Unwanted pregnancies and women’s right to choose in Israel

A few weeks ago, Knesset Members Yehudah Glick (Likud) and Abdel-Hakim Haj Yahya (Joint List) came together in an unusual cooperation between coalition and opposition to push forward a new initiative. They proposed that all abortion committee meetings, held across the country whenever a woman applies to end her unwanted pregnancy, should include a cleric of that woman's religion, something that has led to many objections, but perhaps most interestingly has reawakened the subject of unwanted pregnancies in Israel and how the state relates to them. ACCORDING TO estimates, more than 20,000 induced abortions (including illegal ones) are performed in Israel every year. Generally speaking, Israeli women are prohibited from terminating their pregnancies. The law states that the right to abort a pregnancy will only be given under one or more of the following conditions: if the woman is under 17 or over 40 years old; if she's single, or the fetus was conceived outside her marriage; if the pregnancy is the result of incest or rape; if the fetus is likely to have a physical or mental disability; or if the pregnancy is likely to put the woman's life in danger or harm her physically or mentally. If the request for abortion does not meet any of these criteria, writes the Health Ministry's website in bold, termination will not be permitted. 'Israel loves duality' The bureaucratic procedure involves making a request in front of one of the committees in hospitals around the country and include two doctors (one of whom is an obstetrician) and a social worker. In practice, about 99% of all committee requests are approved, according to the Central Bureau of Statistics. “These committees are nothing but a rubber stamp,” says Ronit Piso, the women and medical technologies coordinator at Isha L'Isha, a Haifa feminist center. “It's the state's way of avoiding actually dealing with the issue. Israel loves duality and has found a solution that satisfies both sides – both the haredi [ultra-Orthodox] community and women's rights organizations. So on the one hand, there is a law that states that abortions are illegal. On the other hand, we see that almost all requests for abortions are permitted and many practices are allowed.” Maya, 25, is a student from Jerusalem who decided to get an abortion about two years ago. She was fresh into a new relationship, got pregnant accidentally, and knew right away this wasn't the right time and circumstances to have a baby. Her committee hearing, she says, went smoothly: “They did their job, they were professional,” she said. For Maya, meeting with the committee was important on the personal level: “Of course the decision should ultimately be the woman's,” she explains, “and of course the fact they can say 'no' is a whole other story, but I don't think it's problematic in and of itself to meet with a professional – a social worker – who can make sure everything is OK and that you're not doing it under someone's pressure.” In her case she's happy she had to go through this particular stage of bureaucracy. “I actually remember it as positive, even reassuring, because they sat with me and explained exactly what was going to happen.” Women holding 'It's my body and it's my choice' signs during a protest (photo credit: ILLUSTRATIVE: REUTERS) Truth and consequences The fact that 99% of abortion requests are granted hides another problematic fact: that many women who attend these committee hearings lie. Or, to be exact, are forced to lie. This is evidenced by the fact that according to the Central Bureau of Statistics, in 2014 some 45.5% of committee applications were made by married women; the most common reason cited – 51.7% of those – was conception outside of the marriage. Unlike the state's other conditions, this one can't be verified by simply reading a medical report or the woman's ID, which is probably why it's so popular. But lying like this can actually harm these women in the future. For instance, citing the most popular one, unfaithfulness can be used against women in divorce proceedings. It's worth mentioning that the law used to include another criterion, a social-economical one, which was soon removed following pressure from Agudat Israel. NURIT (NOT her real name) was a married 28-year-old woman when she accidentally got pregnant a couple of years ago. This was not a pleasant surprise for the couple. “I kind of freaked out,” she told the Magazine. “I was a student, and I just wasn't interested in children, even though I had a good and stable relationship, and even though we were doing just fine financially. It just wasn't right.” Nurit says she knew that being under 40 and married she would have to find some other way to get the committee's green light. She turned to a psychiatrist she knew, a family friend, and explained the situation. “He didn't give it a second thought. He immediately wrote us a letter saying I had been a patient of his for several months, had anxiety attacks, and that I was using psychiatric medication to deal with it.” None of this is true, she clarifies – she had never once seen him professionally. Nurit says she felt that throughout the process the medical professionals were trying to get her to change her mind. She says her family doctor told her it was “a mistake as far as he was concerned,” and quickly adds, “I switched doctors after that incident.” The committee members took a similar stance. “They tried to convince me that having a child might actually help my situation,” Nurit recalls. “I had to play the part – crying, acting hysterical. In truth I really was upset... upset about this unwanted pregnancy...” They even told her that given this would be her second abortion – she terminated another pregnancy when she was 16 – it might cause complications if she ever did want to get pregnant. This, her own gynecologist later explained, wasn't at