Tunisie

OVERVIEW

D'une façon générale, la Tunisie possède une des politiques de planning familial les plus progressistes d'Afrique. La contraception est disponible sans ordonnance, et plusieurs types de contraception sont disponibles, parmi lesquelles la pilule, les injections, les implants, etc. La contraception d'urgence (pilule du lendemain) est aussi disponible sans ordonnance, et le gouvernement régule les prix des marques, telles que NorLevo. Il existe plusieurs endroits où vous pourrez accéder à des tests de dépistage IST/MST, il n'existe pas de restrictions de voyage concernant les statuts VIH. Cependant, si vous êtes étranger et que vous faites une demande de résidence longue durée (en tant que travailleur, étudiant, etc), on vous demandera peut-être d'effectuer un test de dépistage du VIH. Si le résultat est positif, vous n'obtiendrez peut-être pas de visa. Pour les femmes enceintes, il existe un congé maternité, mais seulement pendant 4 semaines avec 66,7% du salaire. Depuis 1973, l'avortement est totalement légal, quelle que soit la raison, pendant le premier trimestre de grossesse. Il existe des cas où des femmes se sont vues refuser un avortement, mais c'est très peu courant, et la grande majorité des femmes accèdent aux soins qu'elles demandent.

Contraception

Note : il existe de nombreux moyens de contraception, comme les DIU (dispositifs intra-utérins ou stérilets), les contraceptions orales, les patchs, les injections, les préservatifs, etc. Pour une liste complète, cliquez ici. Il est recommandé d'aller consulter un spécialiste afin de déterminer quel type de contraception vous est le mieux adapté. Si vous souhaitez savoir quels contraceptifs hormonaux sont disponibles par marque, fabricant ou pays, cliquez ici.

Lois et stigmatisation sociale

En Tunisie, vous pouvez vous procurer des contraceptifs oraux (pilule) sans ordonnance en pharmacie. Selon un rapport de 2015, environ 64% des femmes tunisiennes (mariées/en union ou en âge de procréer) utilisent une forme de contraception. Les plus populaires sont les DIU (27%), la pilule contraceptive (20,3%), et la stérilisation féminine (3,3%). Les taux d'utilisation des préservatifs (1,2%), des contraceptifs injectables (1,1%) et des implants (0,4%) étaient, eux, très bas.

Au Moyen Orient et au Maghreb, la Tunisie est considérée comme très progressiste concernant les droits reproductifs. Suite à l'indépendance tunisienne (un processus qui se produisit de 1952 à 1956), le nouveau gouvernement tunisien effectua de nombreux changements dans la vie des femmes. En 1956, la polygamie est interdite, l'âge du mariage a été élevé à 17 ans, et des droits égaux entre hommes et femmes face au divorce ont été accordés. Le gouvernement a aussi fait des efforts en vue d'offrir une éducation au planning familial, et des cliniques mobiles proposèrent une contraception gratuite et des tests de dépistage du cancer. Ces cliniques mobiles eurent aussi le soutien de leaders musulmans connus.

Que prendre et où?

• Pour dire "contraception", vous pouvez soit dire/écrire تنظيم النسل (en arabe), soit le dire en français.
• Pour une liste complète des options contraceptives en Tunisie, cliquez ici.
• En Tunisie, vous pouvez acheter des contraceptifs oraux (pilule) sans ordonnance en pharmacie. Les marques que vous trouverez sont Diane, Diane Planeires, Diane-35, Marvelon, Microgynon, Microgynon-30 et Microval.
• Si vous souhaitez un contraceptif par injection, vous pourrez trouver Depo-Prodasone, Depo-Provera SAS 150mg/ml ou Megestron.
• Si vous souhaitez un implant contraceptif, vous pourrez trouver Implanon ou Norplant.

Conseil d'une habitante: "Je recommande le Centre de Planning Familial - il y en a un à Ariana, et un autre à la Cité Khadra, parmi les cliniques du CNSS. Là, chaque femme peut venir seulement avec sa carte d'identité et recevoir tous les soins sans payer! Ce programme a débuté en 1966 et il existe toujours. Je recommande absolument ces endroits!"

