Tunisia’s Family Planning Success Underlies Its Economic Progress

by Richard H. Curtiss

Its government brochures describe Tunisia as “A Country That Works” and its achievements since it obtained its independence from France in 1956 bear this out. But perhaps the single most important factor in the country’s economic successes is the fact that its family planning program works extraordinarily well.

In 1956 Tunisian life expectancy was 47 years, the mortality rate was 25 per 1,000 inhabitants, and the population growth rate was 3 percent. As a result, 46.5 percent of the population of 3,783,169 was under 15 years of age.

Thirty-nine years later, in 1995, life expectancy was 72 years, Tunisia’s mortality rate was down to 5.7 per 1,000 people and the population growth rate was 1.70 percent. As a result, only 34.8 percent of the population of 8,785,364 was under 15 years of age.

The most remarkable change, underlying all the others, is that in 1956 an average of 7.2 children were born for every woman in Tunisia, while in 1994 2.9 children were born for every Tunisian woman. This reduction in the birth rate by well over 50 percent began in the early 1960s after all relevant government institutions and mass organizations adopted family planning programs. The Tunisian Family Planning Association was established officially in 1968.

Today the Tunisian Ministry of Health’s National Family and Population Board is headed by Dr. Nabiha Gueddana, who also is a professor of preventive and social pediatrics at the Faculty of Medicine in Tunis and a former secretary of state reporting to the prime minister and responsible for Women’s and Family Affairs. (See “Women’s Rights an Affair of State for Tunisia,” Washington Report, Sept/Oct 1993, pp. 50-51.)

In her family planning capacity, Dr. Gueddana heads a staff of 800 whose work is supplemented by the collaboration of another 800 persons whose salaries are paid by the Ministry of Health or other Tunisian government institutions.

She attributes the success of her organization’s program, however, to a number of societal factors, starting with the emancipation of Tunisian women, which began with the personal status code adopted in 1956, the year the country became independent. “It’s a matter of the right of women to control their own bodies.” Mrs. Gueddana explains. “But for people to accept a program like this there must be a level of public awareness.”

Factors in reaching that level, she says, include the education of girls (in Tunisia education is mandatory for all children), the employment of women, and the legally guaranteed right of both women and men to equal pay for equal work. She also cites the social security program in Tunisia, which eliminates the concern of parents that they may need many children to support them when they no longer can work, and also the greatly improved maternal and child health programs, which reduce the fear of parents that some of their children will die in infancy.

In fact there were 170 deaths per thousand children born when Tunisia became independent. Today the child deaths have been reduced to 35 for every thousand children born. Another factor in the success of family planning efforts in Tunisia is legislation that authorizes both contraception and, since 1973, abortion for families that already have four or more children. Ironically, under French colonial rule, contraceptives were illegal.

Given the climate of awareness and the legal underpinnings for family planning, current government efforts are particularly effective. The Tunisian Ministry of Health provides a clinic or basic health care unit for every 700 women and these units, among their many health services, offer family planning services.

There also are maternal care centers in hospitals that provide abortions, which are legal under certain circumstances if performed by qualified doctors, but not if performed by unqualified practitioners. According to surveys by Tunisian health authorities, 60 percent of Tunisian women practice contraception. The preferred contraceptive device is the IUD, which must be installed by trained medical personnel. The results were dramatically illustrated at the beginning of the 1996 school year when, for the first time in Tunisian history, the number of children enrolled in primary schools dropped slightly from enrollment in the preceding year. Since education is compulsory, the drop indicated that population in the country is stabilizing.

Credit for all this, according to Mrs. Gueddana, also is shared by the media, which constantly air family planning goals; the schools, which have made all teachers and students aware of the health and environmental benefits of population stabilization; and Mrs. Gueddana’s workers, some of whom are employed in 48 mobile clinics assigned to all of the governorates in the country, and who also supervise women outreach workers who go door-to-door in rural areas to answer questions on such subjects as the health benefits to both mothers and children of child spacing.

Other factors include the limiting of family allowances since 1988 to the first three children, raising the legal age of marriage to 17 for women and 20 for men since 1964, and the authorization since 1961 of unrestricted advertising and distribution of contraceptive materials.

Although Mrs. Gueddana discounts its importance, Tunisia also differs from all other Islamic countries except Turkey in prohibiting polygamy (plural marriage) and repudiation, meaning the right of a man to divorce a woman without offering grounds for divorce before a court of law.

Much of this unique Tunisian legislation owes its origins to the writings in the 1930s of Tunisian reformer Taher Haddad, and the pronouncements of Tunisian religious leader Sheikh Fadhel Ben Achour that these laws are not contrary to the precepts of Islam. In addition, the Tunisian government has set up a High Council for the Family and Population to advise its Office of National Family Planning. The government also has established regional councils for the family and population in each governorate, chaired by the governor. The regional councils are consulted on the action plans of the Office of National Family Planning before they are adopted.

As a result of its successes, in a recent study of global family planning programs Tunisia’s family planning program was ranked 14th in the world, and its population education program was ranked 9th. Now Tunisia, which only a short while ago was considered an underdeveloped nation, is used as a training and demonstration center for other countries, particularly those in French-speaking Africa, in programs funded by the United Nations Population Fund, the Rockefeller Foundation, and the World Bank.

As Mrs. Gueddana points out, however, the honors that now are being heaped on Tunisia’s family planning program were not earned by one agency of government or in one generation. They derive from the country’s status as a pioneer in women’s rights and education, and from coordination by the media and government agencies to support a program whose successes now underpin every aspect of “a country that works.”