Sexual and reproductive health and rights in France

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					         Sexual and reproductive health and rights in France:
                      Successes and challenges

                                       Annelle Despres

         On March 8th, 1956, is created “la Maternite heureuse” (= the happy Maternity) in a
France where maternity begins to be heard as a political issue and where sexuality upsets the
institutional frames of marriage and family, especially for young people. Sometimes reluctant
(for example among minors’ access to contraception), the association still more or less
relieves youth and women’s demands. In 1960, it becomes “le Mouvement Francais pour le
Planning Familial” (MFPF = the French Movement for Family Planning), the main French
association ever for sexual and reproductive health and rights. In 1956, they were 23 women;
half a century later, MFPF groups together 20 regional federations and 69 departmental
associations, while managing 30 “centres de planification et d’education familiale” (CPEF =
centers for family planning and education). Its members hard fought and fight for women’s
right to contraception and abortion. MFPF is definitely the core of the French feminist
struggle for free disposal of women’s own bodies. Today, the State is also involved in family
planning services. But some progresses are still to be done and MFPF remains organized to
face the regular attempts to women’s rights.


Centres de planification et d’education familiale
       Between 1961 and 1967, MFPF illegally opened the first centers for family planning,
where information about birth control was provided, and sometimes even contraceptive means
such as diaphragms, spermicidal gels or pills (coming from the US). Although it was
forbidden by the law, that was an undeniable success. In 1967, a law authorizing the provision
of contraceptives for major people on prescription is passed; and in 1974, minors also legally
reach this right. Then, in 1972, the Government allows the creation of centers for family
planning and information. Nowadays, there is at least one CPEF (commonly called “le
Planning Familial”) in each department (there are 100 departments in France); most of them
are now run by the local institutions (the Department and the Municipality) and hospitals, but
some still depend on MFPF (as seen previously).

How does it work?

 These centers provide professional advice from gynecologists or counselors concerning
sexuality, contraception, abortion or IST. All the most intimate topics may be reached without
problems. To fill everyone’s needs, they welcome women during the day but also put in place
help lines (some of them being free). Recently, some CPEF have also introduced Messenger-
permanence. For example, in the department of Marseille, each Wednesday, from 2 pm to 5
pm, it’s possible to ask for “instantaneous information” through Windows Live Messenger.
The success of these CPEF rests on the fact that professionals don’t only provide
gynecological consultation but are also really socially involved. That is to say that doctors and
counselors don’t “do the job and leave”, they are here to help women to be able to decide on
their own in the matters of sexuality or contraception. They do take time to explain issues and
solutions. Concretely, in centers for family planning, one can receive free information, free
condoms, and free emergency contraception without prescription. Doctors are also allowed to
prescribe contraceptive pill and to offer pre-abortion consultation (one of the two compulsory
consultations in case of abortion). Finally, these centers now can perform HIV and other IST-
tests.

The case of minors

  CPEF are particularly useful for minors. Because teenagers also have right to privacy and to
health, they are provided all these services above for free and anonymously. No money is
asked, neither any paper. A minor can use regular contraceptives freely and without having to
tell it to anyone. That was a real progress for teenagers to be able to decide about their sexual
and reproductive life on their own, without fearing any adult pressure. As far as majors are
concerned, they do have to pay for such services, but the “Securite Sociale” (the healthcare
institution) gives them money back (more or less, depending on the services). Nevertheless, it
is worth noticing that major people who don’t benefit from Securite Sociale (for example
foreigners without any French paper) are not asked to pay for anything neither.

  Actually, minors’ rights to privacy and health have to be respected in every part of the
sexual and reproductive health system. So, for example, when a minor girl is asking for
emergency contraceptive in a pharmacy, she HAS to benefit from it without paying and
without being compelled to say who she is. It also supposes that she doesn’t have to prove her
age (because in that case she would be obliged to show her ID). The law precises that the
pharmacist, in this case of a minor, has to lead an interview with her to know if her situation
corresponds to emergency criteria and has to give her information about regular
contraceptives, IST prevention and CPEF. Furthermore, school midwives have to be able to
furnish emergency contraception whenever needed. Minors’ rights have then consequently
increased in the last years. And even the abortion system ensures the respect of secrecy.


