Aligning Islamic ethics with reproductive health policy: addressing gaps in early termination access in Saudi Arabia

Unplanned pregnancy presents ethically and clinically complex challenges, especially in health systems where early termination is legally or procedurally restricted. In Saudi Arabia (SA), Islamic jurisprudence permits abortion before foetal ensoulment (approximately 120 days) under specific conditions, including mental health risk and severe hardship. However, reproductive health policy and clinical practice rarely reflect these ethical allowances. This policy analysis and position paper explores the disconnect between Islamic ethical permissions and their operationalisation within the Saudi health system.Drawing on practitioner insight, conceptual reasoning and comparative policy analysis, the paper identifies six critical gaps in early termination access. These include the exclusion of psychological harm as a valid justification, the absence of policy pathways for rape-related pregnancies, inequities that allow privileged women to access abortion abroad while others remain unsupported, lack of system response to contraceptive failure, the ethical contradiction of offering anomaly screening without actionable follow-up and dilemmas in post-abortion care for unmarried women.Rather than calling for liberalisation beyond Islamic boundaries, this paper urges activation of existing ethical permissions through clearer guidelines, trauma-informed pathways and health system-wide policy reform. It proposes a culturally grounded co-design framework involving religious scholars, clinicians, policymakers and women with lived experience.By centring faith-aligned reproductive justice, this analysis contributes to global conversations on health equity, religious ethics and responsive policy in Muslim-majority contexts.