Women and Their Bodies

Abortion

admin — Mon, 02 Nov 2009 00:16:41 +0000

ABORTION^{^[1]}

INTRODUCTION

In Israeli society, saying ”I’m pregnant” immediately evokes a reaction of ‘Mazel Tov!’ [‘congratulations’]. Yet, not every pregnancy is a wanted one, and even a wanted pregnancy does not always end with childbirth. Many women are unsure whether or not to carry a pregnancy to term. Women may face many uncertainties and questions, such as: “Is this pregnancy a choice of mine or was it imposed upon me? Am I mature enough to give birth and raise a child? Do I have a partner for this new road?” On top of all this are questions regarding economic ability and our mental and physical health. The decision to terminate a pregnancy, be the reason for it as it may, is our own. Each woman makes her own decisions about her own body. In Israel, abortions are legal and no one has the right to prevent us from making that choice; not our parents, not members of our community, and not the man who impregnated us.

WHAT IS AN ABORTION?

The word abortion may refer to a number of situations:

Natural or spontaneous abortion – An abnormal development of the pregnancy sack or the arrested development of the fetus during the first pregnancy trimester, up to week 13.

(Late) natural abortion – Arrested development of the fetus during the second pregnancy trimester, between weeks 14 and 26.

Induced abortion – The termination of a normal pregnancy for reasons relating to the woman, the fetus, or for other reasons. An induced abortion can be carried out in several ways: oral or intravaginal pills, uterine curettage^{^[2]}, or birth induction.

Please note that in the first few days of a pregnancy, it is possible to terminate it without any acute medical intervention by using a “morning after” pill.

TEN FACTS ABOUT ABORTIONS AROUND THE WORLD ^{^[i]}

BEFORE AN ABORTION

How to cope with anxiety and stress

Before terminating a pregnancy, we may experience stress and anxiety. These are natural emotions at such a time. Stress can stem from the decision to terminate the pregnancy, from not knowing what to expect, and from worrying about the medical procedure. It is our right to ask the medical staff for more information. In order to ease the stress, it is recommended to have a supportive companion, and to remember to breathe deeply and slowly. We can also consult various organizations which support women in such situations, even before arriving at the hospital.

Frequently asked questions^{^[ii]}

I would like to terminate my pregnancy – What should I do?

What are my rights?^{^[iii]}

Where can I undergo an abortion?^{^[iv]}

How much does it cost?^{^[v]}

The history of the Israeli Abortion Law^{^[vi]}

Medical confidentiality

In hospitals, special efforts are made to maintain the privacy and confidentiality of women or girls who give birth out of wedlock, or who fear they are at risk in their socio-cultural environment. The hospital staff is responsible for the patients’ confidentiality and is not allowed to disclose information to anyone other than the patient herself. In each hospital, the patients’ personal details are kept electronically or manually. Women who are hospitalized for the purpose of undergoing an abortion are registered at a confidential registry and are hospitalized at the Obstetric and Gynecology ward. If anyone asks whether these women are in the hospital they would receive a negative answer.

If you are concerned about the registration, make a special effort to find out how it could be made easier. The HMO staff is extremely sensitive about this issue and makes every effort to prevent exposure. If you are under 19 years of age, you must draw attention to the problem so that the hospital can find a solution for the payment of the excess insurance. Otherwise, the information could be disclosed to your parents when their bank account is debited.

THE ABORTION

Contractions caused by abortion are not very painful and most abortions are carried out under partial or full anesthetic. If you have an abortion using medications, which is not administered under anesthetic, you will be able to take pain killers. Some women find it helpful to drink something warm or to use a hot water bottle to relieve the pain.

No qualms / Dina^{^[vii]}

Not very often, in narrow forums of social gatherings, a conversation will begin, usually because someone is not sure what to do, and, suddenly, my opinion is more appreciated because I have been through it. So I tell my story… For the full text (link)

Types of induced abortions

There are several ways of terminating a pregnancy. The doctor will suggest those according to the stage of the pregnancy and the reason for the abortion. If you are interested in having an abortion procedure which has not been offered to you, you have the right to ask the doctor about it.

Three types of abortions are carried out in Israel:

1 – Medicated abortion

In this method, medications are administered which ultimately cause an abortion, the contracting of the uterus and the discharge of the pregnancy contents. The process might be accompanied by stomach aches and a bleeding stronger than menstrual bleeding, just as in a natural abortion. The important advantage of a medicated abortion is that it does not require anesthetic or an operation. However it does require patience, persistence and responsibility. Afterwards, you will have to return to the clinic or the hospital for follow up. Medicated abortions can be carried out during the first weeks of pregnancy, up to week 7, and is suitable for most women. It is unsuitable for women who suffer from certain chronic illnesses.

The medications administered for the induction of an abortion^{^[viii]}

Michaela^{^[ix]}

When I was 20, as I finished my national service, I went on a three months trip to the USA. There I met family and friends as well as a few charming men. When I returned to Israel, I discovered that my period was late. A small test from the chemist confirmed that I was pregnant. I knew that I was not ready to raise a child on my own at that point in my life. For the full text (link)

2. Curettage, suction, surgically emptying the uterus

It is possible to use the above-listed methods up to week 24 of the pregnancy; however, the later the stage of pregnancy the greater the risks of using these methods. Most hospitals in Israel use these methods up to weeks 14 to 18 of the pregnancy. During the first weeks of pregnancy the abortion is conducted under local anesthetic, and thereafter under a light full anesthetic. In the early stages of pregnancy it is usually a simple procedure and takes about fifteen minutes.

Curettage, suction, emptying the uterus – details of the medical procedure^{^[x]}

3 – Induced Labor

This method is conducted after weeks 14 to 18, when the pregnancy is at a stage in which curettage is dangerous, and according to the standard practice at the hospital. From week 24 and on the fetus is considered viable, meaning it is able to survive outside the womb and, therefore, it must be put to death before the abortion begins. Unlike laws in other countries around the world, the Israeli law does not qualify abortions from a certain stage of pregnancy, but allows late abortions up to the ninth month.

Nonetheless, approval for a late-term abortion can be issued only by a special committee, called The Committee for Abortion during the Viable Stage. This committee is comprised of more members than the regular abortion committees. The Committee for Abortion during the Viable Stage includes the director of the medical center, the head of the obstetrics and gynecology ward, a senior social worker, the head of the maternity ward, and the director of the genetics institute. At least one of the first three above-listed individuals must be a woman. When appearing before this committee, you will be required to bring a number of documents, such as recent ultrasound images or the results of genetic tests.

Induced labor^{^[xi]}

Abortion after week 23^{^[xii]}

Hospitals that have abortion committees ^xiii

After the abortion

Recovery after an abortion

After undergoing a vacuum or surgical abortion, the patient is transferred to the recovery unit, where every so often the nurses check the patients’ pulse and blood pressure, and follow up for any bleeding. It is natural to have a light to medium flow of blood and even find lumps of tissue in the blood. also It is likely to feel contractions in the lower abdomen which will lessen within the first half hour of recovery. The stay in recovery can last between 20 minutes and an hour or more, depending on the anesthetic you received, the type of abortion you underwent, and how you feel. If the abortion took place under sedation or anesthetic, it is best to have someone who can take you home. You will not be allowed to drive. Before going home, you will receive a prescription for antibiotics in order to prevent infection, as well as medication to minimize the bleeding. You will also receive information about what to expect in the following days and symptoms which may indicate there is a problem. Make sure you know who to contact if there is a problem.

You can resume sexual activities about two weeks to a month after emptying the uterus and after the bleeding from the vagina has stopped. It is possible to become pregnant shortly after an abortion, even before you begin menstruating again, so it is important to use contraceptives if you do not wish to conceive. It is possible to use most contraceptives after an abortion.

Using contraceptives after an abortion ^xiv

In the follow up meeting, about two weeks after the abortion, the doctor will check your physical and mental recovery. Most women feel well and do not suffer from any special problems after an abortion, but it is normal to be tired, or to feel contractions a few days after the procedure. Some women do not bleed at all after the abortion, while others experience a moderate bleeding which may come and go. Some pregnancy symptoms, such as nausea, may continue for about two days after the abortion. If the abortion took place in a later stage of pregnancy, lactation may also occur. This can be avoided by taking Dopamine agonists, such as Cabergoline, or by wearing a pressure bra. It is possible to place (lukewarm) boiled cabbage leaves inside the bra to help stop the lactation.

Possible complications following an abortion

After the abortion, the medical team of the ward in which you were treated will provide you with information about possible side effects and complications, as well as information about places where you can receive emergency treatment if necessary. These places include the women’s emergency room at the hospital in which you were treated, or in other hospitals. It is also possible to go back to the ward in which you were treated, or to phone the medical staff which took care of you. If you did not receive the above information, you should ask the staff for it.

It is unusual to have complications following an abortion, however if you suffer from one or more of the following complications, contact your doctor immediately.

Heavy bleeding

One out of a hundred women may suffer from heavy bleeding which requires medical attention, and one in a thousand would bleed and need a blood transfusion. The best way to know if you are bleeding excessively after an abortion is to check the number of pads you use, and to look for blood clots. Contact the doctor if the bleeding requires more than two of the largest pads every hour or two, if you find large clots of blood, or if you feel dizzy.

