Voluntary interruption of pregnancy (abortion) allows all women, adults and minors alike, to terminate an unwanted pregnancy within 14 weeks. How is an abortion carried out? What are the stages prior to the procedure? Elia tackles this vast subject and explains everything in detail...
What is voluntary interruption of pregnancy?
An abortion, or voluntary interruption of pregnancy, is a procedure initiated by any pregnant woman to terminate a pregnancy unwanted pregnancy. It is available to all women in a situation of "distress" due to their pregnancy.
The legalization of abortion dates back to 1975 (or rather, its decriminalization), which we owe largely to Simone Veil, thanks to whom the Veil Law of January 17, 1975 came into being. The law stipulates that "the woman is the sole judge of this situation and is free to make her own decision": an important phrase, which means that the choice to continue or terminate a pregnancy belongs to any woman who considers that she does not want the child.
In France, abortion is a completely legal, voluntary medical procedure, which enables women to terminate a pregnancy for personal reasons. The procedure can be medical or surgical, and its aim is toexpel the fetus or embryo from the uterus.
The "freedom of women to have recourse to voluntary interruption of pregnancy" is a right that should soon be enshrined in the Constitution, according to Emmanuel Macron's announcement on March 8, 2023 at the national tribute to lawyer Gisèle Halimi.
Not to be confused withmedical termination of pregnancywhich is declared by a doctor when the pregnancy endangers the mother's health.
What techniques are available for voluntary interruption of pregnancy?
At present, there are two methods of abortion: "medical" and "surgical", with different procedures and waiting times.
Medical abortion (7 weeks)
Medical abortion is the "easiest" option for terminating a pregnancy. It is carried out in a health facility (public hospital or clinic), a doctor's office, a planning center or an accredited health center.
There are several different time limits for this method, depending on where it is performed: in a healthcare facility, it is possible until the end of the 7th week (i.e. 9 weeks of amenorrhea, counted from the start of the last menstrual period). This deadline was extended in 2021, at the time of the Covid epidemic. Medical abortion can be performed in a doctor's surgery, planning center or health center up to the 5th week of pregnancy (i.e. 7 weeks of amenorrhea).
Surgical abortion (14 weeks)
Surgical abortion is performed in a healthcare facility (clinic or public hospital) using instruments or suction. It can also be carried out in an accredited health center, provided it has a cooperation agreement with a health facility.
This method can be performed up to the end of the 14th week of pregnancy, i.e. 16 weeks after the start of the last menstrual period (16 weeks of amenorrhea).
How does voluntary interruption of pregnancy work?
Voluntary termination of pregnancy is a procedure that takes place in several stages, or rather, consultations.
In the case of medically induced abortion, both in and out of hospital, the procedure consists of an information consultation, followed by a consultation with delivery of the medication (in two stages) and a follow-up visit to ensure that the embryo has been correctly expelled.
First appointment: finding out about abortion
The aim of the first appointment is to confirm the pregnancy, and above all to find out how far along it is (date of last menstrual period, circumstances, etc.), as well as the reasons behind the patient's desire for an abortion. The patient receives full information on the abortion procedure, as well as on the help available if she wishes to keep the child. Emphasis is placed on possible methods of contraception.
This initial consultation also includes a blood test to determine the woman's blood group . The woman is given a week to think about her decision (not compulsory, but shortened to two days if the pregnancy is too far advanced).
All adult women will then be offered a social interview, which is compulsory for under-age patients: the aim of this interview is to understand the social context and, above all, to find out about the patient's psychological state .
Second appointment: choice of technique and consent
The second consultation (which takes place after the week of reflection) allows the patient to confirm in writing her wish to have an abortion, and therefore her consent . The health professional in charge of the procedure gives her a copy of her request, and can prescribe the contraceptive method chosen if she did not have one.
Third appointment: the abortion procedure
Medical abortion is performed during the third consultation: this option avoids the need for surgery, since it involves taking a drug in two doses, one or two days apart: mifepristone and misoprostol. The first dose is taken in the presence of the healthcare professional during the 3rd consultation (to control the dose and prevent resale or donation to a third party), and the second dose is taken during a short hospital stay on the following day or two.
