The politicization of abortion and hippocratic disobedience in Islamist Sudan

Abstract

In Sudan's Islamist state, abortion is politicized through its association to illegal pregnancy. Fornication is crime against God punishable with 100 lashes. Pregnancy outside a marriage contract constitute sufficient evidence of the woman's immorality. This enables a strong link between the crime of fornication and the crime of illegal abortion, to the extent the terms interchangeably in the Sudanese context. While abortion does not appear in the domestic political debate on women's reproductive and maternal health and is not on the agenda of the women's movement, it is politicized in the implementation of law in government hospitals. There are a number of bureaucratic barriers in place to prevent illegal abortion alongside a strong police presence outside maternity wards in government hospitals. Honoring the hippocratic oath, doctors disobey state policy, refraining from reporting illegal pregnancies to the police to protect unmarried and vulnerable women from prosecution.

Introduction

Unsafe abortion is one of the leading causes of  maternal mortality, and abortion-related maternal  deaths are generally higher in countries that restrict women’s access to induced abortion. In the  Middle East and Northern Africa (MENA) region,  only Tunisia and Turkey have legalized abortion on  demand during the first trimester.  Most abortion  laws in the region are punitive, and legal services  are restricted. In Sudan’s Islamist state, induced  abortion is a crime except when performed to save  the pregnant woman’s life, if the fetus has died in  the woman’s womb, and in cases of rape.

In this article, we explore the political dynamics driving the criminalization of abortion in  Sudan and its effects on women’s access to abortion-related care in Khartoum. The criminalization  of abortion forms an important part of the Islamist  government’s restrictive ideological stance on  women’s sexual and reproductive rights generally.  Sudan has not ratified any international or regional  conventions protecting women’s human rights.  Abortion is a particularly sensitive area within  maternal health and reproductive rights because it  is mediated through the crime of zina (sexual intercourse before and outside of marriage). Sudan is  unique in the MENA region, for pregnancy among  unmarried women is considered sufficient evidence  for the crime of zina as outlined in the 1991 Criminal Code.This enables a strong link between the crime of fornication and the crime of illegal abortion, which shapes politicization in peculiar ways. The prevailing sentiment among Sudan’s Islamist  officials is that the primary purpose of women is  to marry and to produce children—and as long as  reproduction takes place within marriage, there is  no need for abortion except under special circumstances. According to this view, only unmarried  women who get pregnant illegally would seek abortion in order to “hide” the evidence of fornication.

The scarce available research on abortion in  Sudan suggests that the high rate of unintended pregnancy, combined with the country’s restrictive abortion law and social stigma, forces women to seek illegal and unsafe abortion, often in secrecy 
from their families. While women who can afford  it are able to access safe illegal abortions in the  private market (where they may purchase misoprostol), women with lower socioeconomic status  must resort to unsafe illegal abortions, which can  often lead to complications and the need to seek  emergency care at public hospitals.

Based on original data collected through fieldwork between 2011 and 2019, we have found that  although abortion does not appear in the domestic political debate on women’s reproductive and maternal health and is not on the agenda of the Sudanese women’s movement, it is politicized in the  implementation of the law. We understand politicization as the politically contested implementation  of a law. Our findings indicate that bureaucratic  barriers and policies prevent and deter illegal abortion, which is politically and socially viewed as  intrinsically linked to illegal pregnancy. These barriers, which contravene women’s human rights to  health, dignity, and security, are found primarily in  public hospitals, where there is an increased police  presence outside maternity and emergency wards.  Thus, unmarried women in search of lifesaving  treatment find themselves under surveillance the minute they enter a hospital building unaccompanied by a male guardian. 

The women who seek emergency medical care  because of complications after an illegal abortion  are at the mercy of doctors in terms of whether they  will be reported to the police. We coined the term  “Hippocratic disobedience” to capture the subtle and often hidden ways in which Sudanese doctors  disobey state policies to protect a vulnerable group  of unmarried women from prosecution. They do so  at great personal risk, and often against their own  personal beliefs that abortion is haram (forbidden)  in Islam and that fornication is morally wrong. 

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