Dr Mohamed Ali Albar DM, FRCP (London)
Director Medical Ethics Center
International Medical Center Jeddah, Saudi Arabia
A clamor of opposing opinions arises from different camps of religious groups, secular humanists, liberals and feminists regarding induced abortion, creating divisions, dichotomies and even conflict that end in many acts of violence and loss of life. Indeed abortion is the most controversial area of family planning, and it is the last to achieve clinical understanding and social acceptance. However it is the most important method used by those calling for fertility regulation and family planning(1)
Definition of Abortion:
It is astonishing to find differences in defining abortion by different laws, countries and medical practices at different times. Sir Stanley Clayton and John Newton in their booklet: A Pocket Obstetrics (2) define abortion as the expulsion of the conceptus before the 28th week of pregnancy; a view that is still held by the British law up to this moment (3). Ralph Benson in “handbook of obstetrics and Gynecology” (4) defines abortion as “the termination of pregnancy before the fetus is viable. Technically, viability is reached at 23-24 weeks, when the fetus weighs slightly more than 600 grams”. The U.S.A law is variable from state to state. The law allows abortion on demand in the first trimester of pregnancy, with more restrictions in the second trimester, limiting it to medically indicated cases. WHO (world Health Organization) defined abortion as “the expulsion or extraction of a fetus or embryo weighing 500 grams or less from its mother ” (5).
The medical opinion nowadays define abortion as the expulsion of conceptus prior to viability which is defined as 20 weeks of pregnancy or a fetus weighing 500 gram or more. Recently some states lowered the weight of viability to 300 gram (5).
Terms as miscarriage are usually used by the public to denote spontaneous abortion, while the term abortion denotes induced abortion whether legalized or not (5).
The Encyclopedia Britannica of 1982 defined abortion as the termination of pregnancy before viability which was defined to be 1000 gram fetus by weight or more than 20 weeks of pregnancy (3).
Incidence of Induced Abortion:
Dr. Guilleboud in his book “The pill” estimates the incidence of induced abortion in the early eighties of the twentieth century to be 40 million annually; half of them being performed legally while the other half performed as surreptitiously, resulting in the death of about 200,000 women and infliction of hundreds of thousands annually with many serious complications including pelvic inflammatory disease, recurrent abortions and sterility (6). Hawkins and Elder claim in their book “Human Fertility control”, that induced abortion is the most effective method used for curbing increase of population and family planning, resulting in major decrease of growth of different populations (7). The time magazine of August 6, 1984 puts the number of induced abortions globally at 50 million annually (8). Induced abortion in Japan has stabilized at 3 million annually, legally and illegally, which resulted in the decrease of annual birth rate to 13.5 per 1000(1, 9 & 10). The pill is still not available in Japan.
The incidence of induced abortion is very high both in Russia, China and the previous East European block, mainly due to lack of the pill, and abortion being used as a means of birth control. In Belarus there are 200 abortions for each 100 live births i.e. ⅔ of all pregnancies.(11).
Similarly in Latin American countries, which are all Catholic and where contraceptive methods are antagonized by the church (except the safe period), the incidence of induced criminal abortion is estimated at 3 millions annually. In the Iberian Peninsula (Spain and Portugal), another Catholic area, where contraceptive methods and abortion are both antagonized by the church, the incidence of criminal abortion is estimated at 1 million annually, the highest in Western Europe and resulting in the annual death of 3500 women. In Manila (Philippines) it is estimated that 100,000 woman are aborted illegally annually, a figure similar to the abortions conducted in Britain (the population of Manila is 5 million, while the population of Britain is 55 million) (1, 12).