Coûts

Concernant le prix des pilules contraceptives, voici ce que disent habitants et touristes:

• "Il existe un système national d'assurances qui remboursent toujours. Elles s'appellent CNAM et CNSS." (Habitant, mars 2017).
• "La pilule est très bon marché si vous vous la procurez dans une pharmacie privée. Mais elle est gratuite dans les hôpitaux et on la donne à toute femme en faisant la demande. La boîte pour un mois coûte environ 509millims, qui équivaut à environ 2 centimes d'euro." (Habitant, mars 2017).
• "Pour Yaz, je payais le même prix qu'au Brésil, d'où je viens, c'est-à-dire 20USD." (Touriste, mars 2017).

Contraception d'urgence (pilule du lendemain)

Notes importantes: La contraception d'urgence peut prévenir une grossesse jusqu'à 3 jours (72h) et parfois 5 jours (120h) après un rapport non protégé. Prenez le contraceptif d'urgence le plus tôt possible après le rapport non protégé. Si vous n'avez pas accès à la contraception d'urgence, les contraceptifs oraux peuvent être utilisés en remplacement, mais souvenez-vous de ce qui suit: 1- Seulement quelques contraceptifs peuvent être utilisés comme contraceptifs d'urgence, 2- Des contraceptifs différents nécessitent des dosages et des horaires différents pour pouvoir fonctionner en tant que contraceptifs d'urgence, 3- Vous devez uniquement utiliser les 21 premières pilules dans les packs de 28 pilules, 4- Ces contraceptifs seront probablement moins efficaces qu'une véritable contraception d'urgence. Pour des informations générales sur la contraception d'urgence, cliquez ici et ici. Les stérilets en cuivre peuvent aussi prévenir une grossesse jusqu'à 5 jours après un rapport non protégé.

Lois et stigmatisation sociale

En Tunisie, vous pouvez vous procurer la contraception d'urgence (pilule du lendemain) sans ordonnance.

Que prendre et où?

• To say/write "emergency contraception," here it is in Arabic (وسائل منع الحمل في حالات الطوارئ) and French (contraception d'urgence).
• In Tunisia, you can purchase emergency contraception (the morning after pill) without a prescription. You can find EC at pharmacies and IPPF-affiliated programs. You should be able to find NorLevo (take 1 pill within 120 hours after unprotected sex). You may also be able to access ellaOne, which is currently considered the most effective EC on the market, but a prescription may be required.
• If you can't access dedicated emergency contraception, you can use regular birth control pills as replacement EC. To do this, you can take Microval (take 50 pills within 120 hours after unprotected sex). You can also take progestin-estrogen combined pills but remember that, in 28-day packs, only the first 21 pills can be used. You can take Neogynon (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later) and Microgynon-30 (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).

Costs

In 2013, the government-regulated price for NorLevo was 14.397 TND. According to ICEC, this fact was confirmed by visiting over 200 pharmacies in the country.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

Note: Here's how to say sexually-transmitted infection: مرض منقول جنسيا (Arabic), infection sexuellement transmissible (French)

If you're visiting Tunisia as a foreign tourists, there are no travel restrictions related to HIV status. You will not be asked for medical certificates in order to enter the country. However, if you are applying for long-term stay (for example, if you're applying for work permit, residency permit or student visa/permit), you'll probably need to take an HIV test. If your results are positive, you may be denied the permit or visa. Also, according to one source, if you plan to stay in Tunisia for over 30 days, you are required to take an HIV test. This information will need further research to fully confirm its current status.

In Tunisia, there are an estimated 2600 people living with HIV, which is less than 0.1% of the adult population. However, HIV is heavily stigmatized in Tunisia. The groups of people who are most predominantly affected (sex workers, men who have sex with men and intravenous drug users) by HIV often experience extreme disenfranchisement. According to a 2014 Guardian article, "Tunisia, a country with one of the most far-reaching and comprehensive approaches to combating HIV-Aids in the Middle East and north Africa, is in a war of attrition with the pervasive influences of ignorance and stigma that cut through to the marrow of Tunisian society." The Tunisian government is prohibited from working with criminalized populations (such as drug users), so organizations that aren't tied to the state are often the only ones that can deliver crucial services to all affected people. One of these organizations is Global Fund to Fight AIDS, which is primarily composed of volunteers who are HIV-positive.

