An all-too-common sight at the Terem clinic for undocumented residents at the Tel Aviv central bus station is women without medical insurance seeking abortions.
A few weeks ago, M., an Eritrean asylum seeker in her 30s, showed up. A single mother living in dire economic straits, she was forced to work in prostitution to provide for her two little children and got pregnant. She lacks the resources to pay for the abortion or the ability to deal with the bureaucracy involved.
D., another asylum seeker, is a mother of three. One of her children suffers from a medical condition that precludes her from working continuously. What little money she and her partner have goes to cover her child’s medical bills. Their relationship is full of stress and hardship. Her partner does not know that she is pregnant, and she seeks to have an abortion without him learning about it.
They all live in financial distress and employment insecurity, and abortion costs range from 3,000 ($883) to 7,000 shekels
S., a single mother of four, was forced by circumstances to live in the street with her children. Now, she’s pregnant and at her wits’ end. The aid she receives from the Mesila, an NGO that helps people maintain financial independence, is insufficient to cover her abortion.
A., a woman in her 20s from Ethiopia who speaks no Hebrew or English, is believed to be a human trafficking victim who got pregnant. She told the Terem clinic staff that she was afraid of her partner and had no one to support her. These are but a scant few of the cases.
For the past five years, Shiri Cohen has been working as a reception manager at Terem. The public clinic helps asylum seekers and undocumented people without health coverage to obtain medical aid. The first time she received a woman seeking an abortion was shortly after her arrival there. “We got a call from E., a 23-year-old asylum seeker from Eritrea who cleaned homes up north,” she recalls. “She hardly spoke any Hebrew or English. Luckily, the receptionist on duty when she called was a Tigrinya speaker. She told her that she wanted to have an abortion and didn’t know what to do. She had no medical insurance.”
That young woman was already a single mother of two, says Cohen. “She was in a violent relationship until her husband left her,” she explains. “She was held at the torture camps in Sinai for several months before reaching here. She showed us the scars. After her husband left, she met another man who promised to care for her and her children, but when she got pregnant, he too abandoned her.”
These women are already suffering from institutional violence, and sometimes from a violent partner, or are single mothers. In certain cases, they are human trafficking victims.
After the phone call, E. arrived at the clinic, where an ultrasound showed that she was in her second trimester, meaning she would need an abortion at a hospital. “I knew she wouldn’t manage it alone, so I went with her,” Cohen tells Haaretz. “We went to the pregnancy termination committee. The fee then was lower than today, but the visit still cost her 400 shekels ($118). Her monthly salary at the time was 4,500 shekels. She took 300 out of her purse and cried that she had no more. It was heart-rending and of course I couldn’t do anything but make up the sum for her.”
As she does in many cases, Cohen turned to the Isha L’Isha – Haifa Feminist Center, requesting to help E. in funding the procedure itself – 3,000 shekels. “They agreed to cover her fully and she had the pregnancy terminated. It was a great relief for her,” Cohen says, noting that “while we were at the hospital, her Israeli employer kept calling and yelling at her on the phone.”
Prices are higher today. “After the 12th week of pregnancy, or in cases where the woman has medical complications, you have to go through public health care, and the prices there keep rising,” says Cohen. “The committee costs nearly 500 shekels these days, and the procedure costs around 4,000 shekels. If the pregnancy is in the first trimester, we use licensed private clinics with whom we have arrangements,” she says. “Then it costs less, around 2,000 shekels, but that sum is also very high for these women.”
Although Cohen’s duties at the clinic are not limited to abortions, she helps other undocumented women seeking an abortion in several ways. “We help them with the medical exams, explain the options before them and the costs involved, and help them deal with the red tape,” Cohen explains. “We make the necessary appointments for them, direct them to clinics licensed by the Health Ministry, and explain how and where to go.”
She says that in the case of A., her NGO refer women who can’t afford an abortion to places like Isha L’Isha in hopes they can at least partially fund the procedure. The Health Ministry doesn’t cover such costs save for rare cases like undocumented minors.
- Israel Must Help Asylum Seekers Trapped in the Sex Industry
- More Female Eritrean Asylum Seekers in Sex Work in Israel
- Israel Admits Failure to Use Budgeted Funds to Aid At-risk Asylum Seekers
Ayala Olier is the coordinator for women without citizenship status at Isha L’Isha. “The project has existed since early 2018,” she says. “We have met many women who cannot undergo an abortion due to financial obstacles.”