The figures of induced abortion have stabilized in the USA since abortion was legalized in 1973, at 1,5 to 1,6 million annually. More than 60% of all the induced abortions in USA, Canada and Europe are done for young unmarried girls under the age of 20. About one quarter of all performed abortions are carried out for teenagers under the age of 17. The prestigious medical journal Pediatrics (supplement 1985) on “Sex, Drugs, Rock ‘N’ Roll, and Understanding Teenagers Behavior”(13) mentioned that 1,2 million unmarried teenage girls between 12 and 17 years of age get pregnant annually in USA. 49% of them continue their pregnancy until delivery and are dubbed “Virgin mothers”, while 13% have spontaneous abortions and stillbirths, while the rest, 400,000 get aborted. The Time magazine claims that one third of all high school girls get pregnant annually (unmarried) which ends in abortion in half of them, while the rest continue until delivery (14).
By 1982, 80% of all pregnancies for girls under 20 in Britain were out of wedlock, and about half of them procured induced abortion (15).
It is evident that promiscuity and sex revolution constitute the major cause of unwanted pregnancy and hence induced abortion, whether legally performed or surreptitiously, the latter being fraught with serious complications and even death. In the USA, despite the availability of contraceptive methods for young girls in schools, the rate pregnancy is very high indeed. The Time magazine (December 9, 1985) (14) gave the following figures: 30,000 pregnancies for those under 15, and by the age of 17 the figure increases to 1,200,000 (also confirmed by the medical journal pediatrics) (13). By the age of 20 there are 2 million pregnancies outside wedlock, which result in abortion of about a million of them annually. All the studies show that both the pregnancies and abortions are at a much higher level for Afro American’s than for Caucasian origin,(1, 12) the rate being 2.5 to 1. Late in the nineties of the twentieth century, the occurrence of abortion for teenage girls has decreased in USA, as girls became more adept at using contraceptive methods(16,17) A new method of female infanticide is spreading in many countries, especially in China and India after the spread of ultrasonography. If the conceptus proves to be a female by ultrasound, then the parents resort to abortion, which unfortunately is done in the second trimester ending in many complications, especially if it is done illegally (18).
The medical indications for performing abortion are broadened to include not only the physical ailments, but also alleged psychological disturbances that will result from continuation of pregnancy. Similarly if continuation of pregnancy is going somehow to affect any member of the family, then abortion is the solution of the expected family problems. (The British Law of 1967 regarding Abortion). Another new type of indication is what is called “reduction of pregnancy” where the lady suffering from fertility gets pregnant with multiple fetuses either through hormonal treatment alone, or by in vitro fertilization, where the treating physician reintroduces more than three fertilized ova (pre embryos) into the uterus. Such practice was deprecated by Islamic Jurists in their meeting in Kuwait in 1987(19) and Amman 1986 (Jordan)(20). Later-on gynecologists all around the world passed a regulation to limit reintroduction of fertilized ova to two or maximum three in each cycle in the management of fertility by in Vitro fertilization (IVF) methods.
Historical Aspect of Legality of Induced Abortion:
Respect for Human life from moment of conception:
The medical profession since antiquity stood against inducing abortion. Imhotep of Egypt (3000 B.C, deitified as the god of medicine) constructed an oath to be taken by all Practicing Physicians, which prohibited the physician from prescribing an abortificient drug or pessary. Similarly the well known Hippocratic oath entail the solemn pledge by the doctor not to procure abortion by drugs, pessaries or any other means(21,.22). The Declaration of Geneva of 1968, was amended in Sydney, reiterated the Hippocratic oath and pledged “I will maintain the utmost respect for human life from the time of conception” (23). However the Declaration of Oslo, while retaining this moral principal recognized the different opposing opinions on the question of abortion: “Diversity of this situation results from diversity of attitudes towards the life of the unborn child. This is a matter of individual conviction and conscience” (24).
This profound change in attitude came as a result of cumulative change in the fabric of many societies, where mores and life styles have completely changed.
It is interesting to note that old civilizations, though prohibited and even punished harshly those who commit abortion, were lax at some stage of their development and condoned clandestine acts of abortion. Potts and Diggory in their Textbook of contraceptive practice emphasized that abortion was practiced in Middle Kingdom of Egypt (2133 – 1786 BC), and the excavations at Pompeii revealed vaginal speculum suitable for performance of abortion(1). The Roman Poet Ovid lamented “There are few women nowadays who bear all the children they conceive”(1). . It seems equally true to the majority of women in many societies today, which have legalized abortion on demand, or on tenous social or psychological causes.
