In Tunisia, abortion is legal on request in the first trimester. Later abortions are permitted on physical or mental health grounds. Abortion for minors requires parental consent. A 1973 law requires public medical facilities to provide free abortions on request, but many lack the service or enforce additional requirements. Most abortions are performed at private facilities, which are more permissive. Tunisia's abortion law is the most permissive in the Middle East and North Africa.
Tunisia's abortion law was originally based on that of France, which banned abortion. After the independence of Tunisia, political leaders advocated for legal abortion to lower the population growth rate. President Habib Bourguiba passed a 1965 law permitting women with five children to receive abortions with spousal consent, making Tunisia the first country in the Muslim world to liberalize its abortion law. A 1973 amendment extended legal abortion to all women and lifted the requirement for spousal consent. The (ONFP) began providing free abortions under a program to decrease birth rates, which was replaced in the 1990s with reproductive and sexual health programs. Medical abortion was approved in 2001 after a series of tests. By the Tunisian Revolution of 2011, increasing conservatism and an economic crisis led to a decline in abortion access. Some facilities stopped providing the service, and conscientious objection to abortion became common. The ruling Ennahda party opposed abortion, and a member of the party, Najiba Berioul, unsuccessfully proposed a ban in 2013. Later governments supported abortion, and the country signed and ratified the Maputo Protocol in the 2010s.
Medical abortion is the most common method in public facilities, while surgical abortion is more common in private facilities. Only private facilities provide abortions after the first trimester. Despite the legality of abortion, many women are denied access. Many medical providers have negative attitudes about it, contributing to false interpretations of the law. Tunisia has a taboo surrounding abortion, and many women are unaware it is legal. Much of the country opposes abortion on Islamic grounds, especially under the Maliki school of jurisprudence. A few activist groups, including the Tunisian Association of Democratic Women, advocate for abortion access in the country.
Legislation Article 214 of the Penal Code of Tunisia permits abortion up to a gestational age of three months (the first trimester). It does not specify how gestational age is counted. Later abortions are permitted if the pregnancy threatens the mother's health or "psychological equilibrium", as well as if it risks "serious" fetal defects (though it does not specify which defects qualify). Performing, attempting, or procuring an illegal abortion is punishable by a prison sentence of two years and a fine of 2,000 Tunisian dinars. The article of the penal code that decriminalizes abortion is about murder, having initially classified abortion as such. It has not been amended since 1973, .
First-trimester abortions may be performed at any licensed medical facility; public facilities provide them for free. Later abortions are only performed at specially approved facilities and with approval from a treating physician. Abortions for mental health grounds require a psychological evaluation. Spousal consent is not required for abortions, but for minors, parental consent is required. Private facilities do not strictly enforce this. Some public facilities enforce higher requirements than the law allows. Medical providers are allowed to opt out of procedures, but the country does not have a law explicitly allowing conscientious objection to abortion. The law is unclear about the circumstances that permit such objection, which is instead invoked through the guidelines of the International Federation of Gynaecology and Obstetrics.
Tunisia's abortion law is the most permissive in the Middle East and North Africa. It is the only country in the Arab world where abortion is permitted for social grounds, , and one of two countries in the Muslim world (alongside Turkey) with abortion on request.
History Colonial-era ban and post-independence advocacy As a colony of France, Tunisia inherited France's abortion law while also being influenced by the Maliki school of Islamic law. A 1913 act based on the Napoleonic Code made it punishable by five years in prison to receive an abortion and ten years to perform an abortion. A 1940 amendment made an exception if the pregnancy risked the life of the mother.
After Tunisian independence, officials supported reform as the country's development policy shifted to favor lower population growth. In the mid 1960s, the pro-abortion movement in Tunisia was motivated by the Malthusian view favoring low population growth, unlike other countries where it was motivated by women's rights. The political elite advocated for abortion and family planning as a way for families to improve their socioeconomic situations. Though the Maliki school viewed that Islam did not allow abortion, the Hanafi and Shafi'i schools did. The first president, Habib Bourguiba thus argued that abortion reform "used the reason inspired by the very principles of Islam".
