Abortion in Palestine is a highly contentious issue and rates of unsafe abortion are high. The Palestinian Family Planning and Protection Association (PFPPA), a member association of the International Planned Parenthood Federation (IPPF), has been working to provide sexual and reproductive health and rights (SRHR) care in the country since it was founded in 1964.

Working in Palestine is difficult and complex as it is an occupied country separated in two sections, which has not had a sitting government since 2007. Despite these difficulties PFPPA have still managed to continue to provide care across their eight clinics in the Gaza Strip and the West Bank as well as through mobile outreach to more remote locations.

In recent years, the country has become more conservative with notable influence from outside forces and a turn towards more restrictive interpretations of the majority religion Islam. This has led to an increase in early marriage rates and gender-based violence and so-called “honour killings” remain high.

Sex outside of marriage is highly taboo and it is not uncommon for a woman who becomes pregnant outside of marriage, whether willingly or through rape, to be killed by her family. Contraceptive options are also not readily available throughout the country and women’s lack of decision-making ability within the family often mean that they are not able to control how many pregnancies they have, even when this might negatively affect their health.

Despite abortion being legal in cases where the pregnancy poses a risk to a woman’s health or life, there is great inconsistency as to how this is interpreted, with many clinicians arbitrarily refusing to provide care without referring to alternative providers. Religious rules around abortion are also not clear, unlike in some other religions, Islam does not prohibit abortion. However there is no clear text on when you can end a pregnancy. Some say up to 40 days and some say up to 120 days of pregnancy.

Former Executive Director of PFPPA, Amina Stavridis

Former Executive Director of PFPPA, Amina Stavridis

In this context, and recognising a weakness in their work on this issue, PFPPA decided to apply for SAAF funding in 2014 to run a project aimed at improving their abortion service delivery and advocacy.

As Executive Director Amina Stavridis* highlighted, “we wanted to find a way to improve our support to women in need of this care and create change in the country so that the government and population would recognise women’s rights to have access to abortion. We became very active in national committees and started to talk about abortion care and how we could change the law to make it easier for women in need.”

The first SAAF project entailed training their own staff and starting to provide abortion-related services such as counselling, post-abortion care and harm reduction as well as advocating more widely within the community and government for changes to the law.

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“I am very proud that as a peer educator I have expanded my knowledge on many issues, including how to provide harm reduction information to women so that they can reduce risks of unsafe abortion”

In the four years since they started working with SAAF, PFPPA have had some successes “we have noticed changes in how abortion issues are tackled in Palestine. PFPPA has become known for its expertise on this sensitive issue and because we have integrated abortion into gender and gender-based violence issues, we have noticed that it is no longer a taboo issue within the SRHR sector. The biggest impact we have seen from the project is that people are now willing to talk about abortion” mentioned Amina.

The success of this first SAAF supported project meant that they were able to receive further support from IPPF to improve their abortion service delivery. However, the organisation recognised that there was still a need to focus on advocacy, as the law in Palestine is still holding women back. They therefore applied for SAAF funding under Round Four in 2017 to focus on abortion related advocacy more directly with an aim of changing the law to allow for abortion in cases of rape.

“SAAF is a very good opportunity for us to strengthen our work and the flexibility of the fund and the way that it handles issues related to abortion, taking into consideration the context of the countries is very important for us.”
— Amina, ED

The issues faced by women who can’t access abortion are recognised by the organisation as they regularly see clients who have either tried to end a pregnancy themselves by jumping from heights or taking traditional and sometimes dangerous concoctions as well as those that come directly to them seeking help.

In one such case Amina recalls a young girl who became pregnant following rape by a family member.

“She came to the clinic and told the doctors that if she did not get access to abortion her family would kill her. Due to the risks that she would have faced had we had refused to care for her, our doctor provided her with harm reduction care, ensuring that she didn’t end up with an unsafe abortion. When this was complete, she returned to the clinic for follow-up care and she thanked the team, saying that this support saved her life.”

“I wish all government and religious leaders would think of these young women and girls as one of their relatives. What would they do in that situation? People like to say that it wouldn’t happen to them or their families but any woman could be raped and get pregnant against their will. How would they react in that situation? Then they would surely change their attitudes.”

“From my experience the situation in relation to abortion in Palestine is very hard. There are many women who get pregnant who did not plan it and it’s not the time for the pregnancy.”

A PFPPA client

“I put myself into the position of these women who come to us with an unwanted pregnancy and I think what would I wish in that situation, I would hope that someone could take this pregnancy from me or help me to end the pregnancy to be free from any harm. This is my drive for action.”

Dr Layana Nazer, treating a patient at the PFPPA clinic in Hebron

Dr Layana Nazer, treating a patient at the PFPPA clinic in Hebron

“I would like to see in the future that complete reproductive health services including abortion care are available and provided without stigma to any person in need.”

* Since this interview Amina has left her position at the organisation