Tunis, 1992.
Karim stood before the building. The Ministry of Health. A white concrete structure, modern and impersonal. The flag of Tunisia snapped in the wind above the entrance.
He was twenty-seven now. He had been an obstetrician for five years. He had seen the ward change. The deliveries decline.
He had come to ask his father.
He entered the building. The air inside was cool. The fluorescent lights hummed. The receptionist looked up from her desk.
Can I help you?
I’m here to see Dr. Hassen ben Hadded, Karim said. I’m his son.
Ah, the receptionist said. Go up to the third floor. His office is at the end of the hall.
Karim took the elevator. The doors closed. The numbers changed. 1. 2. 3.
The doors opened. The hallway was lined with doors. Nameplates on each. Director of Maternal Health. Director of Family Planning. Director of Demographic Planning.
Karim walked to the end of the hall. The door was open. The nameplate read: Dr. Hassen ben Hadded, Senior Advisor — Office National de la Famille et de la Population (ONFP).
His father was inside. He sat behind a desk covered in documents. Reports from the World Bank. Monographs from the WHO. Statistics from the ONFP — the National Office of Family Planning.
He looked up as Karim entered.
Karim, he said. What a pleasant surprise.
Hello, father.
Hassen stood up. He came around the desk. He hugged his son. The embrace was brief. Hassen stepped back. He gestured to the chair opposite his desk.
Sit, he said. Sit. How is the hospital?
Busy, Karim said. Or — it used to be.
What do you mean?
Karim sat in the chair. It was upholstered in gray fabric. The seat was firm.
I mean the deliveries are down, Karim said. Way down.
Hassen smiled. That’s excellent news.
Is it?
Of course, Hassen said. He returned to his chair. He picked up a document. The latest numbers are extraordinary. We’re ahead of schedule. On track to reach replacement level by 1995.
He placed the document on the desk. He smoothed the paper with his hand.
Replacement level, he said. That’s the goal. That’s success.
Father, Karim said. When I started my residency, we had 10-15 deliveries a week. Now we’re lucky if we have 3-4.
Exactly, Hassen said. Fewer pregnancies mean healthier mothers. Healthier children. Better outcomes.
He picked up another document. The World Bank projects that if we continue this trajectory, Tunisia’s GDP per capita will double by 2010. Fewer children means more investment per child. Better education. Better healthcare. Better futures.
He looked at Karim. This is development, Karim. This is progress.
Karim looked at the documents on his father’s desk. The graphs showed fertility rates falling. 7.0 in 1960. 4.0 in 1975. 2.5 in 1985. 2.0 in 1990. The line sloped downward, toward the target: 2.1.
Replacement level.
But father, Karim said. The women who come to me… they’re not choosing freely. They’re being pressured. By their husbands. By their families. By the poverty.
Hassen’s smile faded. What do you mean?
I mean they’re not choosing abortion because they want to, Karim said. They’re choosing abortion because they can’t afford another child. They’re choosing abortion because their husbands threaten to leave them if they have more children. They’re choosing abortion because the health workers in their villages tell them that large families are “backward.”
They’re being coerced, Karim said.
Hassen looked at the documents on his desk. The World Bank logo was visible on the top page.
These women, Hassen said. They come from villages. They have no education, no income, no future for another child. We’re not taking something from them. We’re giving them a way out.
They’re not choosing, Karim said. They’re being coerced.
They’re being liberated, Hassen said sharply. They’re holding Tunisia back. We can’t modernize if every woman has 7 children. We can’t develop if the population doubles every 20 years.
He stood up. He walked to the window. He looked out at the city.
You don’t remember the old Tunisia, he said. I do. I remember 1950. I remember the poverty. I remember the children begging in the streets. I remember the women dying in childbirth because there were no hospitals. I remember the families that couldn’t feed their children.
He turned to face Karim.
That’s the Tunisia we’re leaving behind, he said. That’s the Tunisia your children will never know. Because of this program. Because of family planning. Because we had the courage to modernize.
