[Voluntary female sterilization in Europe and the world]. / La stérilisation volontaire féminine en Europe et dans le monde.

Voluntary sterilization is worldwide used about 138 millions women in reproductive ages, not only in the developing world. In the North American continent this method is very popular, and most European countries having legalized contraceptives and abortion consider sterilization as a necessary complementary measure for family planning purposes.

[Presidential address at the 20th Journees sur la Fertilite et l'Orthogenie]. / Adresse de la Presidente des 20es Journees sur la Fertilite et l'Orthogenie.

PIP: Recollections of the author's early experiences in French family planning and reflections on the ethical issues and legal status of new fertility technologies are the major topics of this address. The group that was to become le Mouvement francais pour le Planning Familial (MFPF) was founded in 1956 by the author and others and opened its first family planning center in 1961, before contraception became legal. Despite opposition from physicians and Catholic clergy, the MFPF operated 100 centers serving over 100,000 clients by 1965. In 1969 the MFPF began a study of abortion. Despite legalization, the controversy concerning the legitimacy of abortion has not subsided. More recently, the practices of artificial insemination with donor sperm, in vitro fertilization, surrogate mothers, and other medically assisted fertility technologies have raised moral, ethical, and legal questions for all societies. The questions range from the legitimacy of gamete donation to the status of unused embryos. The dissociation of different stages of the reproductive process affects concepts of filiation, paternity and maternity. In the absence of appropriate legislation, it has been left largely to the courts to create a new body of law at this frontier. The review of legislation in France, elsewhere in Europe, and in the U.S. concerning contested filiation in cases of artificial insemination, the legitimacy of insemination of a woman after the death of her spouse, the preservation and donation of embryos, surrogate motherhood, the child's rights to information about his biological parents, and other questions indicate that no consensus has yet emerged concerning the admissibility and legitimacy of specific practices. It would be highly desirable for the European countries to adopt a common legislation in these areas.^ieng

[Vasectomy in France in 1990. A survey]. / La vasectomie en France en 1990. Enquete.

PIP: The legal status of vasectomy and of voluntary sterilization in general remains ambiguous in France despite increasing demand for the operation and an increase in the number of physicians performing vasectomies. A questionnaire was mailed to 250 urologists and other physicians by the National Association for the Study of Voluntary Sterilization in February 1989 to elicit their views and practices regarding vasectomy. 77 responses were obtained. 84.4% of the respondents stated that they had performed vasectomies. 4 performed more than 50 annually, including 1 who performed about 500 each year with his hospital team. 16 performed 10-50 per year and 57 performed fewer than 10. Most reported using local anesthesia expect 10 who required general anesthesia and 6 who did not respond. 20 spontaneous repermeations were observed with good quality sperm. 12 pregnancies occurred. 50% of practitioners reported they had never had a failure. 50.7% reported they had never had complications. 18 reported hematomas and 9 reported infectious epididymitis. Over 40% said they had never observed secondary effects. Granulomas were observed in .9% of patients. 5 patients had psychosexual problems, including 3 with partial impotence. The physician stated that the operation probably was not indicated in 1 of these cases. Only .4% of men undergoing vasectomy reported regretting their operations. 46.6% of physicians stated they had established a protocol for vasectomies. The protocols were nearly identical, requiring that the subject be 35-40 years old, married, and the father of at least 2 children. 2/3 of practitioners followed the 1983 recommendations of the National Council of the Order of Physicians. 2/3 informed their clients of the possibility of reversal, but few had received reversal requests. 18 physicians reported receiving a total of 83 requests for reversal. 68.2% of the physicians performed vasectomies for strictly contraceptive purposes. Almost all favored clarifying the legal status of vasectomy.^ieng

[Vasectomy: legal recognition in Italy, opposition to change in France]. / La vasectomie: liberalisation en Italie, immobilisme en France.

PIP: Voluntary sterilization exclusively for contraceptive purposes is now legal in many countries of Asia, North America, and Europe. Since 1972 most European countries have taken action through statutes, codes of medical ethics, decrees, or court decisions to establish the legality of contraceptive sterilization. France and Italy, neighboring countries with Catholic majorities and a tradition of Roman law, have had great difficulties in recognizing the legality of vasectomy. Italy was 1 of the few countries of the world with a law specifically prohibiting voluntary sterilization. The 1930 law was abrogated by Parliament in 1978, but in 1982 a physician was prosecuted for performing 50 vasectomies on men who had sought the procedure and consented to it. Prosecution argued that sterilization was not decriminalized despite abrogation of the 1930 law, and that voluntary sterilization was prohibited by the article of the penal code dealing with voluntary assault and battery. The interpretation surprised experts in population law, since the physician had received permission from the regional government of Tuscany to perform the vasectomies. The physician won the case, lost it in the Court of Appeals in Florence, and was finally acquitted in the Court of Cassation after a 5-year legal struggle. The court declared explicitly that voluntary sterilization did not constitute a penal infraction, but it recommended legislation to establish a minimum age, assure informed consent, and protect the interests of the spouse. In France, the legality of sterilization for purely contraceptive purposes has not always been explicitly recognized by the courts. Some recent verdicts have held that sterilization without therapeutic motivations is illicit, and some local committees of medical ethics continue to argue that vasectomy is an illicit practice that should only be considered in the presence of precise medical indications. The position is contrary to a resolution of the Committee of Ministers of the Council of Europe which France voted for in 1975, and a resolution of the National Council of the Order of Physicians in 1983. The resolution of the Order relaxed its earlier opposition to sterilization on the grounds that operative techniques had improved and that the chances for successful reversal had improved. It argued that sterilization should only be performed for very serious nonmedical reasons and required informed consent, spousal notification, and a waiting period of 2 months. The resolution has however been largely ignored. Although vasectomies are performed in numerous hospitals in France, their legal status remains ambiguous.^ieng

The legal battle for reproductive rights in Europe.

