Voluntary Termination of Pregnancy among Unmarried Women in Tunisia: Access to Abortion, Sexual Violence, and Gaps in Post-Abortion Care from a Six-Year Hospital-Based Study
Somri Bilel*, Samaali Khaoula, Hannachi Mohamed Amine, Zangar Salim, Mizouni Rihab, Bamri Aziz, Malek Monia and Khaled Neji
ABSTRACT
Background: Although abortion has been legal and free of charge in Tunisia since 1973, unmarried women continue to experience social vulnerability, stigma, and gender-based violence that shape access to reproductive care.
Methods: We conducted a retrospective, descriptive, longitudinal, monocentric study at the Center of Maternity and Neonatology of Tunis between January 2018 and December 2023, including all unmarried pregnant women managed for voluntary termination of pregnancy (VTP), prenatal care, or delivery. Comparative analyses explored factors associated with abortion and post-abortion outcomes.
Results: Among 2,411 included women, 688 (28.53%) underwent VTP. Sexual violence preceded 46.66% of abortions, and adolescents accounted for 11.19% of cases. Most abortions occurred at early gestational age and were predominantly medical, with a low complication rate. Post-abortion contraceptive uptake was extremely low (6.83%), and recurrent pregnancy occurred in 22.38% of women who underwent VTP.
Conclusion: Legal access to abortion in Tunisia ensures procedural safety but does not guarantee reproductive autonomy for unmarried women. Strengthening trauma-informed care, adolescent-friendly services, and systematic post-abortion family planning is essential to translate legal access into effective reproductive rights.
