• A scene from the SBS show The Handmaid's Tale. (Supplied)
It is women of colour and those from poor backgrounds who will suffer the most from draconian US abortion laws.
Imaan Joshi

15 May 2019 - 4:02 PM  UPDATED 17 May 2019 - 7:52 AM

As a GP, I see women in large numbers for advice on sexual health, contraception and pregnancy counselling, including terminations.

Although I am Muslim, the vast majority of my patient base are not Muslim but from all ethnicities and sexualities. It has never stopped me from providing every patient I see the best possible care, irrespective of my personal beliefs.  

I choose, myself, not to provide terminations to patients, but it does not negate my belief that every woman has the right to choose what is best for her and her body. It is not my place to judge.

For me, none of this is in conflict with my faith as I understand it. While placing limitations on termination of pregnancy as to duration and stage, what I hold to for the most part in my understanding of my faith is abortion may be permissible if the physical or mental health of the mother may be jeopardised by the unplanned pregnancy.

Some women suffer terrible nausea and vomiting throughout the entire pregnancy, to the extent that they are hospitalised for weeks and months and even driven to consider an abortion. Other women suffer terrible perinatal anxiety and depression and feel terror at the idea of another pregnancy and baby with minimal social support.

These are not feelings and moods to be discounted and have significant impact on the woman and the family. I have seen a spectrum of all of the above, but thankfully we do have access to abortion in Australia, though at a large private fee that may be out of reach for many women.

Life isn’t a utopia, and even married couples have unplanned, unwanted pregnancies. 

It's why the news from the US is so disturbing. On Friday, while at work caring for patients, my Twitter feed began flooding with news on US bills criminalising abortion. Five American states, Ohio, Georgia, KentuckyMississippi, and now Alabama, have reportedly passed versions of a “heartbeat law”, banning women having abortions once a heartbeat is detected at six weeks. In some cases, women who have had miscarriages could be forced to prove they did not use abortifacients or substances that can cause a miscarriage. This fear of being investigated could prevent women seeking hospital care and increase maternal mortality.

To illustrate the lack of science and medical knowledge in these laws, a sponsor of the Ohio abortion bill reportedly attempted to propose that an ectopic pregnancy - in which a pregnancy implants outside the uterus and is incompatible with life and could also result in death of the mother - should be re-implanted into the uterus. It is a procedure which is, to date, medically impossible. 

Earlier this week there was speculation contraceptive methods, including the Pill among others, could be targeted or denied coverage under health plans for acting as 'abortifacients'. But the Pill normally works by suppressing ovulation when correctly used; there is no egg to fertilise, and no embryo to implant. Similarly an IUD works by making it very difficult for sperm to meet an egg, so that again, an embryo is less likely to form. 

As I read the tweets flowing in, I think about my own work as a doctor, seeing patients, many of whom are women of childbearing age in various stages of their lives.

Many of the women I see are at the most confusing and high-stress point in their lives but still feel judged, shamed, and feel the need to explain or to apologise.

I think about the Muslim woman I saw, who found herself unexpectedly pregnant, and came to see me to ask for information about an abortion, telling me desperately: “We already have (many) children, and we cannot the afford the emotional and physical strain of another one. The thought of one more just makes me cry. I know it might be haram, but I just can’t do it, and my husband understands.”

I listened to her, supported her through her tears and gave her the information she needed to make her choice. 

There are women with mental health issues I see who despite being in stable relationships and using contraception correctly still end up with an unplanned pregnancy and feel panic at the thought of it, when they were quote, “just beginning to come out of the fog”. 

I think about the women I see who seek help in ending an unwanted pregnancy while still in shock from sexual assault. 

Many of the women I see are at the most confusing and high-stress point in their lives but still feel judged, shamed, and feel the need to explain or to apologise. 

Disappointingly I hear many men, Muslim and otherwise ready to present very black and white arguments on this issue. There was the man who commented to me that “in view of these restrictions let’s only allow sex between married people”. Then there was the Muslim man who told me that “there is no marital rape in Islam, once the contract is signed, he supports her financially in exchange for her sexual consent.” Sadly these views are not unusual.

What happens when the person, the man, who helped with the conception, isn’t even part of the picture, and faces no apparent consequences at all.

Life isn’t a utopia, and even married couples have unplanned, unwanted pregnancies. Even married women end up in abusive marriages with rape and pregnancy. What then? 

What happens when the person, the man, who helped with the conception, isn’t even part of the picture, and faces no apparent consequences at all, while she faces multiple insults to her person, and possible investigation based on her location?

White women of affluence will most likely still be able to get the abortion access they need. I fear, as with most things, it is poor women, women of colour, women who suffer the indignity of rape and abuse who will suffer the most. They will be denied the most basic access to autonomy over their bodies, and what happens to it. Women will be forced to carry a pregnancy they didn’t seek or want and if there is sexual assault involved, this will compound the trauma. 

These archaic laws do not decrease the rates of abortion, they simply drive them underground and make them less safe, with women's lives and health jeopardised by seeking illegal methods to obtain an abortion.

Watching the news, I felt terror for American women, coupled with a certain sense of déjà vu of the fictional reality of The Handmaid’s Tale. It reminded me of the frequent superior tone used by Western commentators around women's rights in many less-developed countries where control over the reproductive rights of women and guardianship laws treating women like minors is entrenched in law.

How ironic then that a western country like the US, that has referred to itself as the best country in the world for decades, is now heading exactly that way, by effectively claiming that it has a greater right on the female bodies of its country than the women themselves do.

The danger is not limited to the East or West. The threat of Gilead is everywhere. It's time for women to stand up to reclaim their bodies from men, from lawmakers, from those who stand in the name of religion to deny basic human rights and autonomy to women. 

Dr. Imaan Joshi is a Sydney-based GP. You can follow Dr. Joshi on Twitter @imaanjoshi.

Season 3 of The Handmaid's Tale and critically acclaimed SBS podcast 'Eyes on Gilead' returns to SBS on June 6.

You can catch up on Season Two of The Handmaid's Tale on SBS On Demand. 

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