Abortion in France in 2022

On Friday, June 24, Supreme Court justices overturned federal Roe v. Wade has guaranteed the right to abortion in the United States since 1973. Now each state can independently prohibit abortion (voluntary termination of pregnancy, which consists of voluntarily terminating pregnancy, within a legal framework).

Thunderbolt in the sky of the freedom of women and in particular that of disposing of their bodies.

This thunderclap has, like many, led us to look into our own situation - in France - regarding abortion . We therefore sought to find out not if the grass was greener elsewhere (and obviously we are rather well off if we compare with the American situation), but what was the reality of this practice in our country, how abortion had evolved since the Veil law of 1975 ? Why, despite all efforts to facilitate abortion, access to it remained limited ? Finally, why does it remain relatively stable despite the spread of contraception ?

1. From 1975 to today: many developments to expand access to abortion

A. Initial conditions for abortion in 1975

In France, abortion has been authorized since the Veil law of January 17, 1975 and under the following initial conditions:

• the doctor and the nursing staff could refuse to perform the abortion

• the state of pregnancy must have placed the woman in a situation of distress

• parental authorization was compulsory for non-emancipated minors

• a reflection period of at least 7 days had to be respected before the abortion

• the legal deadline for abortion was 10 weeks of pregnancy

• Health insurance did not reimburse this act.

B. Developments to facilitate access to abortion

Today, after many developments:

• abortion is now accessible to minors, and parental consent is no longer required

• abortion and all examinations are fully covered by social security ( minors are even exempt from the advance fee)

• the establishment of the state of distress as well as the reflection period have been removed

• last but not least: the deadline has been extended to 14 weeks of pregnancy , i.e. 16 weeks after the 1st day of the last menstrual period for surgical abortion.

C. Before the abortion: two medical consultations

Access to abortion must nevertheless be preceded by 2 compulsory consultations which take place with a doctor or a midwife.

• The first consultation must allow you to get information and ask all your questions and/or if the health professional does not practice abortion, to be referred to a professional who does it.

• The second allows you to confirm your abortion request in writing and to choose, in consultation with the health professional, the method of abortion: medical or surgical , as well as the place of the intervention.

D. Medical abortion and surgical abortion

• The drug method has the advantage of being able to be organized by video, in particular by midwives, since it involves ingesting two drugs at 24/48 hour intervals to stop and expel the pregnancy. The deadline for medical abortion is 7 weeks of pregnancy.

• The surgical method , since it requires in particular anesthesia (general or local) to aspirate the egg, is most often practiced in the hospital. The deadline for the surgical method is 14 weeks of pregnancy (and reduced to 12 weeks of pregnancy in the event of local anesthesia).

The IVG gouv website allows you to find all the information you need to have an abortion and an anonymous and free green number is available: 0 800 08 11 11.

In both cases, it is a question of turning as soon as possible to a doctor or a midwife practicing abortion to be sure to respect the deadlines and to be able to choose your method.

*Pr Yves Ville, Head of the Maternity Department at Necker Hospital and member of the National Academy of Medicine, during his hearing by the Delegation on July 3, 2020

2. How to explain the persistent difficulties of access to abortion despite all these efforts?

Why, despite all the measures taken to guarantee access to abortion, is it still complicated to have an abortion in France?

A. Territorial inequalities and shortage of practitioners

In 2020, the question of access to abortion in France was the subject of a report highlighting what could limit its access and here are the most important elements:

• the disinterest of practitioners with regard to a medical act that is undervalued (therefore underpaid), and considered to be of little value

• the limited number of professionals who practice abortion despite the extension of the practice of abortion to midwives (most of them are activist practitioners from the previous generation preparing to retire)

• a very unequal access to care on the territory leading to extended delays and sometimes situations out of delay

• A significant number of closures of the number of anti-abortion centers : Family Planning estimates that, over the past fifteen years, 130 abortion centers have closed their doors . Le Monde, for its part, only lists 45 of them between 2007 and 2017. In any case, it is significant and it does not go in the direction of easy access to abortion.