The Bible considered induced abortion as a crime but not as a murder, the punishment being decided by the husband of the wife aborted in the form of compensation. The judge can also punish the perpetrator by strapping or imprisonment (1).
The Catholic church was more stringent, and in the 7th century, passed a canon punishing the perpetrator inducing abortion by capital punishment viz murder (25).
England passed a law in 1524, Germany in 1531, France in 1562 and Russia in 1649, which punished the participants of the crime of abortion by death penalty (25).
With the advent of the industrial revolution and social upheavals in the 18th and 19th centuries, the European countries gradually revoked the previous harsh laws and replaced them with less drastic penalties e.g. imprisonment, fine and abrogation of medical practice license.
By 1929, the law in Britain allowed abortion if continuation of pregnancy was expected to endanger the health of the expectant mother. The previous law allowed abortion only if continuation of pregnancy endangered her life and not her health (1, 3).
From 1929 to 1967, induced abortion without a clear medical indication was considered a criminal act and was penalized by imprisonment, fine and cancellation of the medical practice license. The 1967 amendment issued by the British Parliament authorized the physicians to abort a pregnant lady if:
(a) The threat to her life through continued pregnancy is expected.
(b) Continued pregnancy posed a threat to her physical or psychological health, or the health of children of the family (whether her own children, her husband’s children or adopted children).
(c) The likelihood presence of congenital anomalies in the fetus.
The operation of abortion should be performed in an institution recognized by The Ministry of Health, but it did not require a specialist to perform it (1, 21 ).
The first country in the world to legalize abortion on demand was communist Russia, which passed a law on 18th November 1920, “Permitting abortion to be performed freely without charge in Soviet hospitals” (1). This resulted in decline of the family and the population. Stalin saw the dangers clearly and hence passed a new law in 1935, which restricted abortion to medically, indicated reasons. The Pravda applauded the law and wrote: “our Soviet women have been given the bliss of motherhood. We must safeguard our family”. However in 1955, the law of 1920 regarding abortion was reinstated (1, 25). The Satellite Eastern European countries soon followed suit, with minor change here and there. Several Scandinavian countries liberalized abortion laws since the thirties of the twentieth centuries. Iceland in 1935, Sweden and Denmark in 1938. Japan allowed abortion on demand and as a means of contraception in 1948, and China followed suit during the cultural revolution of the 1960s. Haiti and G. Britain passed their laws in 1967, India in 1971 and USA in 1973. By 1980 over 70% of the world’s population lived in countries where abortion was allowed on demand or with minor restrictions.
Countries allowing Abortion on demand:
Russia, China, Japan, the Scandinavian countries, Eastern Europe, Vietnam, North Korea, U.S.A and Tunisia (the only Muslim country) (25).
Countries allowing abortion with some restrictions:
G. Britain, Canada, India, France, Germany, Holland, Italy, Switzerland, Turkey and South Africa.
Countries allowing abortion for strict medical reasons only:
Catholic countries e.g. Latin America, Ireland, Spain, Portugal, Malta, Belgium, Philippines and all Muslim countries except Tunisia and Turkey. The Zaidi School (Yemen) of jurisprudence is very lenient and allows abortion in the first 120 days of pregnancy (computed from start of conception and not LMP) for both medical and social reasons (25).
It is quite unfortunate to find many societies using induced abortion as a means of birth control instead of using contraception. Many gynecologists, policy makers, Planned Parenthood world population and organizations related to United Nations call for using induced abortion as a means of birth control, along with whatever available method including sterilization of both males and females. Encyclopedia Britannica mentioned the contemporary views and means of birth control including strict government controls over population numbers using compulsory sterilization to millions of the population as exemplified by Mao Tse Tong (China) policy of sterilization, where 40 million were forcibly sterilized, and by Indira Ghandi (India) policy where 24 million were compelled to perform sterilization (3, 25). Millions were also forced to abort, as the law in China allowed the couple to have only one child (3).
