Unfit Mothers Only: Medical Gatekeeping of Second- and Third-Trimester Abortion in France.

BACKGROUND

In France, abortion is available without restriction as to reason until 14 weeks of pregnancy. Beyond this limit, medical authorization is required and "medical termination of pregnancy" is permitted for fetal malformation or serious danger to the woman's health, including from "psychosocial distress." Little is known about how professionals interpret psychosocial distress criteria and which women are deemed eligible.

METHODS

This study is based on 6 months of ethnographic fieldwork (2021-2022) in two French university hospital maternity wards. Data collection included observations of abortion care, 12 multidisciplinary team meetings, and interviews with 25 healthcare professionals (gynecologists, general practitioners, psychiatrists, psychologists, social workers, and midwives). Analysis of case files from 27 past medical termination of pregnancy requests provided additional data.

RESULTS

Healthcare professionals pathologized reproductive nonconformity by constructing certain women as unfit for motherhood based on intersecting marginalization-class, racialization, age, disability, and family structure. Approval depended on intersecting characteristics distancing women from the "good mother" norm: poverty, violent relationships, incarceration, substance use, and psychiatric diagnosis. Professionals medicalized social inequality while regulating abortion seekers' emotions and behaviors. Gynecologists invoked fetal interests to refuse requests and conditioned approval on long-acting contraception or sterilization. Professional hierarchies shaped decisions, with gynecologists dominating.

CONCLUSIONS

Medical gatekeeping of second- and third-trimester abortion care reinforces reproductive stratification by granting access primarily to marginalized women judged incapable of motherhood while subjecting them to contraceptive coercion. Physicians construct reproductive legitimacy through collective practices, transforming social and political issues into medical problems.