How has the use of abortion evolved, fifty years after the approval of the Veil law?

Fifty years ago, on November 29, 1974, the National Assembly adopted, after long hours of debate, the law that authorized the voluntary interruption of pregnancy (abortion). This text, written by Simone Veil, then Minister of Health, marked a decisive turning point in the social and political history of the country, allowing women to exercise a fundamental right over their body and their future. Since that day, the use of abortion has experienced important advances, both legislatively and socially. Five decades after the approval of this emblematic law, abortion, its access methods and mentalities have changed profoundly.

A recent rise after long stability

Just after the approval of the Veil law, the number of abortions progressively decreased thanks to the generalization of contraception, before stabilizing in the early 1990s. Until 2021, the annual average of these voluntary terminations of pregnancy will remain between 205,000 and 215,000. The years 2022 and 2023 marked an increase, with almost 242,000 abortions in 2023, of which 227,400 in mainland France, according to the Department of Research, Studies, Evaluation and Statistics (Drees).

The proportion has gone from approximately 1 voluntary termination of pregnancy per 4 births to 1 per 3. With the same number of pregnancies, women increasingly make the decision to abort. How can this recent increase be explained? Magali Mazuy and Justine Chaput, two of the three authors of the latest report from the National Institute of Demographic Studies (INED) on the subject, affirm that “We are in a period of change in reproductive norms: marriage and procreation are no longer fundamental rules for the couple”. This effect is also noticeable in the number of annual births, which have continued to decline since the last peak in 2010.

At the same time, career has been occupying an increasingly important place in women’s lives, delaying the average age of arrival of the first child: in 2021, in France, women gave birth to their first child at 29 years and a month on average. , according to the INED, or five years later than in 1974. This dynamic is accompanied by a growing distrust of hormonal contraceptives, such as the pill, in favor of the copper IUD or contraceptives. Natural, less effective.

Other hypotheses may explain the increase in abortions, according to Sophie Gaudu, co-founder of the Orthogenic City-Hospital Network (Revho), which lists establishments that perform abortions and offers training on this topic to health professionals. “The fall in purchasing power, the real estate crisis, the geopolitical context with the war in Ukraine and the conflict between Hamas and Israel, the difficulties in finding work constitute obstacles for a maternity project”explains the obstetrician-gynecologist.

This increase does not only affect France. The Netherlands saw a 10% increase in terminated pregnancies between 2022 and 2023. The same story in the United Kingdom, where a 17% increase was recorded between 2021 and 2022. All explanations point to financial insecurity growing in Europe.

The introduction of the medicinal method disrupts practices

Since the promulgation of the Veil Law on January 17, 1975, the framework for recourse to abortion has expanded considerably. Originally only surgical abortions were possible and had to be performed in a hospital setting. This procedure consisted of removing the embryo or fetus from the uterus by aspiration or curettage. In 1989, less invasive medical abortion was introduced, allowing the termination of pregnancy through medication, first in hospitals and then, in 2001, in community medicine clinics (gynecologists and general practitioners). In 2016, a decree expanded the practice of medical abortion to midwives and, recently, in 2023, the possibility of performing surgical abortions under conditions.

This change in legislation led to the generalization of medical abortion in France. “This technique allows earlier treatment of abortions and can be performed in many more places than instrumental abortion, which can only be performed in hospitals”explains Justine Chaput, INED researcher. The medicinal technique represented 79% of practices in terms of abortion in 2023, compared to only 31% in 2001. This increase was particularly spectacular outside healthcare facilities (hospitals, clinics), as it more than doubled between 2014 and 2023, as shown in the chart below.

“This diversification is good news because it facilitates access to abortion for women, but the continuous advance of medical technology hides a worrying reality”says Sophie Gaudut.

According to her, this practice raises two main problems. First of all, the surgical technique requires qualified personnel, adequate equipment and hospital infrastructure. However, given financial limitations, these resources are often insufficient and increasingly difficult to mobilize, while the use of this technique can sometimes be essential. An opinion shared by Justine Chaput: “The two methods cannot do without each other, because they provide answers to different situations, such as late abortions. » On the other hand, a possible shortage of two essential abortion medications, mifepristone and misoprostol, whose production is ensured by a single group, Nordic Pharma, would make access to abortion impossible, as the medication route becomes democratized.

The private sector disengages

“Although out-of-facility care is increasingly important, the public hospital remains the main place where abortions are performed, while private facilities have almost abandoned care”INED researchers detail. This disengagement from private hospitals and clinics is visible in the figures. Their participation in the abortion process increased from 35.5% in 1976 to 13.8% in 2015 and 4.5% in 2023, according to figures available in the INED abortion statistical directories.

This phenomenon is mainly due to low reimbursement rates for abortion-related procedures, which is pushing more and more private facilities to reduce their offering. “Despite the 25% increase in prices paid to health establishments desired by Aurélien Rousseau [alors ministre de la santé et de la prévention] At the end of 2023, revenues are still lower than the costs incurred”argues Sophie Gaudu.

On March 8, 2024, France became the first country in the world to recognize in its Constitution the freedom to resort to abortion. Despite this strong symbolic protection, inequalities of access persist depending on the department and thousands of women have to resort to abortion outside their department of residence.