The changes in the law concerning abortions were published in the Journal Officiel of the French Republic on July 7, 2001. Essentially, the following two points were revised: (1) the legal period during which an abortion can be performed was extended from 10 to 12 weeks (as in the majority of other European countries), and (2) for non-emancipated minors (girls under 18 years old), parental consent or that of the Children’s Court was obligatory. Now, consent of a person holding parental authority or, otherwise, of a legal representative (named by the court) is obtained by the physician. If the minor wishes to maintain confidentiality, the doctor must make every effort to obtain her consent to have the holder(s) of parental authority consulted. If the minor does not want to undertake this step or if consent is not obtained, abortions as well as related medical acts and treatments can be performed at the request of the young woman. In this case, the minor must be accompanied in these undertakings by an adult of her choice who is called the ‘referent adult’. After the intervention, proposal of a second consultation is mandatory, with the primary objective being to provide new information on contraception.
Worldwide, 10% of the 50 million abortions performed annually concern adolescents 15–19 years old.
Abortion techniques for minors are strictly the same as for older women; that is to say, drug-induced before 5 weeks of gestation and thereafter by aspiration, usually under general anesthesia and only rarely with local anesthesia for this age group.
In our Seine-Saint-Denis study, 46% of the abortions were drug-induced, which indicates that the adolescents had consulted very early, as soon as they had realized they were pregnant and their determination was firmly established.
This investigation raised two disturbing points. First, the high rate of repeat abortions in our population, i.e., 12%, especially for 16- and 17-year-olds, most of whom were of French nationality. Concerning the general population, Kaminski et al. published data showing that women undergoing multiple abortions were remarkable by their younger age at the time of the first pregnancy and that the risk of repeating is clearly higher for a first pregnancy before 20 years of age. Second, we observed that 71% of the adolescents had not used any form of contraception during the 3 months preceding the request for an abortion. Only 5% of the conceptions occurred after forgetting to take a contraceptive pill and 24% arose after highly random contraception, condom or withdrawal, practiced very irregularly. A certain number had previously used a contraceptive method but had let it fall to the wayside; this observation is counterbalanced by the irregularity and unprogrammed nature of sexual relationships in this age group.
These two points clearly show that a certain number of sexually active teenagers continue to use abortion as a means of contraception. The transmission of the double message: ‘pill and condom’, disseminated by national campaigns for contraception, has evidently failed. Nonetheless, it must be emphasized that a number of steps have been taken to facilitate access to contraception for minors in France. First, parental or representative consent is not required for the prescription, delivery or administration of contraceptives to minors. Contraception can be obtained free of charge and anonymously in approved family planning and education centers. Second, a medical prescription is not needed for the delivery of emergency contraception to minors and it can be obtained free of charge in pharmacies. The cost of dispensing morning-after pills is covered by the public health organization, Fonds National de Prévention, d’Education et d’Information Sanitaires (July 2001 decree). Lastly, if a doctor or planning center is not readily available, emergency contraception can be dispensed to minors and adults in second-degree facilities, by the school nurse for example.
They assure the psychological support of the student and supervise the programming of medical follow-up. All these recently revised measures attempt by law to prevent as well as lower the number of unwanted pregnancies in France, which is estimated to be 10,000 per year.
Revision date: July 4, 2011
Last revised: by Jorge P. Ribeiro, MD