If the right to abortion has been gradually strengthened since the Veil law of 1975, in practice, obstacles persist, making access unequal in the territory.
” Just this morning, I made an adverse event sheet: the patient in front of me needed an instrumental abortion but there was no time slot possible for three weeks. Claire Wolker-Jarfaut is a midwife at the Simone-Veil hospital in Troyes, in the east of France, which performs nearly 700 abortions per year. “ Our four places in the block next week have been removed, she continues, and the following week, the operator has a conscience clause: he does not perform abortions beyond ten weeks of amenorrhea*. The patient will then be at eleven weeks.
This situation described by Claire Wolker-Jarfaut is not exceptional. In a global context of deterioration of the health system, “ abortion is the adjustment variable “, emphasizes the practitioner, and respond to the demand for care” a constant struggle “facing an act that still remains in 2023” taboo », « guilt-ridden “.
“ On a continuous basis, French laws are moving in the direction of facilitating access to care, tempers Sophie Gaudu, co-founder of the REVHO which lists the structures that perform abortions : extension of the deadlines, coverage by Social Security, abolition of parental authorization for minors, of the reflection period, development of teleconsultation, etc. »
But, if professionals welcome all the progress made on paper since the Veil law, on the ground, they note that access to abortion in France remains “ fragile », « far from perfect “. Closures of abortion centers linked to hospital restructuring, lack of resources, staff, ideological resistance… The latest study carried out by the Research Department for Evaluation Studies and Statistics (DREES) in 2022 pointed to unequal access according to the profile , the place of residence and the social level of women.
What the law says ?
The Veil law of January 17, 1975 temporarily authorizes voluntary abortion. It is definitively legalized on December 31, 1979 until the tenth week of pregnancy (ie the twelfth week of amenorrhea).
The legal period was extended to twelve weeks in 2001. Abortion has been 100% covered by Health Insurance since 2013, all the acts necessary for its realization since 2016. The medical technique was authorized in 1989 in hospital environment then extended to city medicine in 2004 and to family planning and education centers (CPEF) in 2007. The 2016 health system modernization law authorizes midwives to perform medical abortions and abolishes the Mandatory seven-day reflection period between the first and second medical consultation.
The law of March 2, 2022 aimed at strengthening the right to abortion extends the period for an abortion until the fourteenth week of pregnancy. It also perpetuates the extension of the period for recourse to medical abortion in the city up to seven weeks of pregnancy, introduced during the health crisis linked to Covid-19. The practice of surgical abortions is extended to midwives. The two-day reflection period after a psychosocial interview is abolished. It is now compulsory only for non-emancipated minor women.
However, since the beginning of the 2000s, the use of abortion has been more or less stable. : in 2021, 223,300 abortions have been recorded in France, with a rate of recourse which remains at 14.9 per 1,000 women aged 15 to 49 on average, but which rises to 29.5 per 1,000 in the overseas departments and regions (Drom). The Research Department for Evaluation Studies and Statistics (DREES) also noted in a study last September that recourse continues to decrease among the youngest.
Complex access beyond 12 weeks
With in particular the authorization now of abortion until the fourteenth week of pregnancy (16ᵉ weeks of amenorrhea, SA), against twelve previously, the Gaillot law of 2022 has further strengthened the right to abortion and removed the obstacles to its access. The Ministry of Health and the Directorate General for Healthcare (DGOS) launched in the spring the realization of an inventory but the results are not yet known.
The problem is that in reality, it is not always applied. For now, some structures do not perform abortions beyond twelve weeks of pregnancy. “ Some of the professionals have not yet taken the step of practicing these interruptions between 14 and 16 SA, recognizes Nathalie Trignol-Viguier, general practitioner in Tours and president of the National Association of Centers for Termination of Pregnancy and Contraception (OLD). This means that some women, even if the legislation allows it, have difficulty finding a center that takes care of them. »
In the Center region – Val-de-Loire, only three health establishments allow abortion to be performed between 12 and 14 weeks of pregnancy out of the 17 eligible, specifies Nathalie Trignol-Viguier. ” We set up a project with the ARS (Regional Health Agency) and the perinatal center to guarantee equal access to care for all women thanks to local structures. Clearly, a network of the territory has been established to identify referring professionals everywhere who will be able to provide the two appointments prior to the abortion. A way to limit travel, the cost and the complications that this can cause for those who need it.
