MUSCAT (Reuters) - When unmarried 19-year-old Sama got pregnant, she ran away from home to have an abortion rather than face family wrath.
The young man who got her pregnant had refused to marry her, saying he could not afford the financial burden. So she went to share a room with a friend in a university hostel in the Omani capital Muscat, 450 km (280 miles) away from her hometown of Buraimi in the north of the Gulf Arab state.
The abortionist was her friend's aunt, a 76-year-old woman who boasted that she had successfully terminated over 200 fetuses in a long, illegal career. The operation in April last year proved nearly fatal for Sama.
"It was extremely painful and I nearly bled to death. I stayed in hospital for a week recovering from the botched procedure," Sama, who requested that her family name not be used to protect her identity, told Reuters.
Oman, a conservative Muslim country, is grappling with the strains of modernization.
Two decades of fast economic growth, fuelled by oil exports, have raised living standards and increased people's freedom of movement, giving men and women more day-to-day contact than they would have back in their tribal villages.
At the same time, cultural attitudes have not shifted nearly as much: pregnancy out of wedlock is widely regarded as a sin and young women can face severe beatings at the hands of their families. In addition, a family's honor can be damaged by the disclosure of a pregnancy.
The result is that a substantial number of women feel they have to abort secretly rather than bring shame to their parents, social workers say. Doctors are told by the government to obtain the permission of a patient's parents to conduct an abortion.
"Young women, if the word gets out, will never find suitors after an unwanted pregnancy as the community brands them as prostitutes, because they had a relationship outside marriage," said Fatma Al Rahbi, a social worker at the Ministry of Social Development.
Women in all the conservative Gulf Arab states face similar social taboos and restrictions.
But Maryam Hashim, a women rights activist in Bahrain, said: "To put it in a regional perspective, Omani women issues are less open than any other Gulf countries.
"Young women there are much more controlled by parents. There are no mixed boy and girl parties or gatherings. Girls are told to hang around with other girls and not boys," she said.
"So it is not a surprise that now Omani girls fully capitalize (on their time) at universities and colleges, where they develop secret relationships with boys that end with unwanted pregnancies."
Official statistics are not available, but social workers say they believe the number of out-of-marriage pregnancies, and therefore abortions, has been increasing as Omani society becomes more mobile.
Doctors who talked to Reuters at seven different hospitals across the country said about three unmarried women were rushed to the hospitals every month for treatment after abortion attempts left them fighting for their lives.
Last year, it was an average of two unmarried women every month who had aborted and were admitted to emergency wings. There are 26 government hospitals across Oman.
Some of these women don't make it.
"It is horrible the way they are brought in. One came in the back of a taxi and was left at the emergency entrance. The other was left on the roadside in broad daylight and was picked up by a passing car. They both bled profusely and died. I estimate that there are about 50 to 70 abortions carried out illegally every year, " said Hassan Al Hajar, a doctor at Sur Hospital in the eastern region of Oman.
He added that women being brought to his hospital refused to name the illegal abortionists, often because they had some personal connection to them. The result was that no charges were brought against the people who performed the botched operations.
Saeeda Shamis, 37, a successful businesswoman who runs three beauty parlors in Muscat, married a Jordanian after she was disowned by her family for getting pregnant at the age of 18 with a boy next door. She had a successful abortion but was thrown out of her family home.
"The word gets out very fast when you get pregnant. You find no Omani man wants to marry you, and that's why I got married to a foreigner," she said.
Some blame the spread of higher education for pregnancies out of marriage. The government is promoting education to help more of Oman's roughly 2 million citizens find jobs and is encouraging the education of women as a way to reduce inequality between the sexes.
The number of Omani students in tertiary education in the current academic year is up 9 percent since last year to 41,330, where female students make up 65 percent, according to the Ministry of Higher Education.
In Oman, girls and boys are separated in primary and secondary schools but this restriction does not apply to higher education.
"Now these kids meet at higher education institutes after they leave schools. They sit next to each other in the classes and they develop relationships that lead to unwanted pregnancies," said Salim Al Battash, a father of two daughters whom he said he married off before they reached the age of 18.
The number of Omani women in the work force jumped by 16 percent to 41,000 in 2011 compared to a year earlier, according to official manpower data, and there are more in regular jobs than in other Gulf Arab states.
Shamis said that to end or at least reduce backstreet abortions, attitudes in Omani society would need to change fundamentally.
"This is not about pregnancy or abortion. This is about parents who should stop branding their daughters as sinners when they make mistakes so early in life."
Doctor Hajar said that Omani hospitals are acting under the instructions of the ministry of health not to prescribe birth control pills to unmarried women.
"I suspect (this is) because the health ministry fears that it will liberalize the sexual intercourse among unmarried couple," he explained. Parents agree.
"You will not find a single parent agreeing to have their daughters given free contraception. If the ministry of health does it, then we will protest and make our voices heard about this. Why? Because it is against our religion to have sex outside marriage," Khalfan Al Mhedhery, a 67-year-old retired oil engineer, told Reuters.
A senior official at the ministry of health, who refused to be identified because he was not authorized to talk to the press, said: "Due to religious sensitivities, we do not consider changing laws about birth control at any time. Only married women will receive contraceptive pills.
"This subject is too explosive to discuss further."
Editing by Mark Heinrich