Abortion
        After le Manifeste des 343 Salopes (= Manifesto of the 343 bitches) 1, after the famous
“proces de Bobigny”2 and a long battle led by MFPF and MLF3, abortion is finally
decriminalized in 1975. Seven years later, the operation is told cost-free for women, the
Securite Sociale ensuring refund. But at this time, in the 80’s and the beginning of the 90’s,
anti-abortion groups are seriously virulent. They organize “anti-abortion commandos” (term
given by media) that they are calling “operation rescue”, largely inspired by north-American
“prolife” activists. The action consists in chaining themselves with handcuffs or locks in

1
          This manifesto is published by Le Nouvel Observateur, on April 5, 1971, by the initiative of the MLF.
The text demands the legalization of abortion and is signed by 343 more or less famous women who claimed
having had an abortion. Text available in French on:
http://tempsreel.nouvelobs.com/actualites/societe/20071127.OBS7018/le_manifeste_des_343_salopes_paru_dan
s_le_nouvel_obs_en.html
2
          In october and november 1972 took place the Bobigny trial, led by the feminist lawyer Gisele Halimi.
It concerned a young girl, Marie-Claire C., 16 years old, who fell into pregnancy after rape. Her mother, raising
her three children alone with a few money, and three friends of hers, helped Marie-Claire C. to abort. But she
suffered from complications and had to go to the hospital, where the mother had to pay a big amount of money.
At the same time, the raper, arrested after a theft, denounced the girl, hoping that policemen would be more
conciliatory with him. The police then went to Marie-Claire and her mother’s house, where the young girl
confessed what she’s done. Their trial takes place; this is an open battle against the ban of abortion. The media
get hold of the issue and a national debate is opened. Finally, the five accused are almost not condemned. And
the story leads to the decriminalization of abortion.
3
          Mouvement de Liberation des Femmes. This organization did an important job for women’s rights. It
doesn’t exist anymore.
surgical units where abortions take place, to prevent the operation. However, in 1993, a law is
created to penalize the hindrance to abortion. And in 1994, four “commando participants” are
for the first time sentenced to 3 months’ imprisonment (+ 15 months of suspended sentence).
Moreover, in 1995, presidential elections occurred. Yet traditionally, the elected Head of State
has the right to amnesty people. A debate is opened at this moment concerning commando
members. Can they be amnestied or not? A socialist deputy then proposes an amendment to
the amnesty law, excluding anti-abortion activists from this right. After passionate debates,
the text is finally adopted by the National Assembly, which represented a clear political
choice. Eventually, a law is voted in 2001, extending the right to abortion (the deadline is
extended from 10 to 12 weeks; the hindrance to abortion is more strongly condemned).

How does it work?

  Only the pregnant woman has the right to ask for abortion. Both surgical and medicinal
abortions are allowed. The latter can be performed until the end of the 5th week only and can
be done out of a hospital (the woman is having the medicines in a doctor office and can then
go home). Though, abortion is not considered as a “usual” operation and psychological help
must be proposed to each woman, before and after the intervention. However, if a psycho-
social discussion with a familial counselor was compulsory before 2001, it’s not true
anymore, except for minors.

