A Doctor’s Perspective on Abortion in Islam
June 15, 2022
In the next few weeks or months, the Supreme Court of the United States may be issuing a ruling to overturn the landmark 1973 case of Roe v. Wade, thus restricting abortion access in the United States. Like other faith communities, the American-Muslim community is not immune to the discussions about the legality of abortion according to our faith tradition. I am not a Muslim legal scholar and therefore have no place to issue a religious legal opinion about this controversial topic. However, I am a medical specialist and my suggestions below are proffered from this perspective. Specifically, my recommendation is that both the physical and mental health of the mother be accounted for in any judgment regarding abortion.
By training, I am a pediatric infectious diseases physician and have worked as a pediatric hospitalist for nearly a decade. I majored in Cellular and Molecular Biology with a focus on Genetics. I am well-versed in embryology, have attended countless deliveries, have been interacting with children and their mothers daily for the last two decades. I am an expert in children’s health, including young adolescent pregnant women. Like most seasoned pediatricians, I can easily identify a loved child, as well as the opposite.
I believe the emblematic characteristic of my faith, Islam, is mercy. Every day, billions of Muslims begin their five daily prayers by invoking God through His names: the Most Compassionate, the Most Merciful. Nearly every chapter of the Quran begins with these names of God as well. The role of the Prophet Muhammad—peace be upon him—is also grounded in compassion, since God says about him in the Quran: “We have not sent you except as a Mercy to the Worlds.” For these reasons, I feel it is appropriate for me as a Muslim medical professional to invite Muslim legal scholars (and other scholars from whatever their religious background) to approach the topic of abortion through the lens of compassion.
In most Muslim conversations regarding the legality of abortion, there is one situation whose legality is agreed upon: when the mother’s life is at risk. Muslim scholars understand that one of the main objectives of the Sacred Law is the preservation of life, AND by extension, the protection of health. As modern medical journals are now filled with research highlighting the great extent to which our mental health affects our physical health, it is essential that Muslim legal discussions take into consideration the mother’s mental and emotional well-being as well as her physical health when addressing the permissibility of an abortion.
The physical stress of pregnancy is acknowledged widely. Modern medicine tells us that pregnancy causes the woman to become anemic, which in turn causes fatigue. Pregnancy suppresses a woman’s immune system, making her more prone to infectious diseases, which categorizes her as high risk when she contracts influenza, COVID-19 or other pathogens. Pregnancy, in rare cases, can cause osteoporosis as the fetus leaches calcium from the mother’s bones and as calcium mobilization and bone resorption increases for lactation. Pregnant women are at risk for high blood pressure and gestational diabetes among other issues.
“It is essential that Muslim legal discussions take into consideration the mother’s mental and emotional well-being as well as her physical health when addressing the permissibility of an abortion.”
A woman who has had a baby before no doubt can describe in exquisite detail the feelings of nausea experienced by many in the first trimester and by some for the entirety of the pregnancy. She can painstakingly elaborate about the sharp pains of sciatica experienced during the last trimester as the additional weight adds pressure to joints already made more lax by pregnancy. Upon finding out she is pregnant again, she can reimagine the feelings of shortness of breath even in the first trimester and the leg edema of the last trimester.
It is no wonder that the Quran accurately describes the mother carrying a baby to term as bearing him in “weakness upon weakness” (31:14) in a verse where God commands the human being to be dutiful to his/her parents. The physical stressors listed above may be counted among the factors a Muslim legal scholar reviews when considering the legality of abortion in a particular case. But it is not enough for the discussion to focus on the physical toll that pregnancy takes on the woman’s body. Pregnancy can affect the mental health of the woman both directly as well as indirectly, due to social factors, and the effect on her mental health must also be taken into consideration.
As for how pregnancy and childbirth can directly affect the pregnant woman’s mental health, we know that pregnancy puts women at risk for depression and anxiety. Pregnancy exacerbates pre-existing mental illness but also puts women who have no history of mental health disorders at risk. The risk does not end after the baby is born. Post-partum women are particularly high risk for depression and mood disorders. Post-partum psychosis is well-described in the medical literature. It usually develops in the first two weeks after delivery but the risk remains relatively high for the first three months after child-birth. It is considered a psychiatric emergency.
Along with these direct challenges to mental health, the mental health of the woman can also be affected indirectly due to her particular social circumstances. In many developed societies today, the family and communal networks that used to be in place to help a woman through childbearing and childrearing no longer exist. Along with that, many women can no longer rely on someone else to take care of their basic living needs, such as food, clothing and shelter. This is due to many factors, such as the rise of single motherhood and the need for dual incomes. We must not forget how much mental effort goes into rearing a child: Those that start in the first year of life that require the mother to drop everything and tend to her infant’s crying, to once the child becomes a toddler knowing that even your bathroom time is no longer a time when you can be assuredly alone, to the later years when you help your child navigate friendships and bullying, to even later, navigating peer pressure, romantic relationships and preparing to leave the family nest.
Surely our Prophet Muhammad – peace be upon him – had a deep understanding of how much of the raising of children although may be shared by two parents, usually rests in its majority on the mother. Muslim children across the globe can easily recollect the famous hadith, saying of the Prophet Muhammad – peace be upon him, when the man asked him: “Who among people is most deserving of my fine treatment?” He – peace be upon him – replied. “Your mother.” When the man asked, “Then who?” he again replied, “Your mother.” When the man asked the third time, “Then who?” he again reiterated “Your mother.” It was not until the man asked the fourth time did our Prophet – peace be upon him – reply, “Then your father.”
