Should the deadline for having an abortion be extended? Yes, according to two MPs who made a report pleading in favor of its lengthening on September 16, 2020. Interview with Mélanie Horoks, doctor at a family planning center to better understand the issues.
Extend the legal limit for having recourse to abortion, better regulate the conscience clause of doctors, improve communication on this practice … The proposals of this new report submitted to the National Assembly are numerous. According to a national public survey published on September 24, 2019, the abortion rate has never been so high since the early 1990s. Mélanie Horoks, doctor at the Maison's family planning center des femmes à Saint-Denis, gives us his analysis of this report, which intends to advocate “true freedom of choice”.
This extension had already been requested during confinement, but had been refused. What did you think of it?
We were very disappointed not to be heard. In the field, as doctors, we realized that women had great difficulty in going for an abortion during confinement. So we knew that more time would help women who could not have consulted in time. And this is something that has been confirmed, as there was an explosion of late requests as the lockdown ended.
Even outside the pandemic, what are the consequences of the legal 12-week limit?
We are faced with women who have very clear requests to terminate their pregnancy. They are in very diverse situations, but which mean that they could not make their request or be taken care of on time. It is very complicated because sometimes we find ourselves without an answer to give. We are mobilizing for them to make the medical interruption circuits for pregnancies work, but it is not easy, because there are still many places where we do not accept to receive them. So it concentrates requests on a small number of places.
There are many women who attempt abortion abroad when they are past the legal deadline. In Spain, for example, the legal limit is 14 weeks …
That's right, a lot of women are affected. But many don't go because they simply can't – they just can't afford it. And, in these cases, they are forced to continue their pregnancy. On the other hand, if you have the means, you have one more chance, as in many areas elsewhere … It is very unfair. Extending the legal limit would allow more women to be taken care of and meet demand. It would help a number of them, for whom the circuits are extremely complicated because they were not taken care of in time.
The report also recommends that midwives can perform surgical abortion. A good idea ?
In my opinion, trained and voluntary midwives can perform surgical abortions by suction if they wish. But what would still be important would be to focus on training gynecologists to perform abortion by aspiration under local anesthesia. When you are an obstetrician-gynecologist, very often you have never performed this act: procedures under general anesthesia, yes, but local, quite little. And this is annoying because it means that the offer under local anesthesia is not sufficiently developed in hospitals.
I am very disturbed by the fact that you can go to a gyneco-obstetrics internship without having been trained at all in local anesthesia. At the Maison des Femmes, we have interns and we realize that they learn to do general anesthesia, but local anesthesia, no.
The conscience clause is also called into question. According to your experience at the Maison des Femmes, what problems does it pose?
Even without talking about the conscience clause, we can already see many women who, before arriving here, had to deal with professionals who tried to discourage them, to make them feel guilty, who judged them because they had chose abortion. There is some pressure on these women. Regarding the conscience clause itself, this is a way of stigmatizing this act of abortion. In reality, no doctor is obligated to do anything, except to save someone's life. So it is not useful to specify that a doctor can refuse abortion, because everyone has their own practices and affinities … So why include it in the law? It is unnecessary and it supports the fact that there is reason to refuse to do so. On the other hand, all public hospital services should respect the obligation to organize this activity by not recruiting doctors who affirm this conscience clause.
In the meantime, we find ourselves in some hospitals where there is only one doctor on the whole team who agrees to have abortions. I'm not saying that all gynecologists should perform abortions. But when you work for the public service, when you are a public service manager, and when you train your team, you have to recruit people who do not have this conscience clause.
Overall, after reading the report, what do you think? Are you convinced?
There is too much of a tendency to insist with women who want to abort the risks of this act…. Oddly enough, there are not all these precautions with those who wish to reach the end of their pregnancy. Yet medically, childbirth is more risky than an abortion. We do not ask a pregnant woman who wants to go until the end of her pregnancy to sign a paper to certify that she has fully understood the risks. This is something you see on a daily basis. At the Maison des Femmes, we meet patients who arrive with the fear of having complications. Having an abortion is not always easy, but you don't have to…. There is no need to overdo it by putting misconceptions in women's heads about what they are risking by resorting to them.
A bill has been introduced. Do you think that in France, the lengthening will be voted one day?
I think we are moving, I have hope. This has already been refused once on the grounds of trying to get it through as an emergency during this time of crisis. But by working, debating and discussing, we can move forward.