In the ceremony, which is meant to be public, the woman kneels before her brother-in-law and removes a special handmade shoe from his foot.
She is then required to spit on the ground next to him and recite several verses.
"The presumption is that the brother-in-law brings disgrace upon himself and his family by refusing to marry his brother’s widow," says an entry in the Jewish Encyclopedia.
"It was humiliating for me and it was humiliating for my brother-in-law," Sarah said of the ceremony.
No civil marriage exists in Israel and non-Orthodox marriages performed in the country are not recognized by the state.