The right to confidentiality

  A minor woman, if pregnant, is ALSO the only one to have the right to ask for abortion. Her
parents’ refusal can’t be a reason to cancel the operation if she still wants it. And if she
doesn’t want to tell her parents (or legal guardian), she doesn’t have to neither. But though,
she must be accompanied in her move by a major person, whoever she wants (friends, family,
social educators, health professionals …), to guarantee that she’s not alone and that she can
talk to someone if she feels such a need. Also, the doctors and especially the counselor she
meets have to try to convince her to tell her parents. If she keeps refusing, they have to help
her choosing the accompanying person. Furthermore, if the Securite Sociale ensures the costs
of the abortion for major people, how does it work for minors who are still under the
responsibility of their parents? If those ones know that she’s getting an abortion, there is
obviously no problem, and if they don’t know, absolutely NO fees can be asked to the girl
concerned for medical or psychological consultation and for the operation in itself. It’s free,
entirely free. Then, it can also happen that a major woman wants to hide the abortion to the
people close to her. In this case, there are some hospitals which exempt patients from paying
in advance. It means that one doesn’t have to pay and to be given the money back after, the
Securite Sociale directly pays the hospital, guaranteeing anonymity. Sometimes, abortion out
of hospital doesn’t allow this procedure, but the different papers and the reimbursement are
done in a specific way which permits to keep secrecy among the family circle. All these
adjustments to ensure confidentiality AND free access have been established to prevent
pregnant women having unsafe abortion out of the healthcare system. It is the only way to
allow women to get free disposal of their own bodies, without fearing pressure of parents,
husband or friends.

 After having undergone the abortion, women are compelled to use contraceptives.
Contraception
        In 1920, a law is created to ban all means of contraception. As said previously, this is
repealed in 1967, with a law authorizing contraception for majors only. Then, in 1974, the
contraceptive pill becomes accessible for minors in centers for family planning and education,
freely and anonymously. Actually, many contraceptives are now allowed in France 4. But
though, only the contraceptive implant is entirely cost-free, i.e. reimbursed by Securite
Sociale. However, the most spread mean of contraception is the pill, well-known and which
offers the possibility to stop the treatment whenever wanted. Some pills are free, some are
not. In fact, French women seem to be still reluctant among “new” contraceptives, such as the
implant, which is not very known. Even young women fear that it might cause problems yet
not foreseen by the doctors. There is still an obvious lack of information about contraception.
Also, for example, according to an enquiry led by INSEP5, 22% of French people think that
the pill may make the women infertile. That is why French feminist associations fight for
extending information about contraceptives and for the entire free access to all contraceptives.

  Sterilization has also been recently admitted. In 1996, an enquiry showed that 30 to 40,000
sterilizations were illegally practiced per year6. In 1999 then, a law first authorized therapeutic
sterilization. And sterilization as contraception is finally allowed for both men and women in
2001, which is quite late. But that’s not often used though. And most of the time, the one
submitting sterilization is the woman. Actually, there is a true lack of knowledge concerning
this practice.




The particular case of conscience clause

        The French law allows doctors not to practice abortion or contraceptive sterilization if
it appears contrary to their ethics. Mainly, that are the catholic doctors who are concerned by
this exception to women’s rights. However, if one refuses to practice abortion or sterilization,
he/she HAS the duty to inform about another possibility to get the operation (i.e. guiding
towards a doctor or a hospital where the intervention will be possible). It is worth noticing
that pharmacists can’t use the conscience clause. The insertion of emergency contraceptive,
sold in pharmacies, raised this question. But finally, in 1998, jurisprudence stipulated that
ethical reasons could not be a sufficient ground not to deliver emergency contraceptive.
   Only the two cases of abortion and sterilization authorize the conscience clause. It means
that a doctor can’t refuse to provide for contraceptives because of his/her religion or morals.
But though, it happens. And for example, when the only doctor available in a mountain
village refuses to deliver the pill to a woman, her only solution is to drive to the next village.
It perhaps doesn’t appear as so grave but going somewhere else at least demands time and oil,


4
          The government texts count 12 contraceptives: coil, pill, patch, implant, feminine condom, masculine
condom, ring, diaphragm, cervical cap but also feminine and masculine sterilization and emergency
contraceptive. Condoms and morning-after pills don’t demand medical prescription, all of the others do. And all
the contraceptives which don’t suppose an operation are sold in pharmacies, except of the diaphragm, issued in
CPEF.
5
          Institut National des Sports et de l’Education Physique : http://sante-
medecine.commentcamarche.net/contents/contraception/00_etat_des_lieux_statistiques.php3
6
          Data found on ANCIC’s website (ANCIC is one of the most famous association for reproductive rights
In France): http://www.ancic.asso.fr/etatactueldelalegislation.php
although women shouldn’t be compelled in any case to support the economic price of
contraception.