Regarding HPV, it's estimated that 2.2% of Tunisian women are infected with HPV-16/18 infection at a given time, and 69.5% of invasive cervical cancers are attributed to HPVs 16 or 18. According to a 2016 report, cervical cancer is the third most frequent cancer among Tunisian women. However, there is no nationwide HPV vaccination program supported by the government, as of December 2016.

Testing Facilities

• For a comprehensive list of anonymous HIV testing facilities in Tunisia, click here.
• Centre de Soins de Santé de Base 9 Avril de Tunis: Provides anonymous HIV tests. Address: Avenue 9 avril, 1030 Tunis. Phone: 71 567 607.
• Centre des Soins de Santé Mase de Base de la Marsa: Provides anonymous HIV tests. Address: Borj El Salacel, la Marsa 2070 Tunis. Phone: 71 775 766.
• Centre de l'Association Tunisienne d'Information et d'Orientation sur le sida (ATIOS): Provides anonymous HIV tests. Address: 43, Avenue Hédi Saidi, Bab El Assel, 1005 Tunis. Phone: 71 957 544 or 71 957 511.
• Centre Régionale de l'ONFP de Douar Hicher (Mannouba): Provides anonymous HIV tests. Address: Delegation régionale de l'ONFP. Rue du Kairouan, Douar Hicher, Manouba, 2086 Tunis. Phone: 71 545 090 or 71 622 550.
• One local says, "There are free HIV tests available in every city of Tunisia. They are provided at we call it a "family center," which focuses on things like HIV test, pregnancy test, free condoms and all related things to safe sexual relations."
• One local says, "There are 7 anonymous places where people can get the HIV test. Of course it for free and even the medication and the treatment, if it happens and the test is positive, will be all for free for the Tunisians, no matter what. We have a health national plan for HIV, like for some other diseases, like VHc. So 11 in whole country and 7 in the big capital: Tunis and surrounding cities."

Support

• UNAIDS Tunisia: Contact: Mohamed Soua. UNAIDS Country Manager. Telephone: +21629156256. Email: soual@unaids.org.
• Centre Hospitalo-universitaire de la Rabta: Provides HIV treatment in Tunis. Phone: +216 71 578 825, +216 71 578 823.
• Centre Hospitalo-universitaire de Fattouma Bourguiba: Provides HIV treatment in Monastir. Phone: +216 73 448 303.
• Centre Hospitalo-universitaire de Farhat Hached: Provides HIV treatment in Sousse. Phone: +216 73 321 441.
• Centre Hospitalo-universitaire de Hédi Chaker: Provides HIV treatment in Sfax. Phone: +216 74 246 906
• Association Tunisienne d'Information et d'Orientation sur le SIDA et la Toxicomanie (ATIOST): Address: 43 Avenue Hédi Saidi, 1005 Tunis, Telephone: +216 71 957 544, Fax: +216 71 957 511, Email: atios@hotmail.com
• Association Tunisienne de Lutte Contre les MST et le SIDA - Tunisian Association to Fight Against STD and AIDS: Section de Tunis, Address: 16, Rue 7051 Centre Urbain Nord 1082 Tunis, Telephone: +216 70 866 588, Email: contact@atlmstsida.org
• Association Tunisienne de Prévention de la Toxicomanie "ATUPRET": Address: Route de Gabés Km 10 Thyna, Sfax, Telephone: +216 74 679082, Fax: +216 74 404866, Email: contactatupret@gmail.com
• Programme National de Lutte contre le Sida et les Maladies Sexuellement Transmissibles: Address: 31 Rue Khartoum, Le Bélvédère 1002 Tunis, Telephone: +216 71 786581, Fax: +216 71 789679, Email: ahmed.maamouri@rns.tn

Medications & Vaccines

What to Get & Where to Get It

• There are no official providers of Pre-Exposure Prophylaxis (PrEP) in Tunisia, as of March 2017. This may change in the future.
• If you have a yeast infection, this is how you say it in Arabic (الالتهاب المهبلي) and French (candidose vaginale). You may find medications like Pevaryl or Gyno Pevaryl, which are two yeast infection medications that are sold in North Africa. If those are not available, you can also ask for Fluconazole, and the pharmacist should be able to give you medication that contains the necessary active ingredients.
• If you believe that you have a UTI (urinary tract infection), here's how you say it in French: IVU (Infection des voies urinaires). You may be able to get medication at the pharmacy without a prescription. While it is generally recommended that you visit a health professional to confirm your results before taking treatment, this may not be enforced in Tunisia.
• There is no national HPV vaccination program in Tunisia. However, you can probably get the vaccine at hospitals or clinics.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

