Spring Semester, 2009
Anthropological and Sociological Perspectives on Israeli Society(ies)
Abortion in Israel: Flexible Attitudes in a Pronatalist Environment
In Israeli society, motherhood is constructed as women’s central role, and parenthood is part and parcel of Jewish and Israeli collective identity and societal patterns. Women’s “national mission” of mothering more than one child is built upon the religious commandment to “be fruitful and multiply”, fear of the loss of a child in war, as well a desire to enlarge the Jewish population in order to repair the demographic losses resultant from the Holocaust. In addition, and perhaps most powerfully, national Zionist ideology encourages a high fertility rate in an effort to maintain a Jewish majority in a political situation of conflict and tension with neighboring populations with higher fertility rates, a situation referred to as the “demographic time bomb.” In the context of these strong sociocultural attitudes in favor of high fertility, it is unsurprising that the fertility rate in Israel is higher than in other developed countries, with a Total Fertility Rate measured at 2.7 in 2000, in comparison with estimated Total Fertility Rates of 2.05 in the United States, 1.98 in France, and 1.31 in Italy in 2009. To encourage this high fertility, the state has implemented strong pronatal incentives, including giving new mothers birth grants to cover the cost of childbirth, as well as a birth allowance to pay women for a short period following childbirth. The government also funds expensive fertility treatments for both single and married women until two living babies are born. The state not only shapes women’s reproductive decisions through these pronatalist incentives but also by “delegitimizing alternative life courses in which motherhood is not as prominent,” as women’s responsibilities as mothers are prioritized over their careers. In light of this strong cultural and state-sponsored pronatalist stance, this paper seeks to explore the issue of elective abortion in Israel, seeking to understand the experience of the choice against motherhood in a climate that strongly encourages women to become mothers and to have multiple children. The paper will provide an overview of the practice of abortion in Israel and the religious and civil laws governing it, and will pose questions about what abortion means for Jewish women in Israel.
The Law Concerning Termination of Pregnancy which was adopted by the Knesset on January 31, 1977 legalizes abortion in a recognized medical institution if it fits one of five conditions: the woman is under legal marriage age (17) or over the age of 40; the pregnancy resulted from an illicit (rape, incest) or non-marital relationship; the fetus is likely to have a mental or physical defect; continuing the pregnancy may endanger the woman’s physical or mental health; or an abortion is needed because of family or social circumstances. Although public opinion polls suggest that a majority of Israelis would support such a clause, the final article allowing a pregnancy to be terminated for ‘social reasons’ was removed from the law in 1979, at the request of Agudat Israel, a small but powerful religious party, during coalition building for a new government. The decision as to whether a woman is qualified for an abortion based on these standards is made by committees composed of two doctors and a social worker, established in authorized hospitals and clinics. In 1995, medical committees known as Abortion High Committees were established in Israel in order to consider specifically the issue of ‘late’ terminations, an issue most often involving selective abortions due to genetic defects. These regulations on abortion establish a liberal or flexible view of abortion (legalizing the practice for a variety of reasons that in other Western countries might be quite controversial) that may seem contradictory to the traditional pronatalist stance of the state. Neverltheless, the attitude toward abortion remains conservative insofar as the power to decide a woman’s qualifications for abortion is in the hands of the (largely male) government-approved medical establishment, thus “subjecting individual choice to authoritative scrutiny and approval.” As a result, illegal abortions are not uncommon – in fact, most women who are denied (or suspect that they may be denied) legal abortions in Israel do obtain illegal abortions.
