Abortion in Afghanistan

Abortion in Afghanistan is affected by the religious constraints from the national religion, Islam, and by the extremely high birthrates. Afghanistan has one of the highest fertility rates, but its levels are decreasing since the fall of the Taliban, as aid workers can now enter the country to help with fertility and decrease mortality rates.[1] Afghan law is influenced by Islamic law, which comes from the Qur’an.[2][3] These laws state that abortion is only legal if it is performed to save the life of the mother or if the child is going to be born with a severe disability.[4] This interpretation of Islamic law is based in Islamic medicine, as Muslims cherish the sanctity of human life and believe God does not cause harm or illnesses that are incurable.[5] Due to these constraints, women choose either to pursue an abortion illegally or be shunned by society due to a pregnancy outside of the socially accepted norms.[6] Contraception is approved by Islam when it prevents the formation of the zygote and prevents implantation in the uterus.[3]

Birthrates & fertility

Afghanistan has one of the highest fertility rates in the world, with very few women actively using contraceptive methods, despite support from the government and conformance with religious ethics.[5][1] Only 22.5% of people utilize contraceptive measures in comparison to the United States, where 74.1% of people utilize contraception.[7] In the 1990s, the average woman in Afghanistan had 8 children throughout her lifetime, but this decreased in the mid-2000s to 6.3 and by the end of 2010 to 5.1.[1]

Since the Taliban's fall in 2001, fertility levels are decreasing, stemming from the Taliban's belief in not educating girls, child brides, and not providing healthcare for women.[1] The decreased presence of the Taliban has allowed an entrance of aid workers to the country to provide educational funding for schools, family planning, and more access to birth control. The uncontrolled high fertility rates make it difficult for Afghanistan to manage the poverty level and improve other social conditions, which leaves a high dependence on aid from other countries. High fertility rates cause high birthrates, which contribute to the high fetal mortality rate.[8] Afghanistan has the highest fetal mortality rate in the world, with 110.6 deaths per 1000 births.[7] Mothers are also 19.9 years old on average at her first birth. As access to education across Afghanistan is increasing due to the fall of the Taliban, the fetal mortality rate is also decreasing. In rural areas the mortality rate still remains high, but aid workers are being sent to many regions of the country after receiving training on deliveries and care for newborns.[6]

Religious limitations

Islamic law comes from the Qur'an, which they believe comes from God and Muslims use it to dictate their every day actions. The religious laws of Islam dictate strict policies on gender interactions. One of these requirements is that women use a female gynecologist.[9] Islamic rule says that males in the medical field should only treat females if there are no other females in the field to care for them. Women are more likely to seek care from a female gynecologist to conform to their religious convictions.[4] A suggested improvement is to increase the number of female doctors in Afghanistan to encourage seeking professional help rather than nonprofessional help.

Islamic medicine ideals are based on the sanctity of human life, which states that God created humans and did not create diseases or other ailments that do not have cures or other solutions that humans have the ability to discover.[3] Muslim teachings say that human life begins at conception because the fetus is able to perform actions within the womb that humans outside of the womb are able to perform, such as movement and digestion.[3] This means that the fetus has a soul. This means that the fetus has rights, which the mother is responsible for protecting until delivery. This leads to the overriding belief that abortion should be avoided whenever possible.[10] Any action that would take away the soul of the fetus is illegal. This includes a pregnant mother being murdered, leading to the murderer being tried for both deaths; or if the father dies while the mother is pregnant, the estate will not be divided until the birth of the child, because the fetus has rights to the estate and the father's inheritances.[3] However, in cases of rape, abortion is not permitted because one crime cannot be solved with another crime, and having an abortion for reasons other than the health of the mother and the baby is considered a crime. If a fetus is predicted to die right after birth, the mother and the father must make the decision, considering all factors, that they feel aligns best with the Qur'an.[3]

Islam approves certain forms of contraception as well. Contraceptive methods are acceptable when they prevent ovulation and formation of the zygote.[3] Once the zygote has formed, which means the egg and the sperm have fused, it is considered a human life and thus is protected as such. Ethicists believe that the proper use of contraceptives prevents the need for abortion and the consideration of the moral dilemma.[10]

Stigmatization of abortions

Due to the religious views on abortion, society stigmatizes women who receive abortions. Many women account that they are stuck deciding between whether to have an abortion or have a child outside of marriage, both of which cause them to be ostracized from society.[6] Some reasons that lead women to pursue abortions to avoid being ostracized include drug and/or alcohol addicted husbands, poverty, and being single. Due to the constraints that the government places on access to abortions, women must pursue abortion through illegal means to avoid being shunned by their families or punished criminally.[4] The culture in Afghanistan, developed both from the government and religion, makes women believe that it is their job to have children. This social role for women does not take into account that Afghanistan has an extremely high birthrate, ranked 12th in the world, with little access to education on family planning and contraceptive usage.[5][7]

