If the Holocaust had not happened in the mid-20th century, scholars estimate 26 to 32 million Jews would be alive worldwide today.

Instead, the Israel Central Bureau of Statistics reported in April that there are 14.5 million Jews in the world—still 2 million less than before the Holocaust. Most of these live in the United States or Israel. Rebuilding the Jewish population has always been important to the country: Israel’s first prime minister, David Ben-Gurion, once said, “Any Jewish woman who does not bring into the world at least four healthy children is shirking her duty to the nation, like a soldier who evades military service.”

Wars, terrorism, and a competing Arab population constantly threaten their efforts. Valuing family is ingrained in Jewish culture, and government laws and funding for prenatal care reflect it. Artificial reproductive technologies are also popular: Israel has the highest rate of in vitro fertilization per capita of anywhere in the world, and the government funds the procedure for women up to 45 years old, up to two children.

But a large, invisible enemy takes 40,000 babies from the country of 8.8 million every year with hardly any objections.

In 2014, the Jewish Telegraphic Agency declared Israel’s abortion laws “among the world’s most liberal.” The same year, Israel declared the government would fund abortions under certain conditions for women ages 20 to 33. Abortion is one of the only medical procedures a minor does not need parental permission to procure. A mother is eligible for an abortion up to the 40th week of her pregnancy. The baby has no rights until his or her head emerges from the mother.

In Israel, women have about 15,000 to 20,000 legal abortions per year, and activists estimate at least the same number happen illegally. (A woman must go through a process to obtain permission for a legal abortion.) Jewish women make up the most of these. Palestinian women from the West Bank sometimes take advantage of Israel’s accessible abortion laws because the Palestinian Authority severely restricts the procedure.

This puts the country’s official abortion rate lower than most Western countries, including the United States. Israel’s yearly abortion rate is also lower than in the past. The country has received fewer Soviet immigrants, who tend to abort pregnancies more frequently. Experts say increased access to birth control also accounts for the drop.

But while Israel has fewer abortions than the United States, it also has fewer voices speaking out against abortion.

In a sparsely furnished apartment in northeast Jerusalem, Ruth Tidhar works to convince expectant mothers to keep their unborn children. Tidhar is the chief social worker at Efrat, the largest group combating abortion in Israel. About 20 workers are on staff part time, with a budget provided solely from donations. The group takes its name from Miriam, Moses’ sister who helped preserve the Jewish people by rescuing a baby. (Efrat is an additional name given to Miriam in Jewish tradition.)

With her frizzy brown hair, nose ring, and warm smile, Tidhar seems approachable and open. “Our job is to connect with that woman where she is at and let her know that she’s going to be OK,” she said.

Holocaust survivor Herschel Feigenbaum founded Efrat in the 1950s after deciding the best way to increase the Jewish population was to stop Jewish abortions. Abortion was illegal under the British-based law Israel adopted in 1948, but an estimated 60,000 abortions happened illegally each year. Eliyahu Schussheim, a medical doctor, has been director and president of Efrat since 1977, and he gave Efrat the focus and practical mission it has today.

Also in 1977, Israel legalized abortion, though women must appear before a medical committee to obtain permission. The committees—made up of a gynecologist, another doctor, and a social worker—may legally approve abortions for one of several reasons: if a woman is unmarried, if a woman is under 17 or over 40, or if the unborn baby is disabled or poses a risk to the mother’s physical or mental health.

In 2017, Israeli committees reviewed 19,283 applications for abortions. They only rejected 29.

Efrat staffers work to combat the two reasons they say most Israeli women get abortions. One reason is misinformation about the medical risks and options for pregnancy. Schussheim tells about one incident at his private clinic that sparked his interest to work with Efrat: A patient told him she was pregnant, but her doctors had recommended abortion. They warned that an X-ray she’d undergone before discovering her pregnancy would cause deformities in her baby. Schussheim told her the latest medical research showed that particular X-ray would not be dangerous and she could continue her pregnancy.

She chose to keep the baby, and Schussheim realized the difference proper medical information could make.

The other main reason is financial pressure. If a woman mentions financial challenges, Efrat volunteers assess her situation and verify her story. If she qualifies, staff members deliver supplies like clothes, a crib, and a stroller when the baby is born and monthly packages of diapers and wipes for two years.

Some U.S. officials have recognized Efrat’s work: Photos on one wall in the Jerusalem office show Schussheim in Washington, D.C., shaking hands with former U.S. Rep. Paul Ryan, R-Wis., U.S. Sen. Roy Blunt, R-Mo., and others. On another wall, a poster displays small pictures of babies with the Hebrew words: “For the sake of the children.”

But though Schussheim has met with U.S. politicians, Efrat doesn’t identify with the U.S. pro-life movement. The group avoids politics and doesn’t lobby Israel’s parliament, the Knesset, to change laws. Its workers avoid protesting and using graphic images. (Tidhar says those kinds of associations hurt their work more than help it.)

