PIP: Gynecologist Dr. Sami Ben Ghachem has practiced at the Regional Hospital of Beja, Tunisia, for 20 years. The first tubal ligation had already been performed before the creation of the National Office of the Family and Population and the official launching of the family planning program. 500-600 minilaparotomies were performed per year. The first laparoscopy was performed in 1976, and in 1977 a record 1152 tubal ligations were performed. Some 23,200 women have now undergone the procedure, out of a population of around 70,000 fertile-aged women in the governorate. Along with the IUD, sterilization has contributed to the achievement of one of the lowest natural increase rates in Tunisia, 1.18%, compared to the national average of 1.70%. Sterilization and IUDs have been the appropriate methods for the largely rural population. As the region becomes more developed and educational standards rise, the demand for different maternal-child health services also rises. An integrated approach has been followed at the Regional Hospital. An infertility service allowed the program to gain the confidence of the population. The hospital has participated in several training programs with Johns Hopkins University and has provided training in tubal ligation. The number of births declined from 8651 in 1981 to 5600 in 1996 in the governorate of Beja, a decline of about 30%. The regional hospital has been provided facilities for ultrasound and is expected to offer mammography in the near future. In early 1998, the governorate of Beja will have a new maternity hospital with a neonatology clinic that will allow it to become a referral center for all the governorates in northwest Tunisia.