Mifepristone interrupts pregnancy by blocking the action of progesterone. But it's the second drug (also taken orally), misoprostol, which causes uterine contractions, ensuring expulsion of the embryo. If necessary, the patient can take painkillers to alleviate the pain.
Surgical abortion is also performed during the third consultation of the abortion procedure: the patient is hospitalized in a day hospital and receives local or general anesthesia. The doctor aspirates the egg using a suction cannula, which passes through the vagina and then the cervix (endo-uterine aspiration). Dilatation of the cervix is facilitated by medication. The procedure takes around ten minutes, and the patient is generally discharged the same day. Once the abortion has been performed, contraception is essential to avoid the risk of pregnancy in the near future.
Fourth appointment: check-up
The fourth and final appointment is a non-mandatory but highly recommended check-up. The aim is to check that the uterus has been "emptied", and that no pregnancy is progressing (thanks to a beta-hCG hormone assay). This consultation takes place 2 and 3 weeks after the abortion. An endo-uterine aspiration is performed if the medical abortion fails. During this visit, the patient is offered psychological support.
Is it possible to withdraw an abortion?
As abortion is a right that belongs to women's personal choice, it is only logical that they should be able to withdraw their consent during the procedure, even if written consent has already been signed. Withdrawal must be initiated by the woman herself, and not by a third party.
How is an abortion carried out in the case of a minor?
Underage girls do not need parental authorization to request a medical or surgical abortion, provided they are accompanied by an adult. However, the basic rule remains that parental consent must be obtained.
Under-age patients must first undergoa psychosocial interview with a marriage and family counselor. If they wish to keep the procedure secret, they can go to a family planning center and ask for the procedure to be kept secret, so that it does not appear on their health insurance card. A word of warning, however: if the abortion requires anaesthesia, the under-age woman must be accompanied by an adult.
After the abortion: is psychological follow-up necessary?
Although not compulsory, some women may find it difficult to recover from an abortion. Sleep disorders, anxiety disorders, stress, feelings of guilt, sadness... in such cases, it is advisable to contact a psychologist or psychiatrist in order to benefit from a sympathetic ear and find appropriate solutions.
In all cases, the health professionals who performed the abortion are obliged to offer the patient psychological support and to refer her to a person qualified to provide this follow-up.
Some figures on abortion IVG in Europe
Now that we've covered all the bases, let's take a look at the figures for abortion in Europe:
- Of the 27 member states of the European Union, 24 have legalized or decriminalized abortion, with no need for justification on the part of the woman;
- Iceland and Sweden are considered to have the most protective and effective policies in terms of women's right to abortion;
- In Finland, abortion is authorized before the age of 17 up to the twentieth week of pregnancy;
- Portugal partially legalized abortion in 2007, and the number of abortions has risen every year since.
FAQ on voluntary interruption of pregnancy
Do I have to pay for an abortion?
In France, abortion is covered at 100% by Social Security, whether the woman is a minor or an adult, and no advance payment is required, regardless of the health facility where it is performed.
How can an abortion pill be prescribed?
Prescribing an abortion pill is part of the medical abortion procedure, and therefore requires following the applicable procedure: a first appointment to find out about abortion and the options available, a second appointment at which the doctor receives the patient's consent to proceed with the abortion, and finally a third appointment at which the patient takes the first medication required to stop the pregnancy (in the doctor's presence), followed by the second medication 24 to 48 hours later in an outpatient clinic.
What are the reasons for terminating a pregnancy?
Apart from medical reasons (complications, foetal malformations, risks to the mother's health), an abortion can be requested on a woman's own initiative, provided she has the freedom to dispose of her own body. Whether the pregnancy is unwanted (for personal, family, professional or economic reasons), or due to previous trauma or sexual violence, women are entirely free to request an abortion, as long as the procedure is carried out within the legal timeframe.
