Muslims' Perspectives on Key Reproductive and Sexual Health Issues
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BACKGROUND
Reproductive health strategies are built around a
core belief that women as full, thinking, feeling
personalities, shaped by the particular social, economic,
and cultural conditions in which each of them lives,
are central to their own reproduction (Freedman and
Isaacs, 1993). Consequently, these authors argue,
health policies and programmes cannot treat reproduction
as mere mechanics, as isolated biological events of
conception and birth; rather they must treat it as
a lifelong process inextricably linked to the status
and roles of women in their homes and societies.
Evolution of the Concept
of Reproductive Health
The available literature reveals a high degree of
overlap between definitions of reproductive health,
sexual health and maternal health. The major international
encounters that have taken place since the Cairo conference
have shown that reproductive health has tremendous
potential to bridge gaps between diverse constituencies.
But the concept of reproductive health is also a cultural
product that emerged as a result of a particular historical,
legal and ethical evolution. Implementing it involves
not merely the application of principles and the selection
of measures, but a process of translation across cultures.
Therefore, a cultural perspective that clarifies the
link between the global and the local must be developed.
According to various definitions,
the basic elements of reproductive health are: responsible
reproductive/sexual behaviour, widely available family
planning services, effective maternal care and safe
motherhood, effective control of reproductive tract
infections (including sexually transmitted diseases
(STDs and HIV/AIDS), prevention and management of
infertility, prevention and treatment of malignancies
and elimination of unsafe abortion. These definitions
call for action to consider these demands as human
rights.
Examining the different definitions,
one observes that reproductive health is not defined
by strict criteria. The concept extends beyond reproductive
ages, reproductive events or reproductive organs,
toward a broader perspective on reproduction as situated
within a socioeconomic context. As a result, there
are no precise guidelines about the exact scope of
the concept, or explicit standards for inclusion or
exclusion.
Several major international conferences
in the population and health fields have taken up
the call for comprehensive reproductive health strategies,
and have begun to elaborate what this would entail.
Discussions of reproductive health strategies acknowledge
the close relationship between health and the social
and cultural contexts in which people live and exercise
their health behaviour.
The concepts of 'autonomy' and 'choice'
which are pivotal in international population debates,
are influenced by social and cultural factors that
vary widely, even within one region or country. Jacobson
(1994:26) defined autonomy as 'an individual's ability
to think and act independently of others to achieve
her\his interests'. However, the Western notion of
autonomy which is based on concepts of privacy and
individual rights may be less relevant to Muslim women
who value the interdependence of individuals, families,
and communities.
WOMEN'S STATUS AND AUTONOMY
WITHIN ISLAMIC CULTURAL CONTEXT
A husband and wife form the nucleus of a family. Their
relationship is described in the Quran as having two
major qualities: love (passion, friendship, companionship),
and mercy (understanding, reconciliation, tolerance,
forgiveness) within the overall objective of tranquility
(Omran, 1992). The Quran explains what this means:
"…and one of Allah's
signs is, that He has created for you mates from
yourselves, that you may dwell in tranquility with
them, and has ordained between you Love and Mercy" (Sura 30:21)
Many authors indicate that the status
of Muslim women evokes two contradictory sets of images
(Obermeyer, 1992). While the demographers, sociologists
and anthropologists indicate that the women in Muslim
countries have a lower status (Freedman and Isaacs,
1993; Weeks, 1988), the theologians argue that Islam
itself gives women a high status (Omran, 1992). Based
on the interpretation of the Quran, the theologians
argue that a woman is considered to be equal to a
man in many social and economic aspects (Omran, 1992).
For instance, she has the right to choose her husband;
in marriage, she has the right to keep her maiden
name; she can be completely independent financially
and has the right to do with her money as she pleases,
while the husband is responsible for providing for
her and her children (Omran, 1992).
The first image, which is painted
by the demographers, sociologists and anthropologists,
implies that the lower status of the Muslim women
is part of the explanation of high fertility in most
of the Muslim countries. The relation between lower
status and high fertility is believed to operate in
two mutually reinforcing ways (Obermyer, 1992): first
lower status means restricted access to education
and employment; and second, a woman's economic dependence
puts her in an insecure position, making the threat
of divorce and polygamy more menacing. These, thus,
limit her choices with regard to childbearing because
the one chance to improve her bargaining power and
to insure against risk of divorce is to produce sons
whom she can influence and rely on for support.