Pain

Uterus contractions are normal after any kind of abortion, but continuous pain in the pelvis may indicate inflammation of the uterus. This is an extremely rare occurrence as no instrument is inserted to the uterus. The frequency of inflammations after a vacuum abortion is less than 2.5 percent and most inflammations are light and can be treated with prescribed antibiotics from your attending physician and without a need for hospitalization. Other causes for pain after an abortion could be fetus or placenta tissue or clots of blood left in the uterus. If the tissues or clots are not discharged without intervention, it is possible that you might need to take medications, or require vacuuming the uterus in order to clean it. If after taking pain killers the pain continues, or if you have a fever, contact your doctor or the ward in which you were treated.

Fever

If your body temperature is more than 37 Degrees Celsius (when tested orally) it is possible that you have an infection. Contact your doctor or the ward in which you were treated.

Continued pregnancy symptoms after an abortion

It is possible that you may continue to experience pregnancy symptoms after the abortion, such as nausea and swollen and sensitive breasts. These symptoms should disappear within a week or two after the abortion. If they persist, it is possible that the abortion was not successful and you are still pregnant. This happens once in a hundred vacuum abortions or medicated abortions. In such cases, consult your gynecologist and do not use a home pregnancy test, as positive results can be obtained up to six weeks after the abortion, even if you are not pregnant.

Genetics and abortions

In Israel it is customary to have many checks during the pregnancy in order to ascertain the fetus’ health. These test lead many a time to the decision of conducting an abortion following a suspicion or a doubt regarding the health of the fetus. Researcher Dr. Hashilony-Dolev links the large number of checks conducted in Israel to a variety of Israeli cultural factors. The main factor is that, according to the perception in Israeli society, human existence can be referred to as ‘living’, only if apart from a physical existence it also has other qualities. Fetuses are not considered to be ‘live creatures’, in particular if there is a doubt as to its physical or mental perfection.

This point of view has a few origins: compared to other religions, Judaism is flexible in defining fetus’ status; it does not glorify suffering, rather wishes to get rid of it; moreover, the Jewish society in Israel tends not to criticize the health system, but attempts to adopt new technologies which it sees as beneficial. Added to this, is the standpoint which views fetuses as part of a future family and not as entities with autonomous rights. Therefore, the future mother or parents have the right to decide to terminate the pregnancy, without considering the fetus’ rights.

Hospital Stay

The duration of the stay in hospital changes according to the type of abortion, and to the standard practice at each hospital. In most cases it involves a short stay, which is defined as day hospitalization. In some hospitals the abortion takes place in a women’s ward, and in others in the day hospitalization ward.

When a medicated abortion is conducted, the patient needs to come to hospital twice, each time for a few hours. In the first stage – you will be required to take Mifegyne tablets, and remain under medical observation for two hours. In the second stage – after 48 hours – you will be required to take Cytotec tablets and remain for six hours under medical observation. If complications develop, you might have to be hospitalized.

In curettage abortions, if the procedure goes as planned, you may be discharged from hospitalization of from day hospitalization a few hours after the procedure, according to the standard practice at the hospital. At some hospitals, curettage is conducted only up to week 12 of the pregnancy, while others may do so up to week 22 (such as Assaf Harofeh). Curettage that is conducted in a later week of pregnancy may result in a longer stay during at the day hospitalization or in longer hospitalization. There are different practices at the different hospitals.

Induced labor is done only in hospitals and not in surgical centers and it involves two or more days of hospitalization, according to treatment progression. Abortion by induced labor is conducted during more advanced stages of pregnancy – one week after the latest week for curettage, according to each hospital standard practice.

Links

^{^[1]} Colloquially, termination of pregnancy is defined as an abortion. Despite the negative and judgmental connotations of the term ‘abortion’, we will use it here in its common use.

^{^[2]} Uterine curettage – the extraction of the pregnancy sack, the fetus, or the placenta from the uterus, or causing their total or partial discharge, leaving the uterine cavity empty of the pregnancy. The uterine curettage is required only in few of the natural or late abortions and in all cases of induced abortions.

^{^[i]} Ten facts about abortions around the world

In most countries, abortions are still illegal and unsafe procedures. The World Health Organization estimates that about 67,000 pregnant women, or post-pregnancy women, die each year as a result of complications following illegal abortions. Even more women suffer throughout their life from medical damage caused during unauthorized abortions.

In order to allow every woman a safe abortion, it is necessary to legalize the medical procedure of abortions and make it safe in every country. Abortion is a safe procedure when it is legal and accessible.

The World Health Organization, the Alan Guttmacher Fund and the Fertility Rights Centre have published the following approximate figures:

1. One in five pregnancies around the world ends in abortion (about 42 million abortions).

2. Almost half of them, approx. 20 million, are unsafe.

3. Most of the abortions in developed countries are safe (92%).

4. More than half of the abortions in third-world countries are unsafe (55%).

5. About 60% of the world’s female citizens have access to legal and safe abortions (in almost all of Europe, Australia, North America, most of Asia, and parts of South America and the FSU republics)

6. 26% of women around the world live in countries in which abortions are illegal (African countries, and some Asian and South American countries)

7. About 13% of death cases of women following medical mal-treatment are of women who have undergone illegal abortions (68,000 women each year).

8. Between 1995 and 2000, many countries changed their laws in order to improve access to safe abortions, including: South Africa, Switzerland and Ethiopia.

9. Some countries have imposed legal limitations that have limited the access to safe abortion (Poland, El Salvador and Nicaragua).

10. Medicated abortion is an accepted procedure in many countries. Currently, at least 39 countries allow the use of Mifepristone.

^{^[ii]} Frequently asked questions

Would an abortion affect my ability to have children in the future?

When terminating pregnancy at an early stage, there are almost no complications, and the woman’s future ability to have children is seldom affected. This has been confirmed by many studies. In very rare cases severe pelvic inflammations might cause damage to the uterus. This kind of damage might bring about ectopic pregnancy, or cause fertility problems. The risk can be reduced by taking prescribed antibiotics while having the abortion and by listening to your body. If you identify symptoms of inflammation, you should seek medical treatment.

Does an abortion increase the risk of breast cancer?

No. In February 2003, The National American Institute for Cancer Research gathered more than a hundred worldwide experts in order to survey the research available in this field. The experts concluded that ‘there is no connection between unnatural abortions and the risk factors of breast cancer.’

Do women who have an abortion suffer from post traumatic depression or from abortion syndrome?

No. Many women report that they feel a loss or feel sad after having an abortion, but it has not been proven that abortion has long term or severe psychological implications, such as clinical depression.

Type of anaesthetic	Possible side effects
Local anaesthetic: injecting medication into the cervix in order to anesthetize the nerves around the cervix. This reduces the pain caused by enlarging the cervix, but does not alter the contractions.	Temporary tinnitus, numbness of the lips, the tongue and the vagina. Rare side effects: convulsions and allergic reaction.
Tranquilizer infusion: injecting medication to prevent pain and anxiety. Does not induce unconsciousness.	Nausea, vomiting. Rare side effects: allergic reaction, respiratory or cardiac problems.
General anaesthesia: infusion which induces unconsciousness. This is the most common method in Israel.	Nausea and vomiting, nebulisation.

^{^[iii]} If I wish to have an abortion, what do I have to do? What are my rights?

If you wish to terminate your pregnancy and you qualify according to the above criteria, you are likely to be approved by the committee. Either way it is important to remember that if you were not approved by the committee to which you have applied, you have the right to apply to another committee in another medical centre. The cost of applying in private medical centres is equal, but the social worker and/or doctors are often more flexible at private centres and could find the right legal section which supports your particular circumstances and application.

Preparing for the committee

If you are married and feel that another pregnancy could be a mental or an emotional burden and you have decided by yourself to terminate it, you can see a psychiatrist and present the committee with his/her professional opinion concerning the mental damage you might suffer. If you wish to terminate the pregnancy following a genetic defect, you need to present the committee with a special approval issued by a genetics specialist.

When you appear before the committee bring your identity card and pregnancy confirmation with you. A pregnancy confirmation is a copy of your ultrasound imaging vaginal check which documents the age of the pregnancy. If you arrive without the confirmation, you will be asked, after filling in your details, to go through this check. Sometimes, women who have the confirmation are also asked to go through the check once more (this usually happens in cases in which the foetus has some deformity; the issue will be discussed separately in the sub-section about abortions during the second and third trimesters).

Remember, you are entitled to choose a committee in any medical centre you wish, even if it is not in your residential area. Check first the office hours of the committee to which you have decided to apply, make sure you do not arrive on a busy day and that you can receive the time and the service you are entitled to.

Medical conditions worth knowing before referring to a committee

What kind of abortions are available to me, considering my medical condition and the stage of my pregnancy?
What choices of anaesthetics do I have?
Is there anything in my current or past medical history that the doctors should know before the abortion?
If I am an HIV carrier, can I have the abortion at the hospital I chose?
If the abortion has side effects, can I receive treatment for them at the department in which I had the abortion?

The committee procedure

The social worker will explain the process of getting the approval to you. If you would like counselling or would like to consider other options (adoption, receiving assistance in raising the child), she will refer you to the relevant bodies. If you are considering adoption, it is worthwhile contacting feminist organizations which have legal and other information to help you decide and realise your rights. Usually this advice is free or subsidized. Hospitals in which an abortion committee exists.

If you decided to terminate your pregnancy, you can use the help of a social worker to fill in the application form for the committee. The form includes your personal details and details about your pregnancy and the reason you wish to terminate it. The form and the accompanying documents are put together in a personal and confidential request application file. The details are used only for statistical purposes. All the information and documents submitted to the committee are private and confidential.

