Contraception in France_An Assessment After 30 Years of Liberalization

8/19/2019 Contraception in France_An Assessment After 30 Years of Liberalization

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Population

Contraception in France: An Assessment After 30 Years of Liberalization (Population, 4, 1998)C. De Guibert-Lantoine, Henri Leridon

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De Guibert-Lantoine C., Leridon Henri. Contraception in France: An Assessment After 30 Years of Liberalization

(Population, 4, 1998). In: Population, an English selection, 11ᵉ année, n°1, 1999. pp. 89-113.

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Résumé

Guibert-Lantoine (Catherine de), Leridon (Henri).- La contraception en France : un bilan après 30

ans de libéralisation La contraception a été légalisée en France par une loi adoptée fin 1967. La

diffusion des méthodes contraceptives, notamment la progression de la pilule, s'est ensuite faite

rapidement. La dernière enquête réalisée en 1994 (Ined/Insee) permet de faire le point sur les

pratiques contraceptives. La contraception est généralisée à tous les âges : moins de 5 % de

femmes prennent le risque d'une grossesse non désirée. On observe une forte progression, dans

les générations successives, de la pratique contraceptive lors des premiers rapports sexuels. La

contraception est aujourd'hui essentiellement féminine et médicale : la pilule s'est imposée, en

particulier chez les plus jeunes ; le stérilet apparaît comme la méthode relais après la constitution

de la famille; la stérilisation contraceptive n'occupe qu'une place modeste, réservée à la fin de la

vie féconde ; les méthodes traditionnelles sont maintenant marginales ; l'usage du préservatif

masculin est en progression, surtout chez les jeunes et les personnes seules, souvent utilisé en

complément de la pilule, car il est un moyen de contraception autant que de prévention des

maladies sexuellement transmissibles.

Abstract

Guibert-Lantoine (Catherine de), Leridon (Henri).- Contraception in France: An Assessment After

30 Years of Liberalization Contraception was legalized in France by a law adopted at the end of

1967. Contraceptive methods, in particular the pill, then spread rapidly. The most recent survey,

conducted in 1994 (INED/INSEE), provides material to review the current state of contraceptive

practices. Contraception is now practiced at all ages: less than 5% of women are exposed to the

risk of an unwanted pregnancy. Contraceptive use in first sexual intercourse is observed to have

increased greatly over successive generations. Contraception today is practiced mainly by women

and takes a medical form: use of the pill has become widespread, particularly among young

people; the IUD appears as the follow-on method once the family has been formed; traditional

methods are now marginal; use of the condom is on the increase, particularly among young

people and single people, for whom it is often used in conjunction with the pill, being both a means

of contraception and a protection against sexually transmitted diseases.

Resumen

Guibert-Lantoine (Catherine de), Leridon (Henri).- La anticoncepción en Francia : balance a los 30

aňos de su liberalización Los anticonceptivos se legalizaron en Francia a partir de una ley

aprobada a finales de 1967. La difusión de métodos anticonceptivos, y especialmente la

expansion del uso de la píldora, fue rápida a partir de este momento. La ultima encuesta,

realizada en 1994 (Ined/Insee) permite analizar las prácticas anticonceptivas. El uso de

anticonceptivos se ha generalizado en todas las edades : menos del 5 % de las mujeres se

arriesga a un embarazo no deseado. A través de generaciones sucesivas, se observa un fuerte aumento del uso de anticonceptivos en el momento de las primeras rela- ciones sexuales.

Actualmente, la anticoncepción es esencialmente femenina y médica : la píldora se ha impuesto

particularmente entre los más jóvenes ; el DIU aparece como método de relevo después de la

constitución de la familia ; la esterilización es poco común, y su uso se limita al final de la vida

fecunda ; el uso de métodos tradicionales es marginal ; la utilización del preservative masculino

esta aumentando, especialmente entre los jóvenes y las personas solas, y a menudo se utiliza

como complemento de la píldora ya que es tanto un método anti- conceptivo como una forma de

protección contra las enfermedades de transmisión sexual.


3/27


4/27

90

С.

de GUIBERT-LANTOINE,

H.

LERIDON

'to

regulate

periods' - the only grounds

on

which these

hormonal drugs

were granted marketing clearance. Between 1968 and 1972, the rate

of

uptake increased, despite the lack

of

regulations. It will be seen below

that

pill

use

rose particularly

sharply

from

1970

to

1976.

Latterly,

it

has

more or

less

levelled

off:

the increase

in pill use is now slight and

has

virtually

peaked; IUD use has declined somewhat, and the other methods

barely feature at

all

-

except

for the condom, of

which more

later. The

rise of

AIDS

in the 1980s has had no

significant effect

on contraceptive

practices,

apart from condom use.

Assessments being the order

of

the day, it

may

be relevant

to

consider

how some

of

the expert forecasts made in the 1960s have panned out. In

1956, the INED published a group study

on

'birth-control in France',

which

considered

the prospective birthrate impact of the emergence and licensing

of new contraceptive methods

significantly more

effective

than those then

available

(INED,

1956);

bear

in

mind

that

the

pill

had been

'invented'

by

Gregory

Pincus in 1951, and

was

first

tested out

-in

Puerto

Rico- only

in

1956, before

being

put

on the

United States

market in

1961. The

authors

predicted

two

key results: a sharp decline in the

number

of unwanted

births,

and a scaling-down

of

the

number

of

children wanted; the two combined

could

reduce fertility

to

below-replacement

level

(2.1 children). In 1966,

the INED

published

another

report on

the

same

topic, at the request

of

the High Consultative Committee

on

Population and

the

Family

(INED,

1966). This

time, such

a sharp decline in replacement fertility was thought

likely only if

the

overwhelming majority

of

couples used a 100% effective

method; at 50% use,

the

decline was estimated at

between

5

and 10%.

However, between

the

1935

birth

cohort

(which

had

most

of

its

children between

1960

and

1970, at the end

of

the

baby-boom,

before the

new

contraceptives became available) and the 1950 birth

cohort

(post- Act

children born between 1975 and 1985),

completed

fertility

fell

from

2.6

to

2.1: a relative decline

of nearly 20% to the generation

replacement level

in

the

space

of

fifteen-odd

years.

By 1988, use

of

the most effective

contraceptive methods (pill, IUD and sterilization) had spread

to

57%

of

all

20-44

year-old women,

i.e.,

close to 80% of women

users at the survey

date. The 1966 forecast,

therefore,

was

ail-but

borne out,

even

though the

methods

available

were

not yet 100% effective(1) -probably about 99%

on

average

for the pill and IUD, allowing for the possibility of abortion

in

cases

of

failure.

The

two

effects

hypothesized

in

the

1956

article were

borne

out

in broadly equal proportions: about

half

the fertility decline was

attributable

to

the

fall

in the

number

of unwanted births, and

half

to

a

reduction in the

number

of wanted children (Leridon, 1985).

(1' Contraceptive

method effectiveness is equal

to

the ones

complement

of the ratio

of

the monthly risk

of

conception when the method is used to the

monthly

risk when it is

not, often expressed as a percentage.

A

99%-effective

method

will give approximately 3 to

4 pregnancies per 100 woman-years.


5/27

CONTRACEPTION

IN

FRANCE

9 1

The upheaval

in French contraceptive practices

thus

had

a

discernible

population

impact within

the space

of

the fifteen years from

1965 to

1980.

