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.

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.

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.