The next stage is appearing before the committee. In some committees, women are required to appear, and, in others, the social worker makes the referral on behalf of the woman. If you do not meet the members of the committee, and receive a negative response, you have the right to discuss this with the doctors in order to find out why your request was not approved.

The committee will advise you which abortion procedure is best for you. The various options would be explained together with the medical pros and cons of each procedure. Finally, you will be asked to sign an informed consent form for the medical procedure you are about to undergo.

The committee’s decision is given immediately, outlining the sections which certify the termination of the pregnancy. The doctors can refer you to any recognized medical institution, but it is your right to decide where you wish to have the abortion.

It is important to note that the man who impregnated you has no legal status vis-à-vis the committee. The decision is entirely yours to make. Even if you are under eighteen, you have the right to have an abortion without informing your parents. It is advisable, however, to arrive with someone to support you.

^{^[iv]} Where to have the abortion?

You can terminate your pregnancy in a governmental, private, or HMO hospital. You can choose in which hospital you would like to have the abortion. If you are worried about family, partner or community pressure, you have the right to go to another city and use the hospital services there. Not all hospitals carry out abortions, but in each of the hospitals that do, there is a committee which can approve the procedure. It is advisable to plan this ahead and to speak on the phone with the committee social worker, so as not to arrive on a busy day and have to wait.

^{^[v]} How much does it cost?

The fee to the abortion committee is 305 ₪ in most hospitals in Israel. There are a few hospitals in which the fee is slightly lower, about 205₪ (as of April 2009).

Women have the right for a complete or partial reimbursement for the committee fee and for the abortion from their HMO, if the committee approved the abortion for any of the following reasons:

1. Any medical reason – a deformity of the foetus or a risk to the woman’s health (sections 3, 4e, 4f)

2. Any case that involves a girl under 19. Girls under 19 can apply for a commitment form to the committee from the HMO in advance (available in some HMOs)

Most HMOs pay for abortions also in cases of prohibited relationships – i.e. incestuous relationships and rape.

In general hospitals, the abortion rate is fixed and set by the Ministry of Health. The rate varies according to the stage of pregnancy and depending on the manner in which the procedure takes place. For example, in Hadassah hospital, during 2009, abortions conducted during the 12^th week are through a one day hospitalization. The cost of these abortions is lower than that of abortions for women in a more advanced stage of pregnancy. The reason for this is that these abortions take place in the Obstetrics and Gynaecology ward where the rate is calculated according to the number of hospitalization days.In other general hospitals, abortions could sometimes be done through a one day hospitalization even after the 12^th week of pregnancy, but the cost is higher as the pregnancy advances. In private establishments, such as the various surgical centres (Asuta hospital and Ramat Marpe) the price is higher and can reach thousands of NIS. HMOs pay for abortions only when they take place in a general hospital and not a private centre. All the same, in both Asuta and Ramat Marpe, in the Tel Aviv area, there is the option of a discount of up to 800 ₪ (in April 2009), if a reference is brought from Open Door organization.

^{^[vi]} The history of the Israeli abortion law

The way Israel has conducted itself with regards to abortions, always expressed the gap between the various groups in Israeli society. Abortions have always taken place in Israel, but according to the British Mandatory Law, they were illegal. When the State of Israel was established, Israel adopted the existing law on the issue. In 1952, the Haifa District Court authorized abortions based on medical reasons only. From that year on, some hospitals started to organize committees which included gynaecologists, psychiatrists and social workers, to discuss applications submitted by women. These committees tended to authorize the applications.

In 1962, the Israeli government appointed a Committee for Birth Issues. This committee recommended the institutionalisation of abortions, not in order to encourage it, but so it could be controlled. The committee recommended authorising abortions under certain conditions, in licensed hospitals and with a medical committee’s approval. Among other things, the committee recommended that those committees should try to prevent abortions by explaining the risks involved in the medical procedure and by giving material and moral incentives to try and prevent the termination of pregnancy.

In 1978, the Law to Correct the Criminal Law (abortions) 1977 came into effect. The legislator decided to authorise abortions under the following conditions:

Women under 18, or who are 40 and above
Women who became pregnant through illegal relationships; rape, incest, or outside wedlock
The pregnancy could risk the woman’s health or life
There is a possibility that the foetus might suffer from a physical or mental deficiency

In 1980, following a coalition agreement between the political parties Likud and Agudat Israel, the fifth section, named the social section was abolished. This section added another condition: when the continuation of the pregnancy might cause severe damage to the woman or her children as a result of the difficult social and environmental conditions in which the woman lives, including many children. After this section was abolished, there was no substantive change in the number of referrals, but the number of approvals based on the ‘health’ and ‘illegal relationship’ sections increased.

The public debate between those who in favour of a woman’s right to her body and those who oppose abortions (whether total or partial opposition) continued for many years, however the law was not changed since the social section was abolished in 1980. A few bills to change the situation were proposed but not one passed the first vote in the Knesset.

It is important to point out that according to international rating, Israel is seen as relatively liberal in its approach to abortions, both in the definition of its laws and in the public’s social perception.

About the abortion committees

40 abortion committees operate today in Israel. Every year there are about 20,000 women referring to them from across the country. Each committee consists of two doctors from the hospital in which the committee takes place, and a social worker. The law stipulates that in each committee there must be at least one woman.

The social workers try as best they can to assist the applicants and prevent them from going through unnecessary procedures before referring to the committee. According to official statistics, most of the requests are approved. The main reason for this is that the social worker makes sure, in advance, that the woman meets all the necessary requirements in order to be approved by the committee. The initial questioning helps the applicants and saves time and money. However, it is important to note that many women who are eliminated in advance eventually undergo illegal abortions. To date no estimate has been made of the number of illegal abortions conducted in Israel. According to some estimates, half the abortions each year are illegal and are not carried out under the supervision of the Ministry of Health.

As of 2008, Hadassah hospital (mount Scopus), Soroka, Assaf Harofeh, Bnai Zion and Meir hospitals started a field research, investigating a population of young women under 20 who were referred to the abortion committees. Data was collected over six months in all five hospitals and one of the main findings was that half of the girls age 20 and under, who were referred to the committees were minors.

^{^[vii]} No qualms / Dina

I find myself having to defend my lack of interest in prodding unnecessarily into the choice I have made a long time ago. It seems that it is easier to empathize with someone who is suffering. In contrast, if a woman does not bear the scar of an awful trauma in her womb, she is not worthy. She is not believed. People think it is all just a show, it could not be, or accuse her of being insensitive or in denial. Why?

I tell them that I woke up one morning and decided that I can’t go on enduring the heart burns I have suffered from over the last few evenings, that I haven’t drunk orange juice for the past two years. So I went to the mirror and looked at myself and thought that something was not right. It’s interesting that I realized that.

Two sets of eyes stare at you, and together they encircle a private ‘creature’ in the room, each on her own piece of furniture, rooted in her own agenda. And I continue to explain how, just to be on the safe side, I already bought a pregnancy test kit.

So that morning I was standing in front of the mirror and thinking why not check? Why not find out? It won’t kill you. I thought to myself that it was not such a big deal to pee on a stick, and then the positive result appeared. What luck, I thought, it’s lucky that this check is not fatal. Lucky, for example, that it’s not Aids. I know that, at the moment, this is an unwanted pregnancy. It is very much wanted in the future, but now is not the time. I felt that the general ethics demanded I have second thoughts. And I felt bad that I found myself in a place where other women might develop a dilemma. Other women would know in advance that they were looking for this pregnancy, or were willing to accept it even if it was unplanned because it suited them. But it did not suit me.

So I rang my mother and told her: ‘mom, I am pregnant. I need to have an abortion.’ It was a short conversation and it did not scare me or stress me. Actually it did not do anything. I just thought that one day it would be so right, but at the moment it simply was not.

I made an appointment with a gynaecologist who asked me questions and told me not to feel guilty. I did not feel guilty. I felt that I was part of the small percentage of women who swallowed a small pill every night before going to bed and, yet, got pregnant.

He explained that there are different procedures, prodded inside my internal parts, sent me with forms and procedures and explained that the night before I would have to come to see him. Mmm… I don’t like very much being touched, but I had no choice and I bit my lips, smiled and accepted my verdict.

I see her fidgeting uncomfortably, and think that it might be the right time to calm her down, but I cannot do it. I decide to go on telling her exactly what happened, without sparing the unpleasant details, so she would know. So she could prepare herself, so as not to lie.

In the evening before that day, I can’t even recall what date it was, I only remember that it was the end of winter and beginning of spring, I arrived at the gynaecologist. I put on a robe and sat on a chair without my underclothes. They put inside me, into the same tunnel from which babies emerge into the world, some kind of a coil and I did not feel a thing. But when I got dressed, the doctor explained that the purpose of the coil is to enlarge the tunnel in order to ease the procedure. Ah! I said to myself, he chose the right word – procedure. I never thought it was killing a baby and certainly not murder. I never thought of a live human being. It was a seed of something which was so far away from a human being that the word procedure was just right. I went home and a few hours later, I almost screamed to high heaven when the coil suddenly sprung loose and did what it was suppose to do.

And that was it.

The next day I found myself between white walls, taking off everything apart from my body and hair, completing a form, answering questions and lying on a bed.

I went into a cool room, where two people wearing masks waited. One asked me to open my hand and said: ‘what does your mother do?’ 20 minutes of my life I cannot remember and another fifteen are very vague. Mainly I remember feeling relief, and that I have gone through this procedure – abortion.

