Abstract
Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff.
Highlights
Unsafe abortion continues to pose a significant health risk to women around the world leading to persistent high rates of maternal mortality and morbidity [1]
The women interviewed for this study faced significant challenges to accessing safe and legal abortion services, including personal barriers such as lack of partner support or financial means to seek abortion quickly, as well as logistical and systematic barriers, including ineffective referral systems and service delays
Women were turned away from abortion care for three main reasons: gestational age, medical contraindications, and logistical barriers and delays. Those who were beyond three months gestation were denied an abortion on request and never given the opportunity to be assessed for a second trimester abortion in the context of their physical or mental health [26]
Summary
Unsafe abortion continues to pose a significant health risk to women around the world leading to persistent high rates of maternal mortality and morbidity [1]. Unsafe abortion is the second leading cause of maternal mortality worldwide [2]. Women depend on access to safe abortion to postpone or stop childbearing, for socioeconomic concerns (including disruption of education or employment and resource constraints for existing children), relationship problems, risks to maternal or child health, and pregnancy resulting from rape or incest [4]. Safe abortion access is an essential component of comprehensive sexual and reproductive health care, as defined by the International Conference on Population and Development (ICPD) Programme of Action [5] and the World Health Organization [6]
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