Texas or Iran? US and Middle East Abortion Policy Contextualized

Though the right-wing effort to erode Roe v. Wade has been ongoing for years, the enactment of Texas’s “Heartbeat Bill” on September 1st has driven many reproductive rights advocates to move to solidify access to abortion across the nation as concern about the United States’ ability to provide adequate reproductive health care has reached a critical point. 

Reproductive care, including abortion, is championed by the UN’s 1994 International Conference on Population and Development (ICPD) Programme of Action as an integral part of securing women’s freedom and equality globally. It is well-documented that restrictive abortion laws do not reduce rates of abortion. Rather, the academic body of evidence overwhelmingly affirms a direct association between restrictive abortion law and unsafe abortion procedures, increasing maternal mortality by an average of threefold in relevant states. For these reasons, the UN Human Rights Council recently condemned the “Heartbeat Bill” and called on judicial authorities to strike down the policy.

Consequently, laws such as those passed in Texas, Alabama, and Georgia in recent years have the US falling behind in reproductive health on an international scale. The near-total bans on abortion, which have been proposed, passed, and/or implemented in many US states, leaving millions of American women with less access to the procedure than even those living in the Middle East and North African (MENA) region, where inequity of women is acknowledged by prominent international organizations as a barrier to regional social advancement and international development. 

With the recent developments in Texas, abortion care is now more available for women in Saudi Arabia, which allows the procedure  “in cases of rape, incest, fetal impairment, or risk to the woman’s mental or physical health,” than for those in the United States’ second-most populous state. In fact, around half of the Muslim-majority countries in the MENA region allow abortions in more instances than ascribed in bills approved in Texas, Alabama, and Georgia and in the process of hitting the floor of state legislatures across the United States. 

However, factors beyond policy remain integral in women’s access to safe abortion care, both within the US and in the MENA region. In practice, economic disparities, social factors, and conservative physicians continue to be a barrier to these procedures even in instances when they are legal. In Turkey and Tunisia, for example, where progressive religious interpretations have legalized abortions at a woman’s request throughout the first trimester, budgetary cuts to their public health systems have decreased access to safe abortion for those who cannot afford it. Even in US states where abortion is legal and accessible, “psychologically coercive and assaultive” fake abortion clinics propagated by anti-abortion activists prove to be a substantial threat to women’s informed reproductive decision- making. 

In instances when illegal abortions are undertaken, punitive measures vary drastically between US states and the most restrictive MENA countries. Per Alabama’s “Human Life Protection Act,” doctors convicted of performing an illegal procedure can face  a punishment of up to life imprisonment. Conversely, doctors in Iran, a country that  has similarly incorporated religiously conservative ideology into its policy, would face a maximum sentence of five years for the same offense. 

The role of religion is notable in both the upsurge in and manifestation of restrictive abortion policies in the US and policies— both restrictive and progressive— codified in the MENA region. Evangelical Christians, who have long played a key role in rallying for the anti-abortion policies cropping up in the US, generally profess belief in the notion that life “begins at conception” and should thus be protected from then on. Muslims, on the other hand, largely prioritize the life of the woman over that of the fetus, which reaches ensoulment 40-120 days after conception, and do not typically distinguish the “personhood” of said fetus from the woman. In an interview with Haaretz, Sherine Hamdy, a medical anthropologist specializing in contemporary Islam at Brown University, confirms the general acceptance of this belief by Islamic scholars, referencing the following passage of the Hadith, a major source of religious guidance in Islam outside of the Quran:

“Every one of you is collected in the womb of his mother for the first 40 days, and then he becomes a clot for another 40 days, and then a piece of flesh for another 40 days. Then Allah sends an angel to breathe the soul into his body.” (Hadith 4:549)

While seeking an abortion is generally socially opposed throughout both the United States and MENA countries, such stigmatization is becoming codified in the US. What are seen as “accountability” measures by anti-abortion proponents are being written into laws like the “Heartbeat Bill,” where cash incentives are offered to members of the public who successfully sue care providers and anyone seen as having assisted an abortion. This method of punishment pushes beyond de facto social stigma and justifies legal avenues for any anti-abortion proponent to ensure the newly enacted Texas bill is utilized to punish defectors to the greatest extent.

Broadly, neither US nor MENA abortion policies are “good for women,” if we define this statement as consistent with minimizing maternal mortality rates and maximizing health, well-being, and reproductive empowerment for women and girls. What separates the abortion debate between experts and activists within the US and the Middle East is the trajectory of the regions’ respective political agendas. As Freedom House writes on the “notable progress achieved” in the MENA region with regard to women’s rights in recent years, conversation on US reproductive health policies by leading research organizations like the Guttmacher Institute tends to emphasize the regressive nature of projected US policies. While policy directives like the ICPD are not perfect, their research-backed guidance should steer the development of changes in reproductive policies internationally, from Texas to Iran.

Author’s note:

While the verbiage in this article uses “women” to refer to pregnant people and those seeking termination of pregnancy, the author would like to note her recognition of the identities of all pregnant people who may or may not identify as women. The term “women” has been used in this instance to coordinate with verbiage of international organizations and policies which form the predominant body of literature on the topic of reproductive health care access.

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