Karim looked at the documents again. The zawiya. His grandfather. The circle of men. The transmission.
What about the zawiyas? Karim asked. What about the communities that supported women? That helped with children? That made large families viable?
Hassen’s face hardened. Those communities are gone. We closed them. And good riddance. They were holding us back. They were keeping us backward.
But father, Karim said, what replaced them? The state? The market? Can the state love a child? Can the market care for the elderly?
Hassen looked at the window. The city of Tunis spreading beyond the glass.
Then he spoke. His voice was cold. The state can provide services. The market can provide jobs. That’s more than the zawiyas ever did.
On the desk between them, the coffee had gone cold. Neither of them had noticed.
Hassen looked at Karim.
You’re young, he said. You don’t remember the old Tunisia. You don’t know what we’re saving you from.
I know what we’re destroying, Karim said. I see it in the ward. Every day.
You’ll understand when you’re older, Hassen said. You’ll see that we did the right thing.
I don’t think I will, Karim said.
Then you’re wrong, Hassen said.
The conversation was over.
Karim stood up. He walked to the door.
Karim, his father said.
Karim stopped. He didn’t turn around.
I’m proud of this program, Hassen said. I’m proud of what we’ve accomplished. We’ve saved thousands of women’s lives. We’ve given thousands of children better futures. We’ve built a modern Tunisia.
I hope you’re right, Karim said.
I am, Hassen said.
Karim walked out of the office. He walked down the hallway. The fluorescent lights hummed. The nameplates lined the walls. Director of Maternal Health. Director of Family Planning. Director of Demographic Planning.
He took the elevator. The doors closed. The numbers changed. 3. 2. 1.
The doors opened. He walked out of the building.
He passed a café. Men crowded around a television mounted above the counter. A football match was playing. The room erupted in cheers as someone scored.
Karim didn’t stop. He kept walking toward the hospital.
Two blocks later, he passed a building. The door was boarded up. The wood was rotting. The paint was peeling. An inscription in Arabic was barely visible:
Where knowledge and Quran are gathered
The zawiya.
It had closed in 1980. The government had cut the funding. The young men had stopped coming. The circle had dispersed.
Karim stopped. He looked at the boarded door.
His grandfather’s voice. The hand on the shoulder. Something dies that cannot be named.
The transmission had stopped.
Karim stood across the street. The boarded door was visible through the dusty glass of a closed shopfront. The inscription caught the last of the afternoon light:
Where knowledge and Quran are gathered
Then the sun dipped below the roofline. The door was in shadow.
Karim arrived at the hospital. He went to the maternity ward.
It was quiet. No crying. No monitors beeping. No nurses hurrying. The only sound was the hum of fluorescent lights and the distant squeak of shoes in the corridor.
He walked to the nursery. The cribs were stacked in the corner — three high, unused. The metal was cold to the touch. The bars cast shadows across the floor, long and thin like prison bars.
In the three cribs that held newborns, the babies slept or stirred. The nurses moved between them in soft-soled shoes, their voices hushed.
Karim walked to the window. The parking lot below was empty. The street was quiet. No families coming to visit. No fathers pacing. No grandparents waiting.
He checked the delivery log. This week’s deliveries: three.
Three deliveries in a week.
In 1987, when he had started, there had been seven deliveries a week. The ward had been full. The cribs had been full. The noise had been constant — crying, laughing, talking, living.
Now there were three per week.
He walked to the nearest crib. A newborn slept inside. A girl. Her name was Fatima. She had been born yesterday.
He looked at her face. The perfect features. The closed eyes. The tiny hands.
She was one of three.
He left the nursery. He walked to his office. He sat at his desk. The delivery log was open. The numbers were there. The evidence was clear.
The ward was quiet. The cribs were empty. The shadows stretched long across the floor.
He turned off the light.
That evening, Karim went home. Yasmine was there. She was sitting at the table, grading math exams. She didn’t look up when he entered.
Karim sat across from her. The apartment was quiet.
She marked a paper. She marked another. Then she noticed his silence.