Without the traditional support networks in place, many women feel overwhelmed, anxious, and incapable of fulfilling the necessary requirements to raise a child. To the inexperienced person, these tasks may seem just natural. Isn’t that what motherhood is all about? Isn’t it instinctual for a mother to be able to handle everything required to nurture her son or daughter? There may be a place for maternal instinct, but when all the other social supports that were in place in past societies are no longer available, we cannot assume that women will be able to act on that instinct with as much ease. As a seasoned medical professional, and myself a mother of four children, I understand the feelings of helplessness and desperation. I can easily grasp the mental anguish of women who are struggling as mothers, and so can many other women like me.
The lens of compassion in thinking about abortion would also make us examine what happens to a child who is raised by a mother who did not want him/her. What are the psychological, emotional and physical effects of neglect or abuse on a child? After all, unless a society has a set up in which unwanted children are taken into a warm, loving alternative environment, they will not thrive. Unfortunately, I have yet to see a country where this type of environment exists. Loved and cared for children exude a confidence even at the tender age of toddlerhood. But unwanted children, even those who grow up in wealthy families where their physical needs are taken care of, are always seeking that lost connection. Many times, they seek that connection in the most dangerous of situations. These children become prime fodder for gangs and pedophiles who know exactly whom to groom.
In Islam, it is well known that coitus interruptus is allowed. Some may argue that although allowed, it is not preferred, encouraged or even necessarily liked in our faith tradition. The same goes for divorce but anyone in an unhealthy relationship, having experienced the mental anguish, lack of sleep, and severe adverse psychological events that this creates, can see the Divine Wisdom in the permissibility of divorce. We need to consider the Divine Wisdom behind the permissibility of coitus interruptus with the understanding that it is usually the woman who is the impetus for this shared birth control strategy.
When deliberating on the matter of abortion and its permissibility for Muslims in the United States, [scholars of religious law] must perform due diligence and comprehend all the challenges a woman might be facing when she seeks an abortion.
I don’t envy anyone who has to make decisions involving the sanctity of life. Nor am I proposing that Muslims disregard this sanctity because I believe as a Muslim first and a physician second that every single life is indeed sacred. I am shedding light on issues that require a whole revamping of a social system. This would require the work of intelligent social scientists, public servants, legal scholars, physicians, and others, all collaborating to address the necessary support a mother requires to carry to term and raise a child. Currently, the social and medical support needed by a mother to wholesomely raise her child is lacking, at least in the United States. With respect to abortion and its religious permissibility, I believe it is imperative that these circumstances be acknowledged and be taken into serious consideration before giving any particular legal verdict on the matter.
For the God-conscious Muslim legal scholar, this is not a difficult thing to do by any means. The legal texts of Islam themselves call on the jurist (faqih) to make sure he/she understands the situation on the ground fully before giving a verdict. As the famous legal dictum goes, “al-hukm ‘ala shay’ far’un ‘an tasawwurihi” (the ruling regarding a matter is dependent on first properly grasping what the matter is). I put forth my medical experience on the matter as a means for Muslims jurists to get a fuller picture of exactly what it is they are pronouncing judgment on. This is what is due upon them both as jurists and as Muslims who live by the Islamic command to have compassion whenever possible.
In conclusion, this is not an exhaustive discussion of every scenario in which a woman would seek an abortion. Absent are many issues not the least of which is a woman who is forcibly impregnated. But it should be eye-opening in terms of how many other issues need to be considered besides, simply, the woman’s physical health as has been historically cited.
Upholding the principles of the Sacred Law, maqasid al-Shari’ah, requires critical thinking but equally as important, it requires compassion and creativity. It requires collaboration and consultation. In some ways, it is like being a physician because we also need to think critically about our patients, make risk/benefit analyses and collaborate with physicians from other specialties. As physicians, we do our best to treat people’s ailments and prolong their lives. Scholars of religious law are called upon to do the same, to work diligently and think carefully about what is needed to preserve the spiritual, physical, mental, and social well-being of human beings. When deliberating on the matter of abortion and its permissibility for Muslims in the United States, they must perform due diligence and comprehend all the challenges a woman might be facing when she seeks an abortion. For them to seek out all the factors involved is simply what they must do to pronounce a godly, ethical ruling.
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Dr. Nour Akhras
Dr. Nour Akhras is a board-certified pediatric infectious diseases physician who has been working at a free-standing Women and Children’s Hospital in the suburbs of Chicago for the last 9 years. Dr. Akhras was trained in pediatrics at the University of Illinois Chicago Medical Center and completed her fellowship at the University of Michigan, Ann Arbor. She holds a BA in Cellular and Molecular Biology from the University of Chicago and received her medical degree from Rush Medical College.
She has served on the board of IMAN (Inner City Muslim Action Network), a grassroots organization that fosters transformational change in urban communities where she co-chaired IMAN’s youth group, Pillars, for many years. She has also participated in multiple medical missions to support Syrian refugees and displaced war victims in Yemen. She has served on the boards of the Syrian American Medical Society Midwest chapter and MedGlobal. She has advocated for the rights of refugees by authoring op-eds in newspapers like USA Today and the Chicago Sun-Times and through speaking engagements including presenting at Washington DC’s National Press Club on the effects the violence of the Syrian war has had on the lives of Syrian women.
During the pandemic, she has led many virtual and in-person sessions regarding the risks of acquiring covid, the risk to the healthcare system if public health measures were not heeded and the importance of the vaccine effort. She partner in a program coordinated by the US Department of Health and Human Services and the CDC in one such program and authored a recent op-ed published by Interfaith America Magazine titled “As a Muslim Doctor, I Don’t Say Vaccination Is Permissible, I Say it is Obligatory.”
She lives in the suburbs of Chicago with her husband and four children.