Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine Health Policy

cy and Planning 2014;29:483–494

ß The Author 2013; all rights reserved. Advance Access publication 8 June 2013 doi:10.1093/heapol/czt040

Abortion law in Muslim-majority countries:

an overview of the Islamic discourse with
policy implications
Gilla K Shapiro

Master of Public Administration (MPA) Programme, Institute of Public Affairs, London School of Economics and Political Science,
Houghton Street, London, England, WC2A 2AE. E-mail: gilla.shapiro@cantab.net

Accepted 12 May 2013

Religion plays a significant role in a patient’s bioethical decision to have an
abortion as well as in a country’s abortion policy. Nevertheless, a holistic
understanding of the Islamic position remains under-researched. This study first
conducted a detailed and systematic analysis of Islam’s position towards
abortion through examining the most authoritative biblical texts (i.e. the Quran
and Sunnah) as well as other informative factors (i.e. contemporary fatwas,
Islamic mysticism and broader Islamic principles, interest groups, and trans-
national Islamic organizations). Although Islamic jurisprudence does not
encourage abortion, there is no direct biblical prohibition. Positions on abortion
are notably variable, and many religious scholars permit abortion in particular
circumstances during specific stages of gestational development. It is generally
agreed that the least blameworthy abortion is when the life of the pregnant
woman is threatened and when 120 days have not lapsed; however, there is
remarkable heterogeneity in regards to other circumstances (e.g. preserving
physical or mental health, foetal impairment, rape, or social or economic
reasons), and later gestational development of the foetus.
This study secondly conducted a cross-country examination of abortion rights in
Muslim-majority countries. A predominantly conservative approach was found
whereby 18 of 47 countries do not allow abortion under any circumstances
besides saving the life of the pregnant woman. Nevertheless, there was
substantial diversity between countries, and 10 countries allowed abortion ‘on
request’.
Discursive elements that may enable policy development in Muslim-majority
countries as well as future research that may enhance the study of abortion
rights are discussed. Particularly, more lenient abortion laws may be achieved
through disabusing individuals that the most authoritative texts unambiguously
oppose abortion, highlighting more lenient interpretations that exist in certain
Islamic legal schools, emphasizing significant actors that support abortion, and
being mindful of policy frames that will not be well-received in Muslim-majority
countries.
Keywords: Abortion, Islam, maternal health, Muslim-majority countries, research to policy

