research on sexuality is at least possible; this research, in turn, generates facts and figures, however rough, on the scale of the problem, which allow for more informed argument. Thanks to Chraibi and others, there is visible progress on abortion: the more liberal-minded media, which loves to talk about sex in any case, is largely on board; major religious figures agree; there have been debates in Parliament, and national conferences, and a former government minister has gone on record supporting legal reform as advocated by Chraibi and his allies.

The winds which blew the “Arab Spring” touched Morocco too, with the result that its “moderate” Islamist party, Justice and
Development (also known as PJD, after its name in French), was elected to power in the wake of the 2011 uprisings. Although some of its members are opposed to Chraibi, he is confident that there is enough social and political momentum to push forward abortion reform, especially if King Muhammad VI, Morocco’s highest political and religious authority, signals his approval. “Now we are all governed by Islamists,” Chraibi told me. “If we succeed [with abortion reform] in Morocco, then there will be success in Algeria, in Egypt, in other countries in the region.” Even with legal changes, though, there will be years of hard work ahead, making women aware of their new options and peeling away layers of religious and social compunction.

Back in Egypt, assembling those basic building blocks on abortion is tough work. Research on the subject has all but dried up since the late 1990s, and in recent years those tackling abortion have faced enormous personal and professional obstacles. “The problem with abortion is that there are not statistics to present to policymakers,” one reproductive health expert in Cairo told me. “Authorities say the abortion rate is very low; if you want to have change, you need to bring the numbers, and we have no numbers.” She sighed. “Authorities don’t want to talk about abortion; they don’t want confrontation with religious leaders, who clearly say it is forbidden and never talk about the [options allowed by] other sects. Religious figures say women die all the time. Why is abortion different?”

There have been periodic attempts in the past to ease Egypt’s laws on abortion in the case of rape (a move backed by rulings from some religious authorities) and on other social or medical grounds (which have met with fierce religious resistance). All such efforts have faltered somewhere on the road to legislation, and for as long as Egypt’s brand of Islamic conservatism influences policymaking, progress on abortion is unlikely. Whether subsequent governments will have the stomach to tackle abortion, a problem touching millions of its citizens, will be an important measure of Egypt’s commitment to women’s rights in the years to come.