Filled out by: Dr. Michael Sandler – Israeli Family Planning Association

General information:

• Capital - Jerusalem
• Population - 7.2M
• Women of reproductive age (15-44 years) - 2.7M over 15
• Major languages - Hebrew, Arabic (English)

Brief history of the law:

Since 1977 abortion is allowed by the Israeli Penalty-law with the woman’s approval, and after the approval of a “Pregnancy stopping committee” (3 members), which could be approached in all major Hospitals. Abortion will be allowed in the following conditions:

1. The woman is below marriage age (nowadays 17) or over 40 years of age
2. The Pregnancy is a result of an illegal contact (Rape or Incest) or outside of the marriage
3. The embryo may be born with a physical or mental illness
4. The pregnancy may harm the woman

A 5th condition existed until 1978, by which a woman could perform an abortion because of Socio-Economic reasons. This condition was cancelled by the Knesset (Israeli Parliament), although the “Pregnancy stopping committee is free to decide in problematic cases like these. The law also states that an abortion not in the conditions above is to be punished by 5 years of imprisonment. This law is valid both for Surgical (1977) and Medical (1999) abortions. The Health-insurance (“Kupat-Cholim”) covers the costs of the abortion under the age of 19, and in cases 3, 4 of the law as written above. It also covers the costs in case the pregnancy was a result of rape or insect.

Policy:

The Government Supports childbirth, Families receive money for each child. The amount of money per child is bigger per each new child.Single parents also receive financial help from the government.

Abortion services:

An abortion is performed by the approval of a “Pregnancy termination committee”, found in 33 hospitals. A woman is directed to the committee by a doctor after performing blood tests, Ultra-sound and a gynaecological examination and detection of pregnancy. In most cases, The committee will allow a medical abortion until the 8th week of pregnancy and surgical abortion until the 12th week of pregnancy. However, there have been cases in which the committee allowed an abortion after the 24th week, in such cases there are "Committees on Late Abortion” in major hospitals, which should approve an abortion.

Practice:

All abortions are made in state hospitals.

Reproductive Health Perspective

As mentioned above.

Abortion Statistics:

Induced abortion rate among women aged 15-44 years
Total abortion rate per woman: unknown
General abortion rate per 1,000 women: 11.3
Abortion ratio per 100 live births: 13.3
Age specific abortion rate (per 1,000 women) age 15-19: 9.9

Total number of abortions (indicate source; period)
1st TM : 17500
2nd TM: 1771
Safe: all safe
Unsafe: unknown
married women: unknown
unmarried women: unknown
adolescents: 2700
Septic abortions: unknown

Public sector:

1st Trimester - yes. 2nd Trimester - yes. Cost 2000-4000 NIS (370-740 Euro)

Private sector:

1st Trimester - yes. 2nd Trimester - yes. Cost - varies. The private sector can operate only with legal approval and functions the same - only the rates change.

Methods used :

D&C, EVA, MVA, MA with Mife+Miso (≤ LMP, regimen used), MA with Miso alone (≤ LMP, regimen used), MA with Methotrexate+Miso (≤ LMP, regimen used). 2nd Trimester with Ethacridine lactate, Misoprostol, D&E, Hysterotomy.

Provider level allowed for surgical and medical abortion:

Ob/Gyn only.

Abortion related morbidity mortality statistics:

Unknown.

Manufacture/ import of Mifepristone, Misoprostol:

MIFEGYNE. Man: Exlegyne laboratories, France. Imp: Lapidot Pharmaceuticals, LTD, Israel. Provider price: 1700 NIS = 313 Euro

Information available in national service delivery standards:

All information is available.

Informal / illegal providers – if present who are they:

Private Gynecologists, who don’t work in hospitals.

Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population:

Urban Pop: 90%, Rural Pop: 10%.Rural communities exist all over Israel, and contain: Jewish, Arab, Bedouin, Druze and Adyghe (Cherkes) Population. The Rural population isn’t far from Hospitals (less then 1 hour by car); hence, abortions are available to them as to the Urban population.

Role of government:

Government is enabling by law which also provides adequate funding to run training and service delivery programs.

Role of religion/ religious leaders:

Most Israeli Population is secular. However, Most rural population and a large part of the Urban population are religious. In the Religious sector (Orthodox Jews, Muslims) abortions are forbidden in most cases.

Local Ob Gyn societies:

Supportive mostly.

Current status and potential of research:

Strict confidentiality law makes it difficult to research.

Awareness amongst community members:

Awareness on MVA/EVA, medical abortion (among women): according to our researches awareness to MVA/EVA is highest among immigrants of European origin, and lowest among immigrants of Ethiopian Origin.

Awareness to medical-abortion is rather low in all groups of the population.

Awareness on MVA/EVA, medical abortion (among medical providers): awareness on all issues in medical staff is very high, due to local reaserches and conferences, and high level of qualification.

Role of member organization/ individual:

The Israeli Family Planning association is active in the field of advocacy in the Knesset, and provides information on contraceptives, prevention of unwanted pregnancy and prevention of abortions to the public through the Media (Internet, TV, Newspapers and Radio). The association is not an organization “for abortions” nor “against abortions”.

“Open door” service is a network of consulting centers spread throughout Israel, to which anyone may approach on the issues of “family-planning”, in cases of pregnancy, a woman will be directed to gynecologist, and if necessary to a “Pregnancy stopping Committee”, also the centers provide consulting services on sexual education issues, like contraceptives.
A formal direction from such center to the committee lowers the price of the abortion.

After the abortion, women are welcome to return to our centers to receive psychological help and support, and consultation, in order to prevent another unwanted pregnancy.

The Association studies the approach to abortions in different groups in the population. And the phenomenon of illegal and unconventional abortions (on which there is no official data)

The association is in close contact with many social organizations in order to direct women in socio-economic needs, to prevent unnecessary abortions. Dr. Michael Sandler takes part in all of the above as head of the “Open door” center in Netanya.