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Israel’s Abortion Rate Continues 32-Year Decline
A clinic for the Clalit health fund located in Beersheba, Israel. (Clalit Health Services)

Israel’s Abortion Rate Continues 32-Year Decline

Experts credit increased access to contraception, sex-ed and population growth

Referrals in Israel to pregnancy termination committees, from which approval is required before undergoing the procedure, have been trending downward since 1988, as has the number of abortions performed, according to new data from Israel’s Central Bureau of Statistics (CBS).

In 2019, the most recent year for which data is available, 17,688 females in Israel turned to the committees. Some 99.4% were approved for an abortion, while only 106 applications were rejected.

That same year, there were 8.4 requests to the termination committees per 1,000 females between the ages of 15 and 49, a rate that has continuously declined since 1988, when there were 18.6 requests per 1,000 females.

Druze and Muslims have the lowest rate of abortion referrals in Israel, according to the CBS, with 5.6 referrals and 6.2 referrals per 1,000 females, respectively. This is followed by Christian Arabs, with 8.4 committee requests per 1,000 females, and Jews, with 8.9 committee requests per 1,000 females.

At 10 per 1,000 females, the unaffiliated or nonreligious, and non-Arab Christians, had the most referrals.

“We have the ultra-Orthodox community, and they don’t do abortions and they have a very high birthrate, and we also have the Bedouin community” who experience the same reality, so it affects the total numbers, Sharon Orshalimy, a contraceptive and sexual health counselor, and a doctoral candidate at Ben-Gurion University of the Negev, told The Media Line.

Orshalimy says there are several reasons for the overall reduced rates of referrals to termination committees.

“There is greater access to contraception, greater education of women, more sex-ed in classes,” Orshalimy told The Media Line.

It is not just that women use more contraception, Orshalimy also said. While the number of abortions has stayed nearly the same, the population has grown, which then also creates a decline in the rate of abortions.

In Israel, it’s much less of a political dispute

Orshalimy, who is writing her doctoral thesis on family planning policy and contraceptive use in Israel, notes that when Jews from the former Soviet Union, where abortion was widespread, immigrated to Israel en masse is the early 1990s after the fall of the Iron Curtain, it had a big impact.

When it comes to the approach toward abortion, Israel and the US are vastly dissimilar.

“In Israel, it’s much less of a political dispute,” Michal Gera Margaliot, former executive director of the Israel Women’s Network, told The Media Line. Abortion is a controversial topic in the US “but not here. Part of it is due to different perspectives in Christianity and Judaism about abortion.”

Orshalimy agrees. “We don’t have pharmacists or doctors here who would say: ‘This is against my beliefs; I’m not going to give you this.’ Women might not access it because they are religious, but the providers would never do that,” she said.

Under Jewish religious law, abortion is permitted if the mother’s life is at risk, since the fetus is not considered a separate being.

Another distinction is that in Israel, where abortion was officially legalized in 1977, the abortion can only be legally performed under certain circumstances and with the approval of a termination committee. Thus, the practice is permitted, but not under the school of thought that a woman has the right to make her own decisions about her body.

There are usually three people on an abortion committee: two physicians, one of whom is an OB/GYN, and a social worker. Israeli law stipulates that at least one of the three panelists has to be female.

The group can approve the medical procedure only in the following circumstances: the patient is under 18 or over 40; the pregnancy is out of wedlock; the pregnancy is the result of rape or incest; the mother’s life is at risk; carrying the pregnancy to term would result in mental or physical distress; or the child would have severe medical problems.

The most common reason for abortion approvals in 2019 was that the pregnancy came outside of marriage, accounting for a little over half of abortion approvals, according to the CBS.

Gera Margaliot says that married women have a difficult time getting approved for an abortion except where there are “medical reasons” or rape or incest.

“Married women need to lie and say that the kid is not from their husband or something like that, which is not a good thing, but most requests are approved,” she said.

This is also why Orshalimy finds the logic behind Israel’s rationale for abortion approval problematic.

“The philosophy of the law does not recognize women’s autonomy regarding their reproductive health; it recognizes the state’s autonomy to decide on a women’s reproductive health. The committee is the expression of the state,” she said.

“In Israel, abortion is very accessible, it’s safe, semi-legal and it’s funded up to age 33 and for medical reasons [or rape and incest] after 33,” Orshalimy said. “The reasoning of the law is very conservative, but the practice of abortion is very liberal and there is a big gap between the two.”

As far as paying for family planning to prevent situations where abortion is needed, Israel provides free birth control pills minus a deductible as part of universal health coverage up to age 20, and the HMOs generally discount the pills after that.

“It’s not expensive; it’s not like in the US. But again, it’s the philosophy. Why isn’t this funded?” Orshalimy said.

While accessible, the bureaucracy of getting an abortion procedure approved also can be burdensome, Orshalimy contends, noting that it can get be difficult to get an appointment with a committee depending on where you live and on your health fund, or HMO, and that it can take time to actually undergo the abortion once the request is approved.

“The procedure is never on the same day as the committee meeting,” she said.

The philosophy of the law does not recognize women’s autonomy regarding their reproductive health; it recognizes the state’s autonomy to decide on a women’s reproductive health. The committee is the expression of the state

There are 42 locations nationwide where termination committees meet, and 13 locations for special late-term abortions, 24 weeks and later into pregnancy. However, the latter are rare and account for 1.6% of all abortions in Israel, CBS statistics show. The majority of women undergoing the operation, approximately 85%, are in the first trimester, which is up to the 12th week of pregnancy.

While most applications go through the committee successfully, Orshalimy says that might be a result of prior medical assessments.

“Most requests are approved but the question is, do married women who don’t have a medical problem even go the committee if they know they won’t be approved. So, the screening takes place even before they get to the committee, when they speak to the hospital or to the community health service or to me,” she says.

 

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