483

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 484 HEALTH POLICY AND PLANNING
KEY MESSAGES
 A cross-country examination of abortion rights in Muslim-majority countries illustrates a conservative approach in many
countries albeit substantial diversity.
 Islamic positions on abortion are variable depending on the circumstances of the pregnancy and stage of gestational
development.
 Abortion policy analysis and research in the world’s 47 Muslim-majority countries must consider the Islamic discourse in
order to make more successful and sensitive policy recommendations.
Introduction
Religion plays a significant role in a patient’s bioethical decision
to have an abortion as well as in a country’s abortion policy
(Baker et al. 1981; Hertel and Hughes 1987; Schenker 2000;
Hessini 2008; Padela et al. 2011). An abortion, or Ijhad in
Arabic, is the procedure for terminating an unwanted preg-
nancy before the foetus has attained viability, i.e. become
capable of independent extra-uterine life. Though an induced
abortion is ‘one of the simplest and safest medical procedures
known today’, an unacceptable number of abortions are unsafe
(Berer 2004, p. 5). The World Health Organization (WHO) (2011)
defines an unsafe abortion as the procedure to terminate an
unwanted pregnancy either by persons lacking the necessary
skills, taking place in an environment lacking minimal medical
standards, or both (WHO 2008). Worldwide, between 19 and 22
million unsafe abortions take place annually, most of which
(97%) occur in developing countries (WHO 2011). The result of
unsafe abortion is maternal mortality for many: the WHO (2011)
reports that unsafe abortion directly results in death for 47 000
women annually. However, as Roemer (1967) writes, ‘the toll of
criminal abortion must be counted also in terms of complications,
morbidity, and disability’ (p. 1906). Accordingly, millions of
women who survive an unsafe procedure are left temporarily or
permanently disabled and with serious associated complications
(e.g. sepsis, infection, haemorrhage, and trauma) (Singh and
Ratnam 1998; Brookman-Amissah and Moyo 2004).
The international community is committed to reducing
maternal mortality and promoting universal access to repro-
ductive health. The Programme of Action of the International
Conference on Population and Development (ICPD) in 1994
was the first major international agreement to make recom-
mendations on unsafe abortion when they urged countries and
organizations ‘to deal with the health impact of unsafe abortion
as a major public health concern’ (WHO 2011, p. 1). Currently,
improving maternal health through reducing maternal mortal-
ity is one of the eight Millennium Development Goals sought to
be achieved by 2015. Specifically, the MDG aims to reduce the
maternal mortality ratio by three quarters and achieve universal
access to reproductive health (UN 2012). Further, a current and
central strategy of WHO is to support national governments in
their development of programmes and policies that reduce
unsafe abortion and improve access to safe abortion and high-
quality post-abortion care (WHO 2011).
In order to prevent unsafe abortions, it is important for the
right to abortion to be enshrined in law: ‘liberalization of
abortion legislation has seen a tremendous drop in abortion-
related maternal mortality’ (Singh and Ratnam 1998, p. S123).
Tellingly, Berer (2004) examined 160 countries and found that
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there is a lower incidence of unsafe abortions and much lower
mortality from unsafe abortions in countries with legislation that
allows abortion on broad indications compared to countries with
legislation that greatly restricts abortion. As Singh and Ratnam
(1998) explain, maternal death from unsafe abortions is practic-
ally unknown in countries where abortion is available on the
broadest possible ground (Singh and Ratnam 1998). For example,
Jewkes et al. (2005) found that in South Africa, the incidence of
infection resulting from abortion decreased by 52% after the
abortion law was liberalized. Similarly, the Department for
International Development (DFID) (2005) explains the great
impact abortion law had on maternal mortality in Romania:
Legislation can save women from unsafe abortion.
Restrictive abortion laws were passed in Romania in 1966.
There was a dramatic rise in maternal mortality ratios from
around 80 deaths per 100,000 live births in 1964 to 180 in
1988. After the repeal of these laws in 1989 the maternal
mortality ratio fell, to around 40 deaths per 100,000 live
births in 1992. This fall was almost entirely due to fewer
deaths from abortion (p. 8).
These findings present a compelling public health argument for
enshrining the right to abortion into law and liberalizing
abortion law on the broadest possible grounds (i.e. upon
request). Especially in developing countries where high mater-
nal mortality rates due to unsafe abortion are common,
researchers are advocating the elimination of restrictive laws
(Brookman-Amissah and Moyo 2004). The importance of pro-
abortion legislature in order to prevent unsafe abortions and
promote maternal health is becoming clearer, but the religious
framework and institutions that allow for the development of
legalized abortion remains under-researched. Indeed, the
Western examination of religious approaches to abortion
concentrates on Christian and secular bioethical positions
while Islamic positions are comparatively under-researched
(Brockopp 2003). Though Islamic bioethics began in the
1960s, only a few studies in the field have been published
despite substantial contributions of Islamic scholars to the
debate (Eich and Brockopp 2008).
The paucity of research that has provided a holistic and
critical interpretation of Muslim bioethics is remarkable seeing
Muslims comprise 23.4% of the world’s population (1.6 billion
in 2010) and the Muslim population over the next two decades
is forecasted to grow at approximately twice the rate of the
non-Muslim population (Pew Research Center 2011). Moreover,
the laws in many Muslim-majority countries are prohibitive,
and punitive views on abortion is purported to be associated
 ABORTION LAW IN MUSLIM-MAJORITY COUNTRIES
with religion (Baker et al. 1981; Hertel and Hughes 1987;
Boonstra 2001). In addition, some evidence has shown unsafe
abortions are common and fatal in many Muslim-majority
countries (Hessini 2008) and women in Muslim-majority
countries are presumed to have low levels of autonomy
(Boonstra 2001). For example, Razzak et al. (2011) found that
maternal mortality rates were twice as high in Muslim-majority
countries. Furthermore, though many Muslim-majority coun-
tries are currently under significant pressure to liberalize their
abortion policy (Bowen 2003), there is a research gap in
explaining how such a policy, which would have to consider an
Islamic perspective, may be sensitively and successfully achieved.
Notably, there is remarkable diversity within the Muslim world
in Gross Domestic Product (GDP), political and legal systems,
in religious sect and schools, among many other factors.
Nevertheless, there are also similarities in Muslim-majority
countries as ‘[m]any Muslims incorporate their religion into
almost every aspect of their lives’ (Daar et al. 2008, p. 410).
It is crucial for researchers and policymakers investigating
abortion legal policy in Muslim-majority countries to holistic-
ally understand the extremely relevant Islamic discourse on
abortion rights in Muslim-majority countries in order to make
appropriate policy recommendations. As Hassan (2001) ex-
plains, ‘I do not believe that any viable model of self-
actualization can be constructed in Muslim societies for
women or men which is outside the framework of normative
Islam deriving from Qur’anic teachings and exemplified in the
life of the Prophet of Islam’ (p. 68). Indeed, constructing policy
in Muslim-majority countries is severely hampered if the
Islamic religious position is not considered (Hessini 2008).
This analysis will thereby provide a detailed and systematic
discussion of the relevant biblical sources (i.e. Quran and
Sunnah) and further compelling literature (i.e. contemporary
fatwa’s and jurisprudence, mystical texts, broader principles,
interest groups, and transnational commitments). With a
holistic understanding of religious doctrine and positions, this
analysis will continue to investigate the diversity of abortion
policy in Muslim-majority countries by constructing a count
variable numbering the grounds for abortion that are allowed
in each country. Lastly, opportunities for policy development
and future research directions will be discussed.
Interpretation of key sources: Quran
and Sunnah
It is widely accepted that an investigation into any Islamic
concern should begin with consulting the Quran and the
Sunnah, which are the guiding texts of Islamic religious
authority (Brockopp 2003).1 For Muslims, the Quran and
Sunnah are the main sources of Sharia law, law that is
prevalent in many Muslim-majority countries. However, not-
ably, neither the Quran nor the Sunnah directly address
intentional abortion (Katz 2003). Instead of specifically dis-
cussing a pregnant woman seeking a termination of a
pregnancy before birth, these sources focus on unwanted
children and infanticide (Arbor and Rogers 1999). Table 1
highlights the most relevant texts that are often discussed
regarding abortion. It is evident that the Quran condemns
killing, and particularly infanticide out of economic hardship.
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485
However, these passages are generally understood to refer to
live offspring, not abortion (Katz 2003).
Though the Sunnah does not report a case where the Prophet
Muhammad directly discusses intentional abortion, on one
occasion Muhammad makes a ruling on forced miscarriages. In
a case whereby a woman killed her pregnant co-wife,
Muhammad requires the murderer’s kin to play blood money
(diya) for the co-wife and a payment (ghurra) for the unborn
foetus (Katz 2003). This case provides an understanding of the
legal position of the foetus. As the value of the ghurra is usually
one-twentieth of the diya, it appears that the foetus has some
legal protections but is not a ‘full-fledged human being’ (Katz
2003, p. 28).
A central passage in the Qur’an (2012) explains the devel-
opment from a foetus to a ‘full-fledged’ child: ‘And certainly
did We create man from an extract of clay. Then We placed him
as a sperm-drop in a firm lodging. Then We made the sperm-
drop into a clinging clot, and We made the clot into a lump
[of flesh], and We made [from] the lump, bones, and We
covered the bones with flesh; then We developed him into
another creation. So blessed is Allah, the best of creators’ (23:
12–4). The Prophet Muhammad, the central religious figure in
Islam, explains foetal development as occurring in four stages
(Table 2). As Table 2 illustrates, the Quran is sensitive to a
stage development between conception and childbirth, which
has led to diverse perspectives of law depending on the
gestational stage of the foetus (Musallam 1983).
Additional aspects for consideration
As the Quran and Sunnah do not specifically address abortion
per se, other sources and interest groups inform Muslim countries’
positions and religious practice (Asman 2004). These include:
contemporary fatwas and jurisprudence, Islamic mysticism and
broader Islamic principles, perspectives of interest groups
(i.e. Islamic bioethical and feminist movements), and commit-
ments by transnational Islamic organizations.
Contemporary fatwas
A fatwa is a Muslim jurists’ legal perspective on Islamic law as
determined by scholars (or ‘muftis’). Though not legally
binding or enforced, contemporary fatwas yield significant
authority in informing Sharia law (Nasir and Asnawi 2011).
However, Brockopp (2003) explains that though tremendously
influential, especially if published by important individuals (e.g.
the rector of al-Azhar University), ‘[a]t best, fatwa’s are only a
rough guide to Muslim morality’ (p. 7). Indeed, Islamic law
itself is a discursive structure whose interpretations are socially
contingent. Though Sharia law is often believed to be fixed and
clearly discernible from its sacred sources, ‘the shari‘a is a
product of articulations of legal discourses and institutions to
varying patterns of society and politics’ and has therefore varied
considerably over time and place (Zubaida 2003, p. 1). The
interpretation of Sharia law is also dependent on sect and
school (Zubaida 2003). Although Muslims are often thought of
as a homogenous group, there is a primary division around
Sunnis (75%–90% of Muslims worldwide), Shiites (10%–20%)
and Schismatics (5%–10%) (Barret et al. 2001; CIA 2012).
 486 HEALTH POLICY AND PLANNING