Potts and Diggory claim in their “Textbook of contraceptive practice” that “both contraception and abortion are essential for controlling fertility. A society cannot meet its fertility goals purely by the use of contraception. Therefore the combination of reversible methods of contraception (and sterilization), and induced abortion will remain necessary elements in fertility control. Throughout history, and with increasing force over the past 100 years, societies have used combination of contraception and abortion to control their fertility. The moral and political attributions of abortion services outweigh such factors as proven mortality rates or the evidence of cost benefit studies. Abortion will occur in law fertility societies, and are likely to be most common in those in which birth rate is falling in response to socioeconomic pressures” (1).
The previous paragraph quoted contains many contradictory and illogical statements whereby abortion is used despite its apparent dangers to health and life of expectant mothers, and used in low fertility societies, which are supposed to increase the fertility by prohibiting abortion and encouraging the birth of as many children as possible.
U.S.A and European societies encourage third world countries to curb its fertility and population increase even by resorting to methods unacceptable in their own countries. They encourage governments of third world to implement laws and measures to enforce the policy of birth control, even if it involves compulsory sterilization, the use of unsafe contraceptives or even forced abortion (1, 3, 25).
The medical reasons for the so-called therapeutic abortion constitute a very small portion of the number of abortions carried globally for social reasons. Potts and Diggory claim, “few abortions are carried out because continuation of pregnancy threatens the woman’s life, and a small proportion because of congenital anomalies of the fetus” (1). If a woman wishes to carry her pregnancy to term and delivery, almost all obstetricians will try their best to fulfill her desire, despite the fact that she may be suffering from a disease considered otherwise as indication of abortion e.g. advanced renal, hepatic, cardiac disease, or poorly controlled diabetes, or hypertension, or taking immunosuppressive drugs, or suffering from blood dyscriasis.
Hawkins and Elders in their book “Human Fertility control” emphasize that “countries with a population problem have found it politically expedient, at least tacitly, to support increased facilities for abortion. The public at large are aware that abortion is either wrong or at least a medically and psychologically unsatisfactory solution to social problems. The church is faced with the difficulty that it cannot enforce its views without losing its adherents… Few doctors are happy with those aspects of society which produce the need for abortions; fewer still are satisfied with an environment which generates defects in motivation to employ effective contraceptive measures” (7).
The majority of medical practitioners and gynecologists agree that since criminal abortion is fraught with serious complications including loss of life, then for pragmatic reasons, if abortion is to be carried out, then it should be done by a licensed professional in a safe environment. The complications of such a procedure are much reduced and the mortality of the first trimester abortion is very low indeed, especially after the introduction of anti progesterone agent e.g. RU 486 or mifepristone and misoprostol which acts successfully (90%) if given to women less than 9 weeks pregnancy (computed form LMP) (26). The morality rate of illegal abortion is around 50 per 100,000, while legal abortion in the first trimester mortality is around one to two per 100,000. In the second trimester the mortality rate reaches 40 per 100,000 (1, 5). It is claimed that globally 200,000 women die annually due to illegal abortion (6).
Abortion should not be used as a means of birth control. The social causes leading to unwanted pregnancy should be dealt with accordingly, and if need arises temporary means of contraception should be available to couples. Abortion should be limited strictly to medically indicated causes, which constitute a small proportion of abortions carried in demand and for social reasons.
Religious Aspects of Abortion
Islam, Christianity and Judaism look to procreation as an integral part of marriage. God said to both Adam and Eve in the book of Genesis “Be fruitful and increase in numbers, fill the earth and subdue it” (27).
In Islam, procreation is not only an integral part of matrimony; it is an act of worship. Even the sexual act with a wife is considered as an act of charity as proclaimed by the Prophet Mohammed PBUH (28). The Holy Quran proclaims: “O’ mankind be conscious of your Sustainer, who has created you out of one living entity, and out of it created its mate, and of the two spread abroad a multitude of men and women” (29).
