Wednesday 7 of December, 2022
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The Trouble with Abortion in Egypt

While technically illegal in most circumstances, unwanted pregnancies are terminated in Egypt every day. Farah Hosny meets with doctors, lawyers, and women who have undergone the procedure to discover the social, economic and cultural implications of the controversial practice.

Staff Writer

“I had stored a bunch of abortion pills that I had left over from the first time I’d gotten pregnant and terminated. It wasn’t easy finding them that first time – my boyfriend had to try around 30 pharmacies before he found them, and I knew the pill only had like a 60% success rate, but it was my only option because I didn't know where I could go to get the actual procedure done. When the pills didn’t work with my second unplanned pregnancy, I panicked. I had no idea where to go in Egypt to get an abortion,” says Nadine* a 25-year old Egyptian woman.

Abortion has always been a contested topic; a loaded word; a controversial concept, all around the world. But this is especially pronounced in Egypt where aside from the cultural consciousness regarding the subject, and how religion factors into the equation, the laws of the country also explicitly forbid the procedure unless the mother’s life is in danger. As prescribed by the law, “abortion is regarded as a criminal act,” says Adel Ramadan, a lawyer who works at The Egyptian Initiative for Personal Rights. “The only time you can get an abortion legally is if the pregnancy or the continuation of it causes a risk to the mother’s life. Women who get voluntary abortions can face up to three years in prison; a doctor, surgeon or pharmacist involved can face up to 15 years and any non-medical person who assists her can also be looking at three years.”

Despite the severity of potential sentences, women still seek out abortions, whether surgically, or via the ‘abortion pill’, a medication called Misotac, which can be used up to seven weeks after the fact and essentially induces a miscarriage. “I always get a few women a month who come in asking for abortions, both married and unmarried,” says Dr. Rania*, a gynaecologist who works in a private clinic. “I would say I get about five or six cases a month maybe – they’re mostly unmarried,” says Dr. Hisham* a pro-choice OBGYN – one of the few in Egypt - who provides abortions at a private hospital. “Keep in mind this is a very low number compared to the rate of abortion across Egypt because you should note that the upper social class is a limited class. Most of those who come to me will belong to that class. If you look into the low-middle classes you’ll find its way, way more than this.”

The procedure has always been available in Egypt, but through an unofficial word of mouth network. “It’s not like it’s non-existent in the country; it’s done all the time,” Dr Hisham says. Women in Egypt have always managed, one way or another, to find some method of terminating their unwanted pregnancies, because although most doctors refuse to perform the procedure on legal or religious grounds, there has always been an underground web of physicians who perform them and the women who have had them done, and the web is laden with whispers from both ends. Shereen*, a 70-year old Egyptian woman, says it was fairly easy for her to obtain a termination back in the 60s, when she was married but did not want any more children. “I didn’t ask my regular gynaecologist, I knew he wouldn’t have done it for me. I got a name from a friend and I went to him. It was all through word of mouth; of course it’s not going to be advertised. But it wasn’t terribly difficult to find someone who would do it.”

But yet, the primary issue which remains is with access; not only to someone which will assist or perform an abortion, but sterile conditions and truly qualified medical professionals. As such the issue is twofold; those who don’t know where to procure a termination in the country to begin with, and others who resort to subpar conditions or drastic measures in order to have one carried out. “The second time I tried to abort the pregnancy with the pills, they didn’t work, and I went into full panic mode because I had no idea where to go or what to do,” Nadine says, a reflection of how many women feel they are faced with a dead end when it comes to wanting to terminate a pregnancy. Yasser*, who was 18 at the time, describes his own situation when his girlfriend’s pregnancy test emerged positive. “When my girlfriend got pregnant, I immediately started looking into booking flights to Europe for her to get the abortion there; neither of us had any idea if it was provided here, how we could get access to a doctor, or how clean the conditions would be.”

As many of these women have gotten pregnant due to premarital sex, for most, keeping the pregnancy is not even an option taken into consideration, in a culture so heavily steeped in stigma over sex. “There was never even a question of keeping the baby, both times,” says Nadine. When she felt the pills were failing to work, and she wasn’t bleeding out like she had the first time, desperation kicked in as she searched for a way to abort the pregnancy. “Eventually we found a doctor who we were told would do it, through a friend of a friend. I went to the appointment; it was a really sketchy clinic and I wasn’t comfortable at all.” Abortions can only be performed at hospitals so the doctor told Nadine she could perform the operation the next day at a hospital located in a low income area. “The minute she told me where the place was, in my head I was like, absolutely not. She kept assuring me she did the operation herself and sterilised everything herself and it was perfectly safe but I’m familiar with the area and it’s not somewhere you want to have an operation done. The whole thing was very suspect and I was really uneasy. She looked at me said I looked like 'bent nass' and that was why she was sending me to this hospital. So I don’t know where she would send other girls.”