On

top

of that,

the two effects observed (fewer

unwanted

births

and wanted

children) are

just

two

aspects

of

the

same

underlying

trend:

the

aim

to

exert

more

control

over one's fertility. This

was

what stood behind the

passing

of

the Neuwirth Act, which expanded the ambit

of

personal

freedoms,

particularly

for women. To this extent,

the

Act is not 'responsible'

for

the

subsequent

fertility trend: it

merely

addressed a ground swell of

demand,

amply

borne

out by subsequent

attitudinal

behaviours:

the new

Act was welcomed by 70%

of the

population

in

1976,

and

the

pill

consistently

heads

the

list

of things which

most

changed women's lives' in

the past

quarter- or

half-century (cf Leridon

et al.,

1987).

This

article

will now review contraceptive practices from the

most

recent survey

findings

(INED-INSEE, 1994) and the previous surveys

of

1978

and

1988

(see

Appendix).

Other more

recent

data,

not

least

the

sales

figures for contraceptive

pills,

suggest that

the situation has changed

little

since 1994.

I. - Widespread, medically-provided

contraception

Contraception is mainly

medically provided

to

women

today. A doctor

must be

consulted for the prescription or

use of

the

pill

or

IUD (intra-

uterine device). Non-medical,

traditional methods

- abstinence (periodic

abstinence,

basal

body temperature method), withdrawal and

vaginal

methods

(diaphragm, creams,

jellies,

suppositories,...)- have largely fallen

by

the

wayside.

Only male

condom

use is rising, since

it also addresses

other

concerns.

Reversible contraceptive methods are still the order of the

day

in France - contraceptive sterilization is

little used.

The behaviour

of women

users and

their

male partner if any will

first be

examined, followed

by the practices of lone men. Table 1

shows

contraceptive practice for

all women

of reproductive age, from 20-49

years

of

age at the time

of

the 1994 survey, according

to the

primary method

used at the survey date: where several methods are used at once, the

primary

method

is

determined

by

the

method

hierarchy

given in Table

1

,

which

ranks

those

used

mid-cycle

(i.e.

most

effective)

higher,

and

local/vaginal

methods (especially condom use)

lower

(combinations of methods will be

dealt with below). Table 2

shows

the trend of practices since 1978 using

the same

method hierarchy;

note

that

comparison between the

1978, 1988

and 1994 surveys is possible only for

women

aged 20-44.


6/27

92 С. de GUIBERT-LANTOINE,

H. LERIDON

Table

1 . - Primary

contraceptive

method used

in

1994

for 100

women

in each age group

Age

at

1.1.1994

Year

of

birth

Proportion

of

women :

Currently

using contraception

inc.

Pill

IUD

Periodic

abstinence

Condom

Local female methods

Withdrawal

Other, not

specified

Sterilized (for contraception)

Woman

Partner (male)

Not

using

any contraception

inc.

Sterilized3

Sterile

Pregnant

Seeking

pregnancy

No current partner

Want

another child

Do not

want further

children

All

Population(OOOs)

Survey population

20-24

1969-

1973

68.8

58.6

2.9

2.3

4.0

0.3

0.7

0.0

0.6

0.6

0.0

30.6

0.0

0.4

3.6

2.9

21.3

1.7

0.8

100.0

2 088

496

25-29

1964-

1968

67.9

50.3

7.7

2.1

5.3

0.1

2.4

0.0

0.5

0.5

0.0

31.7

0.0

0.7

11.4

8.5

7.6

3.4

0.1

100.0

2 125

519

30-34

1959-

1963

67.3

41.0

15.0

3.6

4.7

0.7

2.2

0.1

1.6

1.6

0.0

31.1

0.0

2.5

7.1

7.6

8.6

1.9

3.4

100.0

2 170

548

35-39

1954-

1958

69.7

31.2

27.3

3.5

5.3

0.2

1.8

0.4

5.2

5.2

0.0

25.1

1.4

3.0

3.0

3.2

10.0

1.1

3.5

100.0

2 139

563

40-44

1949-

1953

64.7

20.3

25.5

7.8

3.7

1.2

5.1

1.1

7.0

6.9

0.1

28.3

5.9

6.1

0.2

1.1

9.0

0.7

5.4

100.0

2 140

470

45-49

1944-

1948

45.5

14.5

17.6

5.6

4.0

1.1

2.2

0.6

11.9

10.7

1.2

42.6

10.1

16.6

0.0

0.0

10.5

0.0

5.3

100.0

1874

348

All

20-49

1944-

1973

64.3

36.3

16.0

4.1

4.5

0.6

2.4

0.4

4.3

4.1

0.2

31.3

2.8

4.7

4.3

4.0

11.1

1.5

3.0

100.0

12

536

2 944

All

20-44

1949-

1973

67.7

40.2

15.8

3.9

4.6

0.5

2.4

0.3

3.0

3.0

0.0

29.4

1.5

2.6

5.1

4.7

11.3

1.7

2.6

100.0

10 662

2 596

Source: INED, Enquête sur

les

situations familiale

et

l'emploi, (Family

and

Labour

Survey),

March

1994. Women

aged 20 to 49.

Read

as:

58.6

%

of

women aged 20 to 24

were

taking

the pill at the survey

date.

In case

of

multiple responses, the

primary

method

was

determined

according

to the hierarchy:

sterilization followed

by

reversible methods in the table order.

a

: Sterilization on medical grounds (almost

exclusively fem ale

sterilization).

:

Includes

don't

knows .

Widespread female

contraception

from

the start of reproductive

life...

More than

two

in

three

Frenchwomen aged 20-49 use contraception

-

68.6%

if contraceptive sterilization is included. But this is not

to

say

that

most

of

the non-users at the survey

date

were at

risk

of unwanted

pregnancy:

7.5% could not have children -2.8%

as

a result

of

medical


7/27

CONTRACEPTION

IN FRANCE 93

Table 2. -Primary contraceptive method in 1978, 1988,

1994

for 100

women aged 20-44

Year

of

birth

Proportion

of women:

Currently

using contraception

inc.

Pill

IUD

Periodic

abstinence

Condom

Withdrawal

Other

methodsa

Sterilized

(for

contraception)

Woman

Partner

(male)

Not using any contraception

inc.

Sterilizedb

Sterile

Pregnant

No partner

Want

another child0

Do not want further children

All

Population

(000s)

Survey

population

Survey Year

1978

1933-1957

67.8

28.3

8.6

5.5

5.1

18.0

2.1

4.1

4.1

0.0

28.5

3.2

1.4

4.8

9.1

6.3

3.7

100.0

8

899

2 982

1988

1943-1967

67.8

33.8

18.9

5.0

3.4

4.8

1.8

4.2

3.9

0.3

28.2

1.8

2.8

5.4

9.9

6.6

1.7

100.0

10 177

2

666

1994

1949-1973

67.7

40.2

15.8

3.9

4.6

2.4

0.8

3.0

3.0

0.0

29.4

1.5

2.6

5.1

11.3

6.4

2.6

100.0

10 662

2

596

INED, Enquête mondiale de fécondité, 1978

(Leridon,

1987).

INED, Enquête régulation des naissances,

1988 (Toulemon,

1991).

INED, Enquête sur

les

situations

familiales

et l'emploi, March 1994.Local female methods, or method

not

specified.