Table 1 Quranic passages relevant to abortion

Verse Passage Central message

6:137 And likewise, to many of the polytheists their partners have made [to seem] pleasing Do not kill, specifically children.
the killing of their children in order to bring about their destruction and to cover them
with confusion in their religion. And if Allah had willed, they would not have done so.
So leave them and that which they invent (Surat Al-’An‘ām).
6:140 Those will have lost who killed their children in foolishness without knowledge and Do not kill, specifically children.
prohibited what Allah had provided for them, inventing untruth about Allah. They have
gone astray and were not [rightly] guided (Surat Al-’An‘ām).
6:151 Come, I will recite what your Lord has prohibited to you. [He commands] that you not Do not kill, specifically children
associate anything with Him, and to parents, good treatment, and do not kill your out of poverty.
children out of poverty; We will provide for you and them. And do not approach
immoralities - what is apparent of them and what is concealed. And do not kill the
soul which Allah has forbidden [to be killed] except by [legal] right. This has He
instructed you that you may use reason (Surat Al-’An‘ām).
17:31 And do not kill your children for fear of poverty. We provide for them and for you. Indeed, Do not kill, specifically children
their killing is ever a great sin (Surat Al-’Isrā’). out of poverty.
17:33 And do not kill the soul which Allah has forbidden, except by right. And whoever is Do not kill.
killed unjustly - We have given his heir authority, but let him not exceed limits in [the
matter of] taking life. Indeed, he has been supported [by the law] (Surat Al-’Isrā’).
25:68 And those who do not invoke with Allah another deity or kill the soul which Allah Do not kill.
has forbidden [to be killed], except by right, and do not commit unlawful sexual
intercourse. And whoever should do that will meet a penalty (Surat Al-Furqān).

Source: Qu’ran, 2012.

Table 2 Stages of foetal development according to the Quran

Stagea Name Time period What occurs Legality of abortion (fiqh)b

1 Nutfa (sperm) Conception to 40 days Semen and the ovum are Hanafites: permitted
gathered in the womb
Shafites: majority permit
Hanbalites: some permit
Malikites: prohibited
2 Alaqa (blood clot) 40–80 days Develops into a clinging Hanafites: permitted
blood-like clot
Shafites: some permit
Hanbalites: some permit
Malikites: prohibited
3 Mudgha (embryo) 80–120 days Clot forms into clump of Hanafites: permitted
flesh
Shafites: some permit
Hanbalites: some permit
Malikites: prohibited
4 Khalqan Akhar (spirit) 120 days to birth Ensoulment occurs and the Prohibited (consensus across schools)
foetus possesses a spirit

Note: This table is this author’s compilation through consulting Musallam (1983); Bowen (1997); Brown (1999); Bowen (2003); Katz (2003); Hedayat et al.
(2006); Atighetchi (2007); and Al-Hibri (2011). This table discusses Sunni Islam. Each Sunni school interprets the Hadith (i.e. recorded oral traditions of
Muhammad) somewhat differently (CIA 2012). A Sunni Muslim may elect to follow any one of these equally orthodox schools (Zubaida 2003). Notably,
Shiites reject the four Sunni schools (Asman 2004). Most of contemporary Shiite jurists do not allow abortion without any reason at any time; however, they
do allow abortion especially before 4 months on grounds of foetal or maternal conditions that brings extreme difficulties for the mother or family (Hedayat
et al. 2006).
a
Specifically, Muhammad explains that 40 days is assigned to each stage (Bowen 1997). The details of the stages are explained by Muhammad’s companion
Ibn Mas‘ud (Katz 2003).
b
Fiqh does not merely mean ‘jurisprudence’ but also ‘insight.’

Furthermore, Sunnis are divided into four equally orthodox
prominent legal schools (madhhab) named after their putative
founders: Hanafites, Shafites, Malikites and Hanbalites (Barret
et al. 2001; Zubaida 2003).
Unlike Catholicism, e.g., Islam does not have a central
authoritative structure and no single school or theology
dominates Islamic thought (Brockopp 2003). Instead, there is
a diverse understanding of how to practise Islam and a large
amount of tolerance between schools’ legal rulings (Bowen
2003). Table 2 exemplifies the substantial diversity of laws
across legal schools regarding gestational stage of development.
For example, the Hanafites, who comprised the majority of