After that I am allowed off the bed. I still haven’t eaten, or urinated. Then I recalled the peeing of that day when I looked at myself in the mirror and thought – well, I assumed it would take such a long time, and here I am already passed it. I am whole. I am here.

From that day on, I do not talk about it, because it is not something you talk about, at least not if the conversation is not specifically about this issue. And in these kinds of conversations, I tell my story.

^{^[viii]} The medication prescribed to induce abortion

There are a number of standard medical options to induce abortions using medication:

mifepristone and – misoprostol oral tablets
mifepristone and – misoprostol vaginal tablets
vaginal methrotrexate and -misoprostol
vaginal misoprostol alone

Mifepristone – a medication which blocks the action of the Progesterone hormone, an activity that prevents the thickening of the uterine lining and the continued development of the pregnancy. The medication is administered orally.

Misoprostol [Cytotec®] – a medication which causes the uterus to contract and discharge the pregnancy content. The medication is administered orally or vaginally.

Methrotrexate – a medication which targets rapidly dividing cells, amongst them the tropoblast cells, needed in order for the pregnancy to develop.

^{^[ix]} Michaela

When I was 20, as I finished my national service, I went on a three months trip to the USA. I met there, family and friends as well as a few charming men. When I returned to Israel, I discovered that my period was late. A small test from the chemist confirmed that I was pregnant. I knew that I was not ready to raise a child on my own at that stage of my life.

The gynaecologist quickly referred me to an ultrasound, and I found out that I was in my sixth week. It was a great relief to learn from the doctor, that I could have an abortion without scraping, with the help of a pill called Misoprostol. The next day, I immediately appeared before the committee for abortions which approved my abortion. The following Sunday I went to the hospital and received the pill to terminate my pregnancy. All the way back to my parents’ home, I felt so grateful and very lucky. Why? Firstly because I lived in a country which allowed me to terminate an unwanted pregnancy without having to resort to an illegal clinic and put my life at risk. And secondly, that I was left with 3,000 NIS which I earned on my trip, and I did not have to ask my parents for the money. I felt that the responsibility for this decision was mine alone, and that I was completely at peace with myself. I did not want to involve my parents. I knew it would sadden them. And maybe the discussion which might have arisen would have made it more difficult for me to have a medicated abortion, which can take place only until the seventh week of pregnancy.

I went back to the hospital two days later, for one day of hospitalization, and was given another pill which caused contractions in the uterus and helped to discharge the foetus. I stayed there half a day with a good friend. I was very happy she came along. We painted together, listened to music on the Discman and she stroked my head whenever I felt painful contractions.

I remember even today how she asked me if I was at peace with the decision to terminate the pregnancy, and I answered I was. I felt clear headed. I knew it was the right thing to do. Even today, six years later, I know it was the right decision for me. Now, I am beginning to plan a future family with my partner, and I thank god that I have the free choice to have children when I feel I’m ready – personally, mentally and financially, and to raise them with a supportive partner.

^{^[x]} Curettage, vacuuming and surgical emptying of the uterus– the medical procedure

The first stage – broadening the cervix. The broadening of the cervix is conducted by inserting metal rods with an increasing diameter. This process takes only a few minutes. The rods absorb the moisture and expand within a few hours, broadening the cervix. You might feel pressure or contractions while the cervix is broadening. Another option for broadening the cervix before the surgical procedure is by using oral or vaginal tablets 3-4 hours before the curettage. This medication (Misoprostol [Cytotec®]) causes the cervix to soften and open. Side effects – such as contractions, nausea, slight diarrhea or a fever – are rare.

At a more advanced stage of pregnancy, it is possible to broaden the cervix using small rods called Laminaria which are produced from sea weeds. The rods are inserted into the cervix a few hours, or a day, before the abortion by a gynaecologist at the clinic. The Laminaria absorbs the liquid in the cervix and expands like a sponge. The slow expansion of the Laminaria enlarges the cervix gradually and without any pain. With this action the broadening of the cervix during the procedure can be avoided. Broadening the cervix during the procedure could be more difficult and, sometimes, could damage the cervix’s ability to carry a pregnancy in the future.

Second stage – vacuuming the pregnancy content. Following the broadening of the cervix, a plastic pipe, the diameter of which is decided according to the stage of pregnancy and which has at its end an electric or manual vacuuming instrument, is inserted into the uterus. The pipe is inserted between 5 and 12 millimeters into the uterus and pumps the pregnancy content. The procedure is quite short and its complexity mainly depends on the stage of pregnancy. Sometimes, there is a need to use other devices to extract parts of the pregnancy from the uterus.

Third stage – curettage. At the end of the procedure, the clearness of the uterus area is examined and the uterine lining is gently scraped with the help of a scraper – a small metal rod with a round tip. The curettage is usually conducted without imaging, but in advanced pregnancies and in more complicated cases, it is quite common to use an ultrasound.

The whole procedure is conducted under anesthetics and is not painful. At the end, you might experience slight stomach aches similar to those many women have during their period. Usually this may last for two to three days.

Common complications of this procedure are mild and can be cured. Mostly they include uterus infection or the remaining of the pregnancy content in the uterus. Some medical centers prescribe oral or infused antibiotics before or during the procedure in order to prevent infection.

Serious complications include: uterus infection requiring prolonged hospitalization, excessive bleeding, a rupture of the cervix or a puncture of the uterus, and damage to other abdominal organs. These complications sometimes require an additional surgical intervention. The rate of death following surgical vacuuming of the uterus varies according to the stage of pregnancy, and is between 0.1 deaths to 100,000 women in pregnancies of up to week 8, and 7.2 deaths to 100,000 women when the procedure is conducted during week 21 and or later.

Damaging future fertility is extremely rare, and when the vacuuming takes place during the first trimester of pregnancy, it is accepted that the risk of damaging fertility does not increase.

^{^[xi]} Inducing early labour

The largest part of late abortions are carried out in Israel because of the foetus’s health. This kind of late abortion is a traumatic experience for the woman. Today, any termination of pregnancy, especially induced labour, is attended by a social worker who meets with the woman at least once before the procedure is conducted. In order to further trauma, women are hospitalised, before and after the procedure, in the gynaecology ward and not in the obstetrics ward. The woman is transferred to the delivery room only when an active birth develops, and is usually put in a sided room. Even after the end of the procedure, the social worker will come and visit to see how you are doing and to help with the required bureaucratic procedures.

Israeli women, who have had late abortions, report feeling complex emotions of loss and guilt. Unfortunately, some women also report a cold and mechanical approach of the medical team, although this has improved over the last few years. More information about dealing with the death of the newborn can be found in the chapter on “Loss of a newborn” (Link to the chapter), there you can also find a list of internet and other support groups.

Only four hospitals in Israel carry out curettage up to week 20. The others carry out induced labours. After week 24 the emptying of the uterus is conducted in all medical centres by induced labour.

During an induced labour you will experience strong contractions for a few hours or up to a day. It is highly recommended not to have this procedure on your own, but to have a partner or a close person with you, so they can make sure you are treated with the sensitivity required by the team.

This procedure can take a few hours and, sometimes, a few days, and uses medications which causes contractions are, for example:

1. Prostaglandins – sprayed into the uterus through the cervix (inserted through the vagina)

2. Pitocin – given intravenously.

3. Another method is inserting a balloon into the cervix in order to enlarge it.

The uterus contractions cause a gradual opening of the cervix, inducing the birth of the foetus. The medications will bring about stronger and stronger contractions which would become more and more frequent. When the placenta tears, you will feel a warm liquid coming out of the vagina, afterwards you will feel a heavy pressure around the rectum whilst the foetus is being discharged. Usually, after the discharge of the foetus, there is a need to scrape out the placenta or parts of it. Sometimes, the placenta is discharged in full and, after the necessary checks, it can be decided whether curettage is needed.

In order to induce labour you will be hospitalised for two to three days, and when the uterus is being emptied you will be given pain killers, or sometimes a local anaesthetics (Epidural). At the end of the procedure you can decide whether to carry out a pathological test on the foetus and the placenta, or to bring them to burial.

Possible complications of induced labour include a partial abortion and the remaining of placenta particles, bleeding, infection and pulmonary embolism. Failure of the procedure which causes it to be longer than usual which can cause prolonged bleeding and infection.

^{^[xii]} Termination of pregnancy after Week 23

Terminating pregnancy after week 23 requires the approval of a special regional high committee. It is possible to refer to regional high committees through the regular committees (the fee would pass from the regular committee to the regional high committee), or through a doctor. It is possible to refer to any regional high committee irrespective of where you live.

