The problem and puzzle of low female labour-force participation (FLFP) in the Middle East and North Africa (MENA) has long preoccupied scholars. College-educated women have higher employment rates, as they fill professional jobs in the public sector, but their unemployment rates also are high, given the untoward conditions in the private sector and limited jobs in the public sector. Women with secondary schooling or less are not present in the labour force proportional to their population. For these reasons, this author and others have called for institutional support for working mothers, including pre-school facilities, to expand jobs for women without university education and to release others for labour force participation. More recently, COVID-19 highlighted deficiencies in healthcare provisioning, as most MENA countries have few doctors and nurses per 1,000 people. Expanding the social infrastructure by training more women for a variety of good jobs in the social policy domain could enhance FLFP and provide quality care to children and families. Tunisia exemplifies such needs as well as opportunities.
This case study draws on findings from a from a recent international research project and observations since the onset of the COVID-19 pandemic. It argues for a broader, more integrated social policy agenda that includes expanding the social infrastructure (by building more childcare centres and pre-school facilities), upgrading existing hospitals and schools, and training more women as nurses, physicians, teachers, aides, cooks, cleaners, and even school bus drivers. The availability of good jobs accompanied by statutory paid maternity leave and childcare will increase the female labour supply while also enabling citizens to enjoy healthcare, schooling, social provisioning, and income.
FLFP is important for a variety of reasons, among them: women’s empowerment, maximising household income, increasing the tax base, and enriching women’s experiences and perspectives to fill gaps in research, health care, teaching, or policy decision-making. In MENA, however, expanding the female labour force has been an afterthought. In most countries, neither social norms nor social policies encourage female labour incorporation; Muslim family laws arguably discourage it. Women who do work are clustered in healthcare, education, and public administration, mostly as professionals. Lacking paid maternity leave and affordable pre-school and childcare facilities, the private sector does not attract women from working-class or lower-income households.
In MENA, school starts at age six and public pre-school facilities are rare or expensive. In Tunisia, for example, 51% of children aged 3 to 5 attend pre-schools with an uneven distribution between regions, backgrounds and socio-economic status of families, according to a recent report. In urban areas 60% of children attend preschool, against 17% in rural areas. Only 17% of children from the poorest backgrounds have access to this service, compared to 71% from the richest households. All MENA countries require some degree of paid maternity leave, but it remains the financial responsibility of the employer and in some countries is of very short duration. In Iran and only four Arab countries – Algeria, Morocco, Tunisia, Jordan – is paid maternity leave covered through the social security/social insurance system. In Tunisia, however, women are fully covered only in the public sector; income replacement in the private sector is 66 percent. Furthermore, the maternity leave is longer in the public sector than in the private sector (Moghadam 2019). Such discrepancy, common to other MENA countries, contributes to the observed wage discrimination against women in the private sector (Tansel, Keskin, and Ozdemir 2020).
Throughout the world, the pandemic pushed healthcare systems to their limits, but some countries were less prepared than others, with underfunded public health sectors. Egypt and Tunisia, among other countries, have seen the departure of many physicians and other health workers for more lucrative positions elsewhere, which has been the result of declining social investments and low salaries. Staffing shortages and inadequate equipment placed enormous burdens on healthcare workers. Vulnerable to infection and death, women health workers had to navigate family responsibilities as well. Such workers should be at the centre of post-pandemic recovery and resilience plans.
World Bank data show that the number of health workers per 1,000 people in MENA (2013-2018) was 1.3 doctors and 2.5 nurses. This compares to the world average of 1.6 doctors and 3.8 nurses. More apposite comparisons might be Israel (4.6 / 5.7) and Latin America and the Caribbean (2.3 / 5.1). The GCC countries have many more nurses, but they are largely expatriates. The 2018 world average for healthcare spending as a percentage of GDP was 9.9 percent , compared to 5.7% for MENA. In contrast, the MENA region spent much more on the military (5.5% of GDP) than the world average (2.1%).
Tunisia’s military spending has always been low, and at the start of the century, Tunisia had the most developed social welfare system in the Maghreb and indeed the African continent, albeit one with clientelist elements (Ben Romdhane 2006). This enabled the efficient cash transfers to households and enterprises when the pandemic struck in spring 2020 (Krafft, Assaad, and Marouani 2021). But the system had frayed, along with its physical infrastructure.