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 ABORTION LAW IN MUSLIM-MAJORITY COUNTRIES
orthodox Muslims in later centuries, permit an abortion until
the end of the fourth month of pregnancy. On the other hand,
most Malikites prohibit abortion absolutely (Musallam 1983).
Despite their differences, all schools concur that after 120 days
(i.e. ‘ensoulment’) the foetus is considered a child and abortion
is prohibited (Musallam 1983). However, even then, all legal
schools make an exception and permit abortion in order to save
the life of the pregnant woman (Al-Hibri 2011; Nasir and
Asnawi 2011). Notably, even though some schools permit
abortion before 120 days, abortion is never encouraged and only
allowed on very serious grounds as indicated by contemporary
fatwas (Atighetchi 2007). Every act in Islam is classified into
five ethical categories, the so-called ahkam al-khamsa: (1)
necessary (fard); (2) recommended (mandub); (3) indifferent
(mubah); (4) blameworthy (makruh); and (5) forbidden
(haram) (Brown 1999). Even when abortion is not haram, it
is often seen as makruh (e.g. by the Shafiites) (Bowen 1997).
Table 3 outlines fatwas regarding abortion for different
grounds. Importantly, fatwas on the whole do not support
abortion (Rispler-Chaim 2003). Instead, most muftis (i.e.
authoritative persons who render legal opinion) prohibit abor-
tion out of a fear of a ‘ ‘‘mudslide’’ in religious ethics’ (Rispler-
Chaim 2003, p. 92). However, there is extensive debate on what
comprises a ‘good’ reason for abortion. Indeed, some fatwas
have exhibited leniency, particularly when the life or health of
a pregnant woman is threatened or if the foetus is expected to
be deformed. The significance of lenient fatwas is greater still
due to followers’ ability to consider four equally valid schools
within Sunni Islam alone (Brockopp 2003). Evidently, legal
consensus has not been reached.
Islamic mysticism and broader Islamic principles
In addition to the social context discussed above, in Islam legal
texts are understood within a philosophical and mystical
framework. Though Muslims believe the Quran is the word of
God they also believe the Quran is a finite book and answers
are infinite so in finding answers one must also exercise the
‘mind and spirit’ (Brown, 1999, p. 187).. Accordingly, Sufism is
an influential mystical aspect of Islam that provides spiritual
and ethical guidance (Katz 2003). Abu Hamid al-Ghazali (d.
1111 C.E.), one of the most recognized and influential Muslim
mystics, explains that abortion falls short of murder (i.e.
infanticide), but is on a ‘continuum of moral odium’ (Katz
2003, p. 43). Further, Sufism addresses ‘conditions of the heart’
and holds that ‘the same act can have different ethical
evaluations depending on the subjective spiritual state of the
actor’ (Katz 2003, p. 41). Sufism thereby implies a degree of
interpersonal relativism and an abortion may be interpreted as
being acceptable depending on the individual circumstance.
Furthermore, other interrelated Islamic principles that have
been vibrant in both classical and modern ethical reasoning
include the centrality of utility (or public interest, istislah), and
equity (or a just solution, istihsan) (Hedayat et al. 2006; Atighetchi
2007). Other central principles include protection against distress
and constriction (usr wa haraj), necessity to avert probable harm
(daf’al-darar al-muhtamal), and necessity (darura) (Sachedina
2008).2 Accordingly, a number of scholars have allowed abortion
for limited social and medical reasons due to rapidly expanding
populations in Muslim-majority countries, constrained health
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487
budgets, and maternal health (Hedayat et al. 2006). These
principles have also been applied to allow abortion on grounds
of rape, foetal impairment, or adultery (Bowen 2003).
Moreover, Brockopp (2008) stresses that in Islam there is a
philosophical tradition of acceptance of family and individual
prerogative: ‘. . . God alone knows what is right and wrong in
such cases. The individual conscience is considered a better
guide for action, since it is ultimately the individual who will
have to answer to God on the day of judgment’ (pp. 15–6). This
tradition of relativism can also be observed through the actions
of muftis who have given private allowances to individual
couples to have an abortion despite prohibitive public rulings
(Rispler-Chaim 2003; Brockopp 2008).
Interest groups
Growing Islamic bioethical and feminist movements may
increasingly be a source of pro-abortion pressure. Interestingly,
the category of ‘Islamic bioethics’ is highly disputed, as there is
arguably not a singular Muslim position towards bioethical
dilemmas (Brockopp 2008). This again points to the diversity of
Islamic positions towards bioethical predicaments such as
abortion. Significantly, patient autonomy is less valued in
Muslim-majority countries than western societies and ‘phys-
icians are more likely to be asked to defend why they did what
their patients (including pregnant women) wished, in contrast
to cultural settings where they will be asked to defend why
they did not do what their patients wished’ (Outka 2003,
p. viii). Evidently, physicians’ power to challenge the religious
discourse is limited especially when they are not predominantly
answerable to their patients, but to Islamic authority. Never-
theless, physicians have been instrumental in the liberalization
of abortion (Kunins and Rosenfield 1991; McBride Stetson
2001). For example, when abortion was permitted ‘on request’
in Russia (1920)—the first country to do so—physicians played
a pivotal role (Popov 1994). Atighetchi (2007) further explains
that doctors have been a pivotal source of healthcare
modernization in Arab–Muslim countries.
Similarly, Islamic feminists stress that the ‘heinous practices’
surrounding the plight of women in the Muslim world exist,
but that ‘they are less a function of religious doctrine than a
reflection of history, culture, economics and especially politics’
(Boonstra 2001, p. 1). Ramirez and McEneaney’s (1997)
international event history analysis found greater liberalization
of abortion policy in countries with a greater proportion of
women in the paid labour force. Evidently changing these
traditions is possible; however, importantly, Islamic feminists
stress that the impetus of pro-abortion fatwas has not neces-
sarily been the promotion of women’s rights (Hessini 2008).
For example, the Grand Mufti in Egypt upholds patriarchal
structures when arguing that rape victims should have access to
abortions but also to reconstructive hymen surgery to preserve
female marriageability and virginity (Hessini 2008; IWRAW
1998). Some Islamic feminists (although a heterogeneous
group) find compatibility between abortion rights and Islam
and seek to modify strict legal prohibitions, increase safe access,
and in particular modify a patriarchal system whereby hus-
bands or fathers make the decision of whether a woman can
abort, thereby constricting a woman’s right to personhood
(Bowen 2003; Outka 2003).
 488 HEALTH POLICY AND PLANNING