There are 6 authorized regional high committees in the following medical centers:

Rambam Medical Centre, Haifa
Belinson Medical Centre, Petah-Tikva
Sheba Medical Centre, Tel-Hashomer
Ichilov Medical Centre, Tel-Aviv
Soroka Medical Centre, Beer-Sheba

^xiii Hospitals that have abortion committees

Name and ownership of Institution Phone number Address

Governmental

Sheba Medical Center 035033030 Tel Hashomer Ramat Gan 52621

Rambam Medical Center 048542389 POB 9602 Haifa 31096

Assaf Harofeh Medical Center 089648040 Zrifin Beer Yaakov 70300

Wolfson Medical Center 035028321 POB 5 Holon 58100

Rivka Ziv Medical Center 046828811 POB 1008 Safed 13100

Hillel Yaffe Medical Center 046304304 POB 169 Hadera 38100

Western Galilee Medical Center Nahariya 049107107 POB 21 Nahariya 22100

Barzilai Medical Center 086745600 2 Histadrut St., Ashkelon 78306

Poriya Medical Center 046652208 Lower Galilee R.D. Tiberias 15208

Sourasky Medical Center 036974444 6 Weitzman St., Tel Aviv 64239

Bnai Zion Medical Center 048359666 47 Golomb St., Haifa 31048

Clalit Health Services

Rabin Medical Center – Beilinson Campus 039376014 Jabotinsky St., Petah-Tikva 49100

Soroka Medical Center 086403408 POB 151 Beer Sheva 84101

Sapir Meir Medical Center 097472568 POB 88 Kfar Saba 44100

Kaplan Medical Center 089441520 POB 4 Rehovot 76100

Emek Mediccal Center 046494000 4 Jerusalem St., Afula 18101

Lady Davis Carmel Hospital 048250301 7 Michal St., Haifa 34362

Rabin Medical Center – Golda Campus 039372454 7 Kakal St., Petah-Tikva 49372

Yoseftal Medical Center 086358015 POB 600 Eilat 8000

Hadassah

Hadassah Medical Center – Ein Kerem 026777111 POB 499 Jerusalem 91004

Hadassah Medical Center – Mt. Scopus 025844111 POB 5032 Jerusalem 91240

Public

Shaare Zedek Hospital 026555111 POB 3235 Jerusalem 91031

Bikur Cholim Hospital 026464111 5 Strauss St., Jerusalem 91004

Private

Assuta Medical Centers Tel Aviv 035244344 62 Jabotinsky St., Tel Aviv 62748

Elisha Hospital 048300000 12 Yair Katz St., Haifa 34636

Herzeliya Medical Center 099592555 7 Ramot Yam St., Herzeliya 46851

Merav Medical Center 035008800 POB 3530 Bat Yam 59134

Assuta Medical Centers Petah-Tikva 039053511 3 Spiegel St., Petah Tikva 49361

Sanitas Hospital 035225171 18 REines St., Tel Aviv 62748

Horev Medical Center 048305222 15 Horev St., Haifa 34341

Assuta Medical Centers Beer Sheva 086276640 POB 5874 Beer Sheva 84151

Assuta Medical Centers Rishon Lezion 039631631 14 Lazarov St., Rishon Lezion 75654

Assuta Medical Centers Haifa 048810603 Lev Hamifratz Mall, Haifa

Community Clinics

Assuta Medical Centers Ashkelon 086738725 3 Hagvura St., Ashkelon 78306

Medica 088236366 11 Migdal Hanesiim St., Beer Sheva

Medili 089416023 36 Yehuda Halevi St., Rehovot 7653

^xiv Using contraceptives after an abortion

Contraceptive pills

When to start after a vacuum abortion? On the day of the abortion, or 7 days later

When to start after a medicated abortion? On the day you took Misoprostol, or 5 days later.

Notes: if you intend to start using this contraceptive later, it is recommended to consult the gynaecologist for contraceptives you can use in the meantime.

Vagina coil, sticker?

When to start after a vacuum abortion? On the day of the abortion or 5 days later

When to start after a medicated abortion? On the day you took Misoprostol, or 5 days later.

Notes: if you intend to start using these contraceptives later, it is recommended to consult the gynaecologist for contraceptives you can use in the meantime.

IUD device

When to start after a vacuum abortion? Immediately following the abortion, or at the follow up meeting.

When to start after a medicated abortion? Immediately following foetus discharge

Condoms, diaphragm

When to start after a vacuum abortion? From the first time you have sexual intercourse.

When to start after a medicated abortion? From the first time you have sexual intercourse.

Body Image

admin — Thu, 01 Oct 2009 11:22:14 +0000

Our constant preoccupation with our body and its image accompanies us from childhood in different contexts and to varying extents, depending on internal and external factors. The feminine body comes in an amazing array of shapes and sizes: we are tall, short, thin, fat, strong or fragile. Our eyes come in a range of shapes and colours, our skin in a large rainbow of hues and our hair in many shades and textures. All the same, we are all judged (by ourselves and by others) by irrational standards which create an ideal image of beauty, not achievable by most.

This chapter deals with how our body image affects our lives, how it shapes it and how we cope. Areas of Israeli culture also shape our body image, i.e. army service or local ethnic attitudes regarding the beauty ideal. The chapter ends with cosmetic surgeries that are available to women today and about choosing to change your external appearance in this way. This section includes a critical discussion of all angles, the chances and the risks, as well as information on surgical procedures and much more.

We are never satisfied with our looks; there is always something we would change or fix. Our own bodies are never perfect…

Try to think: how many “real” naked women and men we see in our everyday life? Excluding the seminude or nude people (mostly women) we see in commercials, in fashion magazines, in movies and on television, we hardly ever see “real” naked bodies.

The media creates an “ideal reality”, but the feminine body presented in the media is not a real body. We often encounter the bodies of very young girls or of women after plastic surgery, implants and face lifts, starvation and extreme diets. They always wear heavy make-up and the pictures are touched up and air brushed using computer software. The conceptual distortion is that real women become abnormal as opposed to the women we see daily on the screen or on magazine covers. The beauty role model is unnatural and scarce. It overlooks the beauty within as well as the differences between us.

Beauty is deceitful, and the media is vain

Israeli media is mainly run and ruled by male Ashkenazi Jews who are the decision makers, the sponsors and the directors. Women’s place in the media is fro the other direction, namely posing in a variety of inviting positions for magazine covers, billboards and internet advertisements or as movie and television actresses. The camera tends to presents them as passive and helpless, or as the temptress, instigating evil.

The Gaze Theory

The gaze Theory demonstrates how the camera lens reflects a masculine point of view: the man is shown as active, as the observer, as the one for whom the image is designed. On the other hand, the woman is a passive reflection. Even though she is physically situated in the center of the image, hierarchically speaking she is cast aside. And the man? He looks at the woman with sexual, voyeuristic pleasure, his look making her an his object and at his service. We are accustomed to seeing the world through these dominant male eyes, and therefore hardly notice it. The power of the media causes us to internalize the way men look at women, and how we see ourselves from the outside – as an object.

“Honestly, do I look fat?”

Beginning in childhood we are intensely occupied with our bodies and our looks in various contexts and levels, affected by different internal and external factors. Our relationship with the mirror is complex, waves of emotions overwhelming us in the course of our life. Almost every woman likes some parts of her body, while judging others as objectionable, unbecoming, imperfect, or simply different from what she wishes them to be. Think: what is the meaning of living inside a body with which we are mostly displeased? Think how much time and effort we put into our looks, and about the frustration these thoughts cause us.

3 more pounds to the moon / Esther Yedgar

You know what it’s like. You sit down on the couch at the end of your workday. You’ve been dreaming of this moment for at least 10 hours. Putting your swollen legs on a pillow, having a cup of coffee, clearing your mind, turning on the TV and escaping.

There you are, in front of the TV; not so thin, a spider vein showing on your leg, gray hair turning up on your head and one on your chin, you’re sweaty and you’re hot, and you wish the wrinkles on the side of your eyes would be from laughing so much, but – how long can you kid yourself. In front of you – flickering on the TV screen – is a chick, a hottie, a bimbo, a model, an anchorwoman. She has a thousand names; you can’t remember what she calls herself. She is all that you are not, she is all that you are supposed to be, she is all that you would ever like to be. Young, thin, blond, pale smooth flexible skin. But you can’t be what she is. Even if you loose some weight and color your hair blond, you will always be dark, oriental, you we never have a thin pelvis or apollonian legs. Your parents come from the wrong continent, and you will never meet these standards. You try to find comfort in thinking that the girl on the screen has no respect for herself. But how consoling is that? She’s not a girl you marry, she’s a girl you take for a night out and she will be twenty forever.

You also know these texts. You have read them a thousand times, in every women’s magazine and every possible feminist position paper. “The Western Enslavement to Beauty – How Dreadful”. You and I know that the model isn’t real, that wanting to look like her is to be unjust to yourself and that you shouldn’t want to be like her. You are an educated woman, you know what’s what, and you understand that there is someone behind all this: advertising agencies, TV channels, fashion designers and so forth. They want you to want to look like her, and you for some reason believe them. You know it’s a lie but you can’t bring yourself to quit. The beauty ideal is made up of thin young women who don’t work hard, who can afford buying products far out of your reach, who meet the physical criteria you can never meet. The Israeli beauty ideal is based on origin. It is a derivative of the Western beauty ideal that does not embrace a spectrum of beauty, only white beauty. Due to physiological reasons oriental women cannot be a part of the competition. Our starting point is inferior because of our genes. We are darker, wider, not sufficiently milky-white. We are shut out of the game and receive a consolation prize – a promise that if we just loose a few pounds, we can get back in the game. We are always just barely in sight; even in commercials oriental women get close-to-lead parts so that we think we are on the verge of existence, on the verge of having a part in the game. Not to say that Ashkenazi women are automatically allowed to participate in this game. They too suffer the same exclusion we suffer, but at least they exist. To these women I can offer some consolation – perhaps we both wear these few extra pounds, but at least your skin is the right color.

So if we know it’s a lie, why do we still believe it?