Data from Isha L’Isha and the Terem clinic for asylum seekers indicate that there are over 100 such women every year. “They all live in financial distress and employment insecurity, and abortion costs range from 3,000 ($883) to 7,000 shekels,” says Olier. “That’s a fantastic sum for them. We try to help as many women as possible, but unfortunately we can’t help all of them. We’ve spent about 100,000 shekels on this in recent years, and last year we allocated about 35,000 shekels in assistance for funding abortions, but we get continually more requests.”
'Just as vaccinations, for example, are given to everyone and no insurance is required, that’s how abortion should be treated.'
Olier says that women who don’t get financial assistance for an abortion end up turning to illegal medicine, to unlicensed doctors for the procedure. “They often arrive at the Terem clinic afterwards with unspecified medical problems, and there is no record of what was done to them,” she says. “These are life-threatening situations.”
Cohen say: “Often, these women, for lack of choice, turn to unreliable sources who demand sex in return for financial assistance. In many cases, women go to centers that aren’t recognized by the Health Ministry, and are treated by people who aren’t even doctors.”
Sometimes it works, sometimes it doesn’t
The Health Ministry allows a medication abortion up until the ninth week of pregnancy. “This is a two-stage procedure,” explains Cohen. “First you have to take a Mifegyne (mifepristone) tablet that stops the growth of the pregnancy, and then a Cytotec (misoprostol) tablet, which contracts the uterus and is supposed to expel the pregnancy. But Mifegyne cannot be purchased in a pharmacy, as it’s only supplied to licensed institutions. On the other hand, it’s easy to get Cytotec, which has other indications and is very cheap.”
“What often happens is that the women turn to various sources that sell them the Cyctotec for hundreds of shekels, and they take only Cytotec. Sometimes it works, but often it doesn’t. Then the woman is left with the unwanted pregnancy, and often suffers from various health problems as a result of taking it,” she explains.
Olier says the Health Ministry is aware of the problem, but ignores it. “We have brought up the issue of undocumented women who can’t pay for abortions with the Health Ministry several times, in vain,” she says. “The situation here is very sensitive. These women are already suffering from institutional violence, and sometimes from a violent partner, or are single mothers. In certain cases, they are human trafficking victims. They’re all suffering from serious financial distress, and the unwanted pregnancy means additional psychological and health problems.”
Isha L’Isha estimates helping these women would require a 400,000-shekel investment from the Health Ministry, which has a 44.8 billion-shekel budget for 2022. “That isn’t such a great sum for a large government ministry,” Olier says. “Especially if you consider the level of risk for these women – sometimes they’re required to find nonstandard work to pay for the procedure, and endanger their lives. In other cases they skip the abortion and have children they can’t support or care for. It’s unconscionable that the problem is known and there’s no systemic solution.”
The government by law covers the medical procedure up to age 33 only if the woman has health insurance. “The problem is that most of these women have no health insurance. Those who do usually have private health insurance, so they’re required to get a special form from the health maintenance organization. That’s problematic for them both because of the language barrier and because of the discriminatory treatment they encounter,” explains Olier.
“I don’t understand why there’s a problem of providing a budget for that,” she adds. “Some things are in the public interest. Just as vaccinations, for example, are given to everyone and no insurance is required, that’s how abortion should be treated – it’s a medical and mental health crisis. There should be no obstacles preventing women from being able to undergo the process. Moreover, arranging medical insurance for undocumented women is an existential need. It’s basic security. I fear for their lives.”
The Health Ministry commented: “Working undocumented women receive health insurance from their employer, which includes pregnancy termination, in accordance with the conditions of the policy. The Health Ministry pays for every pregnancy termination for undocumented minors living in Israel in public hospitals, even though they aren’t insured under the National Health Insurance Law.
“The Health Ministry also participates in payment for terminating pregnancies resulting from sexual violence, for undocumented victims of sexual assault of any age. We stress that the Health Ministry published a tender in late October for health insurance for undocumented people who are not subject to deportation, which will enable this population to purchase health insurance. A population group not meeting these criteria can purchase a different health insurance.”
To support Isha L’Isha in its effort to help pregnant undocumented women, you can donate here.