Following the 2011 revolution, Islamists took over the Tunisian political scene. Feminist and secular organizations feared that the right to abortion was under threat, and warned of practical obstacles linked to underfunding of services and opposition from many health professionals. Given this context, Irene Maffi wanted to understand the effects of the revolution on abortion, by looking at sexual and reproductive health policies, the day-to-day running of health services and changes in the behaviour of health professionals and women seeking abortions. She conducted a one-year ethnographic study (2013–14) in the Greater Tunis region, at the end of which she argued that continuities are stronger than ruptures: “Rather than bringing about a radical change in the attitudes of healthcare providers and users of government clinics, the revolution of 2011 had exposed existing practices and discourses as well as material constraints that were unknown during Ben Ali’s rule because the authoritarian regime proscribed its citizens’ free expression and strictly regulated their public conduct” (2–3).
The first chapter looks at the renewed debate on abortion, characterized by a strengthening of the secularist versus Islamist divide. Though the lines of opposition are nuanced, Islamist positions on abortion remain highly ambiguous. Among healthcare workers, the liberation of speech has led to the emergence of opposition to abortion, forcing NGOs to adapt their discourse—on the one hand, by integrating the religious dimension and, on the other, by sidestepping their plea for women’s rights and freedoms.
The second chapter explores the reproductive and contraceptive norms that prevail in society. The ideal model is that of the nuclear family with three children, and the woman is considered to be entirely responsible for this planning. Marital status, socioeconomic situation, and education are key factors in understanding the different ways in which women are handled by sexual and reproductive health services. Although women are theoretically free to have an abortion and to choose their contraception, in reality their decisions are guided or even forced by healthcare professionals. Their options are all the more limited because ignorance is widespread in a society where sexual issues are taboo.
The third chapter shows how the category of deviant and irresponsible women is shaped in practice. Practitioners go beyond the medical framework to take on the role of judge and moralizer. Administrative procedures only serve to increase the control exercised over women, particularly those who are unmarried.
The final chapter is devoted to perceptions of the fetus and how they influence attitudes to abortion. Because of the Islamic conception of the fetus (which is not considered a human being until the “ensoulment’ phase) and the low quality and mobilization of biomedical technologies, there has been little debate on the humanization of the fetus. This could explain the pragmatic attitude of women, who generally tend not to feel guilty. The hostility of healthcare professionals is expressed both in their practices and in their discourse. However, their positions are not set in stone and may vary over time or depending on the case. Among those who defend abortion, they are powerless in the face of increasing pressure and aggression.
Recalling that abortion is not a “mere political, medical and technical fact but an arena of contention where different moral subjectivities take shape and meet or clash” (177), Irene Maffi concludes with the paradoxical effects of the revolution: while the right to abortion was better guaranteed under Ben Ali, no debate was possible. Now, dilemmas and disagreements can be expressed publicly.
The thesis of the book, which emphasizes continuities rather than ruptures, suggests that the effects of what might be described as a conservative revolution need to be tempered. Revisiting the debate over the long term shows that violence and control over women’s bodies did not begin with the Islamists’ rise to power, and that they may have been legitimized on the basis of antagonistic discourses at different times: forced sterilizations in the name of modernity in the 1970s, reluctance to carry out abortions in the name of moral and religious convictions from the 1980s onwards. However, some of these changes seem to have been underestimated. In fact, despite the growing reluctance of health professionals, it seems that before the revolution, women always managed to obtain an abortion. After 2011, however, a woman can be openly refused an abortion. This denial of a right calls into question the idea that the public expression of ethical dilemmas is somehow a sign of the liberalization of speech and of the regime. Indeed, one might ask whether it is legitimate, in a democratic system, for a right granted to women to be then contested or even denied within the medical arena. The absence of the notion of “conscientious objection” in Tunisian law and in the political debate certainly has effects that it would have been interesting to explore.
The legal issue is not at the core of the book, but the reader might have liked to know more about risks faced by practitioners who refuse abortion. In a context of crisis, under-equipped services, and staff shortages, they have gained unprecedented autonomy. However, by deliberately obstructing the right to abortion, are they not exposing themselves to prosecution or sanctions? What are the reactions, for example, of feminist and secular movements? Are they taking legal action?
These are just some of the discussions to be continued with the author after reading this fascinating book, based on an extremely rich field survey, and which is truly necessary in a context where the right to abortion is the subject of increasingly polarized debates around the world.