Although the majority of women who obtain abortions and the majority of medical professionals who perform them are secular, they, their society, and the laws of their country are strongly influenced by religious ideas which “function as moral-mental structures” guiding their approach to the meaning of abortion. Thus, it is imperative to outline the attitude toward abortion in traditional Jewish law not only in order to understand the attitudes that religious Jews hold toward the issue, but also to understand the framework in which abortion is viewed throughout Israeli society. According to Jewish law, the fetus is considered an organic part of the mother, and is not considered a nefesh adam (human person) at any stage in the pregnancy, thus abortion is not considered murder. Unlike in other Western countries, influenced by the Catholic notion that the soul enters the body at the moment of conception, traditional Jewish law legislates that life begins on the thirtieth day after the birth, when the baby has begun to exhibit the human characteristics that demonstrate that it was made in the image of G-d. Abortion is not permitted without reason, as life is of supreme value, but in a case where the woman’s life is endangered by the pregnancy or childbirth the fetus can be considered an ‘aggressor’ which may be killed in defense of the mother – the mother’s life is more valuable than the potential life of the not-yet-human fetus. Simply put, abortion is permitted if carrying the pregnancy to term could cause harm to the mother. The interpretation of the needs of the mother’s life in the halachic tradition have varied from a narrow interpretation that abortion is only permitted to physically save the mother to a broader interpretation wherein abortion is permitted if the birth would harm the woman’s psychological wellbeing, cause her shame, or harm the prospective wellbeing of the child. Within these parameters, the debate over the fetus’s “right to life” which is so prominent in the abortion debate in other Western religious contexts, is irrelevant – the fetus’s right to be born is relative to the welfare of the mother.
Instead, the debate centers around arguments concerning the “demographic time bomb” on the one hand, and social distress on the other. The 1977 abortion law emerged from a context in which family size became a mark of low social status and of poverty: at that time 10% of all Jewish households reared close to half of Israel’s children, often under severe socioeconomic conditions. Permitting abortion was seen as a way to relieve this social problem, though concerns were expressed that by encouraging a lower fertility rate in these families, abortion would make the threat of the “demographic time bomb” even greater.
In general, the Israeli abortion debate lacks a strong ideological component on either end of the spectrum, with more liberal segments sympathetic to the demographic argument and more conservative segments approving of abortion under specific, limited circumstances, such as if the potential mother’s life is at risk as a result of the pregnancy. The strongest anti-abortion voice in Israel has been Efrat – the Right to Life Association for the Encouragement of Increase Birthrate among the Jewish People. When Efrat began in 1962, it was without the notion of “Right to Life” and stressed instead a concern about fertility imbalance between Jewish and non-Jewish communities (ie. the “demographic time bomb” argument). Although, through the influence of American immigrants, Efrat introduced the American “right-to-life” strategy in the 1980’s, their primary concern and argument remains demographic, as evidenced by their acceptance of embryopathic abortions, a position that conservative right-to-life organizations in other Western countries would be loathe to adopt. Efrat posits itself as “the real pro-choice organization,” offering money to women so that they won’t terminate their pregnancies for financial reasons. The assumption here is that the “first choice” of most women is to have their babies, an assumption in line with the pronatalist environment of Israeli society.
With a debate focused on demographic issues, the feminist perspective of the right of the woman to control her own body is not strongly represented in the Israeli debate. While in other contexts, “imposing an absolute maternity duty on a woman…was seen as denying her freewill and judgment in matters pertaining to her own life,” in Israel, feminist groups are loyal to Zionist ideals, and as such are followers of the demographic argument. With the lack of feminist struggle in the debate, women’s bodies, even in the context of abortion, are controlled by the state and the medical establishment. Women who wish to exercise their right to an abortion are subjected to intrusive interrogations and “stigmatized as transgressors,” although gynecologists are generally cooperative with women’s choices and abortion committees are generally permissive. Although since 1979 the clause permitting abortion in the case of pregnancy outside of marriage has been invoked in approximately half of all abortion requests, under the abortion law medical experts are called upon to determine a woman’s qualifications for the procedure, thus suggesting that “non-normative” sexual behavior is a kind of illness and giving abortion committees (largely male) moral and physical authority over women’s bodies.
