The Complexities Of Abortion Laws In Afghanistan: Navigating Cultural And Religious Norms

Abortion is illegal in Afghanistan unless the mother's life is in danger or the child will be born with severe disabilities. In these exceptional cases, a certificate from a doctor for internal medicine and permission from the Shura Ulama, the religious council, must first be submitted. In all other cases, abortion is illegal and can result in imprisonment or a fine. Despite the law, abortions are becoming more widespread, and the number of women resorting to illegal, unsafe abortions is consistently growing.

Abortion to save the mother's life

Abortion is illegal in Afghanistan, except when the mother's life is at risk. In such cases, the law states that the person performing the abortion will not be punished.

Afghanistan has one of the highest fertility rates in the world, with very few women actively using contraceptive methods. The average woman in Afghanistan had 8 children throughout her lifetime in the 1990s, which decreased to 6.3 in the mid-2000s and 5.1 by the end of 2010.

Despite these high fertility rates, abortion is forbidden by law in the Islamic Republic of Afghanistan. An "induced termination of a pregnancy" is only permitted when there is evidence that the mother's life is in danger or that the child will be born with severe disabilities. In all other cases, abortion is illegal and can result in imprisonment or a fine.

Even in cases where abortion is legal, women face several barriers to accessing safe procedures. Religious ethical committees must first rule on the ethics and legality of the abortion, after which the woman must obtain approval from a gynecologist, three general practitioners, a counselor, and a doctor.

Due to these restrictions, women often pursue abortions through illegal means, such as untrained midwives or expensive private clinics. This can be difficult for women, as they typically do not have jobs outside of taking care of the house and family.

Afghanistan has one of the highest maternal mortality rates in the world, with a lack of post-procedure care contributing to this issue. International aid workers are working to improve the safety of abortion procedures by educating midwives and nurses on how to better care for their patients and reduce mortality.

Abortion in cases of foetal disability

Abortion in Afghanistan is a highly restricted and stigmatised procedure, with the country's legislation on the topic being heavely influenced by Islamic law. According to the Penal Code, abortions are illegal unless the mother's life is at risk or the baby is born with severe disabilities. In rare instances, abortions are permitted if the mother is too poor to raise the child, but this is decided by a religious council.

Abortions are also allowed if the baby's life is endangered, which is interpreted as the baby having a severe disability or low quality of life. However, abortions are not permitted in cases of rape or incest.

Abortions can be performed by a medical doctor, surgeon, pharmaceutist, or a nurse, but only to save the life of the mother. If the abortion is carried out for any other reason, the medical professional will be punished to the maximum extent of the law.

Abortions are a leading cause of maternal mortality in Afghanistan, with many women resorting to illegal and unsafe procedures. The high maternal mortality rate is due to a lack of post-procedure care and unsafe abortions.

Abortion in cases of poverty

Abortion in Afghanistan is a highly restricted and stigmatised procedure, with women facing severe punishment from their families and society if they undergo a termination. It is also illegal in most cases, with the Afghan Penal Code imposing sentences of imprisonment and fines on those who perform abortions. However, in rare instances, abortions are permitted if the woman is deemed too poor to raise a child. This judgment is made by a religious council, and councils in Taliban-controlled areas are more likely to justify abortions on the grounds of poverty.

Afghanistan has one of the world's highest birth rates, and the average woman has between five and seven children over the course of her lifetime. The country also has a high level of poverty, and many families struggle to support large numbers of children. As a result, some women seek abortions as they feel they cannot afford to raise a child. However, as abortions are largely illegal, women often have to fund the procedure themselves, which can be difficult as it is not socially acceptable for women to work.

Abortion services are provided by private clinics and untrained nurses and midwives, and can be expensive. As a result, some women are forced to carry their pregnancies to term, even if they feel they do not have the financial means to raise a child. This can lead to further poverty for families and a higher dependency on aid from other countries.

The high rate of illegal abortions in Afghanistan has also led to an increase in maternal mortality, as many procedures are unsafe and carried out by untrained practitioners. International aid workers are working to improve the safety of abortions by educating midwives and nurses about how to properly perform the procedure and limit mortality.

Stigma and honour

Abortion is a highly stigmatised practice in Afghanistan, and women who undergo the procedure are often socially ostracised. Abortion is illegal in Afghanistan unless the mother's life is in danger or the child is born with severe disabilities. In rare instances, abortions are permitted if the woman is deemed too poor to raise a child, but this decision is left to a religious council.

Women who have abortions in Afghanistan are often shamed and punished by their families and communities. Abortion is seen as a "blot on a family's honour", and women are often beaten, have their heads shaved, and are socially ostracised. In some cases, women are killed by their parents for having an abortion.

The stigma surrounding abortion in Afghanistan is so strong that even staff at abortion clinics oppose the procedure. One clinic cleaner said:

> I don’t agree with abortion. I think the midwives and doctors are making a big mistake. God will never forgive them.

However, some women who have had abortions have expressed relief at being able to access the procedure. One woman said:

> The honour of these girls is more important than religion. If I don’t do anything for her, it will be shameful for her family. They might kill her.

The taboo surrounding abortion in Afghanistan is so strong that women often have to resort to illegal and unsafe procedures. These procedures are often performed by untrained nurses in private health clinics.

Post-abortion care

• Treatment of complications of induced and spontaneous abortion (miscarriage)
• Counselling to identify and respond to a woman’s health needs
• Provision of contraceptive and other sexual and reproductive health services
• Community mobilisation to increase awareness and address PAC-related misconceptions and stigma

In Afghanistan, PAC is rarely provided and often of poor quality, particularly in humanitarian settings. A 2018 study identified the following barriers to accessing PAC:

• Cost
• Distance to the health facility
• Need for male accompaniment to seek care
• Perceived and actual quality of care
• Stigma and shame

Despite these barriers, community members expressed willingness to help women receive PAC.

To improve access to PAC in Afghanistan, the following actions could be considered:

• Addressing the supply chain problems causing stockouts of essential medicines and supplies
• Ensuring that health workers do not request formal or informal payments for PAC services
• Reducing indirect costs and ensuring that services are free
• Improving the quality of care at health facilities
• Addressing stigma and bias among health workers to ensure respectful care
• Community engagement, including with men, to address perceptions of the health facility and reduce the spread of incorrect information about quality and cost of care
• Community engagement to address abortion stigma, among women, their families, and communities

It is important for the Ministry of Public Health and its partners to prioritize addressing these barriers to ensure that women have access to critical life-saving PAC.

It is normal to experience some vaginal bleeding and cramping for a few days to a few weeks after an abortion. To relieve discomfort, you can take over-the-counter painkillers and apply a heating pad or hot water bottle to your abdomen. You should also change your sanitary pads every 4 to 6 hours and avoid using tampons or putting anything else into your vagina for at least 2 weeks.

It is important to look out for signs of infection, such as fever, foul-smelling vaginal discharge, or abdominal pain that is different from cramping. If you experience any of these symptoms, contact your healthcare provider immediately.

Most people can resume normal activities the day after the procedure, but you should avoid strenuous exercise or any movements that trigger pain for the first few days. If you received oral relaxation or narcotic pain medications, do not drive for 8 hours afterwards. If you received intravenous (IV) medications, do not drive for 24 hours.

It is also important to start using birth control right after your procedure, as it is possible to get pregnant again even before your normal period resumes.

Frequently asked questions