Table 3 Fatwas on abortion

Ground for abortion Summary of prominent rulings (fatwas) General conclusions

Life The principle whereby ‘necessity knows no law’ is applied. There is wide agreement Abortion is widely permitted.
that the primary concern is for the life of the mother and her welfare takes
precedence.
Physical and mental The principle of ‘necessity’ is applied. Ibrahim Haqqi, a Syrian physician, explains Abortion is generally permitted.
health that physical health issues are justifiable reasons for an abortion. For example,
fiqh texts of reasons that merit abortion includes poor health of the mother,
such as a weak bladder, a risk of difficult labour requiring a Caesarean section,
or a disease or malfunctioning of the uterus (Bowen 1997).
Foetal impairment The Grand Mufti Ayatollah Yusuf Saanei (Iran 2005) permits abortion in the first Abortion is often permitted, within
trimester in situations of genetic disorder (Hessini 2008). A similar perspective strict gestational limits.
applies to Sheikh Nasr Farid Wasil, the mufti of Egypt (Rispler-Chaim 2003).
Aul Fadl Mohsin Ebrahim and Abd al-Qadim Zallum also allow abortion of
deformed foetuses if 17 weeks of pregnancy have not passed (Asman 2004).
More strictly, Mufti al-Qardawi allows abortion on this ground only within the
first 40 days. Vaguely, Jad al-Haqq, the late Sheikh al-Azhar, advises against
abortion of deformed foetuses but considers it justifiable in cases of severe
deformities and genetic diseases (Asmam 2004).
Rape or incest Causitry (i.e. case law) is present on rulings regarding rape or incest, and Abortion is disputed, but increas-
significant political events have led to occasionally lenient rulings. In Kuwait ingly permitted within the gesta-
1982, permission was given to abort impaired foetuses up to 3 months into the tional limit. Incest is far less
pregnancy (Rispler-Chaim 2003). However, after the rape of Kuwaiti women by discussed than rape.
Iraqi soldiers (during the first Gulf War), the majority of muftis (i.e. Sunni
Islamic scholars) argued that abortion is not permitted on circumstances of rape
(Asman 2004). Those who permit abortion on the grounds of rape only do so
before 120 days (Asman 2004). In 1998, the Algerian Islamic Supreme Council
issued a fatwa allowing abortion in cases of rape explaining that religious
extremists can use rape as a weapon of war (Chelala 1998). Similarly, the
Egyptian Grand Sheikh of al-Azhar, Muhammed Sayed Tantawi, issued a fatwa
in 1998 that allowed abortion to women who had been raped (IWRAW 1998). In
1999, Ikrima Sabri, chief mufti of the Palestinian Authority also permitted
Muslim women who were raped in Kosovo to take abortifacient medicine to
prevent pregnancy.
Social or economic There is substantial concern that the Quran’s prohibition of infanticides out of Widely prohibited with
reasons fear of financial burden is violated under these grounds (Bowen 2003). However, few exceptions.
as discussed above, foetuses are not always interpreted to be children.
Furthermore, the Sunnah allows termination of the foetus if the mother is
still breastfeeding, as the living child has priority over the foetus. Also, an
extremely young woman (younger than 15 years) is sometimes argued to be an
acceptable reason for an abortion (Bowen 1997). Historically, abortion was also
justified to prevent the birth of a child to a pregnant slave so as to avoid the
obligation of the owner to free the slave (Bowen 2003). Nevertheless, abortions
for SER are explicitly seen to violate Quranic principles, and are therefore widely
prohibited (Asman 2004). A notable exception is Sheikh Ahmed Harayd who
allows abortion in cases where the family is unable to hire a wet-nurse to feed
the unborn foetus.

Note: This table is the author’s compilation through consulting Bowen (1997); IWRAW (1998); Arbor and Rogers (1999); Bowen (2003); Rispler-Chaim (2003);
and Asman (2004).

Transnational Islamic organizations
Lastly, law in Muslim-majority countries and positions of
transnational Islamic organizations (i.e. Muslim countries that
jointly present their view outside their national context, often
on the national stage) are a gauge of Islamic positions on
abortion. As will be discussed in greater detail below, most
Muslim-majority countries have conservative abortion laws,
many only allowing abortion when the life of the pregnant
woman is threatened. However, a more lenient perspective of
Islam’s position has been offered on the international stage. In
1971, an international conference on Islam and family planning
concluded that ‘Islam forbids abortion after the fourth month
of pregnancy, unless the woman’s life is in danger but allows
for abortion under several circumstances in the first four
months’ (Hessini 2008, p. 24). These circumstances are made
explicit in the Rabat Conference on Islam and Family Planning
(1974) whereby Indonesian scholar Achmad Gazali listed
conditions that justify an abortion (e.g. rape, incest, psycho-
logical state of mother, and foetal impairment).
Importantly, in the influential United Nations ICPD (held in
Cairo in 1994), ‘an extremely important landmark in raising
global consciousness with regard to a number of issues that are
central to the lives of women’, Muslim countries dissented from
their originally announced alliance with the Vatican in
opposing abortion (Hassan 2001, p. 64). At the ICPD, Muslim
countries strayed from their initial total condemnation of
abortion (similar to the Vatican) to a circumstantial position
(Bowen 1997). Significant to many was that president of Al-
Azhar University, whose fatwas are widely followed, attended
the meeting (Hassan 2001). Indeed, the conference, notably

