in rural areas, a right that is still precarious

Aurore, a breeder in Charente, was 20 years old when she discovered her first pregnancy. A condom accident, a late period, unusual dislikes. Then one morning, on the plastic stick of the urine test, a second bar not at all planned in the program. She was then an agricultural worker on a goat farm and her partner, Vincent, worked hard at a suckler cow farm. « None of us were ready »she sums up at the microphone of Bliss, a podcast dedicated to motherhood.

What followed were long and trying hours of crying and looking for an appointment for a voluntary termination of pregnancy (IVG). « I found out about Family Planning on the internet. He didn't care about it. I spent my day on the phone calling hospitals for appointments. The local hospital ? He doesn't do that. I was told to call Angoulême or Limoges. » Finally, the young woman gets an appointment that same evening in Angoulême, 65 km from her village. The clinic's gynecologist tells her that he is preparing to leave for training and that she has the choice between returning the next day to have an abortion using medication, or waiting for his return a month later for an operation. Aurore will opt for the first option.

Aurore's story – difficulty finding an appointment, rushing or waiting, lack of choice in method – is sadly banal, particularly in the countryside. 1 in 3 women useIVG during his life. 243,623 IVG were carried out in 2023, for 677,800 births. But while on January 17 we celebrated the fiftieth anniversary of the Veil law which decriminalized abortion, this right of women to dispose of their bodies sometimes remains difficult to implement in rural areas.

« In rural areas, patients face the problem of medical desertification and numerous difficulties linked to the lack of mobility solutions. ; some struggle to obtain appropriate information within the appropriate time frame, while others are refused treatment under the specific conscience clause »listed the deputy (Socialist Party) for Ille-et-Vilaine Mickaël Bouloux.

Medical deserts

First obstacle: the scarcity of establishments (hospitals, clinics) and health centers that practice IVG. 130 centres IVG have closed in the last fifteen years. Between 2000 and 2017, the number of maternity wards, which often house orthogenic services where abortions are performed, increased from 717 to 496.

For the establishments that remain, the situation is fragile, particularly in rural areas. « We can say that in such an area, things are fine. Then six months later, realizing that such a doctor has retired, that such and such a gynecologist too, and suddenly everything falls apart. »observes the D^r Philippe Deruelle, president of the National Professional Council of Gynecology-Obstetrics and Medical Gynecology (CNPGO–GM) and professor of gynecology-obstetrics at CHU from Montpellier (Hérault).

From this point of view, the age pyramid is not favorable: « The burden of effectively maintaining this right rests essentially on a handful of activist practitioners, many of whom will soon be retired. »we read in a 2020 parliamentary report devoted to the issue.

« Sometimes you have to swallow the miles to terminate your pregnancy »

Certainly, since 2020, IVG medicinal products are accessible by teleconsultation, by collecting the tablets in a pharmacy near you. But for those who can no longer use this method or would like less disembodied support, you sometimes have to travel the miles to terminate your pregnancy. In the Lot, 24 % of women of childbearing age now live more than 45 minutes from a maternity ward, compared to 6 % in 2000. In 2023, almost 1 in 5 women (18 %) had an abortion outside their department of residence.

« We get there when we have a car and can organize our working hours. It's much less easy when you're a young high school student or a housewife in a couple who only has one car. »explains the deputy (Socialist Party) of Isère Marie-Noëlle Battistel, co-rapporteur of the report on access toIVG. This is all the more penalizing since a IVG often requires more than one appointment — notably a mandatory psychosocial interview for minors — and may require additional examinations « a would »such as a blood test and an ultrasound.

