Apprehension of women, embarrassment of some of the doctors, restrictions on health insurance, permanent contraception only appeals to 10% of couples. Marisol Touraine wishes to facilitate access to this method.
Condoms, pill, ring, implant… Temporary contraceptives hold no secrets for most couples. But the definitive contraceptives? The question frightens. On internet forums, few women or men dare to talk about it. “I do not want to have my tubes tied even if I no longer want a child today,” says Juliette, 35 years old and 3 children. What will it be tomorrow? We don’t know what life has in store for us… We can change partners and want a common baby project. Elise, 40, had to undergo a voluntary termination of pregnancy (abortion) “despite the pill”, according to her, her gynecologist “had never spoken to her about permanent contraception methods”.
Yet since the 2001 law on abortion and contraception, any adult can have access to permanent contraceptive techniques. For Professor Francis Puech, president of the National College of Obstetrician Gynecologists (CNGOF), “It is true that a doctor can refuse to perform the procedure, but he has the obligation to refer you to a colleague”. Until 1999, serilization for contraceptive purposes was considered to be mutilation by the Code of medical ethics.
For Francis Puech, “today the reluctance also comes from the patients, as for the men it is worse, they tend to flee. The reasons are psychological and cultural, fear of regret for women, fear of losing a part of virility for men ”. Moreover, in 2001 the legislator imposed a mandatory reflection period of 4 months between the first consultation where the adult voluntarily makes this choice and the medical act.
Prof. Francis Puech, President of the National College of Obstetrician Gynecologists: ” Currently the law says that anyone can apply for permanent contraception. “
Permanent contraception also remains a taboo for lack of information and education. In September 2011, the Family planning recalled that in France “the lack of information, the difficulties of access, the costs and the received ideas remain major obstacles to the control of fertility. When will there be sexuality education for all at the rate of 3 sessions per year and per year of age, as the law of 2001 provides? When will the reimbursement of all means of contraception be the only guarantee of a real choice? When will the access and free access for all young people, girls and boys, in complete confidentiality, to all means of contraception? This also applies to definitive contraception. The numbers are there. In France, 10% of couples on average choose sterilization as a contraceptive method, against 49% in the United States and 61% in Canada.
A refund for all women
Maybe things will change. A few days ago, the Minister of Social Affairs and Health said she was in favor of “easier access to permanent contraception”. Marisol Touraine wants health insurance to reimburse all methods of permanent contraception, regardless of the woman’s age.
There are two possible techniques today. “The gyneocologist can cut or ligate the tubes using non-absorbable threads, clips or rings,” explains Professor Puech. The surgical intervention is done by laparoscopy, in a hospital environment.
But since 2002, there is another method which consists in obstructing the tubes using a small spring. The installation is also done in a hospital environment but on an outpatient basis, by natural means, so without incision or scar. It takes 3 months for the obstruction to be complete, during which time another contraception is necessary. And a control is then obligatory to check that the tubes are well blocked. The problem is that this last simpler method is no longer reimbursed by health insurance for women under 40, unless they have a contraindication to pregnancy and intolerance to temporary contraception. Suddenly, women under 40 who wish to have free access to this non-invasive technique must pay nearly 1,300 euros…
This measure taken in August 2010 by health insurance, which goes against the spirit of the 2001 law on abortion and contraception, could be canceled soon. This is the wish of health professionals who have not understood the reluctance of health insurance with regard to an effective non-surgical technique and indicated for all women regardless of their age according to an opinion of the Haute Health Authority (HAS) in 2007.
Pr Francis Puech: ” The method is ultimately less expensive for social security. “
The CNGOF seized the Council of State in 2011. Family Planning has also campaigned against this “discriminatory measure” of health insurance by filing an appeal with the Defender of Rights. An appeal accepted by the Defender of Rights who also recalled that in France “the rate of abortion is still high for women over 35 years”. In 2004, more than 29,000 women aged between 35 and 39 had recourse to an abortion according to the DREES. “It is possible to think that a simpler and less expensive device would be likely to limit the number of abortions and thus meet a public health objective”, underlined Dominique Baudis, the Defender of Rights.
And for men, is definitive contraception reimbursed? “Yes, vasectomy, which consists of blocking the vas deferens, is largely reimbursed by health insurance,” recalls Professor Puech. Like any surgery, this can be risky, but you should know that vasectomy causes about 20 times fewer complications than tubal ligation in women. “
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