PARIS (Tribune News Service) — Since the Supreme Court overturned Roe v. Wade two years ago, Republicans on Capitol Hill and conservative justices have regularly cited European laws barring abortion after the first trimester of pregnancy to argue for similar policy in the United States.

Chief Justice John G. Roberts Jr. and Justice Samuel A. Alito Jr. both cited European abortion limits in their opinions in the Dobbs v. Jackson Women’s Health Organization case. More recently, South Carolina Republican Sen. Lindsey Graham, who has called for a national ban on abortion after 15 weeks of gestation, told reporters on Capitol Hill that a first-trimester abortion limit would put the U.S. in line with other peer nations.

“Forty-seven of 50 European nations have national limits on abortion between 12 and 15 weeks,” Graham said in April after former President Donald Trump said he would leave abortion policies to the states. “This is the civilized world’s position.”

But in one of those countries, France, which bars elective abortions after 16 weeks gestational age (14 weeks fetal age), the comparison falls flat.

For one thing, France holds the distinction of being the only nation that has enshrined the right to an elective abortion in its constitution. And while French law bars elective abortions after the first trimester, that ban includes sweeping exceptions, including medical exceptions that in some cases allow women to access legal abortion through the third trimester.

In short, while French law nominally bars elective abortion after the first trimester, it also ensures that the decision about whether to terminate a pregnancy after that period lies with the doctor and the patient — not the government.

“In America, what is different as compared to France is that after [viability], the fetus is protected by the society. … In France, the fetus had no existence before the delivery,” said Jean-Marie Jouannic, an OB-GYN at Armand-Trousseau Hospital in Paris who specializes in fetal abnormalities.

“This is very, very important for us. It is a societal belief and a legislative decision,” he said.

US law

By contrast, Louisiana and Alabama both have laws on the books establishing fetal personhood, which gives an embryo rights at the moment of conception. That concept is becoming increasingly popular: 13 state legislatures have floated similar proposals this year alone, according to the Guttmacher Institute, a reproductive health research organization.

In the United States, the Dobbs decision created a patchwork, with a swath of differing policies on what is acceptable and what is not and laws ranging from complete ban on abortion services to no bans at all.

As of June, 14 states have total abortion bans in place, and 27 states have a ban based on gestational duration, with seven of those states banning abortion at or before 18 weeks and 20 states at some point after 18 weeks, according to KFF, a health organization. Seven states and the District of Columbia do not restrict abortion based on gestational duration.

Trump, the presumed Republican nominee for president, abandoned his party’s push for a national abortion ban in April, saying the issue should be left to the states. Many GOP lawmakers praised the move, saying Trump’s view represents the majority of Republican voters.

Still, some Republicans continue to push federal officials to crack down on Democrat-led states that allow third-trimester abortions.

During an April 16 hearing of the Senate Labor-HHS-Education Appropriations Subcommittee, Republican Sens. Katie Britt of Alabama and John Kennedy of Louisiana accused the U.S. of being an outlier on the world stage because some states allow abortion up until the moment of birth. Health and Human Services Secretary Xavier Becerra called the examples they used “fiction.”

But in the United States, late-term abortions are incredibly rare, representing about 1 percent of all abortions. They’re usually performed because a fetus is nonviable or there is a danger to the woman’s health.

French law

The French first-trimester abortion policy, as codified by lawmakers in March, applies only to voluntary termination of pregnancy. A woman can come in at any point up until 16 weeks gestation, ask for the procedure and receive it.

After that, however, there’s a very specific process.

French law allows for the “medical termination of pregnancy,” when requested, for fetal malformations, harm to the woman’s health and, in some cases, psychological or economic distress. In those cases, French law requires the pregnant woman to go to a hospital that specializes in fetal medicine. Once there, two doctors must sign off on the procedure.

“The law is very precise,” explained Jouannic.

In some cases, a physician and patient may disagree about the need for an abortion, Jouannic said. If that happens, a larger group of doctors can meet and discuss the case. There is no formal vote on the matter, but the larger discussion helps the two deciding physicians solidify their opinion.