Abortion is widely available in Israel, statistics show that 95% of Israeli women have access to moderately priced abortion and that over 95% of the women who apply for legal abortion are given positive answers. Nevertheless, rates of abortion are relatively low, with the average number of abortions for Israeli women at 0.6 compared to about 0.9 in the US and between 2 and 5 in Eastern Europe, rates that may be explained by the pronatalist atmosphere of Israeli society and by widespread and effective use of contraception. These low and decreasing abortion rates have contributed to the lack of public conversation and debate about abortion.
Because abortion is “silenced in both public and private realms,” women who have undergone the procedure report that they “hardly ever” discussed their pregnancy and its termination after they had undergone the abortion. Many Israeli women who underwent an abortion felt that the institutional involvement in their abortion was justified because “a woman should feel social responsibility when children are concerned.” They tended to see the abortion as a personal failure in responsible sexual behavior. As one Israeli informant of Larissa Remennick and Rosie Segal’s study expressed, “Intelligent women who take good care of themselves and have caring partners don’t get into this…” The issue of non-vital abortion, particularly when pertaining to the clause that allows abortion as a result of out-of-wedlock conception, incest, or conception under illegal circumstances such as rape, is a taboo subject, and the women who undergo the procedure express feelings of guilt and self-accusation for their unwanted pregnancies. This guilt often stems from self-criticism for lack of use or misuse of contraception, rather than guilt regarding non-marital sex, or the choice to abort itself.
Abortions are most often sought by secular, Ashkenazi, middle-class, educated women. While many secular women see a large number of children as a detriment to a good marriage, many religious women perceive a large number of children as an important factor in building a stable family. There is a strong inverse association between religiosity and the acceptance and practice of abortion - religiosity is the single most significant determinant in the practice of abortion. In the 1960’s and 1970’s, as the abortion law was being established, Jewish women of Afro-Asian descent were less likely to have access to family planning services and were also less likely to use abortion services than Ashkenazi or Israeli-born women, thus resulting in high fertility rates for these populations. However, these immigrant groups experienced rapid fertility decline due to increases in the use of fertility control and integration into Ashkenazi social norms such that fertility differences between Ashkenazi and Mizrachi communities decreased in significance. Nevertheless, the country of origin of the woman obtaining the abortion remains a strong factor deciding the practice of induced abortion.
Studies show that Russian immigrants to Israel held a markedly different view of abortion than Israeli-born women. Abortion was very frequent in the USSR as a result of limited contraceptive means, an exaggerated perception of the dangers of modern contraception, underestimation of the dangers of abortion as performed in the USSR, and inadequacy of sexual education programs. In the USSR, abortion had never been seen as an ethical, religious, or political issue, and was instead considered a routine procedure, the most readily available birth control method: Soviet women typically had as many as 35 lifetime abortions. These patterns of attitudes toward and practice of abortion are a striking contrast those of Israel, in which abortion rates are reportedly among the lowest in the world (around 13 per 1000 women of reproductive age). The rate of abortion in Soviet immigrants to Israel declined over time as they have become more accustomed to preferred Israeli contraceptive methods, but a difference remains.
Differences in attitude toward abortion were reflected in Larissa Remennick and Rosie Segal’s study on Russian and Israeli-born women’s experiences of abortion in Israel. Because they regarded termination of marital pregnancy as normal ‘birth control,’ Russian women interviewed in this study negative about what they felt was unnecessary and intrusive bureaucratic involvement in their private decisions about fertility, unlike Israeli-born participants in the study. They tended to see abortion as a misfortune, and to understand themselves as victims. As they were not socialized to see abortions as contrary to ‘responsible sexual conduct,’ they did not experience the same sense of personal failure that was reported from Israeli-born women, and did not express feelings of loss of self-esteem or dignity. Nevertheless, they experienced discomfort as a result of the perceived disapproval of health and welfare workers toward Russian women obtaining abortions. Popular stereotypes of Russian women as sexually irresponsible made coping emotionally with the abortion process difficult for Russian women. This indicates that although abortions were a normal and even a routine aspect of Russian society, Israeli attitudes toward abortion, motherhood, and sexuality influenced Russian women’s experiences about the procedure.