According to a 2015 study by the Tunisian women’s policy agency CREDIF, 42% of Tunisia’s medical personnel were women. Feminisation began in the early part of the century, as more women entered medical-related fields of study (Labidi 2020, 7). Data show that in 2018 Tunisia had 1.3 doctors and 2.5 nurses per thousand people. According to the National Council of the Order of Physicians, 40% of its members practice outside their home country. In June 2020, healthcare workers went on strike to protest cutbacks and reduced salaries and to demand better working conditions. When a young doctor lost his life in a malfunctioning elevator at a regional hospital in early December 2020, the country’s main trade union, the UGTT, organised protests. Tunisia needs to train more nurses and retain its physicians; it also needs to upgrade the health infrastructure.
Key policy actors, institutions, and normative underpinnings
The absence or presence of institutional support for working mothers has been identified as a key driver of FLFP. In interviews in Jordan in 1996, I found that women employees stressed the need for institutionalised and affordable “baby care” (Moghadam 1998, 137). Similarly, Ilkkaracan (2012) underscores the lack of work-family reconciliation measures as an important part of the explanation for low FLFP in Turkey (and elsewhere), and a UN Women (2020) study links low FLFP to the highly unequal distribution of domestic care work in the Arab States.
Tunisia’s 2016-2020 Development Plan called for increasing women’s share of the labor force to 35%, expanding the size of the social-care sector by raising kindergarten enrolments from 35% in 2015 to 53% in 2020, and investing in child protection, sports, and home-care support. The plan’s goals came to be at odds with austerity measures detailed in the government 2018 Finance Bill to reduce the country debt (Moghadam 2019). These contradictory initiatives, as well as popular frustration with persistent unemployment and the high cost of living, triggered a new wave of protests across Tunisia that began in early January 2018. COVID-19 only added to the country’s problems.
In the past decade and following some three decades of research and advocacy by feminist scholars, global governance institutions such as the World Bank, the International Monetary Fund, and the G20 now promote women’s economic empowerment as “smart economics” (Gonzales, et al., 2015; G20 2014: 7; World Bank 2012). Tunisia’s external debt therefore should be forgiven, as it would help realise that goal and put Tunisia back on track toward prioritising human development, human security, and women’s participation and rights.
In May-June 2021, Tunisia began to meet the goals of its 2016-2020 national development plan, which included the expansion of pre-school facilities for both child health and female employment growth (Moghadam 2019). For example, partnerships with UNICEF, the Italian and German governments, and a firm in the industrial zone of Sidi Toumi that mostly employs women broke the ground for an early childhood care and education centre; equipment and educational materials for kindergartens in 23 governorates also were dispatched.
Women’s economic empowerment is linked to the improvement of public services. In turn, upgrading the social infrastructure – healthcare, education and training, and social services – should be an integrated policy domain. Training more nurses to serve in hospitals as well as in schools should be a priority. Affordable and quality pre-school facilities would incentivise mothers of small children to seek jobs. Training more women for good jobs in such pre-school facilities as well as in schools generally as teachers, nurses, social workers, cooks, cleaners, and bus drivers, would increase the supply of job-seeking women, especially women from working-class and lower-income households, and reduce the female unemployment rate while also helping to improve healthcare delivery and outcomes. Statutory paid maternity leave should be regarded as both a labour right and an employment incentive. For reasons of smart economics as well as recognition of women’s contributions and burdens during the COVID-19 pandemic, all MENA countries should prioritise policies and programmes enhancing FLFP and retaining women workers across sectors. More investment in public health and health workers (and less in the military) would yield social and economic gains.
About the Author:
Valentine M. Moghadam is a Professor of Sociology and International Affairs at Northeastern University, Boston. Born in Tehran, Iran, Professor Moghadam received her higher education in Canada and the U.S. In addition to her academic career, Prof. Moghadam has been Coordinator of the Research Program on Women and Development at the UNU’s WIDER Institute (Helsinki, 1990-1995) and a section chief for gender equality and development, UNESCO’s Social and Human Sciences Sector (Paris, 2004-2006).
