In 1962, the Tunisian government introduced the first family planning program in Africa, a program that expanded nationally by the mid-1960s. The legalization of abortion soon followed – first in a limited way in 1965 and then, in 1973, the Penal Code was amended such that abortion became legal, without restriction as to reason, marital status, or age, throughout the first trimester of pregnancy. From its inception, midwives were fully integrated into the national family planning program. Initially, the Tunisian government recruited and trained traditional birth attendants to both support and care for women’s primary reproductive health needs. As professional midwifery training programs expanded throughout the country, the scope of practice of these highly qualified health service providers evolved to include the insertion and removal of intrauterine devices and the provision of first trimester abortion care. Midwives also actively participated in the clinical trials dedicated to both emergency contraception and medication abortion and thus championed the incorporation of new and emerging reproductive technologies into the public health sector. Drawing from primary fieldwork conducted over the last 20 years, this paper chronicles the journey of midwives in the national family planning program in Tunisia. I argue that the recognition and incorporation of traditional birth attendants into the health system in the wake of independence set the stage for a more team-oriented approach to the provision of reproductive health services that resulted in task-shifting in later phases of the program. Further, women’s leadership in the development of the national family planning program and the liberalization of the abortion law proved critical in recognizing the importance of women health care providers, and midwives in particular, in addressing comprehensive reproductive health needs at the individual and community level. Finally, the inclusion of midwives in interventional studies not only allowed the national family planning program to evolve and grow but established some of the best evidence in the region that midwives can provide contraception and abortion care that is at least as good, if not better, than the care provided by physicians. Tunisia’s experience offers important lessons for how midwives could be integrated in ongoing efforts throughout the region to increase access to both contraceptive and safe abortion services.