“And God has given you mates of your kind, and has given through your mates children and grand children” (30). The Prophet Mohammed said to all Muslims: “Get married, beget and multiply because I will be proud of you among nations” (31). He also said: “marry the kind and fertile, for I will be proud of your numbers among other nations” (32).
Though Islamic teachings encouraged procreation within matrimonial bondage, it did not altogether prevent the temporary means of contraception. The Prophet himself (PBUH) allowed his companions to practice aazel i.e. coitus interruptus (Onanism) (33, 34, 35).
His teachings stand in stark contrast to what is mentioned in the Old Testament, the Book of Genesis. Onan, the son of Judah and the grandson of Jacob, spilled his seed on the ground to keep from producing offspring for his deceased brother when he married his widow Tamar (The Jewish teachings gave the offspring to the deceased husband if he had no children, and the lineage will not be given to the actual father). God was furious and caused the death of Onan (36).
The Catholic church holds the most conservative and stringent view point against any means of contraception except abstinence and abstention during and before ovulation i.e. using the safe period. Similarly it holds the most conservative point of view against abortion at any stage of pregnancy as human life is considered to start from fertilization. The fertilized ovum is given the status of a human being, and hence killing it by any means is tantamount to the crime of manslaughter.
In Islam, temporary means of contraception are allowed provided it causes no harm, and should be done by the mutual agreement between consorts (37). Sterilization will not be allowed except for clear medical indications, where pregnancy is going to endanger seriously the health or life of the expectant mother (37).
Similarly abortion will only be allowed if continuation of pregnancy is going to endanger the life or health of the expectant mother; or if there is proven serious congenital anomaly in the embryo or fetus. The performance of abortion should be done prior to 120 days from the start of conception, which is considered according to the Hadith (sayings) of the Prophet to be the time of ensoulment. However, if the life of the expectant mother is endangered, and not only her health, abortion or pre term delivery can be performed at any time of pregnancy to save her life. The decision of abortion should be agreed upon by three specialist physicians with clear medical indication (38-40).
This was the Fatwa (Decision) of the Islamic jurists council of Makkah Al-Mukaramah (Islamic World League) held in Makkah from 10 to 17th February 1990. However the decision was passed by the majority of votes, with abstention of the president late Shaikh Abdulaziz BinBaz and Shaikh Bakr Abu Zaid (40).
Many Islamic jurists are more stringent and would allow abortion in the first 40 days of conception (computed from fertilization and not LMP). In fact this was the official Fatwa in Saudi Arabia until the Fatwa of Islamic jurists council of Makkah extended it to 120 days from start of conception in 1990.
More conservative jurists like the Maliki School and Imam Al Gazali (from Shafii School of Jurisprudence) will not allow abortion at any time of pregnancy except to save the life of the expectant mother (41,42).
Nevertheless there are some jurists who will allow abortion for social reasons e.g. rape or where continuation of pregnancy will affect a nursing child and where a wet nurse is not available or the father is too poor to afford a wet nurse (25, 41). Prominent among those allowing abortion are Zaidi School of jurisprudence who will allow abortion for social and minor medical reasons in the first 120 days of conception (25). Some jurists of the Hanafi, Hanbali and Shafii School will follow suit with minor restrictions (25). However the majority of Islamic jurists throughout history will not allow abortion except for strong medical reasons. This arises from the respect of Islam to life. There are a lot of Quaranic ayas and Hadiths regarding the sanctity of life. “We decreed upon the children of Israel that who so ever kills a soul for other than manslaughter or corruption in the land; it shall be as if he killed all mankind, and whosoever saves the life of one, it shall be as if he saved the life of mankind (43).
The Quran deplored killing children for want or fear of want “Kill not your children on a plea of want. We provide sustenance for you and for them. Come not near to shameful deeds whether open or secret. Take not life, which God has made sacred except by ways of justice and law. Thus does He command you that may learn wisdom” (44).