• If you have menstrual pain (dysmenorrhea), you can say عسر الطمث (Arabic) or dysménorrhée (French)
• One local says, "Since Tunisian women (girls) are most conservative, I think pads are more often used instead of tampons, but you can find both (pads and tampons) in supermarkets or even pharmacies. Pads are available everywhere, from a simple grocery stores to a small shop."
• One local says, "For tampons it is not common here to use it. We prefer and mostly use the [sanitary] napkins. But the tampons are available in the big supermarkets in every branch of the country. Just all women are not aware of it."
• We can't find any sellers of major menstrual cup brands, such as DivaCup, MoonCup, LadyCup, Lunette, etc. in Tunisia. If you do know a seller, please add it to this page.

Gynecological Exams

What to Get & Where to Get It

• Here's how you say/write gynecologist: دكتور امراض نساء (Arabic), gynécologue (French)
• One local says, "Gynecologic department is in every hospital. And there are hospitals only with this speciality and linked to it. So there are: Aziza Othmena hospital in Kasbah in Tunis, which is the oldest one and a great one, actually, where we practise fecondation in vitro!! Then the biggest one is Wassila Bourguiba Hospital in Rabta in Tunis, the famous one that is only dedicated to women and newborn babies. It is big and all crowded. There are two others the same thing in Sousse et Monastir: big cities on the cost... I recommend also gynecology department of Salah Azeiz it is so small but they do great jobs for abortion and so on. And the department in Ariana hospital Mahmiud Matri, I like it there." (March 2017)
• The best private hospitals in Tunisia are Clinique Avicenne, Clinique Saint Augustin Tunis and Clinique Neurologique de la Soukra. However, these are more expensive than public hospitals/clinics, which are used by many Tunisian women.

Pregnancy

Laws & Social Stigmas

In Tunisia, women are now offered two months (8 weeks) of paid maternity leave, according to a local, who says, ˈ'now they are trying to make it longer... the Ministry of Women proposed like a new law, and we are waiting for the acceptance from the Parliament." It appears that, in the past, women were offered 4 weeks of parental leave with 66.7% of wages covered. Men were offered less than one week of parental leave with 100% of wages covered, but we're not sure about their current status.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Since 1973, abortion has been fully legal in Tunisia, making the country one of the most progressive in terms of abortion policy in Africa. All reasons for an abortion are permitted, including to save the life of the woman, to preserve physical health, to preserve mental health, when the pregnancy is the result of rape or incest, risk of fetal impairment, economic/social reasons or simply upon request of the woman. According to the Tunisian Penal Code, a woman does not need to justify her reason for obtaining an abortion.

However, there are some restrictions. The abortion must be performed in the first trimester of pregnancy by a licensed physician in a hospital, authorized clinic or other health care establishment. Furthermore, according to a 2014 article published by Tunisia Live, there have been cases of young women and girls being discouraged from obtaining abortions at some hospitals. In some cases, medical personnel have even denied access to abortion services, citing the medical conscience clause (which allows doctors to refuse services that go against their personal beliefs). Counseling phone lines have also received calls from women who were denied abortion services. It should be stressed that these cases are not incredibly common, but it's useful for people to know that this does exist in Tunisia.

To read more about women denied abortion services in Tunisia, here's further reading:

• Abortion in Tunisia: A Shifting Landscape
• ‘This Is Real Misery’: Experiences of Women Denied Legal Abortion in Tunisia

What to Get & Where to Get It

• Gynecology department of Salah Azeiz
• The public hospitals provide free, anonymous abortion services. Typically, they offer medical abortion (surgical abortions are less common). If you're not a Tunisian citizen or if you're not covered by Tunisian insurance, you may need to pay a fee (but we're not sure).
• One local says: "Abortion providers are only in hospitals. And under the command of doctors. So, in every department, you can ask for it. When you have your meeting with your doctor. And I would recommend the one in Ariana (It is a public hospital Mahmoud Matri). There are clinics who do but it would be expensive. And the health ministry can't control the price because the private clinic and his owner (who generally not a doctor and would ask doctors to work for him) would put higher the price of comfort of his place. For private clinics, there is clinic Ennasser in Ariana, which is nice. The best one in Tunisia the most known private clinic is Les Jasmins in centre urbain nird in Tunis." (March 2017)

Costs

Public hospitals offer free abortions in Tunisia. We don't know the prices at private hospitals.

