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Digest

Most French Teenagers Who Obtain Abortions Had Been Using Contraceptives Before Conceiving

Dore Hollander, Guttmacher Institute

First published online:

| DOI: https://doi.org/10.1363/4420912

Data from the first nationally representative survey of abortion patients in France, conducted in 2007, reveal that nine in 10 teenagers who had an abortion that year were terminating an unplanned pregnancy; two‐thirds had been using a contraceptive method during the month in which they conceived.1 Eighty percent of teenagers left the abortion facility with a prescription for a contraceptive method (mainly the pill); in 68% of cases, the recommended method was a more effective one than they had used before. The majority of teenagers had been involved in the abortion decision (i.e., had made it on their own or in conjunction with a family member or partner), but 9% had terminated their pregnancy strictly because a family member or partner had asked them to.

The sample for the French National Survey of Abortion Patients was drawn from among women seeking abortions at 184 randomly selected hospitals and the offices of private practitioners affiliated with those facilities. Two questionnaires, both administered at the time of the abortion, were used to explore women's abortion experience: One gathered medical information about participants’ abortions from the physicians and midwives who performed them, and the other asked the women themselves about their background characteristics and decision to terminate their pregnancy. Analysts performed chi‐square tests and used multivariate logistic regression to examine data on 1,525 women aged 13–19 who had elective abortions.

Most teenagers who had abortions were 18–19 years old (59%), lived with their parents (75%), were going to school (66%), were childless (80%) and had not had a previous abortion (78%). The vast majority had their abortions in public hospitals; 47% had medication abortions. (In 2007, medication abortion was officially available to women who were less than eight weeks pregnant; French law requires that such women be given a choice between medication and surgical procedures.)

Eighty‐two percent of teenagers had not planned to become pregnant, 7% had intended to do so at a later time and 2% said that their pregnancy had been planned; the rest had not thought about pregnancy or did not know. Virtually all of the young women had discussed the abortion decision with someone; 74% had talked to their partner, and 42% to at least one parent. Forty‐five percent had made the abortion decision on their own, and 46% had involved a partner or family member; 9% had sought an abortion because a partner or family member wanted them to. Teenagers who had intended to get pregnant were more likely than others to have undergone abortion at their partner's or family's request (34% vs. 9%), and those who had played a part in the abortion decision were more likely than others to characterize the pregnancy as unplanned (84% vs. 62%).

Sixty‐nine percent of teenagers had sought their abortion early enough to be eligible for a medication procedure, and 43% of this group had been given a choice between medication and surgical abortion. Overall, 47% underwent medication procedures, including 81% of those who had been given a choice.

During the month of conception, 67% of teenagers had been using a contraceptive method, mainly condoms (31%) or the pill (21%). Condom use was more common, and pill use less so, among those younger than 18 than among 18–19‐year‐olds. Twenty‐six percent attributed their pregnancy to condom slippage or breakage, and 19% to inconsistent or incorrect pill use (proportions that represent, respectively, 84% and 93% of users of these methods). The main reasons teenagers gave for not having used contraceptives were that they had not thought they were at risk of pregnancy, they had not planned to have sex and they had previously had problems with contraceptives.

Before leaving the abortion facility, 80% of teenagers received a prescription or recommendation for a contraceptive method: 66% the pill, 9% the implant, 3% an IUD and 2% the patch or vaginal ring. For 68%, the method recommended for use after the abortion was more effective than the one they had been using before conceiving. However, half of women who attributed their pregnancy to pill failure received a pill prescription, and only one in five were advised to use a highly effective, long‐acting method (i.e., an IUD or implant). Logistic regression results indicate that a teenager's odds of receiving a prescription for a highly effective method were elevated if she lived with a partner, had children, had had a previous abortion or underwent a surgical procedure (odds ratios, 1.7–3.3).

While acknowledging the study's limitations—a 34% nonresponse rate and a lack of information about women's reasons for having abortions and about their postabortion use of contraceptives—the analysts conclude that the findings "produce insights on the realities of teenage abortions in France." Overall, they say, the results "reflect the prevailing social norm to postpone childbearing" but suggest that teenagers’ autonomy with regard to abortion‐related decisions varies. Furthermore, they note that "the small proportion of women who received a prescription for highly effective contraceptives reflects … obstacles in promoting use of these methods, especially IUDs, among young women despite the fact they are the second most popular method of contraception in France.—D. Hollander