“Kill not your children for fear of want. We shall provide sustenance for them as well as for you. Verily the killing of them is a great sin” (45).
Ibn Massoud (a companion of the Prophet) asked the Prophet: What is the gravest sin? The Prophet (PBUH) answered: “That you associate partners with God who created you” Ibn Massoud asked: What is next to this? And the Prophet answered “That you kill your offspring for fear of them sharing your food with you” (46, 47) (Bokhari & Muslim).
Though Muslims at large consider the embryo from its earliest stages to be living they do not give it the status of a full human life except after ensoulment. Ibn Al Qaiyim in his book Attibian Fi Aksam Al Quran brings this question by asking Does the embryo before ensoulment (breathing of the spirit into it) has a life? He answered yes, the embryo has the life of growth and nourishment like a growing plant, but once the spirit is breathed in he acquires perception and volition.” (48).
Similarly Ibn Hajar Al Asqalani discussing which organ forms first in the embryo in his volummous Fateh ul Bari says, “the liver is the first organ formed as it is the site of nutrition and growth. Voluntary movement and perception are acquired only after ensoulment” (49).
Ensoulment only occurs after many stages at which the embryo passes. The Holy Quran says: “We created man from the quintessence of mud. Thereafter, we cause him to remain as a drop of fluid (Nutfa) in a firm lodging (the womb). Thereafter, we fashion the Nutfa into something that clings (Alakah), which we fashioned into a chewed lump (Modgha). The chewed like lump is fashioned into bones, which are then covered with flesh. Then we nurse him into another act of creation. Blessed is God, the best of artisans” (50).
All the ulema and commentators of the Holy Quran agree that the other act of creation mentioned above is the time of ensoulment where the spirit is inspired into the body of the fetus.
The Hadith (sayings) of the Prophet narrated by Ibn Massoud “The creation of each one of you is collected in the womb of his mother in forty days. And something that clings (Alakah) he becomes for forty days, and then he becomes Modgha (a chewed lump) for forty days. The angel is sent to him and the angel writes four things: his provision (sustenance), his life span, his deeds and whether he will be wretched or blessed. Then the spirit is breathed into him”.(51,52) (AlBokhari, Muslim, others).
This simply means that ensoulment occurs at 120 days computed from the beginning of conception. However there is another Hadith narrated by Huzaifa Ibn Aseed which made some ulema (jurists of Islamic nation) decide that forty days computed from the beginning of conception is the line of demarcation and the beginning of human life.
“When the Nutfa enters the womb and stays there for 42 nights, God sends an angel to give it a form and create its hearing, sight, skin, bone and flesh. Then the angel asks, “O God is it a boy or a girl ? and God determines whatever He decides. He then asks what is his livelihood and God determines (Muslim) (52).
It is interesting to note that organogenesis (i.e. formation of organs in the embryo) takes place between the 4th and 8th week of conception (computed from fertilization) and reaches its zenith at 42 days. The embryo has unidentified gonad until that period after which the gonad differentiates into either a testes or an ovary. Similarly the brain stem forms and starts to function in an embryo of 42 days. However the higher functions of the brain are still forming and the cerebral cortex does not have synapses with the lower centers except at the beginning of the 20th week computed from last menstrual period, which is equivalent to 120 days computed from fertilization (viz beginning of conception). Dr. Koren J. presented a paper in the conference on Ethics of organ transplantation in Ottawa, Canada August 20 – 24, 1989, in which he proved with dissection of many aborted fetuses that synapses between the higher centers of the cerebrum and the lower centers does not start to work except in the beginning of the 20th week of pregnancy computed from the LMP which is equivalent to 120 days computed from moment of conception (fertilization) (53).
It is evident that both sayings of the Prophet Mohammad (PBUH) speak of different times of development of the CNS of the fetus, the Hadith of 42 days refers to the development and functioning of the brain stem, while the Hadith of 120 days speaks about the higher centers and its control over the lower ones in the CNS.
