Emergency contraception in post-revolution Tunisia: A national study of pharmacy access

Introduction: In 2001, Tunisia became the first country in the Arab world to register a dedicated emergency contraceptive pill (ECP). ECPs were soon incorporated into the national family planning and adolescent reproductive health service delivery guidelines and became available without a prescription, and without age, gender, or marital status restrictions, directly from pharmacies. However, the election of a conservative Islamic government in the wake of the 2011 revolution raised concerns about the future of reproductive health services.

Methods: In 2012-2014 we conducted a multi-methods study of the availability, accessibility, and acceptability of ECPs in Tunisia. The study included interviews with representatives from 208 retail pharmacies in eight Tunisian governorates. Our French and Arabic interviews focused on current stock and sales patterns, provision practices at the pharmacy, and client profiles.  We analyzed our data using descriptive statistics and for content and themes.

Results: ECPs were in-stock in at least one pharmacy in almost all of our study communities and ECP knowledge among pharmacists was excellent.  However, there were several pharmacists – all in the center and south – that believed that ECPs require a prescription. Although a few pharmacies, as a matter of policy, will not provide ECPs to unmarried women, most pharmacists reported the provision of ECPs to any woman in need was a professional duty. Men constitute a significant portion of ECP clients.

Discussion: Availability of ECPs in the post-revolution period remains excellent. However, continuing pharmacist education efforts and supporting youth-friendly reproductive health initiatives appears warranted.