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Introduction: Worldwide, single mothers are considered a vulnerable group in the society. This vulnerability draws on multiple factors and it is reflected in different aspects of women's social, economic and health status depending on the context. In Tunisia, single mothers suffer from social stigmatization and socio-economic marginalization. There are few studies that have explored the social aspects of single motherhood in Tunisia, but, to the authors’ knowledge, the experiences of single mothers with the maternal health services facilities have not been explored yet. The general aim of this study is to explore the childbirth experiences of single mothers at the public health facilities in Tunisia.

Methods: The thesis follows a qualitative design. In collaboration with non-governmental organizations in Tunisia, 11 single mothers were interviewed in regard to their experiences with maternal health care services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by these women in accessing adequate maternal health care services, and their self-perceptions as single mothers. The data was analyzed using an inductive thematic approach to generate codes. The development of themes was guided by a theoretical framework that connects the gender relational theory and the intersectional approach.

Results: Three themes emerged during the data analysis. The first theme "Health systems disciplines single mothers" describes the relation between the single mothers and the maternal health care providers. The majority of the participants were subjected to discriminatory practices, neglect and even violence inflicted by the maternal health care providers. Few of the participants described positive childbirth experiences that are considered as signs of resistance. The second theme "If a woman makes a mistakes once. She has to pay for the rest of her life" reflects the self-perceptions of the participants as single mothers. The participants' self-perceptions are multifaceted: they are overwhelmed mothers living with a persistent feeling of guilt, and they are also challenging and determined mothers. The last theme "The trilogy of vulnerability" includes: the social stigmatization and the socio-economic marginalization experienced by the participants as single mothers, and the situation of the health system described as crumbling by the participants.

Conclusion: The study highlights that childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal health care services at the public health facilities in Tunisia. Those experiences reflect how the health system translate in its practices the discrimination and stigma culturally associated with single motherhood in this setting. Social discrimination and stigma did not only affect how single mother were treated during the childbirth, but also how they perceived themselves. Thus, ensuring women's right to dignified, respectful health care during childbirth requires tackling the underlying causes of women's marginalization and discrimination in many settings where women face the contingency of multiple social inequities.