The Delivery and Use of Contraceptive Services in Rural Tunisia

Abstract

This article summarizes a 1981 report published by the National Family Planning and Population Office an agency of the Ministry of Public Health of Tunisia. The report provides insights into the fertility and contraceptive behavior of rural Tunisian women and the problems that they face in obtaining family planning services as well as implications for future programs. The report examines family planning attitudes and practice contraceptive availability and accessibility and the unmet demand for family planning in 1 of Tunisias 21 administrative regions the province of Jendouba. The results of 2 special studies are presented here: the 1979 Contraceptive Prevalence Survey a representative sample of 1827 currently married women aged 15 to 49 living in Jendouba; and a 2 1/2 year pilot community based experiment known as Family Planning for Rural Couples (PFPC) which was designed to increase contraceptive availability and use among rural families in 1/2 of the province. 2 most significant findings are the substantial unmet demand for family planning and the inaccessibility of traditional service outlets for the majority of the provinces rural women. Contraceptive users and nonusers alike reported that it was difficult to get to a family planning service provider. The largely urban based health facilities in Jendouba have not adequately met the family planning needs of women living in widely scattered settlements particularly those interested in obtaining the pill and barrier methods. The PFPC outreach experiment provided a low cost nonclinical service delivery model for rural Tunisia that would increase availability and accessibility of family planning services. Results confirm that when contraceptives are distributed at the household and community levels there can be a dramatic initial increase in new acceptor rates. However the pilot project also demonstrates that effective referral mechanisms and permanent resupply points in the community together with sustained information and education activities are essential in order to achieve and maintain high levels of contraceptive use. (authors modified) (summary in FRE)