Enab Baladi – Razam al-Sawadi

Women in Idlib province face societal difficulties and pressures when they decide to undergo an abortion.

These pressures come from relatives, neighbors, and even doctors, despite the woman’s need for the procedure in some cases.

Some believe that abortion is religiously forbidden in Islam and other religions, and this applies not only to Idlib but to many countries that criminalize such operations, considering it as taking a life.

Several organizations and human rights associations supportive of reproductive health believe that abortion is a decision that concerns the woman’s health, and she alone has the right to decide whether or not to take that step.

On the other hand, the doctor risks legal accountability and social accusations from the surrounding community if they perform such an operation. Therefore, some doctors prefer not to take the risk and simply refuse to perform the procedure. This creates the problem of unsafe abortions, as women turn to methods that may not be healthy, especially if done without a doctor’s consultation, or if performed in places or clinics that are not designated for this purpose or are unsanitary.

“I will not participate in such a crime”

Suhad (a pseudonym for social reasons), with her husband’s agreement, decided not to have children for a while because her last pregnancy experience subjected her to placental abruption and anemia, and she had high blood pressure throughout the pregnancy.

Speaking to Enab Baladi, Suhad (24 years old) said she hoped to stop getting pregnant for at least five years, particularly since she had already given birth to two children and she was still only 24.

She was surprised to find out she was pregnant in her first week during a visit to her gynecologist to determine contraception methods.

Suhad did not want a child at the time because her last daughter was still very young, and the pregnancy was weak, as her doctor told her.

Although the doctor told her about the weakness of the pregnancy and the possibility of its spontaneous termination at any moment, she refused to terminate the pregnancy, harshly scolding Suhad with statements such as “You will kill a soul and I will not participate in such a crime,” considering abortion “haram” (forbidden).

The doctor’s words made Suhad fear that if the pregnancy continued, she might face some health risks or increased pain.

The woman sought abortion pills from one of her neighbors after pharmacists refused to sell them, and within 10 days everything had ended with minimal harm, according to her.

Forging a medical report

Insaaf (43 years old), a displaced woman from Damascus, was preparing to send off her 18-year-old daughter as a bride in a few months, and then the news of her pregnancy disrupted her life.

Insaaf could not accept the idea of confronting society with her pregnancy, or even facing herself, partly due to her age over 40, and also because of her daughter’s wedding, questioning “How will I appear before people?”

The midwife refused to prescribe abortion pills since the pregnancy was normal with no problems. However, Insaaf’s issue was not the risk of pregnancy but the community’s perspective and her mental unpreparedness to accept such news.

Initially, she turned to boiled herbal remedies like cinnamon, ginger, and marjoram, as women believe that consuming them in large amounts during pregnancy can cause abortion or premature birth and uterine contractions, but she experienced bleeding without an abortion occurring.

Later, Insaaf managed to get a blank paper with an official stamp from one of the maternity hospitals in Idlib, and her daughter wrote the prescription enabling her to purchase the medication from the pharmacy, and the abortion occurred a week later without serious side effects, she said.

Abortion cases

Enab Baladi spoke with Dr. Khawla al-Sheikh, a specialist in gynecology and obstetrics, to understand the cases where a doctor would perform an abortion.

Dr. al-Sheikh said that terminating a pregnancy is medically indicated when there is a threat to the woman’s life, such as heart disease, kidney failure, and other chronic diseases that exacerbate during pregnancy.

Terminating the pregnancy is not limited to the woman’s condition as the fetus’s condition must also be taken into account, such as when the fetus has deformities that will prevent it from surviving post-birth, like anencephaly and other conditions.

A doctor will refuse an abortion if the conditions of the mother and fetus are good, and there is no reason to terminate the pregnancy.

Abortion ruling and law

In areas controlled by the Syrian Salvation Government (SSG), the political umbrella for the Hayat Tahrir al-Sham (HTS), reliance is placed on interpretations provided by jurists and religious scholars.

According to the Egyptian Dar al-Ifta, jurists agree that if the fetus reaches 120 days old inside the mother’s womb, the time when the soul is believed to be blown into it, the fetus must not be aborted, and abortion is absolutely prohibited in this scenario.

However, if the fetus has not reached 120 days old inside the mother’s womb, jurists differ on the ruling. Some say it is prohibited following the Maliki and Zahiri teachings, others say it is disliked according to some Maliki opinions. Another group permits it if there is a valid reason, according to some Hanafi and Shafi’i scholars.

The final verdict, based on various opinions, indicates that aborting the fetus, if the pregnancy poses a danger to the woman, is permissible regardless of the fetus’s age.

As for Syrian law, it regards abortion as a crime punishable by imprisonment for the mother and anyone who assisted her, including doctors, pharmacists, or others.

The duration of the punishment varies from case to case: a mother who aborts herself can be imprisoned from six months to three years, and anyone who procures an abortion for a woman with her consent is subjected to imprisonment ranging from one year to three years, with the sentence differing if the woman dies, potentially reaching up to ten years.

However, Syrian law has provided a mitigating excuse for the woman or anyone who assisted her in carrying out the abortion, which is to perform the abortion for the purpose of “preserving honor.” In this case, both the woman and those who collaborated in the abortion benefit from the mitigating excuse, whether the abortion was with the woman’s consent or without.

Syrian law imposes harsh conditions on doctors when carrying out an abortion out of extreme necessity, namely, if the fetus poses a risk to the mother’s life, according to lawyer Ali al-Omar in a previous talk with Enab Baladi.

“Abortion is a personal decision”

Fadi Rajab, a social and educational specialist with a Ph.D. in sociology, told Enab Baladi that women resort to abortion for health reasons, but their recourse to unsafe abortions is due to societal reasons 80% of the time.

The woman’s community also plays a role in shaping her decisions, including those related to abortion, despite it being a personal decision that should not be interfered with by anyone other than the woman and her husband.

The decision to abort may also come from a pregnancy that the woman and man are not ready to take responsibility for, resulting from sexual relations they had not considered the outcome of.

A doctor is a product of society, so there are doctors who are guided and restricted by societal laws, in addition to their religious and professional beliefs, which prevent them from performing abortions, as explained by specialist Rajab.

Unsafe abortion

Medical expert Khawla al-Sheikh stated that the process of abortion is dangerous and could pose life-threatening risks to the mother if performed by an inexperienced individual and in a place lacking the appropriate surgical conditions such as sterilization and anesthesia.

Some women may resort to using unsafe methods that cause shocking hemorrhage due to uterine rupture, resulting from the insertion of certain tools or substances inside it, or they may suffer from an infection that could potentially evolve and enter into a septic shock that leads to their death.

It is possible that a woman may face problems that necessitate the removal of the uterus and the loss of reproductive function.

According to the World Health Organization (WHO), nearly half of abortion cases are unsafe, with developing countries bearing 97% of these cases.

Globally, unsafe abortion procedures represent between 4.7 to 13.2% of all maternal deaths, and it is estimated that about 7 million women in developing countries are treated annually in hospital facilities due to complications from unsafe abortion.

“Access restriction”

The World Health Organization believes that restricting access to abortion procedures does not reduce the number of cases, but significantly affects whether these operations are performed safely.

It also points out that the barriers that prevent the provision of safe abortion care in a timely, accessible, affordable, and non-discriminatory manner can cause emotional distress and violate the rights of women and girls to privacy.

The organization’s statistics indicate that half of the pregnancies worldwide are unintended, and nearly 3 out of every 10 end in “induced” (intentional) abortion.

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Enab Baladi’s correspondent in Idlib, Shams al-Din Matoun, contributed to this report.