all true. Heavy silence Though Nurit was open about her own story, most women, says Piso, still prefer keeping quiet about it. The result, so it seems to many, is an overwhelming lack of public debate about the subject. “In terms of the medical institution,” says Maya, talking about her experience in the committee, “it was fine; the bigger problem is that nobody talks about it. Only after [it was done], talking to some friends, I first realized how many women I know had abortions. No one said anything [before then], they were too ashamed. “In the liberal society I live in, no one treats abortions for what they really are: a termination of a pregnancy that could have led somewhere. They treat it as a solution to a problem.” If this discussion had taken place in her case, she says, she could have made a more conscious and informed decision. “I would have made the same decision, yes, but at least it would have been a decision.” Piso adds: “I hear women who even say they've consulted their community's rabbi, he allowed it, and with his permission they go to see the committee. I think that's great – every woman should choose who she trusts to help her make this decision.” (from left) Dr. Noya Rimalt, a professor from the Faculty of Law at the University of Haifa, and Ronit Piso, women and medical technologies coordinator at Isha L'Isha (photo credit: HABIB SAMAAN,Courtesy) The art of persuasion Meanwhile, one prominent voice that does get heard comes from Efrat – The Committee for the Rescue of Israel's Babies. Efrat is an Israeli non-profit organization, a local take on the “prolife” movement in the US. Its website's “About Us” page presents a much milder version, saying it has nothing in common with pro-life and, in fact, presents the organization as much closer to pro-choice but with an even more open mind. “Efrat believes in a woman's right to free choice, and that information is the key to making an educated, well-thought-out choice. An elective abortion is a viable option only after a woman understands the full implications of her decision.” The Hebrew version of the site, quoting a text by Efrat's director and CEO Chagai Goldshmidt, even explains that “after considering all options – help or abortion – the decision made by the woman would be much healthier, voluntary and feminist.” However, as another page on its website explains, it is specifically aimed at Jewish women, based on the ancient command of “pru u'rvu” (“be fruitful and multiply” – Genesis 1:28): “Miriam [Moses's and Aaron's sister] was granted an additional name, Efrat, which has the same root as pru u'rvu – to populate the world… We at Efrat aspire to emulate Efrat's accomplishments and save the lives of unborn Jewish children.” But rather than presenting information about the procedure and possible ramifications, what Efrat offers can easily be seen as an emotional plea. Possibly the best example of this is a short presentation named “The Diary of a Fetus,” available on its website. It shows images of fetuses, coupled with sentimental music. On top of the images are texts representing the fetus's thoughts and feelings: “10 weeks… mother decided that the pregnancy is unwanted. She doesn't understand that this 'pregnancy' is me… I'm scared to death. If I could only shout out: mother, why don't you want me?!” BUT IS it even possible for a 10-week-old fetus to feel or think such a thing, medically speaking? “Absolutely not,” clarifies Dr. Israel Shapiro, MD at the Institute of Ultrasound in OB/GYN Elisha Hospital, Haifa. “At 10 weeks the brain's lobes aren't even connected.” In fact, at that age most parts of the brain don't exist yet, and the nervous system isn't developed enough to allow for thoughts or feelings, he explains. “Cortical functions, those higher things like thinking and as opposed to reflexes or breathing for instance, develop very late in the process,” adds Dr. Sharon Maslovitz, chief of the OB/ GYN emergency room at the Tel Aviv Sourasky Medical Center. “They can't see, they can't hear, they can't think at 10 weeks. They certainly don't have a will of their own.” Presented with these explanations, Dr. Eli Schussheim, president of Efrat, says all information on the site and in the video was checked with an embryologist, a professor who consulted Efrat before the material was released. “We talked to a specialist, not just any GP. And since then we've published these things in millions of brochures, and no one has said anything questioning the validity of the information.” As for the video itself, and the emotional toll it might take, as far as Schussheim is concerned this is simply vital information that the woman has to have before making an informed decision. “The woman needs to know what's happening inside her. Should we hide it from her? If this information raises emotions, so be it. But anyone can present information as they please, and we chose this way, which really lets you know very clearly what's happening inside the womb.” Overall, explains Schussheim, Efrat is a feminist, pro-choice group, which helps women who do wish to continue their pregnancy, “by giving them all the means we can raise for them, and all from donations. We assist the women for two years, sometimes even more. Of about 68,500 cases we supported, no one woman now regrets her decision. These women exist, their children exist, sometimes they even have children of their own by now.” Meanwhile, elsewhere A similar voice exists in the US: the “pro-life” movement, which opposes abortions and is in the center of an ongoing debate encompassing everyone from the (wo)man on the street to the country's highest-ranking policy makers. “The US does acknowledge a constitutional right to terminate a pregnancy,” explains Dr. Noya Rimalt, a law professor from the Faculty of Law at the University of Haifa. That right is based on the famous 1973 case Roe vs Wade, in which the Supreme Court established the woman's