The second image of the Muslim woman
is that painted by the theologians. Omran (1992),
argues that the status of women in Islam is seriously
misunderstood for many reasons. It is wrongly implied,
he observes, when the behaviour of individual Muslims
and Muslim communities are interpreted as reflecting
the tenets of Islam. This is further compounded by
misconceptions about the status of women in Islam
based on the gross abuse of Islamic laws among some
ignorant Muslim groups. In addition, most of the Muslim
communities exist in the Third World which is associated
with the low status of women.
Obermyer (1994) argues that there
are aspects of Islamic doctrine that could be used
to reinforce the case for women's autonomy and equality,
which have received a great deal less attention than
the aspects of the doctrine which tend to promote
inequality. The author maintains that many Muslims
believe that statements in the scriptures that stress
equality of believers before God are the authentic
message of Islam, while those suggesting discrimination
against women are merely reflections of the temporal
conditions in which the religion developed, and a
distortion of its inherent egalitarianism.
CULTURAL CONTEXT OF REPRODUCTIVE
CHOICE
Many researchers have made efforts to link human rights
and reproductive health (Freedman and Isaacs, 1993;
Cook, 1993). The idea of reproductive choice has become
the focus of systematic elaborations based on legal
and ethical principles. One of the central elements
that define reproductive choice is autonomy, which
means that a woman can make decisions in matters of
reproduction and that she has access to the information
and services that can make her choice an reality.
Islamic laws are often seen as incompatible
with international human rights (Obermyer, 1994, 1992).
However, some Muslim authors retort that the standards
governing rights and choice as defined by the West
are contrary to Islam (Omran, 1992). They maintain
that certain infringements on women's freedoms are
mandated by Islam. However, applying the criteria
derived from international conferences to the analysis
of reproductive choice in Islam is difficult, because
of the existing differences in views on the relationship
between Islam and women's status (Obermyer, 1994).
Ahmed (1992) argues that there is
a basically egalitarian ethos in Islam that was distorted
by patriarchal forces. In his view, the religious
texts can and should be interpreted in a more egalitarian
manner. This perspective would be in harmony with
the Western notion of women's reproductive choice.
Obermyer (1994) supports this notion and argues, further,
that there are several aspects of Islamic doctrine
that are clearly compatible with such an interpretation.
She notes that a number of statements in the scriptures
stress the idea that God does not wish to burden the
followers, and suggest that quality is as important
as quantity in child bearing. In addition, a generally
positive attitude exists toward sex in marriage in
the Islamic context, as does a clear recognition of
woman's right to sexual enjoyment.
Obermyer (1994) examined two case
studies that represent interesting links between state
goals, gender issues, and reproduction. The first
is Tunisia, where the state carried out pervasive
reforms to improve both women's status and reproductive
choice without violation of the Islamic tradition.
The second case is that of Iran, where successive
regimes have implemented contrasting policies that
have had a direct impact on women and reproduction,
and where issues related to women have been affected
by political struggles at local, national, and international
levels. She concludes that the constraints on reproductive
choice are a function of state politics rather than
a reflection of religious doctrine, and that leaders
do, in fact, use Islam to justify divergent positions
on gender and reproduction. She states that:
"Like other religious doctrines,
Islam has been used to legitimise conflicting positions
on gender and reproductive choice. The ways in which
the ethical code of the religion is translated into
policies affecting women's status have been a function
of the ideology of groups in power and have been
influenced by changes in the economic, political,
and social spheres." (p:49)
The following sections examine the
concept of choice regarding certain aspects of reproductive
health, namely, abortion, sexuality and contraception
in the context of culture.
Abortion
The main concern for theologians is whether the Shari'ah
is supportive of abortion or not. From this general
question, a list of sub questions would arise:
In the interpretation of the Quran
and Hadith, direct reference is made to the “ensoulment”
of the foetus 120 days after fertilisation. At the
same time, some of the commentators of the Quranic
texts, hold that the words 'Khalqan akher' (i.e. another act of creation) in the Quranic verses
signify the "ensoulment" of the foetus;
and that the stage of 'mudghat ghayer' (i.e.
the lump not yet completely created) in the Quranic
verse refers to the stages when no soul had yet been
breathed into it (Madkour, 1974).
