Abortion in Tunisia: An Unfinished Struggle

Tunisia is the only country in North Africa where abortion on demand has been legal since 1973 — a progressive milestone that sets it apart in the region. Yet, as Hajar Naceur from Groupe Tawhida Ben Cheikh (GTBC) points out, legality does not always mean accessibility. Across Tunisia, access to abortion still varies greatly depending on geography, provider attitudes, and persistent social stigma. We spoke with Hajar Naceur to learn more about how GTBC is working to bridge the gap between the law and reality, ensuring that the right to abortion becomes a lived reality for all.

• Can you tell us about Groupe Tawhida Ben Cheikh—when it started, why it was created, and what its main work is today?

The Groupe Tawhida Ben Cheikh (GTBC), founded in Tunisia in 2012, was created to defend and advance sexual and reproductive rights—particularly safe abortion and bodily autonomy—for women, girls, and people with diverse gender identities. Today, GTBC works on several fronts: strengthening access to quality sexual and reproductive health services, including contraception and safe abortion; raising awareness through campaigns, trainings, and accessible materials; empowering young people with guides, group discussions, and training programs to help them make informed decisions; and combating discrimination by engaging journalists, health providers, and decision-makers to reduce stigma and promote rights. In recent years, GTBC has led evidence-based advocacy, conducted large-scale surveys with young people and LGBTQIA+ communities, trained providers and journalists, organized nationwide media campaigns and regional focus groups with over 190 participants, and inaugurated Al Iyada in 2024—a center for listening, information, and referral developed in partnership with Beity and Y-Peer. GTBC also builds sustainability and multiplies impact through national partnerships with institutions such as ATSF and scientific societies, as well as through regional and international alliances, including Mara Med.

• What does Tunisia’s current abortion law say, and how well is it enforced?

On paper, abortion has been legal in Tunisia since 1973, available up to 14 weeks of amenorrhea without restrictions. Beyond this limit, it is only permitted in specific circumstances, such as when the pregnancy endangers the woman’s life or physical or mental health, or in cases of severe fetal malformation—what is defined as therapeutic abortion. Outside of these conditions, abortion is criminalized under the Penal Code. In practice, however, enforcement remains uneven: while the legal framework is strong, access is often undermined by limited facility availability, inconsistent provider willingness, logistical and supply gaps, and the persistent weight of social stigma—challenges that GTBC seeks to address through advocacy, training, and capacity-building.

• How easy or hard is it for someone to get a safe, legal abortion in different parts of Tunisia?

Access to abortion services in Tunisia shows both inter- and intra-regional disparities. In large urban centers, it tends to be easier, while in peri-urban or rural areas access is more challenging due to fewer services, limited numbers of trained staff, and weaker referral networks. Factors that facilitate access include clear referral pathways, well-trained providers, and youth-friendly information. A 2019 study by Groupe Tawhida revealed that nearly 50% of young people do not know that abortion is legal during the first trimester. More recently, a 2022–2023 survey conducted by Groupe Tawhida Ben Cheikh with 5,837 young men and women aged 18 to 29 across eight governorates confirmed persistent gaps in knowledge: only 26.6% of men and 45% of women were aware of the current law on abortion, while a large proportion (43.2% of men and 30.3% of women) were either uncertain or did not provide an answer. Conversely, barriers such as long distances to clinics, fragmented or unclear information, and inconsistent service readiness make it harder for people in some regions to obtain timely, safe care.

• What barriers, like cost, clinic availability, or social stigma, stop people from accessing abortion?

Barriers to accessing abortion in Tunisia exist at multiple levels. On the service side, some regions face limited clinic availability, logistical or supply issues, inconsistent provider training, and, in some cases, outright refusals. On the user side, cost, transportation challenges, fear of judgment or breaches of confidentiality, and misinformation can prevent timely care. Additionally, the broader social environment—shaped by stigma and traditional gender norms, as highlighted in GTBC’s surveys and in the stories shared by midwives during training sessions—strongly influences people’s decisions and often delays or complicates access to services.

• How do doctors and nurses in Tunisia respond when someone asks for an abortion?