Legalization of abortion Amid the reforms of Bourguiba, Law No. 65-24 was passed in on 1 July 1965, amending Article 214 of the penal code. The amendment allowed therapeutic abortion for married women with five living children, with spousal consent; it was permitted only in the first three months of pregnancy unless medically necessary. The approval of one doctor was required, and some applied the law more liberally, such as allowing abortions based on the number of children of the father rather than the mother. Tunisia was the first country in the Muslim world to liberalize its abortion law, as well as one of the first in Africa. Government facilities began providing abortion for free in 1965, initially only using the dilation and curettage method. The rate of illegal abortion decreased as women receiving abortions produced medical certificates ostensibly giving them permission.
Abortion was decriminalized on 23 September 1973, when the Parliament of Tunisia ratified Bourgiba's presidential decree replacing Article 214. The new law permitted abortion for all women, without spousal consent, and established grounds for abortion after three months. The law occurred after advocacy by the Tunisian Women's Union, which stated, "hundreds of women arrive at the hospital every year suffering from haemorrhage after trying to abort in insanitary conditions," and said that lack of abortion contributed to 55 suicides in 1972. Along with several other laws, it was part of a population policy funded by the Ford Foundation. The law faced little opposition from religious leaders. Bourguiba's support of legalization was backed by national Islamic authorities, who created an interpretation that, according to the main schools of jurisprudence of Sunni Islam, abortion was permitted up to a gestational age of 120 days. Tunisia was the first country to legalize abortion on demand in Africa, the Arab world, or the Muslim world.
In 1973, Tunisia recorded 6,547 abortions. The number of abortions rapidly increased through 1977, when it peaked at 21,162 before a mild decrease. This was correlated with a decrease in maternal mortality. The law also provided legal abortions for young women, which had rarely been reported before 1973. Officials promoted abortion as a form of birth control and, in 1974, aimed for abortion to cause 40% of the decline in birth rate.
Family planning program and introduction of medical abortion Beginning in the 1980s, the (ONFP) established facilities in each governorate to provide free contraception and abortion. The initial aim of Tunisia's family planning program was to decrease birth rates rather than allow freedom for women. Some women, depending on age or birth parity, were only allowed abortions if they agreed to contraception or forced sterilization. In some cases, surgeons gave patients tubal ligation or intrauterine devices without consent, a practice banned in the late 1990s. The family planning program incentivized such actions; beginning in 1974, Bourguiba awarded funds to governorates with the lowest birth rates. Despite providing abortions, many medical professionals opposed abortion; some subjected patients to unnecessary interviews, while others made the experience unpleasant to discourage patients from returning.
The family planning program was defunded in the 1990s, and the ONFP began focusing on reproductive and sexual health and rights following the International Conference on Population and Development (ICPD). According to ONFP president Nebiha Gueddana, the focus had shifted between birth prevention in the 1960s, birth spacing in the 1970s, maternal and infant health in the 1980s, and reproductive health in the 1990s. In the 2000s, Islamic conservatism gained popularity, affecting the attitudes of reproductive health providers, and conscientious objection to abortion became common. Before this, providers could not object to abortion as the government had higher influence.
The country began testing of medical abortion using mifepristone in 1994, conducted by the World Health Organization, followed by a study in Tunis by the Population Council in 1998. Earlier testing had not occurred as the drug's developer, Roussel-Uclaf, had focused on Europe. An American NGO, Gynuity Health Project, also conducted testing. The legalization of medical abortion faced wide opposition; the National Association of Obstetricians and Gynecologists considered the procedure dangerous, and some judges argued that Article 214 could not allow abortions outside of medical facilities. Some medical professionals opposed the legalization for moral grounds or because they feared it would lower the influence of experts. Officials debated whether unmarried women should be permitted medical abortions. Advocacy from prominent obstetricians and from Gueddana led the government to support legalization. The approved mifepristone for abortions in November 2001, the first country in Africa to do so. The approval was made through a government circular rather than a change to the law. ONFP launched medical abortion training, and in 2001, ten of its clinics halted surgical abortions in favor of medical abortions. Despite receiving training, most private clinics did not adopt medical abortion because the drugs had to be purchased from the government, which lowered profit.
Tunisian Revolution Around 2008, Tunisian regional authorities decreased their focus on reproductive health, and government facilities aimed to perform fewer abortions as the birth rate had fallen. ONFP stopped its medical abortion training as the government deprioritized family planning. The 2008 financial crisis affected the country's medical system leading up to the Tunisian Revolution of 2011. In 2010, 72 public facilities provided abortions, according to the United Nations Population Fund.