Medically assisted human reproduction: Progress toward greater reproductive justice?

In 2023, 3.9% of births were due to these methods. This represents one in 25 babies, or approximately one child per school classroom. 

Since 1982 and the birth of the first French child to be born after in-vitro fertilization, the proportion of children conceived through ART has risen continuously and regularly. The pandemic year 2020 was an exception: ART centers were closed during France’s first lockdown period (mid-March to mid-May), leading to a fall in ART activity. 

ART is covered 100% by France’s national universal health system, up to six artificial insemination and four in-vitro fertilization (IVF) procedures for one pregnancy. This greatly facilitates access. Reimbursement data show that from 2007 to 2018, infertility treatments represented the greatest increase in ART use among people over 34. They also suggest the existence of sharp social disparities, characterized by lower levels of access to IVF and very early dropout from treatment programs, despite a legislative framework strongly favorable to ART access. 

Up until 2021, the legal access criteria were quite restrictive: candidates had to be living members of heterosexual couples of reproductive ages who had been medically certified infertile. That situation stood in sharp contrast to the situation in other EU countries, where assisted reproductive technology procedures were legal for everybody, regardless of their marital situation or whether they had a medical infertility problem.

This restricted access framework echoed the “reproductive norm” that socially defined who could have children and with whom and how and when. Once again, candidates had to part of a stable heterosexual couple, not too old and not too young, and the baby had to be conceived by that couple. People wanting a child but who did not satisfy these normative criteria were excluded from ART. Some simply gave up the plan to become parents, others implemented strategies for circumventing the law, including accessing assisted reproductive technology outside France. 

In 2021, France’s bioethics law was revised to make ART accessible to single women and lesbian couples. This also meant that medical infertility and strict gamete donor anonymity were no longer required. The aim of the changes was to reduce the disparity between social demand and the legislative framework and so limit the degree to which people turned to services abroad to meet their desire for a child, since making that choice was understood to carry both legal and health risks. 

The new version of the law did generate a more inclusive approach to the diversity of people’s parenthood projects. But scientific studies show that legislative changes are not enough for such inclusion to be effective; the infertility treatment system also has to be reorganized, particularly when it comes to gamete donation, and some thought must be given to deconstructing the dominant norm of “being a good mother.” In our AMPsf study, interviews with people who used ART bring to light disparities in gamete donation and treatment waiting periods by marital status, body weight, age, and race. Moreover, single women wishing to have a child through ART continue to encounter difficulties. 

Furthermore, surrogate gestation remains illegal in France, preventing male couples, women without a uterus, women whose uterus is not adequate for a pregnancy, and trans persons from becoming parents. 

This discrimination and these exclusions explain in part why inhabitants of France continue to turn to countries abroad for reproductive technology services despite the 2021 legislative revisions—with all the social disparities and difficulties associated with doing so. Research on this subject must continue and should use a participative approach, among others, that encompasses the advocacy groups and associations actively working to change practices and representations in the field.

Sources : 

Ben Messaoud Khaoula, Bouyer Jean, La Rochebrochard Elise (de), 2020, « Infertility treatment in France, 2008-2017: a challenge of growing treatment needs at older ages », American Journal of Public Health, 110(9), p. 1418-1420. DOI: 10.2105/AJPH.2020.305781. En libre accès.

Ben Messaoud Khaoula, Guibert Juliette, Bouyer Jean, La Rochebrochard Elise (de), 2023, « Strong social disparities in access to IVF/ICSI despite free cost of treatment: a French population-based nationwide cohort study ». BMC Women’s Health, 23, 621, 1-6. DOI: 10.1186/s12905-023-02784-4. En libre accès.

Ben Messaoud Khaoula, Bouyer Jean, Guibert Juliette, La Rochebrochard Elise (de), 2024, « The burden of very early dropout in infertility care: a nationwide population-based cohort study ». Human Reproduction, 39, 1, 102-107. DOI: 10.1093/humrep/dead226. Awarded article (Editor’s Choice). En libre accès. 

Bithorel Pierre-Louis, La Rochebrochard Elise (de), 2023, « The Covid-19 crisis and ART activity in France », Reproductive BioMedecine Online, vol 46, n°5, p. 877-80. DOI: 10.1016/j.rbmo.2023.02.004. En libre accès.

La Rochebrochard Elise (de), 2018, « One in thirty children in France conceived through assisted reproductive technology », Population et Societies, n°556, 4 pages. DOI : 10.3917/popsoc.556.0001. En libre accès.

Rozée Virginie, La Rochebrochard Elise (de), 2013, « Cross-border reproductive care among French patients: experiences in Greece, Spain and Belgium ». Human Reproduction, 28(11), p. 3103-3110. DOI: 10.1093/humrep/det326. En libre accès.

Rozée Virginie, La Rochebrochard Elise (de), 2021, « Assisted human reproduction outside the French legal and medical framework: issues and challenges », Population et Societies, n°593, 4 pages. DOI : 10.3917/popsoc.593.0001. En libre accès.

Rozée Virginie, La Rochebrochard Elise (de), 2023, « La PMA en France : une reproduction des inégalités de genre ? ». Travail, Genre et Société, n°50, p. 43-60. DOI : 10.3917/tgs.050.0043. En libre accès. [FR]

Rozée Virginie, Malmanche Hélène, 2023, « Pour être ‘seule aux manettes’ : parcours solo de la PMA en France ». Enfances Familles Générations, 44. En libre accès. [FR]