Roe, Rights, and Resistance: the sexual and reproductive health of American and Palestinian women

Lina AbiRafeh
7 min readJan 23, 2024
Signs at pro-choice march in NYC.

January 22 marked 51 years after the codification of Roe v. Wade into American law, and women across the United States once again find their right to make decisions about their bodies and lives at risk. In 2022, the Supreme Court ruled that abortion rights would, from that moment onward, be determined on a state-by-state basis rather than legalized at the national level. As I mentioned in a piece earlier this year, the Supreme Court is set to hear an appeal about the abortion pill launched by the US Food & Drug Administration with a decision expected by the end of June 2024. And we can count on abortion rights on the ballot for the 2024 US presidential election.

Speaking of presidents, the White House issued a statement by President Biden to commemorate the day. Biden argued that “tens of millions of women now live in states with extreme and dangerous abortion bans” and “women’s health and lives are at risk.” He went on to lament that “women are being turned away from emergency rooms,” unable to get the medical attention they need, and “made to travel hundreds of miles for health care.”

Ironic for the president who has put Palestinian women’s health and lives at risk, resulting in a very similar situation. Instead of being turned away from emergency rooms, Palestinian women have no emergency rooms to turn to at all. Instead of being made to travel hundreds of miles for health care, Palestinian women have nowhere to go at all…

In fact, since October 7, there have been at least 645 attacks on the Palestinian healthcare system. This includes the bombardment of hospitals, ambulances, and vehicles delivering medical supplies.Today, every single hospital in Gaza has been either partially damaged or fully destroyed. The attack on healthcare is a violation of international humanitarian law.

And this is being enabled by the US President — and by American tax dollars. In the US, just like everywhere else, women’s bodies, rights, and lives are a lightswitch being flicked on or off depending on which man is in power — and whose lives he values above others.

In my recent blog for the International Planned Parenthood Federation, I started with the fact that sexual and reproductive health and rights are crucial to Palestinian women’s freedom. This is true for all women — Palestinian and American and every woman in between.

Conflict makes access to reproductive health much more difficult. Palestinian women faced barriers and systemic denial of this aspect of their health well before Israel’s declaration of war on the Gaza Strip in October. Meaning, pregnancy, childbirth, menstruation, contraceptive access and bodily autonomy are now at even greater risk.

Prior to 7 October, around 94,000 Palestinian women lacked access to sexual and reproductive health services due to Israeli restrictions on movement of Palestinians. Gaza has been under Israeli control — and blockade — for decades. Since 7 October, the deliberate destruction of an already feeble health infrastructure has further compounded Palestinians’ ability to access their basic human right to health care.

It’s no coincidence that the vast majority of the more than 25,000 killed in Gaza so far are women and children. Hospitals and health centers providing sexual and reproductive health and rights services in Gaza have been deliberately targeted in airstrikes. There’s a pattern here. Refugee camps, schools, and churches have also not been spared.

We’ve said it over and over. And I’ll say it again here, to make sure we’re clear. On 17 October 2023 the Al-Ahli Hospital was bombed, along with a UN school where thousands of displaced Palestinians had sought refuge. 500 people were killed, including women and children. At Shifa Hospital, babies were left without incubators due to fuel and medical supply shortages following a raid by Israeli forces. The West Bank also hasn’t been spared. The Ibn Sina Hospital was encircled with armored vehicles and raided. These deliberate assaults have resulted in all but the Al Nasser Medical Complex in Khan Younis being rendered inoperative. And the latest reports show that Al Nasser was recently under siege. The violence goes on.

Right now, 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.

Pregnant women are in a particularly heightened state of vulnerability. Many homes have been destroyed, health care no longer exists, and their only option is to give birth in shelters with poor sanitation conditions and the risk of disease outbreaks — if they can even reach these spaces. Women have no choice but to undergo a c-section without anesthesia due to the lack of medical supplies. Stress-induced miscarriages, stillbirths, and premature births are all on the rise, and will continue to rise as long as there is violence. There is constant bombardment. Nowhere is safe.

And it’s not just about hospitals. Starvation of civilians is being used as a method of warfare. That’s prohibited under international humanitarian law too. Lack of food and clean water means nursing mothers cannot produce enough milk to breastfeed. Malnutrition and dehydration further increases the risk of maternal deaths, forcing pregnant women to make impossible choices and jeopardize their own health — and that of their unborn child — in order to survive.

And then there’s hygiene. Without access to clean water, the risk of disease increases. And basic functions become practically impossible.

Periods don’t stop in a crisis. There are over 690,000 menstruating women and girls in Gaza right now. 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. Many women have resorted to using cut up towels or pieces of tent fibers as period pads. These unhygienic and desperate measures can potentially lead to infections and even toxic shock syndrome.

Contraception is also in very short supply, with reports of women sharing contraceptive pills, leading to unintended pregnancies. The unavailability of contraception will lead to the transmission of sexually transmitted infections, including HIV, as well as urinary tract infections, which are all 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.

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.

For generations, Palestinian women have persistently navigated and negotiated their right to personal 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 whatever is available — clandestine and unsafe abortions, period-delaying pills, tent scraps as pads. No, these are not resourcefulness, but rather a desperate perseverance to resist — and to survive.

A feminist approach to providing full access to sexual and reproductive health and rights means ensuring equality and justice for all women.

Reproductive justice is inherently political. That’s true in the US, in Palestine, and everywhere. We’re all fighting the same battle on that front.

Coming back to America and to Roe, American women mourn the loss of our constitutional right to safe and affordable abortion. At the same time, Roe was an imperfect solution to a much larger problem, because, as the statement from the American College of Obstetricians and Gynecologists reminds us, it left many behind, “subject to the legislative, regulatory, and judicial machinations that were designed to stymy their ability to access the care they needed.”

Better still would be to seek to surpass Roe’s protections, so everyone everywhere will have the right to access the care they need. Even women in Palestine.

Ultimately, Palestine is a litmus test — of our collective commitment to sexual and reproductive rights of women and girls, and to freedom for everyone, everywhere. Without exception.

Every day, my feminism is brought into question because I speak out about Palestine. Ironic, when I question everyone else’s feminism for not doing so. The question of Palestine is the line in the sand for feminists, and for all so-called liberals in the West. What’s more, Western feminists are quick to condemn Hamas — or any violence perpetrated by Palestinians — without a word about the extreme violence perpetrated by Israel.

Maryam Aldossari explains this feminist blind spot perfectly, explaining that this brand of Western feminism, of selective empathy and selective outrage, “is aligned not with universal feminist tenets, and a desire to give all women agency and power, but with personal identities and political affiliations.” Aldossari goes on to say that this “hierarchy of concern” allows for the “rhetoric of women’s liberation to be co-opted to further the aims of the powerful, often at the expense of the oppressed.”

What’s more, Aldossari reminds us that the horrors inflicted on Palestinian women should be a rallying cry for all feminists. Instead, these horrors are met with silence. Meaning, endorsement. The political tiptoeing of feminists who perceive themselves to be “neutral” is actually bringing their own feminism into question. Their “selective silence challenges the universality of feminist solidarity.” And it has not gone unnoticed.

Today, to be a woman in Gaza — or anywhere — is to have your basic needs — and your life — relegated to the backseat. And yes, this, just like Roe, is every bit a feminist issue.



Lina AbiRafeh

Global women's rights expert, author, speaker, aid worker, feminist activist with 25 years of experience in 20 countries worldwide - and lots of stories!