Sexual education
        Sexual education has been the topic of many debates in France. The MFPF soon
claimed for a need to educate young people, as far as sexuality was concerned. But they were
not heard. However, the 70’s brought new considerations about sexuality, contraception and
even abortion. The “may 68” movements carried a sincere will of consideration from youth.
And these events are seen as a breaking point with traditional views of family, sexuality and
love. They are the symbolic beginning of “morals’ liberation”. Trying to be in conformity
with social evolutions, the National Assembly adopted guidelines concerning sexual
education, asking school headmasters to organize lessons in colleges. But the practical
realization of the law was hard. Many parents and teachers meetings took place but it seemed
too difficult to agree on what parents should do on one part and what would be the school’s
task on the other part. Nonetheless, the emergence of AIDS in the 80’s reopened the debate. A
sexual education resting on a partnership of health professionals, social educators, teachers
and familial circle became considered as definitely necessary. In 1998, a law made it
compulsory for schools to organize informative lessons about AIDS prevention and sexual
education for 14 and 15 years-old pupils7. Then, because it was not enough, another law has
been adopted in August 2004, which stipulates that: “Information and education about
sexuality are given in primary, secondary and high schools. Three sessions must be organized
per year and homogeneous age groups. These sessions could associate health professionals
and other external relevant stakeholders. Some pupils trained by an organism depending on
the Ministry of Health could also be involved”8. Nevertheless, no official text precises what is
to be taught, then it entirely depends on the open-mindedness of the teacher and the persons
he/she invites to intervene. Yet, as before, the real practice of the law is not as ambitious as
theoretically.

Primary schools

  As far as primary schools are concerned, almost none of them does organize sexual
education. Indeed, school teachers fear that they might be accused of immoral behaviour with
children and consequently fired from their work. In fact, many people are shocked by this idea
of giving sexual education to little children and wrongfully think that it would conduce to
younger and younger intercourse. School headmasters, whose priorities are most of the time
avoiding troubles with families, don’t insist to put in place such lessons. Nevertheless, in the
town of Lyon, successful operations concerning sexual education in primary schools have
been led. An association called “Education a la vie” (= education to life) intervenes among
1,700 children (in 28 schools) at three periods of a child life: at 5 years old9 (the end of the
oedipal phase), 8 years old10 (latency period) and 10 years old11 (a rupture period,

7
         In what are called in France “the 4th” and “the 3rd” class years (= 2nd and 3rd classes in polish
gymnasium)
8
         This translation is not an official one. To see the original French text, please see on the official website:
http://www.legifrance.gouv.fr/affichCodeArticle.do?cidTexte=LEGITEXT000006071191&idArticle=LEGIART
I000006524776&dateTexte=&categorieLien=cid
9
         In the class of « grande section » (= Kindergarten)
10
         In the class of CE2 (= the 2nd class in Poland)
11
         In the class of CM2 (= the 4th class in Poland)
approaching puberty). Of course, they try to adapt their speeches and their methods of work to
the age of the children concerned. They can use fairytales, debates, role games, videos.
According to the responsible for education to health in The Division for Prevention among
Children of the municipality of Lyon, Marie-Françoise Sommer-Peytavin, « [they] approach
sexuality in its large meaning : [they] talk about body, feelings, respect and listening. But the
stress remains put on prevention. The aim is to recognize and to be able to express what is
pleasant or not, what is allowed or forbidden, to be warned of the different forms of sexual
exploitation »12. Moreover, this association organizes meetings with the parents to reassure
them, to allow them to share their experiences as parents, to help them talking with their
children about sexuality. Apparently, this initiative gets a larger and larger success and
everyone seems to get something out of it (children, educators, teachers and parents).
  It seems really important to intervene about sexual education from primary school even it
may appear quite early. Actually, some people assume that the sooner it is, the better it is.
Indeed, sexuality is mainly approached with adolescents. The problem is that it is exactly the
moment when they feel directly concerned and aimed at. They may feel too embarassed or
pressured.On the contrary, children can take more distance to a speech about sexuality and
can integrate more easily what « safe sex » is. If they are permitted to grow up with concepts
of gender relationships and equality, of homo/trans/hetero/bisexuality, of IST risks, then they
will be more prepared for safe and wanted sexuality in the future. Unfortunately, sexual
education still concerns very few primary schools. But we can hope that this practice will
extend. Meanwhile there are many comics for children talking about sexuality very easily,
often with crude language which precisely avoids taboos about this subject.

