To keep up their pattern of sex abuse, Islamic State group leaders force their female hostages to take contraceptives, citing an obscure Islamic law that a man must ensure the enslaved woman he has sex with is free of child.

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DOHUK, Iraq — Locked inside a room where the only furniture was a bed, the 16-year-old learned to fear the sunset, because nightfall started the countdown to her next rape.

During the year she was held by the Islamic State group, she spent her days dreading the odor of the breath of the Islamic State group militant, the disgusting sounds he made and the pain he inflicted on her body. More than anything, she was tormented by the thought she might become pregnant with her rapist’s child.

It was the one thing she need not have worried about.

Soon after buying her, the fighter brought the teenage girl a round box containing four strips of pills, one of them red.

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“Every day, I had to swallow one in front of him. He gave me one box per month. When I ran out, he replaced it. When I was sold from one man to another, the box of pills came with me,” said the girl, who learned only months later that it was birth control.

It is a modern solution to a medieval injunction: According to an obscure ruling in Islamic law cited by the Islamic State group, a man must ensure that the woman he enslaves is free of child before having intercourse with her.

Islamic State group leaders have made sexual slavery as they believe it was practiced during the Prophet Muhammad’s time integral to the group’s operations, preying on the women and girls the group captured from the Yazidi religious minority almost two years ago.

To keep the sex trade running, the fighters have aggressively pushed birth control on their victims so they can continue the abuse unabated.

More than three dozen Yazidi women who recently escaped the Islamic State group and who agreed to be interviewed described the methods the fighters used to avoid pregnancy, including oral and injectable contraception, sometimes both.

In at least one case, a woman was forced to have an abortion, t and others were pressured to do so.

Some described how they knew they were about to be sold when they were driven to a hospital to be tested for pregnancy. They awaited their results with apprehension: A positive test would mean they were carrying their abuser’s child; a negative result would allow the fighters to continue raping them.

The rules have not been universally followed, with many women describing being assaulted by men who were either ignorant of the injunction or defiant of it.

But overall, the methodical use of birth control during at least some of the women’s captivity explains what doctors caring for recent escapees observed: Of the more than 700 rape victims from the Yazidi ethnic group who have sought treatment at a United Nations-backed clinic in northern Iraq, just 5 percent became pregnant during their enslavement, according to Dr. Nagham Nawzat, the gynecologist carrying out the examinations.

The captured teenager, who agreed to be identified by her first initial, M., was sold seven times.

When prospective buyers came to inquire about her, she overheard them asking for assurances that she was not pregnant, and her owner provided the box of birth control as proof.

That was not enough for the third man who bought her, she said. He quizzed her on the date of her last menstrual cycle and gave her a version of the so-called morning-after pill, causing her to start bleeding.

Finally he came into her room, closed the door and ordered her to lower her pants. The teenager feared she was about to be raped.

Instead he pulled out a syringe and gave her a shot on her upper thigh. It was a 150-milligram dose of Depo-Provera, an injectable contraceptive.

When he had finished, he pushed her back onto the bed and raped her for the first time.

Thousands of women and girls from the Yazidi minority remain captives after the jihadis overran their ancestral homeland on Mount Sinjar on Aug. 3, 2014. Since then, hundreds have managed to escape.

Many of the women interviewed were initially reached through Yazidi community leaders, and gave their consent. All the underage rape victims who agreed to speak were interviewed alongside members of their family.

J., 18, said she had been sold to the Islamic State group’s governor of Tal Afar, a city in northern Iraq.

“Each month, he made me get a shot. It was his assistant who took me to the hospital,” said J., who was interviewed alongside her mother, after escaping this year.

“On top of that he also gave me birth control pills. He told me, ‘We don’t want you to get pregnant.’ ”

When she was sold to a more junior fighter in the Syrian city of Tal Barak, it was the man’s mother who escorted her to the hospital.

“She told me, ‘If you are pregnant, we are going to send you back,’ ” J. said.

A 20-year-old who asked to be identified only as H. began to feel nauseated soon after her abduction.

Already pregnant at the time of her capture, she considered herself one of the fortunate ones. For almost two months, H. was held in locked rooms, but she was spared the abuse befalling most of the other women.

Despite being repeatedly forced to give a urine sample and always testing positive, she, too, was eventually picked.

Her owner took her to a house, shared by another couple. When the couple was present, he did not approach her, suggesting he knew it was illegal. Only when the couple left did he forcibly have sex with her.

Eventually he drove her to a hospital with the aim of making her have an abortion, and flew into a rage when she refused, repeatedly punching her in the stomach. Even so, his behavior suggested he was ashamed: He never told the doctors he wanted H. to abort, instead imploring her to ask for the procedure herself.

When he drove her home, she waited until he left, then threw herself over the property’s wall.

“My knees were bleeding. I was dizzy. I almost couldn’t walk,” she said.

Weeks later, with the help of smugglers hired by her family, she was spirited out of Islamic State territory.

Her first child, a healthy boy, was born two months later.