In summary, there are three main
stages in a pregnancy that influence Islamic scholars'
assessment of abortion:
i. Before 40 days
ii. Before 120 days, and
iii. After 120 days.
As was mentioned earlier, the fundamental
question for the Islamic law is at what point
during the process of development does a foetus become
a human being? According to Mussallam (1978),
Muslims believe that point is at the end of the fourth
month of pregnancy, when the foetus becomes “ensouled”.
There is another view, which locates that point at
the end of 42 days, when organ differentiation starts
(Omran, 1992; Mussallam, 1978; Madkour, 1974).
In summary, there is a consensus
among Islamic scholars that abortion after 120 days
is not allowed. However, Islam gives women a right
to abort in cases of severe maternal health problems.
However, these rights are relative and should still
be weighed against other alternatives.
Right to Contraception
The right to contraceptive use is discussed by many
scholars in detail (Omran, 1992). Most of the theologians
are of the opinion that non-permanent methods of contraception
are allowed in Islam provided that they are safe and
they are accepted by both husband and wife. However,
the question of permanent methods (male and female
sterilisation) still needs clarification. Most of
the theologians are of the opinion that these methods
are not allowed except in cases where the health of
the mother is in danger.
The objection to sterilisation arises
from the perception that the woman may possibly regret
this decision at a future date due to a renewed desire
to conceive (Rispler-Chaim, 1993), especially within
the context of the irreversibility of sterilisation.
Another argument is that it is an attempt to change
what God has created (Jad el Haq, et al 1992). In
addition, some scholars indicate that sterilisation
is by analogy like castration, which is prohibited
by the Prophet (Madkour, 1974).
Abdullah observes:
We used to participate in
the holy battles led by Allah's Apostle and we had
nothing [no wives] with us. So we said, "shall
we get ourselves castrated?" He forbade us
and then allowed us to marry women with a temporary
contract and recited to us [from the Quran]: 'O
you who believe! Make not unlawful the good things
which Allah has made lawful for you, but commit
no transgression.'
(Sura 5:87)
Rispler- Chaim (1993) and Omran
(1992) argue that sterilisation, if reversible, could
be viewed as one more variation of “legitimate
contraceptives”. Furthermore, sterilisation
is not similar to castration. While castration involves
impact on virility and fertility and the level of
the hormones, sterilisation affects fertility only.
It is argued that if the short-term methods are allowed,
then, the long-term methods should also be allowed
(Rispler-Chaim, 1993).
On the other hand, Serour, (1998)
suggests that the argument that sterilisation is reversible
is not true, the success rate of the procedure is
very low, it is expensive and needs advanced techniques.
RIGHTS TO SEXUAL HEALTH
AND SEX EDUCATION
This following section argues that Islam provides
both women and men the right to proper sex education,
good sexual health, and sexual enjoyment.
Reproductive Health and
Sex Education in Islam
At the time of the Prophet, sex education was given
side by side with other teachings of Islam. The followers
(men and women) used to ask about their sexual problems,
and the Prophet used to clarify what was obscure.
In addition, women used to ask 'Aisha', the Prophet's
wife, about some aspects of reproductive health. Sex
education is mentioned in the Quran and the Hadith
as follows:
-
Sexual Positions. Any position in sexual intercourse may be taken
namely, sitting, standing, and leaning on one side:
According to the Quran: “Your wives are
as a tilth* unto you so approach your tilth when
or how ye will." (Sura 2:223).
(* Tilth literally means a farm).
-
Family Planning. Abu Sa'd Al-Khudrei says:
We got female captives in the war booty and
we used to do coitus interruptus with them. So we
asked Allah's Apostle about it and he said, "Do
you really do that?" repeating the question
thrice, "There is no soul that is destined
to exist but will come into existence, till the
day of Resurrection." Al Boukhari.
-
Extreme forms of Sexual
Behaviour. Ibn Abbas narrates:
A man came to the Prophet and said: Verily I
have got a wife who does not retract the hand of
a toucher [nymphomania?]. The Prophet said: "Divorce
her". He said : "I love her". The
Prophet said: "Keep her in that case." (Al Boukhari).
It is worth to noticing that the Prophet did not
punish the woman.
