“I had an illegal abortion in a country where it is allowed.” It is with a certain irony that Zeineb* sums up her abortion. For two weeks, at the end of general confinement in June 2020, she had to fight, multiplying the round trips between hospitals and family planning, in a situation made difficult by the Covid-19 epidemic.
No establishment is able to provide her with the drugs needed to perform a voluntary termination of pregnancy (IVG), due to a lack of sufficient stocks. Zeineb finally manages to abort thanks to an acquaintance, who provides her with the treatment in secret. “If it hadn’t been for this sorority, I couldn’t have done it”she says.
“Whether the law allows it or not, it’s my right. I am ready to rip it off if necessary.”
As an exception in the region, Tunisia legalized the practice of abortion in 1973. All women are supposed to be able to abort free of charge during the first trimester of pregnancy either by aspiration (surgical abortion) or by medical abortion. [pratiquée jusqu’à neuf semaines d’aménorrhée].
Almost fifty years after the entry into force of this law, women still face many obstacles. Drug shortages, dissuasion by the medical profession, regional inequalities… Abortion is an obstacle course for many women.
Its legality is even sometimes called into question in public debate. In 2013, MP Najiba Berioul, of the National Constituent Assembly, proposed to criminalize abortion within the future Constitution.
“Access to abortion is increasingly restricted, without there ever being any prohibitions”, summarizes Selma Hajri, founder of the association Tawhida Ben Cheikh, which works for the promotion of sexual and reproductive rights. While in the United States and elsewhere the right to abortion is today challenged […], what about Tunisia? Is this right really guaranteed?
Shortages and Obstacles
Theoretically, abortion should be accessible free of charge to all women in all public health establishments. In 2010, 72 establishments – around fifty hospitals as well as the 24 family planning present in the governorates – carried out surgical abortions, according to a report by the United Nations Population Fund (UNFPA). Today only “of them [hôpitaux]one in Tunis and the other in Sousse, offer surgical abortion”, says Fatma Temimi, deputy director of the National Office for the Family and Population (ONFP). Some family planning would also practice it, without it being possible to obtain clear statistics.
Thus, when medical abortion is not possible due to a shortage of drugs or when deadlines have passed, women have very few means of having an abortion in the public.
“When there is a shortage of stock [des médicaments pour l’IVG]women can no longer have access to abortion”, summarizes Selma Hajri, director of the Tawhida association.
Zeineb experienced it directly. When she discovered that she was pregnant, the young woman had only two weeks left to resort to a medical abortion. “I went to see the head of department [d’un hôpital]”, she remembers, but this one asks her to wait because of the absence of tablets. Except that Zeineb is in an emergency situation: for medical reasons, she cannot have recourse to a surgical abortion. “I couldn’t wait”, she reacts.
Beyond drug shortages, public establishments also suffer from a shortage of staff. “If someone retires or moves, they are never replaced,” testifies a midwife practicing in the region of Gafsa [dans le sud-ouest du pays].
These shortcomings are even more glaring in disadvantaged regions. In Tunis, there are eight med