Her areas of research include globalization, transnational social movements and feminist networks, economic citizenship, and gender and development in the Middle East and North Africa. Among her many publications, Prof. Moghadam is the author of Modernizing Women: Gender and Social Change in the Middle East (first published 1993; second edition 2003; revised and updated third edition Fall 2013); Globalizing Women: Transnational Feminist Networks (2005), which won the American Political Science Association’s Victoria Schuck award for best book on women and politics for 2005; and Globalization and Social Movements: The Populist Challenge and Democratic Alternatives (2020). She has edited seven books, including Empowering Women after the Arab Spring (2016, with Marwa Shalaby). After the Arab Uprisings: Progress and Stagnation in the Middle East and North Africa, co-authored with Shamiran Mako, will be published in summer/fall 2021 by Cambridge University Press.
 Sources of data are the World Bank’s World Development Indicators and the WHO’s Global Health Observatory. Country briefs and profiles are available: https://rho.emro.who.int/country-health-profiles. Another WHO report states that global health spending as % GDP in 2017 was 6.6% (see WHO 2019, Table 1.1, p. 10).
 La Revue de CREDIF, no. 49 (Dec. 2015): 68-69; see also Moghadam (2019), Table 2.
 “Out of Place: Doctors in the Middle East”, The Economist, Nov. 21st, 2020, p. 44.
 https://www.msn.com/en-us/news/world/tunisian-healthcare-workers-strike-to-demand-reforms/ar-BB15FRx5. See also https://www.al-monitor.com/pulse/originals/2020/06/tunisia-coronavirus-fakhfakh-won-virus-reopen.html?utm_campaign=20200616&utm_source=sailthru&utm_medium=email&utm_term=Daily%20Newsletter
 https://www.msn.com/en-us/news/world/outcry-after-tunisian-doctor-dies-in-hospital-lift-accident/ar-BB1bDkpL; and personal communication from a UGTT health sector official.
 See https://www.unicef.org/tunisia/communiqu%C3%A9s-de-presse/le-partenariat-public-priv%C3%A9-une-opportunit%C3%A9-pour-la-petite-enfance-en-tunisie; and https://www.unicef.org/tunisia/recits/l%C3%A9ducation-pr%C3%A9scolaire-de-qualit%C3%A9-un-engagement-conjoint-entre-la-tunisie-litalie-et-lunicef
- G20 Brisbane Action Plan. 2014. http://www.g20.utoronto.ca/2014/brisbane_action_plan.pdf
- Ilkkaracan, I., Kijong, K., and Tolga, K. 2015. “The Impact of Public Investment in Social Care Services on Employment, Gender Equality, and Poverty: The Turkish Case.” http://www.levyinstitute.org/pubs/rpr_8_15.pdf.
- Gonzales, C., Sonali, J.C., Kalpana, K., Monique, N., and Tlek, Z., 2015. “Catalyst for Change: Empowering Women and Tackling Income Inequality. IMF Staff Discussion Note 15/20 (October).
- Karshenas, M and Moghadam, V.M., 2001. “Female Labor Force Participation and Economic Adjustment in the MENA Region.” In Mine Cinar (ed.), The Economics of Women and Work in the Middle East and North Africa. Amsterdam and London: JAI.
- —–. 2021. “Female Labour Force Participation and Women’s Employment: Puzzles, Problems, and Research. The Routledge Handbook of Middle East Economics, editor Hassan Hakimian.
- Moghadam, V. M. 2019. “Women’s Employment in Tunisia: Structures, Institutions, Advocacy.” Sociology of Development (vol. 5, issue 4, Dec.): 337-359.
- —–. 1995. “A Political Economy of Women’s Employment in the Arab Region.” In N. Khoury and V.M. Moghadam, eds., Gender and National Development. London: Zed Books, pp. 6-34.
- World Bank. 2012. World Development Report 2012: Gender Equality and Development. Washington, DC.
The opinions expressed in the guest blogs are those of the authors. They do not purport to reflect the opinions or views of the Middle East and North Africa Social Policy (MENASP) Network or the University of Bath.