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What's Next for Women's Health (And Rights) in Tunisia and Egypt?

Egypt and Tunisia actually had decent family planning under their dictatorships. Where might they move forward under Democratic government?

It is unsettling, but true: the autocratic regimes of Tunisia and Egypt, now overthrown by democratic revolutions, had, in fact, carried forward what are among the most progressive reproductive rights policies in the region. 

While the idea of offering any public funds at all to the Planned Parenthood Federation of America incites debate in the current U.S. legislature, both Tunisia and Egypt have government-sponsored programs that for decades have offered free or nearly free contraception to citizens—not just condoms, but intra-uterine devices (IUDs) and birth control pills.

Tunisia, which legalized abortion five years before the U.S, also has freely available morning-after pills, Pap smears, and breast exams at both local and mobile clinics. Both North African nations can boast of robust publicly supported education programs in sexual health for adults and youth. Both nations were among the first to sign CEDAW (the treaty of the Committee on the Elimination of Discrimination Against Women) back in 1980; Egypt ratified the declaration a year later and Tunisia, with a few reservations, in 1985. (The U.S. is one of seven nations that have not ratified CEDAW.) The policies and practices for most basic reproductive health services in Tunisia and Egypt has become a social norm, and are unlikely to face contention in the emerging governments. Indeed, they have a significant opportunity to expand. 

Particularly as the U.S. grapples with the intersection of government and reproductive health, it is worth asking the question: how did the dictatorial regimes of Tunisia and Egypt make such advances with family planning--and what were the limits of such care under authoritarian and corrupt governments? What might the rest of the world learn from what these North African nations have and have not accomplished with reproductive rights – and where they might move forward under revolutionized government?

It is Tunisia that has long held the reputation as the Arab and African nation that is particularly “modern” on reproductive health and women’s rights. In 1956, shortly after independence and under the helm of President Habib Bourguiba, Tunisia abolished polygamy, granted equal divorce rights to both women and men, and raised the minimum age for marriage to 17 for consenting women (and age 20 for men). It further granted mothers the right to custody of their children if the father either died or “defaults in his responsibility.” In that same decade, Tunisia was both the first Arab and African country to adopt a specific population policy. As part of its plan, families could only receive government subsidies for the first four children. In 1966, the nation legalized abortion for any reason (although there are gestational limits), without requiring a husband’s approval; it was both the first Arab and first African country to take such a step. (There are still only two other African nations—Cape Verde and South Africa—that broadly permit abortions.) 

Abortions are freely available at Tunisia’s state hospitals. While there were 22 abortions per 1,000 pregnancies in North Africa in 2003, according to the Guttmacher Institute, the only procedures that occurred in safe conditions were those in Tunisia. For wanted pregnancies, working Tunisian women can expect to receive 67 percent of their wages covered during the term of their maternity leave although notably, domestic servants are excluded from maternity leave policy. Tunisia also produced the first female doctor in the Arab world – Tawhida Ben Cheikh, a gynecologist who died two months ago at age 101. She is credited for launching Tunisia’s family planning priorities at a department she founded at Charles Nicolle hospital in 1963.

Since Ben Cheikh opened that family planning department, Tunisia has continued to put a substantive portion of domestic spending toward reproductive health. Over the last decade, under the rule of Zine El Abidine Ben Ali, the government has spent about $10 million each year to educate its 10 million citizens about family planning. With support from the nation’s influential Muslim leaders, local and mobile clinics offer free contraception and cancer screenings. Tunisia’s contraceptive use rate is over 65% and the country now has a fertility rate of 2.1 children per childbearing woman (compared to 7.6 in the 1960s); that is, its rate is at replacement level and one of the lowest on the continent. The decline in Tunisia’s fertility rate, which unfolded more than twice as fast as in developed nations, coincides with an increase in the nation’s per capita income, the growing rate of women attending universities, and the rising age at first marriage. While Tunisia’s life expectancy was 51 years in 1966, it was 74.2 years by 1998, according to the National Union of Tunisian Women.