Eventually, Nadine found a qualified doctor and a clean hospital, where the doctor advised her that the pregnancy was already losing life due to the pills and she didn’t need a surgical abortion. But many girls from less privileged backgrounds have no such option. “If you start to look at a lower-middle class demographic, you’ll find that abortion requests can be up to 10 cases per day and there are known “doctors” that girls go to to have them performed. People think that no one is having sex until they get married or that this only happens in upper classes but this is not the case; it occurs across the social spectrum,” says Dr. Hisham. “Between prostitution, rape, and plain desire, people across all social classes in Egypt are having pre and extramarital sex.” And due to the fact that it is a blatant taboo, abortions end up being the natural corollary.

Dr. Hisham works with an NGO which help girls who have been raped get access to a safe abortion. Laws regarding abortion in relation to rape in Egypt are somewhat vague. According to lawyer Adel Ramadan, though technically a termination is illegal even if a woman has been raped, it is possibly to legalise it if she gets approval from the General Prosecution. But there has been no precedent to this, many girls are likely unaware of this law, and even if they were, with the country’s crippled legal system, nothing is assured.

And women who stem from lower income backgrounds have limited options as to where to obtain an abortion, whether the pregnancy came about through consensual sex or not. “If you’re going to look at the lower-middle class, that socio economic sector as a whole, of course, they get stuck in this situation and they go to doctors that they’re not even sure are qualified to do any operations,” Dr. Hisham explains. “Some ‘doctors’ will do sort of what we used to call a ‘kitchen abortion’ back in the day because it was done literally on a kitchen table. But nowadays this is essentially when it’s done in clinic, definitely under sub-optimal circumstances in terms of anaesthetic, equipment, and more. And if something goes wrong, this a person’s life we’re talking about.”

In other situations, doctors smell the blood in the water and, aware that their patients are in a precarious situation, are quick to take advantage. “It occurs in a certain social class that the doctor knows that the person in front of him is in a pinch,” Dr. Hisham elaborates. Acutely aware of the power they lord over women who have no other recourse, many doctors either charge an extortionate amount of money for the procedure, or exchange it for sexual favours.

“Some doctors really make a lot of money out of it,” Dr Hisham says. “And you’ll hear horror stories; sex-trading has happened; some women don’t have the money so they’ll end up sleeping with whoever is providing care for them in order to get the abortion.” It is a testament to the extent at which bearing a child out of wedlock is condemned that women will prostitute themselves for an abortion. Some, however, are not able to procure the procedure entirely. “For a short period of time, I used to work in a public hospital, and you would see women come in, give birth, and the next morning they would flee the hospital and abandon the baby on the bed. A lot of the orphans in Egypt, they’re not a result of parents who passed away; they’re unwanted pregnancies.”

But for those who do manage to obtain a termination, legalities and religion play a role; significant for some, peripheral for others. The legal framework for obtaining an abortion based on medical risk is blurry so doctors find loopholes in order to thread through the law and avoid liability. “If someone wants a termination and I want to make it ‘legal’ I would send her to a colleague as a ‘referral’ and he will write a piece of paper saying that this woman’s life is at risk if she continues this pregnancy. Therefore, I have a legal paper that tells me that I can perform a termination. But most terminations are for social reasons, not medical,” Dr. Hisham explains.

Because the majority of cases are social, women feel they are committing a religious crime by terminating and seek validation for their actions. “Lots of girls will ask me if its haram or not,” says Dr. Rania. “I’ll tell them to call someone from Al Azhar. I can’t impart religious advice.” Similarly Dr Hisham tells us, “The woman often thinks she’s committing a religious crime. They’ll ask me about 40 days and the spirit descending…I’ll tell them to speak to a sheikh; how would I know when the spirit descends? They want to hear it sometimes because they don’t want to feel like they’re committing a religious offense. Even if the psychological part of getting an abortion will remain but they just want to make sure they didn’t do anything haram; that plays a role.”

Shereen says, “Up until now I feel guilty about it even though it was over 40 years ago. At the time I didn’t really think of the religious aspect of it – I was young, I already had three kids I didn’t want anymore. I don’t know how my parents found but my father was so disappointed and he didn’t speak to me for ages. He was like how can you do something like this, how dare you, don’t you know this against our religion? Now I feel that. Up until this day I’m unhappy that I did such a terrible thing.”

But regardless of legal, moral, or religious consequences, women across the board are still seeking out abortions, some for financial reasons, some due to cases of rape or prostitution, but many as a sort of last-ditch remedial effort to conceal the fact that they have engaged in sex out of wedlock, the latter of which, whether or not we turn a blind eye to it or not, is on the rise in Egypt.

“Obviously I felt bad that I’m killing something…A person that I made with someone I love. But keeping it simply wasn’t an option. Of course God and religion were on my mind but I believe I’ll compensate for it,” Nadine concludes.

*Names have been changed to protect the interviewees' identities.

Photography by Christina Rizk.