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 ABORTION LAW IN MUSLIM-MAJORITY COUNTRIES
held in a Muslim-majority country capital, was a momentous
achievement for Muslim countries and many participating
Muslim women (Bowen 1997; Hassan 2001). Markedly, 31
countries with Muslim majorities attended the conference
(Bowen 1997). Nevertheless, 12 Muslim-majority countries
expressed reservations on the original wording of Chapter VII
of the Programme of Action (i.e. Reproductive Rights and
Reproductive Health) (Bowen 1997). The eventual agreed upon
wording that was endorsed by Muslim countries was that ‘[i]n
no case should abortion be promoted as a method of family
planning. All Governments and relevant intergovernmental and
non-governmental organizations are urged to strengthen their
commitment to women’s health, to deal with the health impact
of unsafe abortion (defined in a footnote) as a major
public health concern and to reduce the recourse to abortion
through expanded and improved family planning services . . .’
(UN DPI 1995). Through discussions at the ICPD (1994)
Muslim countries’ position became clearer: although abortion
as a method of family planning is un-Islamic in general,
abortion is permitted in ‘well-defined situations’ (Bowen 1997,
p. 178).
Diversity in abortion laws across
Muslim-majority countries
The above discussion indicates that there is not a singular
Islamic position on abortion. This article continues to evaluate
how the diversity in Islamic perspective translates into abortion
law in the world’s Muslim-majority countries. Not surprisingly,
Muslim-majority countries reflect this diversity. For example,
Tunisia was the first Muslim, African, and Arab country to
liberalize its law in 1973—before France, Germany, or the USA.
In fact, Tunisia permits abortion ‘upon request’ within 12
weeks and services are provided without charge in the public
healthcare system (Hessini 2008; UN DESA 2002). This is in
stark contrast with many other Muslim-majority countries that
only allow abortion if the life of the pregnant women is
threatened. Notably, Asman (2004) conducted a comparison of
three Muslim countries (i.e. Egypt, Kuwait, and Tunisia) and
noted that these countries’ legislation on abortion has become
increasingly permissible.
In examining the diversity of abortion law in Muslim-majority
countries, this study defined Muslim-majority countries similar
to Razzak et al. (2011) as independent countries with a 50% or
greater Muslim population in 2011. Although Razzak et al.
(2011) includes Palestine, making their count 48, this study,
similar to Boland and Katzive (2008), excludes Palestine
because the West Bank and Gaza Strip are not currently
sovereign and there are significant data limitations in assessing
this population. Similarly, the Pew Research Center (2011)
includes Mayotte and Western Sahara as Muslim-majority
countries; however, these are also not included in this study
as these countries are not self-governing (CIA 2012). A total of
47 countries were found to be Muslim-majority countries.
One method to compare Muslim-majority countries position
on abortion is by examining the Number of Abortion Rights
(hereafter NAR) in a country. In accordance with the United
Nations and similar to Ramirez and McEneaney (1997), this
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489
study considers seven dimensions to calculate NAR. These
include:
 Abortion is permitted to save the life of the pregnant
woman (L)
 Abortion is permitted to preserve a woman’s physical health
(PH)
 Abortion is permitted to preserve a woman’s mental health
(MH)
 Abortion is permitted in cases of foetal impairment (F)
 Abortion is permitted in cases of incest or rape (I/R)
 Abortion is permitted for social or economic reasons (SER)
 Abortion is permitted upon request
These seven dimensions are cumulative rather than mutually
exclusive. NAR thereby ranges from 0 to 7. When NAR is seven
this denotes that abortion is permitted ‘upon request’ (i.e.
allowed for all grounds). A country was only recorded to have
an abortion right on each of these grounds if that grounds was
enshrined in law, i.e. not in cases where abortion is allowed
intermittently based on legal interpretation. Notably, the law in
some countries does not specify whether the term ‘health’
applies to both physical and mental health. In line with Boland
and Katzive (2008), but differing from UN DESA (2011) data,
abortion on grounds of mental health is not described as such
unless a country’s legal status specifically expresses this to be
the case (i.e. enshrined in law). A count variable allows the
extent of liberalization of abortion laws to be quantified and
visualized. Table 4 provides a compilation of NAR for Muslim-
majority countries.
Table 4 exemplifies that many Muslim-majority countries are
currently conservative in their abortion policy. Specifically, 18 of
47 Muslim-majority countries only permit abortions in cases
where the life of the pregnant women is threatened (Table 4).
However, notably, all Muslim countries allow abortions to save a
woman’s life, i.e. in no country is there a zero count. The 2011
average NAR in Muslim-majority countries is 2.94 (S.D. ¼ 2.30)
out of a possible 7. Nevertheless, substantial diversity can be
observed (Figure 1), and while some countries are extremely
conservative others permit abortion ‘on request’. The most liberal
countries (NAR ¼ 7) include eight previously Soviet countries as
well as Turkey and Tunisia. Interestingly, while other countries in
the world (e.g. Zambia, Luxemburg or St. Vincent and the
Grenadines) allow abortion for social or economic reasons while
prohibiting abortions on request (UN DESA 2011), social or
economic reasons was not specified in any Muslim-majority
country (Table 4). This is especially notable given the Quranic
context (Table 2) and many fatwas prohibiting abortion on social
or economic grounds (Table 3). Specifically, the explicit condem-
nation of infanticide for reasons of economic hardship translates
into economic or social reasons (rather than grounds of necessity)
being ‘the most hotly debated justification for abortion’ (Bowen
2003, p. 70). In addition, it is rare to permit an abortion on the
grounds of preserving a woman’s mental health.
Recommendations for policy
development
As Cornwall et al. (2008) explain, there are many different
constructs (e.g. reproductive rights, social justice, public health,
 490 HEALTH POLICY AND PLANNING

Table 4 Number of abortion rights in Muslim-majority countries (2011)

NAR 1 2 3 4 5 6 7
Countries Afghanistan L Comoros L.PH Algeria L.PH.MH Burkina Faso L.PH.F.I/R Albania
Bangladesh L Iran L.F Chad L.PH.F Guinea L.PH.F.I/R Azerbaijan
Brunei L Jordan L.PH Gambia L.PH.MH Bahrain
Djibouti L Mali L.I/R Kuwait L.PH.F Kazakhstan
Egypt L Maldives L.PH Malaysia L.PH.MH Kyrgyzstan
Guinea-Bissau L Morocco L.PH Niger L.PH.F Tajikistan
Indonesia L Pakistan L.PH Qatar L.PH.F Tunisia
Iraq L Saudi Arabia L.PH Sierra Leone L.PH.MH Turkey
Lebanon L Sudan L.R Turkmenistan
Libya L Uzbekistan
Mauritania L
Nigeria L
Oman L
Senegal L
Somalia L
Syria L
United Arab Emirates L
Yemen L
Total (%) 18 (38.30%) 9 (19.15%) 8 (17.02%) 2 (4.26%) 0 0 10 (21.28%)

Grounds: L: Abortion allowed to save the life of the woman; PH: Abortion allowed in cases where the pregnancy threatens the woman’s physical health; MH:
Abortion allowed in cases where the pregnancy threatens the woman’s mental health; F: Abortion allowed in cases of foetal impairment; I/R: Abortion is
allowed in cases of incest or rape; SER: Abortion allowed on additional enumerated grounds relating to such factors as the woman’s age or capacity to care for
a child.
Note: This table is the author’s compilation. Abortion legislative data were compiled through analysing cross-country compilations of the WHO (1971); Centre
for Reproductive Rights (2008); UN (UN DESA 2002, 2011); Guttmacher Institute (2012), as well as research by Roemer 1967; Cook and Dickens 1978;
Rahman et al. 1998; and Boland and Katzive 2008.

