Getting an abortion in a “medical desert” (a region whose population has inadequate access to health care): a case where scarce supply reinforces physicians’ power

An article of yours was awarded the journal Population’s Early-Career Researcher Prize for this year, 2026. What was the subject?

Demography research has largely documented regional inequalities in access to abortion in France. Depending on the region, the distances women have to travel to get an abortion, together with abortion methods and the time period involved vary greatly. In my article I substantiate that finding by way of an ethnographic study that sheds light on the mechanisms that produce those inequalities—mechanisms that are often mistakenly considered logistic factors, such as maternity clinic closings, doctor shortages, and the supposed low “profitability” of abortion. In particular, I show the active role doctors play in producing “medical deserts.” Counting the number of health professionals present in a given region does not suffice to describe healthcare supply; you have to consider what those professionals will agree to do and how.

To account for those factors I conducted an ethnographic survey in a rural département, questioning nearly all professionals involved in conducting abortions in either a hospital or doctor’s office setting. I also spent a month at the abortion center of the département’s main city, observing how patients were processed from reception to the operating block—a research method that can be used to determine relations between a range of different levels: département organization of procedures and care, professional relations within hospital teams, and interaction with abortion patients during medical consultations.

One initial research finding is that access to voluntary abortion is limited not so much by a shortage of physicians as of doctors willing to do abortions. In the region studied, national abortion law is applied partially, unequally. Depending on the maternity service, women are permitted to have an abortion up to 7, 10, or 12 weeks of pregnancy, never up until France’s legal limit of 14 weeks. And they are almost never permitted to choose the method, despite the fact that this is a law-guaranteed right. These restrictions are due to gynecologists’ reluctance to perform an act they find repellant—an attitude that may be rooted in their professional, religious, and/or political socialization. Contrary to hospitals in France’s big cities, which have abortion specialist positions, in the country’s “medical deserts” there are no doctors available to take over for physicians who refuse to do abortions. Those physician’s disinclination turns a relative scarcity into a drastic reduction in treatment supply.

However, it is not enough simply to count the physicians who refuse; we also need to observe the practices of those who accept to do abortions. More than elsewhere, professionals in “medical deserts” tend to require repeated consultations and procedures that French law and health authorities do not require; e.g., systematic hospitalization, useless pre-op evaluations, and gynecological examinations. This overmedicalization increases the distances patients have to travel and considerably lengthens their medical trajectory. The surgical method is seldom presented to patients in consultation because there are not enough practitioners willing to use it or because of what are asserted to be risks—which may not be risks according to scientific information and data.

The article, above and beyond its focus on abortion, calls for understanding region-related healthcare disparities through the prism of patient-health professional power relations. The scarcity of medical care supply increases abortion patients’ dependence on their physicians, thereby reinforcing the latter’s power to oversee—and in some cases restrict—access to treatment and care. 

What does Population’s Early-Career Research Prize mean to you?

I’m very honored to have received the prize. I enjoy reading Population, and certain of the journal’s articles proved extremely useful to me in my PhD work. The prize is especially meaningful to me given that I conceived this qualitative-sociology article in close relation with demographic research on abortion. The existence of editorial spaces where social science methods and disciplines encounter and bolster each other around particular research subjects is precious. I see it as the sign that abortion has become a legitimate subject of research in the French social sciences, and I’m delighted about this development! 

What research projects are you planning to work on in the coming months?

My current research concerns types of medical violence other than gynecological-obstetric. The aim is to understand the relations of domination between health professionals and patients and how they in turn are related to attitudes around gender, class, race, and age that thereby expose patients to violence and discrimination to varying, unequal, degrees. I’m currently working on the first part of this project at INSERM, with funding from the ANRS [National Scientific Research Agency], by participating in analysis of the 2023 statistical survey “Sexuality contexts in France.”