-
The Importance of Foreplay. Jabir bin Abdullah narrates:
When I got married, Allah's Apostle said to
me, "What type of lady have you married?"
I replied, "I have married a matron."
He said, "Why, don't you have a liking for
the virgins and for fondling them? Jabir also said:
Allah's Apostle said, "Why didn't you marry
a young girl so that you might play with her and
she plays with you?" (Al-Boukhari)
Rights and Duties in Sexual
Relations
All scholars indicate that the right to sexual enjoyment
is one of the rights of a wife (Omran, 1992). They
do not deny her right to sexual fulfilment. Sexual
fulfilment for women was understood to depend on the
completed act of intercourse, something which withdrawal
was not (Mussallam, 1978).
Accordingly, some scholars disallow
withdrawal without the consent of the wife as they
believe that it would interfere with her enjoyment
of the act.
However, these rights are balanced
by women's duties. Many Hadiths state that a woman
should not refuse her husband. The Prophet said: "If
a man invites his wife to sleep with him and she refuses
to come to him, then angels send their curses on her
till morning." Al Boukhari. Also, he said: "If
a woman spends the night deserting her husband's bed
[does not sleep with him], then the angels send their
curses on her till she comes back [to her husband]."
Al Boukhari.
Islam and Sexual Health
Islam forbids all acts which are believed to be harmful
to sexual health, such as castration, sex during menstruation,
and anal intercourse. It is believed that applying
these teachings will help in maintaining sexual health
and prevent sexually transmitted diseases including
HIV/AIDS.
Sex Outside Marriage: Islam forbids all types of sexual relations outside
marriage, whether premarital or extramarital. Islam
advocates a number of specific measures to reduce
the temptations that may lure one into such relationships.
-
The Prophet encourages all followers
(especially the youth) to get married if they can,
so that their natural desires are legitimately fulfilled:
"Whoever is able to marry, for that will help
him lower his gaze and guard his modesty (i.e. his
private parts from committing illegal sexual intercourse)."
Al Boukhari.
-
Polygamy is allowed by Islam
in a bid to reduce the number of unmarried women
in a society.
-
There are clear instructions
to women to cover themselves and to appear in a
modest way so as not to attract men.
-
Boys are not allowed to associate
with girls after puberty. This tends to limit the
boy/girl friend (dating) practice.
-
Alcohol consumption, parties,
dancing involving both sexes – practices and
settings which can lead to sexual relations outside
marriage - are forbidden.
-
Meetings between a man and a
woman where they are without other company is forbidden.
-
Islam restrains women from the
kind of speech which may stimulate sensual passion
- "If ye fear God, be not too complaisant of
speech, lest the man of unhealthy heart should not
lust after you." (Quran Sura 33:32). The restraint
also extends to posturing and the manner of walking
- "And let them not strike their feet together,
so as to discover their hidden ornaments" (Quran
Sura 24:31). Indecent exhibition is also prohibited
: "And that they display not their ornaments
except those which are external" (Quran Sura
24:31).
Furthermore, the Prophet instructs
his followers that they should have sexual intercourse
with their wives if they get excited according to
the following Hadith. Jaber narrates:
The Prophet said: "Verily
a woman comes near in the form of a devil, and goes
behind in the form of a devil. When one of you is
pleased with a woman and she falls unto his heart,
let him be inclined to his wife and have sexual
intercourse with her, because it drives away what
is in his mind." Al Boukhari.
Sex outside marriage is considered in Shari'a not
only as a sin but also as a crime which is punishable
under law.
Castration: The
Hadith indicates, as narrated by Sa'd bin Abi Waqqas
- Allah's Apostle forbade Uthman bin Maz'un to abstain
from marrying (and other pleasures) and if he had
allowed him, we would have gotten ourselves castrated..
Al Boukhari
Sex during Menstruation: Islam forbids sex during menstruation - Sura 2:222
-
They ask thee Concerning women's course*. Say:
They are a hurt and a pollution: so keep away from
women in their courses, and do not approach them until
they have purified themselves. Ye may approach them
as ordained for you by Allah For Allah loves those
who turn to Him constantly and He loves those who
keep themselves pure and clean." (*Course
literally means menstruation)
Anal Intercourse: As narrated by Khusaimah bin Sabet: The Prophet said:
Verily Allah is not ashamed of truth. Don't approach
women by their backs (anal intercourse). Al Boukhari.