When you are under 18, it becomes very difficult to exercise your right to have an abortion without informing your father and mother. The deputy (Democratic Movement) for Nièvre Perrine Goulet thus alerted to the fact that, in her department, young girls could benefit from a transport voucher to travel to the place of realization of theIVG. But this benefit appeared on the parents' Social Security reimbursement statements…

Having to have an abortion far from home, in an environment they cannot control, can cause additional stress. This is what the D observes^r Philippe Deruelle, who regularly gives « helping hands » at the rural hospital near his home. « I heard a lady say that for her, Montpellier is the other side of the world, he reports. It is already not easy to make the decision not to keep a pregnancy, to wonder how it will go. So imagine, traveling 50 km, finding yourself in a big city where you are not used to going, parking, going to see someone you don't know… Everything becomes more complicated and at risk of a bad experience. »

Too long delays

There is also the question of deadlines. In France, the law authorizes theIVG until the end of the 14^e week of pregnancy. Knowing that women only discover that they are pregnant at least 2 to 3 weeks after conception, sometimes more, it is a race against the clock that begins when the test turns out to be positive. Gold, « this contrasting range of care depending on the territory results in an extension of appointment and treatment times »points out the 2020 report.

The delay accumulates from the information search phase ; the directory — mandatory since 2022 — listing professionals and structures practicingIVG not being up to date everywhere. To improve the situation, the possibility of performing medical abortions has gradually been granted to professionals working outside hospitals or clinics: gynecologists and general practitioners, sexual health centers and private midwives.

Consequently, the rate ofIVG drugs jumped: by 31 % in 2000 at 79 % of abortions in 2023. But this only partially improves the issue of access to abortion in rural areas. Indeed, the High Health Authority (HAS) only recommends the medicinal method until the end of the 7^e week of pregnancy.

Beyond that, the instrumental method is recommended… only possible in an establishment or health center. Who sometimes drag their feet in caring for patients for these so-called abortions « late »after 10 weeks of pregnancy. « Some establishments have not included the new legal deadline of 14 weeks of pregnancy and stop at 12. Women who are beyond this must be redirected to another establishment, which further lengthens the waiting period. »deplores Isabelle Derrendinger, president of the National Council of the Order of Midwives.

This forces some women to turn to the medicinal method to stop their late pregnancy, « in contradiction with the recommendations of the HAS »is indignant Isabelle Derrendiger. There are more than 20 of them % to know about this degraded care in Normandy, in the Grand Est and in Corsica. For women who exceed the legal deadline, the options are becoming even rarer: medical termination of pregnancy (IMG) for reason « psychosocial »particularly for minors, or abortion in border countries with more liberal regulations for others. Every year, 3,000 to 5,000 women go to Spain or the Netherlands to terminate their pregnancies.

Methods ofIVG not often chosen

Beyond the question of deadline arises that of choice. According to the High Council for Equality between Women and Men, less than 4 in 10 women were able to choose the method of their abortion. However, this significantly improves the way abortion is experienced, according to a Scottish study.

« What I understood as I collected testimonies from women is that it is valuable to have a choice in the method, confirms Claire Kachkouch Soussi, author of a two-year radio investigation into abortion in rural areas. We don't all have the same relationship with the body. Some people prefer to be completely asleep and not aware of what is happening. ; others will be relieved to be able to have a medical abortion at home, even if this method is demanding. » Choosing tablets involves bleeding and pain linked to contractions which can be significant, and not completely controlling the timing of the process which can take up to three days.

There is therefore a long way to go to guarantee good conditions of access to abortion in rural areas. This is what partly motivated Chloé Ferron to set up a Family Planning branch in Vigan (Gard), a village in the Cévennes national park, with around ten other volunteers. Its mission will be, among other things, to support residents in their efforts to have an abortion.

« A cultural, economic and political divide is widening between rural and urban areas, with difficulty accessing information and a blatant rise in far-right ideas in rural areas, particularly in the south of France. and in Hérault. This is why it is important to open resourceful, comfortable and secure spaces in these territories. »

In the Cévennes, the need for such places was immediately apparent: « We haven't even been there yet that we have been contacted by a minor from an ultra-religious background, who has exceeded the legal deadlines and has no family resources. »

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