‘This Is Real Misery’: Experiences of Women Denied Legal Abortion in Tunisia

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.

Consideration of and Reasons for Not Obtaining Abortion Among Women Entering Prenatal Care in Southern Louisiana and Baltimore, Maryland

“…They were not policies targeting women's decision-making. This pattern of findings is consistent with extant literature that indicates that the restrictions that create financial and logistical barriers to abortion care-such as restrictions on Medicaid funding for abortion, gestational age limits, and two in-person-visit requirements-limit women's ability to obtain an abortion, whereas laws targeting women's decision-making-such as mandatory ultrasound viewing and waiting periodsmostly do not (Cook, Parnell, Moore, & Pagnini, 1999;Hajri, Raifman, Gerdts, Baum, & Foster, 2015;Joyce et al, 2009;Puri et al, 2015;Roberts et al, 2016;Upadhyay et al, 2017;Upadhyay, Weitz, Jones, Barar, & Foster, 2014).…”

‘I felt the world crash down on me’: Women’s experiences being denied legal abortion in Colombia

“…Legal counselling from the on-site advocacy group played an essential role in enabling participants to effectively navigate a complex and bureaucratic health system, understand the law and its implications, and ultimately arrive at the next point of care prepared to advocate for themselves. Other studies show that women who are denied care without explanation or referral may be left with no option but to carry the unwanted pregnancy to term [ 21 – 23 , 26 ].…”

“…Data were analysed using a qualitative content analysis approach, using a consistent set of codes to organize text with similar content after data collection was completed, transcribed and translated. A priori themes were identified, based on code types and results from previous studies about abortion denial and barriers to abortion in Colombia [ 16 , 21 – 23 ]. Additional codes and sub-codes were generated iteratively according to emergent themes throughout the coding process.…”

“…As is the case in other contexts where barriers to legal abortion care exists, some women may seek services elsewhere, either at another facility, through self-induction, or with the help of an informal sector provider [ 18 – 20 ]. Recent Global Turnaway Studies in Nepal [ 21 ], South Africa [ 22 ], and Tunisia [ 23 ] have shown this to be true in other settings. However, little research has been done in Colombia to understand why women are denied legal services, whether they seek services following denial, and what factors enable them to obtain services after denial.…”

“…We additionally explored the factors that enabled or prevented women from seeking safe and legal services after being denied care and whether women used or considered using informal sector abortion methods outside the formal health system after denial. This study was conducted as part of the Global Turnaway Studies; other participating countries include the United States [ 24 , 25 ], Bangladesh [ 26 ], South Africa [ 22 ], Nepal [ 21 ], and Tunisia [ 23 ].…”