She looked up. She didn’t ask about the Ministry visit. She didn’t ask about his father.
They ate without speaking.
Yasmine marked another paper. She looked up. Your brother called. He got the tourism license.
The partnership? Karim asked.
With the presidential cousin. Fifty-one percent for him, forty-nine for Omar. Omar was excited. He said it’s the opportunity of a lifetime.
After a long silence, Karim said one sentence: He’s proud of himself.
Yasmine put down her pen. She looked at him.
Your father?
Who else? Karim said. He’s proud of destroying the country.
Yasmine didn’t respond. She picked up her pen. She marked another paper.
The next morning, Yasmine stood before her class. The lycée classroom smelled of chalk dust and floor wax. Thirty faces looked back at her. Fifteen-year-olds. Algebra equations on the blackboard behind her.
She had graded papers until midnight. She had slept poorly. Karim’s face from the night before — the exhaustion, the grief — stayed with her.
Good morning, everyone, she said. Her voice was steadier than she expected.
Good morning, Madame, they chorused.
She walked to the blackboard. She picked up the chalk. She wrote the equation for the day:
2x + 3y = 7
Who can solve this? she asked.
Hands went up. Ines Ben Saleh — brilliant at mathematics, fifteen years old, already promised to a cousin in Sfax.
Yasmine called on Ines. Ines solved the equation in three steps. Perfect work.
Excellent, Yasmine said. Now. Who can tell me what this equation represents?
It’s a line, a boy said. In three-dimensional space.
Yes, Yasmine said. But what does it mean? In the real world? What problem would you solve with this equation?
The students were thinking. Yasmine looked at Ines. Her face had changed since September. She looked tired. Her uniform was clean but wrinkled, as if she’d been doing housework before school.
My father uses this, Ines said. For his business. Calculating costs.
Good example, Yasmine said. Equations help us understand relationships between variables. Between inputs and outputs. Between causes and effects.
She looked around the room. Thirty faces. Thirty futures. Some would continue their education. Some would drop out. Some would get married.
The equation shows us that when one variable increases, another must decrease, Yasmine said. To maintain balance.
She thought of Karim. The mother who died. The baby who would grow up without her.
There are trade-offs in life, she said. We can’t have everything we want. We have to choose.
She looked at Noura — brilliant, poor, needing to work after graduation. Yasmine had tried to help her. Had filled out scholarship forms. Had written recommendations.
But Noura’s family needed her to work. The equation was clear: education vs. survival.
Sometimes the equation is unfair, Yasmine said.
She looked at Ines again. Her mother was pregnant again. Her sixth child. Ines had told Yasmine about it last week. She hadn’t been happy about it.
Sometimes, Yasmine said, the variables are outside our control. We can choose our x, but someone else chooses our y.
She thought of her own equation. She and Karim. Five years of trying. No pregnancy. The doctors said it would happen. They said to be patient. But the equation wasn’t balancing.
Is something wrong, Madame? Noura asked. You seem… sad.
Yasmine looked at the class. Thirty faces waiting.
No, Yasmine said. I’m not sad. I’m thinking.
About what? Ines asked.
About choices, Yasmine said. About equations. About what happens when we can’t control all the variables.
She looked at the equation on the board. 2x + 3y = 7. If x was your career and y was your family… what values would you choose?
That’s enough for today, Yasmine said. Your homework is problems 1-20. Due tomorrow.
The students groaned. They gathered their books. They filed out of the classroom.
Yasmine stood at the window. She watched them leave. Ines and Noura walked together down the hall. Two brilliant girls. Two different equations.
Ines would marry the cousin. Noura would drop out to work. Both would solve the equations they’d been given.
The bell rang. Yasmine turned from the window. She picked up her chalk. She erased the equation.
The chalk dust drifted down. It settled on her sleeve, on her hands. White powder on the dark fabric.
She brushed it off. The equation was gone. But the class remained.
Five years later.
Karim came home late. The apartment was dark. The only light came from the streetlamp outside, filtering through the curtains.
