No freedom without reproductive freedom for Palestinian women

Since 7 October, the breakdown and deliberate destruction of an already feeble health infrastructure has further compounded Palestinians’ ability to access their basic human right to health care. Hospitals and health centers providing sexual and reproductive health and rights (SRHR) services in Gaza have suffered damage due to the airstrikes. A health center run by the Palestinian Family Planning and Protection Association (PFPPA), IPPF’s local member association, was destroyed after an Israeli airstrike targeted an adjacent building on 8 October. This has severely hindered their ability to deliver services for women and young people, and as long as the bombs keep dropping, there will be no safe places in Gaza for the center to relocate. 

Israel's targeted attacks on hospitals, many of which provide maternal, neonatal, and other sexual and reproductive health services, have become a consistent pattern. Refugee camps, schools, and churches, which have also not been exempt from the attacks. On 17 October, the bombing of the Al-Ahli Arab/Baptist Hospital and a school run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in northern Gaza, where thousands of displaced Palestinians had sought refuge, resulted in the killing of at least 500 persons, including women and children. At Shifa Hospital, out of the 39 babies left without incubators due to fuel and medical supply shortages following an Israeli forces raid, only 31 have been successfully relocated to the southern Gaza Strip. In the West Bank, Israel's military actions extended to encircling hospitals with armored vehicles, even raiding the Ibn Sina Hospital. Notwithstanding a clear violation of International Humanitarian Law, the persistent systemic assaults on medical facilities have resulted in 26 hospitals and 55 medical centers being rendered inoperative. 

These ongoing hostilities are having direct - and often deadly - impacts on women’s reproductive health. An estimated 50,000 pregnant women in Gaza urgently require prenatal and postnatal care. Of the 180 women giving birth daily in Gaza, 15 percent are likely to encounter complications during pregnancy or childbirth and will be unable to access the emergency obstetric services essential for safe childbirth and the care of their newborns. 

Stress-induced miscarriages, stillbirths, and premature births are all on the rise, and will continue to rise as long as there is violence.  A United Nations rapid gender analysis of the situation indicates that the crisis will likely result in increased maternal and infant mortality and morbidity, threatening to undermine the crucial health gains previously made in Palestine.  

Ammal Awadallah, the Executive Director of PFPPA stated: "If pregnant women are lucky enough to reach a health center or hospital, they are only admitted when they are fully dilated.”  Afterward, women are discharged within as little as three hours after giving birth due to a lack of capacity and resources in hospitals. This places women in a heightened state of vulnerability, where they must decide between opting for privacy and cleanliness within their homes, where they still stand, or seeking refuge in shelters with poor sanitation conditions and the risk of disease outbreaks. 

As a result, women are forced to give birth in cars or in overcrowded and unsanitary shelters, where the risk of infection is high, all while under constant bombardment. Some women have no choice but to undergo a c-section without anesthesia due to the dire lack of medical supplies. 

The UN Security Council has repeatedly condemned the use of starvation of civilians as a method of warfare, which is prohibited under international humanitarian and criminal law. According to the UN, people are getting about three liters of the 50 to 100 liters of water per person, per day, recommended by the World Health Organization. For sexual and reproductive health, the consequences of a lack of water and hygiene are severe. With deteriorating access to food and water, mothers are facing challenges in producing enough milk to breastfeed, as well as providing for and taking care of their families. Malnutrition and dehydration further increases the risk of maternal deaths, forcing pregnant women and girls to make impossible choices and jeopardize their own health – and that of their unborn child – in order to survive.

Periods don’t stop for war

Maternal and newborn health is far from the only concern. Insufficient supplies, resources, and equipment for sexual and reproductive health and rights were already a pressing issue in Gaza, which has been under Israeli occupation and blockade for decades. Periods don’t stop in a crisis, and women and girls in Gaza are menstruating without the basic decency of pads, tampons or other safe alternatives, compelling them to use period-delaying pills that may have dangerous side-effects. For the over 690,000 menstruating women and girls in Gaza, this is compounded by the severe lack of water, hygiene and privacy. 

Contraception is also in very short supply, with reports of women sharing contraceptive pills leading to unintended pregnancies. The unavailability of condoms, which were already heavily restricted in Gaza, will lead to the transmission of sexually transmitted infections, including HIV. Urinary tract infections are also on the rise with limited or no access to medical treatment. Women with intrauterine contraceptive devices (IUDs) are facing complications like bleeding and infections due to unsanitary camp conditions. There are currently no available options for IUD removal in Gaza, posing potential long-term risks to women's reproductive health, including the risk of severe bleeding. 

Reproductive justice is inherently political

The psychological toll of the hostilities continue to wreak havoc on women’s bodies and bodily autonomy. In recent decades, the acknowledgment of the "demographic threat" has become more explicit. Higher Palestinian fertility rates are not only viewed as a personal family matter but also framed as a security threat by Israeli officials. This perspective emphasizes the need not just to prevent Palestinians from returning but also to implement policies restricting population growth. Israel's settler-colonial regime of violating Palestinians' right to live has long instructed Israel’s operations and the occupation structures that sustain it. 

Reem Alsalem, UN Special Rapporteur on violence against women and girls has warned that the continual reproductive violence inflicted by Israel on Palestinian women, newborns, infants, and children might be considered acts of genocide under Article 6 of the Rome Statute of the International Criminal Court, which encompasses actions such as "imposing measures intended to prevent births within a group”.  The gravity of this declaration underscores the necessity to address reproductive justice as inherently political while acknowledging the intentional severity of such reproductive violence that has prompted U.N. experts to warn that Palestinians were “at grave risk of genocide.”

A feminist approach to providing full access to sexual and reproductive health and rights means ensuring equality and justice for all women and marginalized groups. Feminist foreign policy entails an end to violence and access to full humanitarian aid and full respect for international and humanitarian law – without exceptions. This includes differentiating between civilians and combatants, and does not tolerate collective punishment, as is being inflicted on Gazan civilians, particularly women and children.

Sexual and reproductive health and rights are crucial to Palestinian women’s freedom 

For generations, Palestinian women have persistently navigated and negotiated their right to bodily autonomy in unimaginably difficult circumstances. With such severe restrictions on their ability to exercise their rights to sexual and reproductive healthcare, women have no choice but to resort to informal means to access sexual health services. Whether it's through unsafe abortion, using period-delaying pills, or unmarried women and girls seeking contraception discreetly, these actions are not a reflection of admirable resourcefulness, but rather a lamentable perseverance to resist and live. Access to SRH services stands as a pivotal issue in Palestinian women's pursuit of self-determination, one that is intrinsically political. Reproductive violence is tied to determining the fate of future generations to come in the wider context of eradicating the Palestinian population. Therefore, it must be liberated from the intertwining influences of occupation and patriarchy.

Palestine is a litmus test. It is a test of our collective commitment to sexual and reproductive rights of women and girls, and to the freedom for all people everywhere. Now is the time to protest, boycott, organize, and demand that the voices of the oppressed be heard. 

Banner image: Anas-Mohammed, Shutterstock