It has been argued that we women tend to keep everything inside. Perhaps we also tend to do that when it comes to violence. We direct the violence inwards, towards ourselves. Wanting to be someone you are not is not accepting yourself. Does self-hatred sound familiar? What is self-hatred if not violence towards myself? The immediate expression of violence directed inwards is feeling uncomfortable inside my own body, not accepting myself. We are like tourists inside own our bodies, always living in a borrowed body: before long it will transform into a thin lovely well-built body, and then I will be seen as I really am. My boss will know that I am a woman, a person, and that I have an opinion worth hearing. Just 3 more pounds and I will be heard.

On the other hand, men are taught by society to direct violence outwards. Some beat up women, some drive violently on the road, and most of them play soccer. They also know how to make time for themselves. Regardless of how the house looks, they will always find the time to play basketball with the guys. And you? You never make time for yourself, you don’t play soccer, and you drive as if the road embarrassed you. Where does your anger go? Inside. You are angry with yourself. Your daily exhaustion and pain and your existential anxiety accumulates into the illusion of an escape through a physical change. You are violent towards yourself. Anything you don’t have the nerve to say to the world, you say to yourself. Just a few more pounds and everything will be alright.

We generally begin life feeling comfortable with our bodies. As youngsters we learn to discover the world through our bodies. However, as we get older we tend to feel less and less “at home” inside our own skin. Only a few of us continue to feel comfortable with their bodies as they mature.

Young girls and their bodies

Growing up is a process that each and every one of us goes through in her own individual way and at her own individual pace. The body significantly changes between the ages of 8 and 17: some become more rounded, some grow taller, and others experience early development of breasts. One feels the hormones flowing through her body and mind while the other doesn’t. Most girls have a hard time getting used to the changes their bodies go through and to the way their bodies look and move. Adolescence can put individuals under a lot of pressure, because during that period girls are more sensitive and easily influenced by their environment and the culture in which they live. This influence might be harmful and confusing when it comes to the shaping of our body image. The influence of our peers grows stronger and so does the influence of our role models on television and in the movies, in commercials and on the internet. Commercial companies in the beauty industry are aware of the fact that girls at this age are intensely occupied with their bodies, and make their fortunes out of the aspiration for a perfect body.

Female soldiers’ body image / Orna Sasson-Levy

The Israeli military body is a male body. A masculine, healthy, strong body is the primary requisite for serving as a combat soldier. This is the body, the model, with which all other male and female soldiers’ body image aligns.

Female soldiers’ body image is not uniform or stable, but rather it varies according to the soldier’s job, the army base she serves in, her social environment and her distance from the combat soldier. It is therefore impossible to characterize the female soldiers’ body image, and there is need to approach the issue in a pluralistic view and talk about the various body images of female soldiers. These images are closely related to the different jobs the soldiers have.

Female soldiers who serve in “masculine” or combat jobs, as infantry instructors or as border police officers (2.5% of the female soldiers serve as combat soldiers) adopt and imitate the physical practice of the combat male soldier: they learn to walk like him, dress like him, talk and even think like him. “I remember myself in infantry instructor training… they teach you a masculine walk, a fast walk. In the beginning the company commander walks that walk, and you run after him because you can’t keep up with his pace. In time you learn to walk like him and you stop running.” Or as a basic training officer put it: “If you had seen me in the army you wouldn’t believe what you see today, two completely different things. I looked like a guy. Because you’re walking around with fatigues, so it’s very awkward, you don’t wear tight flattering uniform, and you carry a firearm, so you’re very clumsy, and your tone of voice is lower; I wouldn’t talk to him like this [in a normal voice], I would talk like this [uses a low voice].” When female soldiers adopt the male combat soldier’s body image an ambivalent feeling is planted in them: on the one hand they develop an active body image which emphasizes capability, acquiring new abilities and physical confidence. On the other hand, their bodies stay feminine, and as such their body is the eternal “witness for the prosecution” against complete integration of women in the army.

On the other side of the military continuum are many, at least one third, female soldiers who serve in various administrative jobs. Doing these jobs the soldiers, fixed in front of a desk and surrounded by four walls, idly get bored. In one interview, one of the interviewees, a clerk, told me what she was about to do once the interview was over: “Just like now… sit with my legs crossed and think how am I to pass the time”. Many clerks have talked about the custom of keeping them in the office until the officer tells them they are free to go. “What do I do until 12 o’clock at night? I play solitaire and he invites his friends for coffee at the maintenance office.” The body image of these soldiers is shaped as the opposite of the combat soldier’s body image: a passive, fattening, idle body. The physical boredom joins the mental boredom, they maintain each other; and the low self esteem is linked to a negative body image.

How can we help our daughters foster a more positive body image?

Those were the days… we were once teenagers. Do you remember how hard it can be sometimes? How you used to strictly test every inch of your body, how you used to harshly criticize yourself and your body? It seems every teenage girl has difficulties accepting her own body. These difficulties tend to persistently accompany us throughout life, and sometimes it is very hard to free ourselves from their grip. Our feminine body image is largely shaped in these fragile years. How can we mothers help our daughters or sons in this context? How can we play an active role and help our children foster a positive body image?

Here are a few suggestions for encouraging a more positive body image in our children. Note that the suggestions talk about our daughters, but are equally applicable to our sons too.

Let’s start with ourselves: ask yourself do you set a good example for fostering a positive body image? The messages we give our daughters affect them, sometimes even more than the media does. The sad truth is that many girls learn to hate their bodies by imitating their mothers. We should notice how we speak of our bodies with our daughters, our friends, and our spouse. How much time do we spend daily talking about our looks, clothes, diet or weight?

From time to time, watch a movie, a commercial or a TV program with your daughter. Talk about the characters; help her notice stereotypes and the point of view of the people “behind the camera”.

We can encourage a more positive body image by teaching our daughters to focus on health and not body weight, by encouraging them to exercise in a fun activity and to plan and prepare healthy meals together. It is advisable to initiate conversations regarding the social messages that shape the “desirable body”, the distance between the actual and the desirable and the price we might pay while trying to achieve that ideal. Try to listen and not judge the way they talk about their selves and their bodies, and look for changes in their eating habits.

Fostering a positive body image is also linked in various ways to self-perception, especially with our daughters. Try directing them towards the search of personal strength based on achieving one’s dreams and goals, and not just based on their beauty. If we enable our daughters to define their own values and fields of interest, help them live by these values, encourage them to stick to their opinion and listen to their inner voice, we can help them build their selves into independent complete women.

Most of us have inner voices that accompany us with every bite. Let’s release ourselves of that soundtrack, indulge our passions once in a while with the things we love to enjoy, without feeling guilty.

Instead of being passive consumers, we can use our purchasing power. A consumer embargo can work if we are decisive. The embargo on cellular companies resulted in a reduction of call prices, and an embargo on the SuperPharm chain led to a change in policy that allowed the cashiers to sit down during their shifts. If we use our purchasing power wisely, we can also make a change…

Trying a new kind of exercise or other physical activity (such as dancing or martial arts) that we have yet to try is recommended. Physical activity helps us appreciate our body and our strength, and learn to know it better. This is how we learn to appreciate what our body can do instead of being preoccupied only with its appearance.

Women and their maturing bodies

During pregnancy, birth, and in most cases after giving birth, our bodies change and reveal our maturing femininity, leaving our youth behind. Israeli women are in a sense between a rock and a hard place – on the one hand the Israeli society sanctifies motherhood and the idea that motherhood is the ultimate realization of femininity; on the other hand, the glorification of skinniness and youth drives women into an impossible Sisyphean struggle with their evolving bodies as a result of the long- awaited motherhood.

In a society that worships youth and skinniness, we find it hard to accept and love our changing bodies, to learn to appreciate the trails signifying our travel through the cycle of life.

Maturing, a natural process, is considered a process that should be prevented, stopped, treated and even cured, as if it were a disease. Very often technology provides us with various new “Anti-Aging” products, establishing the illusion that if we just give it the right amount of work, we will acquire everlasting beauty and youth. The pursuit after youth and beauty prevents some of us from seeing the beauty of maturity and old-age. Many cultures admire and respect the beauty and wisdom of their elders (for example: the Jewish, Native American, Chinese and Polynesian cultures). These perceptions present the years gone by and the maturation as bestowing a rich life experience, honor, wisdom and clear judgment.

Once a “bombshell”, now a “manatee”

In everyday life we are referred to with various names focusing on our looks, be it when we walk down the street, go to the grocery, or at the playground. The name continuum begins with beautiful and ends with ugly, and these names affect our body image and self esteem. We are categorized as very beautiful (hottie, foxy, sexy, milf, chick, stacked), average or ordinary (nothing special, second rate), ugly or fat (dog, whale, butt-ugly, hideous, manatee). Our body parts also receive various names, independently, as if autonomous organs: knockers, fun bags, honkers, melons (or other types of fruit, depending on the size).

Women in general, and our vagina in particular (“what’s that matter, are you a pussy?!”), are perceived as negative. Most curse words use names and words regarding women and their vaginas, be it mothers, sisters or spouses.

Women’s bodies in the eyes of society

Most cultural works of art emphasize beauty as the most important feature of women and ties between beauty and positive “feminine” characteristics such as tenderness and pleasantness. Boys and men are defined using various “masculine” characteristics: tough-guy, go-getter, mischievous, and sophisticated.

We all experience these social messages in our daily reality: messages we receive on the street, at work, at home or at school regarding the importance of perfect looks are often accompanied with offending or degrading comments about our nose, breasts, legs, buttocks or bodies; we sometimes see these messages with sarcastic eyes in an effort to nullify them, and at other times we are flattered by them. However these messages can sometimes become invasive, violent acts such as sexual harassment and abuse; others can also be sexual assault, sexual violence and rape, events which many of us experience throughout life.