Although religiosity is the most significant indicator of the likelihood of a woman to pursue an abortion, in the case of the potential for health problems with the fetus, women of many different backgrounds, including religious, undergo abortions. Religious leaders approve of this practice, encouraging or permitting members of their community to undergo prenatal testing in order that they will be more comfortable with having children at an older age, when health risks for the fetus are higher. Israel has among the highest rates in the world of termination of abortion due to genetic defects found in the fetus. In 2003, 3,476 pregnancies were terminated for this reason– 17% of all abortions in Israel. Elective genetic testing is more common among educated middle class Ashkenazi women, and is often refused among non-Ashkenazi women. The costs of testing are also a limiting factor, making such tests less popular among women in lower social stratum. Women who chose against testing do so for ethical or moral reasons, for the cost, or because of poor understanding of the meaning of the tests. Women who do chose prenatal genetic diagnosis do so for a number of reasons including fear of having a sick or socially unaccepted child, concerns about lack of government and communal support for the raising of such a child, and apprehension regarding Ashkenazi genetic make-up due to high incidence of certain genetic disorders.
Genetic testing has become socially constructed as part of “good motherhood,” insuring the health of the child, even before it is born. This is an important point, as motherhood is so central to Israeli women’s identities and social roles. Genetic screening has become part of the normative behavior of expectant mothers, and compliance with this behavior is seen as indicating responsibility for the future of the child. Refusal to comply with this behavior may be labeled, conversely, as irresponsible. Because Israeli culture is very informal, women who discuss their decisions not to partake in prenatal genetic testing face social disapproval expressed both tacitly and openly by their peers.
Acceptance of prenatal genetic testing and selective abortion is made possible by the low tolerance of disability in Israeli Jewish culture, which results not only in families dreading the idea of having a child with special needs, but also with the low level of support given by the government to families with disabled children. In a society that does not provide adequate support for children with disabilities, parents fear that a child with disabilities will be too great a burden, emotionally and financially. As, according to Jewish law and popular Israeli perception, a fetus is not yet a child, deciding to abort a child because of possible disability is not viewed as a discriminative practice, but instead as a way to insure a high quality of life for children born in Israel. Willingness to abort a fetus because of a possible defect may also be explained by Jewish attitudes toward suffering. Unlike the Christian tradition, in which suffering is punishment for the original sin and dealing with suffering is seen as a challenge from G-d, the Jewish tradition does not glorify suffering and tries to prevent it. In this context, there is no meaning behind the suffering of a child with a disability and its family, and prevention of the suffering (perceived as greater in Israel because of the low tolerance for disabilities) is merciful and responsible.
Genetic testing and selective abortion have become so much the norm in Israeli society that children born with disabilities or their parents are able to bring lawsuits to court on the assumption that, had they received accurate information, they would have aborted the fetus. “Wrongful birth” suits, in which parents sue genetic counselors or gynecologists, claiming that they would have terminated the pregnancy had they been properly informed of the fetus’s diagnosis, and “Wrongful life” suits, in which the infant sues the medical agent because of an incorrect diagnosis, claiming that had the parents been given accurate information the claimant never would have been born and would not have to suffer living with a disability or hereditary disease, have both been accepted in Israeli courts. Israel’s permissive stance on abortions because of possible defects found in the fetus allows for the assertion that the parents, with the right information, would have aborted the child, thus making the “wrongful life” and “wrongful birth” arguments possible. Yael Hashiloni-Dolev notes that while Israeli law does not acknowledge that a fetus has any rights to life, under Israeli law the fetus does have the retroactive right, determined in a “wrongful life” case, not to have been born handicapped. The existence of these legal precedents may lead genetic counselors to encourage women to partake in genetic testing and to abort a fetus with a possible defect, for fear of a lawsuit should a child with a defect be born.
