At a time when the right to abortion is threatened in the world, as in the United States, where the Supreme Court overturned the Roe vs. Wade judgment – which guaranteed the right to abortion at the federal level – takes place , Wednesday, September 28, the international day of the right to abortion. In France, the deputies will consider, at the end of November, the majority bill aimed at enshrining this right in the Constitution. But, despite recent advances, such as the extension of the legal period to fourteen weeks of pregnancy, since the law of March 2, 2022, inequalities in access to abortion remain, depending on the profile of the women or even their place of residence. Less known, another issue is debated: preserving the choice of abortion method. An element which nevertheless appears in the preamble of the recommendations of good practice of the High Authority for Health (HAS).
Updated in 2021 in order to adapt to the context of the health crisis, the HAS recommendations recommend the practice of medical abortion in health establishments and in the city, up to nine weeks of amenorrhea. After this period, the HAS strongly recommends that practitioners have recourse to an instrumental abortion, up to sixteen weeks of amenorrhea, or fourteen weeks of pregnancy.
A medical abortion begins with taking a first drug that can stop the pregnancy: mifepristone. A second intake of the drug, misoprostol, takes place thirty-six to forty-eight hours after taking the first. It promotes contractions and causes the expulsion of the egg. Instrumental abortion, a surgical technique that requires anesthesia and a brief hospital stay, has so far been practiced only by doctors – an experiment must start to open this practice to midwives.
No overall data exists, at the national level, concerning the number of medical abortions after nine weeks of amenorrhea. According to the latest data from the Research, Studies, Evaluation and Statistics Department (Drees), published on Tuesday September 27, 76% of all abortions performed in 2021 were medical, whether performed in a medical establishment. healthy or not. This figure rose to only 31% in 2001. And 76% of medical abortions carried out in the hospital are less than eight weeks of amenorrhea.
“A little shameful medicine”
However, Isabelle Derrendinger, President of the National Council of the Order of Midwives, makes an alarming observation: “If we cross-reference the various data from the DREES, in addition to the increase in the number of medical abortions, there is an increase in the number of abortions performed between twelve and fourteen weeks of amenorrhea. [1 sur 20 en 2020]. There is therefore an increase in the number of medical abortions beyond nine weeks of amenorrhea, which goes against the recommendations of the HAS. »
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