Perspectives on Elective Abortion Among Palestinian Women: Religion, Culture and Access in the Occupied Palestinian Territories

Abstract

Background: Termination of pregnancy remains a highly debated topic in women’s health in the Middle East and specifically in the occupied Palestinian territories (OPT), where it is illegal in most cases. To better understand the ways in which Palestinian women interface with a healthcare system governed by an Israeli system in certain places and limited by the Israeli occupation in others, and to reconcile religious, ethical, and social challenges in this context, this study is designed to elicit the views of Palestinian women exclusively on elective abortion. To our knowledge, this would be the first study exploring women’s views on abortion in Palestine to specifically include the dual sociopolitical context of Jerusalem in which Israeli laws govern healthcare. Methods: We designed a qualitative study that used convenience sampling to recruit Palestinian women (patient and non-patient) from the department of Obstetrics and Gynecology at Al-Makassed Islamic Charitable Hospital in East Jerusalem. After obtaining verbal informed consent, participants were interviewed in Arabic one-on-one using an open-ended questionnaire eliciting perceptions on the religious implications, social consequences and accessibility of elective abortions in the OPT. Interviews were transcribed and translated to English. Two members of the research team open-coded the transcripts of the interviews. Codes were identified independently then refined collaboratively to finalize a list of reoccurring themes. Data was analyzed using MAXQDA 11. Results: Sixty women were interviewed, ranging in age from 18-70, living in East Jerusalem, the West Bank, and Gaza. The majority of participants were Muslim, married, urban dwellers, with a high school education or less, and with at least 3 children. Themes arising from the interviews included the centrality of religion and religious authorities in affecting women’s choices and views on abortion, the importance of community norms in regulating perspectives on and access to elective abortion, and the effect of the unique medico-legal situation of the OPT on access to abortion under occupation. Many women expressed opposition to abortion on religious and cultural grounds with most excepting to save a woman’s life. Participants diverged most widely in their views on abortion in the cases of fetal anomalies, pre-marital pregnancy, and rape. Limitations identified to safe abortion access by Palestinian women included: legal restrictions, hospital policy restrictions, prohibitive prices at private clinics, significant social consequences from the discovery of an abortion by one’s community or family, and different levels of access to abortion depending on whether women were residents of Jerusalem, the West Bank, or Gaza. Conclusions: A deeper understanding of variations in religious beliefs and practices, and of the interplay between politics, religion, history and reproductive rights is crucial in the war-torn context of Palestine, as Palestinian women are subjected not only to the realities of occupation, but also to historically patriarchal social and legal structures. This study offers some insight into the views of Palestinian women on the important women’s health and human rights issue of abortion. This information can help physicians, policymakers, and women’s reproductive health and rights organizations better understand the views and needs of their constituency and how to best address them and care for their health and well-being in the intimately challenging circumstances of abortion.