There are a lot of Hadiths (sayings of the Prophet Mohammed PBUH), which
assign to the conceptus an important status that gradually increases, with the time of pregnancy. If a lady commits a crime punished by the death penalty, then the fulfillment of the penalty is postponed until delivery and nursing of the baby for two years, or if a wet nurse is available for a much shorter period. This applies even if the pregnancy is illegitimate (21, 25, 41, 54).
The fetus has the right of lineage of his father, and if his father dies while he is in utero, his share of the inheritance will be kept for him/her until delivery.
Killing the fetus intentionally or unintentionally is penalized by paying 1/20 of the diyha (blood fine), which is equivalent to 500 golden dinars. There is another penalty to be decided by the magistrate for intentionally induced abortion (25, 41, 54).
Sheikh Mohmoud Shaltout (grand Imam of Al Azhar in the forties and early fifties of the 20th century) wrote: “ Old scholars are agreed that after quickening takes place (120 days of conception), abortion is prohibited to all Muslims, for it is a crime perpetrated against a living being. Therefore blood ransom is due if the fetus is delivered alive and then dies immediately after delivery, and ghorra ( 1/20 of the diyah) if delivered dead.” (Shaltout Islam: creed & Law) (55).
Imam Ghazali (died 505 H = 1122 CE ) in his well-known book Ihyia Oloom addin considered abortion at all stages of conception to be Haram (prohibited), with a gradation of the sin along with the advent of pregnancy. It is tantamount to manslaughter if he is delivered alive and then dies because of the abortificient act or drug. However, he recognized that the abortion of Nutfa (at 40 days) is much less of a crime than the abortion of Alakah (40 to 80 days), which is less than the abortion of Modgha (80 to 120 days). It becomes a full crime after ensoulment i.e. after 120 days. In his opinion, abortion should be avoided at all stages of pregnancy except if the life of the expectant mother is endangered (25, 41,54).
Muslim physicians like Abubaker Al Rhazi (died 313 H/925 CE) mentioned in his book Al Mansouri and in his encyclopedic Al Hawi many abortificient drugs and methods to be used if continuation of pregnancy is going to endanger the health or life of the expectant mother. Similarly Ibn Sina (Avicinna) wrote in his well known (Al Kanoon fi Tibb) a chapter on medical indications of abortion and how to perform it (25).
I think that their recognition of the need of abortion in certain cases where continuation of pregnancy is going to endanger the health or life of the expectant mother, is more realistic and humane than the stance of the church in medieval Europe, and the Catholic church up to this moment.
Abortion on demand, as carried out in many countries, which liberalized abortion laws, will never be condoned by Shariah (Islamic Law). Unfortunately Tunisia passed a law 65/24 dated 1st July 1965, which allowed abortion for tenous reasons. It became worse when the law no. 73-75 dated 19th November 1973 came into effect. It allowed abortion on demand in the first trimester of pregnancy, and on tenous reasons in the second half of pregnancy (25).
It is the only Muslim country with such a law defying all the recognized Fatwas from all Islamic Jurists and Islamic jurists conferences and meetings. Turkey allows abortion with some restrictions i.e. there should be some medical or social reason. The rest of the Islamic countries will allow abortion either to safeguard the expectant mother from serious squeals of pregnancy endangering her health or her life. Many have recognized abortion for a seriously malformed embryo or fetus. The time limit for carrying such abortions is 120 days computed from fertilization which is equivalent to 134 days from the LMP (25,41).
1. Potts M, Diggory P: Textbook of contraceptive practice. Cambridge University ress, 2nd edition, 1983: Abortion pp 274-367.
2. Clayton S, Newton J: A Pocket obstetrics, Churchill living stone, Edinburgh, London & New York, 8th edition 1976 pp 35.
3. Encyclopedia Britannica, 15th edition, 1982, vol. 2: 1069-1072.
4. Benson R: handbook of obstetrics and Gynecology. Lange medical publication, Middle East Edition, Lebanon, 6th edition, 1977 p 260.
