Fifty years after the Veil Act, INED reviews how abortion practices and rates have evolved over the last half century

Authors: Justine Chaput (INED, Université Paris 1, HED), Elodie Baril (INED), Magali Mazuy (INED)

For the 50th anniversary of the Veil Act, the French Institute for Demographic Studies (INED) has published an article in Population & Societies describing how access to abortion and abortion practices have evolved in France. It analyses key developments in modes of access to elective abortion, reveals considerable heterogeneity across the country, and examines recent trends.

A recent increase after a long period of stability 
After 3 decades of stability at around 220,000 per year, the number of elective abortions rose to 242,000 in 2023, and the ratio of abortions to births rose from 1 in 4 to 1 in 3. The extension of the time limit in 2022 has had little impact on abortion numbers, so this increase may reflect an increasing propensity to terminate pregnancy at a time of growing social and economic insecurity.

A broader range of abortion methods
Since the 1975 Veil Act, the legal framework of elective abortion has been progressively relaxed. Medication abortions, first available in 1988, now account for 80% of all abortions, of which half are managed outside a hospital setting. Since 2016, midwives have been authorized to manage medication abortions, and under the 2022 Gaillot Act their remit has been extended to include surgical abortions. This Act also extended the time limit for elective abortion to 14 weeks. However, access to these new forms of abortion provision depends on healthcare infrastructure that varies across the country. 

Large geographical variations in abortion rates
In 2023, there were 17 abortions per 1,000 women aged 15–49 in France, but with major disparities between regions. Abortion rates are higher in the Paris region, Provence-Alpes-Côte d’Azur and the overseas departments, but lower in Brittany and Pays de la Loire. These differences in ease of access to elective abortion and in the methods used are often linked to an unequal geographical distribution of healthcare professionals and facilities across the country.

Unequal access by method and setting
The choice and accessibility of abortion methods is strongly dependent on the availability of medical infrastructures. In 2023, non-hospital medication abortions represented 42% of abortions on average, with a share ranging between 81% in certain departments and just 4% in others. Surgical abortions in a hospital setting, while becoming less frequent, are still widely practised in certain departments (up to 49% of elective abortions). Despite the arrival of new abortion methods and care professionals, public hospitals are still the main abortion providers, with few private clinics now offering services of this kind.

Access to elective abortion reliant on continuous production and supply of abortion pills
With the growing use of medication abortion, the production and supply of abortion bills is a key concern. As abortion pills are supplied in France by a single private laboratory, access to elective abortion is exposed to risks of shortages and price variations liable to threaten supply continuity across the country. 

The importance of antenatal diagnosis centres (CPDPN) for therapeutic abortions
The Veil Act also defined the framework for ‘voluntary terminations of pregnancy for medical reasons’, known as TPMR. In 2023, there were 8,400 abortions of this kind, 5 per 10,000 women aged 15–49. TPMR rates varied substantially between departments, depending on the presence or not of a multidisciplinary antenatal diagnosis centre (CPDPN). In 2023, almost 6 in 10 departments had no CPDPN. While this does not mean that TPMRs were unavailable to women in these departments, geographical disparities suggest inequalities in access to TPMR services linked to the distance that must be travelled to reach them.

This INED study reveals the challenges of ensuring equitable access to abortion in France. While the ‘freedom’ to terminate a pregnancy was recently enshrined in the French Constitution, ease of access depends on the quality of infrastructure and the commitment of public players to reducing disparities. 

Published on: 27/11/2024