He placed his bag on the table. He walked to the window. He looked out at the city. The traffic had died down. The streets were quiet.
He heard Yasmine behind him.
Hard day? she asked.
Karim didn’t turn around. Yes.
A difficult case?
Karim looked at his hands. Doctor-patient confidentiality. He couldn’t share the details.
But she understood anyway.
You don’t have to talk about it, she said.
He felt her presence before he felt her touch. She walked to him. She placed her hand on his back. Between his shoulder blades. Where the tension gathered.
I couldn’t save her, Karim said.
The mother?
Karim nodded.
Was it… Yasmine began. She didn’t finish the question.
Complications, Karim said. Hemorrhage. We tried everything. But she… she didn’t make it.
And the baby?
The baby survived, Karim said. A girl. Healthy.
That’s something, Yasmine said.
Is it? Karim asked. He turned to face her. The baby will grow up without a mother. How is that something?
Yasmine looked at her husband. She saw the exhaustion in his eyes. The weight. The grief.
I’m sorry, she said.
It happens, Karim said. It’s part of the job. You know that going in. Not everyone survives. Not every birth ends well.
But this one was hard, Yasmine said.
Yes, Karim said. This one was hard.
He walked to the sofa. He sat down. He leaned forward, elbows on his knees, head in his hands.
Yasmine went to the kitchen. She returned with two cups of tea. Mint tea. Hot. Sweet.
She placed one cup on the table next to him. She sat beside him. She picked up her own cup.
How was your day? Karim asked.
Yasmine was a math teacher at a lycée. She taught algebra and geometry to fifteen-year-olds.
Hard, she said.
The students?
The system, she said. I have a student. Samiya. She’s brilliant. She understands everything I teach. She could be an engineer. A scientist. Anything.
But?
But her family is poor, Yasmine said. They need her to work. After she graduates, she’ll have to drop out. Get a job. Support the family.
Can she get a scholarship? Karim asked.
I’ve been trying, Yasmine said. I’ve filled out the forms. I’ve written the recommendations. But the scholarships are limited. The competition is fierce. And…
And what?
And she’s a girl, Yasmine said. Some families don’t believe in educating girls past the basic level. They think she should get married instead.
Karim looked at the tea in his cup. His own patients. The women who couldn’t afford children. The families that pressured them. The poverty that made choice impossible.
The system is failing everyone, Karim said.
Yes, Yasmine said. But it fails the poor first. And it fails girls first.
They sat in silence. The tea cooled in their cups. The streetlamp outside cast long shadows across the floor.
I witness it too, Yasmine said.
I know, Karim said.
At school, she said. I see the bright students who can’t continue. I see the girls who are pulled out of school to get married. I see the families that are crushed by the economy.
And I see it at the hospital, Karim said. The women who can’t afford children. The families that are falling apart. The deliveries that keep declining.
They sat together. The darkness gathered around them. The silence stretched.
What are we going to do? Yasmine asked.
What can we do? Karim asked.
We can witness, she said. We can remember. We can… we can bear witness to what’s being lost.
That doesn’t change anything, Karim said.
No, Yasmine said. It doesn’t. But it’s something.
She reached across the space between them. She took his hand. Her fingers were warm. Her grip was firm.
We’re in this together, she said.
Karim looked at his wife. They had been married ten years. No children yet. They were trying. But the pregnancies… they weren’t happening.
I’m sorry, he said. About the baby. About us.
Don’t be, she said. What will be, will be. If we have children, we’ll love them. If we don’t, we’ll love each other.
But your parents, Karim said. My parents. They expect grandchildren.
Let them expect, Yasmine said. We don’t live for them. We live for us.
Karim felt the weight in his chest lighten. Just a little. Just enough.
I love you, he said.
I love you too, she said.
They sat together. The tea went cold. The darkness deepened. But they were together.
From the street below, the sound of a television drifted through the open window — a football match, the crowd roaring, then fading as the evening deepened.
End of Chapter 3