Secondary and high schools

  As far as secondary and high schools are concerned, there are more interventions about
sexual education, but still consequently less than foreseen by the law. Most of the schools
organize one lecture per year, not more, some of them even none. These interventions are
made by external stakeholders, who are often young and who organize the lesson as they
want. Most of the time, it is based on the principle of questions-answers. It means that pupils
write a question or more on a paper, anonymously, and then, each question is told loudly and
a discussion is opened between teenagers and professionals. However, adolescents often feel
uncomfortable and don’t dare to ask what they really want to. If it is right that young people
have to be directly involved in sexual education, the problem is that it’s not easy for any
adolescent to speak about his/her sexual life in front of his/her classmates. For example, if one
asks a question about homosexual relations, he/she knows that others may lead an
“investigation” to know who in the class is homosexual. Moreover, some professionals,
following this will to make teenagers participate, directly questions the class, which puts
pupils under stress. This way of doing doesn’t seem to be fully satisfying.
  Then, most of the time, the stakeholders finally lead the lesson as they want. It appears that
the topics approached are mainly contraception (chiefly condoms, the regular pill and
emergency contraceptives), abortion and IST. But we can be sorry about the fact that the
called “sexual education” is still based on a biological and a heterosexual point of view. If
issues concerning IST and contraception are approached in their biological meanings, these
courses still don’t come up to social facts and interrogations, they don’t put into question the
gendered behaviours and the consequences it may have on sexual and reproductive health and

12
         These information come from a magazine website:
http://www.vousnousils.fr/page.php?P=data/pour_vous/temoignages/en_pratique/&key=itm_20021122_113935_
education_sexuelle_au_primaire_l.txt
rights. Moreover, issues of homosexuality and homophobia certainly begin to be considered at
school (more and more LGBT organizations are allowed to intervene in scholar frames).
However, it appears that homophobia is more studied than homosexuality. It means that if
there is an education emphasizing on the social problem of homophobia (homosexuality seen
in its “negative” aspect, how discriminated it is), which is already a good march, there is still
a lack of “homosexual” education in its positive aspects, how happily and safely it could be
lived. Transsexuality is still less approached. And then, even the current sexual education
doesn’t seem to be fully efficient. Indeed, an INSEP enquiry showed that 1 young between 16
and 25 years old out of 10 thinks that the pill does protect from IST13. It is then clear that
efforts have to be done to organize complete sexual education, paying attention to all aspects
of a sexual life, emphasizing on undoing all the presuppositions about gender roles and
“normal” sexuality, and respecting young people privacy. Even if the initiatives of the sexual
educators are worth welcoming, there are still improvements to be done.



Current challenges
        Since the 60’s, the French law allows a larger and larger access to sexual and
reproductive health and rights for women. Consequent progresses have been done, concerning
abortion, contraception and sexual education. Also, the will to respect young people privacy
and dignity is real. Nevertheless, we have to bear in mind that these advances are constantly
put into question.

Anti-abortion movements

  The number of Catholics “pro-life” (how they call themselves) is not decreasing. Even if
their actions are less violent and less visible, they still do organize demonstrations and some
of them have built strong relationships with extreme right-wing political parties who bring
consequent funds. Moreover, a new movement has been recently created, whose name is “Les
Survivants”14 (=the Survivors) and who appears quite dangerous because it rests more on
“modern” views than on catholic traditional moral. This association indeed clearly differs
from other anti-abortion groups in many forms. Firstly, they claim not to have any linkage
with religion and politics. Then, its members are exclusively young (born after 1975).
Thirdly, their methods of action consist in doing pacific, “funny” and “colorful” protests, and
organizing parties. Finally, their demonstration against abortion doesn’t rest on catholic
conceptions but assumes that it is such a shame that many “babies” are not born on account of
abortion, because if they were here, they would have been more to party together and it would
have been more fun. This association cannot be said really influential. However, we can see
that since its decriminalization, there has always been an “anti-abortion side”, more or less
virulent, more or less influential. And the right of abortion is not as established as we could
wish.