Figure 1 Muslim-majority countries by Number of Abortion Rights (2011).

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 ABORTION LAW IN MUSLIM-MAJORITY COUNTRIES
development, and harm reduction) that support a woman’s
right to have ‘access to safe, affordable services for the termin-
ation of pregnancy for the widest range of reasons’ (p. 1). It is a
public health priority to address the thousands of annual
deaths that result from unsafe and illegal abortions. For
example, as Mohammed (2003) explains in reference to the
Nigerian circumstance: ‘It is imperative to do something about
the appalling annual death rate from abortion in Nigeria, but
success can come about only if the matter is approached with
due sensitivity and consideration for these cultural and
religious factors’ (p. 225). Indeed, the religious position of
Islam ‘affect[s] policy formation in many Muslim nations’
(Bowen 2003, p. 52). Drawing from the analysis of Islam’s
position on abortion, some strategies can be outlined which
provide opportunities for the formation of more liberalized
abortion rights in order to better safeguard Muslim women’s
health and rights.
Firstly, it is important to disabuse individuals of the incorrect
assumption that the central legitimizing Islamic texts (i.e. the
Quran and the Sunnah) unambiguously oppose abortion. This
is especially fundamental as ‘few Muslims are versed in
medieval legal texts . . . [and] customary practice assumes
more force’ (Bowen 1997, p. 181). Contrarily, the Quran and
the Sunnah sources do not explicitly address intentional
abortion but focus on infanticide and particularly wa’d (i.e.
female infanticide) (Asman 2004; Table 1). Although many
interpret these verses on children as applying to potential
children (i.e. foetuses), it is clear from the Sunnah that there is
a distinction between the death of children and foetuses, and a
central (and unifying) point of distinction is ensoulment at 120
days (Boonstra 2001).
Secondly, the above analysis exemplifies that Islam has the
possibility of being interpreted leniently, despite the monolithic
image that is often presented (Hassan 2001). As Brockopp
(2003) explains, ‘Islam does not speak with one voice on the
question of abortion’ (p. 24). In fact, the flexibility of Islamic
law is a cornerstone of Islamic philosophy and because Islam
was revealed ‘to all people for all times’ its laws are thought to
be capable of adaptability (Al-Hibri 2011). Furthermore, dating
from the pre-modern Islamic world, there was a recognition
and cultivation of variation to the Islamic tradition (Reinhart
2003). A general prohibition of abortion disregards the leniency
of certain religious authorities (Tables 2 and 3). Indeed, the
Islamic legal system ‘provides a means to increase the incidence
of abortion’ (Bowen 2003, p. 75). Accordingly, lenient positions
and the reciprocity of different legal schools should be
emphasized which may make ‘abortion religiously possible’
(Bowen 2003, p. 60). Contrary to what many may believe,
Musallam (1983) explains that ‘given the fact that prohibition
was not the dominant view by any standard, given the fact that
Muslims believed in ensoulment as the crucial event before
which the foetus was not a person, and given the fact that the
sanction of contraception strengthened the view that abortion
should be legalized before ensoulment, perhaps we can say
that, on the whole, abortion was religiously tolerated’ (p. 59).
It is also evident that Sufism and broader Islamic principles
(i.e. equality, public interest, and compassion for individual
circumstances) provide justification for the application of
lenient legal rulings when legal principles have been otherwise
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491
harsh or impractical in their application. These principles allow
for a more compassionate understanding of the Quran and
Sunnah and have been considered ‘the open frontier of Islamic
ethics’ (Brown 1999, p. 192). In this regard it may be useful to
emphasize that abortion is a serious health concern as a large
number of abortions are performed in Muslim-majority
countries and due to their illegality, the practice is often
carried out secretly and unsafely, thereby jeopardizing the lives
of pregnant Muslim women (Hessini 2008; Pew Research
Center 2011). For example, Hedayet et al. (2006) explain that
this logic may have been particularly influential in the case of
Iran’s liberalizing its laws in 2005: ‘Being faced with health
crises on a large scale may be partly responsible for scholars
invoking istislah and istihsan in their rulings on medical and
health affairs . . . it is also a social reality that more than 80 000
illegal abortions are performed in Iran every year, possibly in
unsanitary conditions that put the life of the mother at risk—a
public health crisis in its own right’ (p. 655).
Thirdly, it is important to emphasize significant actors that
support legal, safe, and rare abortion. As Bowen (1997) points
out, the decision on abortion’s legality currently rests with the
government. In this regard, it is important to hold Muslim-
majority countries to their transnational and international
commitments. In addition, due to the respectability of the
juridical-religious bodies in Egypt and Saudi Arabia, fatwas
issued in these countries are held in especially high esteem
(Atighetchi 2007). Accordingly, a focus on policy development
in these countries would have a wide impact. Further, though
governments are central for abortion rights to be achieved,
there must be greater acknowledgement and support of interest
groups, including physicians and Islamic feminists. In this
regard, Fazlur Rahmun, a Pakistani theologian who argued in
favour of abortion within 120 days of pregnancy, believes that
women’s groups in the Muslim world are central in liberalizing
abortion legislation (Bowen 1997).
Lastly, it is strategic for policymakers to be mindful of the
frames that will not be well-received and emphasize those that
will be ideologically acceptable. In this regard, the above
discussion has shown that abortion as a method of family
planning or as justifiable so to promote woman’s reproductive
rights have not been successful frames (Bowen 1997). For
example, the Pakistan Medical and Dental Council’s Code of
Ethics (2001, art.7) explains that ‘[i]f secular Western bioethics
can be described as rights-based, with a strong emphasis on
individual rights, Islamic bioethics is based on duties and
obligations’ (Atighetchi 2007; Daar et al. 2008). Instead, public
health (on the basis of istislah) and economic development have
been more persuasive. For example, Bowen (2003) deduces that
abortion liberalization in Tunisia centred on economic develop-
ment and Tunisia’s concern to lower their birth rate.