On

medical

grounds

only.

c Now or later, includes don't knows .

sterilization,

4.7%

due

to

being

sterile

or

past

(at

least

presumptively)

childbearing age; this relates mainly

to women

aged 45-49, more than one

in

four

of whom consider themselves

sterile.

Also, among

all

women of

reproductive

age,

8.3% had

other reasons

not to use

contraception: 4.3%

were

pregnant and

4.0%

seeking pregnancy;

this

even

includes 15

to 20%

of

young

women

aged 25-35. Finally,

one woman in

ten

had

no

current

partner or at least

reported

having little or no sexual intercourse ;

this

was mostly young

women, and almost

exclusively

women

not

in

a

partner

relationship

(but

that

applies

to

only one third

of

lone women). That leaves

just 4.5%

of women

not

in

any

of the above

categories

-i.e.,

at risk

of

unwanted

pregnancy - one

in

three

of whom wanted

more children: only


8/27

94 С. de

GUIBERT-LANTOINE, H. LERIDON

3%

of

these

wanted no

more

children.

Contraceptive protection

can be said

to be almost total, therefore,

at

an

average 97%: it

is

maximum

among

young

women and about 95% among the

40-plus group.

Who

are

these

4.5%

presumptive

risk-takers?

Under

30,

they

mainly

run

the risk

of earlier-than-planned childbearing. Above

30, they are mainly

women

who

report

being

finished

with childbearing:

3%

of 30-39 year-olds

and

5%

of 40-49

year-olds;

a

significant number

of these, however, are

not at risk

of pregnancy,

either

because

they

are not

living

with

a partner,

or because they are at the end

of

their

reproductive

life, have lower fertility

and less frequent sexual intercourse.

Contraception,

then,

can be said

to

be widely practised in France.

This is not

a

new

phenomenon - there was

already

a

68% contraceptive

prevalence rate

among women

aged 20-44

in 1978 and

1988.

It is among

young people

that contraceptive

prevalence has increased

most since

the

1988

survey:

68.8%

of

20-24

year-olds were users

in

1994,

i.e., 8%

up

on

1988. The

prevalence

rate was

already close to peak in

1978, when

fewer than 10%

of women

aged 20-44 were exposed

to

the risk

of unwanted

pregnancy;

the

proportion decreased slightly (8.3% in 1988)

to

level off

at

9%

in 1994.

Of

the

6%

of non-contraceptors who still wanted children

(proportions

observed

in

all three

surveys), those not using contraception

because they are trying for a child can be singled out

in

the 1994 survey:

this is the

case

with

three

quarters, and virtually all the

young

women

(under

30). These

results

confirm the

controlled use of

contraception at

all

ages,

especially from the start

of

the

reproductive period

(see,

below,

steady

increase

in

contraception

at first

intercourse).

Women's conjugal status has

an undoubted impact on

their

contraceptive behaviour,

but

less

so than their

sexual relations

(the role

of

conjugal status will be considered in

more detail

below,

see

Table

5).

Women

living

in partner relationships, or

their partner, more frequently

use

contraception (70%), but so do over

half

of women

who

are not

in

partner

relationships. Among those women not living in partner relationships,

taking

the 51%

of women

users with the 36%

who

have

no

sexual

partner,

and adding those who know themselves

to

be sterile, pregnant or seeking

pregnancy

(7% in

all), we find

that

they are barely more at risk

of

unintended pregnancy (6%) than

women

who are living in partner relationships

(5%).

Also,

30%

of

women

not

living

in

partner

relationships

report

that

they have a

stable loving

relationship:

contraception

prevalence

is high

amongst

this

group - nearly 80%;

of

those

not in a

stable

relationship (who

may have

occasional

partners), 37% are protected by a

contraceptive method.

This analysis bears out

that

contraception is widespread

among

women

engaging

in sexual intercourse at

all

ages and regardless of conjugal

status.

It

will

now be

seen

that further change

has

occurred in

the

methods

used since the 1988 survey, towards increased médicalisation

and

hence

greater

effectiveness;

there

is still wide variability according

to

the

woman's

age, conjugal

status and parity.


9/27

CONTRACEPTION IN FRANCE 95

More

use of hormonal contraception

Since contraception was legalized in 1967, non-medical methods have

declined

steadily

in

favour

of

the

pill, and

to

a

lesser

extent,

IUDs.

Other

than

condom use, boosted

by

AIDS awareness campaigns,

non-medical

methods are being forsaken:

withdrawal and

periodic abstinence continue

to

wane in popularity: both are now the primary means

of

contraception

for only

6.3% of

women, against 9.8% in 1988 and

23.5%

in 1978; vaginal

methods - never

very

widespread - are

now preferred

only by fewer than

1% of women.

By contrast,

52% of

women aged

from 20 to 49

- i.e.,

76%

of users, including sterilization - now use the pill or IUD. The pill is the

clear

leader

(36%

of

women),

and its use

increased

still further between

1988 and 1994 to the detriment of IUDs, still the

second

most usual

contraceptive method (16%

of women).

Contraceptive

sterilization is

not

prevalent

in

France

-just

4%

of

all

women

of

reproductive

age.

Significantly,

the

morning-after

pill is ail-but non-existent; only one survey respondent

reported

having used

it, although, admittedly, it

is not available on the

market

as such.

Some doctors, however, prescribe an elevated dose

of

a

readily

available

hormonal contraceptive as emergency contraception after

unprotected sex.

The salient feature

of

French contraception, then, is the high

prevalence of

medical contraception:

the pill as birth

spacing

contraception and

then as birth

stopping

contraception, and IUDs

as contraception designed

to prevent further childbearing. The

1994 survey also points

up

the growing

use

of

condoms

among young

people

and those

not

living

with

a

partner,

and the low prevalence of contraceptive sterilization,

used

only

at

the

end

of reproductive life. The

decisive

factors in

the

choice of

pregnancy

avoidance methods are the woman's age,

number

of

children

already

born, and

conjugal status. These will now be

looked at

in

more

detail.

Medical methods Thirty

six

percent

of 20-49-year-old women use

the

pill, i.e., 53%

of

contraception or

sterilization

users.

Prevalence is

highest

among 20-24 year-olds: 59% of

young

women take

the pill, i.e., 85%

of

users; thereafter, it decreases progressively with rising

age

(Figure

1), but

the

pill

is

primary

contraception

for

women

up

to

nearly

40

years

of

age.

As

the

preferred

contraceptive

method

for

three

in

every

four users under

the

age of 30, it is the primary method of birth

spacing.

The pill

has

increased in

prevalence at all ages

in recent

years,

rising from

33.8% in

1988

to 40.2% in

1994 for all 20-44-year-olds.

Figure

2a shows

the age-specific rates in

the

successive birth cohorts: in the 5 years leading

up

to the

last survey, the rate

of

increase was particularly marked

among

the youngest groups,

rising from 50.9% to 58.6% among

20-24-year-olds,

and from 41.4% to 50.3% among 25-29-year-olds.

A

sharp

rise during the 1970s has

been followed

by

slower

but steady

growth. The

levelling

off

in

the sales

figures curve

after

1990 plotted in


10/27

96

С. de


г

КеУ:

I i

Contraceptive sterilization

[ 1,1

Periodic

abstinence + withdrawal + local methods

|

Condoms

|IUD

I

Pill

20-24

I

25-29

I

30-34

I

35-39

I

40-44

I

45-49

Figure

1.