In some cases and in certain regions, doctors and midwives may refuse to provide abortion services, hesitate, or use stigmatizing language, creating obstacles for women to exercise their right to abortion. These gaps in service often stem from a lack of training or support. However, targeted programs like Values Clarification & Attitude Transformation (VCAT) can significantly change provider attitudes by combining clinical updates with reflective exercises that challenge personal biases. GTBC uses VCAT, along with supportive supervision and clear rights-based guidance, to ensure that providers deliver safe, respectful, and informed care to all patients.

• What role do activists and local NGOs play in helping people access abortion services?

In Tunisia, the Groupe Tawhida Ben Cheikh is the only organization actively working on abortion rights, while most other NGOs focus on different topics within sexual and reproductive health or broader human rights issues. GTBC conducts research and studies to generate reliable evidence, which informs its advocacy and helps guide people toward safe and authorized abortion services. It also focuses on capacity-building by training healthcare providers, activists and journalists to use accurate, human-rights-based approaches. In addition, GTBC leads advocacy efforts by building coalitions with youth groups and feminist networks, publishing evidence, and engaging the media to ensure that abortion services remain accessible, safe, and respectful.

• How do Tunisian families and communities generally view abortion, and how does that affect someone’s choices?

Attitudes toward abortion in Tunisia are mixed, ranging from supportive to strongly stigmatizing. This stigma can delay care, force secrecy, and increase health risks for those seeking abortion services. In some areas, particularly in border regions, women resort to obtaining abortive pills through informal channels, which are often more accessible than safe, legal abortion services. In other regions, healthcare professionals may refuse to provide abortion care regardless of a woman’s circumstances, forcing women to travel to other regions to access their legal rights. In the majority of cases, women cannot afford the travel costs, leaving them unable to obtain safe care. In addition, single women may face strong social stigma that prevents them from accessing abortion, leaving them with no choice but to continue their pregnancies.Minors also face particular difficulties in accessing abortion, as the pathways are unclear and procedures are very slow, often causing them to exceed the legal time limits for abortion.

• What changes to law, policy, or healthcare services would make abortion safer and more available across the country?

To make abortion safer and more accessible across Tunisia, several measures are needed. The government should recognize abortion as a fundamental human right and prioritize women’s health in its policies. On the policy and systems level, this means ensuring consistent service readiness nationwide, with authorized sites, trained staff, and reliable supplies; standardizing referral pathways and hotlines while guaranteeing confidentiality and youth-friendly services; and institutionalizing provider training—including clinical updates and values clarification—while protecting against unjustified refusals. In terms of information and media, it is essential to scale up evidence-based public education and support journalists in using ethical, accurate terminology. 

Finally, to promote equity, costs and travel burdens for young and marginalized populations should be reduced, and community-level entry points for services expanded.

A key priority is also to establish accountability mechanisms: currently, when refusals of care are reported—whether in ONFP centers or hospitals where gynecology residents decline to perform aspiration procedures—there is no follow-up or corrective action. Setting up an observatory to systematically document and transparently report such cases as violations of human rights would help strengthen accountability. In addition, engaging the legal community is crucial, as illustrated by GTBC’s recent agreement with the Faculty of Legal, Political and Social Sciences of Tunis to foster collaboration on these issues.

• How do you and other activists work to reduce the shame and stigma around abortion in Tunisia?

To reduce stigma and improve access to abortion, research findings from surveys and data issued from training sessions should be translated into accessible campaigns using videos, graphics, comics, podcasts, and booklets. Language plays a crucial role, so promoting rights-based, non-stigmatizing terminology through journalist training is essential. Bringing information closer to the community through youth-centered groups, campus sessions, and regional discussions helps normalize help-seeking and clarifies both the law and the pathways to care.

• In five years, what would you hope Tunisia’s abortion landscape looks like—for laws, access, and public attitudes?

In an ideal scenario, Tunisia would have stable legal protections for abortion, combined with robust nationwide implementation and accountability. Access would be guaranteed in every governorate, with reliable, youth-friendly, and confidential services, streamlined referral pathways, trained providers in all authorized facilities, and sustainable supply chains. Attitudes toward abortion would show a noticeable decline in stigma, with the media routinely using accurate and respectful language, and communities recognizing abortion care as an essential component of health services.