In Toulouse, French Family Planning Can’t Keep Up

TOULOUSE, France (WOMENSENEWS)–France has one of the most progressive provisions on abortion and access to contraception in the European Union, but women outside the capital city and those in rural areas still hit plenty of rough patches when they attempt to access the procedure.

In some places it can take as long as three weeks to schedule an abortion; even longer in summer months.

In Toulouse, for example, the fourth largest city in France, where nearly 4,000 abortions are performed each year, members of the Family Planning association–which defends rights to abortion, contraception and provides sexual health education–described some obstacles.

While the mandatory waiting time period for an abortion in France after the first consultation is seven days, women can end up waiting between two and three weeks before the second and final consultation leading to the procedure. Some women wait more than a month in July and August, when doctors are on vacation.

Minors and women who do not wish to tell others about their pregnancy are the first to suffer from long waiting periods, said a staffer at the Family Planning association in Toulouse, who asked not to be named. “It becomes hard to hide a pregnancy and stay anonymous if you have to wait more than a month [for an abortion] and when you have to deal with all the medical complications and symptoms of pregnancy,” she said.

Meanwhile, funding for the Family Planning association–which provides counseling at all its sites and abortions at some–is a matter of political flux.

In 2009, after announcing a drastic funding cut (about 1 million euros out of 2.6 million), the French government had to backpedal in the face of national outcry. But today, the association, which also receives money from local governments, has complained about not receiving the money promised by the national government.

Here in Toulouse, the association has just one 430-square-foot office, open only four hours a day, to serve the entire area of Haute Garonne, which has a population of over 1 million spread over a large swath of Southwest France.

Bigger Office, More Hours Needed

A social worker at the Toulouse center who declined to be identified said it needs more hours and a bigger office to meet the needs of all the women it is supposed to serve.

Among the resources she wishes they had: a van to act as a mobile consultation center for women in the remote areas and villages of Haute Garonne. The privacy of such a service, she and the other staff member both said, is key to true abortion access.

“When you live in rural areas, it is hard to stay anonymous if you want to have an abortion or get contraception,” the social worker said. “Most likely, you will end up going to your family practitioner, who is the only doctor in the village, and also to the only pharmacist.”

This center, like 150 other Family Planning centers in France, only offers counseling (no doctors or midwives are on staff to help with consultation and medical abortion). While the association is comparable to Planned Parenthood in some ways, it has no facilities for surgical abortions. Only 29 of its centers in France provide medical consultation, prescribe contraception and perform medical abortions.

Medical abortions count for more than half of the abortions performed in France, according to the country’s Directorate for Research, Studies, Assessment and Statistics.

All surgical abortions in France have to be performed at clinics or hospitals, where waiting times and appointment scheduling can vary greatly.

While some will guarantee a maximum waiting period of one week for an appointment, others simply shut off appointments if they get overwhelmed by demand. Recently, a hospital in Toulouse stopped scheduling consultations until one of their few midwives resumed work after a sick leave, a Family Planning association staffer said.

Women who are near the 12 weeks of pregnancy must be given priority for an abortion. But it’s not unheard of for women, after facing scheduling delays, to miss that time limit and either carry an unwanted pregnancy to term or travel to another country that has a longer time limit.

Additional Limitations

Another limitation to abortion access is that some doctors may invoke a conscience clause to refuse to perform the procedure, though they must find another doctor to perform the abortion if they do so.

A staffer at the Family Planning association in Toulouse added that women’s access to information about reproductive health can be highly inconsistent, which means some women lose time because they don’t quickly get the correct information. “By the time some women arrive to the Family Planning, they have already lost between 15 and 21 days,” the staffer said.

Long waiting periods are tied to other problems. Over the past few years abortion centers have been closing and France’s supply of gynecologists overall is dwindling. At the same time, anti-choice activists are becoming wealthier and better organized in France and Europe.

Over the last 10 years, about 180 abortion centers throughout the country have closed due to budget cuts and restructurings of facilities, according to the French Directorate for Research, Studies, Assessment and Statistics.

In 2013, 564 health facilities were allowed to perform abortion in France, according to the Ministry of Health. That’s down from 624 in 2007 and 729 in 2000, marking a steady down turn.

In France gynecologists can perform abortions, as can general practitioners who have agreements with an abortion center and have been trained to perform the procedure. Midwives may also be able to perform the procedure under the supervision of a doctor.

But France is losing obstetricians and gynecologists. Today there are barely 1,500 doctors with the combined credential of ob-gyn and 1,356 gynecologists, according to the French National Council of Physicians, and the average age of these specialists is 60. In 2010 those figures were 1,952 ob-gyns and 1,648 gynecologists.

Part of the pressure on abortion providers comes from hospital finances. Since abortion units are not very lucrative, public hospitals may move to shutter them in hard times, several health practitioners said. Some units reopen under pressure from medical staff and activists. As an incentive, the government recently increased reimbursement prices for abortion providers and made the service fully covered by insurance.

The instability makes it hard for authorities to track the number of hospitals that have severed abortion services and those that have resumed them. In this context, a counselor with the Family Planning association said that medical abortions outside of hospitals, which are less costly for the medical facility, are often presented as the only option.

This story was reported and produced by Juhie Bhatia, Women’s eNews’ managing editor, and Hajer Naili, Women’s eNews’ staff reporter, for the series “Backlash in Europe: Women’s Reproductive Rights Threatened.” This special project was funded by a group of private donors and contributors to the Women’s eNews Catapult online campaign. Join the conversation on reproductive health issues in Spain and France on Twitter #EUReproRights.