-

Primary

method in 1994

for

100

women

in

each

age group

Figure 3 appears

to

conflict with the 1994 survey findings. The discrepancy

may

be due

to

an

increase

in

the

prescription

of

progesterone-only-pills

for

treatment of

perimenopausal symptoms:

because

such

treatments

also

have contraceptive effects, respondents would

in

the

nature of

things

report

them in the survey, even though not all such products are licensed for

marketing

as

contraceptives.

If a

third of

the sales

of

this type

of product

are added

to

those

of contraceptive pills proper,

the number

of pill

users

tallies with the survey

estimate:

5.2 million

users in

1994,

against

4.0

million in 1988 (Toulemon and Leridon, 1995 b).

The pill

thus

continues to gain in

popularity at both ends

of the

reproductive age range. Furthermore, the

development

of mini-pills

extended

the range of situations in which the pill could be prescribed and made

doctors

less

reluctant

to

prescribe

the

pill

for

more

than

ten

years:

as

a

result, the use

of

hormonal products continues

to

increase

among

the over-

35s, checking the prevalence of IUDs

among

these

age groups.

On

average, the IUD is the second most popular

contraceptive

method,

with an overall prevalence

of

16%,

i.e., 23%

of

users. But

the

age-specific

trend is

very

different

here, with

a

very

pronounced peak

(26%)

between

ages

35 and

45: the IUD tends to

be used by

women

seeking

to

stop childbearing;

although completely reversible, it can be described

as

a 'stopping

contraceptive

method'.

This makes

it

the primary contraceptive technology for

those around 40 years

of

age.

On

the whole,

IUD

prevalence has stopped


11/27


15-19

20-24

N.B. There

is

a

one-year variance between the birth cohorts observed in 1994

(end point

of

each curve) and those given in the key

to

the chart.

Figure

2a. -Pill

use

among

women

by age and birth cohort

50-

40-

30-

20-

10-

0

15-19

i i

B- IUD

-

1958-62K

1963-67—

^g/--

1

1953-57K

i

i i

J 948-52ГГ- /*._

1 1

INED

09998

—

—

20-24 25-29 30-34

35-39

40-44 45-49

Age

N.B.

There is

a

one-year variance between

the

birth

cohorts

observed

in 1994

(end point

of each

curve) and those given in the key to the chart.

Figure

2b.

-IUD

use

among

women

by age

and birth cohort

Sources: 1978

and

1988 surveys,

and

sales figures

(Toulemon, Leridon,

1991); ESFE

1994 survey data


12/27

98 С. de

GUIBERT-LANTOINE,

H.

LERIDON

40

1 1 1 1 1 1 1 1

-Key:

1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994

Figure

3. - Pill and IUD

use

(among 100

women

aged 15-49)

rising,

and even declined

from

18.9% to 15.8%

among all

20-44 year-olds

between 1988 and 1994, corresponding

to

a sharp

fall

in use between ages

25 and 35. So, only 7.7%

of

women aged 25-29 use IUDs compared

to

14%

of

those

born

six

years

earlier,

and

15%

of

those

aged 30-34

against

25% (Figure

2b).

At the

same

time,

oral

contraception prevalence added

eight points,

as

we have seen.

Use of IUDs

is

constrained

by two factors.

The

(slight) risk

of

infection and

possibly sterility

make

most doctors reluctant

to

prescribe it

for

young

women and those with incomplete

fertility;

as a result, the current

trend to

defer

age

at

childbirth

has limited the proportion

of women

aged

under

35 likely

to

use

IUDs.

For older women, the new hormonal products

seem

to

offer

the

twin benefits of contraception and preventive treatment

of the effects of the menopause, which IUDs cannot provide.

Note

on

social differentials

During the

1970s, medical methods

(the pill and

IUD)

were more

prevalent

among women

in the socio-economic

groups

most in touch with preventive health,

e.g.,

better-educated, urban, non-manual

workers. By 1988, practices had

grown

more

consistent:

pill

use, in particular, was

no longer

connected

with educational level,

occupation or residence; IUD use, on the other hand, remained more

prevalent

amongst

the most highly-educated

women

(see Toulemon and

Leridon,

1992).


13/27

CONTRACEPTION N FRANCE 99

Condoms Condoms are the contraception of choice for 4.5% of 20-

49-year-old

women, slightly more

than

the

3.4%

of

1988,

following a downturn

during

the 1980s. But their

position in

this method

hierarchy

belies

the

reality,

because

they

are often

used

in

combination

with another contraceptive method; in

all,

7.8% of

women

aged

20

to

44

reported

using them - a

significantly higher

proportion

than

the

5%

of

preceding

surveys

(see

infra).

In fact, condom prevalence has increased since 1988,

especially

among

young

people and

those

not

living

in partner

relationships,

as

a

provisional method,

particularly

for first intercourse (about

half

of which

is with condoms today). Furthermore, condoms are as

much

a contraceptive

method as a means of averting sexually transmitted diseases. Also, their

use

is

assessed

here

based on

women's

replies,

but

must

also

be

judged

on

those

of men,

who

report significantly higher frequencies

of use, as

will

be

seen

later

(see

also Toulemon

and

Leridon,

1995

a).

Contraceptive sterilization France has no specific legislation

permitting or prohibiting voluntary sterilization.

The French General Medical

Council

allows it only on very serious

grounds ,

but

what

these are

remains unclear. There is

little legal precedent

on the matter,

but

some

insurers take the

view that accidents

connected

with

sterilization

procedures are not part

of the practitioner's

or

anaesthetist's

normal

duties (and hence not covered by their professional

liability

insurance). This climate of

uncertainty

is

obviously

no great

incitement

to

use

sterilization

as

a

method

of

birth

control

in

France, unlike

other

comparable countries. The distinction that can be made between sterilizations

'to

avoid further childbearing'

(contraceptive) or

'on

medical

grounds is

based

solely on

respondents replies; contraceptive sterilization includes

partially

contraceptive

sterilizations (carried out

on

both grounds), but not

procedures carried out

on

purely medical grounds. Given the uncertainties

surrounding the precise purpose

of procedures,

the analysis

will

embrace

all sterilizations, specifying the reported

purpose.

6.8% of

women aged

20 to 49 in

1994

had

been

sterilized, including

4.1% (i.e.,

two

thirds

of them) for contraceptive purposes.

The method is

not prevalent

among

the

under-40s, and even

less so

among

the under-35s;

it

affects

7%

of

40-44

year-olds

and

11%

of

45-49

year-olds.

A slight but

steady decline

in female sterilization is discernible

through the results of the

three surveys.

The proportion of surgically treated

20-49-year-old

women

declined from just under 10%

in

1978

to

7.6%

in

1988 and

6.8%

in 1994. The corresponding proportions

of

purely

contraceptive

sterilizations decreased from 4.3% in 1988

to

4.1% in 1994. The

decrease in

such procedures

is

most marked

among the under-40s, and is

now

almost

nil before the

age of 35. The

decline

in

medical sterilizations

was

relatively more pronounced between 1978 and 1988;

this

form of

major

procedure

-

usually

hysterectomy -

now

seems

less prevalent

than before.


14/27

1 00 С. de GUIBERT-LANTOINE,

H.

LERIDON

As a result,

the relative

share

of surgical

contraceptive procedures

among

all

sterilizations

has increased

from

56% to 68%.

