Access to abortion is far from certain in rural France

One Sunday in August 2022, Camille, 30, learned she was pregnant. On holiday in Gruissan, she asked a friend about the procedure to follow for an abortion. It is in the Tarn that she made an appointment, where her family lives. “I called family planning who offered me an appointment two weeks after my call”it also explains if the High Health Authority recommends an appointment within five days of the call.

Access to abortion, anything but obvious

The 30-year-old has experienced a succession of very destabilizing events linked in particular to the summer holidays of the services, but also to the lack of choice in rural areas. : “I called the abortion hotline and still had a very reassuring interlocutor who provided me with a list of liberal carers who practice medical abortion in Albi”. Only one responded positively, the others are on vacation. Camille then tells the galley to find a midwife to perform an ultrasound, but also a catastrophic blood test in Gruissan where she had to “Shouting in front of other patients that she was going to have an abortion” to explain his coming, even though he had a recipe.

The extent of these dysfunctions was realized by the deputy for Isère Marie-Noëlle Battistel by drafting an information report on access to abortion on behalf of the delegation for women’s rights of the National Assembly. “Honestly, before writing this report, I was like ‘what for? “because it was obvious to me that this works everywhere”she testifies. “My first surprise was seeing that abortion is far from certain. During the hearings, I realized that territorial inequality weighed heavily on non-access, but also that some doctors exercised the conscience clause. »

Disparities according to the territories

In the territories, some structures, such as Family Planning, are fundamental and act as a link between all the members of the medical network. “In Lozère, we are lucky to have liberal carers who make sure to take into account mobility problems, for example”, tell Lena Kumurdjian and Elsa Lescure, employees of Family Planning in Lozère (in EVARS status, i.e. a non-medical place). Previously, only the Mende hospital center, prefecture of the department, practiced medical or surgical abortions. But for two years the situation in this very rural area has improved with the arrival of liberal carers authorized to perform medical abortions. A local network that makes life easier for those concerned, especially as Family Planning can conduct psychosocial interviews and accompany minors to appointments.

“Access is very unequal on French territory”observes Marie-Noëlle Battistel. The report highlights dating delays that often penalize the most vulnerable women: “It is also linked to medical desertification, to young doctors who have no training and do not consider abortion a real problem”, says the deputy. For her, as long as abortion is considered a “separate” act, undervalued, her access cannot be guaranteed everywhere.

At Family Planning in Lozère, employees meet women “who constantly justify themselves” of their choice. Camille also felt guilty and found herself alone making arrangements for the appointment, which added stress: “Waiting for an appointment makes the process very difficult, especially when you are confident in your choice. For me, there has to be an element of urgency in abortion.”he claims.

“18% of metropolitan women have an abortion outside their home department”

A medical abortion can be performed up to five weeks of pregnancy in the city (or seven weeks of amenorrhea) and up to seven weeks in a health facility (or nine weeks of amenorrhea). Surgical abortion can be performed up to 14 weeks of pregnancy (i.e. sixteen weeks of amenorrhea) by the law of March 2, 2022*. Indeed, women therefore have the choice of method, but the report of the women’s rights delegation highlights the difficulties of access to surgical abortion in rural areas. : some patients are redirected to other departments, such as in Aveyron where instrumental abortion is not practiced at all. A study by DREES, published in 2020, indicates this “18% of metropolitan women have an abortion outside their home department”. If this choice can be explained by geographical proximity, or by a need for confidentiality, the lack of access to appointments and carers who perform the act also explain this fact. Furthermore, in Lozère, Elsa Lescure and Lena Kumurdjian notice a large gap between the methods and question the choice offered to women: there would be about 90% medical abortions to 10% surgical abortions.

Extension of the period of access to abortion to improve the situation of women in France

The report of the National Assembly also shows that every year between 3,000 and 4,000 women go abroad because they run out of time. Marie-Noëlle Battistel wants to conduct an evaluation mission to find out if the extension of the deadline has had a positive effect and allowed some women to stay in France. “The smallest grain of sand, sick leave, retirement or savings to be made, access to abortion becomes more complicated”, warns Dr. Brigitte Noale, an anesthetist at Orleans Regional Hospital in the report.

In rural areas, there are many grains of sand. But the deputy from Isère still hopes that the constitutionalisation of abortion, which will be discussed in the Senate in February, will put resources on the table. Even in Lozère the optimism of Family Planning employees is palpable, even if they denounce the “discrepancy between the improvement of access to abortion at the level of law against the reality of the means assigned to this right and the training of health professionals”.

*In France, there are between 225,000 and 230,000 abortions per year. In 2018, 69% of abortions were performed with medication.

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