Legislation

 Furthermore, the defenders of reproductive and sexual health and rights claim for a clearer
writing of the law. Indeed, it may sometimes be interpreted in an anti-abortion point of view.
13
        Institut National des Sports et de l’Education Physique : http://sante-
medecine.commentcamarche.net/contents/contraception/00_etat_des_lieux_statistiques.php3
14
        http://www.survivants.com/index.php3
For example, in February 2008, the Superior Judicial Court (Cour de cassation) recognized
the possibility for fetus dead before 22 weeks of amenorrhea to be registered on the Registry
Office, allowing parents to give her/him a name, to organize funeral and to benefit from some
rights. But this recognition may lead to legally consider an abortion as a murder. That’s why
feminists fully disagreed on this conclusion.

Doctors’ power on women’s bodies

  Eventually, the number of gynecologists cruelly decreased. Less and less medicine students
choose this speciality. And less and less doctors agree to practice abortion which remains bad-
paid and bad considered within the medical field. In work-periods, there is already a lack of
staff, and it’s worst in summer, when doctors are leaving for holidays: hospitals and clinics
systematically don’t succeed to fulfill the needs of women who want to abort. And many see
their appointments delayed. Yet, when a woman has taken the decision to abort, it is very
difficult for her to wait. Furthermore, women constantly depend on the good will of doctors.
The website of “avortement-IVG: pour le droit au libre choix” (= Abortion: for the right to
decide freely) publishes testimonies of women. One of them explains that her abortion
occurred when the fetus was 10 weeks, although she had decided to abort when it was 1 week.
First, she went to see a gynecologist who didn’t answer when she asked for an abortion as
soon as possible. 2 weeks later, during the 2nd appointment, the same gynecologist told her
“congratulations, your baby is going very well!”. She was afraid to tell him again that she
didn’t want to keep it. And when she did, he explained that he disagreed on giving medical
contraceptive to women but that he could call a clinic where this could be practiced. He also
missed to propose her psychological help. Finally, she went to the clinic but caught by panic,
she went away just before the intervention. She then called her gynecologist to have the
number of centers for pregnant women, what he did while telling her that he would soon leave
for holidays but that someone would replace him. Unfortunately, the two phone numbers he
gave were not available anymore. The woman was on total panic, she didn’t have anyone to
talk. Nobody understood her and she was ashamed of her will to have an abortion. Finally,
after having thought again, she decided to get the abortion for sure and called back the
gynecologist. But it turned out that no one was replacing the one gone in holidays. Though,
she had to find a practitioner as soon as possible. She called several hospitals where she was
always answered the same things: “no place anymore”, “you should have thought before!”,
“the doctor is on holidays”, “I can find a place available in a month”… Finally, that’s her
familial doctor who found her a place in a hospital where she could undergo the abortion15.
  This fact to be dependent on doctors’ will and availabilities is unbearable. Also, as long as
the abortion will be considered as shameful, dirty and taboo, as long as women will be made
guilty for not wanting a baby, as long as they won’t be allowed to live abortion in good
physical and psychological conditions, then this right would be endangered and the free
disposal of women’s own bodies a myth. That’s why feminist associations as MFPF keep
vigilant to ensure that rights acquired with difficulties remain rights, fight to make abortion
recognized as a positive right to life, health and dignity and not as a shameful right to be
hidden, and fight to make abortion the decision of the woman, not of her doctor.


       Thus, although there is still some resistance on the way towards women’s access
to reproductive and sexual rights and health, we can notice a constant progress since the

15
       Testimony available in french on http://www.svss-uspda.ch/fr/temoignages_opinions/andree.htm
60’s, especially thanks to feminist organizations which hard fought and fight to gather
women and make their voices heard.

				
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