Male sterilization is so uncommon as

to

be hardly discernible in the

survey;

only

about

0.4%

of

women

living

in

partner

relationships

reported

having

a

sterilized partner in

1988,

and even

fewer

in 1994

(11

and

5

survey respondents respectively).

Using data

from

the

three

surveys, we

can calculate

the cohort trend

in sterilization (Figures 4a and 4b)(2). The

findings

confirm

a decline in

sterilization

at

all ages, from the oldest

to the

most recent birth cohorts:

so, the proportion

of

women

already sterilized

at

age 40

decreased

from

16% for those born

in

1939-1943

to

10%

for

those a decade their juniors.

Note

that

the decrease in operations

among the

younger

generations

occurred between 1978 and

1988,

with the

proportion

of women already

sterilized

at

age

35 seeming

to level-off

at the

low

level

of

nearly

5%. There

is

a

comparable

trend

in

purely

contraceptive

sterilizations:

the

proportions

of

women

sterilized by the age of 40 declined quite sharply from 8.5%

to

5%

in the 5

years

between

1988-89

and 1994 (C. de Guibert-Lantoine,

1997).

Sterilization thus

predominates among comparatively

older,

ever married

mothers of

large families: 8.5%

of

two-parity

mothers

were sterilized

(only

3.3% of

them for contraceptive reasons), but

14.4%

(12.6% contra-

ceptively)

of three-parity

mothers, and 20%

(14%

contraceptively)

of

mothers

with

four or more children. Overall, average parity per

sterilization

contraceptor

is

almost

double

that of

all

women

-2.8

compared to

1.5.

Contraception in

France,

therefore, is essentially

female,

hormonal - so,

effective yet reversible - permanent and not

coitus-related.

Male

contraceptive

methods (condoms and

withdrawal)

which involve

the

woman almost as much

as the

man

and are coitus-related, are often used in combination.

'Dual method'

contraception

Contraceptive practices

do

not

boil

down

to

a

choice

of

just one

of

the methods available:

7%

of women, and

11%

of men, contraceptors

also

use a back-up

method. The

proportions are higher still - 15%

and 21%

respectively

- among respondents

not living in partner relationships, and

markedly lower among married women, where under 5%

are

dual method users.

(2)

Figures 4a and

4b

were plotted from the 1988

and

1994 surveys,

by

comparing

results

for

the same birth cohorts

and

estimating

mean values

where

divergences occurred;

some of the 1978 survey

findings

were factored in.

The

low numbers

concerned

mean that

trends

and orders

of magnitude

are

what is essential.


15/27

CONTRACEPTION

IN FRANCE 101

Figure

4a. -

Women

already sterilized

(all reasons),

by age and

birth

cohort

20

15

10

5

0

i

-

-

-

■

i

Г

i i

1939-43^

_,.

''-^ ^^*tí^-^ — —

__

/954-5S

jr^^ ^\

1959-63

i

^]

944.48

^^1949-53

i

INED

09698

-

20 25 30 35 40 45

Age

Figure 4b.

-Women already

sterilized

for contraceptive

reasons,

by

age

and birth cohort

When

these

combinations are considered, the use of

non-medical

methods

is thrown into

stark relief: they are

used,

alone or

in

combination,

by 16.4%

of 20-49-year-old women,

compared

to having been

the

primary

method for

just

11.6%. The proportion of

women

using

each

method, alone

or combined, in the survey month

with

a summary for those using

at least


16/27


17/27

CONTRACEPTION N FRANCE 103

up

by another method (in

2.7% of cases),

the

pill slightly

more often

(6.0%), the most usual

(four

in five)

backup

to

medical methods being the

condom: 2.2% of

women

with an IUD and 4.9% of

women

taking the

pill in the month preceding the survey used one in the same month. Non-

medical

methods

are

much more

often

backed-up

by

another

method:

41.6%

for condoms,

36.7%

for withdrawal, 43.0% for abstinence, over 50% for

vaginal methods. The most frequent combinations are condoms and the

pill,

abstinence and condoms, withdrawal and

periodic

abstinence.

'Dual method contraception is

most

prevalent among and

characteristic

of lone

contracepting

women: nearly one in

four was

using condoms

at the survey date, more than half

(55%) in

combination with medical

contraception.

In

this

context, condoms

are

used as

much

to

protect against

STD

(especially

AIDS)

as

pregnancy, especially when

combined with

efficient technology

like the

pill.

Methods

known and

previously

used,

medical

advice

Measuring the generation-

specific

dissemination of

contraceptive

information and practice

through

two questions put in

the

1994 survey - have

you

previously used such a contraceptive method at

least once? and

have

you

previously

discussed

contraception with a

doctor?

-

reveals

a mix

of

at

least

temporary individual practices. These results are shown

in Table 4.

Table 4. - Contraceptive methods used at least once and medical advice

sought

for 100

women

in each age group

(1994 survey)

Age at 1.1.1994

Proportion of women having:

Sought

medical

advice

Sought advice or used a

medical

method

Using a medical method

Pill

IUD

Used

a

non-medical method

Periodic

abstinence

Condom

Withdrawal

Used

pill +

condoms

Population (000s)

Survey

population

20-24

1969-

1973

78.7

87.1

83.0

82.7

4.5

68.6

12.1

58.3

32.3

52.6

2 088

496

25-29

1964-

1968

88.0

96.4

93.6

93.3

13.4

69.6

15.1

52.7

39.6

50.7

2 125

519

30-34

1959-

1963

81.0

93.8

90.7

88.6

27.7

67.2

20.9

41.5

36.6

39.1

2 170

548

35-39

1954-

1958

86.7

93.7

90.9

86.3

46.9

68.1

14.9

41.9

40.3

38.1

2 139

563

40-44

1949-

1953

79.0

88.7

83.8

77.3

48.9

76.1

27.9

44.4

47.2

37.8

2 140

470

45-49

1944-

1948

69.0

84.5

80.6

72.5

42.1

71.1

26.4

36.8

50.9

29.9

1

874

348

All

20-49

1944-

1973

80.6

90.8

87.3

83.7

30.5

70.1

19.5

46.1

41.0

41.5

12 536

2

944

Source:

INED, Enquête

sur les situations familiales

et l'emploi, March 1994. Women

aged 20-49.


18/27

1 04

С.

de GUIBERT-LANTOINE,

H. LERIDON

Methods previously This question gives information both about

con-

used

at least

once traceptive knowledge and

practice,

in

that

use

of

a method, even if

once

only,

necessarily

betokens

knowledge

of

it.

It

also

supplements

the

findings presented

above

on

the

practice observed at

the

survey

date

for both primary and secondary methods:

the fact is that the

contraceptive

behaviour of

non-users at

the survey date,

e.g.,

pregnant women

(4.3%)

and

those seeking pregnancy (4.0%)

-highest

at ages 25-29

(11.4%

and 8.5%, respectively) escaped notice; and yet it is

precisely they

who

had most prior knowledge and practice, especially in

medical methods:

93.3% of

them

had

previously taken

the

pill.

The overwhelming majority

of women of

reproductive age (87.3%)

have previously used a

medical

contraceptive method, and 83.7% have

taken

the

pill. Prevalence

of pill use

is highest at ages 25-29, decreasing

slightly

among

the older birth cohorts, from

93.3% to 72.5%

for ages 45-49

years

at

the

survey

date.