In cases of severe conditions associated with pregnancy, like cardiac disease or cancer, three physicians and a social worker or psychologist must sign off on the procedure.

“Our work is always in the favor of the woman,” Florent Fuchs, head of gynecology at Arnaud de Villeneuve Hospital in Montpellier, France, told CQ Roll Call.

In the U.S., by contrast, the post-Dobbs landscape sowed enough confusion about what qualifies as a medical emergency in the context of abortion that the Supreme Court had to intervene.

Last month the high court dismissed a case about whether Idaho’s near-total ban on abortions preempted a 1986 federal law known as the Emergency Medical Treatment and Labor Act, or EMTALA, which requires hospitals to provide stabilizing care — including abortion, when necessary — as a condition of Medicare funding.

The stay on the Idaho law will continue. But since the court didn’t rule on the merits of the case, and because another case on the 1986 law is pending, some advocates and lawmakers believe the future of emergency abortion care remains in question in the United States.

Sen. Bill Cassidy, R-La., said Democrats are “fearmongering” about abortion access.

“Every state in the country allows for doctors to treat a woman experiencing an ectopic pregnancy, miscarriage or other life-threatening condition. That is called health care, not an abortion,” Cassidy said.

But Idaho doctors say that when the state’s abortion ban was in effect, at least six women experiencing pregnancy complications in Idaho had to be airlifted to neighboring states for care.

Government facilitating access

When the French government does get involved with abortion, it’s to facilitate access.

In 2016 the French government created Numero Vert National, or the National Green Line, a hotline that people can use to access their nearest abortion center or contact about any other sexual health question.

Jöelle Daviaud, a volunteer elected to the board of directors for Le Planning Familial Lille, the French equivalent of Planned Parenthood, has worked shifts taking calls on the Green Line a few hours a week for several years. She had to receive extensive training to answer questions.

“My only role or responsibility is to help de-stress and discuss next steps,” Daviaud said.

Recently, a 21-year-old woman called seeking an abortion. Daviaud gave the woman three options near her small town.

The U.S. Department of Health and Human Services lacks such a hotline, but after the Dobbs decision, the Biden administration launched a website to help educate women on their rights, regardless of state laws. The site allows people to file complaints with the HHS Office of Civil Rights if they believe their state isn’t following civil rights or privacy laws relating to reproductive care.

Changing attitudes

Philippe Faucher, a longtime abortion provider at Armand-Trousseau Hospital in Paris, has witnessed French societal opinions on abortion change firsthand. When he first began practicing abortion about 30 years ago, the procedure was legal but considered “taboo,” he said.

Now, there are about 230,000 abortions per year in France, a number steadily increasing even as the number of live births declines. More than 80 percent of citizens supported enshrining access in the constitution, according to a survey from the French polling company IFOP.

In the United States, voters remain supportive of abortion as access wanes. Eighty-five percent of voters say abortion should be legal in certain or all circumstances, according to a May 2024 poll from Gallup.

Texas now averages five abortions per month, compared with 4,400 per month before the Dobbs decision.

While many U.S. states have limited abortion access, the French consider access to the procedure akin to a government benefit. So concerned were they about provider shortages that the nation in 2022 passed a law allowing midwives to perform surgical abortions.

Sandra Queron works the front desk at Trousseau Family Planning Center in Paris, a public hospital, where she meets with women before and after they meet with a doctor about abortion. The front office is covered in signs about women’s rights.

“Honestly, in France, there are no blockades to abortion,” she said. “In my work I’ve never encountered anything that prevented me from giving a woman her right to have an abortion.”

But health care providers recognize this could change despite the constitutional language allowing abortion. Some worry that the election of a conservative government could lead to budget cuts for family planning clinics, waiting periods before procedures or other barriers.

“You don’t have to forbid an abortion, you just have to complicate it,” said Jennifer Constant, a midwife who runs a small private practice outside the northern French city of Lille. “And every time you will have women in trouble.”

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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