Emergency contraception in Tunisia: A multi-methods assessment of availability, accessibility, and acceptability

In 2001, Tunisia became the first country in the Arab world to register a dedicated emergency contraceptive pill (ECP). Over the last decade, emergency contraception (EC) has been integrated into both the public and private health sectors, incorporated into national service delivery guidelines, and made available, without a prescription, directly from pharmacists. Although ECPs have been registered in six other Arab countries, Tunisia remains the only country in the region to have undertaken significant efforts to expand access to EC. However, though Tunisia’s policies and programs demonstrate a longstanding national commitment to comprehensive reproductive health service delivery that is exceptional within the region, national statistics mask persistent geographic, urban/rural, and marital status disparities. Little research has been undertaken to systematically evaluate the service delivery and use patterns of ECPs in Tunisia.

Our study aimed to fill this gap. Through this multi-methods study we assessed the availability, accessibility, and acceptability of EC in Tunisia and focused on the perspectives and experiences of pharmacists and both married and unmarried women. The study included three components: a retail pharmacy survey, a mystery client survey in pharmacies, and in-depth interviews with family planning clients. In addition to improving EC service delivery in Tunisia, we hope this study can inform broader regional efforts to introduce ECPs and incorporate EC into reproductive health and family planning services.