PIP: Thanks largely to medical progress, restrictive family planning laws have been increasingly viewed as an intolerable limitation of individual freedom and as intolerable state interference in private life. Most European countries have reformed their legislation to take both medical improvements, e.g. vacuum suction abortion, and the needs of society into account. In France, Belgium, Luxembourg, and the Netherlands, Napoleonic Code sanctioned the segregation of sexes in conjugal and family relations. Due to this legal background and the Catholic culture, very strong taboos developed concerning sexual life. It has taken a long time and a tough fight to establish modern legislation. In France, the family planning debate began in 1965. In December, 1974, a new law made contraceptives widely available, even to minors, and reimbursable by the Social Security system. Abortion was legalized in January, 1975, after the election of Giscard d'Estaing. Sterilization is not illegal. In 1975 the Committee of Ministers of the Council of Europe recommended that member governments make voluntary sterilization available. Scandinavian countries are in the forefront of fertility control. Both Denmark and Sweden have liberal abortion laws allowing the operation up to the 12th week. Poland, Bulgaria, Hungary, Romania, Czechoslovakia, and the German Democratic Republic adopted liberal abortion laws from 1950 to 1960. In most Eastern European countries voluntary sterilization is not practiced.^ieng

An international overview of sterilization.

PIP: Sterilization, both male and female, for family planning purposes developed very rapidly, beginning in Puerto Rico and Japan between 1940 and 1950 and continuing in India and Pakistan on a large scale after the mid-1950s. The legal status of voluntary sterilization around the world is confused, but recent developments show a trend toward liberalization of the laws. Certain countries still consider sterilization punishable under the criminal law, but there is a gap between the law and the practice. Certain countries have made the issue of consent relevant under the law. Certain other governments are studying the question of sterilization officially. Countries with heavy population pressures are employing incentives to encourage sterilization and others, specifically European countries, have legally authorized sterilization. The procedure is becoming increasingly accepted.^ieng

[The problem of abortion in the countries of the European Community]. / Le probleme de l'avortement dans les pays de la Communaute europeenne.

PIP: The abortion laws in effect and being considered in several European countries are summarized briefly (Scandinavian and Eastern European countries, Switzerland, Austria); others are more comprehensively reviewed, including dates, content and individual sponsors of proposed laws (Denmark, England, France, Belgium, Luxembourg, Holland, West Germany, Italy). Denmark and England have liberal abortion laws; Denmark permits abortion on demand up to 12 weeks but to residents only, but England performs about 25% (24,000/year) of its abortions on foreigners. Illegal abortions are estimated at 500,000-1,000,000/year in Germany, 250,000-800,000/year in France, and 30,000-50,000/year in Belgium. All of these countries have repressive abortion laws, usually prescribing 5 years in prison and/or a fine for the woman, and 5 years in prison with suspension of license for the practitioner. Convictions are rare in comparison with illegal abortions not prosecuted. A controversial conviction was that of Dr. Willy Peers, Professor of Gynecology of Brussels, who was imprisoned for performing an abortion on a mentally retarded girl raped by her father. Germany, France, Holland, and Belgium each have proposed liberal legislation during 1971-1973. A condemnation of abortion by Pope Paul has prompted 2 proposed bills in the Italian assembly which stand, however, little chance of being ennacted.^ieng

[Abortion].

PIP: The historical and current (1969) abortion laws in France as well as those in other Western countries are analyzed. France has had a series of punitive abortion codes since the Napoleonic Code of 1810 prescribing solitary confinement for the woman. The reforms of 1920 and 1923 made provocation of abortion or contraceptional propaganda a "crime" (felony), later a "delit" (misdemeanor), called for trial before magistr ate instead of jury, but resulted in only about 200 convictions a year. The decree of 1939 extended the misdemeanor to women who aborted even if they were not pregnant, and provided for professional licenses such as that of surgeon or pharmacist to be suspended. The law of 1942 made abortion a social crime and increased the maximum penalty to capital punishment, which was exercised in 2 cases. About 4000 per year were convicted from 1942-1944. Now the law still applies to all who intend to abort, whether or not pregnant or successful, but punishemnt is limited to 1-5 years imprisonment, and 72,000 francs fine, or suspension of medical practice for 5 years. About 500 have been convicted per year. Since 1955 legal abortion has been available (to about 130 women over 4 years) if it is the only means to save the woman's life. Although pregnancy tests are controlled, the population desregards the law by resorting to clandestine abortion. The wealthy travel to Switzerland (where 68% of legal abortions are done on French women) or to England. Numbers are estimated by the French government at 250,000-300,000 per year, or 1 for every 2 live births, but by hospital statistics at 400,000-1,000,000 per year. The rest of the review covers abortion laws in Scandinavian, Central European, and individual US states as of 1969.^ieng