IUDs

had been

used

by

30.5%

of

women,

chiefly

the

over-35s.

The

use of

a

contraceptive

method at least once is

not equally

meaningful for

medical

methods and

local methods

in

terms

of

duration

and constraint;

there

are, for

example, few

grounds of comparison between

an IUD fitted and

normally

worn for a period of

years,

and the transient

use of a

condom.

The fact

remains that

7 women in 10 have used local

methods during their contraceptive life, often ad

hoc:

46.1% used condoms

and

41.0%

withdrawal. Prevalence is higher for condoms

among

the

younger age-groups (58.3%),

and for withdrawal (50.9%)

among the

older

age-

groups;

significantly,

however, nearly a third of young

women

had already

used

withdrawal, and

more than a third

of

the older age-groups

had

also

used condoms

at

least

once

in

their

life.

While

the

survey

shows

a

highly

age-specific differentiation between 'current'

methods, it

is

also true

that

respondents

of

all ages across the board have at one time or another, even

transiently, used

different

methods.

Contraceptive

information and

practice

is already widely

disseminated

among

the youngest women, a

small

proportion

of

whom can be assumed

not yet

to

have had or considered sexual intercourse. In 1994, the

proportion of

20-24-year-old

women

who

had already

taken the

pill

(82.7%) was

close

to that of

women who

already

had

coitus,

but their

contraception

experience was not limited

to that

method:

68.6%

used a non-medical

method,

mainly

condoms.

Other methods are known

to

the

younger

age-

groups

- 32.2%

of

20-24-year-olds

had

used

withdrawal and

12.2%

periodic

abstinence- but not routinely; in the survey month, only 1.3% of 20-24-

year-old women used withdrawal and 2.3% periodic

abstinence.

Medical

advice

Medical

follow-up

is

now

an essential

of

tion; non-coitus-related contraceptive

methods

imply

forethought, which entails consulting

a

doctor to prescribe the pill

or

fit

an IUD.

In fact,

78.7% of women

aged 20-24

and 88.0% of women

aged

25-29

report

already having

seen a doctor about contraception. If

women


19/27

CONTRACEPTION

IN FRANCE 105

who have previously used the pill or an IUD but did not

report

having

seen a doctor

(i.e., who

may

have gone to

a family planning clinic) are

included, those proportions rise

to 87.1%

and 96.4%, respectively.

Women

born in

the mid-1950s,

whose sexual life commenced post-Neuwirth Act, were

more

likely

to

seek

medical advice,

while

those

who

were

older

at the

survey

date - ages 45-49, born in 1944-48 - were

less

likely: only

69.0%

had sought

medical advice, and

approximately 15%

had

neither sought

medical

advice

nor

used medical

contraception. By

comparison, only 63% of

the

1940 cohort

had seen a doctor about

contraception (Leridon

and

Toulemon,

1990).

In

three

of

four cases, doctors

prescribed

the

pill

at the first

consultation;

from the turn of the

1980s,

doctors

also began

prescribing

condoms:

77%

of women

were prescribed the

pill on

first consultation between 1990-

94, of whom

12%

said

their

doctor had

also advised condoms.

II.

- Men's and women's replies compared

The 1994 survey

questionnaire was also put

in broadly

the

same terms

to

a representative sample

of

men aged 20-49. This was because the survey

was

chiefly

concerned

with family patterns and backgrounds, where the

two

sexes'

life paths were not necessarily

identical.

These enabled us

to

compare men s and women'

replies

on contraceptive practices. In some

cases, similar

replies

could be expected: methods reported by people living

in partner relationships should be identical for men and women (at least,

taking

only

couples

where

both

members

fall within

the

scope

of

the

survey).

In other

cases,

especially people living alone,

replies can differ

very

widely.

The

wording of

questions is

crucial in

this context.

A seemingly

straightforward question like Are you currently

using

contraception,

and

if so,

what

type?

actually contains

three

key ambiguities:

—

the

base period is not

specified:

does currently mean this month,

or usually (even if

no

method has recently been used because the woman

is pregnant, for

example)?

—

it

is not

clear

whether the you is the interviewee

(man

or woman)

alone,

or

the

couple

of

which

s/he

may

be

part;

if

the former,

a

man

whose

wife uses the

pill should

reply

none (because he is not personally using

any),

whereas

in the latter,

he

should reply the pill (because

'the

couple'

uses

the

pill);

— for

many

respondents,

the term contraception excludes all

'natural' methods and refers only

to

the pill and IUDs, which may result in

a significant under-reporting of the prevalence of

traditional

methods.

For

these

reasons, the INED questionnaires

on

these

topics

contain

a battery of questions designed

to

dispel

the main ambiguities. Bear in

mind that,

throughout

the preceding section, the

methods reported were


20/27

106

С. de GUIBERT-LANTOINE,

H. LERIDON

those

used in the survey

month, by

the respondent

or

partner

if

applicable.

For

those living

in partner

relationships,

comparing replies will

act

as

a

cross-check: any

discrepancy between the

partners'

replies will be

attributable

to

misinformation

(some

men may

be

unaware

that

their

partner

uses

the pill or IUD) or a

misunderstanding

of the questions. For those not

living in partner relationships,

by

contrast, the variances will be indicative

of

different

behaviours (men cannot use the

pill

or IUD), or interpretation

problems (will a woman relying

on

condom

use by

her

casual partners

report what

she

may

regard as a

male

method?).

People in marital and Men's and women's replies (for the

consensual partner

relationships

primary method) are compared by

conjugal status

in

Table

5.

People

living

in

marital and

consensual

partner

relationships

were

first

distinguished from those not living in partner relationships.

Table 5. -

Primary

contraceptive method

used

in 1994,

by

conjugal

status

A/ All women aged

20-49

- Use contraception:

inc:

pill

IUD

condom

other

- Surgically sterilized (M or F)

- Use

no

contraception

inc: not

wanting

further

children

- All

-

Use contraception:

inc:

pill

IUD

condom

other

- Surgically sterilized (M or F)

- Use no

contraception

inc: not wanting

further

children

- All

All

64.3

36.3

16.0

4.5

11.4

4.3

31.3

3.0

100.0

In partner

relation

70.0

36.1

20.0

4.6

9.3

5.1

24.9

3.1

100.0

В/

All

men aged

20-4Ç

All

62.5

33.6

13.5

8.4

7.0

3.4

34.1

3.9

100.0

In partner

relation

70.6

37.6

19.7

4.2

9.1

5.0

24.4

4.5

100.0

Not in partner relationship

A 11

50.9

36.9

6.5

4.4

3.1

2.4

46.7

2.9

100.0

)

Stable

loving rel.

78.6

57.8

8.7

5.6

6.5

1.8

19.6

2.2

100.0

Not in

loving rel.

37.3

26.6

5.7

4.2

0.8

2.8

59.9

2.9

100.0

Not in partner relationship

Д

11

46.6

25.6

1.0

17.0

3.0

0.0

53.4

2.9

100.0

Stable

loving

rel.

86.8

65.2

2.6

13.5

5.5

0.0

13.2

2.2

100.0

Not in

loving

rel.

30.6

9.6

0.0

19.0

2.0

0.0

69.4

3.3

100.0

Source:

INED,

Enquête sur les situations familiales

et l'emploi, March 1994.


