Abortion: Why Egypt's children are being dumped on the streets

CAIRO - "I would rather kill myself than tell my parents that I was pregnant," says Sara*, 26, as she wipes tears from her large hazel eyes.

"It was two years ago, I had not confessed to anybody yet that I had had an abortion," she tells Middle East Eye, sitting on the broad plush sofa on her terrace.

"I have not told anyone. Not my family, not my closest friends, nor even my boyfriend. Otherwise he would have just treated me as a slut who deserves all that. We cannot talk about it; it's such a taboo ... But if you are a bit resourceful, you can find ways."

Sara went through a long list of steps in order to have an abortion. She had to make more than 30 phone calls to various pharmacies to try to obtain antimalarial medicines known to cause miscarriages.

"But pharmacists are well aware of the side effects and refuse to sell them without medical prescription."

There were also unsuccessful attempts to search on Google for an "acceptable" clandestine clinic. Sarah checked a website called Women on Waves that provides information for women seeking abortions in countries where the practice is illegal.

Via the black market, she ordered misoprostol, a treatment used for gastric disorders, which if taken in large quantities, can cause lethal contractions to any intra-uterine life.

"I decided to operate my own abortion," she says. "I imported the medicine from India by DHL. It cost me 80 euros, plus 135 euros for postal charges, plus a bribe of 200 Egyptian pounds [23 Euros] to the postal centre."

New waves of tears stream down her cheeks.

"I was living with my uncle. I did not even have a room of my own," she sighs. "I took the first salvo of pills. A few minutes later, I started having cramps ... It was like introducing a speculum and having it wide open. It was an indescribable pain," she whispers.

"I started bleeding, enormously ... My family was in the next room. I screamed in pain, pretending I had painful menstruation. But I wavered. My aunt called the emergency pharmacist. He made several tranquilising injections. The only thing I thought was: hopefully he wouldn’t realise ... He understood, but he didn’t utter a word. I think he didn't have the strength to denounce me to my family and therefore face their insults - until they too realised that I was trying to carry out an abortion in their bedroom."

The taboo of unwanted pregnancy

In Egypt, where the practice is shrouded in total secrecy - and the statistics are in fact impossible to conduct - many women each year resort secretly to abortions.

Abortion, considered illegal unless there is an imminent threat to the mother’s survival, is punishable by three years in prison, and up to 15 years for anyone providing assistance with medical skills.

"There is not a single figure on the number of abortions performed in Egypt. How do you quantify something illegal, carried out under such secret conditions?" asks Dahlia el-Hameed, head of the defence of sexual rights unit at the Egyptian Initiative for Personal Rights (EIPR).

"Abortion is as common as it is forbidden," said Iman Bibars, head of the Association for the Development and Enhancement of Women. "But it's a taboo subject on all levels! From a religious perspective, you are considered a whore, and from a legal point of view, you are a criminal. Then comes the social pressure, which is surely the worst," adds Bibars, a committed feminist.

In 2000, 11 percent percent of Egyptian women admitted having had an abortion, according to a study conducted by a dozen doctors and compiled in the report "Egypt Demographic and Health Survey".

Also, 19 percent admitted to have had unwanted pregnancy. Theses figures are certainly old, but they are valuable, given the omerta that hangs over this issue.

"Abortion and unwanted pregnancy are indescribable taboos," says Dr Mohamed Harby, responsible for the birth unit at the family planning section in Cairo. 

"The problem is that there is a demand for abortion and the fact of not having a [legal] framework encourages women to carry it out illegally, through drugs purchased from the black market or in health clinics that have serious hygienic issues."

"We try to force the authorities to rethink the legislation, at least on the issues of prevention and contraception, but the meetings held at the Ministry of Social Affairs are attended by sheikhs who strongly oppose this idea. They believe that every woman must respect God’s will. If you become pregnant, it is Allah’s will. Even if the child to be born appears to be deformed or has diseases," the doctor explains.

"In our society, it is unthinkable for a woman to say she does not want the child she carries," says Hala Masr, a young pro-choice activist who is trying to raise awareness through social networks.

"It is considered haram [religiously forbidden] to spit on a pregnancy; women are constantly under pressure," she explains. 

"We are in a society that is male-centered. A woman's body belongs to the society. It belongs to a father, a brother, then to a husband or a brother-in-law in case of the death of the husband ... Having a premarital sexual relationship is sacrilege, so no need to say what being pregnant would be. And wanting an abortion?" 

"So, women resort to many tricks, such as drinking boiled Coca-Cola, introducing hangers into their uterus or getting beaten up," Masr says.

"This is due to the fact that women’s moral independence and their ability to make choices for themselves are not integrated. Additionally, it's quite ironic that there is no word in Arabic to define the concept of 'pro-choice,' because in our language, taboos don’t have names."

A difficult prevention

Indeed, instead of declaring their open support for any struggle for the right to abortion, many organisations are denouncing the difficulty of promoting contraception and prevention related to sexuality.

"People accuse us of promoting decadence, extramarital sex and prostitution," says pediatrician Hanna Aboulghar.

Aboulghar is a founder of Banati association, an organisation that helps street children, especially girls.