Also, as narrated Abu Hurairah, the Prophet said:
“Cursed is he who goes to his wife by her back.”
Al Boukhari.
In summary, Islam gives women and
men the right to sexual health by forbidding all what
is believed to be harmful. In addition, it provides
them the right to sex education and sexual enjoyment.
However these rights are not to be practiced outside
of legal marital relations.
DISCUSSION AND CONCLUSION
A growing literature of social, and anthropological
studies shows that Islam is interpreted differently
in different countries and by different social groups.
Religion is not the only factor, although it is very
important, that determines social outcomes. Traditions,
customs, and geographical differences are other factors.
Moreover, Islamic texts are flexible and could be
adapted for all places and all times. Some of the
current theologians tend to quote from the classics,
even with regard to old medical opinions whose errors
have been brought to light and which have since been
superseded by other more scientifically-grounded ideas.
These factors could explain some of the gaps between
Islamic ideology, as expressed by the Quran and Hadith,
and the practices which are based on customs and traditions
but misinterpreted as grounded in Islam.
From the Islamic point of view,
two different positions on reproductive choice may
be taken. The more traditional position gives women
little freedom to make decisions that bear on reproduction.
The second argues that constraints on reproductive
choice that exist in some Muslim countries are not
inherently Islamic. Hey further argue that the egalitarian
elements in the sacred texts should be the guide to
a reinterpretation of the doctrine that would be fully
compatible with ideas of human rights and reproductive
choice.
Contraception rights in Islam have
been discussed in detail in many other publications
(see the work of Omran, 1992). The majority of these
authors indicate that Islam gives women absolute right
to contraception. However, there is a diversity of
opinions regarding the permanent methods (surgical
sterilisation).
Regarding abortion, there is consensus
among the theologians that abortion after 120 days
is not allowed except to save the life of a mother.
However, there is no unified position among Muslim
scholars on abortion before 120 days. All the schools
of thought agree that Islam gives women a right to
abortion when their lives are in danger in the case
of a high risk pregnancy. Also, some schools agree
on the right to early abortion in cases of health,
social, mental and economic problems. There is a clear
indication of the need to revise and unify the Islamic
laws regarding abortion in the context of recent advances
in medicine and technology.
Regarding sexuality, Islam gives
women the right to sexual health by discouraging all
that was believed to be harmful, such as anal intercourse
and sex during menstruation. Islam also gives women
the right to proper sex education and the right to
enjoy sex. However, all these rights should not be
practiced outside of marital relations.
Rereading of reproductive health
definition: Taking into cognisance the socio-cultural
dimensions of reproductive health, the international
definitions of reproductive health can be adapted
to make them acceptable to, and adoptable by Islamic
countries. The proposed adaptations are as follows:
Reproductive Health in Islam:
A Redefinition
Within the framework of Islamic teachings, reproductive
health implies the ability of women and men to live
from birth to death with reproductive choice, dignity
and, to be reasonably free of reproductive health
diseases and risks. In addition, the ability of a
married couple to enjoy marital sex without fear of
infection, unwanted pregnancy, or coercion; to regulate
fertility without risk of unpleasant or dangerous
side effects; to go safely through pregnancy and childbirth;
and to bear and to raise healthy children.
Ahmed R. A. Ragab. Dr. Ragab is the
Associate Professor of Reproductive Health, International
Islamic Center for Population Studies and Research
at Al-Azhar University, Egypt.
References
Ahmed L. (1992). Women and Gender in Islam.
New Haven Yale University Press.
Cook. R. J (1993). "International Human Rights
and Women’s Reproductive Health." Studies
in Family Planning, 24 (2) pp 73-86.
Freedman, L and Isaacs, S (1993).
"Human Rights and Reproductive Choice." Studies in Family Planning, 24 (1), pp 18-30.
Madkour, M. (1974). "Muslim
Outlook on Abortion and Sterilization." In the Proceeding of Islam and Family Planning Conference In Rabat Morocco. Dec. 1971. Vol II:263-86. IPPF,
Middle East and North Africa, Lebanon.
Mussallam, B (1978). Sex and
Society in Islam. Cambridge University, Cambridge,
London, New York.
Obermyer, C. (1994). "Reproductive
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___________ (1992). "Islam,
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