right to abort an unwanted pregnancy. Voices from the “pro-life” camp contested, saying that this negates the fetus's right to life as promised in the constitution to every person. “The court solved that by stating that a fetus is not a person. At the same time, they did add two government interests that could, potentially, limit the woman's right: protecting the mother's health (relevant in the second trimester of the pregnancy) and protecting the potentiality of human life (relevant in the third trimester.)” Almost two decades later, things changed yet again, with the 1992 case Planned Parenthood v. Casey. “The Supreme Court did reacknowledge the right to an abortion,” says Rimalt, “but it canceled the trimester system. In its stead it established the undue burden test, according to which a state can place any limitations it wants on abortions – but only as long as they don't become an undue burden on the right to terminate a pregnancy.” This rather vague definition does not run smoothly. Over the years several cases have reached the Supreme Court claiming that some state legislation or other is violating the Planned Parenthood v. Casey decision. “In theory, the law goes by Casey. In practice, though, things are very difficult for women who want to have abortions. Those in more liberal states have more options, more clinics. Those women who have more means can have abortions privately or find it easier to travel to distant clinics, whereas poorer women, those living in rural areas for instance, have a bigger problem. They have to travel far and they find it harder to fund the procedure. The right to an abortion is considered a negative right; you're allowed to do it, but the government will not assist you. And that's the most significant restriction when it comes to abortions.” Not only in the US is there a correlation between how liberal a country is and how many abortions it performs. But it might not be the correlation you imagine. “There's a paradox there, because the more liberal countries, which do give the right to abort a pregnancy, have additional things like high accessibility to contraception, sex education, and of course more awareness. So in those places you would have fewer teenage pregnancies, for instance, and fewer unwanted pregnancies in general.” Rimalt says the state's role in prevention is even more significant than its role in termination of pregnancies; that's why liberal countries also have an entire support system in place. In that sense, the US is hardly uniform, with much variance between states and communities. Could the president-elect change that? Rimalt points out that Donald Trump's most likely immediate effect regarding this issue would be through his influence on the choice of members for the Supreme Court. Antonin Scalia, who recently died, needs replacing; Ruth Bader Ginsburg, who is considered one of the most progressive voice in the court, is rumored to be very ill. “Any majority in the Supreme Court is always very fragile,” says Rimalt. “Decisions often rise or fall by a single vote... These are not something that Trump has a direct say on, but the court is sometimes the only option, the single protector of the very thin ideal of the right to terminate a pregnancy.” A complete overturn of Roe vs Wade, on the other hand, is not so likely, estimates Rimalt. “You don't reverse so easily something that has been in practice for so many years. Then again, the US is a country in which a doctor can be murdered for conducting abortions,” she says, referencing past attacks surrounding pro-choice health professionals (the murder of Dr. David Gunn by an anti-abortion protester in 1993, and the murder of Dr. John Bayard Britton and clinic volunteer James H. Barrett outside a women's health clinic one year later, were two such cases). Asked about the situation in Israel, Rimalt says that it is “quite complex...We have a law that's pretty disconnected from daily societal reality. So many of the committees' decisions are not following the law but bypassing it.” But as it does serve as a certain equilibrium at the moment – as Ronit Piso of Isha L'Isha explained – traditionally no political side wanted to revisit it. Reacting to and Hajj Yahya's recent initiative to include a cleric in the committee, the organization Israel Hofsheet (Be Free Israel) that seeks to create a complete separation between religious institutions and state, has started a Facebook campaign against the very idea of the committee. Mickey Gitzin, the executive director explains: “The whole concept of this committee, the very thought that someone else can make a decision about a woman's body, is fundamentally wrong...But when professional considerations are mixed with religious views which are thoroughly conservative, the results are obvious from the get-go. The State of Israel is headed in a frightening direction, with religion taking over more and more institutions and aspects of life which should be private and personal, mostly the woman's but not only her own... It doesn't even stop at the door,” he continues, “but goes all the way in - right into women's wombs.” However, Rimalt thinks that things are not going to change so easily in the near future. “Even if tomorrow an ultraconservative voice suddenly calls for a stricter anti-abortion law, that request can still be attacked using the Basic Law of Human Dignity and Liberty, which serves as a mini-constitution. Personally I wish it could change in the other direction – I would like to see a more liberal law. But that's even less likely, unfortunately.”

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Unwanted pregnancies and women’s right to choose in Israel

Some 99% of women’s applications for abortions are approved, and yet many feel there is a problem with the current process. Why is that, and are things likely to change anytime soon?

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