Has access to abortion been facilitated in France since the new law?

At a time when the United States is in danger of going back 50 years, in France, access to abortion has been improved. At least on paper… A subject discussed at the Pari(s) Santé Femmes conference held this Wednesday. The law concerning the right to voluntary termination of pregnancy was amended at the beginning of March 2022. Since the decree was published on March 3, 2022, three changes have affected the right to abortion in France, which can be performed at home or in the hospital, with medication or in the hospital with a surgical operation called “aspiration”*.

Midwives can now perform surgical abortions up to ten weeks of pregnancy. In addition, the deadline for performing a medical abortion on an outpatient basis, which had increased to seven weeks of pregnancy during the Covid crisis, has been made permanent. “It is one of the rare beneficial effects of the health crisis”, quips Joëlle Belaisch-Allart, head of the obstetrics gynecology and reproductive medicine department at Saint-Cloud hospital (Hauts-de-France) and president of the National College of French Gynecologists and Obstetricians (CNGOF).

“We had requests for abortions between 12 and 14 weeks”

It is above all another measure that has caused a lot of ink to flow: the maximum period for an abortion has increased from 12 to 14 weeks of pregnancy. At a time when we see this right threatened in large democracies like the United States, the CNGOF recalled its “unwavering support” for abortion. “This lengthening will facilitate the approach of some women, recognizes Joëlle Belaisch-Allart. No woman happily has an abortion. »

Before the law was passed, around 2,000 women went abroad to have an abortion after twelve weeks. Has this modification changed the situation? “We do not yet have national figures, but we have had requests for abortions between 12 and 14 weeks”, answers Geoffroy Robin, general secretary of the CNGOF and obstetrician in Lille. “But less than we thought,” adds Joëlle Belaisch-Allart.

Technical and organizational difficulties

This does not prevent some reluctance. “In the profession, this modification was received in a mixed way, summarizes Geoffroy Robin. Technically, surgical abortion at 14 weeks is more complex. The fetus is larger, the skull more compact. The cervix needs to be further dilated. “Which requires skills and time, in a context of chronic understaffing of caregivers…

“In general, the gesture takes 3 to 4 minutes for an abortion before 12 weeks and 20 minutes for an operation after 14 weeks”, specifies Cyril Huissoud, gynecologist in Lyon. This implies a different organization for the operating rooms… “We had to get in working order overnight, continues his colleague from Lille. It is even feared that certain professionals, in favor of abortion, will resign because they are not sufficiently trained. “An unverifiable fear, especially since these changes have not affected the conscience clause of doctors.

Increased risks for the patient

Second concern: “the extension of the maximum period does not mean that women have two more weeks to decide, nuance Geoffroy Robin. It is important to favor treatment as early as possible. “Because the risks increase as the pregnancy progresses. “Since we are going to dilate the cervix more, it is likely to increase the risk of miscarriages for future pregnancies”, insists Cyril Huissoud.

Important clarification: for a medical termination of pregnancy (if the life of the mother is in danger in particular), which can be carried out up to nine months, drugs will be used. Some gynecologists therefore wonder about the possibility of promoting medical abortion between 12 and 14 weeks, provided that it is carried out in the hospital and not at home. “But it’s not so pleasant for the patients, nuance the president of the CNGOF. The ideal is that they have a choice. »

A glaring lack of resources in maternity wards

But the greatest concern of these women’s health professionals concerns the means allocated to abortion. “We do not think that the right to abortion is called into question in our country, but our certainty is that our maternities are in danger”, warns Cyril Huissand. However, all surgical abortions and some of those carried out with medication are carried out in these maternities. Some close permanently, others every other day, some are sorely lacking in midwives…

“Giving two more weeks is not going to facilitate access to abortion,” warns the president of the CNGOF. Today, as soon as there is a shortage of personnel in the maternity ward, we take paramedics or block slots for abortions. It is essential to give us more resources. In addition, a study revealed that 70% of women who were going to have an abortion abroad beyond fourteen weeks because they discovered too late that they were pregnant. It is difficult to say, with only two months of hindsight, if this modification amounts to a revolution.

For these gynecologists, in any case, the French State cannot stop at this modification of the law. “The most important thing would be above all to facilitate early access to abortion centers throughout the country,” continues Geoffroy Robin. Especially in medical deserts. But the work must be done further upstream. And this doctor to list: “Prevention should be optimized with information on very young emotional and sexual life, improved access to contraception, research on new, safe and effective contraceptive methods…”

* There is a green number on abortion: 0800 08 11 11.