21/27

CONTRACEPTION

IN FRANCE 107

Significantly

more

women

in partner relationships

than

lone

women

used

IUDs (nearly three times more)

and traditional

methods (other than

pill, IUD

and

condom); by contrast, the women's

replies

revealed

no

significant difference between the

two

groups

for the pill and condoms. The

age

difference

is

certainly

contributory, but not

the

only

factor

in

the

observed variances: being

younger than the

others, lone

women

should use

the

pill

more than those living

in partner

relationships,

which

is not the

case. The fact is that lone

women

use less contraception

all

told, but when

they

do,

they

tend to use the pill

more

often.

The replies of men in partner relationships are

remarkably akin

to

those given

by

women

living

in partner relationships, even for condoms:

mutual

information

is clearly good and

it

can be

concluded

that

contraception is definitely 'a joint concern'. The convergence also bears out the

reliability

of

our

data,

since the

two

samples

are

independent (only one

interviewee

was selected

per

household).

People

not

living These

people may

obviously have

sexual

in-

in partner relationships tercourse with more or less regular partners.

Some also

self-reported at

the survey

date

as being

in

a

stable loving

relationship

which,

for

these

purposes, puts

them in a similar category

to

living in a partner relationship .

Others

may have one or more

regular

partners, whom they know and may well

trust for contraception. Yet others

engage

only in casual sex, which

presumably suggests that

they

make

their

own contraceptive

protection

arrangements.

A

final

category had had

no

coitus

in

the

recent

or

more

distant

past, and so needed

no

contraception. The category studied here is a very

mixed one, therefore: the only

distinguishable

sub-group is

those

in stable

loving

relationships ,

other than which we have

no

information

on

respondents sexual activity.

On

balance, slightly fewer

men

than women not living

in partner

relationships were self-reported users;

the

more

marked difference lay in the

distribution

of methods: the pill and IUD

significantly

less

than

the

condom.

What

is interesting, however, is that the archetypically male

method

- the condom - still trails

the

field: the

pill

still tops the

list

of methods

reported by lone men.

These

results

can

be

further

clarified

by

distinguishing

within

the

group

of

those not in partner relationships those (m/f)

who

were

reportedly in a stable loving

relationship

at the

survey

date.

It can be

assumed

that

most of

these

loving relationships

involve coitus,

and that

the

description of them as both loving and

stable

suggests that they are the

primary, if

not the

sole, focus

of the

respondents'

sexual life. To take the

women's replies first, the

very

high

prevalence

of pill use and

lower

prevalence of IUDs in

this group

is

unsurprising

inasmuch

as they are mainly

young

women; but pill use rises

to

70%

among

20-29-year-olds

(significantly more

than

among

those of

the

same age in partner relationships),


22/27

1 08 С. de


which

is

indicative

of specific behaviour:

all

told, contraception is

more

prevalent among these

women than those

in partner relationships, probably

because

pregnancy

is not an

option

in this phase

of

their

life.

It is relevant

that

men

in

the

same

loving

relationship

situation

report

a

somewhat

higher

contraceptive

practice still, but

also

rely overwhelmingly

on

their

partner's

hormonal

contraception.

Final finding: men and, even more,

women who

are

neither

living in

partner relationships nor

claiming

to be in

a

stable loving relationship,

reported significant.

contraceptive use of about

half

that of those in partner

relationships. The

pill

was still most reported by women

(27%,

rising

to

38%

at ages

20-29), while for

the first time, condom

use

was most frequent

for men

(19%), i.e., two-thirds

of

reported use.

Again,

this

must be

caveated

by

the

lack of information

on

sexual activity

among

this last - probably

fairly

mixed -

group

of respondents.

All

told,

it

can

be

concluded

that

men s

and

women's replies

are

highly self-consistent where that is

to

be

expected

(living in partner

relationships),

and

that

otherwise

they

show that, consensually or otherwise,

men rely largely

on

their long- or

short-term

partners' contraception. That,

moreover, is probably as the latter

wish

it,

confidence in condom

effectiveness not being sufficient for

women

to

rely

on

it

alone.

III. - Methods

at

first intercourse

After

being

questioned

on

their

current

method,

respondents were

asked a

series of retrospective questions, beginning as follows:

— Let's

go

back

a

little

...

Let's start

with

the

first

time you had

sex:

how old were you at

the

time?

— Did either you or your partner

use

contraception or take

precautions

when you

first

had sexual intercourse?

1. Yes, starting before, you were already on the

pill

2. Yes, starting then

3. Starting

just

after

(the

following month)

4. No

—

{If

yes): What

method(s)

did

you

use?

(You

can

give

two

answers)

A

word first

about

ages at first intercourse. Men are traditionally

younger than

women,

but the gap halved

between

the 1944-48

birth

cohorts

and the

1969-73

birth cohorts. However, the reduction in age

was

less

marked for men

than

for women: the median age

fell

from

19.5

to 18.4

years

for

women

and 18.5

to

17.9 years for men (Toulemon and de Guibert-Lan-

toine, 1996). It should also be noted

that

most

of the

trend was

accomplished in the earlier birth cohorts (1944

to

1953), and

that

the median

ages

now seem to have

levelled

off.


23/27

CONTRACEPTION IN FRANCE

109

Method used at first To

take women's

replies first, Table

6-A shows

intercourse a sharp rise

in

contraception at first intercourse

through

the

successive birth cohorts: 72% of

the

1944-48

birth cohorts

used

no contraception

at

first

coitus

against 32%

of

the

1969-73

birth

cohorts.

The

rise

was

initially

due

to

the

increase

in

pill

use from 11

to 44%,

and -more recently-

to

condoms,

reported

by

6%

of women

in the older birth cohorts against 27%

of

the

1969-73

birth

cohorts (and

even

nearly

39% of

those

born in 1973

only).

It

has

to be

said that, in

this table, dual

pill and

condom

use

could

be

reported: under

1% of women

aged 30-plus, but

5% of

the youngest

women (ages

20-24)

did

so.

Table 6-B shows the men's replies. The first

thing

to

say is

that

they

do not tally exactly with the women's

replies

due

to

the

differing

ages at

first intercourse,

and

the

widely

varying previous

sexual

experience

of

the

first

partners;

the

women,

for

example,

had

their

first

intercourse

with an

appreciably older partner (at mean age 19 with a 22-year-old, generally

experienced,

partner:

see

Bozon, 1993). Condom use is

more often reported

by the

men, the

proportion rising

to

38% for

the

1969-73 birth

cohorts

(and 48%

of

those born in 1973 only). Overall, the men

more

frequently

report

not

having

used any contraception at first intercourse (generally

+

10%): some may

have been unaware

of

their partner's

behaviour, as is

suggested by the markedly lower reporting rate for the

pill

(-10

percentage

points

in the oldest birth cohorts

to

-25 in the

most

recent).

Table 6.