• the conscience clause which in particular complicates the operational management of abortions.

B. Focus on the conscience clause

This last point was the subject of an entire episode dedicated to the subject in the (superb) podcast of France Culture LSD : "Abortion, the power of the doctor".

When one is a doctor, one can exercise, for any type of act, the conscience clause when one does not wish / cannot carry out a certain act or treatment authorized by law, for reasons which are specific to us ( no need for justification to invoke this clause). In the case of abortion and sterilization, there is a conscience clause specifically mentioned in the law which comes to re-specify this right and thus reinforce the effect of the first general clause, thus conferring on abortion a status apart from the acts carried out.

Thus, gradually, most of the initial restrictions linked to abortion have been removed except with regard to the (double) conscience clause specific to abortion, which has a very strong symbolic significance on the one hand, but which also greatly complicates the operational management of these acts. Listening to the podcast, we understand that it can be to try to develop a schedule according to the doctors who exercise their clause or not, the nurse anesthetists available or not etc... Note nevertheless that this clause has at least the merit of obliging the healthcare professional to redirect the patient to another professional practicing abortion and not to leave her untreated.

To conclude on this point, if abortion is legal in France, access to it is not easy or quick, and abortion can be much more complicated to implement in remote areas, where access to care is limited and the number of doctors practicing abortion even more. Finally, remember that the major problem remains the number of practitioners practicing this act: explained by the lack of interest in the act (little valued or remunerated) and/or by the exercise of the conscience clause.

3. Why abortion does not decrease despite contraception?

Among the many questions raised by abortion, one caught our attention; why despite the generalization of contraceptive methods, abortion remains stable? How to explain that contraception has not drastically reduced recourse to abortion? This is the question of the contraceptive paradox , which was also the subject of an episode of LSD, some elements of which we wanted to give you.

Indeed, the number of abortions has stabilized for the last 10 years between 200,000/230,0000 abortions per year. Two-thirds being carried out in the hospital (whose current difficulties are not recalled) by medication in the vast majority of cases (73% of cases in 2020 compared to 31% in 2001).

To explain this famous paradox to us, it is the sociologist-demographer Nathalie Bajos, researcher in public health, director of research at Inserm, head of the sexual health gender team, who shed light on our lantern. To shorten it ; two trends cancel each other out to keep the number of abortions stable :

1. The decrease in the number of unplanned pregnancies; largely made possible by the spread of contraception. So far it's clear.

2. The increase in the probability of resorting to abortion in the event of an unplanned pregnancy (about 60%): and this is where Nathalie Bajos enlightens us. The average age of first childbearing has risen from 25 to 30, this is what is called the reproductive norm. Basically today the procreative norm “wants” that we wait until we have finished our studies and be installed in a job to have a child, which brings us to around thirty . Which is 5 years later than the standards of the previous generation. Women are therefore exposed to a potential pregnancy for 5 more years, at a time in their lives when they are particularly fertile . Nathalie Bajos thus explains to us why abortions are stable and above all that they testify, for young women practicing an abortion during their twenties, to new standards of procreative norm. Interesting no?

She also reminds us that it is illusory to consider zero risk in the context of contraception, but also that the desire for motherhood is ambivalent, that it can change over time, sometimes also suddenly. Contraception is thus just as necessary as abortion and one cannot replace the other.

By way of conclusion, we will once again quote Nathalie Bajos, who recalls very simply in an interview of October 10, 2018 on France 3 that " what changes when abortion is not legalized is that women die of it ” and that “ more than 50,000 women die each year from clandestine abortions without counting the complications ”. The importance, of course, of continuing to preserve this right (we are thinking of our American colleagues) and of encouraging all initiatives to facilitate its access and smoothen its course, which is sometimes strewn with pitfalls, the main victims of which are, how often , the most vulnerable and the poorest .

Sources:

• 2020 Parliamentary Report

• The website ivg.gouv.fr

• The France Culture LSD podcast: "Abortion, the power of the doctor".