In our modern world we are surrounded and flooded with commercials, overt or subtle. Many of us believe ourselves to be immune to the effects of commercials, and this common mistake is one of the major reasons for the tremendous effectiveness of the advertising world. Ask yourself: would commercial bodies invest 70,000NIS per broadcast minute during Channel 2’s Prime Time, if it weren’t a highly effective minute? The fact that the media and advertising world focus their efforts on this issue stresses the social-commercial connection between our need for social acceptance and our personal happiness.

The “perfect” image we see everyday in the media consistently eliminates and excludes disabled women, older women, and over-weight women who are perceived as deviating from the “normal” body. Moreover, when disabled, over-weight or older women are shown in the media, they are not shown as sexual, attractive, “real” women, but rather as a stereotype. Fox example, disabled women appear in the media as helpless victims in search of protection and assistance, or as heroes of tear-jerkers in which they overcame all of life’s barriers. Most of us, not having to live with disabilities, have virtually no information about the life of disabled women. Over-weight women appear in the media in one out of three main scenarios: in commercials trying to convince us to buy a certain food product, as the “before” image in a commercial for dietary products, or as supporting actresses struggling with romantic disasters brought upon them by their obesity. Older women generally appear as confused, senile, nagging old ladies, or as witches.

Scarred doll / Iris Barkan

In Native-American tradition, warriors were considered more heroic and important based on the number of scars on their bodies.

In western modern society, a masculine imperfect and scarred body is treated forgivingly.

In the Israeli society we outdo ourselves and link scars and injuries with bravery and manhood, perhaps due to the reality which surrounds us and maybe because we need to legitimize man’s stupidity. Men with any sort of physical disability are often thought of as war heroes, justly or unjustly, and therefore their physical disabilities are forgiven and forgotten.

But I am a woman, and as such I must be flawless, perfect and smooth. My defects are not given clemency.

But I have also lived a complete life, and my body is a map of my life history.

Therefore I bear many scars – road accidents, Cesarean operation, hot water burn, hysterectomy.

I started collecting body signs when I was young: a fall off a tree left my elbow with an abrasion, a bicycle crash cut deeply into my thigh, an attempt to show off at gym class led to a complicated fracture of the thumb which never healed nicely. All these I accepted with pride, as if they were signs of my bravery and ability to withstand pain.

In those days of innocence, the body was still thought of as perfect despite these many traces which did not receive that ugly name – scars.

The change probably started with the all-out war I was trying to run against the pimples.

At 16 I thought my looks were my only property and therefore must be carefully protected.

Waking up each morning and finding a new “enemy” in the shape of a pimple on my face was practically heartache and seemed like the end of the world.

There, in the mirror, was this hideous creature not fit to leave the house, so I could not let nature take its course and mercilessly picked my pimple, and that of course left signs on my face.

Years later I had to face a bad injury from a road accident, which left my mind and body wounded and scarred. Yes, this time I called it scars.

Though over 20 years have passed, I still can’t uncover my scarred body parts in public – at the beach, wearing short pants or a skirt on a hot summer day.

I don’t have the right to impose the difficult sight of a woman’s distorted and scarred legs on society.

I must pay the price of lack of heroism and loss of perfection.

Alone.

As women do.

There are of course the “feminine” scars which will for ever belong to us.

Some we bear proudly, with joy and love, like the scar of the Cesarean operation which brought my only son into the world. With this scar I live happily despite the fact that it crosses my belly, creates folds on either side and looks bad with a bathing suit. And still, it’s mine; I earned it and I love it, and mostly him.

But there are also scars that signify the loss of femininity.

Like the one that took my uterus away from me. I try to overlook that one.

I’m angry with it, knowing it robbed me of the world, but maybe also freed me of the perception that measures me by my fertility.

My body is inlaid with scars, stretch marks, folds, expression wrinkles of happiness and sadness; and as I stand in front of the mirror, I see a scarred doll that can’t find its place with the others.

Many women work diligently on “improving” their looks in order to please men. Living in a patriarchal society, in which men are the bearers of power and control and women are judged by their looks and associations with men, has many a time brought us to compete with one another. Women learn that their central source of power is in their sexuality and beauty.

The way we treat our bodies is very much affected by our life experiences. Many women feel unsafe inside their own bodies, while shifting negative experiences of mental, physical and/or sexual injuries into their bodies. Another known response to these injuries is taking hold on the body, believing that a “perfect body” will protect us from discrimination and help us be happy, successful, and for-ever loved. A different reaction to injury is a feeling of alienation from one’s body, which can lead to neglect, extreme obesity or skinniness, drug and alcohol abuse, or a radical use of one’s sexuality.

It is customary to say that true beauty is within, regardless of weight, age or skin color.

Concealment, Revelation, and what lies between them / Rivka Neria-Ben Shachar

I’m four years old watching mom combing her black, long, beautiful hair. She braids her hair and rolls it into a ball. She fastens the ball with a hairpin, takes her square kerchief, folds it in half and there we have a triangle. She ties it round her head with two hairpins. A head cover.

I’m playing mommy with my friends. I have a kerchief on my head. I try to tie it, to fasten it, but it keeps falling. But how will everyone know I’m the mommy in the game if I don’t have a kerchief? All mothers have one, don’t they?

I’m a girl and a young woman, all the women and mothers around me cover their heads: kerchiefs, hats, wigs. Once in a while I see a woman without a head cover. “She’s secular or almost secular,” I think to myself. I learn how to sort women into groups by fine distinguishing lines: Is some hair showing? Is the hat set in a certain angel? What kind of wig does she wear?

My friends’ “Shabat Kala”, the Saturday before the wedding. Everyone is excited, jealous. The bride is thrilled, she can barely speak. Saturday afternoon is the peak of the event: trying on the head covers. She brings a pile of hat boxes from the other room, we all try them on. Maybe we are playing mommy again, like in kindergarten. At the next wedding we will all look at today’s bride, for the first time with a head cover. Almost every minute she goes to the ladies room to fix the hat. “I haven’t gotten used to it yet,” she apologizes with a perplexed smile.

I am a bride now too. Mom takes me to buy head covers. The excitement is exhilarating. In the store the women carefully try on the hats – putting on the new one and only then pulling out the old one, not to reveal their hair. They look at me – taking off one hat, revealing my hair and trying on another. Mom’s excited smile is revealing – it’s allowed, she is not married yet….

And there I am, already married. Excitedly tying the kerchief round my head (two weeks before the wedding I find out that the man I am marrying absolutely hates hats). The relatives are coming for Shabat Sheva Brachot; they are excited: look how pretty she is with the kerchief! What a Jewish face!

On the first couple of days the kerchief is like a crown. I wear it and feel everyone knows I’m not a child anymore; indeed I am only 21 and a half, but already married! The crown is a bit tight, but the excitement, oh the excitement…

In these first days, we are opening the wedding presents until the middle of the night. At 2AM we are going down the stairs to throw the empty boxes. Suddenly, half way down I notice something strange. The crown! I throw the boxes at once and run back home. My husband is running after me – What’s wrong? What’s wrong? And I’m embarrassed: I went out without the kerchief… We both laugh…

The days go by and I get used to the crown/kerchief/head cover, but they do not get used to me. It falls off, and it’s hot, and not always comfortable, but the excitement lasts. Professors, especially the Rabbis at the seminary at Bar Ilan act differently. I’m a married girl!

Now I’m a real mother. I have a kerchief, a baby carriage, and a beautiful little baby girl. And still, something feels strange, as if not really belonging to me.

And I’m pregnant again. I’m a student at the Hebrew University, completing my MA in communication and taking every possible feminism course. In the Hebrew University my kerchief is unusual and strange (social sciences, not humanities!). But I’m used to it…

I teach at the university. At the first lesson the students are a bit shocked. A teacher with proper dress and a kerchief? One day I told them that I’m not hiding a horn underneath. Maybe that calmed them down…

I’m sitting in an advanced feministic theories course. The wonderful lecturer Orna Sasson-Levy talks about radical feminism. “Male dominance over the female body through…” a thousand hammers are banging on top of my head. The kerchief, thin and delicate, is burning. I have been religious since the day I was born, I grew into it; but I have also been a feminist since I was a little girl (so they say…), and now I’m even a professed feminist. How can I allow this male dominance over my body?

I study the Halakha and understand that things aren’t so simple. I feel that today it all comes to a social symbol, an ideological statement and not the straightforward compliance to a rule. It’s a lot easier to keep the Sabbath and observe kashrut, it’s the Halakha – and it also doesn’t hurt me. It’s harder to keep an amorphous and complex commandment, which requires such a great sacrifice.

Ever since the revelation in class I’m not who I was before. My parents had a good reason to fear my going to the university. I have become a woman with a critical approach, who asks questions and looks for answers. How does that go hand in hand with faith and keeping the commandments? Since it is strong, it is real, and it has always been there.

Perhaps the revelation is internal and the concealment is external. Perhaps in the effort to combine my being religious and a feminist I must sacrifice something – something of them or of myself.

And perhaps the revelation is the true concealment and the concealment the true revelation?

Perhaps.

Migration is engraved on the body / Ina Michaeli

Migration is engraved on the body. On the facial features, the sound of the voice. The accent.