5. Bennett M: Abortion in Hacker N, Moore J.G.: Essentials of obstetrics and Gynecology, 3rd edition, Saunders Co. Philadelphia, 1998 pp 477-486.
6. Guilleboud G. The Pill. Oxford University Press, Oxford. 3rd edition, 1987:15.
7. Hawkins D, Elders M: Human Fertility control, Butterworths, London, 1979: 237-260.
8. Time magazine, Aug 6, 1984.
9. News week December 10, 1979 p 29.
10. Goto A, Fujiyama-Kiriyama C,Fukoo A etal: Abortion trends in Japan 1975-95 Stud Fam Plann 2000 ,31,(4):301-8.
11. Kovasc L: Abortion and contraceptive practice in Eastern Europe Int J Gynaecol Obstet 1997 ,58, (1): 69_75
12. News week July 17, 1989: The Future of Abortion pp 32-40.
13. Straburger V: Sex, Drugs, Rock “N” Roll. Understanding Teenagers
Behavior. Pediatrics (supplement), 76, (4), Oct 1985: 659-663.
14. Time magazine, cover story: Children having children, December 9, 1985: 28-31.
15. Tindall VR: Jeffcoats Principle of Gynecology. Butter worths, London, 5th
16. Kaufman R, Spitz A , Moris Letal: The Decline in US Teen Pregnancy Rates 1990- 95 Pediatrics 1998,102,(5) :1141-7
17. Henshaw SK: Abortion Incidence and Services in the US, 1995-96 Fam Plann Perspect 1998, 30: 263-270 and 287.
18. Tifts: Curse Heaven for little girls. Time magazine Jan 4, 1988:46-47.
19. Ibrahim M.A: what to do with excess fertilized ova? (Arabic) and discussions 3rd Symposium on some medical practices, April 18, 1987. Islamic organization for medical sciences, Kuwait, pp 450-455 and 666-678.
20. The complete works of the 3rd meeting of the International Islamic jurists
council OIC, October 11-16, Amman, Jordan vol. 1, pp 425-515.
21. Hathout H: Topics in Islamic Medicine. Islamic Medicine Organization,
Kuwait, 1984 pp 93-135.
22. Ahmed W.D: Oath of Muslim Physician JIMA, 1988, 20:11-14.
23. Phillips M, Dawson J: Doctors’ Dilemma, The Harvester Press, Brighton (G.
Britain), 1985, Appendix: The Declaration of Geneva pp 211.
24. ibid pp 45-49.
25. Albar M: Policy and methods of Birth control (Arabic: Siyasat wa wasayil
Tahdid Annasl) Al Asr AlHadith Publication, Beirut 1991, pp 119-123.
26. Jian J, Meckstroth K,Mishell D:Early pregnancy termination with intravaginally administered moistened misoprostol tablets. Historical comparison with mifepristone and oral misoprostol . Am J Obstet and Gynecol 1999,(6) :1386-91
27. Holy Bible, Book of Genesis 1:27,28. New International translation, Hodder
and Stroughton, London, 1980.
28. Muslim: Sahih Muslim Bishareh Al Nawawi, Dar Al Fik, Beirut, 2nd edition,
1972, Book of Zakat vol. 7:92.
29. The Glorious Quran Sura 4, Al Nisa (women), aya 4.
30. ibid Sura 16, Al Nahil (The Bee), aya 72.
31. Ibn Maja: Sunan Ibn Maja, Cairo, Matbaat Issa Al Halabi, (No date
mentioned), Kitab Al Nikah, 8.
32. Ahmed ibn Hanbal: Musnad Ahmed. Comment by Ahmed Shakir, Cairo, Dar Al Maarif (nd) vol. 3:158,245; vol. 4:349,351.
33. AL Bokhari M: Al Jamie Al Sahih, Cairo, Maktabat Al Nahda Al Haditha
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