Study of the provision of care and barriers to the management of unwanted pregnancies, Tunisia At Doctors of the World – Belgium

Full description of the terms of reference in the PDF to download on our site

WHO ARE WE ?

Médecins du Monde is an international medical development NGO that is part of an international network. We provide medical assistance to vulnerable groups, in Belgium and around the world. We want universal health coverage where everyone has access to care, without obstacles.

In Belgium and around the world, our projects are aimed at all people who do not have or no longer have access to health care. In particular, they are structured around five axes: people on the margins of society, children in vulnerable situations, women, migrants or displaced persons and victims of crises or conflicts.

To carry out our mission, we rely on three pillars:

• Care : provide real access to care for populations.
• Change : more than helping, we want to change things in the long term.
• Bearing witness : we do not remain silent. Thanks to our experience and our presence on the ground, we challenge the authorities (local, regional and (inter)national) with facts, figures and realities.

Our projects follow a series of values ​​common to our entire organization: Social Justice, Empowerment, Independence, Commitment, Balance.

CONTEXT

Sexual and Reproductive Health and Rights (SRHR) are an essential element of universal health coverage and are necessary to end discrimination against women and girls.

A study published by the Guttmacher Institute, the World Health Organization (WHO) and the United Nations Special Programme for Research in Human Reproduction (HRP) has highlighted major disparities in access to sexual and reproductive health care by analyzing rates of unintended pregnancy and abortion in 150 countries. [1]

Over the past decades, Tunisia has made undeniable progress in improving the health of the population, particularly in reducing maternal, infant and neonatal mortality. However, despite this progress, family planning indicators have declined quite sharply between 2012 and 2018, with a drop in contraceptive prevalence during this period of 12% (from 62.5% to 50.7%) at the national level. [2] Unmet needs for contraception were 19.9% ​​in 2018 and 16.1% in 2023 at the national level, with a higher proportion recorded in the South-East region (23.4%). [3] The 20-24 age group has the lowest contraceptive prevalence, with little data available on contraceptive prevalence among those under twenty.

In terms of access to comprehensive abortion care, Tunisia has a rather advanced legal framework compared to other countries in the region with a law dating from 1973 which authorizes abortion during the first three months of pregnancy and beyond in cases where the health of the woman or the fetus is in danger.

Despite a rather advanced National Sexual and Reproductive Health Plan (PNSSR) 2020-2030 and efforts made by the Tunisian government in terms of sexual and reproductive health and rights, numerous access barriers exist, particularly in terms of prevention and management of unwanted pregnancies, as demonstrated by the study on access to and quality of sexual and reproductive health services published in 2021 by the National Office for Family and Population (ONFP) [4] .

[1]  Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019 (bmj.com)

[2]  report_health_plan_2021-2030-web.pdf (unfpa.org)

[3]  https://www.ins.tn/sites/default/files/2024-02/Livret%20FR%20-%20Re%CC%81cap%20des%20donne%CC%81es%20MICS%202023.pdf

[4]  report_study_services_ssr_cefir_2021.pdf (unfpa.org)

Description of the consultancy

Mission objectives:

• Develop a map of the range of care available in terms of contraception and comprehensive abortion care and the actors active locally in this range of care;
• Conduct a literature review on the prevention and management of unwanted pregnancies in Tunisia, including an analysis of the legal framework and various scientific publications
• Develop an analysis of the barriers to access to contraception
• Develop an analysis of the barriers to access to comprehensive abortion care based on the care pathway
• Develop recommendations for removing these barriers to access to the prevention and management of unwanted pregnancies

The consultant will have to propose an inclusive methodology taking into account people with diverse SOGIECS, people with disabilities, etc. within the framework of an intersectional approach to vulnerability.

DELIVERABLES

• Deliverable 1: A detailed methodological note including the collection tools, the mission timetable and an ethical protocol for the mission
• Deliverable 2: A literature review (studies, existing similar research on access to contraception and abortion in Tunisia and the MENA region)
• Deliverable 3: A summary report on the legal and institutional framework in Tunisia and the MENA region
• Deliverable 4: A mapping of the care offer relating to contraception and comprehensive abortion care and the main actors active locally in this offer with an analysis of the dynamics between them.
• Deliverable 5: A study of the barriers to access to contraception and comprehensive abortion care in the patient pathway with recommendations for removing these access barriers.

EXPECTED PROFILE

Consultants must have the following profile:

• Hold a university degree (Master 2 or equivalent), preferably in development, political sciences, social sciences, legal sciences or related fields;
• A master’s degree in public health is an asset
• Minimum 3 years of experience in the field related to the services requested, in particular sexual and reproductive health and rights;
• Specific experience and expertise in assessing barriers to access to services;
• Experience in research methodology and qualitative data collection;
• Have a perfect command of French;
• Analytical mind and synthesis skills;
• Excellent writing skills.
• Knowledge of the Tunisian context