PARIS — In an airless classroom in Paris City University one Friday afternoon in March, a group of 17 female health care professionals — some doctors, some midwives — gathered to spend the weekend learning how to perform surgical abortions.
Sophie Gaudau is the no-nonsense leader of REVHO health network, which started providing abortion training for health professionals 20 years ago, back when abortion access in France was slightly more limited for patients and in terms of what the doctor could do. Today her organization receives support from the French Ministry of Health and Prevention.
Asked whether she’s faced political pushback for the training she provides, Gaudau did not hesitate.
“Never,” she said. “We are not in the United States.”
In the nearly two years since the U.S. Supreme Court overruled Roe v. Wade, U.S. states with strict abortion bans have increasingly struggled to attract and retain OB-GYNs. But in France, where elective abortions are effectively limited to the first trimester of pregnancy under a law the French Parliament enshrined in March, medical students and providers display little worry about the impact of abortion restrictions on their jobs.
The disparity highlights the impact that government reproductive care restrictions, and how they are imposed, have on physicians’ ability to provide care and patients’ ability to seek it.
In interviews with dozens of French medical students and health care providers, none said they felt any political pressures preventing them from providing abortions, or any reproductive care, in emergency medical situations.
Unlike in the United States, French physicians are not at risk of losing their license or facing jail time for performing abortions. While elective abortion is restricted beyond 14 weeks after conception, or about 16 weeks gestational age, French physicians have the flexibility to provide abortions beyond the first-trimester limit for a plethora of medical exceptions, including threats to the woman’s life, fetal abnormalities and some mental health or social emergencies.
That autonomy, they say, has meant that politics did not impact their decision to pursue an OB-GYN specialty.
“I’m very sorry for your situation in the United States, I think that it’s worse than in France,” said Jennifer Constant, a midwife outside Lille in northern France, adding, “We are very lucky.”
Post-Dobbs drop
During the 2023-24 application cycle, fewer new U.S. graduates of medical schools applied to OB-GYN residency programs in states that banned or restricted abortion compared with states where abortion remains legal, according to an analysis from the Association of American Medical Colleges, or AAMC. This is the second year in a row this has happened since the Supreme Court changed the abortion landscape with the Dobbs v. Jackson Women’s Health Organization decision in June 2022.
In the 14 states where abortion is completely banned, 6.7 percent fewer medical students applied to OB-GYN residencies compared with the previous year, which also saw a similar drop from the year before.
States with strict abortion laws are also struggling to recruit general practice physicians, not just OB-GYNs, according to data. Across all specialties, states with abortion bans or abortion restrictions saw a starker decrease in residency applications compared with states where abortion is legal, according to the AAMC data.
This could have unintended consequences and worsen provider shortages in rural red states, said Atul Grover, executive director of the Research and Action Institute at the AAMC.
“Even if the state has been putting tons of effort into recruiting and retaining physicians, they may be really undercutting that effort by passing these laws,” Grover said. “I mean, that’s their decision, but they need to be informed about the widespread implications of those decisions.”
In Idaho, for example, the state’s restrictive abortion laws have made it difficult for the state to retain or attract OB-GYNs. Nearly a quarter of Idaho’s practicing obstetricians left the state between August 2022 and November 2023, with 58 physicians leaving the state, according to data compiled by the Idaho Physician Well-Being Action Collaborative.
Only two obstetricians moved to the state during that same time period. Idaho has no OB-GYN residency programs, so the state must rely on recruitment from out-of-state hospitals to bolster its workforce.
Former Health and Human Services Secretary Donna Shalala said she expects this trend to continue, and she worries that red states will see an exodus of health care providers afraid of losing their license to practice medicine.
“Licensure is the responsibility of the states, and that’s the leverage they have to make doctors terribly uncomfortable and suggest that they do inappropriate things,” Shalala said on a call with reporters. “What we’re asking doctors to do is to abide by political decisions as opposed to health decisions when they practice medicine. And that is simply unacceptable.”
Between 2022 and 2023, medical school and osteopathic medical school applicants to OB-GYN residency programs dropped by 6.75 percent. The drop was more stark in states with strict abortion laws.
Another story abroad
Dozens of French physicians, medical students and midwives interviewed said they never felt any outside political pressures preventing them from providing abortions or any sort of reproductive care.
France allows doctors to perform at-will abortions through 16 weeks of gestation. After that, there is a clear-cut process for determining when abortion is permissible; the French call this medical termination of pregnancy.
A small group of physicians caring for the patient must discuss the best course of action in the case of a fetal abnormality or when the woman’s life is in danger. But at the end of the day, the decision resides with the physicians and the patient.
Even if the situation is unclear, a physician in France cannot lose their license or face jail time for performing an abortion if multiple doctors concur it is beneficial to the health of the woman.
Mathilde Landru, a 26-year-old student at the University of Lille studying to be a general practitioner, is spending her spring semester working at Le Planning Familial, the French equivalent of Planned Parenthood, meeting abortion patients.
Asked about whether politics deterred her from interning in an abortion clinic, she laughed and said, “No, in France, we don’t have this problem.”
Sometimes, societal and social attitudes can influence individual providers. As in the U.S., French physicians can invoke a “conscience clause” if they feel they cannot perform a medical procedure. But they are required by law to refer the patient to a doctor at the same hospital or in the surrounding area.
The small seaside town of Sete is home to about 60,000 people and has two hospitals, one public and one private. The two OB-GYNs at the public hospital are Catholic and refuse to perform any kind of abortion care. They send their patients to Frantz Bousquet and his colleagues at the private hospital.
Bousquet, meanwhile, said he’s “never” experienced any political or social resistance to doing his job in the 25 years he’s been at the private hospital. Even though he is Catholic himself, and there’s some religious influence in Sete, he insists that “abortion is not taboo here.”
“In my life I’ve had many different situations in the context of abortion, but it has always been a provided service for the population,” Bousquet said, “and never a political problem.”
This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.
Siobhán Silke contributed to this report.
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