In his address to a joint session of Congress in the wake of the events of September 11, President George W. Bush went out of his way to acknowledge the vast majority of Muslims throughout the world whose faith is "good and peaceful" in contrast to the radical network of terrorists he described as "traitors of their own faith, trying, in effect, to hijack Islam itself." Behind Bush's remarks is a complexity of thinking about Islam that may not have been commonplace among Western observers. All too often Islam and its believers have been presented as one monolithic culture. Mention the plight of women in the Muslim world and the worst case scenarios come to mind: women strictly isolated within the home, subjected to public floggings and female genital cutting, forcibly given in marriage as a child and condemned to death for presumed adultery.

To be sure, these heinous practices exist, but most Muslim scholars contend they are less a function of religious doctrine than a reflection of history, culture, economics and especially politics. Countries that make up the Muslim world (those with a majority Muslim population) span the globe from Sub-Saharan and Northern Africa through Europe and the Middle East to Southeast Asia (see box). It would be grossly misleading to assert that there is one homogeneous Muslim world. In contrast to the lives of women in Afghanistan under the Taliban, women in many other Muslim countries enjoy the right to work and to participate in public affairs and have far greater control over their reproductive lives. Still, the unmet needs among women in the Muslim world for reproductive health services, and for reproductive and other societal rights, are enormous.

Islamic Doctrine and Country Law

Religious authority in Islam is derived primarily from the Koran (also spelled "Quran"), which Muslims hold as having been divinely revealed to Muhammad in the seventh century. For cases not explicitly addressed in the Koran, Muslims look to other written sources—including the collected examples and sayings of Muhammad (his sunnah)—and follow the direction of religious leaders. The concept of ijtihad, which allows the formulation of independent judgment and interpretation, is also important in Islamic teaching, although various schools of law differ in the extent to which they allow ijtihad. But unlike Catholicism, for example, Islam does not have a central authoritative structure of religious interpretation. Instead, Islam plays out differently across cultures, and various schools of law and religious sects provide diverse understandings about how Islam should be practiced.

As is the case with Judaism and Christianity, however, Islam clearly values procreation within marriage, and fertility is highly prized. Children are a gift of God, the "decoration of life," says the Koran. Some have used this basic position to argue that Islam does not permit contraception or abortion. But on the whole, says Carla Makhlouf Obermeyer, in Power and Decision: the Social Control of Reproduction, the Islamic texts do not present a major obstacle to family planning. Indeed, many Muslim religious thinkers over the past quarter-century have maintained that, notwithstanding Muhammed's exhortation to multiply, family planning is permitted and even encouraged by Islamic law.

A number of Koranic verses, says Obermeyer, emphasize the notion that God does not wish to burden believers, with the implication that the well-being of children overrides concerns for a large family. As a result, contraception has a long history in Islam. Early Muslim doctors recorded the tradition of herbal prescriptions to prevent pregnancy in Islamic books of medicine, which were used for centuries in Europe.

Muhammad, himself, encouraged the practice of al'azl (withdrawal or coitus interruptus). By analogy, the use of other barrier methods, such as the condom and diaphragm, is also allowed. Islamic thought varies on the use of other modern methods, says Nawal Ammar in On Being a Muslim Woman: Laws and Practices. While some religious leaders consider the use of oral contraceptives or implants to be undesirable or even forbidden, most encourage their use as long as these methods do not interfere with a woman's health and well-being.

Tubal ligation and vasectomy pose greater difficulty. Some religious leaders argue that sterilization does permanent harm to a person and is, therefore, unacceptable to Islam. Others argue that to the extent sterilization is reversible, it is permitted.

In keeping with predominate Islamic attitudes toward birth control, the legal status of contraception in Muslim countries (derived primarily from European civil codes) is overwhelmingly permissive. The exception to this rule is sterilization, which is illegal in some countries and remains the subject of ongoing debate within Muslim communities. Iran, Turkey and Tunisia are among those countries that allow both tubal ligation and vasectomy, for example, while Jordan and Egypt do not allow either.

The Koran does not explicitly address abortion, but there is general agreement in Islam that abortion is only permitted for the most serious reasons, such as saving a woman's life. And even then, it is only allowed before "life is breathed" into the fetus, variously regarded as within the first 40, 80 or 120 days. A minority of scholars oppose abortion at any stage of development, based on the belief that the embryo is already on its way to having a soul from the moment of conception.

The legal environment surrounding abortion reflects the prevailing view that abortion is permissible only in the first trimester and only for the most serious reasons. Laws on the books in nearly every Muslim country permit abortion only on narrow grounds. However, a few countries—primarily former Soviet republics—permit abortion without restriction as to reason: Albania, Azerbaijan, Kyrgyzstan, Tajikistan, Tunisia, Turkey, Turkmenistan and Uzbekistan.

Programs and Practice

Within this religious and legal landscape, many national governments in the Muslim world are actively involved in the distribution of contraceptives and the provision of reproductive health services through a variety of government-sponsored family planning programs. Some of these programs have been more successful than others in increasing contraceptive prevalence and reducing birthrates, depending mostly upon the level of government commitment, and interestingly, some have been associated with improving the status and condition of women, while others have not (see box).

Where women do not have ready access to contraceptive services, they often turn to abortion to avoid unwanted births. In Kazakhstan, for example, where contraception has been difficult to obtain from government or private sources, the abortion rate is high: For every 1,000 women of childbearing age, 44 have an abortion each year. In Tunisia, by contrast, the abortion rate is relatively low. There, only nine per 1,000 women of reproductive age turn to abortion, both because a high proportion of women in that country (40%) are using a modern method of contraception and because many still desire relatively large families.

Where abortion is illegal, many women go to extreme measures to obtain one anyway. This often means an abortion that it not only clandestine but also one that is performed under unsanitary conditions and by an unskilled practitioner. Unsafe abortion puts women at serious risk of impaired health and, sometimes, of dying. In Egypt, for example, some 216,000 women were hospitalized in 1996 for treatment of abortion-related complications, according to a study of postabortion caseloads published in 1998 in International Family Planning Perspectives.

Successes and Challenges

In short, the notion of family planning is overwhelmingly sanctioned as compatible with the teachings of Islam. The extent and manner of reproductive health service provision, however, varies across the Muslim world according to the cultural and political context in which women's rights are defined.

Successes abound, and so do the challenges. Few know this as well as do the two Muslim women who most recently have led the United Nations Population Fund (UNFPA), Thoraya Ahmed Obaid of Saudi Arabia, the current executive director, and her predecessor, Nafis Sadik of Pakistan. Obaid describes herself as a product of Islam interpreted as a religion of moderation. This, she says, allowed her to rise to the level of Under-Secretary General of the United Nations: "[In the context in which I was brought up,] I was able to pursue my education to the highest level, to choose my specialization, choose my husband, plan my family, work and pursue a professional career of the highest quality." But Obaid is painfully aware that not all women in Muslim countries—or women in other countries for that matter—are afforded the same level of opportunity. She not only advocates for women's access to reproductive health services but also makes the case that all women should be able to exercise their right to "development as individuals." "Supporting women to have choices in their lives [need] not threaten the social fabric," Obaid contends. "Ensuring that people enjoy the full measure of their rights strengthens the community. And by way of shared values, it extends the sense of community, even to the global level."