They also avoid talking about religion, even though religious Jews tend to oppose abortion.

“Our faith places primacy on life (almost) above all else,” said Rabbi Bini Maryles, director of another abortion-fighting group, Just One Life. “‘And you shall live by them’ is a value of ours with regard to appreciating and giving value to life each day.”

Jewish law generally discourages abortion or restricts it to the first 40 days of pregnancy or cases in which the pregnancy threatens the mother’s life. But Maryles said, “In general, the Jewish community runs the spectrum of opinions on this matter.”

Instead of persuading people abortion is wrong, Efrat staff members try to show women other options. Tidhar said they don’t consider the question of morality relevant to their work, and they don’t tell women they shouldn’t have abortions based on religious reasons.

Tidhar said the Jewish culture involves more than the religion, and Efrat opposes abortion because of the demographics involved. When non-Jewish women come to Efrat for help, Efrat refers them to Be’ad Chaim, a Christian pro-life group in Israel.

“Most Christians in Israel oppose abortion on the grounds of the conviction that the unborn are human persons,” said Pastor Baruch Maoz. But the pastor clarified that Israeli Christians often do not know how to use Scripture to defend this conviction. Maoz pastored in Israel for over 30 years, and he remembers having to inform a couple that if they chose to abort their child, they would face church discipline. He said Israeli Christians tend to oppose abortion “as a knee-jerk reaction,” not because they have thought deeply about the issue. He said he has never heard an Israeli Christian describe abortion as murder.

Sandy Shoshani, Be’ad Chaim’s national director, is an example of this. She became the group’s director in 2005, 17 years after the Messianic Jewish group was founded. When the board’s chairman initially offered Shoshani the position, she turned it down. “Like most believers, I thought abortion was wrong but didn’t want anything to do with it,” she said later.

The chairman sent Shoshani home with books and videos about abortion and told her to come back in a month and see what God showed her. The resources convinced her that she could not ignore the 20,000 government-funded abortions in Israel each year. She decided her only choice was to take the position.

So far, Shoshani says, Be’ad Chaim has helped save 2,500 babies. The group’s motivation is not rebuilding a threatened demographic but saving children made in God’s image. Shoshani said she knew 2,500 babies is a relatively small number but, “Thank God, it’s something.”

The organization’s Operation Moses program provides diapers and other supplies to expectant mothers who are considering abortions because of finances. Be’ad Chaim also offers post-abortion counseling and the chance to plant a tree in memory of aborted, miscarried, or stillborn babies. Its “Garden of Life” is a plot of land between Jerusalem and Tel Aviv with places for prayer, Bible-verse-inscribed benches, and close to 2,000 trees.

Shoshani has written to and met with members of the Knesset to discuss the abortion laws. But she said the Knesset members who are personally pro-life tend to believe abortion should be a woman’s choice.

Occasionally, legal challenges to abortion arise. In 2012, Knesset member Nissim Ze’ev tried to ban abortion after 22 weeks, except for danger to the mother’s life or fatal birth defects. Two Knesset members unsuccessfully tried in January 2017 to get a religious figure (rabbi, priest, or qadi) added to the termination of pregnancy committees. But in 2014, the Israeli Cabinet approved a measure to fund abortions for women ages 20-33 as part of the country’s subsidized “health basket” of coverage.

It remains a tragic conundrum: Though the country has deeply religious people and extremely pro-family values, Israel’s abortion laws remain in practice some of the world’s most liberal.

—Read the next story in this Roe v. Wade special section: “A question of ethics”

Life around the world

Irish voters overwhelmingly approved stripping the eighth amendment from their constitution in May, opening the way for legal abortion up to 12 weeks of a mother’s pregnancy, and upending the nation’s near-total ban on abortion.

Seven months later Irish lawmakers alarmed pro-life doctors and nurses by passing legislation that would require medical professionals to refer patients to abortionists if they ask for abortions. Religiously affiliated hospitals wouldn’t be able to opt out of offering abortions under the new law.

In Argentina, House members passed a bill to legalize abortion up to 14 weeks of gestation, but the Senate later struck down the measure. The defeat sparked violent protests from some pro-abortion demonstrators in the streets of Buenos Aires.

The Australian state of Queensland removed protections for the unborn in October, joining six other Australian states and territories that have removed criminal penalties for abortion. In November, the Australian district of New South Wales rejected legislation to legalize euthanasia. A month later, the state of Victoria legalized euthanasia for terminally ill adults.

Belgium has long allowed euthanasia, but Belgian officials launched a criminal investigation into three doctors who approved the assisted suicide of a woman who had Asperger’s syndrome—a mild form of autism. Tine Nys, 38, wasn’t suffering from a terminal illness, and her family filed a complaint against the doctors who approved her request to end her own life because of mental distress.

Going into 2019, Canadian authorities will be watching the Belgium case unfold, as they consider extending Canada’s euthanasia law to allow assisted suicide for children, people with mental disorders, and those who request euthanasia in advance directives. —Samantha Gobba