4. Navigating Barriers to Abortion Access: Misoprostol in the West Bank
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58 4 Navigating Barriers to Abortion Access Misoprostol in the West Bank Francoise Daoud and Angel M. Foster Nabiha’s story Nabiha and her husband live with their four children in greater Bethlehem.1 At thirty-eight, Nabiha discovered she was pregnant. She knew that she didn’t want another child—with her husband unemployed and her mother-in-law’s health deteriorating, she didn’t feel that this was the right time to expand their family. Because of her family’s political history, Nabiha didn’t think she would get a permit to travel to Jerusalem for an abortion, even though East Jerusalem is less than ten kilometers from her home. Nabiha discussed her situation with a neighbor, who advised her to use an acidic douche to terminate the pregnancy. The process was painful, and Nabiha developed an infection, but her pregnancy continued. Desperate and believing she had no alternatives, four months into her pregnancy Nabiha threw herself down the stairs and provoked a miscarriage. In the wake of the Second Intifada (uprising) in 2000, the previously fragile health services in the West Bank deteriorated considerably. The creation of the vast concrete wall dividing occupied Palestinian villages from each other and from Israeli settlements, frequent curfews and road closures, increased restrictions on freedom of movement, and the implementation of the Jerusalem identity card and travel permit system severely impeded Palestinians’ access to health care facilities. The system of checkpoints and the continued occupation disrupted the supply and distribution of essential drugs and other medications, the ability of both health service professionals and patients to present at health facilities, and the ability of ambulances to transport patients to tertiary care facilities in East Jerusalem (Devi 2007; Giacaman et al. 2004; Jamjoum 2002). The consequences for women’s health were especially devastating, with docu­ mented increases in maternal death, unassisted home deliveries and Navigating Barriers to Abortion Access   59 stillbirths, and decreased utilization of prenatal services (Al-Adili, Johansson and Bergström 2006; Giacaman, Wick, and Abdul-Rahim 2005). Indeed, from late 1999, just prior to the Second Intifada, to the summer of 2002, the percentage of births taking place at home increased from 8 percent to 33 percent. The majority of these were unplanned and unassisted home deliveries , and the rate of stillbirths increased by 56 percent (Giacaman, Wick, and Abdul-Rahim 2005). By early 2004, the Palestinian Ministry of Health had documented over fifty cases of women who had given birth at Israeli checkpoints awaiting passage to a medical facility, and over thirty newborns had died as a result of delays at checkpoints (Azzouni 2010; Giacaman Wick, and Abdul-Rahim 2005). The continued occupation and the overarching political situation also severely disrupted preventive care, including women’s access to contraceptive and family planning services (Bosmans et al. 2008). This was especially true for unmarried women, many of whom have historically traveled outside of their own communities in order to obtain contraception. Researchers have speculated that the political context, the intensified conflict, the worsening economic situation, and barriers to safe delivery have affected Palestinian women’s pregnancy intentions (Giacaman et al. 2008; Giacaman, AbuRmeileh , and Wick 2006). Although it is difficult to document, anecdotal evidence suggests that there was a rise in unintended pregnancy in the earlyand mid-2000s. Some of this evidence comes from what we have seen with respect to abortion practices. Abortion in Palestine Abortion is legally restricted in the West Bank to cases in which the women’s life or health is severely endangered (Azzouni 2010; Hessini 2007; Deif and Mair 2006). Best estimates based on limited data suggest that 15 percent of pregnancies in Palestine end in abortion and that approximately onethird of these are unsafe, either because they are self-induced, as illustrated by Nabiha’s story, or because they are performed by an untrained provider (United Nations Population Fund representative, personal communication; International Planned Parenthood Federation 2014). A study conducted in the mid-2000s found that one in four women in refugee camps had participated in unsafe abortion practices (study director, personal communication). However, by virtue of Israeli law, in Jerusalem abortion is legally per­ missible for a range of indications and is available through fourteen weeks gestation; facilities in Tel Aviv provide later second trimester procedures, through twenty-four weeks (Wilder 2000; Levine 1994). Prior to the Second Intifada, 60   Abortion Pills, Test Tube Babies, and Sex Toys many women from the West Bank traveled to Jerusalem for their abortion care. The...



Subject Headings

  • Human reproductive technology -- Middle East.
  • Human reproductive technology -- Africa, North.
  • Birth control -- Middle East.
  • Birth control -- Africa, North.
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