When I came to Israel with the major Aliyah wave of the 90s I was 9 years old. I knew of the social connection between Russian women and prostitution long before I learned about sexual harassment of Russian women who don’t know their rights, financial exploitation of immigrants by manpower agencies and women whose limited options of making a living push them into working in the sex industry.

Body image is not just how I see my body, but also how I see it through the eyes of others – what meaning they give it; how they read it. As someone whose Russianness “shows”, the way my body is perceived in the public sphere has never been an enigma to me. My body image was shaped and constructed within a reality in which the Russian woman’s body embodies sexual accessibility. Once I wanted to be a prostitute. I eventually became a leftist lesbian.

The life experience of women of my mother’s generation taught me that the body of the female immigrant, new in Israel or not, never stops being a body of a female immigrant. These women are also “showing”, although in a different manner. In the socioeconomic reality that surrounds them, the body continues to be related to migrant workers: child care, nursing the elderly, cleaning houses and offices.

As an immigrant, it is as though my body declares: “I am not from here”. My body and I, we have a mutual history – before Israel. We come from a different place. That is why the control that this place has on my body is limited. The foreignness is protective and creates a safe distance from the meanings that are projected on to me, on to my body, and on to my sexuality. The amazing part is that in this foreignness I find also a promise – to discover myself in other places, in other meanings, in other women.

However, we cannot disregard the social advantages of being beautiful. Studies have shown that beautiful women and men are considered more attractive, sociable and smart. Do our looks stand in our way to happiness? Are women who underwent plastic surgeries defined as successful really happier? According to various studies, this is not necessarily the case: happy people are women and men with a positive self-image and who are supported by the important people in their lives.

You only have but one body. Look at your hands, your legs, and your belly. Close your eyes, feel the air going in and out of your body. This is the body you were born with and with which you will keep on living. Look at the real women around you and see the great variety. We are tall or short, erect or bent; we have eyes in different colors; our skin color varies from pale-pink to coppery-dark. The range of colors and textures of our hair is endless. A few of us could ever fit the desirable model as defined by the society we live in. Whether we are fat of thin, disabled or not, young or old, we are all different from what society expects us to be. The daily struggle to accept and love ourselves in our own bodies is not just a constant struggle important for each and every one of us; it is also a political and personal statement which promotes change. The aspiration for physical perfection leads to an eternal feeling of dissatisfaction towards our bodies, a feeling that can sometimes come to self-loathing constantly eroding our happiness and quality of life.

Let you hair down / Michal Lester Levi

Einat has hair on her big toe (I pluck mine out when I’m nervous); Racheli underwent a total-body laser hair removal; I have a hairline from my bellybutton downwards and it bothers me; Ronit has hair around her nipples; Osnat does a bikini wax, and Yaeli shaves her whole body; Orna shapes her own eyebrows; Ortal prefers the cosmetician; Moran removes facial hair with a string; Orit doesn’t remove hair at all; I only shave my armpits in the summer. We are all very busy with our body hair. Our body hair is not trivial. Why are we so pedantic about removing our body hair? Why are we prepared to suffer different kinds of pain in order to permanently or temporarily remove the hair? Some women feel that body hair “catches” dirt, as though if we didn’t remove the hair we would sweat more or our sweat would have a stronger odor. Women and men tend to link body hair with masculinity and masculine bodies, while women are linked to smooth skin. Women with body hair are considered masculine and hear negative remarks about the issue.

The issue of body hair, the measure of hairiness and the color of the hair keeps us Israeli women very busy. The association between body hair and oriental people and Arabs drives many women, who wish to look more westernized, to remove their body hair, an act that seems very natural through our eyes. Most women “take care” of the “bikini line”; some remove hair from the entire crotch area. Removing hair from this area in older women creates a girlish or childish look. The hairless child-like look is considered to be erotic. We are not aware of the erotic meaning that the hairless child-like look receives; however that look reinforces and glorifies the young feminine look, and blurs the boundaries between pedophilia and erotica. The hairless look is very common in pornographic materials.

Eating Well

admin — Thu, 01 Oct 2009 11:21:32 +0000

Eating is not just a physical need which influences our health, but also a product of culturally defining elements. All over the world many more women than men cook, feed, are concerned with food as eaters (or perhaps as ones who do not eat enough – Israel is rated highest in teenagers who are forever dieting). The chapter deals in femininity & eating, the representation of women in food ads, eating & sexual abuse and more. This chapter was compiled by a nutritionist, a specialist in eating disorders, women who suffered eating disorders at various levels, a vegetarian, a vegan etc. The correlation between femininity, love and food is especially strong in the Middle East.

Addictive Substances – Alcohol, Drugs and more

admin — Thu, 01 Oct 2009 11:20:51 +0000

Most of us have used addictive substances at some point throughout our lives, as adult women or as teenagers. Some drink a glass of wine or beer in the pub, others drink daily. Some try cannabis once and some smoke regularly, while others are addicted to pain killers. Even if we ourselves do not use any addictive substance, we often share our homes or our communities with those who do.

The chapter deals with addictive substances and their physical and mental effect on us, how to reduce the risk and damage, ways of fighting addiction, support groups and centers available in Israel, preventative measures and ways to help.

Our Bodies in Motion

admin — Thu, 01 Oct 2009 11:16:54 +0000

The human body was created to move. Motion does not necessarily mean exercise or sports. Working in or out of the home has become, over the years, much more mechanical, so that women, nowadays, are less mobile. Physical exercise includes an array of activities which can be done alone, in groups, or as competitive or achievement-orientated activities. Physical activities need to fit personal inclination and the health of each of us. The chapter discusses fully the influence of movement and exercise on physical and mental wellbeing. It deals with general Israeli issues such as access to sport facilities and financial support (or lack of) of women’s sports by the government and local municipalities.

Holistic Medicine

admin — Thu, 01 Oct 2009 11:15:44 +0000

The health system in Israel meets, confronts and sometimes even cooperates with holistic practices such as acupuncture, homeopathy, chiropractics and many other methods. The holistic approach does not only tackle the physical ailment, but aims to strengthen both the body and mind as one. Most of the Israeli public does not yet have access to a large pool of information on holistic practices. This chapter surveys the various holistic approaches while offering the reader basic tools to take care of herself and how to weigh up the advantages and disadvantages of different types of holistic medicine. It also reviews the accessibility (or lack of) of such health services to the weaker sectors of society.

Emotional Well-Being

admin — Thu, 01 Oct 2009 11:14:52 +0000

The well known Greek saying “a healthy spirit in a health body” is just as true today as it was three thousand years ago. During our lives we deal with emotions, situations and events which require mental support from family members, friends and relatives. It is often their support which provides us with a sense of security and stability. Yet there are situations and events in life in which this support does not provide adequate assistance, and the guidance of a professional is essential.
The chapter on Emotional Wellbeing provides an in-depth description of the array of therapy options available in Israel today, from publicly funded services, options available through the different Kupot Holim (HMOs) and private services. This rich overview, combined with personal narratives collected from women of varying ages, ethnicities and socio-economic backgrounds, enables the readers to make educated and informed choices regarding which professionals would be most suitable for them.

Chapter sections include: Therapy as an option – Finding a competent, caring therapist – Is it all in our brain chemistry? – Concerns about medication – Challenges for consumers – Social or political action: an often overlooked source of help. The chapter answers such questions as: Which therapeutic methods are available in Israel today? How to I select the type of therapist which would best suit my needs and values? When should therapy include psychiatric aspects?

Environmental and Occupational Health

admin — Thu, 01 Oct 2009 11:14:11 +0000

The quality of the environment has an impact on our lives and shapes our health in various ways. Our environment has, over the years, become less and less safe. The air is polluted by poisonous gasses omitted by cars, factories and more. The waters are polluted by chemicals and from the over use of pest control in agriculture and more. Our food is sprayed, sterile and full of hormones and chemicals. Even inside our homes we are not safe. We breathe poison from detergents, from the paint on the walls or the infected water and food. These substances affect our health and we need to be aware of their danger.

Even our work place, were we spend a large portion of our day, does not always take enough care of our health and safety. This chapter reviews the various hazards and how we can combat them. For instance, the workers in factories are exposed to poisonous gasses; a growing number of women are working in commerce and are standing for long hours, without rest or available chairs; continuous work in front of the computer can distress joints and sight.

Violence and Abuse

admin — Thu, 01 Oct 2009 11:13:31 +0000

The phenomenon of violence against women is typified by the close relationship with the attacker, who usually comes from within the circle of the woman’s close relatives. The private nature of the violence against women sometimes renders it ‘transparent’, so that it is almost not seen because it takes place within the home or because society views it as legitimate. Violence puts the women victim at risk of death, disability and affects their emotional state and health. A long string of laws and regulations define violence at different levels as punishable criminal offences. Nowadays, women in Israel are regularly battered, raped, sexually harassed, are trafficked and even murdered.

The chapter strives to support women who experience violence and sexual harassment by undermining the common myths relating to rape, highlighting the indicators of violent men and surveying the available legal, mental and medical support systems.

Gender identification and Sexual Orientation

admin — Thu, 01 Oct 2009 11:12:21 +0000

Our personal gender identification and our sexual orientations do not always correlate to the accepted social norms which identify two categories – man and woman. This chapter delves into the complexities and fluidity of gender identification. Such an outlook is challenging or unacceptable for some and an intimate personal story for others. The chapter deals with topics that might influence the relationship we have with ourselves, with others and with the world.