Current legislation

Afghan legislation is based heavily on Islam, with the preamble of their constitution referencing Allah.[11] Article 3 of Chapter 1 outlines that no law in Afghanistan should contradict Islam.[11] The Afghan Independent Human Rights Commission was created to protect human rights and as a response to Shia Family Law, which violates human rights.[12][13] The heavy influence of religious beliefs on the law leads to strict laws surrounding abortion. Chapter 4 of the Afghanistan Penal Code outlines the consequences for performing abortions. It states that abortions outside of saving the life of the mother or if the baby's life is endanger, interpreted as a severe disability or low quality of life, are illegal.[2] Article 402 says that anyone who purposefully kills a fetus will be sentenced to no more than 7 years in prison. Article 403 says that anyone who performs the abortion will either be imprisoned or fined up to approximately 12,000 Afghanis ($165USD). If the person performing the abortion is a doctor they will be punished to the fullest extent of the law.[2]

Access to abortions

Few legal cases allow women to seek abortion care. Women are able to get an abortion when their life is endangered by the pregnancy, or if the baby will be born with severe deformities or disabilities.[4] Religious ethical committees must rule on the ethics and legality of the abortion before it can be carried out.[10] After ethical approval of the abortion, the woman must obtain approval from a gynecologist, three general practitioners, a counselor, and permission of the doctor.[4] One additional situation that occasionally allows abortion to occur is poverty. This is especially prominent in areas that the Taliban is still present in. Within Taliban controlled areas, poverty based abortions are generally approved more often because they have too many children.[6]

Women often pursue abortions through illegal means because of the few cases that allow abortions legally. They believe it is necessary in order to avoid shame from their husbands, families, and society. This leads women to having to fund the abortion themselves, which can be difficult because of the social norm that implies that it is women's job to have children and thus they don't have jobs outside of taking care of the house and the family.[4] Many women would prefer not to have children, but lack knowledge on how to limit the number of children they have outside of abortion. When pursuing abortions, they many times need to use uneducated midwives who don't know how to properly perform the procedure or deal with complications. Another option they have is to use expensive private clinics, which leads to the issue of funding the expenditure. Since women are typically unemployed, rounding up the funds for an abortion can be difficult. The price of an abortion has decreased from 250,000 Afghanis (US$3,500) to 17,500 Afghanis (US$250).[6] This decrease has been seen because of the increasing need of abortions. But the price is still 15,000 Afghani (US$150) higher than the average price of an abortion in the United States, where abortions are legal and generally publicly accepted.[6]

Safety of the procedure

Afghanistan is in the top 16 countries worldwide for the highest mortality rate from abortion.[14] The healthcare system in Afghanistan is also not at a level to properly care for pregnant mothers.[4] Every 2 hours there is a pregnancy-related death in Afghanistan.[6] The high maternal mortality is due to lack of post procedure care. Although the procedure is illegal in most cases, women still pursue abortions, motivating aid workers to make it safer. International aid workers are working to improve the safety of the procedures by educating midwives and nurses about how to improve care for their patients and limit the mortality of the procedure.[6] Aid workers hope to decrease the stigma surrounding the procedure so that there is lower mortality.

References

1. Nasser, Haya El; Overberg, Paul. "Fertility rate drops in Afghanistan, but will it continue?". USA Today. USA Today. Retrieved 13 May 2018.
2. "Abortion in Afghanistan". Women In Afghanistan. Word Press. 2015-11-05. Retrieved 23 May 2018.
3. Athat, Shahidi. "Islam and Abortion". Islamic Horizons. 45 (4): 40–41.
4. Hasrat-Nazimi, Waslat. "Afghan women use abortion as a way out". DW Made for Minds. Deutsche Welle. Retrieved 13 May 2018.
5. Abortion Policies: A Global Review. New York: United Nations. 2001. pp. 17–18.
6. Rasmussen, Sune (2017-04-26). "'I Am a Criminal. What is My Crime?': the Human Toll of Abortion in Afghanistan". The Guardian. Guardian News and Media. Retrieved 11 May 2018.
7. "The World Factbook: Afghanistan". Central Intelligence Agency. Retrieved 18 May 2018.
8. Constable, Pamela. "Afghan babies have been dying in huge numbers for decades. Now, something is changing". World Views. The Washington Post. Retrieved 13 May 2018.
9. "Rules Regarding Looking, Touching and Examining". Al-Islam.org. Ahlul Bayt Digital Islamic Library Project. Retrieved 16 May 2018.
10. Bowen, Donna Lee. "Abortion, Islam, and the 1994 Cairo Population Conference". International Journal of Middle East Studies. 29 (2): 161–184. doi:10.1017/s002074380006445x.
11. "The Constitution ::: Embassy of Afghanistan". www.afghanembassy.us. Retrieved 2018-06-10.
12. "Afghanistan Independent Human Rights Commission". www.aihrc.org.af. Retrieved 2018-06-10.
13. "The Shia Family Law". www.mtholyoke.edu. Retrieved 2018-06-10.
14. Ansari, Nasratullah (February 2015). "Assessing Post-Abortion Care in Health Facilities in Afghanistan: A Cross-Sectional Study". BMC Pregnancy and Childbirth. 15 (1): 1–9. doi:10.1186/s12884-015-0439-x.