Image: Selma Hajri
Tunisia, a pioneering country in relation to sexual and reproductive rights, has had legal abortion since 1973. What has happened to this right in the past 50 years? As part of a collection of articles in the dossier “Abortion, a struggle without end”, we publish an in-depth interview with Selma Hajri, age 70, a doctor and militant Tunisian feminist who has been involved in struggles for access to the voluntary termination of pregnancy across the African continent. Her involvement began at the beginning of the 2000s with an article in the Lancet about making abortion pills accessible in the global south by reducing the price of the pills. Since then and until today, Selma has been a pillar of the Association Tawhida Ben Cheikh, founded in 2012 to campaign for reproductive justice and sexuality education. She is also active in promoting MARA Med, the new Mediterranean Movement for the Right of Access to Abortion and as the vice-president of the Association for the Health of Women in the Maghreb and Middle East (ASFAMM).
In September 2023, during celebrations of 50 years of legal abortion in Tunisia, Selma sounded an alarm because in spite of a positive law, it is becoming more and more difficult to get an abortion in Tunisia, especially for the poorest and most rural women. In 2014, UNFPA noted that only two hospitals in Tunisia were providing surgical abortions, and during the Covid-19 pandemic, access to abortion pills was very limited. A reduction in access to the wider range of reproductive and sexual health services has been rapid too, but the extent is difficult to pinpoint because the Tunisian Family Planning stopped publishing statistics many years ago. Tunisian feminist groups have been gathering testimonies that describe pitfalls all along the path to obtaining abortion services, which sometimes do not succeed.
Women report multiple obstacles: attempts at dissuasion, provision of false medical information, illegal demands made by healthcare workers, and appointments offered only after the legal time limit has passed (five examinations are necessary to obtain medical abortion pills in Tunisia). Or the
patient is told that the services are overloaded; or she is accused of having aborted several times and told that she is not a “priority”; or that they forgot to book an examination; or they must have authorisation from the husband even though this requirement does not exist in the law; or many extra trips to the hospital are required by staggering appointments, making them costly and not very discreet for anyone who would like to have an abortion without her husband or parents knowing.
In parts of the country, gynaecologists in the public health service no longer provide aspiration abortions, or the few who do charge high fees. Hence, Tunisian feminists are mobilising to defend access to abortion. In 2022, the Association Tawhida Ben Cheikh did a study among 1,000 young women and young men ages 18 to 29. It found that 40% of the young women did not know that abortion was free and accessible for those over the age of responsibility. Knowledge of the existence of abortion services was clearly disappearing. Both teaching and informing is basic and necessary, and the few feminist associations began informing the media and the public in Arabic in the absence of action by the Ministry of Health or the Family Planning. In the past, leftwing women, who did not see themselves as feminists, paradoxically found they had been given a right by a government whose policies they usually opposed, which they consequently did not embrace. Another consequence of how this right was obtained was that the taboo on sexuality, women’s sexuality in particular, has remained strict. While this has meant that an anti-abortion movement never developed in Tunisia, as it did in Europe, abortion never became an issue of public debate either, not even among the left.
Why is there suddenly such timidity to raise these matters in the public space? In the 1970s the subject was raised and the abortion law was passed as part of a national population policy on limiting the number of births and also in relation to feminist calls for women’s liberation. Today, Selma argues, the right to abortion is endangered by a conservatism that is gaining ground almost everywhere in the world. We must oppose it, obviously, and at the same time continue to fight for access to contraception and sex education. Moreover, there is a glimmer of hope: experts and professionals on the subject argue that access to safe abortion, regardless of national laws, will become more and more universal.
Today, Selma argues, the internet makes access to abortion pills easier, despite borders and national laws: it is a wave that cannot be stopped. She feels deeply optimistic because no power has the means to stop this. They may hinder, slow down or channel information, but delete it: no. Organizations like Women on Web disseminate information and pills around the world with great ease. In countries where abortion is prohibited, women have the pills sent by post and it works very well: taking the tablets triggers a miscarriage which they complete alone or in the hospital. The future is here. It’s easy, it’s known, it’s published in scientific journals: women are perfectly capable of getting by without a doctor, without putting their lives in danger. On the contrary, there has been an extraordinary drop in mortality following unsafe abortions in countries where abortion is illegal since women began to use medical abortion pills. This practice, already extremely widespread, called “self-managed abortion”, is recommended by the World Health Organization as among the safest of techniques.
This demedicalisation is the future. But it does not resolve the question of law, she says, because criminalisation does not remove the taboo; it generates trafficking, inflation of costs, inequalities of access and the risk of having to find pills on the black market. We must therefore fight against criminalisation, and on this political and social ground too, only the organisation of women can make it possible to win, and this generally involves a fight for changing the law. We need to combine the two struggles. This is all the more important as there are still a low level of incomplete abortions with abortion pills (1-5%): it is therefore important that women can have access to several methods and, again, as always, are able to choose.
SOURCE: Revue La Déferlante, by Sarah Benichou. 1 March 2024. PHOTO: Ons Abid pour La Déferlante. Translation from French: Marge Berer