Developing an African Network on Medical Abortion Johannesburg, South Africa March 2009

Abortion: Policies and Practice MENA Region Mawaheb El-Mouelhy MD, DRCPI, MPH Cairo Family Planning and Development Association Cairo, Egypt

MENA Region Middle East and North Africa Region Extends from Iran East to Morocco West Predominantly Moslem Mainly Arabic Origin (except Iran and Turkey) Political, Socio-cultural and Economic Diversity

Islam and Induced Abortion Different interpretations No consensus among religious scholars on abortion before 120 days Varies from allowing for justifiable reasons to absolute restriction All disapprove after 120 days of pregnancy (ensoulment)

MENA Region Laws and Grounds for Abortion  Risk to woman’s life: All countries  Risk to physical health: Jordan, Kuwait, Qatar, S. Arabia, Morocco  Risk to physical and mental health: Algeria  Fetal impairment: Qatar and Kuwait  Rape: Sudan  All grounds in 1 st trimester: Tunisia and Turkey

Women and Abortion Laws in MENA Nearly 80% of women in MENA live in countries where abortion laws are restricted 55% of women live in countries where abortion is prohibited

Abortion and Maternal Deaths MENA Around 6% of maternal deaths are due to unsafe abortion In the MENA region

Unintended Pregnancy in MENA One in four pregnancies in the MENA region is unintended (not wanted or wanted in a later time)

Unmet Need for Contraception In MENA Varies widely 6% in Turkey To 51% in Yemen

Need for Safer Abortion Services MENA Region Socio-cultural and economic changes in societies Age at sexual initiation is decreasing Average age of marriage is increasing Gap leading to unwanted pregnancy New patterns of secret marriage (urfi and Mesyar)

Type of Abortion Service  Surgical: D&C, MVA  Medical: Misoprostol  Traditional: Herbs, intrauterine insertions, vigorous exercises, etc..

Reduce Incidence of Unsafe Abortion and Maternal Death related to Abortion  Reduce rate of unmet need  Ensure availability of safe abortion services  Strengthen Post Abortion Care Programs  Use available safe medical abortion techniques  Develop safer abortion techniques

More Readings  Rasha Dabash and Farzaneh Roudi-Fahimi. Abortion in the Middle East and North Africa. Population Reference Bureau, Washington DC, 2008  Leila Hessini. Abortion and Islam: Policies and Practice in the Middle East and North Africa. Reproductive Health Matters 15(29), 2007  Annual Review of Population Laws. Harvard University, 2004 ( annualreview.law.harvard.edu/annual_review.htm)  World Health Organization. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in WHO, Geneva, 2004

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