The practitioner remains optimistic, like the co-founder of REVHO. ” According to our estimates, abortions beyond 14 WA should concern between 1 and 2% of all abortions, therefore between 1,000 and 2,000. We will know more when we have the official data, but one year after the vote of the law, more than a thousand abortions had been carried out. Even if it’s not perfect, it shows that doctors have given themselves the means to get started “says Sophie Gaudu. In 2005, the obstetrician-gynecologist founded the first diploma devoted specifically to issues of contraception and abortion when these issues were almost non-existent in the course of medical studies. For her, training is the key: “ It is necessary to support, to train globally, so that the doctors understand that this gesture, certainly very simply technically, can save the life of women and their future. »
Supporting midwives
The law of 2022 also planned to open up to midwives the possibility of performing instrumental abortions. A way to strengthen the supply of care. In recent years, their place in the management of women’s sexual health has become central. Since 2016, they were already authorized to perform medical abortions. But for the moment, only 26 health establishments have been authorized to set up this device as part of an experiment. A slowness in the implementation which also reveals the weight of corporatism. The arrival of midwives in the theater is not always well received.
The generalization of the device is announced ” by the end of 2023 by the ministry. ” But we already know the advantages “, according to Claire Wolker-Jarfaut, who is also co-president of the National Association of Orthogenist Midwives (ANSFO). She herself is in training to perform instrumental abortions: “ At home, as elsewhere, we have great difficulty every week in scheduling instrumental abortions due to a lack of operators. “. In his hospital, out of twelve gynecologists, four perform abortions up to fourteen weeks, as provided by law ; two do not do so at all, and the others have conscience clauses which extend from ten weeks. In France, abortion is subject to a specific conscience clause, in addition to that contained in the code of ethics for doctors. This stipulates that a doctor is never required to carry out a voluntary termination of pregnancy but must immediately inform the person concerned of his refusal and immediately communicate to her the names of practitioners likely to carry out this intervention “. And the difficulties are even greater during the summer holidays or the end-of-year celebrations. ” When we are trained, we will enter the pool of operators and we will be able to schedule abortions up to 16 SA, as the laws of the Republic provide. “, she concludes.
A way perhaps also to guarantee the choice in the manner of abortion. According to the DREES, in 2021, 76% of abortions were performed by medical method, compared to 31% in 2000. But this inversion of the curves reflects more the reduction in the supply of care in instrumental abortion than the choice of patients, underline the professionals.
Constitutionalizing abortion, a symbolic guarantee
The original text of the law of March 2, 2022 provided for the deletion of this clause but this provision was withdrawn during the second reading in the National Assembly. A regret for Albane Gaillot, author of the text. ” It is an important ideological symbol and it is a fight that remains to be waged because this double conscience clause still makes it a separate act. », Estimates the ex-MP, now in charge of advocacy for Family Planning. ” People often think that because it’s written into the law, it’s simple, there are no difficulties, but we see on a daily basis that abortion is still an obstacle course “, insists Sarah Durocher, the president of Family Planning.
The activist also recalls that the attacks against this right are still topical. Witness the anti-abortion campaign on Vélib’ in Paris claimed at the end of May by a group called “Les Survivors”: thousands of stickers had been discovered on self-service bicycles. Recently, in the regions, Family Planning premises have also been the target of degradation.
Actions that recall for the signatories of a forum published on June 1 in the daily Release and titled ” Those who think that abortion is not threatened in France must open their eyes »“ the urgency of including this right in the French Constitution “. Since the revocation by the American Supreme Court of the judgment which guaranteed the right to abortion at the federal level, the idea has gained ground in France. A bill was passed in the Assembly and then in the Senate, although in a modified version. On March 8, during the tribute to Gisèle Halimi, Emmanuel Macron promised “ a bill prepared in the coming months “. One way, hammered the president, “ to solemnly assure that nothing can hinder or undo what will thus be irreversible “. But since then, nothing. And impatience is felt. In everyday life West Franceit is the Vice-President of the Senate, Laurence Rossignol, Senator EELV, Mélanie Vogel and LFI MP Mathilde Panot who call on the Head of State to “ stop procrastinating “.
” Constitutionalization would be an additional guarantee, believes the former MP Albane Gaillot: Of course, it’s a symbol, but we need it to tell women in France, but also around the world, that this right is fundamental. »
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*The legal threshold for performing an abortion can be calculated in weeks of pregnancy or in weeks of amenorrhea (WA), that is to say from the first day of the last menstrual period, which corresponds to approximately two weeks before the date of pregnancy.