-

Contraceptive

method used

at first intercourse

by

age at survey

date

by

100

people

in

each

age

group

(Column

totals

may exceed 100 where combined

methods are

used)

A/ WOMEN

Age

at 1.1.1994

Year

of

birth

- No

contraception

- Pill

- Condom

- Other methods

inc: Pill + Condom

45-49

1944-48

71.6

11.0

6.3

14.3

0.0

40-44

1949-53

68.7

14.1

7.6

10.8

0.5

35-39

1954-58

59.1

29.5

6.3

5.6

0.0

30-34

1959-63

56.9

34.7

3.8

5.2

0.3

25-29

1964-68

41.2

43.8

9.4

7.9

1.6

20-24

1969-73

32.0

44.4

26.7

1.8

4.6

All

1944-73

54.2

30.6

10.0

7.2

1.2

B/

MEN

Age at 1.1.1994

Year

of

birth

-

No

contraception

- Pill

- Condom

- Other methods

inc: Pill + Condom

45-49

1944-48

78.8

1.7

8.0

15.5

0.5

40-44

1949-53

77.9

5.0

9.9

9.3

0.7

35-39

1954-58

68.0

15.6

11.4

7.0

0.5

30-34

1959-63

72.6

15.4

8.5

4.6

0.7

25-29

1964-68

60.9

18.5

17.0

6.0

0.8

20-24

1969-73

42.4

19.6

38.0

4.5

3.1

All

1944-73

65.5

13.8

16.2

7.0

1.1


24/27

110

С.

de


The earlier the first coitus

-especially in

the

under- 16s-

the

less

frequently protected it

was.

So,

56% of 20-24-year-old

women

whose first

intercourse occurred at age 14 or 15 reported

no contraception,

against

only 23% (under half) whose

first

coitus was at ages 18-19; it could be

argued

that

the

earlier

first

intercourse

occurs,

the

less

likelihood

there

is

of

it

being

planned

and prepared for,

but

these

findings also

suggest that

the

younger age-groups are

not well-enough informed about

the

risks and

available

methods

of prevention

at

the time of the

event.

The pill in

particular is notable for its absence

among

the

younger

age-groups (this is

apparent from the women's replies), while condoms are more frequently

used in later

intercourse,

after age 18.

While first intercourse may be 'unplanned' and unprepared, it cannot

go unremarked

that

even including contraception started immediately after

produces

only

a

slight

increase

in

the rates

of use

at first intercourse:

less

than

1%

for

condoms, approximately

5%

for

the

pill,

according

to

the

women's replies across

all

birth cohorts.

Conclusion

Trends in contraceptive practices in

France

could have been heavily

influenced

by three

key facts: the misgivings

voiced

in some countries

about the side effects

of

the

pill and

IUDs, or a measure

of

apathy by

users;

the

possibility

that

'competition' from abortion

may

have led

to

some

laxity

in

contraceptive

use;

and

finally,

the

sudden

development

of

the

AIDS epidemic. In fact, none

of

these

have had

a

deep-reaching

effect

on

contraceptive behaviour.

Since

its introduction into France,

the

pill

has

become

the

norm

among

the youngest

women, and

take-up has grown

steadily in that

group.

Among older women, the new hormonal products seem

to

offer the

twin

benefits of contraception and preventive treatment of perimenopausal

problems: growth of

these

has

offset a decline

in the use of strictly

contraceptive pills. The

general

trend in hormonal contraception has

thus

traversed

the forecasts

that

increasing user

apathy

might send the method

into

an

early decline, and

the ground

swell of concern

which

led women

in

some

countries (the

United

States, Great

Britain)

to

shun

it

has

not

emerged in

France.

The IUD is increasingly

seen

as the preferred 'follow-on method' for

women

of 30- or 35-plus, and

once

the family has been formed. Here too,

the

absence

of controversy - like that in the

United

States

which

led to

ruinous lawsuits against

doctors

and

manufacturers

and

the

withdrawal of

all

intra-uterine

devices

from the market

-

has

allowed this method

to

become established, in

all

likelihood

curbing

an increased use of sterilization.

There

were fears

that

the passing

of

liberal abortion laws would see

a turning away from contraception. Our

findings

clearly

show

that modern


25/27


methods

have continued to gain ground

steadily

across all social groups

(see Toulemon and Leridon, 1992),

leaving only

a very small part of

the

population at

risk

of unwanted

pregnancy. It is clear

that

termination

of

pregnancy (IVG) has largely supplanted the old

illegal

practices, and helped

reduce

the

number

of

unwanted

pregnancies

and

births.

But

it

still

remains

the final resort after

contraception

failure, or unprotected

intercourse;

some

of

these

abortions

could doubtless be

avoided

by better public information

about

the

different

methods available and, especially, exactly how

to

use

them.

Finally,

the AIDS epidemic

prompted

vigorous campaigning for

condom

use at the turn of the

1990s. One

fear

was

that this approach might

lead some

young

people

to

turn away

from

the pill: judging

from

the

situation

at first

intercourse,

condom use initially seemed

to

be a back-up

method used with

the

pill; more recently, it

may

have led

to

some decline in

pill

use,

and

the

situation

should

be

kept under

close

review.

The

specific

roles

of the pill and condom

are better known among older women

and men,

and condom

use

- more

prevalent

among

those

most at

risk

of AIDS - does

not seem

to

be curbing

the

use

of

other more

effective

contraceptive methods.

APPENDIX

on the surveys

The Enquête

sur

les situations familiales et l'emploi (Family and Labour

Survey)

(ESFE)

was conducted by

INED

and

INSEE in

March 1994. It was supported

by

the

National Family

Allowances

Fund

and

the

Department

of

Health

in

the

Ministry for Social Security, Health and

Urban

Development. Approximately 5,000

interviews (1,926 men and

2,944

women) were conducted by INSEE after

the Annual

Labour Force Survey. The

sample

is representative

of

all

men and women aged

from

20 to 49, and children

under

18 years of age. 'Non-standard' situations were

over-represented

in the sample

by

an

unequal probability

of selection

procedure.

The

results for

women

are comparable

with those

of two

similar

surveys

carried out

in France: the

1978 Enquête mondiale de fécondité (World

Fertility

Survey)

among

2,982

women

aged from 20 to 44; and the 1988 Enquête sur la régulation

des naissances (Family Planning Survey) of 2,666

women aged from

18 to 49.

BIBLIOGRAPHY

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M.,

1993,

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sexualité

adulte : le

premier

rapport et ses suites»,

Population, 48(5), p.

1317-1332

and in English in: Sexuality

and the Social Sciences,

M.

Bozon and H. Leridon

(eds.),

Dartmouth

Publishers,

1996.

Guibert-Lantoine

C.

de, 1997, «Le

choix

de

la stérilisation, comme

méthode contraceptive,

dans les

pays développés : l'exemple de

la

France et du

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Congrès de l'UIESP, Pékin, octobre 1997.

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Population, 40(3), p. 507-526.

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L.,

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Toulemon L.,

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Toulemon L.,

Leridon

H,

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H,

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Family

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Guibert-Lantoine (Catherine

de), Leridon (Henri).- Contraception

in

France:

An

Assessment After 30

Years of Liberalization

Contraception was legalized in France by

a

law

adopted

at the end of 1967.

Contraceptive methods, in particular the

pill,

then spread rapidly. The most recent survey,

conducted

in

1994

(INED/INSEE),

provides

material

to

review

the

current state

of

contraceptive

practices.

Contraception is now practiced

at

all

ages:

less

than

5% of women are

exposed to

the

risk

of an unwanted pregnancy. Contraceptive use in first sexual intercourse is observed

to

have increased greatly over successive generations.

Contraception

today

is

practiced

mainly by

women

and takes a

medical

form:

use of

the

pill

has

become widespread, particularly among

young

people;

the

IUD

app

Date post:	08-Jul-2018
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