Conclusion
The diversity in Islamic thought and abortion law throughout
Muslim-majority countries is evident. As Al-Azmeh (1996)
explains, ‘there are as many Islams as there are situations that
sustain it’ (p. 1). Investigating Islam’s position on abortion
reveals that though Islamic jurisprudence does not encourage
abortion, there is no direct prohibition on abortion from the
 492 HEALTH POLICY AND PLANNING
Quran and Sunnah, the two most authoritative biblical sources.
Further, positions on abortion are notably variable, and many
scholars permit abortion in particular circumstances and stages
of gestational development. Evidently, Islam has also been
interpreted to be compatible with abortion rights in prescribed
situation. Particularly, the least blameworthy abortion is that of
‘necessity’ (i.e. if the life of the pregnant woman is threatened)
and when 120 days have not lapsed (Bowen 2003; Katz 2003;
Hedayat et al. 2006).
An analysis of abortion laws in Muslim-majority countries
exemplified a generally conservative approach where 18 of 47
countries only legally permit abortions in cases where the life of
the pregnant women is threatened (i.e. not in cases to preserve
a woman’s physical or mental health, rape, foetal impairment,
or for social or economic reasons). Nevertheless, the substantial
diversity among the world’s 47 Muslim-majority countries is
often under-appreciated. Indeed, 10 Muslim-majority countries
allow abortion ‘on request’, which, e.g., is more lenient than
Japan, Iceland, Ireland, New Zealand, or the United Kingdom.
The diversity found in Muslim-majority countries is likely in
part due to the variability of the Islamic position as well as
many other factors including whether the legal system is based
on Sharia law exclusively (e.g. Iran), a combination of Sharia
law alongside civil or common law (e.g. Saudi Arabia), or
whether the legal system is not formally based upon Sharia law
at all (e.g. Turkey) (CIA 2012).
This article makes policy recommendations for Muslim-
majority countries that currently only allow abortion to save
the life of the woman (e.g. Afghanistan, Bangladesh, Yemen
and 15 other countries). Particularly, more lenient abortion
laws may be achieved through disabusing individuals of the
incorrect assumption that the Quran and Sunnah unambigu-
ously oppose abortion, highlighting more lenient interpretations
that exist in certain legal schools, emphasizing significant
actors that support abortion, and being mindful of policy
frames that will not be well-received. In so doing, the
heterogeneity of Muslim-majority countries should be taken
into account and the implementation of these strategies should
be country specific. Other social and cultural strategies should
be explored alongside these to reduce the stigma associated
with abortion and improve access to abortion.
In terms of future research, further investigation of the Shiite
position (rather than Sunni) is especially merited. As Islamic
bioethics is neglected as a whole, the minority Shiite position is
especially overlooked (Shanawani and Khalil 2008). Moreover,
it would be beneficial to more comprehensively survey Muslim
believers and religious leaders to ascertain abortion attitudes. In
so doing, the World Values Survey asks only one question on
abortion (i.e. whether it is a justifiable practice on a scale of
1–10) (WVS 2012). An expansion of this data would be useful
in analysing individuals’ practices, reasoning and any cognitive
dissonance. A Critical Discourse Analysis would be another
effective methodological approach to evaluate a potential
discrepancy between reports by religious observers and their
practices (i.e. why so many women in Muslim-majority
countries have abortions for economic reasons despite its
generally prohibitive nature). Further empirical analysis would
also be useful in understanding what factors are associated
with more liberal abortion laws in Muslim-majority countries.
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A better understanding of the factors associated with more
liberal abortion laws could guide theoretical analysis. In
addition, greater examination of an Islamic perspective on
other methods of family planning (including withdrawal,
menstrual regulation, sterilization, pre-conception counselling,
the pill, long-active reversible contraceptive methods, and
infertility management) is merited.
In addition to the findings that have been presented on Islamic
perspectives on abortion and the diversity of abortion law in
Muslim-majority countries, one more general conclusion results
from this study: that a deep and diverse understanding of Islamic
positions is crucial given the important use of religion in bioethical
decisions (Hessini 2008). Indeed, abortion policy analysis and
research in the world’s 47 Muslim-majority countries must
consider the Islamic discourse in order to make more successful
and sensitive policy recommendations. As Hassan (2001) insight-
fully explains, ‘compelled by facts of modern history, some social
scientists in the West are now beginning to concede that Islam is
one of the factors which needs to be considered—along with
political, economic, ethnic, social and other factors—in planning
and evaluating development projects’ (p. 68).
Acknowledgements
I would like to thank Dr. Juan Fernández-González, Professor
Patrick Dunleavy, and Dr. Lloyd Gruber for their valuable
comments on an earlier draft of this article.
Conflict of interest statement. None declared.
Endnotes
1
The science of Usūl al-fiqh, investigating Islamic sources, outlines
specific rules for using sources in contradicting cases (Brockopp
2003). It is important to be mindful of which text is being used, as
texts differ in importance. Muslims believe that the Quran (or
Koran) was divinely revealed (i.e. god’s own speech) to the
Prophet Muhammad from 610 to 632 C.E. (Boonstra 2001).
Therefore, the Quran is the most fundamental religious source
for Muslims (Brockopp 2003; al-Hibri 2011). The Sunnah is a more
informal source based upon oral tradition (known as hadith) that
is a collection of practices and sayings of Muhammad, which
provides guidance on issues not explicitly addressed in the Quran
(Brockopp 2003; al-Hibri 2011). The Quran and Sunnah are the
primary sources of Sharia law (or ‘Islamic law’). When law cannot
be derived from the Quran and Sunnah, Sharia law is determined
through Igma (i.e. unanimous consensus of the faithful) and Qiyas
(i.e. reasoning by analogy).
2
These pivotal bioethical concerns in Islam can be compared to the four
basic prima facie ‘ethics of principles’ in Western bioethics:
autonomy, beneficence, non-maleficence, and justice (Beauchamp
and Childress 1989; Gillon 1994; Daar et al. 2008).
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