Advocacy & Counseling

List of Additional Resources

• Tunisia LGBTQI: "A monitor interested in everything related to the Tunisian & international LGBT community. For the abolition of Article230 in the Tunisian Penal Code."
• Klemty: An association for LGBTQ people in Tunisia.
• Shams Tunisia: LGBTQ Rights organization in Tunisia.
• All of Tunisia Women for Research and Information on Women: 7 rue Sinan Pacha, Tunis, Tunisia
• Alliance Tunisienne Des Femmes De Carriere Juridique: 56, Boulevard Bab-Benat, Tunis 1006, Tunisia, 561-845 / 260 178, 567-131
• Alliance Tunisienne Des Femmes De Carriere Medicale: Rue Sinan Pacha, Tunis, Tunisia, 260 834
• Association De Developpement Et De Protection De L'environnement (ADPE): B.P. 73, La Marsa 2070, Tunisia, (2161) 742 400, (2161) 765 428
• Association Des Femmes De L'information Et De La Communication: 32, Rue Charles De gaulle 1000, Tunis, Tunisia, Tel: (216-1) 350650, Fax: (216-1) 350650
• Association Des Femmes Tunisiennes Pour La Recherche Et Le Developpement (AFTURD): Cite Sprols, Rue 7301 Bloc 09 El Menzh, Tunis, Tunisia, 28741, 794 131/785605
• Association Tunnisienne Des Femmes Democrates (ATFD): 6 Rue du Liban 1000, Tunis, Tunisia, Tel: (216 1) 794131, Fax: (216 1) 794131
• Association Tunisienne Du Planning Familial (ATPF): 9, Rue Essouyouti, 1004-El Menzah, Tunis, Tunisia, Tel: (2161) 232419, Fax: (2161) 767263
• Association Tunisienne Des Sages Femmes: 9, Rue Essouyouti-1004- El Menzah. Tunis, Tunisia, 232 419, 767 263
• Center Of Arab Women For Training And Research (CAWTAR): 44 Rue de Polgne, 1005 El Omrane, Tunis, Tunisia, Tel: (216-1) 571945, Fax: (216-1) 574627
• Centre International De Developpement En Tunisie: B.P. 377 (7 Rue Remada) , 2000 Tunis-Le Bardo, Tunisia, (216-1) 510 714, (216-1) 510 714
• Centre de Recherches, d'Etudes, de Documentation et d'Information sur la Femme (CREDIF): Avenue du Roi Abdelaziz Al Saoud, Rue 7131, El Manar II, 2092 Tunis, Tunisia , Tel: +216 1 885 322 , Fax: +216 1 882 893 or +216 1 887 436
• Chambre Nationale Des Femmes Chefs D'entreprise: 103 Avenue de la Liberte, Tunis 1002, Tunisia, Tel: (216-1) 780366, Fax: (216-1) 782143
• Comite Des Dames Du Croissant Rouge Tunisien: 19, Rue d'Angleterre, Tunis 1000, Tunisia, (261-1) 240630/245572, (261-1) 340151
• International Planned Parenthood Federation (IPPF) - Arab World Regional Bureau: 2 Place Virgile Notre Dame 1082, Tunis, Tunisia, Tel: (2161) 284 309, Fax: (2161) 789 934
• Organisation Tunisienne De L'education Et De La Famille: 78 Avenue de la Liberte, Tunis, Tunisia, Tel: (216-1) 286410, Fax: (216-1) 783594
• Tunisian Mothers' Association: 2 Rue des Dattes, Borj Baccouche/, 2 Rue du Lycee El Menzeh 6 1004 , Tunis, Tunisia, Tel: (216-1) 753012, Fax: (216-1) 752 666
• Union Nationale De La Femme Tunisienne - (or Union Nationale des Femmes de Tunisie): Faiza Kefi, 56, Boulevard Bab Benat, Tunis 1006, Tunisia, 561 845 260 178, 541 567 131