The issue of abortion in Israel walks the tightrope between the state’s pronatal attitude, influenced by religious and political dimensions, and the nature of Israel as a modern, Western country wherein families adopt lifestyles that involve low fertility. The low abortion rates in Israel coupled by the lack of moral argument because of the fetus’s non-human status in Jewish law means that abortion is a low-profile issue in Israel, but it is nevertheless an important one. Bridging the gap between abortion as a choice against motherhood and the cultural celebration of the role of the mother stands the issue of prenatal genetic testing and selective abortion, wherein the choice not to carry a pregnancy to term is constructed as one align with the concept of “good motherhood.” In this case, the choice not to have a child, and thus not to become a mother, can itself, somewhat paradoxically, be an act of good motherhood. This changes the nature of motherhood in Israel - the mother is unsure if she will carry the fetus to term because of the possibility of selective abortion for genetic reasons, transforming a pregnancy into a tentative experience. The mother may feel that she cannot bond with the baby for fear that she will have to make the decision to abort it, and the lack of bonding leads to a further construct of the fetus as not-human, making an abortion more of a possibility.
If the decision to abort a pregnancy can be constructed as “good motherhood,” this may have implications for women who lost their fetuses in a miscarriage or during the first 30 days of the baby’s life, when according to traditional Jewish law and to the law of the State of Israel, the baby was not yet a person. Although pregnancy loss and death of a newborn may continue engender a feeling of failure to fulfill the social ideal and expectations of motherhood, perhaps a growing body of women who have chosen to abort their pregnancies in order to prevent the suffering of their children will lead to a new societal category of almost-mothers, a category that will give these women a place to speak and acknowledge their identity as “good mothers” even though they never had the experience of giving birth to a baby that survived to be acknowledged as a person in society.
Abortion in Israel, however, is not only a question of good motherhood, or ensuring that the potential mother has an opportunity to prevent the suffering of her potential child, but is more often a question of the potential suffering of the mother herself. The flexibility and conservatism of Israeli law and interpretations by individual abortion committees centers around the question of how much carrying the pregnancy to term could harm the mother physically, psychologically, or in terms of causing her shame (in the case of a pregnancy conceived outside of marriage). In a debate not centered on feminist ideals, the woman’s right to choose is not in question. It is the medical institutions and the government that set the framework for whether a pregnancy can be aborted, based on guidelines about how the pregnancy may harm the potential mother. These decisions include moral decisions about acceptable sexual behavior and construction of families, such that a pregnancy conceived out of wedlock is considered a great enough shame to merit abortion, and the idealization and elevation of motherhood such that the pregnancy of a healthy married woman legally must be brought to term, as it is inconceivable that such a pregnancy could harm the potential mother. An intrusive and paternalistic system controls the bodies of the women themselves, a practice to which Israel-born women seem not to object to but that Russian-born women who come from outside of Israeli societal norms find uncomfortable and unnecessary. Despite the intrusiveness of Israeli law regarding abortion, women who do obtain abortions are able to do so in an environment where their decisions are considered acceptable and the question of a fetus’s right to life is not present. In abortion for reasons other than the clause regarding possible defect in the fetus, the abortion does not occur in the context of “good motherhood” but it also does not occur in the context of murder or immorality. Rather, judgment is centered around questions of sexual responsibility, issues that are easier for women undergoing the abortion procedure to handle emotionally. Women undergoing the crisis of problematic pregnancy may be able to recover faster and more fully in Israel than in other Western countries with more conservative attitudes toward abortion.