"The issue is not subject to discussion in our society today," says Dr Asfar*, who works for a humanitarian organisation, speaking on the condition of anonymity. 

"If we allow abortion, this will mean in people’s mind, allowing libertarian practices," the doctor tells MEE.

"It is a real burden. Yet the government is well aware of the problems cause - homemade abortions that go wrong, a very significant abandonment rate, hidden pregnancies and brutal deliveries resulting in the death of the baby, and sometimes the mother. You have no idea how many newborns are found dead in dustbins."

Stuck between a rock and a hard place

For some women who do not have the resources to pursue a secret abortion or feel that they are too unsafe, they choose to hide their pregnancy and abandon the baby at birth.

"Some make the deliberate choice to hide their condition rather than have an abortion because you have to see the circumstances under which abortion is practiced. In dirty clinics with doctors who sometimes are not real doctors, or midwives and nurses informally trained, without equipment," described Bibars.

Some women also mentioned a droit de seigneur - traditionally a "right" claimed by a feudal lord to have sexual relations with the bride of a vassal on her first night of marriage - that is sometimes practiced by doctors on patients who filed for abortion.

"For me, it was inconceivable to go to a clinic," says Sarah, "for I don’t want to get on my knees to give a blowjob to the doctor. The guys must say: anyway, she is a slut, so why would she hesitate. And many girls do it, because the pressure caused by a pregnancy is stronger than such acts."

"Hiding your pregnancy is as common as having an abortion, it seems to me," says Bibars. "In a country with a very dominant Islamic culture, most women are fully veiled, if you have a few extra kilos, people won’t even notice it!" But again, it is impossible to get statistics.

A vicious circle

However, it is important to draw a distinction, experts say. While some of these secret children are directly thrown into the street, with a survival rate close to zero, most of them are placed in hospitals, mosques or orphanages.

"Unless the woman gives birth in secret - and in that case she will leave her child in the street - newborns, say 95 percent of them, are left in hospitals or directly abandoned in mosques or in orphanages," Dr Aboulghar tells MEE.

A view shared by Iman Bibars, with a nuance: "Those who are born in the hospital are placed in orphanages or picked up by third parties. The problem is that this trend of unwanted pregnancies, ending in abandonment, encourages human trafficking. Some of the people who pick up these children then sell them either to wealthy families of the Gulf or sometimes also to street beggars’ networks."

Toddlers, therefore, swell the ranks of atfal al-shawaaria (a pejorative term for street children). UNICEF estimates the number of those children at more than 10,000 in Cairo and Alexandria alone.

Therefore, would legalising abortion have an impact on the number of children left on their own?

"It is certain that the illegality of abortion encourages and perpetuates the problem of abandoned children and street children," according to Adel Ramadan, lawyer specialising in private rights within the EIPR.

"And the pattern continues with the children themselves, who are more likely to suffer from sexual violence because of their vulnerability, and more likely to have unprotected sex and therefore suffer unwanted pregnancies once they hit adolescence. It's an endless vicious circle."

"It's almost inevitable," notes Amira el Feky, a young researcher who followed street girls as part of her research thesis.

"They have sex with men; they are often raped and abused. Moreover, some of them leave home because they discover that they are pregnant, either after incest or because they had sex outside marriage."

"It is obvious that legalising abortion would solve part of the problem," says Dr Asfar. "For average women, but also for all those who grew up outside of a home and who are expecting a child. If they had the choice, they would not impose on their offspring the type of life they lead ... It should be noted, moreover, that unmarried women who end up in a hospital to give birth are still exposed and arrested today by the police."

But for the Banati association, the equation does not seem that simple. This invisible population - prone to risky sexual relations - is hardly monitored by the medical community.

"The problem lies on several levels, since today’s street children do not all hail from the first generation. Rather, they belong to second and even third generation. Children who are being collected today were born in the street, and before that, their mothers were often street children," says Dr Aboulghar.

"Even if we try to end this trend, the homeless are rejected by institutions and refuse to see doctors. A pregnant girl would prefer a thousand times to continue the pregnancy and give birth in the street than consulting," she says.

"We must not forget that having a child in the street is a real added value. You gain status among gangs and a child helps you earn money when you practice beggary, and can even be rented sometimes. It is considerable - many women in the street are actually happy to be pregnant."

For Dalia Abd el-Hameed, "the illegality of abortion highlights the limited freedoms available to women in Egypt, and specifically women from impoverished backgrounds and who are poorly educated".

"Today in Egypt, if you have access to information - including through the Internet and social networks - and money, you can find a way to have an abortion, but it is still necessary to be aware of the possibilities."

"I think it's a difficult question to answer," says el Feky. "I would think that legalising abortion would change only a few things. Even if abortion became legal, women could hardly have access to it because after all they are often poor, homeless, some of them even don’t have legal papers, and without a husband or relatives to support them.

"So I do not think it would miraculously solve the question of abandoned children. That being said, I tend to believe, nevertheless, that beyond the mere legality, if women could benefit from real access to abortion, they would be much more likely to undertake the operation."

*Names in this article have been altered to protect women’s identities.

This article was originally published on Middle East Eye’s French page on 28 September 2015