BY Nana Abuelsoud
“If we think of abortion as a choice, we have to understand the circumstances and the number of options a woman was given before calling her abortion ‘a choice’.”
I met with two Egyptian women* who had an abortion in Cairo. They drew from their experiences to imagine what post-abortion care[1] (PAC) would look and feel like if they, for a moment, forget about what it means for women to face an unwanted pregnancy in Egypt.
The first woman I met with; I will call her Sara, is 27 and had her abortion at the age of 25.
“The thing with the law is that it doesn’t change the attitudes and behaviours of service providers overnight, but it somehow lifts the un-welcomed feeling of fear. The fear of all possible scenarios; me dying aborting or going to prison if my very illegal act was discovered.
“Three months after my abortion, I broke down. I wrote a letter to that fetus and shared it with a friend who had undergone abortion herself. My friend said the letter had given her room to grieve and be sad. It validated her right to mourn. I lost a good part of my tenderness after this experience. I felt my world should pause for me to grieve, but it didn’t. I still had to work through everyday and I had a rent to pay.”
I asked Sara what she wished people around her had done to make her experience a little more bearable. “You know, I get that owning my body is badass and all great; making informed decisions is awesome, but my abortion was not any of that! Friends and partners should understand abortion isn’t easy. They should be patient with my feelings of loss. Friends should make room for abortion’s collateral emotional damage.”
Institutional PAC emerged as Sara revisited her experience. “Well, as you know we don’t have abortion pills here; we use other meds to induce abortion. When my pregnancy test came back positive, I went to see a gynecologist who prescribed me chemotherapy meds [to induce abortion] without even asking for my medical history. She didn’t check later if my procedure went ok. If I were to design a systematic PAC, it should include leads on psychological care, post-abortion consultation and nutrition.”
Then I met with Farida who is 25 and had an abortion five years ago. Her abortion was different. She didn’t know where to go for a prescription, instead, she reached out to her friend’s mother who open-mindedly gave her two abortion pills. Even though the majority of her friends are physicians; Farida was afraid to ask for help, “I felt ashamed to tell my friends I was going to have an abortion. They knew I was sexually active but that changed nothing.” She dealt with so much anxiety that she underwent a herbal abortion, as well. “I was alone in this.” Farida further explained, “Every time my friend and her mother checked on me, I assured them I was doing just fine. I felt as though if I died bleeding, I deserved it. Or at least, that’s what my 20-year-old self thought.”
Farida couldn’t help but think of her abortion as she stood by her cousin while she was having hers, shortly after she relocated to a western country. “My cousin had her boyfriend, myself, and her friends. It was the moment I stopped blaming myself.” A year later, Farida told her friends about her abortion. They were angry she had gone through all of this alone. She risked her life because she feared she would be stigmatized.
I asked Farida about community care. “It’s burdening having people pity you or go overboard with empathy with reactions such as “oh my God, I’m so sorry.” Instead, something along the lines of, “If you need support or anything, I’m here for you” would have been better. While well-intentioned, these reactions of pity sound as though folks want to help; but they carry an impression that you’re not sad “enough”.” For Farida, “care” means someone is present and available during such a personal experience.
In speculating about what systematic PAC could be, Farida listed: accurate scientific information, psychological support and a safe environment. “When my cousin had her abortion, her room had many windows with sunlight penetrating, not in the dark in the middle of the night, in Cairo’s outskirts. A person undergoing abortion better feel the outside world doesn’t exist for this one moment.” Farida also thought consultations should provide all available options (medical/clinical abortion), including pre-and post-abortion check-ups. Specifically, post-abortion check-ups that make you feel looked after. “When you schedule a post-abortion check-up appointment, it reminds you that life goes on … you’re no longer stuck in that moment and living hour-by-hour, as I felt in my experience.”
Sara and Farida reminded me that we all experience things differently. Community care for each of them carried different meanings, similar but not exact. More often than not, policies are not thought of and implemented based on women’s experiences, in all their diversity. Changing the law would uplift an unnecessary feeling of fear, which Sara experienced and Farida navigated in the dark, anxiously. However, when advocacy relies solely on legislation, we replicate past failures.
Female Genital Mutilation (FGM)[2] has accentuated this equation and its imbalances. I take this chance to reflect on how our realities could be changed, and to learn from past advocacy efforts, by setting FGM as a reference to guide advocacy on abortion. This is not to belittle the magnitude and the essence of advocacy to devise an accountability process that does not intrinsically lead to more human rights violations (legislation), nor undermine the indispensable nature of guaranteeing access to accurate information through awareness raising actions (or community storytelling). Rather it is a call to draw a parallel advocacy line sensitizing health care providers simultaneously. Health care providers who, based on the FGM collective experience, have not shifted their behaviours and attitudes since 2008 [3].
Women’s autonomy and bodily integrity are predominant in the fights to secure access to safe abortion, access to contraception, and unequivocal agency over one’s own body and sexual expression. More often than not, those fights solicit resources to raise awareness and lobby for policy change. On one side, knowledge is emancipation. On the other side, rights-oriented legislation guarantees social justice, and somewhere in the middle, service providers and those who enforce the law are overlooked.
As individual advocates and active groups, we prioritize issues differently. Yet all issues are interconnected. It is inefficient to just legalize safe abortion and wait a decade to realize we should have worked with those who deliver the services, as well.
*These interviews are meant to capture the thoughts and feelings of the persons who lived them before, during, or after an abortion. They are meant to remind us that everyone’s experience is unique and that they don’t speak to or represent all the wide ranging experiences with abortions.
[1] Post-abortion care, a term originated by Ipas in the early 1990s, is an approach for reducing deaths and injuries from incomplete and unsafe abortions and their related complications. Post-abortion care is an integral component of comprehensive abortion care and includes five essential elements: Treatment of incomplete and unsafe abortion and complications. Counseling to identify and respond to women’s emotional and physical health needs. Contraceptive and family-planning services to help women prevent future unwanted pregnancies and abortions. Reproductive and other health services that are preferably provided on-site or via referrals to other accessible facilities. Community and service-provider partnerships to prevent unwanted pregnancies and unsafe abortions, to mobilize resources to ensure timely care for abortion complications, and to make sure health services meet community expectations and needs.
[2] 77 percent of girls who have undergone FGM/C were cut by a medical professional. (https://www.unicef.org/media/files/UNICEF_FGM_report_July_2013_Hi_res.pdf)
[3] On 16 June 2008, FGM was outlawed in Egypt. https://www.28toomany.org/static/media/uploads/Country%20Research%20and%20Resources/Egypt