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شبكة العلوم النفسية العربية

Women’s Mental Health in Tunisia

 Pr. Saida Douki, Dr. Fathi Nacef

World Psychiatry

Official Journal of The World Psychiatric Association (WPA )

Volume 1 N°1 – February 2002

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Tunisia is the only country in the Arab world where the principle of equality between genders bas been consecrated in legal texts. In 1956, the Code of Personal Status introduced the equality of rights, through a set of provisions such as the abolition of polygamy, the institution of legal divorce and recognition of both spouses' right to seek divorce, and the setting of a minimum age for marriage to young women. From that time on, these tights have become irreversible and have continued to adapt to social transformations which have occurred in Tunisia. However, women keep on being more exposed than men to many specific risk factors which greatly contribute to threaten their mental health, throughout their life (1).

   Being a woman is still a misfortune, and discrimination against girls starts since their birth, because a girl is unable to transmit the family name and is considered potentially dangerous for the honor of the family. They will thus be brought up under close surveillance. Suicide attempts, far more frequent in female teenagers, are too often the only solution for them to advocate some freedom (2). Besides, the ultraconservative upbringing of many females paves the way to development of morbid fear of sexual intercourse and even non-consummation of marriage. In fact, one woman in two declares being indifferent to sexual relationships (3).

    Women have gained today the right to be educated, but not too high! So, despite steady investment (as much as 10 per cent of the state budget is allocated to education) and progress women are still the major victims of illiteracy,(41% of females over 15). This affects twice as many women over 15 as men.

    Similarly, women have now conquered the right to work (the percentage of women in the working population bas risen from 6% in 1966 to 25% in 1999), but they are mainly represented in sectors of activity which resort traditionally to female manpower, such as education, health, or textile industry. Moreover, this resulted in work overload, marital conflict and exposure to moral and sexual harassment. In fact, several women develop depressive disorders and are required to give up working (4).

   The taboo of sexuality keeps on being highly significant and often causes suicidal behaviors in young girls who lost their virginity. In a recent survey, virginity was considered by 90% of women 'a social rule to be maintained" (3). This taboo ends up only with marriage :30% of women are still opposed to sex before marriage) but, then, women have to rapidly prove their ability to procreate, males preferably.

   That's why infertility is still a real drama, which justifies divorce and provokes mental disorders. The importance of being fertile is also a major obstacle to contraception. Despite the intensive family planning policy carried out for decades, the contraceptive prevalence reaches only 51 %. Many studies have reported a high rate of psychiatric morbidity in women on contraceptive pills or women who had their tubes tied. On the other hand, illicit pregnancy is strongly condemned and leads in most cases to abortion or to the newborn's abandonment (5). In the same way, menopause (which in Arabic is called 'despair') triggers depressive and anxious disorders in 37% of women (6).

     Women remain the main victims of domestic violence. Some surveys in various medical and psychiatric settings have shown that 30 to 40% of women report having been assaulted by their husband or another family member at least once (7). The major problem is that most of them keep the violence a secret. Women who are beaten by a relative are often reluctant to report the crime to police, family or others. In the above survey, only 60% of women and 50% of men considered wife abuse intolerable! In case of disclosure, family, police and even health professionals are often not of great help, given the importance attached to maintaining the marital link. Women are thus advised to pardon to protect children and home. However, a recent study showed that abused women were at higher risk than a control group to develop depressive (98% vs. 50%) and medical problems (72.5% vs. 27.5%) (8).

     Finally, when they are mentally ill, women don't benefit from the same protection as men and suffer from a worse clinical and social outcome. Given the stigma attached to mental disorders in women and their important role in the family, they are referred to care at a later stage and quickly discontinue treatment. Moreover, women are underrepresented among psychiatric inpatients, because their admission carries greater stigma and reduce their marriage prospects. Indeed, they are far more likely than men to be divorced and separated from their children, or to be rejected by their families and to end up their life in a mental hospital.

     Women's mental health is inextricably linked to their status in society. It benefits from equality and surfers from discrimination. Despite their privileged status, Tunisian women share the same mental health problems as all the other Arab females. The example of Tunisia shows that a legislation empowering women is necessary but insufficient to guarantee them a real promotion. The gap remains large between the legal framework and the reality. This means that the protection of women's mental health is not only a medical challenge but also a cultural one, involving many partners to second a policy of steady empowerment and advances to reach a real equality.

References :

1.      Attia A, Douki S, Haffani F. Condition féminine en Tunisie. Evolution socio-culturelle et psychopathologie. Evolution Psychiatrique 1981 ; 46 : 109-27.

2.      Douki S. Echec de la tentative-réussite du suicide. A propos des suicides et tentatives de suicide en Tunisie. Psychiatrie Francophone 1983 ; 1.

3.      Belhadj A. Le comportement sexuel féminin. MD thesis, Faculty of Medicine of Tunisia, 1993.

4.      Douki S. La dépression au féminin : dépendance et/ou autonomie. Revue Maghrébine de Psychiatrie 1990 ; 1.

5.      Ben Salah J. Profil psychopathologique des mères célibataires en Tunisie. Etude prospective à propos de 50 cas. MD Thesis, Faculty of Medicine of Tunis, Tunisia,1999.

6.      Kadri N, Zarbib K. Ménopause et santé mentale. Caducée 2000 ; 46.

7.      Belhadj A. Les épouses battues : enquête dans les centres de soins de santé de base. Unpublished paper, 1997.

8.      Chéour M. Le retentissement des conflits conjugaux sur la santé mentale des femmes en Tunisie. Unpublished paper, 2001.

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Douki-WomenMentalHealth 

ترميز المستند OP.0007