The issue of abortion in Israel shows the convergence of conservatism and non-Christian perspectives that in other contexts might be considered liberal. A paternalistic and conservative attitude toward fertility does not prevent the legalization of abortion because of a conservative attitude toward religion – in this case a religion that is permissive and flexible on the issue of abortion. Women who undergo abortions in Israel do so in this framework in which the fetus is not considered fully human, but in which the decision to abort may be perceived as going against women’s “national mission” of motherhood. Thus, the issue of abortion in Israel involves a balance between the pronatalist attitude of the state and the flexible attitude toward abortion as professed in the official state religion and as adopted by a modern, Western, secular society.
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 Sered 22
 Birenbaum-Carmeli 102, Toren 64, Landau 74
 Yishai 217
 DellaPergola 33; Central Intellegence Agency: The World Factbook
 Sered 25
 Landau 71
 Birenbaum-Carmelli 110
 Wilder 137
 Wilder 137, citing public opinion polls published in Yishai Y. (1993) “The hidden agenda: Abortion politics in Israel.” Policy Studies Journal, 7 (270-289).
 Wilder 137
 Hashiloni-Dolev, A Life (Un) Worthy of Living 86
 Yishai 214
 Wilder 138
 Hashiloni-Dolev, A Life (Un) Worthy of Living101
 Davis 316
 Hashiloni-Dolev “Reproductive Genetics…” 136
 Hashiloni-Dolev “Reproductive Genetics…” 136
 Hashiloni-Dolev “Reproductive Genetics…”136, Davis 318
 Hashiloni-Dolev, A Life (Un) Worthy of Living 99
 Hashiloni-Dolev, A Life (Un) Worthy of Living 97
 Yishai 217
 Levine 322
 Levine 391, Hashiloni-Dolev, A Life (Un) Worthy of Living 98
 Friends of Efrat website: www.friendsofefrat.org
 Yishai 209. 223
 Birnbaum-Carmeli 106
 Sered 35
 Wilder 139 Remennick and Hetsroni 195
 Remennick and Hetrsoni 195-196, citing Sabatello, E. F. (1993) “The impact of induced abortion on fertility in Israel” Social Science and Medicine, 36, (703-707) and The Alan Guttmacher Institute (1999) “Sharing Responsibility: Women, society, and Abortion Worldwide”, NY, The Alan Guttmacher Institute. In Israel, in the 1950’s and 1960’s abortion was used as a standard method of limiting births. The decline in number of abortions is linked to the adoption of new contraceptive practices. (Wilder 140)
 Remennick and Hetsroni 195
 Remennick and Segal 56
 Remennick and Segal 57
 Remennick and Segal 60-61
 Remennick and Segal 62
 Landau 68
 Wilder 141, 155
 Friedlander 123
 Okun 333
 Wilder 154
 Sabatello 118
 Remennick and Segal 51
 Remennick and Segal 52 citing David, H. P. (1992) “Abortion in Europe, 1920-1991: a public health perspective. Studies in Family Planning, 23 (1-22); Sabatello, E. F. (1993) “The impact of induced abortion on fertility in Israel” Social Science and Medicine, 36, (703-707); and Central Bureau of Statistics of Israel (CBS) (1998) Demographic Characteristics of Applicant for Pregnancy Termination (Jerusalem: CBS)
 Sabatello 12
 Remennick and Segal 57, 62
 Remennick and Segal 60
 Remennick and Segal 60
 Hashiloni-Dolev “Between Mothers, Fetuses, and Society” 131
 Remennick 21
 Remennick 22
 Remennick 21
 Remennick 21, 26
 Remennick 21
 Remennick 26
 Remennic 46
 Remennick 26
 Hashiloni-Dolev “Between Mothers, Fetuses and Society” 130-131
 Hashiloni-Dolev A Life (Un)Worthy of Living 128
 Hashiloni-Dolev A Life (Un)Worthy of Living 119-120
 Remennick 123
 Hashiloni-Dolev A Life (Un)Worthy of Living 124
 Hashiloni-Dolev A Life (Un)Worthy of Living 124
 Remennick 22