How is abortion use evolving in France?

L’évolution démographique récente de la France 2023, an article published a few weeks ago in the INED journal Population (French edition), analyzes the most recent trends in recourse to abortion in France.

SUMMARY OF FINDINGS

232,000 abortions— voluntary terminations of pregnancy or VTPs (interruptions volontaires de grossesse or IVGs)—were done in France in 2022. After two years of stability, this marked a considerable rise compared to 216,000 in 2021. The ratio of abortions to births was 1 to 3 in 2022, as against 1 to 4 in 2017. Most abortions involved women aged 20 to 34, while within this range the highest rates are in the 25-29 age bracket. The increase in abortion numbers therefore concerns the highest-fertility age brackets.

Three-quarters of abortions in 2022 were medication abortions. Over the years, midwives have assumed an increasing role in VTPs conducted in the private sector. The healthcare facility or setting in which a VTP is done varies by age: while most (including many medication abortions) are done in hospitals, older women more often go to private-sector physicians or facilities, whereas 25- to 34-year-olds consult midwives and young people under 20 turn to public hospitals. 

In 2022, there were 232,000 abortions (Voluntary Termination of Pregnancy or VTP; IVG or Interruption Volontaire de Grossesse) in France, 216,000 of them in Metropolitan France. This was an increase after two years of lower figures: 215,000 in 2020 and 216,000 in 2021. While the decreases of 2020 and 2021 compared to 2019 (224,000) seem due to a fall in conceptions linked in turn to the COVID-19 health crisis—an effect likewise reflected in a decrease in births—the considerable rise observed for 2022 occurred as birth numbers have continued to fall. So while the abortion/birth ratio remained near 1 in 4 from the 1990s, it began to rise in 2017, reaching 1 VTP for 3 births in 2022.

Highest recourse to VTP between the ages of 25 and 29

VTPs in France are concentrated in the 20-34 age bracket, while within that range the highest rates are among women aged 25 to 29 . From 2019 to 2022, the rate in that group increased while decreasing among 25- to 19-year-olds (Figure 1). In other words, VTP use increased primarily among women at the earliest ages of motherhood and beyond. Two years of health crisis had led to a fall in conceptions (particularly during France’s first lockdown period, from March to May 2020) while the degraded socioeconomic context induced by the pandemic was still in place in 2022. It is highly likely that this last situation explains in part the increasing recourse to abortion at the most fertile ages: people may have turned more often to VTP in a period deemed not very promising for having a child. Additionally, in March 2022 the legal time limit for pregnancy termination in France was raised from 12 to 14 weeks—another explanation for the rise in abortions, though of lesser impact. The new law enabled later recourse to VTP; specifically, many women no longer had to go abroad for the procedure.

Abortion methods and healthcare facilities or settings that vary by age

A VTP can be done in a public hospital or clinic or, alternatively, in the private or non-hospital sector, i.e., in a GP’s, gynecologist’s, midwife’s office, or in a family planning clinic or community health center. 
In 2022, 38% of VTPs were medication abortions that took place in a private-sector or non-hospital setting; 40% were in-hospital medication abortions, while the remaining 22% were surgical procedures (Figure 2). Three-quarters were medication abortions, continuing a long-term trend of rising predominance for this technique. 
Moreover, 39% of private-sector or non-hospital abortions in 2022 were conducted by midwives—a proportion that has been rising since 2016, when members of this profession were authorized to perform them there. This in turn has played a role in the overall proportional increase in medication abortions. Only 6% of VTP procedures are done in private hospitals or clinics, attesting to the long-term reduction of abortion treatment in this particular type of facility. Conversely, 58% of VTP procedures are conducted in public hospitals—a figure that rises to 76% among 15- to 18-year-olds. Lastly, the proportion of surgical abortions is highest among the youngest (29% for 15- to 19-year-olds, compared to 15% among women aged 45 to 49); surgical abortions also concern what are, on average, longer pregnancies (Figures 2 and 3). Young people’s particularly high recourse to public hospital care can be explained by the fact that those institutions are more clearly identified generally/by people in this age bracket than private or non-hospital healthcare structures and offer greater anonymity than physicians’ offices, particularly those in which the women in question and/or their families receive healthcare on a regular basis.
The diversification of health professionals and healthcare facilities or settings allows for greater flexibility in responding to VTP demand. However, VTP services are not equally available throughout France or by age of the person seeking them—a situation especially true for the youngest age bracket. Access to information and to nearby health facilities is essential to ensure that people can receive abortions when they seek them and by way of their chosen method. In this respect, France’s public hospitals continue to be crucial for access to VTP, particularly for the very young. 

 

French VTP data

The data used are from the Système National des Données de Santé (SNDS), which groups together hospital data (PMSI) and private-sector or non-hospital data (CNAM). The SNDS accounts for 99% of the population in France and provides VTP numbers for procedures throughout France.

Figure 1

Reading: From 2019 to 2021, VTP rates fell 16 percentage points among 15- to 19-year-olds; they then rose 11 points in this age bracket from 2021 to 2022 while remaining below the 2019 level.
Definition: VTP rate is number of VTPs done during a given period in relation to the female population of reproductive age living in the same period.

Reading: In 2022, 42% of VTPs for women aged 20 were medication abortions conducted in public hospitals.

Reading: In 2022, 5.5% of medication VTPs done in the private or non-hospital sector were for women aged 26.

Source : Conjoncture démographique de l’Ined : Didier Breton, Nicolas Belliot, Magali Barbieri et al., 2023, L’évolution démographique récente de la France : Les comportements des femmes et des hommes sont-ils si différents ?, Population (édition française) 78: 1-68.